Autism and Empathy

Well, the Autism pre-assessment has happened. Mr S (Advanced Practice Nurse) took down some of my history and symptoms and then talked about the assessment procedure with my mother and me. Thankfully the Crisis Team Psychiatrist who referred me had taken a very comprehensive history and symptoms, so there wasn’t much more history that needed to be taken down. At various points in the history where I had been in contact with child psychiatry, educational psychology or mental health services, he asked if Autism had ever been mentioned. “No” each time. He seemed increasingly bemused, as if they had repeatedly missed the blatantly obvious. Things that never used to make sense about my childhood now make sense. I had a feeling that I was backward compared to my own age group in communication, manual dexterity, co-ordination and social skills. My grades in English, Art, Music and PE bore that out. It turns out that the Ed Psychs’ reports reinforced that. I was ahead of my age academically in the other subjects. My IQ was above average academically, but in all other areas I was effectively learning-disabled. No wonder there were disagreements over admitting me to secondary school early. The average 11 year old finds the transition to a much bigger school daunting, so I can see why the local state secondary school would have been reluctant to admit a socially backward 9 year old. Hence why I was eventually sent to a small all-age private school for a while to smooth the transition. It seems that the Ed Psychs weren’t too worried about my social backwardness – they figured that I was intelligent enough to compensate for it or even catch up eventually. Clearly that hadn’t happened otherwise I wouldn’t be seeing Mr S or, indeed, posting this monologue.

The assessment process involves three questionnaires, one of which relates mainly to behaviour between ages 4 and 11 and so is to be completed by the parents. The questionnaires are completed over the course of 3 weekly appointments. They are a lot like questionnaires available online, but examples have to be given to support the answers to each question. Once completed, the questionnaires together with case notes are given to a panel who determine whether the client is or isn’t on the Autism spectrum. A more detailed diagnosis as to position on the spectrum would usually not be done on the NHS, but that shouldn’t be a problem as DSM-V only talks about ASD rather than breaking it down further into Asperger’s, HFA and so on. The diagnosis of ASD and accompanying medical evidence should be enough to prove care and support needs.

One questionnaire has 50 questions which scores specifically for Autism spectrum traits. I recognised it instantly as being one that I have done before online a few times and scored consistently in the high 40s. The name of the questionnaire escapes me.

The other questionnaire is an Empathy Quotient questionnaire of 60 questions. It was much harder for me to figure out what they were trying to assess. I’m aware of the fact that my empathy is stunted in areas that NTs have no problem with. And from my reading about Autism vs Narcissistic Spectrum Personality Disorders, Autism usually involves deficiencies in different sorts of empathy to the deficiencies experienced by Narcissists. According to this article, the EQ doesn’t pick out which areas are deficient, it simply calculates an overall score. The lower the score the higher the probability of ASD / Narcissistic Spectrum PD.

I think we can easily rule out Narcissism Spectrum. Narcissists know when they’re hurting people or manipulating them and don’t feel much remorse if any. When I know I’ve hurt people I always feel remorse. Usually I don’t realise until somebody tells me that I’ve hurt their feelings and what it was that I said or did. Usually I’m surprised that they are upset about it (usually it’s something that wouldn’t bother me if they did it to me), but I’m still remorseful for the upset caused. I usually then remember it as something that NTs get bothered by and try not to do it again. It’s a bit like living in a foreign culture (e.g. sniffing is ruder than blowing your nose in the UK, but in Japan blowing your nose is ruder than sniffing because the loud noise draws attention to you)

All in all, the process seems very forensic and thorough. A lot like what I’ve read about the process of diagnosing personality disorders. Perhaps not surprising given that both diagnoses involve assessing pervasive impairments in social functioning across most of the client’s lifetime. Indeed, Autism was originally classified as a type of personality disorder, but was reclassified when it became clear that autistic behaviours appear much earlier on in child development than behaviours typical of personality disorders. Advances in neurology have also made it clear that autism is invariably linked to neurological variations and that nurture rarely has much effect on the outcome. PDs on the other hand either have no neurological underpinning (only early psychological trauma), or neurological differences give a propensity for a PD which is then sometimes (but not always) triggered by early psychological trauma. This is why PDs show up later in child development than autism.

If Mr S’ instincts are right, then I am indeed Autistic, something I’ve suspected for over a decade. Odd how I’m only now starting to see the down sides of the diagnosis, though. I guess I always used to be able to say to myself that I could well have been wrong about my suspicions, but wanted to be right. Now it seems that I could well have been right, but I’m not sure I will be glad about it. When my problems seemed to be anxiety, depression and being a bit of a klutz, there was always a sense that I would completely recover eventually. Now it’s looking like a long hard slog to learn enough social and emotional skills to try and get by in a world that I’ll never truly easily understand and will always scare the cr*p out of me. Daunting…

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