"My wife suspects that I have Asperger's..."

Question

My wife suspects that I have Asperger Syndrome. I often wonder the same thing. She's been pushing me to seek a diagnosis. How exactly do they diagnose an adult who may (or may not) have this disorder? And is it ever too late to seek a diagnosis (I’m 32-years-old!)?

Answer

It is never too late for you to increase self-awareness in order to capitalize on strengths and work around areas of challenge. Knowing about Aspergers [now "ASD level 1"] gives you an explanation, not an excuse, for why your life has taken the twists and turns that it has. What you do with this information at the age of 32 is a personal decision, but it is still very important information to have.

AS one man with AS stated:  "42, not diagnosed, but my NT wife and I have two daughters on the spectrum. Having sought out help for them, it has opened us up to considering how all of my atypical behavior and odd social skills have affected my personal relationships with family and (very few) friends. It has helped immensely in explaining my anxiety at work in a high tech service support position where I deal with multiple people one on one all day long and come home absolutely wiped of energy."

When adults come in for a diagnosis, the therapist usually begins the exam with an IQ test. Since Aspergers adults have normal or above normal IQs, this is a good place to start. The therapist also administers an assessment of adaptive skills which tests the client’s ability to manage complex social situations.

Aspergers doesn't suddenly show up when you're 32, so most young people with true Aspergers showed symptoms throughout their childhood. Thus, if a parent is available, a parent interview called the Autism Diagnostic Interview Revised (ADI) is administered. The therapist will be looking at current functioning and early history to get a sense of the client’s skills in social, communication and behavior domains.

If parents aren't available, the therapist may ask the client to recall their childhood, asking such questions like “What hobbies did you have?” … “Did you have a lot of friends?” … Where you bullied as a child?” … “What did you enjoy doing?” …etc.

The therapist may also administer the ADOS Module IV (i.e., the autism diagnostic observation schedule; module four is for high-functioning, verbal adults). Along with the ADI, it allows the therapist to look carefully at social and communication skills and behavior. The tests look at such questions as:

• Are you interested in the others people’s thoughts and feelings?
• Can you have a reciprocal social conversation?
• Do you demonstrate insight into relationships?
• Do you have odd or over-focused interests?
• Do you use appropriate non-verbal gestures and facial expressions?

The test allows the therapist to attach a grade in each domain to determine whether the client meets the criteria for Aspergers.

It's not unusual for a client to come in expecting the diagnosis of Aspergers and to leave with a different diagnosis. Distinguishing between social phobias or shyness and actual impairment with Aspergers can be very tough for a layperson. Other disorders, such as OCD or social anxiety can sometimes look like Aspergers. If the therapist picks up on these other disorders, he/she can recommend appropriate therapy and/or medication.

A diagnosis is primarily used to drive treatment decisions and to make it easier for clinicians to communicate with each other. But in many cases, it can also be an enormous comfort to the adult and his family. As long as a person with Aspergers feels like he is being blamed or criticized for something he doesn’t even understand, he can only be defensive or bewildered.

When the people around him feel offended or disrespected, he can only get exasperated, argue, or write them off. But when the thing that makes a relationship difficult is named and understood, it becomes a problem that can be worked on together. That shift can change everything.

Resources for Neurodiverse Couples:

==> Online Group Therapy for Men with ASD

==> Online Group Therapy for NT Wives

==> Living With Aspergers: Help for Couples 

==> One-on-One Counseling for Struggling Individuals & Couples Affected by Asperger's and High-Functioning Autism  

==> Online Group Therapy for Couples and Individuals Affected by Autism Spectrum Disorder

==> Videos to help you understand your partner on the autism spectrum...  

 

COMMENTS:

•    Anonymous said... Always knew inside but didn't get diagnosis til 52! Definitely helps explain all the train wrecks of my life, but don't know if it will prevent future ones yet. I'm going forward with hope that "knowledge is power" and wishing for the power to find a way to live happily in the mostly NT world. I would encourage you to get a diagnosis, though for adults it's frustrating trying to find someone to do this unless you live in a progressive area. Good luck!
•    Anonymous said... I also have trouble making eye contact, but I'm getting better each day as I practice more and more. Whenever I get asked to stare someone in the eye, that's when it gets awkward I find.
•    Anonymous said... I was diagnosed late at age 48. The diagnosis helped to explain a lot of my inner feelings(shy/withdrawn/living in one's own world/almost obsession with certain 'specific' subjects that did particular appeal to me)/outward behaviors(not given to socializing much/not understanding why I'm so damn awkward in public/avoiding parties like it was the plague...-(due to too much over-stimulation)- like I just cannot 'fit in'?!). it gave me the 'why' I do what I do; whereas before I never really quite understood what made me think/feel/act/behave so 'different'; and, now, I feel it all makes perfect sense, and, finally, I know why. This was/is a great big relief; as I feel we all wish to both know/understand ourselves more...and, why we relate to others like we do. For example, When somebody asks me why I'm NOT inclined to go stare them directly in the eyes; I can now-a-days say it's because I suffer from Asperger's; but, that still doesn't mean I cannot 'try' and look them in the eye; some AS people through doing sufficient practice have been able to overcome this. That's why I say 'labels should never ever limit you; because we as human beings are totally and completely limitless, instead; we constantly develop/change/grow.' The person who I was yesterday; might not be the same person who I am today; and, tomorrow, I might have changed yet again.
•    Anonymous said... Like any other disability, you can't manage what you don't know you have. Getting diagnosed allows you to start learning how to adapt to this neuro-typical world. You'll definitely gain a better understanding of yourself, and why you see the world so differently than other folks.
•    Anonymous said... my husband was diagnosed age 60yrs old,never too late,both daughters have it too,best thing ever ,hubby glad he got diagnosed too,we understand each other more now,
•    Anonymous said... My husband wasn't diagnosed till late 30's and it helped make everything fall into place and things started to make sense in certain areas and ways for him. It saved our marriage ! I said to him you either have Aspergers or you are one self centred prick! It could help you both in numerous ways!

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Social-Skills Training for People with Autism Spectrum Disorder

Social skills are the skills we have to get along with others. Often times, we take our social skills for granted without realizing all the complicated skills we use when we interact with family, friends, coworkers, and so on.

Some of these skills are very basic (e.g., saying hello, smiling, making eye contact). Others are more complex (e.g., negotiation, conflict resolution, etc.). Some adults on the spectrum learn social skills easily and quickly, whereas others find social interactions more challenging and may need to work on developing their social skills consciously.

Social skills are important for ASD (high functioning autistic) adults for a number of reasons. Those with good social skills are naturally more popular than their less socially adept peers, which means they have better supports to call on when experiencing difficulties in their lives. Also, well-liked individuals get more “social reinforcement” (i.e., messages from others that they are appreciated and worthwhile), so they tend to have higher self-esteem, which can also help them through tough times.

ASD adults often experience social difficulties, social rejection, and interpersonal relationship problems. Such negative interpersonal outcomes cause emotional pain and suffering. They also appear to contribute to the development of co-morbid mood and anxiety disorders.

Because ASD is an "invisible disorder," often unrecognized by those who may be unfamiliar with the disorder, socially inappropriate behaviors that are the result of autistic symptoms are often attributed to other causes (i.e., people often perceive these behaviors and the individual who commits them as rude, self-centered, irresponsible, lazy, ill-mannered, and a host of other negative personality attributes). 

 

Over time, such negative labels lead to social rejection of the person. Social rejection causes emotional pain in the lives of many adults who have ASD and can create havoc and lower self-esteem throughout the life span. In relationships/marriages, the “inappropriate” social behavior may anger the neurotypical partner/spouse, who may eventually "burn out" and give up on the relationship/marriage.

 

==> Online Group Therapy for Couples and Individuals Affected by Autism Spectrum Disorder

 

==> Videos to help you understand your partner on the autism spectrum...  

 

Educating individuals with ASD, their significant others and their friends about the disorder and the ways in which it affects social skills and interpersonal behaviors can help alleviate much of the conflict and blame. At the same time, the individual with the disorder needs to learn strategies to become as proficient as possible in the area of social skills. With proper assessment, treatment and education, adults with ASD can learn to interact with others effectively in a way that enhances their

social life.

Social skills are generally acquired through incidental learning: watching people, copying the behavior of others, practicing, and getting feedback. Most people start this process during early childhood. Social skills are practiced and honed by "playing grown-up" and through other childhood activities. The finer points of social interactions are sharpened by observation and peer feedback.

Children with ASD often miss these details. They may pick up bits and pieces of what is appropriate but lack an overall view of social expectations. Unfortunately, as adults, they often realize "something" is missing but are never quite sure what that "something" may be.

Social acceptance can be viewed as a spiral going up or down. Individuals who exhibit appropriate social skills are rewarded with more approval from those with whom they interact and are encouraged to develop even better social skills. For those with ASD, the spiral often goes downward. Their lack of social skills leads to peer-rejection, which then limits opportunities to learn social skills, which leads to more rejection, and so on. Social punishment includes rejection, avoidance, and other, less subtle means of exhibiting one's disapproval towards another person.

It is important to note that people do not often let the offending individual know the nature of the social violation. Pointing out that a “social skill error” is being committed is often considered socially inappropriate. Thus, people on the spectrum  are often left on their own to try to improve their social skills without understanding exactly what areas need improvement.

Specific Social Skills—

• A momentary lapse in attention may result in the adult with ASD missing important information in a social interaction. If a simple sentence like "Let's meet at the park at noon," becomes simply "Let's meet at noon," the listener with ASD misses the crucial information about the location of the meeting. The speaker may become frustrated or annoyed when the listener asks where the meeting will take place, believing that the listener intentionally wasn't paying attention and didn't value what they had to say. Or even worse, the individual with ASD goes to the wrong place, yielding confusion and even anger in the partner. Unfortunately, often neither the speaker nor listener realizes that important information has been missed until it is too late.

• Actions speak louder than words. If someone's words say one thing but their actions reveal another, it would be wise to consider that their actions might be revealing their true feelings.

• Be alert to what others are doing. Look around for clues about proper behavior, dress, seating, parking and the like.

• Be aware of body language, tone of voice, behavior, or the look of someone's eyes to better interpret what they are saying.

• Find a guide to help you with this hidden language. Compare your understanding of reality with their understanding of reality. If there is a discrepancy, you might want to try the other person's interpretation and see what happens, especially if you usually get it wrong.

• Learn to interpret polite behavior. Polite behavior often disguises actual feelings.

• Look at a person's choice of words to better detect the subtext. ("I'd love to go" probably means yes. "If you want to" means probably not, but I'll do it.)

• Look for clues in your environment to help you decipher the subtext. Be mindful of alternative possibilities. Be observant.

A related social skills difficulty for many with ASD involves missing the subtle nuances of communication. Those with the disorder will often have difficulty "reading between the lines" or understanding subtext. It is difficult enough for most to attend to the text of conversations without the additional strain of needing to be aware of the subtext and what the person really means. Unfortunately, what is said is often not what is actually meant. 

 

==> Online Group Therapy for Couples and Individuals Affected by Autism Spectrum Disorder

 

==> Videos to help you understand your partner on the autism spectrum...  

 

Treatment Strategies—

When the social skill areas in need of strengthening have been identified, obtaining a referral to a therapist or coach who understands how ASD affects social skills is recommended. Social skills training usually involves instruction, modeling, role-playing, and feedback in a safe setting such as a social skills group run by a therapist. 

 

In addition, arranging the environment to provide reminders has proven essential to using the correct social behavior at the opportune moment. These findings suggest that adults with ASD wishing to work on their social skills should consider the following elements when seeking an effective intervention. It is important to note that these treatment strategies are suggestions based on clinical practice, rather than empirical research.

1. ASD adults should have a positive attitude and be open to the growth of their social skills. It is also important to be open and appreciative of feedback provided by others.

2. Adults with ASD may want to pick and work on one goal at a time, based on a self-assessment and the assessments of others. Tackling the skill areas one at a time allows the Aspie to master each skill before moving on to the next.

3. According to social exchange theory, people maintain relationships based on how well those relationships meet their needs. People are not exactly "social accountants," but on some level, people do weigh the costs and benefits of being in relationships. Adults with ASD are considered to be "high maintenance." Therefore, it is helpful to see what they can bring to relationships to help balance the equation. Investigators have found that the following are characteristics of highly likeable people: sincere, honest, understanding, loyal, truthful, trustworthy, intelligent, dependable, thoughtful, considerate, reliable, warm, kind, friendly, happy, unselfish, humorous, responsible, cheerful, and trustful. Developing or improving any of the likeability characteristics should help one's social standing.

4. Oftentimes social skills can be significantly improved when there is an understanding of social skills as well as the areas in need of improvement. Reading books on the subject of social skills training can provide some of that knowledge.

5. Adults with ASD can learn a great deal by watching others do what they need to learn to do. They may want to try selecting models both at work and in their personal lives to help them grow in this area. Television may also provide role models.

6. Adults with ASD can use prompts to stay focused on particular social skill goals. The prompts can be visual (an index card), verbal (someone telling them to be quiet), physical (a vibrating watch set every 4 minutes reminding them to be quiet), or a gesture (someone rubbing their head) to help remind them to work on their social skills.

7. Practicing the skills they need with others is a good way for individuals with ASD to receive feedback and consequently improve their social skills.

8. Those who struggle with missing pieces of information during conversation may benefit from developing a system of checking with others what they heard. "I heard you say that. Did I get it right? Is there more?" Or an individual with ASD could ask others to check with them after providing important information. "Please tell me what you heard me say." In this way, social errors due to inattention can be avoided.

9. Visualization can be used to gain additional practice and improve one's ability to apply the skill in other settings. Those who need practice in social skills can decide what they want to do and rehearse it in their minds, imagining actually using the skill in the setting they will be in with the people they will actually be interacting with. They can repeat this as many times as possible to help "over-learn" the skill. In this manner, they can gain experience in the "real" world, which will greatly increase the likelihood of their success.

 

==> Living With Aspergers: Help for Couples

Social skills are like any other kind of skill – they can be learned. How do you know if you need to improve your social skills? 

• Do you wish that you had more friends but don't know how to go about making them?
• Do you think of yourself as a 'loner'?
• Do you feel like there's nobody to turn to when you need support?
• Do you often feel uncomfortable around other people?
• Do you find it hard to know what to say sometimes?
• Do you consider yourself a rather shy person?

If you answered yes to any of these, then you may benefit from working on your social skills. The following is a list of basic social skills. Take note of any areas where you might need improvement. We will be discussing each of these areas in greater detail in subsequent posts.

Here are the simple skills involved in conversing and interacting with people on an everyday basis:

• Basic politeness (e.g., saying ‘please’ and ‘thank you’, saying ‘hello’ and ‘good-bye’, etc.)
• Making frequent eye contact
• Showing "confident" body language (e.g., an open and direct stance, not fidgeting or twisting, etc.)
• Showing interest in others (e.g., asking how their day was, how they thought they did on an exam, etc.)
• Smiling when greeting people and talking

Here are the skills you use when talking to other people:

• Knowing when to disclose personal information and when not to
• Listening and showing interest in what the other person has to say
• Nodding and smiling to indicate that you are following along
• Small talk or being able to chat about unimportant things
• Taking turns when talking
• Using humor

Here are many skills involved in making and sustaining friendships:

• Approach skills (e.g., being able to go up and start talking to someone who you don't know or don't know well)
• Sharing decision making (e.g., not always insisting on having one's way but negotiating about what to do, where to go, etc.)
• Showing appropriate affection and appreciation
• Maintaining contact (e.g., not expecting the other person to "do all the work" of keeping up the friendship)
• Being supportive (e.g., showing concern when your friend is having a hard time)
• Allowing distance and closeness (people need time apart as well as together)
• Thoughtfulness (e.g., "thinking ahead" about what might be a nice thing to do for your friend)

Empathy means being able to put yourself into someone else's shoes and recognizing their feelings. It is not the same as sympathy or "feeling sorry for someone". Empathy is responding in an understanding and caring way to what others are feeling. Empathic skills include:

• Being able to recognize what someone else might be feeling in a given situation
• Expressing concern at others' distress
• Noticing other people's feelings
• Showing sensitivity to others' feelings when communicating (e.g., being tactful when making critical comments when criticism is necessary and/or appropriate)

Social interactions do not always run smoothly. Conflict resolution skills include:

• Assertiveness (e.g., being able to say what you are feeling without being aggressive or getting personal)
• Negotiation skills (e.g., being able to discuss a conflict calmly and rationally and come to an agreement about a solution)

Principles for learning social skills:

• Identify the skill you want to learn and specify the actual behavior, the social group, the setting, and the situation.
• Social skills need to be learned in small steps (and only one or two at a time).
• Social skills are practiced best in role play situations but are learned best in real-life interactions.
• As much as possible, get immediate feedback and reinforcement from others.
• Learning social skills takes time.

Although ASD certainly brings unique challenges to social relationships, information and resources are available to help adults with the disorder improve their social skills. Most of this information is based upon sound clinical practice and research. There is a great need for more research on social skills and ASD in adults. Seek help through reading, counseling, or coaching and, above all, build and maintain social connections.

==> Living With Aspergers: Help for Couples

 

==> Online Group Therapy for Couples and Individuals Affected by Autism Spectrum Disorder

 

==> Videos to help you understand your partner on the autism spectrum...