Observed to be Autistic

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It came to my attention after my last visit with my psychiatrist that the profession diagnoses autism based on observation. He said I do not exhibit the behaviour of autistics more severe than I am. So I wikipediaed it and an autism diagnosis is dependent on exhibited behaviour.

I cannot be more irked by this. Just because my passing skills are excellent doesn't mean my experience of life isn't autistic.

I found what he said and things I have found said elsewhere to be almost disrespectful of my experience of life.

(note... he ultimately diagnosed me with HFA,GAD and depression.)

LOL...there are no lab tests for autism.

The Asperger (now Autistic Spectrum Disorder) diagnosis, for adults, is based primarily upon the adult's self-representation, as well as the representation of the adult's parents or friends. Plus various intelligence tests and similar tests to that which people take on this site, and reveal their scores within their avatar area.

Frequently, psychologists are reluctant to diagnosed ASD's because of the feeling that it is "overdiagnosed."

Yep...the infant-child diagnosis of autism is based primarily on observation, and on the representations of the infant/child's parents.

Why would you be offended by being autistic? You're talking about it like it's a bad thing.

Behavioural diagnosis based on a "one size fits all" is fraught with assumptions that lead to incorrect outcomes and fundamentally wrong attributions and conclusions.

For example, this psychiatrist may have been taught during training that "Autistic people don't make eye contact". So a big and erroneous leap is made:

autistics don't make eye contact
this patient makes eye contact
so this patient cannot be autistic.

We expect the professionals who regard themselves as "scientists" will not think in these simplistic and uninformed ways, though it certainly happens.

Psychiatry is, in particular, hidebound by all kinds of inflexible ideas, which leads its critics to conclude that it is not a scientific discipline at all. And many of them have a point. If you are interested in this, read about D L Rosenhan's "On Being Sane in Insane Places", a landmark study that exposed appalling prejudice and misconceptions in psychiatric diagnosis and observation.

Also, psychiatrists are not immune from the human failing of prejudice! As individuals, there are ideas they chose to have, without reliance on evidence. For instance: "ASD is just a diagnosis most people want to excuse their own personal failings". Unfortunately, you do not get a printout of the individual prejudices and "isms" that any psychiatrist happens to hold before consultation. Expecting a psychiatrist to have a competence which is entirely free of prejudice, fashions, bias, self-interest amounts to misplaced faith, I think. Their record of misdiagnosis is very high and rarely subject to academic scrutiny - and they want to keep it that way - for obvious reasons.

They have got away with a lot of malpractice over the decades by discrediting the patients that dare to complain, as if complaint itself was merely another symptom of some mental disorder. To some extent New Zealand tried to address this with the introduction of independent patient advocates to present complaints on behalf of and with patients who had genuine grievances, and the installation of a health and disability commissioner who can independently review complaints of malpractice relating to any medical practitioner, hospital or other provider. This has operated for some time and has very significantly raised practice standards here. Without some kind of external and independent process like this, improved attitudes and practices are far less likely to happen.

The more I read about the issue of adult diagnosis, the more I gather that it really is a common problem that even specialists in the field of autism diagnosis may be more familiar with the assessment of children or young people than with mature adults.

And the problem inherent in this, is that children and younger people are often closer to a raw and undeveloped state of presentation of themselves, have not yet developed coping skills or masking skills that some adults may have managed to take on, and their traits and symptoms may be so much more visible and clear to perceive.

By contrast, an adult who has made it through under the radar because earlier generations were simply never flagged if "high functioning," may have developed some social skills, coping skills with overload or sensory issues, masking skills to hide other manifestations of their autism that they realized wasn't "how other people behave," for example. Therefore a specialist has to have the experience with adult cases that helps them see through the various coping skills or masking behaviors that the person may have taken on, in order to see that there are autistic traits and symptoms underneath those layers anyway, to the skilled observer.

In a sense they have to be clever enough to overlook a lot of things and know how to spot the other things that are the indicators shining through.

They should also take into account anecdotal testimony concerning childhood, as factors in the official criteria must be present at a certain age in childhood for it to be autism.

Even though human beings in general tend to put trust in the professionals we rely on, they themselves are only human and they can and do sometimes fall short of all the skills they might need in some cases, and some can be inexperienced in what to look for at this or that age or stage of life.

Diagnosis of adults who grew up before anything but severe autism was being looked for in a child (and anything less obvious was dismissed as everything from "just shyness" to mental disorders, is relatively new, and the expertise of specialists has not universally caught up with that.

If you can get a second opinion with someone else, or investigate if there are any autism specialists specifically interested in or experience in adult assessment within reach of your location, that might be the best thing.

I can understand economic issues being prohibitive. I also agree that the part of the diagnostic process that is dependent on the observations and perceptions of the specialist(s) is rife with complication and therefore problematic, as myself and B19 have remarked.

Unfortunately that remains part of the diagnostic process and currently part of (at least, one of the parts of) what a person's diagnosis may potentially live or die upon.

I would prefer for there to be a definitive means of diagnosis such as a brain scan or anything at all that says more objectively and more certainly that someone has ASD, anything other than the reliance of human beings to make their judgement calls on the only evidence that's on offer at this time.

I am fairly optimistic (now that the human genome is mapped and intensive studies are going on) that diagnosis one day will probably depend more on disciplines derived from the work currently being done by molecular biologists and other related fields of science allied to this very exciting field. This is where the big neurological advances in understanding tend to be happening right now.

There has already been significant work done on OCD which suggests that a lack or a deficiency of a single amino acid may be the causal factor for some if not all. (This is serious work, not naturopathic based assumption). Autism is a far more complex condition and I doubt there will be simple answers ahead, though the sophistication of the science being done right now in this astonishing field of molecular science is rarely reported in the popular media.

Yes. Epigenetics - ie how genes are moderated by the environment (including the uterine and post uterine environment) has developed to the point that it has conclusively disproved the prevailing beliefs about simplistic genetic inheritance.

I think it's reasonable to look for signs of autism in your behavior but an experienced psychologists/psychiatrists should know that an autistic person (or anyone) will try to behave in a "normal" way and learn to naturally hide what's not considered normal. The fact that he eventually diagnosed you with autism seems to mean that he is aware of that.