The AQ-Test on Facebook

Even though I haven’t seen it on Facebook myself, I heard from several sources that the Autism Spectrum Quotient test (AQ-test) is now there inbetween quizzes such as “Which Spongebob character are you?” and “What color should you due your hair?”. The AQ-test, developed by Simon Baron-Cohen, is used as a screening instrument in the diagnosis of autism spectrum disorders.

It doesn’t really surprise me that this test made it to Facebook. It’s been online on several sites since at least 2003, when I first took it and scored 43.

In fact, it suprises me more that this test is apparently psychometrically valid enough to be used as an autism screening tool. In my opinion, it measures how much you want to be on the autism spectrum: when, in 2006, I wanted to prove how tests you find on the Internet are not reliable, I took it again and scored 22 – just barely more than the average NT.

The fact that the AQ-test made it to the world’s most popular social network, does prove how popular autism is. This is not surprising, since it has been “in” for at least ten years. Autism is a popular catch-all diagnosis for children who do not quite fit in as well as serial killers. People call politicians who don’t listen to the people – essentially all politicians when it’s not election time – “autistics”. In short, autism is a popular term for anyone who isn’t quite acceptable. Which is ableist and psychophobic. But autism is also the diagnosis du jour for geniuses, which is also ableist, since it turns real autistics into stereotypes.

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PTSD in People with Intellectual Disabilities

When searching for studies on post-traumatic symptoms, I came across an interesting paper on PTSD among individuals with an intellectual disability (ID. This study is the first systematic review of prevalence, assessment and treatment of PTSD in people with ID.

There are several reasons why people with intellectual disabilities are more susceptible to PTSD than the general population. Firstly, they are more likely to experience traumatic events, such as sexual or physical abuse. They are also more likely to experience negative life events, such as serious illness or injury. Secondly, higher intelligence is associated with better ability to avoid traumatization and to cope with its consequences. Therefore, people with ID may have a lower threshold for PTSD. Thirdly, people with ID are more likely to experience early separations from primary caregivers, hence putting them even more at risk of traumatization. Lastly, the recognition of oneself as disabled may be traumatizing to some individuals. For these reasons, there is an elevated rate of PTSD among people with ID. The literature review found four articles discussing prevalence of PTSD among those with ID. However, all studies were conducted on people referred for treatment who had gone through at least one traumatic event. Studies based on a large, heterogenous sample were lacking. Prevalence rates of PTSD varied from 5% – the prevalence among the general population -, to 60%.

Assessment of PTSD is difficult among individuals with ID, because these people tend to display different symptoms from people with normal intelligence. The Diagnostic Manual-Intellectual Disability (DM-ID, 2007), which is an adaptation of the DSM for assessing individuals with ID, has adapted PTSD criteria for people with mild to moderate ID on the one hand and severe or profound ID on the other. There are also some good instruments for measuring anxiety among people with ID, but these are not specific for PTSD.

The assessment of the traumatic event itself poses problems, as caregivers are not generally aware of a person’s trauma history or may not recognize traumatic events. Furthermore, what may not be traumatic to the average person – for example, a move arranged by others -, may be traumatic to someone with an intellectual disability.

Several treatments are recommended for PTSD in individuals with ID, but the evidence base is small. Firstly, a thorough medical evaluation is recommended, because of the high comorbidity with medical disorders. Psychopharmacology is discussed, but specific research on medication intervention for this population, is absent.

The second treatment approach focuses on changing the environment to eliminate frightening cues. Training and support of caregivers to teach them appropriate responses to PTSD symptoms, is also mentioned. This is particularly relevant for those with lower levels of intelligence.

Lastly, psychotherapy can be useful for the treatment of PTSD. There is clinical support for the use of cognitive-behavioral therapy (CBT) in people with mild ID. The techniques reported on were exposure therapy and imaginary rehearsal therapy. Two case reports were also found on the use of EMDR for PTSD among individuals with mild ID. In all therapeutic approaches described, modifications were made for the clients’ disabilities.

Reference

Mevissen L., De Jongh A. (2010), PTSD and Its Treatment in People with Intellectual Disabilities: A Review of the Literature. Clinical Psychology Review, 30(3):308-316. DOI: 10.1016/j.cpr.2009.12.005.

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Exploring Dissociation: What Does “Mid-Continuum” Mean?

I identify as mid-continuum multiple. Many readers have commented and E-mailed me asking what “mid-continuum” means. Put simply, mid-continuum – also known as median in the natural multiple community – refers to being inbertween singlet and multiple. It could mean that the insiders are obviously parts of the host. In my case, however, it means that I am almost always present when an insider is out. My insiders are also not as individualized as the people in other multiple systems.

When an insider is out, in my case, almost always I am there to sort of be represented by the insider. That being the case, I can almost always intervene when an insider says something or does something that I feel uncomfortable with. While I cannot stop them from being front, I can interrupt them and make it clear that this was a part.

Some of this likely has to do with co-consciousness, that is, the ability to share information amongst the system members. But apart from that, I also do see the insiders as less “real” than myself. That perception is changing somewhat as I get to know more about the insiders and about multiplicity in general though, so I sometimes don’t use the word “mid-continuum” as explicitly as I used to anymore.

With regard to dissociation, there is also a continuum from being totally in the present to being totally disconnected from one’s surroundings. I fall somewhere in the middle of this continuum, too, in that I often feel unreal, but rarely leave my environment entirely.

The continuums of multiplicity and dissociation may be connected, as they are in my case, but a multiple can also have fully individual system members while never dissociating. This is the case for most natural multiples. Alternatively, someone can be severely depersonalized without having alternate personalities at all.

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Where Are the Autism Severity Criteria?

Harold L. Doherty of Facing Autism in New Brunswick poses the question of what autism severity criteria are being tested in field trials for DSM-V. Indeed, the DSM-V website has, ever since it started posting proposed criteria, including severity criteria for various disorders, told people interested in autim severity to check back soon. That was since February. It’s now October. May we know, after nine months, what criteria will be used?

One proposition I heard of is to use the Social Responsiveness Scale, which measures autistic traits in the general population. I am opposed to this, because it will leave out those at the severe end of the spectrum, and it will focus mostly on social communication. What about non-core symptoms? Another possibility that I speculate about, is that severity will be classified by impairment in social and/or occupational/academic functioning, as is the case in DSM-IV. I like this idea much more, for it will enable diagnosis of the more severely disabled and it focuses on real-life disability. In any case, we don’t know, and, as a curious autistic, I’d like to be informed of how I’m going to be assessed by 2013. Or am I supposed to take a clinical psychology class then to find out?

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Prospective Study Finds Increased Psychopathology among Persons Sexually Abused as Children

When reading the study I’m going to review here, one would almost say “Oh, duh!”: it is logical and common sense that childhood sexual abuse (CSA) leads to psychiatric disorders. What is new about this study, however, is that it is prospective rather than retrospective. The presence of abuse was ascertained using a forensic medical registry. Unlike what the title suggests, not all subjects were followed up after 43 years: all cases of CSA between 1965 and 1995 were collected. Psychiatric pathology was also ascertained using a state registry of public mental health contacts that detailed the persons’ diagnosis. The sexual abuse victims were compared to a sample of the general population.

Sexual abuse victims were over three times more likely to have contact with public mental health than were the general population controls. This held true for both males and females. They were also more likely to suffer from all types of disorders except for eating disorders. The reason there was no significant correlation between CSA and eating disorders, may be that only those treated by the public mental health system were counted. The most significant risk correlation was found for PTSD, alcohol and drug abuse, and personality disorders. Female sexual abuse victims were significantly more likely to suffer from most disorders than controls, while non-psychiatric complaints were more likely to occur in males. Of note is that three sexually abused males had a diagnosis of pedophilia, compared to none in the control group. However, significance could not be calculated.

When comparing diagnoses in childhood versus adulthood, both remained significantly higher among the CSA group. In childhood, PTSD, conduct disorder and known drug abuse were the most significant, while in adulthood, other disorders and known substance abuse were more likely to occur.

When examining abuse characteristics, it was found paradoxically that mental health contact, diagnosis of a clinical disorder, and diagnosis of a personality disorder, were significantly associated with older age at abuse. On the other hand, most clinical disorders were significantly associated with younger age of abuse. I do not understand this paradox, although it was concluded that psychopathology is not associated with younger age at abuse.

Those who were raped rather than victimized to non-penetrative abuse were more likely to have contact with mental health services and be diagnosed with most disorders. Having multiple offenders was also a significant risk factor for mental health contact and diagnosis of psychopathology. However, whether the perpetrator was related or not, was only significantly correlated with psychosis, where people abused by a non-relative were more likely to develop a psychotic disorder.

Reference

Cutajar MC, Mullen PE, Ogloff JRP, Thomas SD, Wells DL, Spataro J (in press), Psychopathology in a Large Cohort of Sexually Abused Children Followed up to 43 Years, Child Abuse & Neglect. Published online: October 2, 2010. DOI: 10.1016/j.chiabu.2010.04.004.

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Family Environment Predicts Outcome in Women Physically Abused as Children

I started reading research articles again. In the most recent issue of Child Abuse & Neglect appeared an interesting article on the variables influencing adult outcome for women who experienced childhood physical abuse (CPA). The authors interviewed 290 women living in a community in the northeastern U.S., who had lived for at least ten years of their childhood in a two-parent home. The two-parent home was chosen to increase homogeneity among the women. For the same reason, all women had to be at least second-generation U.S.-born. Blacks and those with an alcoholic parent were oversampled due to their underrepresentation in community settings. However, there was no significant effect of either of these factors on the presence of abuse.

Of the 290 women, 84 met conservative criteria for CPA. CPA was defined as resulting in at least some injury and not merely used as corporal punishment. I wonder how many CPA cases were missed when women perceived their abuse as punishment. However, since the prevalence of CPA was high compared to other studies rather than low, this is likely not considered interesting. What this did show, according to the authors, is that living in a two-parent household is not a protective factor against CPA.

Severity of abuse was assessed using a seven-point scale that assesed whether abuse occurred at all, whether it occurred at least weekly, whether the mother was the perpetrator or there were multiple perpetrators, whether the abuse lasted for more than one year, and whether injury was severe. When predicting adult outcome, however, severity was not more useful than a dichotomous measure of whether CPA had occurred or not. This is not saying that severity is not important. Rather, they may be the specific dimensions of severity measured that were not significant. This finding needs to be replicated.

Other variables that were assessed where the quality of the family environment and childhood stresses. The quality of a family environment was measured using nine items for each of the following four dimensions: conflict, cohesion, expressiveness, and organization. I could not make out how childhood stresses were measured.

Adult outcomes were measured with a variety of scales, measuring self-esteem, depressed mood, life satisfaction, satisfaction with social support, social adjustment, and the presence or absence of a psychiatric disorder or alcohol problem.

As I said, severity of abuse did not predict adult outcome better than whether abuse occurred at all, so when adding family environment and childhood stress into the model, the authors used the dichotomous measure of CPA. As the authors expected, family environment contributed significantly to adult outcome. Particularly, conflict, cohesion and expressiveness were correlated with all seven measures of mental health. When childhood stress was added as a variable, family environment remained a significant predictor of the women’s outcome. Childhood stress alone was not a significant outcome predictor.

Reference

Griffin ML, Amodeo M (2010), Predicting Long-Term Outcomes for Women Physically Abused in Childhood: Contribution of Abuse Severity versus Family Environment. Child Abuse & Neglect, 34(10):724-733. DOI: 10.1016/j.chiabu.2010.03.005.

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Speak Up on Shutdown

There’s a campaign on November 1 called “Communication Shutdown”. The idea is for people to shut down their Facebook and Twitter for a day as to get an idea of what it is like to have the communication difficulties autistics experience.

I am wary of disability simulations in general, but this one is particularly bad. Online communication is one of the venues by which autistics access contact with the world, so shutting that down would essentially be shutting down the mode of communication most accessible to autistics.

Furthermore, if you really want to get an idea of what it is like to have a communication shutdown, you should stop all communication for a day. Don’t answer when someone asks you a question, because you can’t speak due to overload. Of course since you are not really experiencing overload, you will still not experience what it is like to have an autistic shutdown, but you will come closer than if you just shut down your social networks for a day.

Many autistic bloggers have called onto autistics to speak up on November 1 and raise awareness of what it is really like to be autistic. I will join them, and hope enough NTs will have missed the call to shut down their Twitter or Facebook, so that they will actually hear what I have to say.

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Exploring Dissociation: “Time Shifting”

“Time is not a linear flow, as we think it is, into past, present, and future. Time is an indivisible whole, a great pool in which all events are eternally embodied and still have their meaningful flash of supernormal or extra-sensory perception, and a glimpse of something that happened long ago in our linear time.” – Frank Waters

All parts in the system live both in the present, and refer to some point in the past – the moment they were created or some other moment that is important for them. Every now and then, when a part is active, I get what you might describe as flashbacks, only they don’t necessarily have to be of unpleasant events. I’ve had this experience for at least twelve years and refer to it as “time shifting”.

Time shifting can occur at any moment, but usually there is something that triggered it. For example, some futile detail of the environment may be similar to how it looked back at that moment, and I for a while believe that I am in that past moment. I know, rationally speaking, that it is, say, 2010, but it feels remarkably like, say, 1998.

I don’t know how this relates to regular memories and deja vu, which is a spiritual phenomenon I don’t entirely believe in (but one of my parts does). I hesitate to post this in the “Exploring Dissociation” series, because I’m not certain whether it is at all dissociative, but at least it has some connection to my parts.

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Blog Carnival of Mental Health, Anyone?

It never ceases to amaze me how many active and beautiful mental health blogs are around. That got me thinking already a while ago about a blog carnival of mental health (or mental illness if you want). A blog carnival takes the following:

• An organizer. Being that it’s my idea, I would love to take that job upon me, but if anyone with a bigger blog wants to, that’s fine with me, too.
• Hosts. Every month or quarter or whatever we decide, someone will host a carnival on a specific theme.
• Participants. People will have to submit posts to the carnival that fit the theme. They don’t need to be primarily mental health bloggers, but their post needs to be about mental health.
• Readers, of course.

I was thinking about either a monthly or quarterly carnival, depending on interest. I would be willing to host the first carnival, but I need other mental health bloggers interested in taking over from me. So, if you are interested, please let me know.

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What Is Empowered Multiplicity?

Some so-called empowered mutiples claim empowerment based on the fact that they don’t have a diagnosis, don’t see a therapist, or don’t experience post-traumatic symptoms, or not in a way that limits their functioning. I consider all these assertions ableist and psychophobic. In fact, empowerment can mean pursuing treatment for severe symptoms.

If people have dissociative or post-traumatic symptoms, they don’t choose to have these symptoms. Seeking treatment is then one of the most empowered decisions to make, because people then decide to do something about their symptoms. It is ableist to blame people who for example have daily flashbacks. If they choose to see a therapist multiple times a week, that is up to them, and it may be the only way they can cope with these symptoms. That is empowerment, because empowerment is about taking responsibility for dealing with your condition.

Empowerment is also being on a road to recovery. If you still require trigger warnings, that doesn’t mean you’re not empowered, if you take the responsibility not to seek out places that don’t use triggers. You might eventually, as treatment proceeds, not need triggers as much, but that doesn’t make you inherently more empowered.

Being naturally multiple, or not wanting a DID diagnosis, doesn’t make you more eempowered than those with DID, either. Again, it is about taking responsibility to learn to cope with whatever condition you have. If you are naturally multiple and have always cooperated well, that is great, but it doesn’t mean you’re inherently better than someone with DID who still struggles with communication amongst their alters.

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