Late life psychiatric evaluation for Autism spectrum.

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evelusive
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07 Jun 2013, 5:17 pm

Hi, I'm pretty new to this so please bear with me.

A little back story, I am 33 and a couple of days ago my wonderful wife passed on to me the Aspie quiz and said that quite a few of the questions reminded her of me, and on doing the test I realised the same thing (Results were Aspie = 184, NT 19). While being deeply interested in my psychological makeup for pretty much all my life (I have always been painfully aware of just exactly how weird I am) I had never even considered Autism and so I have only as much information on the subject as 2ish days of research can give, I am ambivalent as to the accuracy of my self diagnosis, most especially as it would so very clearly explain the difficulty I have had with so many things in my life.

So.... I have gone to a GP and gotten a referral to a psychologist for an evaluation.

Anyway, my question is.... To those who have had an evaluation late in life, what am I getting myself in for? Is it usually a sit down and fill out a questionnaire or an Interview or some other kind of thing that I haven't even considered?

I also kind of feel like the doctor will just laugh me out the door (but then again that is pretty much how I feel about all communications with unknown people), after all I have really done quite well with my life, I am obviously managing things pretty ok. And there are indicators that I just don't have. I feel like I have nothing that I have any right to complain about.

There is just so much to take in.

Anyway, that's enough, thank you in advance for anyone who decides to respond........ It is massively appreciated.



Thelibrarian
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07 Jun 2013, 5:24 pm

I found out I had AS at age 46 in an off-handed way from a psychiatrist I was seeing at the time. She didn't do me a bit of good, and I soon stopped seeing her. I have learned far more from the people at this website and from doing my own research. My experience suggests the question of why you would want to get a formal diagnosis. It will be a lot of time and expense, and I can see very little benefit for one who is already established in life.



evelusive
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07 Jun 2013, 5:35 pm

I don't really trust my own judgements, I think I just need confirmation. I have no intention of seeking "treatment" as I quite like my brain the way it is, I think that I mainly just want to understand. I also have a 2 year old daughter who seems to share some traits with me, and as she is too young to test effectively this feels like it would be a "proxy" test for her (but admittedly this is a weak 2nd rationalisation).
It doesn't seem like it would be quite that time consuming, as I'm pretty sure a single consultation will do, hopefully I'm not too wrong :) .



NEtikiman
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07 Jun 2013, 5:38 pm

Thelibrarian wrote:
It will be a lot of time and expense, and I can see very little benefit for one who is already established in life.


I'm in a similar situation. I'm 29 and have only recently learned of my own AS. I've felt disconnected and different my whole life and have had a hard time understanding why. After repeated issues with understanding others, misinterpreting situations and managing obsessions, learning about my own AS diagnosis has made me feel less deficient. I'm not an abnormal human... I'm a rather normal one with AS.
I have had a fair share of academic success and some reasonable successes professionally, but I still feel it is beneficial in terms of understanding myself. In fairness, I didn't go the psychologist route (it is rather expensive). My diagnosis came from a licensed social worker with ample experience with spectrum disorders.


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MrStewart
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07 Jun 2013, 6:25 pm

evelusive wrote:

Anyway, my question is.... To those who have had an evaluation late in life, what am I getting myself in for? Is it usually a sit down and fill out a questionnaire or an Interview or some other kind of thing that I haven't even considered?


Hi. I did my psych evaluation last year. I was 28 at the time.

It will be a couple of formal interviews with psychologist. Mostly asking you about problems you encounter in life, things that are difficult; questions about depression, anxiety, substance abuse, legal trouble, etc. Those initial interviews cast a very wide net, so don't be surprised if you find yourself answering 'no' to the majority of them. They're never going to laugh at you or suggest you are wasting their time, please try not to worry about that. Psychologist is just trying to pin down exactly where your psychological strengths and weakness lie.

After that will be a series of mostly pen and paper tests. An intelligence test is usually involved, then tests revolving around facial recognition and social response. One involved listening to a recorded voice, then pointing to a multiple choice page of pictures of people that I believed was most congruous with the audio clip. Memory tests. There will probably be a few tests asking about mood disorder stuff just to see if any of that applies to you.

My evaluation consisted of about two hours of verbal interviews and maybe five or six hours of the tests. The reason the testing is extensive is that autism spectrum is a neurological developmental disorder with quite specific series of criteria. It can be more difficult to diagnose than mood and even personality disorders because of that.



Rooster1968
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07 Jun 2013, 6:36 pm

I was diagnosed at the age of 44 (last September). My story is an odd one for most Aspies on the surface. I, too, had a reasonably successful life - I was earning upwards of £60k (in a sales job) with a Managing Director wife earning similar. 5 holidays a year in places like Barbados, Venice etc - all upmarket, expensive trips. The trouble is, I felt like the world was insane and I was playing along. This manifested, since 19, in multiple (what I now know to be) meltdowns, which, at the time, I characterised as "needing a break".
Having said that, the pervasive feeling of being different has been with me since I was around 6 years old. I quickly learned not to discuss this, especially since I had no idea what it meant either. Anyway, long story short - I was successful for quite a while until I hit the wall that made me investigate why I felt so s**t all the time and why I had learned to mistrust myself so much (I often received advice from successful friends and had found that following their advice, no matter how BS it seemed to me and they turned out to be right)
I am considered by most to be sociable and confident - almost supremely so. The reason for this, and the reason I urge you to seek a diagnosis are one and the same. You can fool all of the people some of the time but you can't fool anyone all of the time. If you're an Aspie you'll know and most of the people around you will have no problem in describing you as "unusual" or "different" etc. The mistake I made, albeit profoundly aggrivated by the lack of information available "in my day", was to fail to recognise what I and everyone else saw - that I was, and remain, different. The break point - the diagnosis point - is whether that level of difference f***s up most of your days enough that you fail more than you succeed at things that you care about. If this is not the case for you, no matter how aspie you score, you won't get a diagnosis if you don't need one. People can be odd, quirky yet functional. My brother displays lots of stereotypical aspie traits (files his shirts in colour order in the wardrobe, polishes his and any other shoes he can find when he has a hangover, values logic over all else etc) yet manages to be the Managing Director of a massive company and earns shedloads of cash - so he's not an apsie - he doesn't struggle with his life. A diagnosis would seem specious and irrelevant to him as he doesn't need one - no matter how weird he is. Only you know the answer to "Am I autistic". It's a big step - be careful.



evelusive
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07 Jun 2013, 7:06 pm

Well, I don't know how much my life is affected.... I work as a chef, which tends to attract quite a lot of strange people so the tolerance for weird is quite high. I have had probably more that 20 jobs in the last 16 years or so, I can't deal with aggression in people, but this seems to be mostly compensated for by an ongoing obsession with food and all of its peripherals.
I recently have had a little difficulty when I changed jobs and found myself under a lot of pressure and surrounded by aggressive people (quite a common thing in this industry), so I changed jobs again, before once more returning to my old job.
Having autism would be a good thing as it would give me a framework to understand myself and my reactions, but also it would mean that I am probably going to always have difficulties with people (especially in my industry).
Honestly, I am having quite a lot of difficulty adjusting to this, even though nothing about me has changed.

Thank you for your responses by the way, they are very appreciated.



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07 Jun 2013, 7:20 pm

Hello.

I would not base anything too heavily upon one quiz. In my opinion quizzes can be fun but are not scientific.

Also a lot of psychologists, therapists and psychiatrists are very inexperienced and lack knowledge about the autism spectrum. It is possible to get a misdiagnosis one way or the other.

Perhaps a more practical action based therapy could help you to cope with aggressive people and unfriendly environments. Some type of cognitive behavioral therapy. The problem is them, but since sometimes it's hard to avoid those people or surroundings, it's good to learn coping skills.

In the end labels are really less important than understanding ourselves and how we interact with our environment and peers, and how we can improve what we wish to.



one-A-N
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07 Jun 2013, 7:49 pm

I was diagnosed with Asperger's in my fifties - and I am married with children and have a well-paid job. I deliberately chose a psychologist who specialises in ASD and who had trained with an international expert in ASD.

The psychologist interviewed me for about two hours, and also got me to do the AQ Test beforehand. He also got my wife to complete the AQ Test about me (she gave me roughly the same score as I got when I did it - only 2 points difference). In a second session, the psychologist interviewed both of us together for an hour. Besides the questions and answers, the psychologist was also observing my behaviour and manner of communication - he pointed out several things that I had never noticed (e.g. accent, softness/loudness of speech, use of gestures, etc). The interviews ranged over a whole lot of topics - childhood characteristics, workplace behaviour and attitudes, problems in my teens and twenties, my career successes, etc.

Even though I had already worked out that I was on or near the autism spectrum, it was still a change in self-concept when I was officially diagnosed. I think part of the problem was seeing things as discrete binary groups (e.g. NT versus Aspie) rather than saying "I am way along the scale towards autism, compared to the average person, and I have had significant problems as a result - especially during my adolescence and early twenties". I am near one end of a broad population-wide spectrum, rather than belonging to a distinct group. I am not defective, but I am different and have developed at different rates and in different ways than most other people (grown faster academically, but slower emotionally and socially).

It is possible to go through a "grief cycle" (denial, anger, despair, acceptance) when you are diagnosed at a mature age - you are rewriting your life's story from an Aspie point of view, changing your way of seeing yourself. I think this is glossed over sometimes - sure, it is freeing to realise that you were right, you really are different to the majority of people. But if you have spent your whole life trying to be a typical person, and not quite making it, you have to make a switch - you are forced to "lose" that goal of being typical, and take up the goal being the best Aspie that you can be (using your strengths, knowing and working with your weaknesses).



slave
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16 Aug 2016, 3:05 am

great thread!

sry for necro, i just had to acknowledge it.



Biscuitman
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16 Aug 2016, 5:44 am

Butterfly, your story is not too dissimilar to mine.

36 years old, have always lead a fairly 'successful' life but always felt like a bit of an outsider. only heard the detail of what Aspergers was around 4 years ago and couldn't believe something could describe me so well. spent a while researching and about a year later went for a docs appt, was referred to a clinic for diagnosis but bottled it and never went along.

I now want to do it, have private healthcare this time and just need to go back to the docs for another referral. been meaning to do that for 3 weeks and am far to anxious and worked up about making that initial call for a docs appt to actually do it. :oops:

on the outside you would think everything is fine. Married, got a young daughter, got a reasonable paying job etc etc. The AQ test (along with the others) does suggest I may be on the spectrum though and once I researched it all there was enough there to add to the test scores to make me think about it. I am the sort of person that needs answers though, I can't go my life undiagnosed or just wondering.



jbw
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16 Aug 2016, 7:13 am

Thanks. Yes, a very good thread that will be useful to many who have recently discovered the autistic spectrum.

The following teaching resources from Nick Walker on neurodiversity may also be of interest to some who are wondering whether a late diagnosis is useful.

http://neurocosmopolitanism.com/autism- ... -paradigm/
http://neurocosmopolitanism.com/my-auti ... e-at-ciis/
http://neurocosmopolitanism.com/guiding ... on-autism/

If you have managed to survive on this planet for three or four decades, the main benefit of a diagnosis may be a confirmation that most people indeed perceive, think, and act very differently from you. However, you can get the same benefit of clarity and acceptance by establishing conversations and some level of shared understanding with older people in the autistic community.

Social progress has already been made in other areas. For example no gay person would ever seek an official diagnosis of gayness. I would argue that older people in the autistic community may be better equipped to recognise autistic traits in others than many professional psychologists or psychiatrists, and they are definitely better equipped to offer valuable and practical advice to autistic adults than non-autistic "autism professionals".

In fact, depending on where you live, you may want to actively stay clear of official diagnosis, to avoid being discriminated against in your professional life. Being autistic can be like being gay in the first half of the last century. Here is a good book that discusses these topics https://amiautistic.com/.

If you can pass as reasonably "normal" when in public, consider yourself lucky. I've seen intelligent and capable professionals with strong autistic traits being dismissed at work and escorted out of the building by security. Here are two examples of very sad stories about the current reality for some autistics:

Medication and seclusion: http://m.nzherald.co.nz/nz/news/article ... d=11648771 and http://attitudelive.com/documentary/seclusion

Lack of even basic support even for children with an "official" diagnosis: https://www.theguardian.com/world/2016/ ... ld-poverty



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16 Aug 2016, 7:56 am

Biscuitman wrote:
Butterfly, your story is not too dissimilar to mine.

36 years old, have always lead a fairly 'successful' life but always felt like a bit of an outsider. only heard the detail of what Aspergers was around 4 years ago and couldn't believe something could describe me so well. spent a while researching and about a year later went for a docs appt, was referred to a clinic for diagnosis but bottled it and never went along.

I now want to do it, have private healthcare this time and just need to go back to the docs for another referral. been meaning to do that for 3 weeks and am far to anxious and worked up about making that initial call for a docs appt to actually do it. :oops:

on the outside you would think everything is fine. Married, got a young daughter, got a reasonable paying job etc etc. The AQ test (along with the others) does suggest I may be on the spectrum though and once I researched it all there was enough there to add to the test scores to make me think about it. I am the sort of person that needs answers though, I can't go my life undiagnosed or just wondering.


Docs appt made for the 1st Sept to hopefully get a referral!



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16 Aug 2016, 10:47 am

I first learned about Asperger's when I was 49. At the time, I had never heard of Asperger's or Autism. Well, I had heard of the term, but had no idea what it was. I started to become obsessed with the topic. I read a multitude of books (~ 20) and articles on the topic. I started to think about it night and day. I spent much of my time thinking about my younger years and started to look at my prior life experiences through the lens of "possibly having Asperger's". It just about explained everything. Still, I am the skeptical type. So, I started reading additional books about other psychological disorders that could best describe a number of my behaviors. At the time of my diagnosis, I was not at all certain that I would be diagnosed with Asperger's. I kind of expected to be diagnosed with a combination of Schizoid PD, Obsessive Compulsive PD and Generalized Anxiety Disorder. There is a LOT of overlap between these conditions. I am amazed that someone can actually differentiate between these conditions.

Anyhow, back to your question. My evaluation included the following tests:

- Cognition/Information Processing
--- Wechsler Adult Intelligence Scale (WAIS-IV)
- Attention/Executive Functions
--- Integrated Visual and Auditory Continuous Performance Test (IVA+Plus)
--- Brown ADD Scales
--- Wisconsin Card Sorting Test (WCST-R)
--- Behavior Rating Inventory of Executive Function (BRiEF-A)
- Memory
--- Wechsler Memory Scale (WMS-IV)
- Adaptive Behavior
--- Vineland-II Adaptive Behavior Scales
--- Advanced Clinical Solutions (ACS)
--- Adult Asperger Assessment (AAA)
--- Social Responsiveness Scale (SRS-2)
- Social/Emotional
--- Millon Clinical Multiaxial Inventory (MCMI-III)
--- Multidimensional Anxiety Questionnaire (MAQ)
--- Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
--- Rorschach Psychodiagnostic Test
- Interview
--- Discussion mostly focused around an intake questionnaire I completed which documented my history

Some of these were questionnaires that I filled out at home. The testing took a total of 6 hours, divided into 3 x 2 hour appointments.

By the way, even after being diagnosed, I remained skeptical of the whole thing. It was not until I participated in an autism research project, that I became convinced me that I was somewhere on the spectrum.

Good luck.



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16 Aug 2016, 10:53 am

slave wrote:
great thread!

sry for necro, i just had to acknowledge it.

Thank you Slave for dumping these gems


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16 Aug 2016, 2:00 pm

I was dx'd at 58. There is some VERY accurate observation in this thread, and I'll be necro bumping it forever if no one else gets there first.