Please Help Me to Prepare For Psych Nurse

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I have an appointment with a psychiatric nurse on Monday. She is going to assess my needs and (hopefully) refer me for diagnosis. Please see below the notes I have made - can you suggest anything I should/should not mention or anything I have forgotten? Do any of you who have seen me around the last few months have anything to add, maybe something you've noticed or something I've posted about? Or any experiences to share? NO HORROR STORIES PLEASE!!


Appointment with Psychiatric Nurse
Monday 14th December 2009
10 - ?

AQ Test Score: 41

Aim: To be referred to a psychologist for a diagnostic assessment for Asperger's Syndrome.

Reasons for Seeking Diagnosis: Since learning that I may have AS I have read a lot about it and was surprised at how well it fits me. There is a feeling of relief, knowing it's not my fault I haven't fulfilled my promise in certain areas. It will also be useful for accessing services such as help gaining paid employment, asperger's groups and therapy for my anxiety.

Diagnosis History: My university counsellor noticed signs of AS and referred me to the learning centre. They gave me a test and concluded that I had many of the traits. As I was about to graduate I was not referred for an official diagnosis as I should have been. I visited my doctor in October and was referred to the psychiatric nurse.

Childhood Signs of AS:

- did not enjoy parties as I felt I didn't know what I was "supposed to do"

- felt uncomfortable visiting stranger's homes, a feeling which increased after several misunderstandings that left me feeling humiliated

- never asked adults direct questions, preferred to write them down, even to own parents

- strange way of playing with dolls involving stripping them and tying them up

- took instructions from adults very literally (boot incident - I will elaborate when asked)

- got along much better with teachers and older cousins than fellow students and peers

- avoided situations I could not predict, like tests, despite always doing very well - faked illnesses and self-harmed to get out of anxiety-causing, unpredictable situations

- absolutely no aptitude for sports and clumsy in general

- sensitive to sharp, loud sounds like dogs barking and toilets flushing but comforted by the hum of the vacuum cleaner

- fascinated by ribbons and tassels on anything - stimming

- some difficulty learning to tell time and tie shoes

Adult Signs of AS:

- I have struggled in post-GCSE education, despite a very high intelligence level due to difficulty in social areas and lack of support and structure

- trouble discerning the boundaries between public and private information i.e. when to disclose and who to tell

- uncomfortable making eye contact with strangers

- much lower ability in verbal vs written communication

- large vocabulary of words I know how to use in the right context but can't explain the meanings of

- find it very difficult to judge in conversations when to speak and also when to stop, leading to either remaining silent, interrupting or "monologuing" - am often told I have been rude when I did not realise I had

- get along better with men as they are easier to read

- don't understand most people's obsession with tidiness

- need to script formal phone conversations to overcome anxiety and avoid becoming speechless - do not like answering my phone even when I know who it is

- more empathy for fictional characters (e.g. on TV) than for real people

- little interest in the comings and goings of others i.e. any kind of gossip or small talk

- easily distracted and overwhelmed by external stimuli

- sensitivity to squeaky textures (e.g. polystyrene, leeks, apples)

- love of certain tactile sensations since infancy, touching/stroking fingertips in various ways to calm (stimming)

- unable to imagine the future and therefore to plan for it leading to financial trouble and poor organisational skills as well as anxiety of the unknown

- a need to make extensive lists and do things in set orders to avoid forgetting things

- obsessive, absorbing interests in Buffy the Vampire Slayer and other American TV dramas

looks to me like you have a good list there.

good luck.

I think they will diagnose you, I don't think you need help with preparing for that.

But my question is what are you hoping to get assistance with, after you get the diagnosis? So I would make a list for that, and maybe they can refer you on at the time of diagnosis to any relevant services, if there are any.

The list looks good. You might want to write down some anecdotes, at least for your own reference, to explain some of the points on the list (imagine the nurse asking you to clarify each point.) If you're anything like me, you may suddenly find yourself at a loss for words when asked to explain something you think should be self-evident, so it helps to have something you can refer to. (Something I did, was to use the DSM-IV criteria & write an anecdote for each criterion that fit me.)

Also, have you taken the Aspie Quiz? - http://rdos.net/eng/Aspie-quiz.php - It's almost identical to the list of questions that my psychologist asked during my evaluation (it took us four sessions to get through the list.) You may also find that some of the questions jog your memory for explanatory anecdotes.

Best of luck!! !

Thanks for the luck Bhetti:)

emc2 - I do definitely need the list as this is only a pre-assessment for them to see what I need after being referred by the GP, it's not an actual Asperger's assessment. Hopefully it will lead to that. It is a good idea for me to write a list of the things I want to gain from the diagnosis, services I want to access and how they'd impact my life. I've heard that it costs the NHS a lot to assess adults for AS so they sometimes need convincing you need it.

Zeichner - I have done that test but don't think I'll take it along, I don't wanna send the self-diagnosis vibe. I may take it with me when I get referred. Anecdotes though - yes! Just like you my mind will go blank when asked to elaborate if I don't have prepared examples. In fact I should give my preparation for this session as an example of my aspieness!

finding a roadmap for my future was one of the reasons I went for an assessment. I told the neuropsychologist up front that I want to know if I have AS because I want to rejoin the workforce and I want to know what impact it has on me so I can make better job choices, and that I was hoping to get a better idea of what kind of career would work since I'm on the voc rehab list.

the report includes a recommendation for social skills training to help me compensate for areas of difficulty, which may help me get services I need. the report also gives an overview of ideal vocational conditions for me, so that when I go into voc rehab they won't try to stick me into an inappropriate setting (they probably will anyway, but with the assessment results I'll have a better chance for good placement).

Please elaborate about the boot incident.

Yes, please do!

Good luck for tomorrow!

So I saw the psych nurse. We talked for about 75 minutes. She asked afterwards if there was anything else I wanted to mention and of course I couldn't think of anything until I was on the bus home and remembered lots of essential stuff I'd never mentioned. I talked A LOT about my special interest and about social anxiety which she said I def had had since I was small and found coping mechanisms to deal with it. She also asked a lot about self harm. She concluded that I was "not for her" - meaning I didn't belong with the psychiatric team - and she said she would refer me to the psychology department - where I have already been referred about 5 years ago and my experience wasn't great, CBT was not for me - who will then decide whether to send me for an asperger's assessment or simply deal with me themselves either with CBT (which I don't want) or psychotherapy (which I really do want but preferably after being diagnosed)

LOL!

The Boot Incident

We were kinda poor when I was a kid. My mum was a single parent and had very little disposable income. When I was seven she bought me a pair of Hush Puppy boots. They were probably the most expensive and definitely the most stylish shoes I'd ever had. The first day I wore them to school my mum dropped me off with the very clear warning,

"Don't go on t' grass wi' them boots." (<--- Yorkshire accent)

I always did everything my mother told me. I was a very good little girl. I think I was actually unaware that there were people who did not do everything their mothers told them. So I kept off the grass. I played in the playground at break time and at lunch I played my fairy game next to the school doors while my friends ran round the field neighing like horses. My beautiful new boots were still shiny and lovely. I noticed that they were getting slightly creased from walking in them. I hoped this was normal.

School ended and I went to the edge of the field. My childminder had come to pick me up and stood, as always, across the field. I tried to indicate to her that I was unable to cross the grass due to my new boots. I tried shouting to her and gesturing but she still just kept saying I had to come over there. She was getting really angry and most of the other kids had gone home.

Luckily my friend's big sister had come to pick her up and she offered a piggy back. I was so happy to have the dilemma resolved. I didn't want to keep my childminder waiting but she wasn't my mum, she couldn't make me disobey my mother's instructions. When I reached the other side my childminder shouted at me. She went on about her responsibilities and her time and my "cheek". She seemed to be under the impression I had done this to be purposely disobedient - a concept I could not fathom. Raised voices scared me and the disapproval of adults was upsetting so I cried all the way home.

When my mum picked me up my childminder actually apologised to her - in her own way. She said she felt bad for yelling at me that way, she was so used to disciplining her own unruly daughter and had expected back chat, not tears. My mum didn't say much. I think she was secretly proud that I had taken such good care of my brand new boots.

Congratulations on clearing another hurdle!

I think you are right about CBT not being right for you - I asked my psychologist to describe it to me & I immediately realized that it is basically the same as the "Inner Game" series of books - http://theinnergame.com/ ("The Inner Game of Tennis" was an incredibly popular book when I was in college. It's about how most of our failures come from counter-productive thought processes & covers techniques for changing your way of thinking. I was required to read it for my advanced conducting class.) Unfortunately, for adults with AS, there really don't appear to be any other useful therapies. I still go to my psychologist, but it's not really structured therapy. I talk about the ways that I feel impaired by AS & we try to come up with coping strategies.

(If the nurse determined that you don't belong with the psychiatric team, it seems to me that your path is not likely to lead to a psychiatrist. Psychiatrists concern themselves mainly with treating psychiatric illnesses - which AS is definitely not.)

Loved the story of "the boot incident"! Reminds me of when I was young, my mother told me to always look all ways to see if it was clear, before crossing the street. To this day, she still laughs that I would include up & down, when checking for cars!