‘How can you not hear that??’ communicating sensory difficulties

I have always had sensory sensitivities but never knew that was what they were called; I always felt like others thought I was just being dramatic, so I rarely said anything. It’s nice, in a way, to have these sensory differences acknowledged. 🌸

YennPurkis

I’m not sure if this is the case for anyone else but the older I get, the worse my sensory sensitivities are. I used to be able to eat almost anything and it all tasted good and had a texture which didn’t revolt me. Now I am anxious about going to restaurants in case they have nothing I can happily eat.  I eat exactly the same dish every night unless I get take away, in which case I usually order the same dish! (Except for pizza. I think it’s pretty hard to make pizza horrible). To the horror of my vegetarian, vegan and health conscious friends, the things I am able to eat mostly come from the meat group or the sugar group! I am only 42 so worry that if I get old I might only have one thing I can eat!

I also have an increasingly heightened sense…

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Debunking “Everyone is a little autistic.”

I know several people who have said, “Everyone is a little autistic” in one way, shape or form.  Hell, even before I was self-aware of my own autism, I hold my hands up and say that I thought this too.  I’m writing about it now because it’s recently come up in a conversation with a well-intentioned friend and despite my attempt at a tactful way of saying, “Actually, no…” I don’t think this person quite understood and it’s been bugging me a bit for the past few days.  Because I am a non-confrontational person, I didn’t escalate it any further because I was off-guard and didn’t quite know how to appropriately argue the point.

In the video Things not to say to an autistic person posted by BBC Three (which I have recently re-shared on social media), the panel of autistic people give their thoughts on this statement (ellipses denote going to another panel member’s thoughts/opinion):

“So we’re taught in school we’ve got five senses. Wrong – we’ve got six. The sixth one being our Theory of Mind, the ability to understand everybody else’s thought processes… You don’t have that instinctive understanding… and we rely on people’s body language and they lie with their body language, and that just makes me angry… So if you have the ability to do that, please don’t ever say you could be a little bit autistic, because it really is… Yeah, just don’t, just stop.”

I have managed to mask my lack of Theory of Mind quite well.  With hindsight, I think I ended up studying Psychology and Social Work because I wanted to understand how people thought and why people behaved the way they do.  Because I had the personality traits of a typical first-born in being a “people-pleaser” and learning from observing and trial-and-error, I learned a set of social skills to be able to appear to anticipate the needs of others based on what I thought I would need in the same situation.  In my email correspondence with Katherine Green after my first two appointments, she read the longest version of my questionnaire responses (because I sent the very long version, an abridged version and a mid-sized one restoring some of the more significant details I had taken out because I felt the abridged one was then too short) and noted that I wrote in everything that I thought was relevant, not really having awareness of what details were more important and which ones were not.  Even with this pointed out to me, looking back through what I sent, I still couldn’t unpick how I could have made it more relevant… This probably extends to my difficulties with job interviews because I know what I think is important, but I don’t know and can’t easily anticipate what it is that the interviewer is looking for in my responses.

I believe that when people say “everyone is a little autistic”, they’re trying to say that we all have certain levels of quirkiness and find certain things easier or more difficult than others, but ultimately, that’s just being human.  It then makes those who are autistic feel dismissed and their autism not being that big of a deal.  I came across a post on this topic by another blogger and thought these few sentences illustrate it much better than I feel like I am at this precise moment:

The only way I know to communicate how dismissive it is to say something like “we are all a little autistic” is to shift the whole idea into the context of some other disabilities:

“Sometimes I am looking for something and it’s right in front of me and I just kept missing it even when I was looking right at it. We’re all a little Blind, aren’t we?”

…When you use someone else’s disability as an adjective for your quirks or otherwise reduce it to a one-dimensional descriptor, you are making light of their entire life. And when you say everyone is a little bit autistic, you are trivializing what it actually means to be Autistic. ~ Unstrange Mind

So, while I recognise that I’m still coming to grips with this new aspect of my personal identity, this is one subject that I felt needed addressing separately.  For more on this, please do check out Unstrange Mind’s post (link above in quote box) because they explain it far more articulately than I can.

Invigorated!!

Funny how much difference a few days (and an undoubtedly life-changing diagnosis) can make to one’s humdrum life.

Last night, I spent more time sorting out this blog and my new Facebook page in one sitting than probably the last two months combined. I didn’t get to bed until after Paul got home from his gig, despite me saying to him that I’d likely be zonked out asleep before he got home… So imagine his surprise to see me still awake at 01:30!!

And even during the night, I was having all sorts of happy dreams about making positive connections within this community with women who I’ve silently been admiring from the sidelines, too scared to reach out to until I had my official diagnosis (for fear of rejection – see my last blog here). And I woke up feeling happy for the first time in a very, very long time. I can’t remember the last time I woke up feeling this unburdened… I am starting to think I’ve never felt this way before (without trying to sound too full of myself).  You can certainly expect more writing from me now that I have emerged from this dark cloud of uncertainty and am now standing in the glorious sunshine of confirmation and validation.

And even looking through my news feed on Facebook (as I was waiting for Paul to awaken), I came across an amazing blog post written earlier today that I could have written myself verbatim, even down to the “growing up in a very small country town” and using the phrase I have been using for the past year and a bit – “this is my truth”. I feel overjoyed to connect with these like-minded Aspie women… I feel like I belong.

This is my truth, my perspective. My life. Your story might be completely different and that is okay! We are all different with the same Autistic core. I’m sure I will have days where I hate my Autism, I will fall back into the trap of being miserable about my past I cannot change – this is realistic. Today, however, I’m simply just glad I know now.

Source: The power of diagnosis as an adult.

1 year, 1 month and 24 days later…

…I walk into the clinic’s group room with my dad, my husband and meet the psychiatrist and the speech & language therapist (from my first two appointments).  The time is 10:00am.  We break the ice talking about tea before getting down to business.  We talk… a lot.  I cry… a fair bit.  My dad speaks… I speak… Paul doesn’t say too much, but what he says is helpful and relevant.  Hours pass.  Around 13:30 (at an estimate, because I wasn’t actively looking at my watch), the psychiatrist said that she was still unsure about me.  She felt that we had to address “the elephant in the room” before proceeding with the discussion about whether I am autistic or not – the underlying and apparent feelings of rejection I possess which run very deep.

The rejection primarily stems from my mother, which really is unsurprising; it’s just that I’ve just not had it reflected back to me in that way before.  I could sense the shift in her attention from the age of four and a half when my brother was born.  I could sense that she didn’t want me “in the way” when my brother was having his speech therapy sessions (with her best friend) and his occupational therapy sessions (because he had balance & coordination difficulties).  I could sense her pushing me away after I reconciled with my dad because I didn’t tell her straight away in case we fell out again (despite it being none of her business) because she thought we were conspiring against her somehow (ridiculous, I know).  I knew she had “wiped her hands clean of me” on 13th July 2008 when the last phone call I had with her concluded with her saying, “Have a nice life” before hanging up the phone to me indefinitely (still haven’t spoken with her since).

The second stem of rejection came around the end of high school.  I don’t think I could cope with the prospect of my school routine being thrown completely into turmoil by graduating and going to university.  I think I felt like my circle of friends were more ready to move on than I was.  I am obviously looking back on events that occurred over 14 years ago, so I can only guess what I was actually feeling at the time because a) I can’t completely remember and b) I don’t think I even knew at that time.  In order to feel some semblance of control, I felt like I needed to distance myself from my friends, completely cutting myself off from them.  I did not attend anyone’s graduation party and I did not have one of my own.  When my friends came round to try to talk to me to find out what was wrong, I refused to go out and speak to them.  I didn’t know what to say or how to face them.  I was hurting, I was embarrassed, I was confused.  I wanted to apologise but I didn’t know how or what to say.

The third stem of rejection was losing my job just after returning from our honeymoon.  In brief, I interviewed for a career enhancing position with an independent fostering agency after I had about three years of experience as a Local Authority social worker.  They briefly threw the word “recruitment” (of new foster carers) into the interview, and because I wanted the job, I said that I’d be open to learning about how to do it.  After I started, it became apparent that despite my job title officially being “Supervising Social Worker” my actual role was to go out and recruit my own caseload of new foster carers.  For someone without additional (and at the time unknown) difficulties, this would seem a steep request.  Counting from the day I started (1st December 2011) to the day they fired me (15th February 2012), a week and a half after I returned from getting married and having our honeymoon (15 working days off), I had actually worked for them for 36 actual days.  How in the hell was I supposed to recruit ten new sets of foster carers in 36 working days where the Christmas period was smack in the middle of it all??  I think it boiled down to a personality conflict with my line manager, who was on one day nice as anything, and the next day could be extremely unapproachable.  I didn’t like her approach and she didn’t give me any sort of actual support in doing the recruitment, even after I asked for help because she expected me to “use my initiative” but that’s very hard to do when you don’t even know where to start.  I’d spend 8 hours sat behind a table with leaflets on it and a pull-out standing poster behind me in a supermarket foyer, hoping somebody would come and talk to me (as I could not badger customers coming in or going out of the store).  It was hell.  It was demeaning.  It was embarrassing.  I’m glad I didn’t end up being there very long, but I’m painfully embarrassed to the pit of my stomach about being fired from there.  I had never failed at anything so severely before in my life and I wanted to die.  I was miserable for weeks and struggled to find long-term work after that.  After several short stint jobs (teaching assistant, outreach worker, SEN Casework Officer for three months), I finally landed the fixed-term contract with the authority just south of where I live and was there for ten months before landing the post I’ve been in for two years (as of the 1st of August).  I don’t talk about this period of my life much because it caused me so much turmoil and grief.  Not long after losing that job, Paul and I were faced with having to move out of the annexe and move into the house Paul grew up in, with his mother.  The plan had always been for this house to eventually become ours, but we were newly married, I was newly unemployed and had been faced with the biggest rejection I had personally felt in my young adult life.  While one could argue that the rejection from my mother would be more hurtful, she had been gradually rejecting me throughout my life, whereas the job rejection was far more personal and felt much more traumatic.  I think this experience has also reinforced my feelings of being unable to work at a higher level where I’d be managing people… I could not bear the responsibility of causing anyone else that kind of pain.

The psychiatrist said she would not be doing her job properly if she did not address this with me, which I understood and thanked her for because this will ultimately help me be more mindful and recognise things more readily when I find myself feeling down.  Thankfully, she explained how she didn’t think the rejection exclusively explained all my other difficulties.  The other element that stumped them was my ability to read and anticipate from others’ facial expressions, body language, and vocal tones.  I explained that I did train in graduate school to be a social worker who did counselling, as well as studying psychology in undergrad, so it’s hard to say if this is a natural ability or if I have just learned and retained this because of my level of intelligence.

They both said that having read through my information (the many, many pages of it) and speaking with me, there were definite moments where they felt it was clear that I was autistic, but then I’d do something unexpected and sway them back to thinking I wasn’t.  They explained how they have seen many women over time, some blatantly obvious and others who have learned how to mask and cope so well, and that I’m probably at the highest functioning end that they’ve seen – they joked that they’ll need time in a dark room to recuperate from this diagnostic process!! – but that they felt that it would be beneficial for me and my mental health to have a diagnosis at this time, and that if in the future (whether it be the upcoming weeks, months or years) I chose to not disclose it to people or not recognise it in myself anymore, then that would be my choice.  However, I don’t think that is likely to happen, considering that since I had my “moment of clarity” at the Birmingham Autism Show on the 19th of July 2015, I’ve gone through 420 days (or 1 year, 1 month and 24 days) of wondering and seeking validation… and at 14:30 yesterday afternoon, I walked out of that clinic with a smile on my face and a feeling like a massive weight had been lifted off my shoulders.  I walked out into the sunshine with the diagnosis of autism that I had been hoping for.  I feel like while the journey to validation has come to an end, my new journey has just begun: to continue sharing my story, to continue sharing information, to continue adding more to the collective voice of women around the world with autism who may not yet know it or do know it and need help being believed.  We all know our own truths.  This is my truth… tell me yours.

One Hurdle Overcome… One More Left?

Okay so I know I’ve been off the radar again for a little while, so thank you to those of you still hanging in here with me.

Since I last posted about the Autism Shows I attended, I’ve kinda gone into self-preservation mode… working in Special Educational Needs, the end of an academic year is always a trying and manic period of time with schools and parents rushing to get things sorted out for September and us caseworkers get caught in the crossfire.  Whilst I was exceptionally pleased to have had places in special schools obtained for not one but two of my cases (when it was looking unlikely due to lack of spaces), I was finding that my sensory differences were getting the better of me in the office the more stressed and anxious I was feeling.  I have been effectively wearing my sunglasses almost nonstop whilst in the office (only lifting them to the top of my head to speak to a colleague so I could focus better) as well as my iPod (because the noise created in an open-plan office is enough to drive me batty).

I emailed the Autism Assessment Team again on the 5th of July about what kind of time frame I was facing in relation to the Occupational Therapist referral, as I was starting to feel even more acutely anxious about everything.  I reiterated my sensory issues in the office and also wrote the following:

I am so sorely disappointed with everything to do with this diagnostic journey and I had certainly hoped that this would have been resolved already. I simply do not have the financial ability to pay for a private assessment and feel like I’m being treated as a hysterical woman that should not be reacting to things the way I am…  I feel like I’m being punished because I have learned and adapted ‘so well’ over my life thus far because I had no choice but to do so; just because someone has learned to cope does not mean that they don’t experience difficulties at all.

I reiterate again that “the woman in the questionnaire” was the honest and true me… I am experiencing such levels of traumatic despair at the fact that I am not being believed and I do not feel like this is being taken into consideration. I don’t want to go to my GP, break down and get signed off work because all of this being too much for me to deal with, but I almost feel like I have no choice but to do this, even though it won’t make things any better on the work front because the work will still be there, along with everything else!!

I need to know:
a) that the referral to the Occupational Therapist has been made
b) that the appointment will allow full exploration of my sensory differences and strategies to mitigate the stress and anxiety that they cause me
c) what the time frame is for me to be seen because this particular unknown is unbearable

Speaking to my dad about this all, he believes me and agrees that I may very well be autistic and he was astonished that no one from the service contacted him to discuss his questionnaire. I was given the impression that there was nothing of significance in his questionnaire to highlight things that may point to a positive diagnosis; he explained to me that he spent a lot of time on his questionnaire and had fully expected someone to contact him in some way to discuss things further. As such, he will be attending the appointment on the 11th with me and my husband Paul.

Having been to the Autism Shows both in London and Birmingham a few weeks ago has further validated me and given me more fire to pursue this diagnosis. It is very apparent that the further away one lives from London, the harder it is for females to be diagnosed as autistic. If anything, it’s a shame that I attended my appointments prior to attending the Autism Show, because I have come away armed with far more information than I had previously and several well-respected professionals in the field agree that the diagnostic criteria used is based on the young male presentation of Autism and does not take gender variations into consideration, least of all the cultural differences with me being born and raised in America (because I speak perfectly understandable English, I think this element was not taken into consideration at all, as per my letter of the 13th of June).

My mental health should not be suffering as much as it is because of all of this.

Thankfully, I received a response from the OT (I’ll call her Emily) the next day (as I had sent my email outside of office hours).  She said that she was fully booked until late September/early October, but asked if I would be happy to take up any cancellation appointments should they become available.  She also briefly explained what the appointments would entail and that a written report would be provided afterwards.

I wrote back saying that I would be glad to take any cancellation appointments, but that just knowing that it would be late summer/early autumn was extremely helpful; it allowed me to “park” my anxiety so to speak, as there was no point in me staying angsty about it.

Fast forward to Monday the 25th July.  I received an email from Emily saying that a cancellation had come up on Wednesday the 27th July in the afternoon.  I responded straight away saying that I would accept the appointment.

Going back to the same clinic building where I had left so upset and (without wanting to sound too dramatic) a bit traumatised, my anxiety was rapidly climbing upwards, despite me actually feeling relieved that I was finally on my way with the OT component of my diagnostic journey.  I explained this when we got into the room and Emily suggested I try a few assistive items, including rolling balls with rounded-tip spikes on my thighs (where deep pressure receptors are high in concentration – it felt nice on my thighs but not on my hands), weighted lap pads (2kg each – which didn’t do much) and a weighted blanket (7kg – I really liked this one, despite the warm weather on the day).  Emily advised that I only keep the weighted blanket on for about 15-20 minutes and that the effects should last for about an hour or two.  We spoke for a bit, me answering open-ended questions about my sensory sensitivities and sensory-seeking tactics, and after what only seemed like a few minutes, Emily suggested that I take the blanket off… I was absolutely amazed at how calm I felt because it happened completely subconsciously.  When we finished the open-ended questions, we went on to the Adult Sensory Profile questionnaire (Based on the intersection of two continua [neurological threshold and behavioral response/self-regulation], this model describes quadrants identified as Low Registration, Sensation Seeking, Sensory Sensitivity, and Sensation Avoiding), ranking my sensory experiences from 5% or less of the time, 25% of the time, 50% of the time, 75% of the time, or 95% or more of the time (there were word associations with each ranking that I can’t remember but the numbers helped me personally be able to rank myself with each question).  When we were done with the questionnaire, we scheduled a follow-up appointment the next week to discuss the outcome of the questionnaire, how sensory processing works and strategies to help me moderate my sensory differences (because there’s no “cure” for it, just management, which I understood).

Fast forward again to Thursday the 4th August – my second appointment.  I was given the validation that I do experience some sensory differences which are made more apparent/acute depending on my mood (i.e. the more stressed I am, the more sensory sensitive/sensation avoidant I become), which made sense.  We talked through the report and strategies and how the body processes sensory information and where we ideally would like to be in a middle ground between agitated (extreme high end) and lethargic (extreme low end).  Emily also provided me with a list of suggestions for the workplace, because it was clearly identified that I was able to cope in office spaces before but that this particular office space (since we moved to it in October 2015) has been progressively having an impact on my mental well-being the more my sensory differences have been agitated.  I was grateful for the list of strategies/suggestions given and looked forward to discussing them with my manager the next day [side note: chatting about it with my manager was so positive; I sent her an email summary of our discussion which she is going to send to HR to see what can be done to help me out – will update when things happen!].  The suggestions for modulating my sensory differences were quite extensive, many of which I do to some degree already, and I will actively try to put these strategies to use and hopefully improve things for myself.

I left still preoccupied about my third appointment with the psychiatrist next week on the 11th with my Dad & Paul… she said that the appointment should help, regardless of the outcome.  I said again how I’ve been waiting a very long time and in that time have constructed this identity around being an autistic woman, which felt shattered to pieces after the second appointment.  Emily was sort of hinting at how a label of autism could sometimes be more detrimental than helpful and that I should think if it could be anything else…

One of the questions in the first appointment was if I had experienced any abuse in my life, which I flatly replied, “no.”  When Emily asked again in the second appointment if I had experienced any sort of abuse or trauma, and I made the throwaway comment that my mother cutting me off eight years ago probably wasn’t great and that through this process I’ve begun to wonder if she too is autistic… it was then that Emily said I should think if it could be anything else.

I had a 25-minute drive home ahead of me, and when I was sat in a queue of traffic trying to make it onto a main road near a very busy roundabout, a little gremlin popped out of a dark corner of my brain… something that had come up both when I was working as a social worker and in SEN… attachment disorder can present with a lot of the same characteristics as autism.  My heart sank.  Could all of this be attachment issues??  Does my mother have attachment issues which permeated her parenting??  It became far too much to bear.  I got home and was hardly able to speak.  I handed Paul the report and the workplace suggestions and sat silently on the sofa with the TV off.  Paul read the report and thought it all looked really positive, so was naturally confused as to why I seemed so out-of-sorts.  When I briefly explained, he didn’t know what to say.  I turned to my phone and sent a message to my fellow American expat Katherine (mentioned in Birmingham Autism Show) because if anyone I knew would know anything about this, it would be her.

I have to leave it there for now… more very soon. xx

Birmingham Autism Show

Another helpful day of information gathering to bolster my case for diagnosis.

The sessions today were different from the ones I attended last week in London… well, with one exception.

I finally got to look at the artwork from Willard Wigan – seeing is believing!!  Seeing all the photos in his slideshow last week were incredible, but to see the needle underneath the high-powered microscope on its own and then looking through to see it with your own eyes… it was amazing.  I actually sat in on his talk again at the end of the day because I enjoyed it so much!!

The first session was Allies to the Neurodiversity Movement… the speaker was a transgender woman and while she had a lot to say and was very passionate about it, though I couldn’t help but notice several spelling and grammar errors in the PowerPoint presentation, which detracted from the full impact for me.  She also made some quite controversial remarks (particularly one around the Holocaust which I don’t want to repeat) which made me feel a bit uncomfortable.

The next talk was by Dr. Glenys Jones, psychologist and researcher in the Autism Centre for Education & Research (ACER) at the University of Birmingham, talking about Autism Through the Lifespan.  Quite informative, highlighted again the difficulties of obtaining a diagnosis in adulthood, especially for women.

The next talk was the lovely woman I befriended at last year’s Autism Show in Birmingham, speaker and fellow expat Katherine Green (her own blog is at Wishing on Jupiter).  The subject of her talk was Autistic Girls and Romantic Attachments – a subject I related to very well!! 🙂  I have always had a quite intense attraction to boys with certain characteristics… one of them even married me. 😉  I always had a sense that my intense feelings were probably greater than other girls my age, but I always kept it quite private and didn’t go about talking incessantly about boys I thought were cute, even though I could very easily have if given the opportunity.

After her talk, we went off to have a bite to eat and a catch-up for about 45 minutes, which was absolutely lovely.  Both of us were blown away by the result of the EU Referendum vote and chatted about that and other miscellaneous things.

The next talk was Women & Girls with Autism by Dr. Elisabeth Hurley from Autism West Midlands.  It was quite interesting to hear that genetics may have an explanation as to why girls may not present as severely with Autism than males – because of the second X chromosome perhaps being ‘protective’ in some way.  She also appeared to have full confidence in how sociability does not mean that a girl does not have Autism – all down to GENDER SOCIALISATION, a topic that I wrote about a fair amount when I was a graduate student.  It always angered me how social standards were so high for girls… I never wished I was a boy, but I wished it was more balanced.  She has edited a book called Ultraviolet Voices, comprised of personal stories from women on the spectrum, and co-wrote one called The Good & Bad Science of Autism, both of which I’m looking forward to reading.

I ended up missing the BBC Neurodiversity Project talk as I ended up speaking with a woman who was listening in the previous session and heard my question about improving diagnostic processes for women, after briefly outlining the uphill struggle that I’m having.  She had a few suggestions, all of which I have already exhausted, but we ended up chatting for so long that the entire session ran through!  We both sat down together to hear Willow Holloway speak about The Autistic Women’s Empowerment Project, which was another positive session; however, she was having difficulties with her PowerPoint presentation, jumping ahead and back on slides several times which was quite distracting and made the talk hard to follow in places.

When that talk was done, I went back to the Autism Matters Theatre to hear Willard Wigan speak again. 🙂

I think I will be doing the two shows again next year because it was great to get to see so many different speakers and to learn so much about Autism and other people’s experiences, especially those of other women.

Mulling it over…

I have written a letter which I intend to email to the ASC Diagnostic Team tomorrow for the attention of the Speech & Language Therapist and Clinical Psychologist I saw. The majority of it is below, modified for clarity in the context of this blog:

I feel that perhaps enough wasn’t taken seriously or discussed with me in depth from my written questionnaire; you both said that “the person in the room was different from the person in the questionnaire”. I think this is because I have had to “put this mask on so much that it has become my face” and that my most truthful self is the one written about in my questionnaire; it’s too painful for me to reveal that person in a room with complete strangers, though perhaps it would have been better to do so because of the outcome of the two appointments.

I feel that I was discredited because I’m too sociable. I feel that, despite my indicating early on in the first session that my American-ness may work against me here, this was disregarded. Also, being the firstborn in my family could also be an indicator as to why I am outgoing, but being outgoing is not a contra-indicator of ASC; being outgoing is a big feature of being from America – if we don’t take initiative and present as “confident”, we’re classified as “weird”. In England, one is allowed to be quiet and more reserved. I don’t believe that the reality of how I was taught to be was fully taken into account, and certainly, my more ASC-type traits did not come out in just seven hours of observation.

Watch Jennifer Cook O’Toole on YouTube (https://www.youtube.com/user/AsperkidsVideos) – remind you of anyone? She is a well-known writer with ASC and is very American and outgoing, and probably would have been undiagnosed in the UK.

I have related my experience to a fellow female expat who is a writer and public speaker with ASC (I will refer to her as G); I have been chatting with her periodically online since meeting at the Autism Show in Birmingham last summer. She indicated that I may need a longer than average assessment and this would be in keeping with the Equality Act of 2010, which would argue that reasonable adjustments need to be made so that I am not inadvertently discriminated against because I am from a different culture. She said a longer assessment would be totally reasonable to ask for as 50% of the diagnosis rests on how I interact socially and I’m from another country where social interaction is reinforced differently (remember that I was 23 when I moved to the UK, so beyond my formative years). This is especially true if your service is considering denying the diagnosis based on my social presentation. As you know, women with ASC are good at hiding their traits, and American women will be exceptionally good at hiding them. G’s first diagnostic appointment resulted in her being told that she did not have ASC, but following further appointments for a second opinion, she was eventually diagnosed. I did not think that I would have to go through the same uphill struggle that she has; she is also the one who shared the YouTube link above.

Not much was discussed regarding how I felt about being on the periphery of my social group at school, despite me explaining how traumatic it was finishing high school and just completely obliterating my relationships; that is not typical behaviour, especially since I couldn’t identify a particular incident or altercation which caused it. G also read the extended version of my questionnaire and said the following (this was via email communication):

You mentioned feeling like you were on the periphery of your social group at school.  You mentioned being bullied and taking times away from people.  There was some detail but try to dig out more. It may be hard to do with you not being able to recognise and retell the specifics of what transpired or what went wrong. It’s hard to know at which moment you were “being weird” if you don’t know when you’re “being weird”.

A person on the spectrum would be bad at explaining exactly when they “got it wrong” socially, why they didn’t click with the group as well as others. I imagine this is the most difficult part for you to dissect, but this also is the part that your “outgoing” personality masks the most.  They aren’t seeing the social disconnect in the room, so you need to dissect past social exchanges and explain where it has happened.

It’s hard for me to recall back this far, as the high school fallout occurred 12 years ago and my memory is patchy at best. The only things I seem to recall in clear detail are things that had very strong emotions attached, usually of guilt or shame, which I have worked hard to cast from my mind because they are so debilitating. When I think about finishing high school, I can only remember feeling very anxious, uncertain and out of control. I think I cast away my friendships from the past 4-7 years [middle school into high school] at that point because that gave me some semblance of control, despite it completely isolating me between graduation and starting afresh at university in the dorms. I did very little that summer break because all my friends must have grown weary of trying to engage me and dealing with my flat-out refusal. Like I indicated on my questionnaire, I’ve “virtually reconnected” with most of these friends, but we have not spoken of what occurred at the end of high school, and while they are on my Facebook friends list, we do not talk like friends do. We may exchange birthday greetings, but that’s about it – how much more superficial can this be?? We have reconnected as “someone that I used to know” but that’s about it. Does that help?? Just because I appeared on the surface to get along with them all fine in my early years, doesn’t what happened in adolescence obscure that somewhat?

G also indicated that I wrote a lot about rigidity and a need for sameness and routine in my life in ways that have nothing to do with my sensory issues, and she said, “I don’t know how anyone can dismiss these.”

She indicated certain points from my questionnaire under Current Difficulties which jumped out at her:

  • needing sameness when living with Paul’s mother
  • I hate answering the phone, especially at work
  • I struggle being in overcrowded spaces where personal space can be an issue, especially any store which becomes crowded with shoppers prompts me to leave
  • social blindness when out in public
  • group conversations, especially being interrupted and unable to finish my thought or story – present in childhood and adulthood.
  • I can understand sarcasm, but only when context is given
  • perfectionism, which I had always attributed to being a “typical first born”, which can explain why I am so outgoing
  • as a child, I was very particular about keeping my toys in order and in pristine condition; my dad’s questionnaire probably didn’t say anything about this and he would probably have put it down to having taught me to respect my belongings… it was much more than that.
  • I preferred playing alone a lot of the time and didn’t regularly have friends over; I also did not (and still do not) initiating interactions and prefer someone else taking the lead and joining in when appropriate. I do not feel confident in initiating but will only do so when no one else will because I’m frustrated and want to get on with whatever the task is because I can’t take the awkward silence anymore.
  • you had me talk in detail about the bullying that I endured; I thought surely this would have mattered more strongly – again, just because my dad didn’t pick up on it does not mean it didn’t happen; I was quite private and didn’t tell my parents everything or would just tell them things were fine
  • particular about colour-coding things, especially in a ‘rainbow’ order
  • need for symmetry and matching
  • borderline ritualistic about numbers – I even described how Paul’s and my wedding date was “pleasant” – no one else I know has done that
  • resorting to putting on the same movies or TV series that I’ve seen multiple times to have on in the background – I can’t even begin to guess how many times I’ve watched and re-watched Daria on my Amazon Fire TV box or on my Fire Tablet when getting ready (for work or going out)
  • parking space at work and parking near an edge so I can find my car again
  • gauging the speed of fast-moving objects
  • handwriting and drawing – having an awkward grip and not ever being picked up on for it
  • problems with hormonal birth control – although others might not register this, but she agrees this demonstrates a fragile chemistry and I felt was quite compelling

G also attached some PowerPoint slides called Missed Diagnosis or Misdiagnosis? Girls and Women in the Autism Spectrum from Dr Judith Gould, Director of the NAS Lorna Wing Centre for Autism. I will attach it with this letter but I am going to highlight some of the stronger points here:

  • Historically there has been a strong gender bias of more males than females; as a result, professionals are less likely to diagnose girls/women even when symptoms and behaviours are evident
  • Asperger (1944) suggested autistic traits in females become evident only after puberty
    • My dad moved out of the family home when I was 13 years old and only saw me once every two weeks for several years, so he would not have necessarily noticed these traits and would assume my stroppiness whenever he came to visit was because of being a teenager rather than anything else presenting differently to my peers. I would agree that difficulties became more present after moving up through middle school into high school, culminating in the friendship breakdown at the end of my senior year of high school.
  • There is still a strong gender bias towards diagnosing boys (linked with descriptions in the International Classification Systems)
  • Social Interaction
    • Girls more able to follow social actions by delayed imitation; they observe children and copy them – masks symptoms
    • They are on the periphery of social activities [which I highlighted]
    • Girls more aware and feel a need to interact socially
    • When involved in social play are often led by peers rather than initiating contact [I agree with this – I rarely initiate because I don’t feel confident enough to do so.]
    • Girls more socially immature and passive than typically developing peers
    • In primary school more likely to be ‘mothered’ by other girls but bullied in secondary school [YES to the second part for sure; I can’t remember being ‘mothered’ in elementary school.]
  • Social Communication
    • Little difference in acquiring speech in girls and boys
    • Girls generally have superior linguistic abilities to boys of a similar cognitive level
    • In society, girls are expected to be social in their communication but they do not “do social chit-chat or make meaningless comments to facilitate social communication” [when I do make social chit-chat, it’s to quell the awkward feelings when not much is being said… that’s more unbearable for me than sitting in complete silence when there’s a lull in the conversation.]
  • Social Imagination
    • When involved in solitary doll play, they have a ‘script’ and may reproduce a real event or a scene from a book or film [I vaguely recall playing with my Barbies with an almost soap opera-like script, as when I was at home with my mother, she would regularly watch The Young & The Restless.]
    • There is a lack of reciprocity in their social play and can be controlling or domineering [I would get cross if my little brother wasn’t playing the way I wanted him to, which would lead to him and I bickering and fighting, which was probably minimised to sibling interaction.]
  • Special Interests and Routines
    • The male stereotype of autism has clouded the issue of diagnosis
    • Girls are more passive and collect information on people rather than things
    • The interests of girls in the spectrum are similar to those of other girls
    • Perfectionism is frequently seen in girls [Ding! Ding! Ding!]
    • It is not the special interests that differentiate them from their peers but it is the quality and intensity of these interests [I minimised the intensity of my areas of interests in the appointments because I have enough social wherewithal to know when it is and is not appropriate to talk about them in great detail, but that doesn’t mean that they are not there. Again, something not touched on much in my two appointments.]
  • The Diagnostic Criteria
    • The current systems do not give examples of types of difficulties shown in girls
    • There is a need for a wider perspective regarding social, communication and imaginative dimensions in addition to special interests and rigidity of behaviour
    • There is a need to ask the right questions and make appropriate observations
    • Over- and under-reaction to sensory input is an important feature for all on the autism spectrum and is common in females
  • The Importance of Diagnosis
    • A diagnosis is the starting point in providing appropriate support
    • A timely diagnosis can avoid the difficulties women experience throughout their lives
    • Diagnosis can lead to assessment of needs in employment (amongst other areas)
  • Dale Yaull-Smith, NAS Communication, 2008 – “The fact that girls with undiagnosed autism are painstakingly copying some behaviour is not being picked up on and therefore any social and communication problems they may be having are also overlooked. This effort of mimicking and repressing their autistic behaviour is exhausting, perhaps resulting in the high statistics of women with mental health problems.”

I don’t dispute that there may be an element of Sensory Processing Disorder on my part and look forward to meeting with the Occupational Therapist to discuss this further. I have also purchased Too Loud, Too Bright, Too Fast, Too Tight to investigate things further (like I have done with Aspergirls and the other ASC books I have read) in the meantime whilst I’m awaiting the appointment to be made. However, I still feel that my diagnostic process was too short and inconclusive. I’ve been doing my best to keep myself back from the edge of completely shutting down and being signed off work until this is resolved, mostly because I cannot afford to be off work long-term and I know myself enough that if I were to cave in and stay at home in bed, it will be infinitely harder to pull myself out of that funk and get back into work than just persevering with it, no matter how much it emotionally drains me.

You want to see the real me? Please read between the lines of my questionnaire again. Read between the lines of this letter. Yet again in my life, I feel like I’ve been misunderstood and it hurts me to my core that I have to practically beg for this to be understood. The thought of going into work today and facing people was too much to bear, so I’m working from home. I feel like raw nerve endings – on edge, anxious, unsettled, unsoothed – even a nice shower didn’t alleviate my anxiety this morning. Is this what you needed to see? This is the person that is in the questionnaire; I’m sorry you didn’t get to see her in those two short appointments, but considering that I’ve had 31 years of adapting my behaviour to appear “normal”, I think it takes a bit more than six hours to get to see her, especially since she knows how to behave in a clinical setting.