The Differential (Self-)Diagnosis: why it’s Asperger’s and not something else

My presence in the blogosphere has been nonexistent, compared to my usual activity.  For that, I apologize; although it may have seemed (and sometimes felt) like I had dropped off the face of WordPress Earth, I didn’t.  After a long-but-decent-and-surprisingly-productive week, I’m settled back into my apartment sanctuary and ready to pick up where I had left off…

…which, before Tom Clements’ beautiful Asperger’s Syndrome poem, was my likely-excessively-meticulous account of my own Asperger’s-related self-discovery process.  In that post (the latter link), I hinted at the end that there might be a follow-up post that details why I’m so convinced it’s Asperger’s and not an outwardly similar-looking classification, such as ADHD, OCD, or another such issue.

Any time an assessment is made and a is label applied, it’s wise, ethical, and logical to check it against other assessments with similar characteristics.  Here, I’ll attempt to explain (almost as meticulously) how my thought process unfolded as I systematically self-checked, as objectively as possible.

Before I go much further, a few notes:

1) I assume nothing, and I don’t want anyone to feel left-out or talked-over so for those who are unfamiliar with the medical jargon term “differential diagnosis”, it generally refers to the process described above, when a person is examined and the signs/symptoms (or in this case, traits/characteristics) of several diagnoses on a “short-list” are compared and contrasted with each other to arrive at the final single diagnosis.

2) A little thought about objectivity: It’s sought after as a desirable characteristic of science.  I’ve frequently seen people develop a superiority complex regarding their level of objectivity, or how their viewpoints are so much more rooted in objectivity or science.  However, the reality is that objectivity is often a much more difficult–and less common–idyllic pipe-dream to reach or attain than we think.

My mind mushroomed with an entire diatribal essay on this topic just now, but for our purposes, I’ll simply leave it with a statement of my opinion: who is more objective–the licensed clinician with the degrees, accolades, clinical experience, clipboard, and symptom checklists, or the layperson who has been living that neuro-type, firsthand, every minute of every day throughout their entire life?  Sometimes, it’s the former; more often (based on my experience), it’s the latter.

OK, with the formalities out of the way, I’ll take the scenic route through the Diff-Dx (pronounced “diff-dye”) process.

I’ll start with my previous “official” diagnoses.

My first diagnosis (when I was 14), was Clinical Depression.  So, I took the Depression Quiz (link to PsychCentral’s version).  My score was 16 out of a possible…well, I’m not sure, but the highest category in the Scoring Key says “54 on up”, so I reckon the score goes pretty high.  The screenshot of the results is included below:

Screen Shot 2016-08-26 at 6.32.12 PM

Let’s break this down a little.  First, I took PsychCentral’s version in the interest of keeping my data uniform.  They have a variety of quizzes available, and I’ve used a lot of them already to explain my perspective.  So, I’ll try to use them whenever possible (barring any glaringly deficient or inaccurate questionnaire).

The first criticism of the PsychCentral Depression Quiz that I have is that the quiz is very short (18 questions), and the second is the non-specificity of the questions; many of the symptoms listed may be present in a slew of other diagnoses, or even in normal life in general.  Or, they may be present for other reasons or in other varieties that have nothing to do with depression.

For example, I may do things slowly, but not because I’m depressed; it’s because I’m clumsy.  I may have gained weight over the past couple of years (ugh!) but after scouring several medical journals, I’ve found at least 40 root causes of weight gain that have absolutely nothing to do with depression.  My sleep patterns are extremely erratic, but that may be more dopamine- or catecholamine-driven than depressive in nature.  I may find it tough to sit still, but I experience that the most when I’m overly excited (with glee or joy) about something, which is pretty much the opposite of depression.

A personal thought is, that’s a pretty finely-detailed little scale, and I think there might be some bias in the scoring.  The Scoring Key goes all the way up past 54, and yet only “0-9” is “no depression likely”?  This means that once you hit a score of “10”, the “experts” who designed the quiz begin to suspect that you may have “possible mild depression”.  It’s been too long since I’ve taken a statistics class, but I’m pretty sure that a scoring scale/curve like that is probably known as a Stats Nightmare.

My next diagnosis was ADD/ADHD.  Here are my results from that online assessment (link to quiz):

PsychCentral ADHD

This one is trickier, because the scores were a bit stronger (19 out of a possible…well, at least 34, because that’s where the highest-ranked category begins on the Scoring Key), and these symptoms have been present since early childhood.  But let’s break that one down, too.

My major issue with ADHD in general is that it’s probably a subset of the autism spectrum.  (I’m not at all the first person to suggest that.  Here’s an excellent article on the two conditions.)  Thus, it’s possible that a lot of kids are getting slapped with an ADHD label (and being drugged accordingly with a chemical whose molecular structure is eerily similar to methamphetamine, which may have permanent effects on brain wiring and function), when actually they’re exhibiting characteristics of Asperger’s or elsewhere on the Autism Spectrum, which are being completely misinterpreted.  This happened to me, minus (thankfully!) the medication part.

Specific overlapping symptoms (for me) include: being easily distracted by external stimuli, difficulty organizing a task (i.e., executive function issues), misplacing things, difficulty listening to someone when they’re speaking directly at me, etc.

What rules ADHD out in my case are the following: despite my time management issues, I have never missed a deadline.  I’ve also never forgotten to pay a bill.  I try very hard not to make careless mistakes; I proofread my work and as I catch mistakes, they gnaw at me until I correct them.  I’m generally pretty–almost overly–detail-oriented.

I can certainly engage in leisure activities quietly, I’ve never left my seat when it’s expected that one remains seated, and I don’t typically get impatient while waiting in line.  (I do get bored, at which time I pull out my smartphone and occupy myself.)

Lastly, the ADHD-related symptoms pretty much only occurred at school, where I was more likely to be bored, and not so much at home; therefore, the diagnostic criterion of “must occur in at least two different settings” is not met.

Another (minor) aspect of this quiz to consider are the two Subscales and their separate scoring Key (the smaller lavender box, in the bottom-right corner of the screenshot).  My Subscales were 11 and 8, respectively, and the lowest category of the Key ranges from 0-12, which fits (as opposed to Moderate or High).

The last official diagnosis I got was PTSD, which was last spring.  That is a true and accurate diagnosis.  However, the PTSD developed in response to a few extremely traumatic events during 2009-2010, and by then I was firmly into adulthood.  The PTSD complication simply influences/adds to the underlying Asperger’s I’ve had all my life.

The next diagnosis was suspected (but never solidified) was Bipolar Disorder.  I’ve experienced highs and lows, depression and elation, high-and-low-energy cycles, and all that.  But then I got to thinking…doesn’t everybody?  Another possibility is that my annually cyclic childhood environment might have played a “Nurture” part in establishing this variation.  But when the quiz is a whole 12 questions long, it might be tough to explore all the pertinent specifics.  I was actually surprised at how bipolar I’m not:

Screen Shot 2016-08-26 at 7.31.32 PM

The text on these screenshots is tiny, so I’ll translate.  I scored 8.  That lands me in the “No disorder likely” category, although at the high end.  Like the Depression scale, it’s very interesting how many gradients/ranges there are on the Scoring Key, and given how high the numbers go, it’s interesting how early the chances of diagnosis start climbing.  The suspicious elf in me begins to wonder, again, about bias or some Statistics Fail.

The next suspected (but again, never officially rendered) diagnosis was OCD (Obsessive Compulsive Disorder).  I have always been pretty detail-oriented and semi-anal-retentive, so I was curious to take that questionnaire and see how I came out.  Here are my results:

PsychCentral OCD

Yeah, not likely.  I had scored a total of 7, and again I’m not sure how many points were possible, but “0-7” said that “OCD is unlikely”.

Out of curiosity, I decided to undergo two more online questionnaires.  I wanted to ensure that I didn’t have Borderline Personality Disorder (BPD) or Narcissistic Personality Disorder (NPD).  I took the BPD assessment primarily in response to those who claim that (genuinely) Asperger’s/autistic people are somehow “attention-seeking”, “dramatic”, “emotionally unstable”, etc.  I took the NPD assessment in response to the ignorant who accuse people on the spectrum of being “self-centered”, “all about ourselves”, “uncaring”, etc.

Here are my BPD questionnaire results:

PsychCentral BPD

Here again, I’m not sure how many “points” were possible, but as with the rest of the PsychCentral questionnaires, the higher the score, the more likely the label applies to you.  Well, let’s just say that there’s no BPD in my makeup.  My score was 6, which falls comfortably into the “Unlikely” category (which ranges from 0-14).

And last but not least, my Narcissism questionnaire results:

PsychCentral Narcissism

The text is tiny, but it says “Your Total: 4” and goes on to explain: “Between 12 and 15 is average.  Celebrities often score closer to 18.  Narcissists score over 20.”

So I guess that although I blog, tweet, and talk about myself/my own experience a lot, I’m “keeping it real” when I say that I’m not seeking fame, attention, or admiration; I’m truly doing it to help, support, and contribute after all 🙂

And with that, I’m going to go proofread, and probably edit this post 14 times ❤

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