What do you think I should do?

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My daughter has decided to seek counseling. She's 21.

As I have posted on other occasions - she was diagnosed and I think diagnosed incorrectly (or at least incompletely) by the psychiatric team at the hospital a couple years back. They said it was a matter of schizo-affective. I think she has Asperger's and perhaps OCPD.

When it comes to some things - she is completely a perfectionist and it has become her downfall. She has no perspective on things. She also fits about every criteria there is when it come to Asperger's (I also read that schizo-affective can briefly manifest itself with Asperger's at the age it did for her.)

Should I just hope that the doctors get it right this time? She is not interested in my opinion anyway. Is there any point in me trying to do anything? Or should I just forget it?

(I think I have Asperger's also - but my problems are not as severe as hers. She doesn't drive - seems to overwhelm her. She drops out of school when she gets stressed out, etc. On the plus side - she is a genius at math and has an amazing memory).

[Random_Australian]

1. I hear you. In the next few days

The MHSG persons with aspergers should be able to give you better info, but for now:

You are not alone.

:hug:

[Kire]

2. I have Schizo-Affective

Over the years, I and my family are always thinking of new ways to self-diagnose. Never Aspergers, but OCD, or bipolar, or AD/HD or borderline. But, the first real diagnosis was Schizo-Affective and to get another legitimate doctor to contradict that first diagnosis is a feat I've never heard done. It either happens naturally or it doesn't happen at all. We are not doctors, we are patients (and family members). We can't diagnose ourselves. I don't even think we could do that if we went to medical school and got a license to practice psychiatry. Of course, you could, but in my opinion, it shouldn't be done.

I wish you luch in your endeavors. I hope I have been supportive, even if it was bad news.

Warm Regards,
Kire

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3. It wouldn't matter

So much - and I am willing to believe that she had Schizo-Affective at one time - but I don't think she will get the treatment/approach that she needs if people don't recognize what she has.

For instance - how a person is socially with Asperger's would be viewed a lot differently through that frame than if the practitioners thought there was some other diagnosable cause.

And I'm not sure that all the mental health practitioners recognize AS as well as others. The people at the Autism center seemed to think that that was the case.

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F84.5 Asperger's Syndrome

A disorder of uncertain nosological validity, characterized by the same kind of qualitative abnormalities of reciprocal social interaction that typify autism, together with a restricted, stereotyped, repetitive repertoire of interests and activities. The disorder differs from autism primarily in that there is no general delay or retardation in language or in cognitive development. Most individuals are of normal general intelligence but it is common for them to be markedly clumsy; the condition occurs predominately in boys (in a ratio of about eight boys to one girl). It seems highly likely that at least some cases represent mild varieties of autism, but it is uncertain whether or not that is so for all. There is a strong tendency for the abnormalities to persist into adolescence and adult life and it seems that they represent individual characteristics that are not greatly affected by environmental influences. Psychotic episodes occasionally occur in early adult life.

Diagnostic Guidelines
Diagnosis is based on the combination of a lack of any clinically significant general delay in language or cognitive development plus, as with autism, the presence of qualitative deficiencies in reciprocal social interaction and restricted, repetitive, stereotyped patterns of behaviour, interests, and activities. There may or may not be problems in communication similar to those associated with autism, but significant language retardation would rule out the diagnosis.

Includes:
autistic psychopathy
schizoid disorder of childhood

Excludes:
anakastic personality disorder
attachment disorders of childhood
obsessive-compulsive disorder
schizotypical disorder
simple schizophrenia

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4. discussion- differential diagnosis

Schizophrenia

Adults with Asperger syndrome may be diagnosed as suffering from schizophrenia. The differential diagnosis of schizophrenia has been discussed elsewhere (J.K.Wing, 1978). The main difficulty arises from the fact that schizophrenia has been defined loosely by some and strictly by other workers.

If a loose definition of schizophrenia is accepted, based only on characteristics such as social withdrawal and speech disorder, then a case could perhaps be made for including Asperger syndrome in this group. As with schizoid personality, the question is whether doing so has any advantages. Poverty of social interaction and abnormalities of speech can have many different causes, so the diagnosis of chronic or simple schizophrenia tends to cover a variety of conditions having little in common with each other.

Careful observation of speech in Asperger syndrome discloses differences from thought blocking and the 'knight's move' in thought described by Bleuler (1911). In Asperger syndrome, speech may be slow, and there may be irrelevant or tangential replies to questions, but these problems are due partly to a tendency to become stuck in well-worn conversational grooves rather than to produce new ideas. Utterances are always logical, even if they are unrelated to the question, or originated from an unusual point of view. Thus one young man, when asked a general knowledge question about organised charities, said 'They do things for unfortunate people. They provide wheelchairs, stilts and round shoes for people with no feet'. There is a marked contrast between the vague woolliness of schizophrenic thought and the concrete, pedantic approach found in Asperger syndrome.

The term schizophrenia can be used more strictly. It can be confined to those who have, currently or in the past, shown the florid first-rank symptoms described by Schneider (1971). In this case, the differentiation of Asperger syndrome rests on accurate definition of the clinical phenomena. Unless they have a superimposed schizophrenic illness, people with Asperger syndrome do not experience thought echo, thought substitution or insertion, thought broadcast, voices commenting on their actions, voices talking to each other, or feelings that external forces are exerting control over their will, emotions or behaviour. The young man, L.P. (Appendix No. 2), when asked if he had such experiences, gave the matter long and careful thought and then said, 'I believe such things to be impossible'.

During clinical examination it is necessary to be aware that comprehension of abstract or unfamiliar concepts is impaired in Asperger syndrome. Those with the more severe form of the handicap may have a habit of answering 'yes' to any question they do not understand, this being the quickest way to cut short the conversation. Some may also pick up and repeat phrases used by other people, including other patients in a hospital ward, making diagnosis even more difficult.

....Finally, the relationship to schizophrenia of Asperger syndrome, autism and similar impairments can be reconsidered. Although they are dissimilar in family history, childhood development and clinical pictures, both groups of conditions affect language, social interaction and imaginative activities. The time of onset and the nature of the disturbances are different, but there are similarities in the eventual chronic defect states that either may produce. It is not surprising that autism and schizophrenia have, in the past, been confused. Progress has been made in separating them and it is important to continue to improve precision in diagnosis, despite the many difficulties met in clinical practice.

http://www.mugsy.org/wing2.htm

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5. "What Autism is not" - on Autism and OCD and OCPD

Autism is not Obsessive-Compulsive Disorder

Autistic peoples' ritual preoccupations and behaviors are similar to the obsessions and compulsions characteristic of Obsessive Compulsive Disorder (OCD), and with the need for order and perfection characteristic of Obsessive Compulsive Personality Disorder (OCPD). Obsessions are intrusive thoughts that reoccur constantly and which cannot be suppressed or escaped. Though they may not be worries in-of-themselves, their very incessant and unrelenting quality causes affected people to become anxious and to behave in ways that will reduce that anxiety. For example, someone might develop an obsession concerning whether a door handle is dirty. Anxiety around that contamination fear would motivate action; once the door handle was cleaned, some anxiety relief might be experienced. In this manner are born compulsions, which are anxiety motivated behaviors that once performed, help to reduce distress (however short lived that relief might be). OCPD is a distinct condition from OCD. People with OCPD do not experience true obsessions or compulsions, but are instead basically very uptight, rule-governed, inflexible people rigidly concerned with their position within their social hierarchy, and with the orderliness and perfection of their personal environments and projects.

Thought there are similarities between autism and the obsessive compulsive disorders, these disorders are also distinct from one another. Autism begins in early childhood while the other disorders do not tend to manifest until early adulthood. There is also the matter of motivation to be considered. Autism is a brain disease reducing affected people's capability for appreciating the existence of the social world populated by other feeling human beings. Moderately and severely autistic people have difficulty appreciating that other people have different agendas than they do; it is in question whether they appreciate other people as having independent existences at all. This is in contrast to people with OCPD who are hyper-aware of their social position. Though both OCD and autistic people engage in repetitive obsessive behaviors, OCD compulsiveness appears to be motivated more by anxious attempts to self-sooth, while autistic compulsiveness may be motivated by their need to self-stimulate. At any rate, the disease process that creates obsessions and compulsions in OCD appears to have a different mechanism than the one responsible for autistic deficits. This means that autistic people could develop OCD as well as autism and receive both diagnoses. However, if this were to be the case, both disease processes would be occurring simultaneously. One diagnosis does not reduce to the other.

http://mentalhelp.net/poc/view_doc.php?type=doc&id=8769&cn=20

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I ended up leaving a message with the therapist so she would at least hopefully consider Autism/Asperger's as a factor in the depression.