Friday, January 18, 2013

It's Asperger's Not Bipolar

Several months ago I wrote about my son's suicidal thoughts. Specialists thought he probably had bipolar disorder. Over the intervening months my son has received intensive treatment at a center that specializes in behavioral problems and related conditions.

While it was obvious that our son had issues, specialists at the center were not comfortable with a diagnosis of bipolar disorder. It turns out that his regular psychologist and psychiatrist weren't either. Their documentation said merely that he exhibited some symptoms consistent with such a diagnosis.

Our son's case was referred to a group known as the leading experts in the state on behavioral issues. They gathered a huge amount of data from us as parents, our son's teachers, and the various specialists that have been involved in our son's treatment. They conducted an intensive parental interview. And finally they spent an entire day putting our son through a variety of tests and exercises.

We recently met with the specialist in charge of our son's case after they had taken time to consider all of the information. He explained to us that our son has Asperger Syndrome (which will soon be classified as an Autism Spectrum Disorder rather than being classed s a separate condition). While it is not uncommon for people with AS to have other coexisting conditions, it was felt that our son's anxiety, depression, and mood swings fit best within the context of AS. Diagnosing problems of this nature is rather complex and is not as straightforward as some might think.

At first we were a little surprised by the diagnosis. We know people with AS and we had developed a stereotypical idea of what people with AS are like. But as the specialist went through the findings in some detail, my wife and I frequently found ourselves looking at each other and nodding our heads.

It turns out that cases of AS can vary quite a bit. A common symptom of AS is difficulty developing and engaging in normal human relations. But such challenges are not always present in AS or may be rather mild. Our son, for example, seems to do generally well in this arena. He has always demonstrated a high degree of compassion and empathy for others.

Among our son's challenges are significant diminished abilities to plan and to contextualize (which means fitting details into the bigger picture). It's not that he hasn't had enough training in these areas. Despite his level of intelligence, he will never be able to do these things naturally. He can, however, learn coping skills that may allow him to somewhat compensate for these deficiencies.

Since our son can't engage in normal levels of internal planning and has difficulty fitting details into context, he tends to use external planning methods and to focus intently on details. I have long criticized him for refusing to consider alternatives. If his Plan A doesn't work out, he will melt down or lash out rather than consider Plan B. I now understand that this is because, for him, there is only Plan A. Plans B, C, etc simply do not exist. He can talk about alternatives academically. But he can't really consider or manage them in the regular flow of daily life.

Our son's diminished ability to fit details into context means that if a detail (even a minor detail) of his Plan A doesn't work out as he has anticipated, the whole plan is ruined. His anxiety levels skyrocket because he feels that he has run out of options, leading him to engage in antisocial behavior.

This explains our son's suicidal thoughts. The diagnosing specialist explained to us that a common misconception is that suicidal people are ultra-sad. Rather, people that are suicidal feel as if they are have no other remaining options. Thus, it is important to deal with our son's planning and context deficiencies rapidly and as well as possible. He has learned some hard and fast rules for what to do when he has a suicidal thought. Having sure-fire instructions to follow reduces the need for developing new plans on the fly.

Our son's focus on details frequently leads him to engage in long-winded, extremely detailed monologues on subjects that are of interest to him. He can go on and on (enthusiastically) without making any particular point. I'm not sure whether he doesn't perceive others' social cues telling him to curtail his speech or if he grasps these but still feels compelled to complete what he has to say anyway.

Depression and low self esteem are pretty serious issues for our son right now. This is fairly common for kids with behavioral issues because they tend to get an overwhelming number of negative (or corrective) messages from those around them, mainly based on others' unrealistic expectations. Right now our son feels as if he can't do anything right. He wants more than anything just to be normal.

Fortunately many resources now exist for helping people with AS. Many people with AS live rich and fulfilling lives. Successful technologist, businessman, and author John Elder Robison, who has AS, provides a lot of hope for kids with AS in this recent blog post about developing compensating skills. Our son's diagnosis provides us direction in getting him the help he needs.

1 comment:

blitton said...

My son was diagnosed with Asperger's about six months. This after years of us trying to figure out why he had such a difficult time with schoolwork, etc. Since the diagnosis he has been having biofeedback treatments which seem to be helping, but he still has a way to go before he gets over his anxiety and other problems.