Sifting through the US CDC’s official diagnostic criteria for autism ~ Part A: Persistent deficits in social communication and social interaction

My lifelong experience is that I’ve had a tough time getting other people to take me seriously.  I’ve often felt that what I’ve had to say often goes unheard or unlistened to.  Out of this history evolved an instinctual defense mechanism: gathering evidence to support my position.

I guess that this post (which will definitely become a series) is probably a product of that instinct; as I prepare for my evaluation(s), I’m anxious, fearing that if I “go in cold”, I might freeze up or forget important details, details that might get missed if I forget to bring them up, details that might help my professional(s) evaluate me more accurately, the more information they have.

I’m considering this a “dry run”, putting this information out there so that it’s on record.  No matter where I am, I’ll be able to access it.  And, even more importantly, it might help someone else who can relate, maybe providing them the inspiration to look further.

The US CDC criteria for the autism spectrum is semi-cryptic.  Even though I’m a doctor (family practice with a specialty in integrative health, for those who are curious, as I’ve been questioned on this issue) and thus I’m familiar with CDC jargon and all that, the criteria didn’t seem obviously applicable at first glance…

…that is, until I thought about it and took the extra step of translating them into everyday life.  I’ve become more aware of how they apply to me.

The heading for the first criterion (Part A) states “Persistent deficits in social communication and social interaction”.

What the hell does that mean?

Three subcategories are listed.  They are:

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Well that sure clarifies things…not.

At first (in the very beginning–think six months ago), I didn’t think that the first subcategory applied to me.  After all, I like to call my closest friends and family.  I like to talk (yes, even on the phone!) for hours with them.  And I do like to share my interests with them.

Oh wait…I do like to share them…too much.  Before I knew (learned) better, it didn’t really matter (to me) what they were doing at the time; I barged right in and played show-and-tell.  It’s not that I was being rude; I was just excited to share.  As an adult, I’ve (embarrassingly recently) learned to STOP myself and assess the other person first–as in, what are they doing right now?  Are they deep in concentration or in the middle of a complex or time-sensitive task?  Would this be a good time to interrupt?

And about that “talking on the phone” part…I call exactly three people on a regular basis (once a week or so), and probably two more on a less-frequent-but-semi-regular basis (every few months).  Those conversations last anywhere from an hour and a half to almost six hours.  But I’ve noticed a few things about those conversations…

The first thing I’ve noticed (over time) is that I frequently end up embarrassed and apologizing for going on and on about “my nerdy subjects”.  I don’t hesitate to explain the intricacies of biochemical pathways right down to the minute detail (I simply don’t know how to leave out those details; I don’t know how to pick and choose which “main ideas” to talk about, so I end up giving the person a very scenic tour of my biochemical knowledge).  I get so engaged in my own interest in that topic that I monopolize the entire conversation, forgetting to “check in” with the other person to see if they’ve nodded off or not.  I’ve gone back to check my Facebook or other social media, only to find out they were posting and commenting during the time that we were on the phone.  I don’t feel slighted; I feel embarrassed.

The second thing I’ve noticed is that whenever the other person has been able to get a word in edgewise, it’s usually because it’s a subject that I share an interest in, so I’m content to remain silent and learn.  That’s about the only time that the back-and-forth conversation is there.

The third thing I’ve noticed is that whenever I’ve dominated the past few conversations and I remember to make it a point to sit back this time and let them talk, but they talk about something that I don’t personally find interesting, I’m the one who gets on Facebook or Twitter and starts checking in!  The other person doesn’t know I’m doing that, and may never find out, but it embarrasses me that I feel the compulsion to do this.  I’m not trying to be rude; I’m just succumbing to the temptations of my brain; it’s bored, and I can’t seem to help that, and it wants to be entertained and distracted.

The second subcategory didn’t seem right at first, either.  But again, I gave it consideration.  I can read some body language or facial expression, but (I think) it’s different.  I seem to be “blind” when it comes to traditional interpretation of body language and facial expression.  I can tell when someone’s smiling.  I can tell if they’re angry or sad, if they’re obvious about it (such as crying or yelling).  But the subtleties are lost on me.  I often find myself in hot water because I failed to pick up on less-apparent nonverbal cues; for example, someone might have been attempting to downplay their irritation with me, and I do or say something that serves as the final straw that sets them off.  Go me.

I think that my affect and vocal tone are probably somewhat adjusted to the neurotypical standard; after all, it’s a neurotypical world, and my instinct is to aim to please, so as not to create discord.  Thus, I honed my acting skills.  Those acting skills aren’t entirely seasoned, however; on many an occasion, I’ve been prodded to “smile!”, my neutral facial expression being mistaken for unhappiness when the reality was that I was just relaxed and deep in thought.

At first, the “abnormalities in eye contact” element didn’t stand out to me, either.  But I began to pay attention to myself and lo and behold, I realized that I didn’t actually know the color of any of my patients’ eyes; I did, however, know how thick or thin their lips were, what color (and how straight) their teeth were, how their nose was shaped, or how many lines there were on their forehead or how deep they are.  I can force myself to stare at someone while they’re talking; I just look at the space between their eyes.  But when it’s my turn to talk, I suddenly feel like I’m in front of a video camera, recording a performance, and I feel incredibly self-conscious…cue the “irrational”/unnecessary anxiety…

The third subcategory didn’t require nearly as much thought.  Relationships are my nemesis.  I want them, I crave them, and I know that there are times when I do/will need them, but somehow I seem to have been born without that innate social instinct.  Forming a friendship is not as easy as going up to someone and saying “you seem to be nice; I like you; will you be my friend?”  People will look at you like you’re from Neptune.

Maintaining relationships is somewhat easier than developing them in the first place, but not by much.  It’s all-too-easy for me to allow even a close friendship dissipate due to lack of contact or initiative on my part.  I’m usually pretty sad or even heartbroken when it happens, and I’m always sorry for my (major) part in it.  I always regret letting them go.  I’m pretty crappy at sending cards or emails, I might not check Facebook on the day that happens to be their birthday, and I’m really crappy at calling people outside the three-to-five members of my “inner circle”.  I abhor the phone most of the time (unless talking on the phone is absolutely necessary and/or I’m calling someone with whom I feel very comfortable).

As for the third subcategory of the criteria, “difficulties adjusting behavior to suit various social contexts” didn’t jump out at me at first.  I mean, what does that even mean?  For me, I think it means things like giggling like an adolescent or fidgeting during a post-doctoral conference.  Or perhaps failing to resist the temptation to open up a little too liberally to a colleague, or even a patient with whom I share much in common.  Or being too chatty in former jobs, such as restaurant waitressing/serving or massage therapy.  Those clientele just want to eat and relax, respectively; they don’t need my intrusive conversation.  I hadn’t been as aware of that then, and I probably lost out on many a waitressing tip or massage therapy client because of it.

Do I have an absence of interest in peers?  Yes and no.  I would like to have more in common with them.  I would like to have more of them as friends.  But alas, I don’t.  Thus, I’ve justified this to myself in my brain by deciding that the rest of the world sucks anyway, and thus, I’d rather not be included, and I stopped striving for their approval.  I’ve convinced myself of that, so strongly such that I’m not sure what I’d do if somehow the world magically wanted to be my friend.  If everyone suddenly took an interest in me, would I reciprocate and suddenly be the social butterfly extraordinaire?  It’s hard to ascertain when it’s so far into theory-only territory.

Regardless, I know that my mom was particularly supportive, and this probably encouraged some extra socialization within me that otherwise probably wouldn’t have developed at all.  So does my so-called “higher function” (although I despise that term, I can’t think of a better one right now) render me unable to meet the criteria?  Or have I developed fantastic acting skills with the tools that my awesome education-oriented and special-education-degreed mom was armed with and thus imparted to me?  My mom is truly special and instrumental in shaping my life; how would I have turned out had I had a “regular” mom?

Parallel universes and all that… which is probably another special interest.  At the risk of going on endlessly, I’ll stop before I get started down that rabbit hole.  With any luck, though, the criteria aren’t quite so ambiguous or academic, and with any luck, I’ve interpreted them correctly and I’ve successfully applied them to (my) real life.  And with any more luck, I just might have helped someone else do the same. 🙂

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(Image Credit: Cyril Rolando)