DSM change justified due to pandemic of AS misdiagnosis

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AgentPalpatine
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15 Jun 2013, 7:14 pm

daydreamer84 wrote:
AgentPalpatine wrote:
Leaving aside DSM-5 for a moment, are you advocating a position where if someone is "doing okay", they are "not autistic"?


Well "doing okay" could mean many things. I would never advocate that an autistic person who lives at home and is supported by his parents as an adult and has no friends or relationship but is happy and enjoying his time pursuing his special interests and is okay financially because his parents have a lot of money is not autistic because he's okay. What I meant by saying that my hypothetical professor is "doing okay" is that he is maintaining a marriage , relationships with his children and professional relationships with co-workers enough to keep a job for many many years. My hypothetical prof has some issues with socializing with his peers but not enough to put his job or marriage in any serious danger and this is WITHOUT any support or accommodation. That is not a severe impairment in social interaction. Without a severe impairment in social interaction he (hypothetical prof) is not autistic although he may have some autistic traits.

If a person can maintain relationships up to the level expected in this society for their age/developmental level and a job WITHOUT support or accommodation of any kind, he or she is not autistic. Autism is defined by a severe impairment in social interaction and RRB's causing severe impairment in a person's life. Without that impairment a person is not autistic.


You appear to be advocating is a standard based on an outcome (ie, that the person does'nt require any additional outside supports outside what they obtain through daily interactions).

If I could take your hypothetical answer and tweak it a little, Mr. Asperger was married and had three kids. Mr. Asperger worked in the oil & gas business for many years, and was doing quite all right, with no additional supports. Then, when the economy turned, Mr. Asperger got laid off due to his company getting bought out (nothing to do with AS), now he can't find a new job because his Aspie traits, which wer'nt an issue before, now are an issue in his current situation.

Under your proposed definition, is Mr. Asperger "doing okay" when he had his job, and is he "doing okay" after he lost it?


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daydreamer84
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15 Jun 2013, 7:27 pm

AgentPalpatine wrote:
daydreamer84 wrote:
AgentPalpatine wrote:
Leaving aside DSM-5 for a moment, are you advocating a position where if someone is "doing okay", they are "not autistic"?


Well "doing okay" could mean many things. I would never advocate that an autistic person who lives at home and is supported by his parents as an adult and has no friends or relationship but is happy and enjoying his time pursuing his special interests and is okay financially because his parents have a lot of money is not autistic because he's okay. What I meant by saying that my hypothetical professor is "doing okay" is that he is maintaining a marriage , relationships with his children and professional relationships with co-workers enough to keep a job for many many years. My hypothetical prof has some issues with socializing with his peers but not enough to put his job or marriage in any serious danger and this is WITHOUT any support or accommodation. That is not a severe impairment in social interaction. Without a severe impairment in social interaction he (hypothetical prof) is not autistic although he may have some autistic traits.

If a person can maintain relationships up to the level expected in this society for their age/developmental level and a job WITHOUT support or accommodation of any kind, he or she is not autistic. Autism is defined by a severe impairment in social interaction and RRB's causing severe impairment in a person's life. Without that impairment a person is not autistic.


You appear to be advocating is a standard based on an outcome (ie, that the person does'nt require any additional outside supports outside what they obtain through daily interactions).

If I could take your hypothetical answer and tweak it a little, Mr. Asperger was married and had three kids. Mr. Asperger worked in the oil & gas business for many years, and was doing quite all right, with no additional supports. Then, when the economy turned, Mr. Asperger got laid off due to his company getting bought out (nothing to do with AS), now he can't find a new job because his Aspie traits, which wer'nt an issue before, now are an issue in his current situation.

Under your proposed definition, is Mr. Asperger "doing okay" when he had his job, and is he "doing okay" after he lost it?


Well if his marriage and relationship with kids after years and years is good and he did well at his old job and didn't have problems because of social impairment than he's in the same position that anyone is in who lost a job because of the economy. Impairment does not = Asperger's or Autism. The person has X number of X traits to the point where they cause impairment in the person's daily life. My mum is socially awkward and has a bit of trouble finding new jobs (with the interviews) but eventually she finds them and is okay at work without any support. This is just normal variation in personality. Some people are shyer and more socially awkward. At least your hypothetical dude did well at his last job and can get a decent reference. Maybe his wife works or could work, If your Mr Asperger or my mum wanted to say "I think I have some autsitic traits and though I'm not great with social chit chat I think I'd be a great fit for this job because I'm really hard working and detail oriented ect. ect. ' they'd be being perfectly honest and are well within their right to do so. My mum wouldn't do this because of her shyness, of course. However neither my mum nor your hypothetical man needs a diagnosis of autism and neither would qualify for one.



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15 Jun 2013, 7:33 pm

daydreamer84 wrote:
AgentPalpatine wrote:
You appear to be advocating is a standard based on an outcome (ie, that the person does'nt require any additional outside supports outside what they obtain through daily interactions).

If I could take your hypothetical answer and tweak it a little, Mr. Asperger was married and had three kids. Mr. Asperger worked in the oil & gas business for many years, and was doing quite all right, with no additional supports. Then, when the economy turned, Mr. Asperger got laid off due to his company getting bought out (nothing to do with AS), now he can't find a new job because (of) his Aspie traits, which wer'nt an issue before, now are an issue in his current situation.

Under your proposed definition, is Mr. Asperger "doing okay" when he had his job, and is he "doing okay" after he lost it?


Well if his marriage and relationship with kids after years and years is good and he did well at his old job and didn't have problems because of social impairment than he's in the same position that anyone is in who lost a job because of the economy. Impairment does not = Asperger's or Autism. The person has X number of X traits to the point where they cause impairment in the person's daily life. My mum is socially awkward and has a bit of trouble finding new jobs (with the interviews) but eventually she finds them and is okay at work without any support. This is just normal variation in personality. Some people are shyer and more socially awkward. At least your hypothetical dude did well at his last job and can get a decent reference. Maybe his wife works or could work, If your Mr Asperger or my mum wanted to say "I think I have some autsitic traits and though I'm not great with social chit chat I think I'd be a great fit for this job because I'm really hard working and detail oriented ect. ect. ' they'd be being perfectly honest and are well within their right to do so. However neither my mum nor your hypothetical man needs a diagnosis of autism and neither would qualify for one.


Bolding added above.

I specified "now he can't find a new job because (of) his Aspie traits, which wer'nt an issue before, now are an issue in his current situation. ", because I'm not sure how one can get to the arguement that not getting a job is not "an impairment".

daydreamer84 wrote:
Impairment does not = Asperger's or Autism. The person has X number of X traits to the point where they cause impairment in the person's daily life.


I'm also not sure what the above means. By the standard that you've advanced earlier in this thread, if someone is "doing okay" they don't have an ASD. Now you appear to be suggesting that if someone ever was able to hold down a job, that they never can have impairments that reach the level that you believe is required for an ASD.

I'm fairly confident that more than a few people would have issues with this standard.


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15 Jun 2013, 7:42 pm

AgentPalpatine wrote:
daydreamer84 wrote:
AgentPalpatine wrote:
You appear to be advocating is a standard based on an outcome (ie, that the person does'nt require any additional outside supports outside what they obtain through daily interactions).

If I could take your hypothetical answer and tweak it a little, Mr. Asperger was married and had three kids. Mr. Asperger worked in the oil & gas business for many years, and was doing quite all right, with no additional supports. Then, when the economy turned, Mr. Asperger got laid off due to his company getting bought out (nothing to do with AS), now he can't find a new job because (of) his Aspie traits, which wer'nt an issue before, now are an issue in his current situation.

Under your proposed definition, is Mr. Asperger "doing okay" when he had his job, and is he "doing okay" after he lost it?


Well if his marriage and relationship with kids after years and years is good and he did well at his old job and didn't have problems because of social impairment than he's in the same position that anyone is in who lost a job because of the economy. Impairment does not = Asperger's or Autism. The person has X number of X traits to the point where they cause impairment in the person's daily life. My mum is socially awkward and has a bit of trouble finding new jobs (with the interviews) but eventually she finds them and is okay at work without any support. This is just normal variation in personality. Some people are shyer and more socially awkward. At least your hypothetical dude did well at his last job and can get a decent reference. Maybe his wife works or could work, If your Mr Asperger or my mum wanted to say "I think I have some autsitic traits and though I'm not great with social chit chat I think I'd be a great fit for this job because I'm really hard working and detail oriented ect. ect. ' they'd be being perfectly honest and are well within their right to do so. However neither my mum nor your hypothetical man needs a diagnosis of autism and neither would qualify for one.


Bolding added above.

I specified "now he can't find a new job because (of) his Aspie traits, which wer'nt an issue before, now are an issue in his current situation. ", because I'm not sure how one can get to the arguement that not getting a job is not "an impairment".

daydreamer84 wrote:
Impairment does not = Asperger's or Autism. The person has X number of X traits to the point where they cause impairment in the person's daily life.


I'm also not sure what the above means. By the standard that you've advanced earlier in this thread, if someone is "doing okay" they don't have an ASD. Now you appear to be suggesting that if someone ever was able to hold down a job, that they never can have impairments that reach the level that you believe is required for an ASD.

I'm fairly confident that more than a few people would have issues with this standard.


As to the first point I was just saying that since he kept one job and did really well for many years and maintained a marriage for many years and good relationships with his kids maybe he can;t get a new job because he's too socially awkward or shy and they want someone more outgoing and there aren;t many jobs to begin with. Otherwise he'd have had problems with his old job and in other aspects of his life. If this is the case like I said it's still just a personality variation not a disorder.

What I was saying is that I never said impairment = autsim. I said certain symptoms to the point where they're severe enough to cause impairment =autsim. Someone with relationships maintained up to developmental level -first of all does not have all the symptoms of autism because not having developed or maintained relationships to developmental level is now a mandatory symptom of ASD and second of all obviously doesn't have severe impairment in social interaction. If someone has a good marriage of many years, good relationship with his kids and a few friends and no problem with co-workers for many years WITHOUT ACCOMMODATION AND DISCLOSURE then he has relationships developed and maintained to appropriate developmental level.



Last edited by daydreamer84 on 15 Jun 2013, 7:46 pm, edited 1 time in total.

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15 Jun 2013, 7:46 pm

daydreamer84 wrote:
AgentPalpatine wrote:
I specified "now he can't find a new job because (of) his Aspie traits, which wer'nt an issue before, now are an issue in his current situation. ", because I'm not sure how one can get to the arguement that not getting a job is not "an impairment".

daydreamer84 wrote:
Impairment does not = Asperger's or Autism. The person has X number of X traits to the point where they cause impairment in the person's daily life.


I'm also not sure what the above means. By the standard that you've advanced earlier in this thread, if someone is "doing okay" they don't have an ASD. Now you appear to be suggesting that if someone ever was able to hold down a job, that they never can have impairments that reach the level that you believe is required for an ASD.

I'm fairly confident that more than a few people would have issues with this standard.


As to the first point I was just saying that since he kept one job and did really well for many years and maintained a marriage for many years and good relationships with his kids maybe he can;t get a new job because he's too socially awkward or shy and they want someone more outgoing and there aren;t many jobs to begin with. Otherwise he'd have had problems with his old job and in other aspects of his life. If this is the case like I said it's still just a personality variation not a disorder.

What I was saying is that I never said impairment = autsim. I said certain symptoms to the point where they're severe enough to cause impairment =autsim. Someone with relationships maintained up to developmental level -first of all does not have all the symptoms of autism and second of all obviously doesn't have severe impairment in social interaction.


So, holding a job and getting married automatically disqualifies someone from an ASD?

How is that different than just saying "You can't be an Aspie, you have a job"?


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daydreamer84
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15 Jun 2013, 7:47 pm

No holding down a job does;t automatically disqualify you. To reiterate: Someone with relationships maintained up to developmental level -first of all does not have all the symptoms of autism because not having developed or maintained relationships to developmental level is now a mandatory symptom of ASD and second of all obviously doesn't have severe impairment in social interaction. If someone has a good marriage of many years, good relationship with his kids and a few friends and no problem with co-workers for many years WITHOUT ACCOMMODATION AND DISCLOSURE then he has relationships developed and maintained to appropriate developmental level. It's not just that he kept a job -in my original example I specified that any problems he had were to the point that they didn't cause him to be in danger of losing his job and the fact that he maintained all those relationships without problems severe enough to threaten them and all this with NO ACCOMMODATION OR SPECIFIC SUPPORT.



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15 Jun 2013, 7:53 pm

edited for disambiguation, this post is a response to Daydreamer84's comments about what "obviously is and is not impaired"

Hypothetical bollocks. Real lives don't work that way.

You don't have the first clue about other peoples' lives.

The people who diagnose them probably know more than you about both the criteria for diagnosis and the details of the individuals life.

I keep seeing variations ont the same theme here: "There are people out there who are not impaired in the same way I am, so they can't be autistic." That's faulty thinking.

What's obviously true to you about an autistic person with a long term marriage or job may in fact have no resemblance to reality.



Last edited by Adamantium on 15 Jun 2013, 8:02 pm, edited 1 time in total.

daydreamer84
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15 Jun 2013, 8:01 pm

^^

No , I don't think p[people have to be as impaired as me to have ASD but I'm just saying that some people just have traits of autism and not the full disorder and I'm sure people are misdiagnosed. People get misdiagnosed with lots of things. Of course professionals know more than me about criteria and the lives of people they diagnose. I would and never did dispute that. Obviously the p[professionals thought the criteria should be stricter and i'm saying I agree with that. I was only using hypotheticals to show an example of someone with autsitic traits but without impairment. Also, I specified that the marriage or job were not in danger and the person had no support or accommodation to distinguish between someone who might be married and have a job but still be impaired and someone without impairment.

Sorry to have brought my hypothetical prof into this discussion. I'd like to continue the argument/discussion about the changes to the DSM and whether or not they're justified without him in it. He's going to go retire to his sitting room with a glass of brandy to swill and a good book.



Last edited by daydreamer84 on 15 Jun 2013, 8:15 pm, edited 1 time in total.

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15 Jun 2013, 8:11 pm

daydreamer84 wrote:
No holding down a job does;t automatically disqualify you. To reiterate: Someone with relationships maintained up to developmental level -first of all does not have all the symptoms of autism because not having developed or maintained relationships to developmental level is now a mandatory symptom of ASD and second of all obviously doesn't have severe impairment in social interaction. If someone has a good marriage of many years, good relationship with his kids and a few friends and no problem with co-workers for many years WITHOUT ACCOMMODATION AND DISCLOSURE then he has relationships developed and maintained to appropriate developmental level.


Your approach would say that if someone found one place where they were able to support themselves with no external supports, that they could never be on the spectrum. In many respects, that's "You have a job, you can't be an Aspie".


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15 Jun 2013, 8:18 pm

AgentPalpatine wrote:
daydreamer84 wrote:
No holding down a job does;t automatically disqualify you. To reiterate: Someone with relationships maintained up to developmental level -first of all does not have all the symptoms of autism because not having developed or maintained relationships to developmental level is now a mandatory symptom of ASD and second of all obviously doesn't have severe impairment in social interaction. If someone has a good marriage of many years, good relationship with his kids and a few friends and no problem with co-workers for many years WITHOUT ACCOMMODATION AND DISCLOSURE then he has relationships developed and maintained to appropriate developmental level.


Your approach would say that if someone found one place where they were able to support themselves with no external supports, that they could never be on the spectrum. In many respects, that's "You have a job, you can't be an Aspie".


No , it has more to do with the many good relationships combined with no problems at work with no support. You can have a job and have ASD. You can't be unimpaired and have ASD. You must have a severe impairment in social interaction and repetitive behaviours/interests to the point that they cause you severe impairment in order to have ASD. This is the way it actually is and the way I think it should be.



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15 Jun 2013, 8:21 pm

daydreamer84 wrote:
AgentPalpatine wrote:
daydreamer84 wrote:
No holding down a job does;t automatically disqualify you. To reiterate: Someone with relationships maintained up to developmental level -first of all does not have all the symptoms of autism because not having developed or maintained relationships to developmental level is now a mandatory symptom of ASD and second of all obviously doesn't have severe impairment in social interaction. If someone has a good marriage of many years, good relationship with his kids and a few friends and no problem with co-workers for many years WITHOUT ACCOMMODATION AND DISCLOSURE then he has relationships developed and maintained to appropriate developmental level.


Your approach would say that if someone found one place where they were able to support themselves with no external supports, that they could never be on the spectrum. In many respects, that's "You have a job, you can't be an Aspie".


No , it has more to do with the many good relationships combined with no problems at work with no support. You can have a job and have ASD. You can't be unimpaired and have ASD. You must have a severe impairment in social interaction and repetitive behaviours/interests to the point that they cause you severe impairment in order to have ASD. This is the way it actually is and the way I think it should be.


Your approach is situationally dependent on what is and is not "impaired". I hope you'd understand if I decline to agree with that arguement.


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Last edited by AgentPalpatine on 15 Jun 2013, 8:22 pm, edited 1 time in total.

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15 Jun 2013, 8:22 pm

The thing is, unless you are in intimate conversations with someone, like a therapist, you know very little about what goes on in their life and in their head. Aspects of their lives that look very functional from the outside may be fraught with the difficulty on the inside--there's no way to tell unless the person let's you in.

And yet people say that the kids and the marriage and the job make it obvious that the person is not impaired.

How do you know? You don't. Really. You don't know. So why do you choose to believe this?

I have been in a relationship with my wife for nearly three decades and I have had a job for nearly two decades. I have two kids. And you have no idea what that means, how hard it has been, in what ways i have had unofficial accommodations and supports or how badly autism has impacted my social communication, social interaction or social imagination.

iI don't think you know this about many other people either. So how can there be a conclusion that there are lots off unimpaired autistics rushing around claiming a classification they don't deserve! It seems insane to me.



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15 Jun 2013, 8:25 pm

AgentPalpatine wrote:
daydreamer84 wrote:
AgentPalpatine wrote:
daydreamer84 wrote:
No holding down a job does;t automatically disqualify you. To reiterate: Someone with relationships maintained up to developmental level -first of all does not have all the symptoms of autism because not having developed or maintained relationships to developmental level is now a mandatory symptom of ASD and second of all obviously doesn't have severe impairment in social interaction. If someone has a good marriage of many years, good relationship with his kids and a few friends and no problem with co-workers for many years WITHOUT ACCOMMODATION AND DISCLOSURE then he has relationships developed and maintained to appropriate developmental level.


Your approach would say that if someone found one place where they were able to support themselves with no external supports, that they could never be on the spectrum. In many respects, that's "You have a job, you can't be an Aspie".


No , it has more to do with the many good relationships combined with no problems at work with no support. You can have a job and have ASD. You can't be unimpaired and have ASD. You must have a severe impairment in social interaction and repetitive behaviours/interests to the point that they cause you severe impairment in order to have ASD. This is the way it actually is and the way I think it should be.


Your approach is situationally dependent on what is and is not "impaired". You'll understand if I decline to accept that arguement.


I don;t think it's situationally dependent to a large degree. I think most people with symptoms of a certain severity will show impairment. There may be rare exceptions. This is the way the criteria are written and I think this is right. You don't have to accept my argument and I don;t have to accept yours.



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15 Jun 2013, 8:35 pm

Adamantium wrote:
The title of the threat suggests that there is (or I suppose was recently) a "pandemic of AS misdiagnosis" -- does anyone have any evidence for this?

I don't know enough about it to have a strong view, but I have heard a number of experienced clinicians suggest that the misdiagnosis was historical. Autistics were routinely misdiagnosed with mental retardation, childhood schizophrenia as the rate of correct ASD diagnoses has grown, the rates of retardation and childhood schizophrenia have dwindled just as dramatically. It's also proposed that a significant number of people who previously have gone without a diagnosis are now being diagnosed because of the increase in trained, experienced clinicians.

The idea that developmental pediatricians, neuropsychologists, child psychiatrists and pyschologists specializing in ASD are making significant numbers of misdiagnoses, and casual observers can detect this from reading posts on the internet in which unknown strangers make claims about ASDs seems, frankly, totally absurd.


If, and this is a big if, there was a large number of erronous DXs, particularly around the 2000 to present era, we would expect there to be one very large organization who would be interested to know....the US Department of Defense.

This is the exact age group that would be going through recruitment screening and (if relevant) background checks, and DoD policy is currently that an AS dx requires a waiver*. With the amount of individuals who go through screening, if there was a huge number of erronous DXs, then I would have expected to hear about it by now.

* I'm not sure on the details of the waiver process


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15 Jun 2013, 8:44 pm

^^^
There were empirical studies showing that about 60% of people with PDD NOS and a smaller but significant number of people with AS were misdiagnosed when their records were examined in detail. Peter Stazmari said this at a conference I believe. I will check this with my friend who attended said conference....Ill try to get the study to post. That is part of why they did change the criteria The main thing was that they couldn't reliably distinguish between the various PDD's so it made sense to subsume them all under ASD but there were also concerns about the criteria not being strict enough.



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15 Jun 2013, 9:26 pm

I often relate positives about my Asperger's and the gifts it has given to me. But I have also made if perfectly clear that I have challenges like others. And, I have also had my share of time in The Haven during difficult moments.

For those of you who have known me here at the WP and the way I think about having autism, let me relate some things about me:

*social situations cause me extreme distress, I feel so awkward at social events I feel it would easier to float an anvil in a lake, (at one social event I attended years ago I felt so awkward that I got physically ill and began breaking out in hives), I have had to find darkened rooms away from the crowd during some social events. This evening for example, I had to go to a family member's b-day party and her mother's retirement party combined event---I excused myself after awhile to get to a private area for about a half hour just to regain myself so I could return to the party. As a child I hated any kind of social events with classmates---I hated it!! !

*sensory issues---yeah, let me tell you about those. In a restaurant for example, if we (family) are seated next to a sunny window, my wife automatically speaks up for me and asks the waiter or waitress for a table away from bright lights. If a place is noisy, I can't take it---I will go into meltdown. I don't like being touched by people other than my immediate family. This evening at that party, several people patted me on the shoulder and it felt like a gun blasting through me---aghhhhh!! !! ! DON'T TOUCH ME!! !! !! !! !

*friends??? hmmm...I don't guess I have any. I speak to my neighbor maybe once a month, and our houses are close together. In school I could manage one close friend, but when there was more than one friend around---awkward!! ! And as I said, today, no friends.

*taking things literally---yeah, all the time. I get lost in most movies because of this.

*depressed---yeah, I've just been going through a bout of it.

*my job---I've been screwed like most of you. I got pushed into spending $7000 to get schooling for another position because the administration yanked me out of teaching English. Then, after that new job, and $7000 in the hole, I got screwed again. They took that job away and now I work in a position that I....well...I'd rather not talk about it.

*rules follower---I get extremely irritated at people on the road (for example) that speed or don't come to complete stops at stop signs that it makes my entire family nervous at me ranting about it behind the wheel.

*eye contact---I've been to therapy to try to learn how

*empathy---I feel for others, I just have difficulty expressing it---and I have been to therapy to try to learn how to show it

Gee, I could go on and on and on...but yeah, I have plenty of challenges. Those were just a few. Trust me...I can't even throw garbage out without inspecting it because of fear that something might have gotten thrown away that shouldn't have---you know, attention to detail---afraid of doing something wrong.

But...................I could focus on those things to the point of making myself miserable. But, I try to focus on the positives and post those things here on WP. I am a talent savant in music. I can memorize statistics to certain things that interest me. And I love my special intense interests---they make life fun.

*oh, did I forget bullying? Let's see, maybe I would have been bullied more if I hadn't been 6'1" in 7th grade and my father hadn't been a respected teacher in the same school---students were afraid of him, so most wouldn't have picked on me (his son). But---I did get my trombone smashed, I did get my shop project (chess set) stolen (though later recovered), I did get set on the water fountain, I was a passenger in an older student's car who decided to drive ultra fast to bully me and scare me, I was bullied by students when I began teaching, I was...yeah...I could go on. But I don't want to dwell on that anymore.

To the OP. Yes, a lot of us seem to really emphasize the positives, but I think you will find most of us that do have also had some major issues. As for the ones who say they have never had any issues, I can't judge them.


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"My journey has just begun."