Thank you for referring this pleasant 49 year old man. He had requested you refer him for a developmental assessment to find out whether he had Asperger Syndrome. On Assessment his problems were:
- Asperger Syndrome
- Associated Developmental motor co-ordination difficulties (mild)
- Associated Attentionional deficits/partial Attention Defect Hyperactivity Disorder (Adult type)
- Broader Autism Phenotype features in family
- In process of Divorce
Developmental and clinical history was provided by Laurence and his mother, on separate interviews. There was good recall over a number of salient features although not of others of Herbert’s early development, which are crucial in making a firm diagnosis of Asperger Syndrome. However, with a very high degree of probability, Laurence does have life long qualitative impairments in his reciprocal social relationships, social communication and symbolic imagination; with important associated features and with cognitive abilities in the normal range. These features are consistent with the diagnosis of Asperger Syndrome. Important information was also accrued from school reports and industrial (occupational) psychology report carried out in his late teens.
In his social relationships as a child he was not a cuddly affectionate or warm child . He showed limited attachment behaviours and appropriate stranger anxiety. He appeared to be in a world of his own and oblivious of emotional atmospheres. He would not seek comfort when hurt or distressed nor offer comfort or concern to others including peers. He had difficulty in establishing peer relationships and a limited in other children generally. He preferred the company of adults if anything. the overall impression he wasn’t particularly interested in people and quite self-sufficient. He had poor eye contact. Joint attention was extremely limited.
At school he was easily bullied and teased. He did not make himself popular with teachers. he once reported his music teacher for smoking in class because he felt he was a reverent “anti-smoker ” and also felt sensitive to cigarette smoke. He recalls having one friend only at school over the years. He felt he was out of place in the social mix that was at his school in his later years.
As an adolescent he found that he could not hit it off with girls and he recalls he was asking his parents at 16 how to manage a date, e.g. asking what to do about kissing. He describes himself as a late starter with girls and perhaps had three or four girlfriends altogether., very intermittently, before getting married at 29. Before then he had always worried about what other people thought about the girl he was with. He felt wracked with doubt whether she might be perceived as unattractive in some way by other people but could not make up his mind on all sorts of issues and these concerns invariably preoccupy him a lot of at times.
As an adult his personal friendships have been focused around his interest and business activities. his wife who he has been separated from since December and whom he is currently in process of divorcing has accused him of being someone she felt she could not talk to. She is also 49. He reports she suffers from ‘manic depression’. There has been no psychiatric involvement. His children also say they feel they cannot talk to him. As an Adult, that his ability to understand why people react in certain ways is limited. He feels he used to upset people easily. He feels that he can very easily not notice people and finds himself often noticing things and gave the example of talking to someone and then starting to count the tiles on a fireplace.
In his social communication as a child his early development was reported to be normal. There were no neoglisms but possibly use of adult words at an early age. However, his understanding of language was sometimes poor and things were taken literally. He did not understand jokes or humour (something Laurence says he still has difficulty with as an adult). There were no abnormalities of speech, tone, rhythm, pitch or volume as a child or teenager.
In conversation as a child and teenager, this was predominately a one-sided monologue and Laurence lacked the ability to engage in two-way conversation s. He would often not appear attentive to whom he was speaking to or what was said to him . As a child it was often perceived when one talked to him it was more to the “wall behind him.” He did not seem to pick up gestures or facial cues when he was young.
His repertoire of non-verbal expression was limited and awkward.
In his symbolic imagination, his imaginative play, though present, was possibly late in developing and restricted in nature for his chronological age. His interests were rather factual; he started stamp collecting for instance when he was 14 and very quickly was totally absorbed in this hobby knowing a great wealth of details. He also enjoyed reading a “Knowledge magazine” which had obscure facts he could reel off. However, he said although knowing all these facts, he did not have commonsense or was “worldly wise .”
He would go through various interests with which he was totally absorbed for a while before moving onto the next.
Alongside his narrow interests there were odd and restrictive behaviours. He refused to use the toilet at school and his mother, on a few occasions, on the way back from school, had to use other people’s toilets by knocking at their doors. He would inspect a toilet as soon as visiting another person’s house with his family. It was to check that it was clean. When he was six to seven years of age, he had a ritual while walking down the street of touching his head, his stomach, knee and feet, that he rigidly adhered to. It is of note between the age of four and nine he attended child guidance clinic. He had been referred by his headteacher because it was felt there was something different about him and he had difficulty with poor social relationships. He was offered individual counseling and psycho-therapy and the diagnosis of his difficulties was underlying insecurity. It is not clear how helpful this was at the time.
As an adult, Laurence has had difficulties in being physically touched and this was a source of difficulty within his marital relationship. In his sexual relationships he always instead he had to be the first one to initiate sexual contact. In particular, he found it easier to cope with having his sexual needs attended to by visiting massage parlours. He told me that he has spent thousands of pounds having massages and often wishing the masseuse was naked although not wishing to look at them . Over the years he has had intercourse with ten women in this context and once caught a non-specific urethritis. He reports no other sexual interests or thoughts .
He reports a special skill with numbers and timetables and the ability to memorise notes in classical music. In contrast he feels he does not have good ability in memorising names or faces . His ability in remembering detail allowed him to succeed as stamp dealer for quite a few years after leaving school before getting into the antiques business.
He always had mild motor co-ordination difficulties. As a child he struggled with laces
. His pencil grip was not good early on. There was no hand/eye or facial co-ordination difficulties although there was often the impression of clumsiness. He was able to ride a bicycle . He possibly looked funny running but had knock knees .
Also aged 12-14 there was abnormality inches bone growth in his arms that gave him some pain and made it difficult to hold a knife and fork. This difficulty has for the most part sorted itself out although there is some residual limited range of flexibility. (fuller medical details are not available.)
On clinical observation there were mild awkward postural shifts and appearance of gait . These mild developmental co-ordination difficulties are not uncommonly associated with Asperger Syndrome.
Particularly Laurence has had life long attentional deficits. Both as an adult and a child he portrayed features of physical restlessness and over activity alongside mental restlessness. Although he is always very interested in what he is doing, his concentration has always been poor and he has been easily distracted. There have been features of social and emotional impulsivity with poor relationship with memory, e.g. easily misplacing things and lifelong problems with organisation.
Laurence describes himself as being very untidy and living in chaos . These difficulties afflicted his abilities at school. He often would not check his work and he would make plenty of spelling mistakes . His homework was often late and poorly organised. he got bored in class. He did poorly in class although he describes himself as brilliant with numbers and take a ten figure number and multiply it in his head. he left with no O or A levels despite above average intelligence. His occupational report commented on his poor concentration, organisation, presentation and sustained attention. These attentional deficits are not uncommonly seen in association with Asperger Syndrome. the features of social impulsivity cannot often be distinguished from social insensitivity or or emotional impulsivity, so it is often difficult to decide whether certain difficulties are a part of an attend deficit hyperactivity disorder range of difficulties or part of the classical Asperger Syndrome. Thus this range of difficulties may be best described as partial ADHD syndrome.
In Laurence’s family on his father side there is history of bipolar illness and on his mother’s side traits of being on the go and Laurence’s mother’s mother is described as being very cold . His first cousin has four boys all reported to have behavioural problems. Both Herbert’s sisters had no problems as children or adults. However, one sister has two boys of whom there are behavioural problems with the eldest and the other sister also has a boy with behavioural problems and difficulties with over activity and poor concentration. Herbert’s son Tim, who is 19 years old, had some behavioural difficulties and was described as “wild” at one time. He is settled now. Herbert’s son Sam has some degree of poor confidence and is not able to listen to others. He is apparently impatient and asks questions repetitively. His daughter Julie has no reported behavioural or developmental difficulties.
These features are consistent with broader autism phenotype. There is no official definition for this term, but describes a scatter of psychiatric, behavioural or developmental difficulties that are not uncommonly if not usually seen in the immediate and extended family where someone carries the diagnosis of Asperger Syndrome.
On mental state examination, Laurence was a pleasant, likeable and friendly man. At times he displayed subtle but odd facial expressions or postural shifts. On first meeting his greeting behaviour was gauche with poor eye contact and at time inappropriate social distance . These quickly settled as Laurence became more relaxed. He has struggled over the years to dress appropriately and this is something he recalls being criticised by his wife previously. There was no evidence of psychotic or paranoid features. He is currently troubled, preoccupied and anxious by his impending divorce and coping with living away from his family home.
I imparted the diagnosis of Asperger Syndrome and associated difficulties. I commented on the fact that despite his social impairments, he has over the years, managed extremely well and achieved a high level of psychosocial adjustment, which is often illusive to other people Asperger Syndrome. He is able to have had a successful business as well as a family. Further help will be to provide further psycho-education and sources of information. Cognitive behavioural strategies to help with social and other anxiety including situations may be appropriate should he wish for help in these areas. Treatment of his ADHD symptoms may be a consideration with a trial of psycho-stimulant medication .
I imagine in the background there must have been some underlying stress. regardless to Aspie’s sexual behaviours of my past, Jacky had forgiven him for these misdemeanours when she found out. Normally these occurred when her constant repetitive, “tele the truth, I won’t bite but the shouting and screaming afterwards would tell me I had wished I had kept Aspie’s mouth quiet. The problem I have with Aspie is he is unable to withhold the truth, just can’t lie even tell a yarn even if it could save his life. Often got me into embarrassing and panic situations where I found myself getting into more trouble than if I could have only kept my cool.
But with Jacky the love making that would follow on that night, it was as though whatever shouting and screaming she might have done immediately after telling her I had been to a massage parlour on in the case of my affair admitted to it, by the following morning all would have been forgiven. We would carry on as husband and wife, she oblivious to Aspie and I to her manic changes in the state of her mind that Aspie was possibly blind to, aware of deep emotions he couldn’t understand or I relate to. But Jacky do something about it, see a therapist, no way!
These impairments probably showed up in Aspie’s behaviour when he appears to be solely into himself rarely seeing from another persons perspective.
An example of this was a recent incident when one of my son’s explained that he couldn’t definitely make my book launch, that he was very disappointed because he wanted to be there to support me.
Aspie didn’t see it from his perspective saw it from his own that my son should have made every effort to come along, put his priorities in the right order that was from Aspie’s perspective knocking on its head anything he had on that conflicted with the book launch and make certain he was there.
However what Aspie was blind to was that my son couldn’t make it not because of his other priorities but because his conflict was it was on a study day for an important course he was on and he would have to check with his tutor to see whether he could miss a class or make up another time.
My qualm with Aspie is this often occurs as though it is on a regular basis. Even if Aspie analysed the entire situation it would be a rare occasion indeed if he could relate to why my son couldn’t come along and apply the same regime in thinking to other incidents that might conflict from time to time.
I am hoping that one day Aspie will surprise me and see something from the other person’s perspective rather than causing unnecessary conflict that is often the case. While I do not know what the ideal remedy for this trait of Aspie’s I am hoping it is not permanent even though this has been the way for his thought processing throughout his life. My only hope is the elasticity in the brain and hope rewiring can outwit this unnecessary way of only seeing every situation from his perspective and no one else.
In my story I look back at my Mother’s life prior to my birth to see if this could be a possible cause? Could it be something to do with my Mother’s upbringing where she was forced not allowed to outwardly show her grief after losing half her immediate family. I wonder whether this trait of my Mother’s was transported into me during my birth. I find these days that the idea that I couldn’t be a warm or cuddly child impossible to believe. Yet perhaps it is the reason Aspie is addicted to love searching so evident in my story.
Too much smoke in my immediate proximity could unleash a host of anxiety attacks let alone the distasteful smell.
Is it not surprising I didn’t hit it off with girls with Aspie interfering after the unfortunate indulgences with the Paedophile left Aspie feeling very distraught. However there was another condition at play here, Alexithymia. His alexithymic condition meant he could read how girls felt. it wasn’t just the case of watching other boys hitting it off with girls it was as though he could read their minds, relate to what they were thinking, “tough luck mate, you had your chance but I beat you to the kill”.
All these feelings and emotions were drowning Aspie not knowing where to filter them to. It is not surprising when he picked up vibes from the girls almost as though what his experiences mimicked was telepathy. The girls felt sorry for him, knew felt his emotional predicament, wanted to respond but felt powerless to intervene and it just meant more plied feelings and emotions being plied accumulating infinitely not doing Aspie’s self esteem the one bit of good and making my life a complete mystery when chatting up girls.
These are still with me today and can play havoc on my lifestyle. It is no doubt a negative side effect of Alexithymia. Aspie is automatically drawn to some deep emotive expression that can be displayed in any woman(love at first sight), he is unable to filter the emotion so it will stay with him indefinitely until I somehow find a way to change this feeling. But invariably Aspie wins presents me with a panic attack as is clearly seen in my story when the same occurs while taking a date we meet on the beach to Las Vegas where he compares her obesity to other women who are far less so, yet have hour shaped figures.
Aspie is unable to emphasise from a neuro-typical’s (non-autistic) perspective where it doesn’t matter what size or shape a woman or man might be but what counts is the acceptance of each other with all of their faults. If only Aspie wasn’t looking for the perfect woman. But would Aspie know the perfect woman if he found her; I think not.
I am not certain whether this is an ADHD thing but it may have a relationship with my Aspie’s ‘ants in my pants’ behavioural thinking pattern.
If it is a pattern it occurs too often. There is an example of not seeing my brother in law yet he was only a few feet away from me; how is this possible, yet it is? I can only interpret these incidents the they occur as a missing link in the communication between the brain and eyes. the eyes see, the brain doesn’t.
What is humour to a non-autistic is not necessarily unfunny to me it’s just that Aspie’s ability to filter humour and see it as thus or being able to differentiate it between truth of fiction is very limited. this is another example when Aspie’s ability to define facial cues or expression that might identify with a particular humour is non existent. Only under certain conditions, persay, a balanced lifestyle will he be in more of a position to identify.
This is still true with me today as though Aspie always has a lot to say(too much) as though it is important for him to get out(emotionally painful to leave in). He find’s it very difficult to see the world from another person’s perspective. This puts me in a very trying position since although I am aware of this annoying trait I have yet to find a permanent remedy. Only occasionally will a trickle of actual listening without him having to interrupt and I can hold him back from more obsessive talk bringing himself into the centre of the conversation. I wonder whether this is due to some lack of confidence or fear of rejection that any opinion I may have might be rejected.
This difficulty is still present with me these days. Perhaps born from ADHD with my mind wandering without any warning. This trait might have something to do with making eye contact. Perhaps while I am in this pose, Aspie is fighting me finding it very uncomfortable, his only defence (self protection) is to allow his mind to wander.
This is another of my challenging areas of communication. Sometimes these cues can be too obvious and I get caught out just as I do when people have intent on manipulating me. Again possible Aspie generated, when asked a question or a statement is being made it takes him out of his comfort zone and there is a war going on between the two of us. I intent on keeping eye contact and him hoping to reversing my role.
Throughout my life Aspie was accident prone. While I was consciously aware of my immediate surroundings Aspie would somehow intervene at the most inappropriate moment, take my mind off where it was needed and at times my life felt like it hung on a thread. This is emphasised in one major incident at home where I nearly literally died, an accident on a small step ladder resulted in me falling on to a sharp object that cut through several ribs(more info can be found in my story chapter ). In this scenario Some of the things I did could be said to be stupid even life threatening. I didn’t see consequences as Neruo-typicals might therefore I wasn’t aware of dangers. This was also another reason I couldn’t recognise facial cues in people who had abuse tendencies towards people like me.
I would have difficulty interpreting this phrase. I would consider myself very wise of the world. However aware of pitfalls and wise to consequences , this is where Aspie intervened as he does on occasion today normally out of the blue when I least expect. This unfortunate trait of his may be down to everyday life style inadequacies where my relationship with diet and sleep is poor and when anxieties can be elevated. A recent example of this almost caused a serious fight to erupt in a road rage incident I write about in my blog.
I required privacy . Ideally any toilet had to have a tiled wall or floor where I could occupy myself with counting or going into my own imaginary world and pretend the wall was a gigantic spaceship just like one of the books my father got me to read. It would be about five years after my diagnosis that I would find it comfortable going into strangers toilets. Even relations were no go areas as I was afraid people could either hear or watch what I was doing.
I have no remembrance of doing this so I imagine this bit of information was from my mother. However just like some young people in their teens who rigidly have to swing their arms and have no control over doing otherwise I have since grown out of I hope. However I something wonder whether this has something to do with the child in me (Aspie) playing games because he wants to get noticed, where to my detriment is not regarded in the slightest, just his selfish need to do.
If I be candid I think I should never have attended these guidance sessions in the first place given that I felt I was no better afterwards. Looking back I can only make this assumption based on that the experts had zero knowledge of Autism that had only recently been discovered therefore could not have known how it affected me or been able to come up with a remedy. At best my Mother was told what ever I had it was hoped for their and my sake I would lose my attachment to during my adolescence.
My incidents with sexual abusers were not discussed. I worried that it might have put a different light onto the authorities perception. Autism was in it’s infancy as was the knowledge of Aspie actually existing. The very thought of anyone knowing I may have been sexually molested and my ongoing interactions with these extremely harsh and and damaging thoughts created a no go area that I would not entertain until I reported the matter to the Police in May 2015. It is no wonder having angst being physically touched. How this might have affected my relationship with my wife or other relationships I am unaware of. What I am aware of is how I could easily feel threatened if anyone entered what I considered was my personal wall protecting my space. Even people who might consider were more than an arm’s length away and how they were situated personally in conversation with others might be for me too close for comfort.
it is no wonder I took up this attitude of not wanting to look at the female body given being groomed by the Pedophile that all women were whores, should not be respected and the only reason they were born to the world to produce babies. Hence that is why God ensured their sexual organs sat between their legs because God decided man did not have to look at their ugly creation.
The only reference I can think this refers to is other psycho sexual or deviances that can be found throughout sexual relationships for example I know Aspie enjoyed being blindfolded and tied up and put into a position where he was helpless. yet into bondage( I only tried in once and it brought on a T-Rex of an anxiety but in this scenario I was in a dungeon and left tied up and the lights turned off and the thought I could not escape brought T-Rex into the scene. Then there is the erotic side of sex. I have also not been able to condone the swinging sect. Found enjoying sexual intercourse with others around me very unsatisfactory. Aspie on the other hand finds anything including the most unsavoury or sordid very stimulating(another area where we can be at war with out pet likes and dislikes.
this challenge is still very much with me today. Often people come up and say hello Laurence and I have to say that I don’t remember them. However, I don’t believe this is just an Aspie thing as I hear other people say they have similar trouble remembering names or faces and perhaps the solution is mindfulness, standing back and trying to be mindful of the person’s name or actual facial expression.
This is still prevalent with me today but I prefer to blame it on having limited rotation in my wrists due to the congenital malformation of the bones in my arms than of anything related to motor challenges although I did suffer with much clumsiness. Whether this has any relationship with Aspie’s attention span could be a possible cause.
This is an area that is still problematical with me today, I can write with ease but often challenged with the inability to read my own hand writing. I just wonder whether these days this trait has more to do with losing one’s attachment to writing in general due to the age of the computer where little actual writing is initiated unless making notes. It is interesting even though there is so much advanced voice type dictation on so many devices Aspie’s preferred choice is to type away at the keyboard than actually speaking into a microphone.
Although seemingly unrelated I wonder too whether lack of pencil grip is due not just to poor motor skills but also, getting bored with doing what seems today; i) a harder way of doing things and ii) losing complete interest in going back to something previously learnt. Here I am referring to when I used to be a very successful philatelist but today although there is still moderate interest I would have to do so much relearning to catch up on values that I worry that I do not have the confidence to initiate this.
ride a bicycle yes but be aware of consequence when I was 12. There are two sides to Aspie’s demure. There is his self awareness to movement around him or the unawareness. As an example of this feature of his. Aspie somehow lost his balance while riding my bike, came off my and almost tore my little finger off my left hand, it required a couple of stitches. However on other occasions his self awareness is so cute he can spot the vibration of a leaf on a bush hundreds of yards away. For the most part I am grateful that Aspie keeps me informed of any possible complacency that might occur; having to put up with the ones that don’t is a small consolation to pay so long as it doesn’t mean me forfeiting my life.
I imagine this is why some women refuse to dance with me because they find me too embarrassing although I am not aware of being any different from any other man of my age abate that I am aware I have much difficulty relaxing and my body often feels constantly stressed and unrelaxed.
This is an understatement by a long shot I had to endure the most horrible of cramps lasting 24 hours a day up to three months at a time. This was due to growing pains caused by bones manoeuvring themselves into an incorrect position when compared to most persons arms. Even today I have only limited movement that is particularly noticeable with my wrists and the difficulty I encounter when eating certain foods when going out on first dates I had no knowledge women found me rather uncouth.
yes I can touch type but write clearly and effectively entirely a different matter. Now when I entertain I have to tell people I am unable to hold a knife and fork properly.
I would say that i have perfected this area to a degree
This replacing things has a relationship with clumsiness. Whether this is an ADHD thing or Aspergers, whether it has a relationship with organisation the latter has been with me throughout my life and may have contributed to an inability to run a successful business without help from someone who has a good association with organisation. These days I am more equipped to deal with organisational skills than I used to be.
This is an area I have difficulty in defining. Perhaps it is an Aspie thing where he feels more at home amongst chaos because he is used to being surrounded bymess. These days I may not be the tidiest person but certainly a vast improvement on how I was before bearing in mind being diagnosed with clumsiness hasn’t benefitted me.
In my opinion a combination of either or dyslexia or ADHD. The former I was not diagnosed with but I do find whilst I am typing to often doing this.
I cannot relate to what partial is supposed to relate to other than say ADHD did and still does play havoc in my lifestyle. I personally believe when I have lack of sleep, my diet is unbalanced then Aspie’s negative traits are more evident around me.
Aspie didn’t enjoy any relationship with my grandmother. He couldn’t emphasise with the immense loss of losing half her near family in the Blitz or that she was fraught with much illness. To him she played the part of a Witch and he only yearned for the day she died. A sentiment that was shared with my Mother who possibly didn’t resent because she knew of my cognitive difficulties of understanding.
I am not really aware of this although I am aware of staring and perhaps this is what this refers to. Staring is particularly a habit I am still unable to relinquish although not for any ulterior motive even though it could be suggestive there is
This is an area I have mostly conquered however may be noticeable if I am tired or anxious.
This is an area I often find challenging as previously mentioned. Just as I don’t feel comfortable when I think someone is invading my immediate comfort zone I can do the same as they might do to me but not be at all aware I am in the wrong.
It wasn’t a case of not dressing smartly as I often bought expensive clothes. However dressing inappropRia.tely I wasn’t aware of some of my actions. Again I blame on my inability to have proper rotation in my wrists and this meant sometimes I forgot to do up laces, buttons in shirts and also my flies but here not in the slightest sexually motivated irrespective of that it could be suggested given my history of the fact of being groomed.
This was an area where I mistakenly believed would have no value in my life since I was convinced of certain abilities that in affect were of no use to me whatsoever. Several years before I had learned a course of Autogenics, an advanced form of Hypnosis. When NLP hit the news and became quite mainstream, my Lifecoach made reference to NLP in the wrong hands could be detrimental. I just wished Aspie could have listened and took in his well worth words but instead convinced me that I didn’t have to ‘learn’ anything more about NLP given my course in Autogenics so long ago. Only under certain conditions when Aspie is not so much in my face am able to invoke Autogenics. I just wish I could have heeded the warning ‘don’t believe all that Aspie believes he can succeed with”.
Given how such treatments destroyed Jacky’s life not in my wildest dreams would I ever contemplate any sort of medication. Just the thought of the slightest concern that Aspie might intervene and test out his beating death at it’s own game as is seen at the beginning of my story. It is challenging enough just like the other day I was turning into a busy three lane dual carriageway and I had a bout of Aspie generated ‘mind blindness’, Aspie was completely blind to the coach while we were on my bicycle. When I realised the danger I preyed there was enough room for the coach to pass. It was travelling at 40 MPH while I was sticking as close to the kerbside as I could. I felt like the cat that had used up one of its nine lives. Thankfully though and perhaps one of Aspie’s more positively healthier traits is the awareness to danger from other road users but it is just the odd occasions when I do worry about my finality and especially if stimulated by medication.