Play armchair psychologist - Is psychopathy misdiagnosed as autism?

[MotherGoose]

Yes, very close. The goal with antisocial pd is to install an external code of conduct that replaces an internalized morality (because they lack that emotional guidance). For some this works. It is all about convincing them about how it benefits them to play within the rules of society as opposed to always following their whims and desires. You can not make them care or feel for the sake of someone else. The "how would you feel in Bob's shoes" or "how would you like it if..." type of exercises are totally useless and only serve to better help them mimic appropriate social cues. I heard it repeated many times..."We can teach him right and wrong. We can teach him alternative coping skills. We can't make him care or want to implement any of it." :sad:

 

But, for them, It is not usually about pursuing evil. It is about following their desires, proving they are the smartest, best or most cunning etc. and they get bored easily. Of course to the rest of us it sure looks like a love of evil things.

Yes, when I said evil I was thinking of the Ted Bundies of the world. There are plenty of antisocial personality disorder people out there that are just manipulators, adulterers, and successful corporate executives or whatever. Not murderers.

[nixpix5]

I think "not knowing what to do" are the key words there. DS19 certainly understands emotions and has empathy. He just doesn't intuitively know what to do with that empathy. Although I think that's relatively normal for many NT males of the same age.

 

It is extremely troubling to see autism equated with psychopathy. Ignorance and ugliness both seem to be running rampant this week.

Yes, I have been concerned about this too. The issue is masses not educated in genetics and brain science are making blanket assumptions.

 

Genetically, we know there are some genes that scientists think of as "resiliency" genes. Through heredity, some people hit the jackpot and regardless of negative life events they bounce back. It is speculated that they work to buffer. So for example, if an infant is neglected in the first year of life, their nervous system primes itself for "harsh times ahead" it is a survival technique. Dopamine response, serotonin response, cortisol output and neuroepinephrine response all get tweaked in concert to prepare the individual for a hard world. This tends to result in low reactivity and distrust of good intentions and heightened awareness of someone out to harm you.

 

When the resilience buffers are present, they seem to be able to adjust the system. So if they suddenly get warm loving responses then their neurotransmitters recalibrate the system for "better times ahead" and those that don't have this super plasticity of system tend to maintain some level of the original operating system. This is typical of what we think of as reactive attachment disorder for example.

 

Now, let's say system is primed for harsh times and their is an in utero environmental insult that causes the brain to produce the constellation of behaviors that look like autism, now suddenly we have a problem.

 

Contrary to popular belief, people with autism have very vivid internal imaginations that are often hard for them to differentiate from reality. They are optimal pairers, meaning...one trial learning is at play for some senses. "I went to that store once and someone looked at me wrong so now I feel panicked when I see that store" they often cannot verbalize it like this but this one time pairing of an event has caused a confusing situation for them and their parent.

 

They often are highly emotionally aware and what looks like an inability to read social situations and lack of empathy is actually a heightened mis-reading of social responses. Anxiety is triggered from seeing other people's faces and responses and interpreting them as aggressive or aversive. This causes a deep belief people don't like them, will cause them emotional pain etc. It is hard to have empathy when you are so focused on your own anxiousness. Yet they do have empathy. Often times though it is directed at animals and so forth because there isn't a hurtle to get over of mis-interpreting social intent.

 

There is also what I call "created event" where some children or people with autism mentally prepare and fixate on an event. For example, let's say you tell you child you are going to visit a store for a science learning event. The child will then start ruminating and visualizing this event in their head until they can see in detail exactly what they think it will look like, what people will say, what they will make and so forth. It is so detailed it feels real. If they get there and anything deviates from this expectation it can result in anxiousness, confusion, meltdown and it leaves the parent feeling confused.

 

I say all of this because these kids are already working with a challenging situation and rhen add nature insult to it (early abandonment, a learning difference, etc) a system already primed to interpret negative outcomes is even more so. This is why fear that someone with autism will do this is as wrong as fear someone adopted will. Much goes into the nature and nurture component. I wish we would stop putting disorders in a neat box and start looking at individualized brain experiences that lead to certain behaviors and diagnosis.

[Liz CA]

Yes, I have been concerned about this too. The issue is masses not educated in genetics and brain science are making blanket assumptions.

 

Genetically, we know there are some genes that scientists think of as "resiliency" genes. Through heredity, some people hit the jackpot and regardless of negative life events they bounce back. It is speculated that they work to buffer. So for example, if an infant is neglected in the first year of life, their nervous system primes itself for "harsh times ahead" it is a survival technique. Dopamine response, serotonin response, cortisol output and neuroepinephrine response all get tweaked in concert to prepare the individual for a hard world. This tends to result in low reactivity and distrust of good intentions and heightened awareness of someone out to harm you.

 

 

I say all of this because these kids are already working with a challenging situation and rhen add nature insult to it (early abandonment, a learning difference, etc) a system already primed to interpret negative outcomes is even more so. This is why fear that someone with autism will do this is as wrong as fear someone adopted will. Much goes into the nature and nurture component. I wish we would stop putting disorders in a neat box and start looking at individualized brain experiences that lead to certain behaviors and diagnosis.

 

Yes. This. Sigh.

 

You also described very well in the first paragraph how the system gets primed to expect negative events. I have seen this result In some extreme cases where the amygdala is so "overtrained" that fight. flight or freeze responses occur at minimal triggers.

[mellifera33]

In our area there are not enough professionals to deal with the number of kids who are on (or suspected of being on) the spectrum. There are wait lists for diagnoses, wait lists for therapies, and kids who need meds get a consult with a child psychiatrist and then are bumped back to their pediatrician or family doc for monitoring. I know from talking with other moms that there are a lot of primary care docs who feel unequipped to deal with complex kids, but who are having to pick up the slack while families wait for months for an appointment with a specialist. I sometimes hear people complain that primary care doctors are too quick to prescribe psychoactive meds for kids, but that has not been my experience, or the experience of the moms who I know.  

 

My ds was officially diagnosed with autism after a 60 minute appt., but that was after various evals and screenings with speech therapists and school and private psychologists. The diagnosing psychiatrist put together all of the pieces for the "permanent record." On the other hand, I talked with a mom who has a kiddo in the same social skills group as ds, and her child has been receiving therapies for five years without a firm diagnosis. I also know moms who do not want a diagnosis for their kids, and who receive services with a diagnosis of "anxiety disorder nos" or something else that is less stigmatizing than an autism diagnosis.  

[nixpix5]

Yes. This. Sigh.

 

You also described very well in the first paragraph how the system gets primed to expect negative events. I have seen this result In some extreme cases where the amygdala is so "overtrained" that fight. flight or freeze responses occur at minimal triggers.

It is also a feed forward system too because of these kids having primed nervous systems they are and appear more anxious and uncertain. Anxious and uncertain behavior results in less confidence and more socially "odd" behavior that makes people uncomfortable and want to avoid them. Avoiding said person makes them less confident and more anxious leading to depression. I mean it is just horrible. It is also hard to convince socially typical young people to truly befriend a person like this. People will be cordial or nice but these kids are looking for true connection.

 

As a counselor I cannot tell you how many of these kids spent lunch with me and told me they finally felt like they had a friend and could be themselves. It broke my heart so much. It was because I kept a poker face and let them get comfortable enough for their true authentic person inside to come out. These were nice kids with dreams and passions. Yet broken and depressed. Their nervous system was their own worst enemy :(

[Liz CA]

It is also a feed forward system too because of these kids having primed nervous systems they are and appear more anxious and uncertain. Anxious and uncertain behavior results in less confidence and more socially "odd" behavior that makes people uncomfortable and want to avoid them. Avoiding said person makes them less confident and more anxious leading to depression. I mean it is just horrible. It is also hard to convince socially typical young people to truly befriend a person like this. People will be cordial or nice but these kids are looking for true connection.

 

As a counselor I cannot tell you how many of these kids spent lunch with me and told me they finally felt like they had a friend and could be themselves. It broke my heart so much. It was because I kept a poker face and let them get comfortable enough for their true authentic person inside to come out. These were nice kids with dreams and passions. Yet broken and depressed. Their nervous system was their own worst enemy :(

 

 

Maybe I should PM you but it may be of interest to others:

Do you think treatment protocols similar to PTSD and other trauma could reverse some of this early programming? Coupled with some other modalities, I feel it may serve to "retrain" some of those responses and possibly intercept the HPA (Hippocampus, Pituitary and Adrenal/Amygdala) circuitry.

We know of the plasticity of the brain so maybe we should start there.

[Rosie_0801]

Maybe I should PM you but it may be of interest to others:

Do you think treatment protocols similar to PTSD and other trauma could reverse some of this early programming? Coupled with some other modalities, I feel it may serve to "retrain" some of those responses and possibly intercept the HPA (Hippocampus, Pituitary and Adrenal/Amygdala) circuitry.

We know of the plasticity of the brain so maybe we should start there.

 

Wouldn't that depend on whether that trauma was ongoing?

 

I haven't been able to wrap my head around the idea that you can cure ongoing trauma. We can't cure broken legs until they've finished breaking.

[Crimson Wife]

Maybe I should PM you but it may be of interest to others:

Do you think treatment protocols similar to PTSD and other trauma could reverse some of this early programming? Coupled with some other modalities, I feel it may serve to "retrain" some of those responses and possibly intercept the HPA (Hippocampus, Pituitary and Adrenal/Amygdala) circuitry.

We know of the plasticity of the brain so maybe we should start there.

 

I attended a very interesting talk by a professor in the UC Berkeley psychology program that included discussion of how "microdoses" of certain narcotics have been shown successful in treating PTSD in conjunction with psychotherapy. I am definitely not a fan of recreational drug use but am in favor of therapeutic use by legitimate mental health practitioners (not the Timothy Learys of the world).

 

[Liz CA]

I attended a very interesting talk by a professor in the UC Berkeley psychology program that included discussion of how "microdoses" of certain narcotics have been shown successful in treating PTSD in conjunction with psychotherapy. I am definitely not a fan of recreational drug use but am in favor of therapeutic use by legitimate mental health practitioners (not the Timothy Learys of the world).

 

 

Interesting. I had not thought of pharmacological therapies but in acute cases, it can definitely help get the person to a point to function enough to benefit from other modalities.

Did they mention what kind of narcotics?

[Crimson Wife]

Interesting. I had not thought of pharmacological therapies but in acute cases, it can definitely help get the person to a point to function enough to benefit from other modalities.

Did they mention what kind of narcotics?

 

IIRC, things studied include mushrooms, LSD, Special K, and Ecstasy. Here's an interesting article based on the PBS program NOVA.

[Liz CA]

IIRC, things studied include mushrooms, LSD, Special K, and Ecstasy. Here's an interesting article based on the PBS program NOVA.

 

 

Thank you!

I just remembered as I read this that I did read a study about some mushrooms alleviating severe migraine symptoms in some people. Judicious and well monitored use where beneficial should be studied more.

[Katy]

I attended a very interesting talk by a professor in the UC Berkeley psychology program that included discussion of how "microdoses" of certain narcotics have been shown successful in treating PTSD in conjunction with psychotherapy. I am definitely not a fan of recreational drug use but am in favor of therapeutic use by legitimate mental health practitioners (not the Timothy Learys of the world).

 

 

Yes, and I also heard about a study that a person is significantly less likely to develop PTSS (I think it's been changed from disorder to syndrome) if they are given even a small dose of an opiate between the trauma and falling asleep.  Something about the way the trauma is encoded in long term memory.

 

Thank you!

I just remembered as I read this that I did read a study about some mushrooms alleviating severe migraine symptoms in some people. Judicious and well monitored use where beneficial should be studied more.

 

Yes, microdoses of LSD and mushrooms work on the same receptors and can also treat cluster headaches and trigeminal neuralgia.  I know there was a study with Harvard and some university in Germany with trials of a new drug that targeted the same receptors without the trippy side effects, but I haven't heard the results.

[nixpix5]

Maybe I should PM you but it may be of interest to others:

Do you think treatment protocols similar to PTSD and other trauma could reverse some of this early programming? Coupled with some other modalities, I feel it may serve to "retrain" some of those responses and possibly intercept the HPA (Hippocampus, Pituitary and Adrenal/Amygdala) circuitry.

We know of the plasticity of the brain so maybe we should start there.

Yes. This is actually one thing my DH and I have been discussing at length as he works in PTSD research as well as TBI which goes hand in hand.

 

I often start treatment with kids coming from an angle of PTSD assumption when kids exhibit symptomology in this area. I also begin DBT right away as teens that are not self aware or more narcissistic in presentation just cannot seem to get to the level necessary with CBT. I also do a TON of narration therapy when necessary with kids who fall in this category but are not ready for DBT. Often rewriting their personal story away from victim hood is the only way to help venture out of that level of mindset.

 

We have ventured far off the path of autism and more into the sociopathic tendency here but I take this profile seriously and start actively working with the kid. I have worked with many teens I thought capable of being a shooter or who could do a terrible act.

Edited February 16, 2018 by nixpix5

[AimeeM]

Yes. This is actually one thing my DH and I have been discussing at length as he works in PTSD research as well as TBI which goes hand in hand.

 

I often start treatment with kids coming from an angle of PTSD assumption when kids exhibit symptomology in this area. I also begin DBT right away as teens that are not self aware or more narcissistic in presentation just cannot seem to get to the level necessary with CBT. I also do a TON of narration therapy when necessary with kids who fall in this category but are not ready for DBT. Often rewriting their personal story away from victim hood is the only way to help venture out of that level of mindset.

 

We have ventured far off the path of autism and more into the sociopathic tendency here but I take this profile seriously and start actively working with the kid. I have worked with many teens I thought capable of being a shooter or who could do a terrible act.

 

I'm not even close to being a scientist, so please bear with me here if I misread this (and your earlier posts in this topic). It's entirely possible that I'm combining your responses in a way they weren't meant to be combined, lol.

 

If an autistic person's brain is wired in such a way that "one trial learning" or "created event" is just how their brain processes situations (or upcoming situations), how is rewriting their past personal story a long-term solution?

 

Both our younger boys are autistic (and not high functioning). And both the "one trial learning" and the "created event" scenarios are very, very true in their cases -- but even if they are talked through a previous negative situation, the next just presents the same issue. 

 

For example, DS8 became lost in a very crowded Lego Land when he was about 5. He looked up from the soft play area he was in, and in that exact moment, taller adults blocked his view and he couldn't see me, Sissy, and Grandma. It was only for a moment, but my nephew had (just seconds before) told DS that we were going to get lunch. Nephew meant all of us, kids included, and he meant later (not that moment), but when DS couldn't see us for a second, he thought we'd left him. He took off to find us. The place was bottom-to-bottom and insanely busy. He panicked and just wandered around, unable to do anything but sob uncontrollably, until a worker eventually found him and we, luckily, ran into the worker while we tried to find him. 

He's almost 9 now and that event still haunts him. He talks about it and worries about it and tries to replay it in his head.

 

Similar for my almost 6 year old ASD kiddo. Over two years ago he sat on a public restroom toilet to potty, the toilet had an automatic flush which went off -- he leapt up screaming about rocket ships or similar, and at that same moment, a woman outside the stall turned on the hand-dryer, which prompted even more panic.

He went from completely toilet trained, to having meltdowns every time he needed to pee -- even after we moved him back into a diaper. He would shriek and run from room to room, trying to not urinate.

He is only, just now, urinating on a removed toddler potty. Over two years after an event that lasted only seconds. 

 

Again, though, these are reactions that happen with most negative situations the boys experience.

 

So would approaching it from a PTSD angle teach the autistic individual how to work through potential situations later, or would it only rewrite what has happened in the past?

[nixpix5]

I'm not even close to being a scientist, so please bear with me here if I misread this (and your earlier posts in this topic). It's entirely possible that I'm combining your responses in a way they weren't meant to be combined, lol.

 

If an autistic person's brain is wired in such a way that "one trial learning" or "created event" is just how their brain processes situations (or upcoming situations), how is rewriting their past personal story a long-term solution?

 

Both our younger boys are autistic (and not high functioning). And both the "one trial learning" and the "created event" scenarios are very, very true in their cases -- but even if they are talked through a previous negative situation, the next just presents the same issue.

 

For example, DS8 became lost in a very crowded Lego Land when he was about 5. He looked up from the soft play area he was in, and in that exact moment, taller adults blocked his view and he couldn't see me, Sissy, and Grandma. It was only for a moment, but my nephew had (just seconds before) told DS that we were going to get lunch. Nephew meant all of us, kids included, and he meant later (not that moment), but when DS couldn't see us for a second, he thought we'd left him. He took off to find us. The place was bottom-to-bottom and insanely busy. He panicked and just wandered around, unable to do anything but sob uncontrollably, until a worker eventually found him and we, luckily, ran into the worker while we tried to find him.

He's almost 9 now and that event still haunts him. He talks about it and worries about it and tries to replay it in his head.

 

Similar for my almost 6 year old ASD kiddo. Over two years ago he sat on a public restroom toilet to potty, the toilet had an automatic flush which went off -- he leapt up screaming about rocket ships or similar, and at that same moment, a woman outside the stall turned on the hand-dryer, which prompted even more panic.

He went from completely toilet trained, to having meltdowns every time he needed to pee -- even after we moved him back into a diaper. He would shriek and run from room to room, trying to not urinate.

He is only, just now, urinating on a removed toddler potty. Over two years after an event that lasted only seconds.

 

Again, though, these are reactions that happen with most negative situations the boys experience.

 

So would approaching it from a PTSD angle teach the autistic individual how to work through potential situations later, or would it only rewrite what has happened in the past?

I am sorry, I was once again typing free brain from an Android and was very unclear. I was not talking about Autism in terms of needing narrative or DBT. I was referring to those individuals that lean more toward being in the classification of antisocial/RAD/ODD/narcissistic....essentially those disorders that come about due to some level of ACES in their life (ie early life abuse, neglect, in utero insults, adoption history, and so forth). I was chattering away not realizing I wasn't being explicit. Partly because I was talking from a place of having a live breathing teen in my office with a laundry list of past diagnoses and family/environmental trauma that lends itself to the young person being self protective and not "others oriented". Narrative isn't a rewrite history but more reframing. It is finding the power in our own narrative even when it was horrible. It is not letting it shackle us anymore. We no longer carry our knapsack of garbage that we show to people to martyr ourselves but looking for the gems in the bag that have shaped us, moved us forward and we don't need to dwell on but learn from. That is simplified but it is powerful. I have seen it work on some extreme cases.

 

Autism is different. My son is also on the spectrum. I was jumping around so when I was talking about their ability to imagine what a situation will be like or how one poor outcome can lead to pairing and future issue with said thing, that was different.

 

With my son before going somewhere he is super excited about (for example, he is about ready to meet the 10th Doctor David Tennant soon) and he has an idea about how it will go. I sit and deconstruct his imagination with him. I might say "well, that might happen but what will happen if x,y or z happens? Then we talk through how would you feel? What would you do to get unstuck? That sort of thing. We have done this for years and he is so much more flexible now. I literally have to say "so how will you feel if he looks older, has shorter hair, doesn't have his brown coat..." because I know in his brain this is what he is picturing and he will get stuck.

 

I completely get your experience. I would happily walk you through some trouble shooting if you pm me. Not many people think about Autism the way I do. Much of this is based in my own research and work with kids on the spectrum. We too had the toilet flush/hand dryer incident too. It took ages to overcome that one.

 

Right now my son gets ill when he sees men with curly hair. Not super short curly but lots of curls. He turns three shades of white and dry heaves. Same thing if it is women with short curly hair. We have no idea why so we are reprogramming him through exposure therapy lessons. It has gotten way better this last week because I ordered a short curly wig and will wear it for intervals. Sounds silly but much like PTSD, avoiding the association solidifies it and makes it worse. It is really just an extreme anxiety so exposure therapy therapy works well. We typically start with visualization and pictures and work up in baby steps.

 

One way autism and PTSD are similar though is that in PTSD a huge insult event primes the nervous system to be highly reactive as a survival mechanism. Kids on the spectrum exist with their nervous systems primed like that so when what seems like s minor event happens, their nervous system reacts as if in survival mode. Heightened senses can be so overwhelming. Super sonic dog hearing, eye for minute details, and a smell/touch/taste response that pairs ill feelings with permanent avoidance for survival. Constant ptsd essentially.

 

Was that any clearer? This is so much easier in person ;)

Edited February 17, 2018 by nixpix5

[jewellsmommy]

In regards to treatments/therapies...

 

I have seen neurofeedback be at least moderately effective in different situations to include milder attachment problems and PTSS/trauma.

[Liz CA]

Just wanted to add to nixpix5's post that exposure therapy sounds almost cruel in some cases - or it did to me until I heard from a soldier how the VRT (virtual reality therapy) helped his PTSD. Soldiers are hearing sounds and seeing visuals from the same area where the traumatic incident occurred. Gradually even smells can be added to the experience. As weird as it may sound, reliving it and reframing it while knowing they survived has evidently great potential in PTSD treatment. VRT is always done while the therapist is nearby and can stop the experience if the patient gets overwhelmed. Many therapists have the person talk through the incident as they are experiencing it via VRT. Vitals are monitored and somewhat similar to EMDR, the clinician can reroute immediately when necessary.