Wow, great, I won in the category best autistic spectrum disorder blogger at the Mental Nurse TWIM Awards 2010. Winners are entitled to display a shiney thingy on their blogs, but I don’t know how to do that. So, without shiney thingies, here I acknowledge I have won. Congratulations to all the other winners and runners-up in all the other categories.
Archive for December, 2010
I’m not quite in the mood for studying. However, I thought that, since I’ve been nominated for best autism spectrum blogger in the Mental Nurse TWIM blog awards, I’d better do an autism post for a change. This time, I’m going to review a study on a subject that is dear to my heart: the effects of exiting high school on autism symptomatology and maladaptive behaviors in adolescents and young adults with ASD.
The study authors measured autistic symptoms using mothers’ responses on the Autism Diagnostic Interview-Revised (ADI-R) and maladaptive behaviors using the behavior problems subscale of the Scales of Independent Behavior-Revised (SIB-R), a scale I’ve never heard of so can’t judge. The ADI-R has four subscales – non-verbal communication, verbal communication, repetitive and stereotyped behaviors, and reciprocal social interaction. A symptom was rated as either present or absent, which allowed for a conservative estimate of improvement. On the SIB-R, there are three subscales – internalized behavior, externalized behavior, and asocial behavior -, and in this case, the mothers filling out the scale did rate severity and frequency. Autism symptoms and maladaptive behaviors were assessed at five different times over a ten-year period. For this study, only those who would exit high school during the study period or who were still in high school at the end of the study period (N = 242) were eligible. They were a subgroup of a larger study of 406 autistic adolescents and adults.
The study authors hypothetized that there would be a continuing improvement in symptomatology, but that improvement would slow down after high school exiting. This hypothesis was indeed confirmed. On all autism symptom subscales except for verbal communication, progress slowed or was reversed into a decline after high school exiting. The same goes for the internazed behavior score, but not externalized or asocial behavior.
The authors hypothetize that the reason for the slowed improvement after high school, is the less stimulating adult services as compared to school services. However, they cannot prove this by comparing services, because they did not examine them. I think there are numerous other explanations: ones the authors already mentioned, such as hormonal changes and slowing cognitive development, but also post-high school burn-out from a too stimulating environment.
Unlike what the authors expecting, the slowing in improvement after high school was the greatest among those who did not have an intellectual disability (ID). The authors assume that this is because the services to adults without intellectual disabilities are poorer than those for autistics who do have ID. This is quite possible, since a lot less non-ID autistics have employment or day activities than do autistics with ID.
Family socio-economic status had some influence on trajectories, where autistics living in the lower classes had more change in improvement after exiting high school than did those in the higher classes. This was, however, difficult to prove, because the sample included an overrepresentation of Caucasians and those in the higher socio-economic classes.
The authors recommend that adult day activities and employment programs should be improved to adequately serve autistics, especially those without intellectual disabilities. This is rather an early conclusion, given that services were not examined. However, any improvement to autism services is always welcome, of course.
Taylor J, Seltzer M (2010), Changes in the Autism Behavioral Phenotype During the Transition to Adulthood. Journal of Autism and Developmental Disorders, 40(12):1431-1446. DOI: 10.1007/s10803-010-1005-z.
For most of my life, even when I knew that I was multiple, I didn’t know that I lost time. In fact, I’m still not certain whether I lose enough time to qualify me for a diagnosis of DID. I lose a few minutes to an hour every now and then – it’s never days since I last remembered what was going on. Then again, that is probably a Sybilesque stereotype.
Even when I did know that I forgot important things I’d done, I didn’t usually connect it to the parts. In fact, I still quite often lose time without another part coming front as far as I know. Of course, this could indicate I’m not aware of the switch. For example, Carol is severely autistic and often has meltdowns. Does this mean that she is out everytime I have a meltdown? Of course not, but it is possible that she comes front and has a meltdown, and I’m not aware of it. I’m often not aware of the worst meltdowns, which could indicate I was not there during them, but which doesn’t necessarily indicate that someone else was front.
I also recently found out that time loss is something different from forgetting what goes on with intact time perception, and I have more of the latter. In my case, usually, I’m aware of the passage of time even when I don’t register consciously what goes on. Sometimes, my sense of time is distorted. For example, I vividly remember the sun shining brightly when the police picked me up in my crisis in 2007 – around 8:15 PM on an early November evening. Still, at the time, I was well aware of the passage of time. I, by the way, only forgot part of the crisis, so I don’t even know whether any of this has to do with dissociation at all.
In the proposed DSM-V, dissociative fugue will be removed and replaced by a subtype of dissociative amnesia. The rationale for removing dissociative fugue as a separate disorder, is that amnesia, usually for identity, is a more common feature than traveling away. Besides, the disorder is very rare and therefore does not warrant a category of its own.
There are very few changes to the diagnostic criteria for dissociative amnesia, apart from the adding of the dissociative fugue subtype. There is a minor change to a criterion about the amnesia not being merely due to another mental disorder (eg. PTSD or somatization disorder), which allows comorbidity with other disorders.
For the dissociative fugue subtype, the criteria have been amended to include bewildered wandering as a possible symptom, rather than just purposeful travel away from home or work. Partial amnesia for identity is also sufficient for a diagnosis, rather than the complete adoption of a new identity.
I do not fully understad how dissociative amnesia and its fugue subtype relate to dissociative identity disorder. After all, amnesia is a required feature of DID, and travel or wandering while in a dissociative state, are common. I was unable to understand whether there is a possible comorbidity between dissociative amnesia or fugue and DID or not.
This post could alternatively be titled “Why DID is not real, and neither is brain injury”. W.A. Wagenaar, a well-known Dutch psychologist, has a series of lectures on the topic of legal psychology. In one of them, he discusses repressed memories and multiple personality disorder. He references a study, in which people with DID, non-multiple controls, and people who were told to simulate DID, were compared on an implicit memory test. They were given a set of words to memorize, and then told to change personality for the DID and fake DID groups. Then, they were given another set of words to memorize, which bore some similarity to the previous set of words. Even though the DID and fake DID people reported not remembering the first set of words, this did interfere with them meorizing the second set of words just as much as in the non-multiples.
Wagenaar goes on to say sarcastically that psychiatrists, who usually diagnose DID, have probably never heard of implicit memory tests. They probably have, since they will have gotten neurology in their medical school years.
The thing is, in any form of amnesia, whether psychiatric or neurological in origin, implicity memory is intact (except in a few specific neurological conditions). H.M., the most famous case of brain injury amnesia, had fine implicit memory. Does this indicate that he faked his amnesia? Not in the least.
All that this study indicates, is that memories are not “gone”, but are not accessible to different personalities in DID. Since the same goes for neurologically-caused amnesia, there is just as much indication that DID is fake as there is that amnesia with a neurological cause is fake. Of course, it is possible to simulate amnesia, but the fact that is is possible, does not mean the condition itself is not real.
Switchin is when a person who is multiple changes personality. There may be warning signs to the switch, such as shivering, changes in breathing, or nonepileptic seizures. In our case, sometimes my breathing goes faster, but there is usually no warning sign. Sometimes I don’t notice that I’ve switched until I hear myself saying that I have or find myself using a different name in places that accept this. (We all use the name “Astrid”, except in places or to people that are supportive of the multiplicity.)
Some multiples have distinct physical features between their members. We mostly don’t as far as I can tell. Sometimes, the voice changes – Milou, for example, has a slight stutter -, but not much else. For this reason, most people cannot tell who is out.
Switching can happen rapidly or it can happen slowly. When it happens rapidly, it’s like having rapidly cycling moods and attitudes, which can be greatly confusing. When I switch at a slower pace, I can usually tell that someone else is near the front and wants to come out. That way, I have some warning that I’m going to switch.
Welcome to the first Blog Carnival of Mental Health. I’m a day late, but I’m going to share with you an interesting if small collection of posts. I must say that it’s rather ironic that I’m hosting a carnival on the theme of diagnosis barely a week after receiving a new diagnosis myself. Anyway, enjoy!
The next Blog Carnival of Mental Health will be hosted by CBTish. I haven’t yet received a theme, but will let you know as soon as I find out.
ETA: CBTish E-mailed me to let me know the theme for the December blog carnival will be “night”.