Sifting through the US CDC’s official diagnostic criteria for autism ~ Part B (2-4): restricted, repetitive patterns of behavior

This is the third post (although it could be considered the second half of the second post) in a multi-post series (not sure exactly how many posts this series will ultimately end up with).

With a slightly clearer brain and clearer sinuses than I had this morning (three cheers for bone broth!) 🙂 I think I have more mental stamina, so here we go….

If you haven’t yet seen the first two posts (Part A and Part B (1) ), I’m writing this series for two reasons:

1. To prerecord my thoughts, should my words escape me during evaluations or other situations where I’m trying to explain this topic, and
2. More importantly, to provide other people who might be trying to research this topic with one real-life example of how the criteria might apply to real life people and their situations

In order to be considered Aspergian/autistic in the official sense, certain criteria have to be met; in the United States, the end-all-be-all of official criteria come from the CDC (Centers for Disease Control) (which I personally find very strange and misplaced, but…oh well).

My brain gave out in viral/mold sickness exhaustion before I could get very far with Part B, so that’s where this post picks up.  Part B of the 5-part CDC criteria is sort of a mouthful.  The heading of Part B says: “Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history”.

Underneath that heading are four sub-parts; they read:

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

I covered the first sub-part (about stereotyped or repetitive motor movements) in the previous post, so I’ll pick up with Number 2.

I didn’t think I “insisted on sameness” at first.  After all, I crave variety in terms of food, music, road trips, and certain other activities.  I don’t have any greeting rituals, nor must I take the same route every day (I do insist that the route I take is the least congested with traffic and takes the least amount of time, but that’s it).  I don’t have any other stereotypical or arbitrary rituals like needing to wash my hands three times, or feeling compelled to wipe door handles before touching them, or feeling uneasy if I step on a sidewalk crack.

So, in bewilderment, I turned to my partner, reading the text from the CDC’s website verbatim.  “Honey, do I have ‘insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior, like extreme distress at small changes’, etc?”

He looked at me, just as bewildered, and to my surprise, he said, “uhhhh….yeah.”

For real?  I asked him to elaborate.  He said, “you freak out every time you have to suddenly do something you hadn’t planned to do.”

I thought about that.  It didn’t take long for me to realize he was right.  And there was more, and the more I thought about it, the more there was.

I thought back to the weekend in which March transitioned to April of this year.  It was Friday morning and I had planned on an easy day to finish out the week, during which I would settle in, make myself comfortable in my office, and work independently and uninterrupted until closing.  I had my day perfectly planned out, and that plan was very agreeable to me.

A few hours later, my partner entered my office suddenly and said, “um, we have to be downtown, like, right now.  Your conference has already started.”

I did freak out.  A lot.  I said, “what???”  And he reminded me of an annual conference I had signed up for over a month ago, that I had subsequently completely forgotten about.  “Oh shit!”  I said, and my brain “blanked”.  I had no clue what to do.  This sudden change was overwhelming, too much for me to process, and I became irrationally irritable.

That wasn’t the first time my “irrational irritability” revealed itself in my office setting when faced with the need to suddenly “switch gears” (as I came to call it).  Our last office assistant simply could not follow my dictum “Thou Shalt Not Interrupt Me When My Door Is Closed” (or if my keyboard is tapping, or if I’m talking to myself, as all of those are signs that I’m in the middle of a task requiring deep concentration).  I tried repeatedly to gently-but-firmly coach/counsel her on this, but she just wouldn’t abide by it.

One day, I didn’t try to hide my irritation at being interrupted again (she’d been working for us for over a year by then!), and I think she actually got the message because she saw my facial expression (which I was unaware of) and her eyes went wide and she became apologetic and somewhat timid, as though she were taking me and my wishes seriously for the first time.  She meekly smiled and slunk out of the office.

I caught up with her a little while later and apologized, realizing that I must’ve really looked pissed off at her and probably hurt her feelings.  Truthfully, I wasn’t exactly mad at her personally; I was simultaneously overwhelmed and annoyed at the interruption itself, and I was slightly annoyed with her personally for being the agent of that interruption.  We talked more about it; she described my facial expression as “the look of death”.

My partner also started school in a nearby large city, and because he can’t drive, I drive him back and forth.  I knew very little about this city, other than the major interstate highway that ran through the middle of it.  It took me literally five months to learn where we were going; during those five months, he (again, literally) had to guide me every step of the way.  Driving this new route in an unfamiliar city always stressed me out, and I feel badly that I’ve snapped at him on more than a few occasions.

OK, check one (or more than one) up for “extreme distress at small changes”.

Task-switching sucks, too; it takes me forever.  Disengaging from one task and engaging in a different task takes a neurotypical person a few seconds to a few minutes; by contrast, this could take me anywhere from 15 minutes to 1-2 hours.

The third sub-part mentions “Highly restricted, fixated interests that are abnormal in intensity or focus”.  At first, I interpreted that as “obsession” and I didn’t think I was obsessive by nature.  I certainly wasn’t highly-restricted; hell, I changed college/university majors eight times, because I was interested in many subjects and couldn’t decide which one to stick with!  Even now, I love researching and learning about many different topics.  So, I’m not quite so sure about the “highly restricted” part.

But words and phrases like “fixated” and “abnormal in intensity or focus” ring pretty true.  I absolutely love to study topics of interest down to the smallest detail, and I can “hyperfocus” for hours, failing to realize that I haven’t taken a break to eat, drink, or use the restroom for a long time.  When those natural urges reveal themselves, it’s very sudden–or at least, it appears that way; chances are, my physiological reflexes (stomach growling, etc) have been sending me subtle hints for the past few hours and I hadn’t noticed.  Finally, my physiology starts yelling at me to satisfy those needs already.

I don’t exactly have a preoccupation with unusual objects….or do I?  I love to collect little detailed sculptures of little Medieval European houses.  I love to collect pewter figures of sorcerers and wizards.  I like to hang crystals from windows that catch the sunlight and bounce little rainbows off the wall.  (Rainbows are the bomb!)  And although I don’t collect them, I love engines.  I mean, totally love them.  I like to watch them run, I like to hear them rumble, purr, and whine.  I like to think of the gears and belts, spinning faster than my eye can detect.  I like to think of the cylinders and/or turbines, turning, churning, and pushing, with power and controlled mini-explosions that make everything go, bringing action to the world.  Oh yes, can you tell I love them?  The bigger the engine, the better, so I love truckstops and airports, and I won’t drive anything smaller than my V8 pickup.  (Not too worried about our carbon footprint; ours is smaller than most, since we’ve decided against having any children, which is by FAR the biggest carbon footprint one can leave.  Besides, I despise driving and we purposefully live fairly close to the office and do very little driving otherwise.)

And I like enzymes.  As in, enzymes in the body.  This goes well beyond the ones your pancreas uses to digest your food.  There are tons of enzymes throughout your body, doing (almost) everything.  They burn fuel, transform one thing into another, produce what we need, mop up waste products, and more.  It’s music; it’s art–all at the same time.  It’s awe-striking.  Enzymes are confusing, though, and I can spend eight hours researching a single one; I usually end up “fighting” with it, in my quest (read: struggle) to obtain information.

The fourth sub-part, unlike some of the other criteria, was a slam-dunk.  I’ve always been aware of my “Hyper- or hyporeactivity to sensory input”.  I seek certain sensory input and thrive on it, while my nervous system goes ape-shit at others.

I spent my childhood summers on the fairgrounds.  This is the ultimate sensory stimulus environment; lights, sounds, and smells are everywhere, and usually multiple at once.  Strobe lights (hundreds) coupled with booming music systems (usually about four or five at any given time) and smells (dozens at once–some good, some not-so-good); it’s a sensory smorgasbord.  Rides, games, food, and the occasional show penetrate the nervous system from about 10am until about 4am.  It was amazing.  I didn’t consider myself a thrill-seeker, per se, but I may have had bouts of tendency toward it; I had ridden on every fairground ride (even all the adult ones) by the time I was twelve.  I could handle even the ones that others couldn’t.  I had a strong stomach, so I never even got sick on any ride.

Off the fairgrounds, I seek some stimuli, too.  Music is a constant.  I love it, collect it, play it, and create/write it.  My collection of almost 7 terabytes spans 40 different genres (actually, there are more, since some genres are grouped together under the same main folder, and there are 40 “main folders”).  Art is another (doesn’t take long to corroborate that, scrolling through my blog LOL); I realized about 15-20 years ago that I actually got “high” for a couple of hours during/after looking through art magazines.  I love art that much.  Who needs to huff paint or sniff glue when you’ve got art magazines?? 🙂

And then there’s the “flip side”.  I hate scratchy clothing tags.  I can’t stand the sensation of water hitting my skin, or the feeling of being wet.  Environmental humidity really get to me.  I can’t stand leather, either in a vehicle or on home furniture; if I wear a leather jacket, I have to also wear a long-sleeved cotton shirt.  Mashed potatoes are a no-go, as are refried beans; I’m not exactly a fan of any legumes (such as beans, peas, etc).  I’m not into bitter or “gamey” foods; if I eat kale, for example, it must be blended up with fruits and other vegetables in a smoothie.  Deer or lamb meat, especially lamb liver, is very iffy for me; the taste is often too intense.  Oranges are too sour for me (always), and milk, although I used to love it–tastes sour and mildly disgusting (milk chocolate simply disintegrates into separate sour milk + fake chocolate tastes to me); I can do ice cream on occasion, and certain types of cheese.  Forget Parmesan and other similar cheeses, though–Not Happening.

I can’t stand subwoofers but other than that, I don’t have a lot of “forbidden” sounds, because I’ve been blessed (not sarcastically, these days) with hearing loss.  My ability to hear and my audiological tolerance–strangely enough–actually vary from day to day, so the volume at which my partner has to talk to me on one day (in order for me to hear him) may actually be too loud for me to handle the very next day (or even a few hours later).  I can’t handle much musical dissonance or fingernails on a chalkboard, of course.  And compressed audio (a technique used on TV and radio stations) is highly annoying.  For a long time, I also couldn’t handle hi-definition TV, either, opting for the older non-hi-def channels instead.

Strobe lights can sometimes land me with a migraine, especially blue ones.  Fluorescent lights and older-generation LED lights (and especially those awful CFL lightbulbs) are abhorrent, as are vehicle headlights of a similar color spectrum.  Concerts are iffy; I really enjoyed seeing Garbage a few weeks ago, but it got so loud that the clarity of the music was lost, and between the pounding bass and the 6000-candle-power cannon lights (plus lots of strobe lights) which were sometimes directed toward/into the audience (!), my nervous system (although prepared for and enjoying the show itself) gave out and I was fatigued for the duration of the following week.  We saw the B-52s recently also, however; that concert was much more sensory-friendly.  Although there was lots of color and a little flashing, there were no bright strobe or cannon lights, nothing was shone into the audience, and all of the instruments were individually miked, which controlled how loud it could get, which wasn’t excessively loud at all.  (As a result, I never experienced overwhelm, overstimulation, or the post-stimulus fatigue/recovery at all!)

Don’t get me started on smells.  Good smells have a euphoric effect, similar to looking at beautiful art.  I have to smell every naturally-scented candle (the artificially-scented ones are way too overpowering, as are chemical-fragrance detergents).  Bad smells (such as kitchen trash, dumpsters, dog business piles, perfumes, etc) can actually make me very cranky, especially if prolonged.

My reaction to even a brief, passing smell can be pretty marked, too.  While driving with the truck windows down on a beautiful spring day, we drove past someone’s newly-fertilized yard/garden; instantly I wrinkled my nose and said “ew!”  My partner started chuckling.  I asked him, “what’s so funny?”  He said, “you were trying so hard to get away from that smell as fast as you could, that you actually punched it (sped up).”  Well, OK, that was funny; I had to laugh, too.

Only two out of the four sub-parts of Part B are actually required in order to meet sufficient criteria for a formal diagnosis.  However, between this post and the first sub-part of Part B, if I’ve interpreted these criteria accurately, and properly applied them to my own situation, then I think I’m actually 4/4.  🙂

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(Image Credit: Cyril Roland0)