Asperger Syndrome: Diagnosis

by Michael McCroskery

 

Here is some of what convinced my neuropyschologist to give me the diagnosis of AS. Actually, if you think about it, the first time I asked to get this diagnosis is this one. Other visits were for dopamine concentrations in brain and depression. The first visit was in 1992 and the second one was in 1995. It was in 1998 that I got the diagnosis of AS.

 

The way this works is that my mom had sent me some questions to the place where I was working during the summer of '98. I was told to answer the questions the best way I could. These responses were accurate responses for I had no knowledge of AS before responding or any coaching on my mom's behalf.

 

Before submitting it to my neuropsych, she filled in some of the questions with info that I could not recall or to just explain some of my answers better.

 

* excellent rote memory

 

Michael: In preparing for tests, I would go through notes and other materials and rewrite them over and over. I have been very good at memorizing things after I see them in print or writing them down myself.

 

Mom: I remember Michael being able to memorize quickly and easily: arithmetic tables, speeches, vocabulary, Spanish

 

*absorbs facts easily

 

Michael: I have always been an inquisitive person and often tried to learn more things than what was covered in school. This ability has helped me a lot on tests. Once I see facts in written form or write them down myself, I pretty much absorb the information easily.

 

Mom: We often tell Michael he is like a walking encyclopedia or dictionary. He can recall amazing detail from years back-he will hear a song on the radio and remember what movie it played in, what scene, the actors in that scene, who was with us, etc.- even if it was 10 years ago. This memory ability is selective, however. [From my child development studies, the correct term is cued memory - Michael]

 

*Generally performs well at math and science.

 

Michael: I tended to be more interested in these studies than others. I am really good with numbers and applying them-applications and formulas. In high school, I was involved with gifted classes in both science and math.

 

Mom: On all the standardized tests, from primary school on, Michael was in the 90+ percentile in both math and science. I remember an incident in about third grade. Teacher put a 4-5 part arithmetic problem on the board and turned around to ask the children to solve it. Michael was talking to someone, and she called him back to attention. He said he was already finished. Calling his bluff, she erased the formulas and asked him for both the formula and answer, which he promptly produced. He can do complex sums in his head. Some fictional stories he wrote around age 10 were loaded with precise numbers, e.g., Sinbad in exploring the fire-sea around Venus caught 72 silver fish, 6 weighing 21 1/2 pounds, 2 weighing 36 pounds ... and so on.

 

*Generally anxious: hard to cope with criticism or imperfection.

 

Michael: I tend to get very anxious when I have trouble doing something. I have usually thought that I should be able to do things perfectly when told how to do them.

 

Mom: I recall incidents from Michael's first-grade days when he would go straight into his room after returning home, where he would carefully use whiteout to correct any mistakes on his homework, then give himself a 100 before putting the homework in the drawer. I assume it wasn't for anyone else's benefit but his own, since I didn't even know for a while that he was doing this. This theme has carried on throughout his life. He gets very nervous and shaky when he thinks he's making mistakes, or when someone criticizes him.

 

*Can be victim of teasing in school environment, causing withdrawal into isolated activities

 

Michael: In high school and before, people used to make fun of my voice and of the way I sound. I have been pretty much a shy person. Any involvement I had with activities was with a small group of people and limited. During high school, however, I interacted with others--more so than after high school. In earlier years, I kept to myself because of my eagerness to want to learn. After being accepted into the gifted program I did seem more interactive.

 

Mom: I know kids can be cruel, but Michael has been the brunt of more than his share of teasing. He has been teased about his voice, his ears (which used to protrude--"Dumbo" and "Michael Monkey Ears" were some of the taunts). Kids used to call him "retard" in early years, then teased him in high school years because of his studiousness--stole his briefcase and hid it from him, swiped his pens and pencils so he couldn't take notes in class, etc. In second grade he made valentines for everyone in class, but only received one in return-a hate one. About broke my heart. Again, this has been a repeated theme.

 

*May appear clumsy and have unusual gait or stance; sometimes not well-coordinated or have trouble with balance.

 

Michael: When I was little, I had trouble learning to ride a bike, and even today my coordination affects me to some extent. I've had trouble with standing up straight (slouching); when I'm aware of it, I usually correct it, but sometimes it has been hard. I've had trouble with walking and during high school I needed sports orthotics for running. In college, I needed orthotics for wearing at all times.

 

Mom: Michael didn't learn to ride a bike until about 8 or 9 years of age. Even as a teenager and in college, he wrecked bikes by running into things (walls, parked cars, and curbs). When we tried him out on the riding mower, he couldn't work the brakes, so he just leaped off and let it run into the woods to stop it. He has difficulty with mechanical operations, such as working hand tools. Walks with a stiff, somewhat awkward gait; stoops over.

 

*May seem a bit odd or eccentric.

 

Michael: I've always been told that I was a dreamer. I've seemed to focus more on future things than present ones. My always wanting to know more about things separated me from most others, except for those class of people I would best represent (the intellectuals, not the "jocks", "preppies" etc).

 

Mom: Michael has always seemed "different" from other children. At kindergarten "graduation," when all the children lined up to sing and gesture their little rehearsed numbers, Michael just leaned up against the wall and watched everyone else, refusing to participate. Again, a repeated motif in his life--always the one different from others, separated from others, behavior, of rejection by others.

 

*Good language skills (grammar, spelling, writing)

 

Michael: I've always done quite well with these skills. In elementary school, people in my class became quite impressed with my spelling ability. In 6th grade I took 5th place out of the whole school in spelling bee. I've communicated best through my writing.

 

Mom: Michael has always performed and tested exceptionally well with the mechanical parts of language. A junior high teacher called him "The Grammarian." One year he had a perfect record on spelling tests. Learning Spanish was easy--the grammar, vocabulary, memorization, etc. Letters written to politicians have been extremely sophisticated--such a contrast to spoken communication that it hardly seems like the same person.

 

*May have difficulty with language content, comprehension, expressing oneself.

 

Michael: I've had trouble expressing myself because of difficulties in deciding what words to use. On standardized tests, I 've usually had the most difficulty with these portions (comprehension) -such as SAT, ACT, GRE.

 

Mom: Using example from earlier item--although Michael can recall tiny details with great precision (as from movie seen 10 year ago), he has great difficulty explaining the plot or meaning of that same movie or even one that he's just seen. The reading for comprehension part of tests always makes him confused and anxious, even though he may know the definition for all the words, understand the sentence structure, etc. Stumbles easily in trying to verbalize his thoughts. On SAT & GRE, got extremely high scores in math, but had to retake the verbal & reading comprehension portion on the SAT up to 5 times to get high score to get scholarships, etc.

 

*Difficulty with "social understanding"-difficulty "reading" social situations and interacting with other people.

 

Michael: I've always had trouble interpreting other persons in terms of what is actually meant by what they are saying, and what I've perceived them to be saying. My tendency to be literal minded causes me a lot of misunderstanding of people. For example, I might perceive something as normal talk, but the person is actually joking. This has sometimes caused me to take offense and I try to avoid such encounters. Because of my difficulty in expressing myself, I try to avoid having to do it whenever possible. Being a shy person attributes a lot to this as well.

 

Mom: This issue, of course, is at the heart of the problem for Michael as far back as I can remember. He has been the quintessential loner--no "best friends" or buddies or pals much beyond the few neighborhood friends in elementary school. The isolation deepened until Michael began running track and cross country, at which point he had somewhat of a social group with whom to associate--but always during the activity itself mainly. This never extended to social time. Never had kids over to the house, or was invited to theirs. Didn't date, except 2 or 3 somewhat arranged outings.

 

*Attended ordinary primary and secondary schools and was perceived to do well in school.

 

Michael: All throughout school, I had very decent grades. In 6th grade, I was placed into the gifted program, and thereafter took gifted courses, which I did pretty good with. I graduated high school with a 4.23 and college with 3.49.

 

Mom: Michael's teachers all perceived him to be a highly intelligent, gifted student, an over achiever. Expectations were always very high. He got scholarships to college and did well there too.

 

*Difficulty with interpersonal communication causes many problems with employment.

 

Michael: My difficulty in expressing myself, or understanding how something should be expressed, as well as viewing myself as needing to be perfect and being afraid to admit mistakes kept me from interacting much. My first year at Glacier Park, I started as a reservation clerk and ended up as a kitchen assistant because of my becoming really agitated under stress. At Busch Gardens, I started working behind the lines at FestHaus, but was moved to become a floor attendant because I had trouble doing things under stress. At the Tampa Tribune, I had trouble asking questions and admitting mistakes; tended to fix them without anybody knowing.

 

Mom: There is a long history of getting jobs (or getting interviews) based on written resume (looking well qualified & educated), then having it come to nothing due to difficulties with interpersonal communications. Another example is a political internship with a local congressman, whose staff person wrote Michael that he couldn't work there due to poor communication skills, A VISTA job was all but his until the interview phase, after which Michael was told his communication skills were too weak for placement in VISTA. He essentially had to leave the Tribune because of difficulties communicating with supervisors and fellow employees.

 

*Preoccupation with an area of interest or task (obsession, compulsion)

 

Michael: Making out lists involving statistics (lengths of rivers, area sizes of countries, populations of countries, etc.). Keeping track of movies or shows I've seen-obsession with things involving movies (actors, actresses, scenes in movies, music from movies). Trying to fill up my yearbook with as many signatures as possible.

 

Mom: The yearbook incident was indicative; Michael made elaborate schedules of when students had classes, and which signatures to try to solicit between which classes on specific days. He got very anxious when the planned solicitation of signatures did not go as planned. On graduation day, he still needed a dozen more signatures to complete his list. He completely ignored his father (who had flown in for the occasion after not seeing him for years), in order to track down the few who had not signed. Caused a big rift with his dad, understandably. The lists have been a regular activity, occupying many hours (from childhood to present). If it wasn't geography, it was the Olympics, or politics, or movies, or dinosaurs. One preoccupation would replace another.

 

*Stereotyped and repetitive motor mannerisms.

 

Michael: Picking at my fingernails, rubbing my finger against my nose, rubbing my fingers together. Strange throbbing on my throat.

 

Mom: Michael does have some unusual twitches with his throat muscles- in/out involuntarily, like the throat of a frog or lizard showing off it colors. He has nervous habits with his hands. Also has an involuntarily benign tremor which has no diagnosable organic cause (has been checked by neurologist for epilepsy, diabetes, EEGs, etc.). This tremor makes small motor coordination difficult (writing is almost impossible to read clearly, difficulty wielding a screw driver, etc.).

 

*Hard to keep eye contact.

 

Michael: Most of the time I have problems with eye contact when I have trouble grasping someone's thought, or have trouble deciding how I want to respond.

 

Mom: This is something very disconcerting to people in conversation with Michael- his eyes wander everywhere but at the person speaking to him. I've worked with him a great deal in this, and he has improved significantly. But it's always a conscious effort.

 

*Prefers schedules, rituals, routines--does not like things to change, or dealing with unexpected events.

 

Michael: I am a very good at doing routine things. Sometimes I had trouble doing things without making a schedule. It is hard to deal with unexpected events of situations or talk about things at whim without having thought them through them first or having knowledge of them.

 

Mom: Michael has always done his best when he worked out a very detailed schedule of his plans--like preparing for exams, daily routines, decision-making process. Things have to be outlined step by step in some detail. Each year he has done better out at Glacier Park because the routine is the same. New situations make him extremely anxious. When he was 4 in preschool, he was asked to repeat the previous year's curriculum because they thought he hadn't learned it. But he had remembered it verbatim and got extremely upset when a teacher reversed 2 lesson plans from a year a whole year previous. He gets upset and anxious if I say I'll be somewhere to pick him up at a certain hour and am 3 minutes late.

 

*Finds it difficult to express emotions, or to explain what/how you feel about things: hard to exchange emotions with others.

 

Michael: This is mostly because of my difficulty in deciding how best to express myself about how I am feeling. I might have felt afraid at times to let certain emotions be shown based on how I would be perceived.

 

Mom: Michael seems "dead pan" a lot of times--a more or less flat effect, even when the situation would call for an emotion to be evoked/expressed, like the death of a pet, or his grandmother. Emotional responses are limited to a few degrees on either side of "OK." He occasionally rents a video he knows will evoke emotions or even make him cry because he feels such a need for emotional release.

 

*Does not seek the company of other people on a regular basis to share activities with--prefers to do many things alone.

 

Michael: Mostly due to being a shy person and possible fear of rejection of how people would react towards me. Most of activities were during school years.

 

Mom: Michael has always been a loner. On hikes, he insisted on walking either way ahead or way behind everyone else. When he got a Busch Gardens pass in junior high, I offered to get 2 so he could invite another along. He refused the offer, saying it would be too difficult to accommodate someone else. The few times we had a playmate over, he was under great strain and behaved rudely--on one occasion locking out the other kid out of the house so he wouldn't have to accommodate him about which cartoons to watch. Goes to movies alone, travels alone, ate alone in school cafeterias, etc. A major motif throughout his life.

 

*Some delay in learning language or some speech difficulties in childhood. Peculiar or unusual voice characteristics.

 

Michael: Mostly I can remember is that I mumbled a lot.

 

Mom: We've had extensive diagnostic work done to determine the cause of the mumbling. There is no structural defect--speech therapist said the nasal speech may have started when Michael had adenoid/asthma problems, but there was no reason he couldn't with practice develop normal voice.

 

Michael was slow in language development. I remember working with him on enunciation at around age 3 & 4, and rewarding him with M&M s when he enunciated sounds correctly. His speech was very garbled--he clearly knew what he was saying and flew into frustrated rages when we couldn't understand what he was trying to communicate. We think now that chronic middle ear infections were to blame for much of this. Michael has a flat, unemotional, somewhat high and nasal speech. On the phone people often think they are talking to a woman, which insults him greatly. Not much inflection or variation. Speaks softly and still mumbles--often is asked to repeat a statement so someone can hear/understand what he's said.

 

*Very literal in use of language-hard to understand symbolism and figurative use of language.

 

Michael: My literalness tends to cause me to misinterpret meaning of things from what is actually meant and what I think is meant. I've always had trouble with people joking around me because of this.

 

Mom: It's a standing joke between us about Michael's literalness. Also, if you ask him to interpret sayings such as "rolling stone gathers no moss," he's hard put to understand and explain it beyond its literal meaning.

 

Michael: These responses are indicative of my childhood years up to 1998, so a lot do not apply to me now for I have shown great improvement over the years. My AS still bothers me but not nearly like what is described here. Some of this is still a maybe.