Tag Archives: Autism

Dropping the Mask: Does it Take a Diagnosis? #TakeTheMaskOff

Today, the theme for #TakeTheMaskOff is diagnosis or self-discovery and its effects on masking. This is applied mostly to the experience of being autistic, but I can relate to it from a trauma survivor perspective too.

I haven’t yet read any of the other contributions for this week, but I assume the idea behind this challenge is that discovering you’re autistic, either through professional diagnosis or not, can help you drop a facade.

This is definitely true for me. When I was first diagnosed with autism in 2007, my staff claimed that I was using it as an excuse, because I reacted more to for example loud noises than I’d done before diagnosis. Similarly, my parents claimed that I was over-protected by the staff who felt I’m autistic and this led to my psychiatric hospitalization in November of that year.

To be honest, yes, I may’ve started to use autism more as an explanation for my behavior once I was diagnosed than I did pre-diagnosis. Note that I say “explanation”, not “excuse”. I don’t feel I need an excuse to act like myself, unless acting like myself were harming other people. Saying that we use autism as an excuse for our behavior is really saying that we should conform to non-autistic standards of behavior at any cost. Autism is an explanation for why I can’t conform to these standards, but even if I could, that doesn’t mean I should.

Then again, once my autism diagnosis was taken away in 2016, I did feel like I needed an excuse. And so did many other people. I was kicked out of autism communities that I’d been a valued part of for years. Suddenly, I’d been faking and manipulating and “acting autistic-like” all those years rather than just having been my autistic self. One Dutch autistic women’s forum’s members and admins were notorious for spinning all kinds of theories on why I’d been pretending to be autistic all those years and had finally been unmasked.

<PAnd at long last, I started to believe these people. I started to believe that self-diagnosis may be valid for other people, but it isn't for me. I started to wonder whether my parents were right after all that I'd been fooling every psychologist and psychiatrist before this one into believing I'm autistic.

This process of self-doubt and shame led to my first real episoede of depression. After all, if I’m not autistic, why did I burn out and land in a mental hospital? I’d been diagnosed with dependent personality disorder by the psychologist who removed my autism diagnosis, so were my parents right after all? I suddenly felt like I needed an excuse to act autistic-like, as if being autistic is indeed less than, not just different from being neurotypical.

I sought an independent second opinion and was rediagnosed with autism in May of 2017. I still am not cured of the idea that it takes a professional diagnosis to “excuse” a person from acting non-autistic. I don’t apply this to other people, but I do still apply it to myself and that’s hard.

I originally posted this to my other blog. I use that blog to counteract this self-stigmatizing attitude. This, after all, also applies to my status as a trauma survivor. I got my autism diagnosis back, but I never got and most likely never will get my trauma-related diagnoses back. I still mask, hiding my trauma-related symptoms when I can. And that’s not usually hepful in the long run.

#TakeTheMaskOff: What Is Masking?

Today, rather late, I found out about the #TakeTheMaskOff campaign designed to promote autism acceptance and awareness of the effects of masking. I really want to participate, so even though it’s incredibly hot here, I’m writing a post.

The campaign consists of six consecutive weekly themes about which participants blog, vlog or post on other social media. The first weekly theme is “What is masking?”

Masking, put simply, is pretending to be something you’re not. This can be done either consciously or uncnsciously. Many autistic adults have learned to mask so well it’s almost second nature. We’re also encouraged to mask on a daily basis when people judge us about being autistic. Then when we mask successfully, we’re told we don’t look autistic.

For example, I’m often told that I don’t appear autistic. After all, when I hold a conversation, I appear pretty “normal”. I am told I can hold down a reciprocal conversation that doesn’t sound stereotyped or like I’m scripting. I ask people about their interests, for example. Now that it’s been extremely hot here for a few weeks already, I have even mastered some smalltalk about the weather.

This obviously (to me) does not mean I’m not autistic. Autism, despite what many people think, is not about social niceties. Autism is not the same as a lack of interest in others. Besides, I have 32 years of experience being told how selfish I am for not appearing to show an interest in others. So instead of showing a genuine interest in the people and topics I’m genuinely interested in, I learned to appear to be interested in whatever and whoever I am supposed to be interested in. In other words, I learned to mask my autistic curiosity.

For example, I was eleven when my mother told me I might be institutionalized if I didn’t become more age-appropriate. My having too many toys and dolls, according to her, contributed to my challenging behavior and I was to get rid of them. Instead, I was supposed to develop an interest in music. I wasn’t all that sophisticated at the time, so rather then developing a genuine-appearing interest in music, I hung Backstreet Boys posters on my wall.

Similarly, I was encouraged to wear jeans rather than sweatpants even though jeans were a sensory nightmare to me. It was assumed that I wore sweatpants because I didn’t care about my appearance – which is partlty true – or because I, being blind, didn’t know that my peers were wearing jeans.

Masking can become so internalized, apparently natural, that you no longer notice you’re doing it. For instance, I wear jeans without a problem now.

It is easy to assume that, because the autistic person no longer notices that they’re masking, it must not be affecting them. This often leads to the assumption that, if someone doesn’t appear autistic and isn’t acting out, they must not be autistic after all. Then people go on to assume that, if said neurotypical-appearing person does act out, it must be “manipulativeness”.

I am, however, definitely masking when I wear jeans, or listen to my husband’s favorite radio station in the car, or engage in smalltalk about the weather or someone’s upcoming vacation. It isn’t always a negative thing, but it is still masking.

#WeekendCoffeeShare for June 3, 2018

Welcome to this week’s #WeekendCoffeeShare. I’m a little late this week, as yesterday my husband and I spent most of the day at my in-laws and I didn’t have my computer or external keyboard for my phone with me, so I could barely type. So grab a cup of your favorite drink and sit with me as I write about this week. I’ll have a cup of green tea instead of coffee even though it isn’t terribly late here yet.

On Saturday last week, I finally went onto the scale again. I hadn’t weighed myself in a few weeks. As I feared, I had gained weight, but even more than I expected. I’d gained 2kg. I was so angry with myself. I mean, yes, we’d eaten pizza three evenings that week, but that couldn’t possibly explain such a huge weight gain. My husband tried to reassure me, saying I was probably constipated. This may be so, as the next day I’d gained another 800 grams. Tomorrow marks one year since the start of my weight loss journey and I’m afraid I will not reach my goal of having a BMI under 30. Then again, last January, I did reach this goal already and stayed at that weight all through early May.

On Sunday evening, the Center for Consultation and Expertise (CCE) coordinator E-mailed me and my support coordinator. As we’d had the meeting with her on the 15th of May, she’d planned on discussing my case on the following Monday but hadn’t realized this was a bank holiday. She had eventually discussed me with her colleague and had decided to ask a consultant to focus assessment on my needs and wishes rather than on a diagnosis. On Tuesday, she E-mailed us again to let us know she’d found a suitable consultant and we’d be contacted again to set an appointment for a first meeting.

My support coordinator had also inquired about getting long-term care funding for me. Whether this is possible, depends on whether my blindness is the primary reason for my care or my mental health or autism. If it’s blindness, I may get long-term care funding, whereas if it’s autism or mental illness, I definitely won’t. Long-term care funding would enable me to move to supported housing for the disabled or get more support while living with my husband.

On Thursday, I had my first session of dialectical behavior therapy (DBT) with my new nurse practitioner. DBT was originally developed for treating people with borderline personality disorder (BPD). It’s usually group therapy. Though I do have BPD traits, I’m also autistic, which means that group therapy would be hard for me. I therefore do the DBT individually. I had already started DBT with my community psychiatric nurse, who left recently. My nurse practitioner, who took over from her, proposed to start at the beginning of the therapy manual again. We only managed to work through the first page, which details the goals of DBT. There are four skills domains on which I’ll work: mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance.

I also realized as I was talking to my nurse practtitioner how angry I still am at the psychologist from the institution who kicked me out almost with no after care last year. My nurse practitioner did the intake interview for this team with me last year and mentioned how he and the psychiatrist got a totally different impression of me than said psychologist had painted. The psychologist had diagnosed me with dependent personality disorder for claiming care I supposedly didn’t need. She removed my autism diagnosis. The nurse practitioner and psychiatrist saw pretty soon that I’m not dependent at all. Yes, I need a lot of support, but that’s due to my disabilities (including autism), not low self-esteem. In fact, I just realized how this psychologist had in fact broken my self-determination. I don’t feel safe to ask for help much now and am a lot more passive than I was when I had this dependency diagnosis. My nurse practitioner validated my feelings, in fact saying that the reason for the CCE involvement is in part the poor after care this psychologist had arranged for.

On Friday, I went adaptive horseback riding again. Angie, my horse, was scared of a car passing by and attempted to go on the run while I sat on her back. This was terrifying. Thankfully, I managed to keep seated on her back. She was quickly calmed down again, but I was shocked for a bit aftwards. So was the girl who held the horse. Thanfkully, the instructor always walks beside my horse because of my blindness, so the girl wasn’t on her own. I still had fun horseback riding.

I’ve yet to think of what I want for my birthday at the end of the month. I will have to look at sensory toy shops for inspiration. I’m also thinking of starting up the soap making craft again, so maybe I’ll ask for supplies for that.

What have you all been up to this past week?

Sensory Processing Issues: Touch

Today, I listened to a Dutch video about sensory processing and creating a sensory valuable environment for clients with challenging behavior due to sensory processing issues. As I may’ve shared, the Center for Consultation amd Expertise (CCE) coordinator asked whether I’d ever had a sensory integration assessment. I haven’t and figuring out my sensory needs by myself is really tough.

It doesn’t help that I have little memory of my sensory needs growing up. As you might know, my parens don’t believe I’m autistic, believing instead that I choose to misbehave out of a will to manipulate. As such, I cannot ask them (particularly my father) to provide insights into my sensory needs. As the video presenter didn’t say whether sensory needs can change over time, and I am unsure about my childhood, I do not know whether my needs are valid.

After finishing the video, I read The Realistic Autistic’s post on touch-based sensory processing issues. This was really insightful. I could relate to a lot of the issues Sarah, the post author, describes. For example, growing up, I do remember hating the seams in socks and possibly the tags in clothes too. Now that I’m an adult, I don’t experience this issue that much anymore.

Like Sarah, I also prefer deep pressure to light touch, but I don’t have a problem with light touch usually when I’m okay mood-wise. Unlike Sarah, I’m more sensitive to cold than to heat.

One particular aspect of touch that Sarah didn’t touch on (no pun intended), is the experience of tactile stimuli in the mouth. I seem to have a lot of issues with this and always have.

In some respects, I seek extra stimulation in this sense. As a child, I’d very often chew or suck on my clothes and, later, my hair. I still chew on my hair on occasion (though, having had a haircut a few weeks ago, I no longer can).

On the other hand, I hate the feel and taste of teeth-brushing, particularly with toothpaste. I couldn’t stand brushing my teeth with toothpaste until I was eighteen and even now, I want it over with quickly.

What I also notice is that, if I have control over the stimulus, I may seek out more stimuli or avoid them less than when others impose them on me. For instance, Sarah talked about the issue of having a haircut. I hate this. Interestingly though, hair-twirling is one of my main stims.

In the Dutch video, it was mentioned that between eleven and thirteen million stimuli get to our brains each second. Most are immediately filtered out, but roughly 4,000 are processed on some level. For this reason too, the presenter said eliminating all stimuli is not possible. I find that sometimes adding a stimulus will help me deal with overload. For example, I recently discovered some weighted stuffed animals at day activities. These provide a form of deep pressure that helps me feel calmer when overstimulated.

Keep Calm and Carry On Linking Sunday

Play

And I didn’t continue with the #AtoZChallenge after all. Now I could write my Q post today and just have enough time to get to Z on April 30, but I have no clue what to write about that starts with Q. Besides, I’d just be too behind. I will continue with random reflections whenever I can, but I’m tiref of sticking to the alphabet. At least, the challenge so far taught me that I can, in fact, write a blog post almost everyday.

A few minutes ago, I looked at the friendly fill-in questions for this week. I’m not inclined to join in with the thing in a traditional way. However one of the prompts stuck out to me. It was: “When I was a child, I loved to play ___”. Today, I’m going to write about the joys of playing as a child (and as an adult, too).

As regular readers know, I’m autistic. However, when I was a toddler, I wasn’t the type to line up my toys. In fact, at about age three, I had three PlayMobil figures called Pekel, Foet and Laren. No, these aren’t common Dutch names. The characters would just eat, drink and go to the toilet. Nothing too interesting but nothing too stereotypical either.

I also loved to play outside. I loved the swings in particular. When we were on vacation at the campsite, I’d also climb a tree. I wasn’t as adventurous as my sister, but I nonetheless enjoyed getting outdoors.

One other memory that stands out is my learning to rollerskate at aroudn age eight. My next door neighbor, who was the same age as me, used to teach me and my sister and a bunch of other girls (and a few boys). It was fun until I realized how I, being legally blind, wasn’t able to keep up. Once I was about twelve, I eventually learned to rollerblade too. That too didn’t last long, as my vision became too poor.

My sister and I would play with dolls too. I’d often make up the stories. Like, we were going on vacation to Suriname with the dolls, because, you know, my sister’s doll was brown. Though I showed some level of imagination – more so than my neurotypical sister -, I could be quite controlling. For example, I’d get upset whenever my sister said “said the doll” after a sentence that the doll supposedly said.

I continued to play with dolls and Barbie dolls until I was around fourteen. By the time I was thirteen and about to transfer to mainstream school, I decided I really needed to stop playing. However, I didn’t know what else to do. Once my computer and eventually the Internet took my interest, I hardly ever played anymore.

As an adult, I had a time when my inner child parts were particularly active and I’d even buy Barbie dolls for them. They however usually enjoy stuffed animals. I still sleep wth a bunch of stuffies on my bed.

Neurodiversity: What I Like About My Neurodivergence #AtoZChhallenge

Welcome to day 14 in teh #AtoZChallenge. Phew, I completed half the challenge already. Today’s letter is N and my word for today’s post is “Neurodiversity”. Neurodiversity is the concept whereby people with different neruologies, such as autistics, are still equal. People who support neurodiversity value autism and other similar conditions as neurological variations rather than disorders.

I for one appreciate neurodiversity. I am not a radical supporter, as I do see autism and such conditions have clear disadvantages. However, I support the social model of disability in this respect. As such, I see autism as a disability, not just a difference, but not a disorder either.

I am neurodivergent. I am formally diagnosed autistic and self-identify with a couple other neurodivergent conditions. Today, let me share what I like about my neurodivergence.

First, I like my ability to perseverate on things I truly feel passionate about. I do not have one special interest that I’ve had for life. Rather, I’ve had many over the course of my lifetime. However, when I have a special interest, I can really be passionate abut it. Unfortunately, I don’t have one now.

On a similar note, I like my ability to hyperfocus. If I want to get information about something, I will fully dive into it. For example, when my husband and I were discussing moving out of area, I had no trouble comparing all the community care policies for the different cities we were thinking of moving to.

I like my “splinter skills”. This is what professionals call areas in which autisitc people have a lot of knowledge that is out of line with their general intellectual ability. Though my general intellectual ability is above-average already, my calendar calculation skills at least used to be far better. They’re not as good now, unfortunately.

What special talent do you possess?

Emotions: Dealing with Emotion Regulation Issues #AtoZChallenge

Welcome to day 5 in the #AtoZChallenge of random reflections. For my letter E post, I focus on emotions. In this post, I’ll explain what it is like living with emotion regulation issues and how dialectical behavior therapy helps. Both I and my treatment team prefer the term “emotion regulation difficulites” over “borderline personality disorder traits”, as my emotion regulation issues are likely in part due to my autism. Also, borderline personality disorder is very stigmatized. Now I know the solution to that is not to avoid the term, but I do feel I’m not the “classic” borderline.

First, I have difficulty understandign my own emotions. This is called alexithymia and is relatively common in autistic people. I can usually tell whether I’m feeling “good” or “bad”, but not whether “good” is joy or love or “bad” is anger, sadness, etc.

I feel “bad” far more often than I feel “good”. This may be because I suffer with depression too. I however tend not to express my depression as sadness. Rather, I express all “bad” feelings as irritability. Over the years, I have gotten slightly better at knowing when I’m genuinely angry and when it’s another feeling that I express as irritability.

In dialectical behavior therapy (DBT), the treatment I follow for my emotion regulation difficulties, we learn to counteract emotions by acting opposite to how the emotion “makes” us act. For example, one skill that I’m trying to practice is to half-smile, accepting the situation as it is even if I don’t like it. I initially thought that acting opposite to emotion was acting cheerful whenever a cheerful mood was expected. For example, I’d greet my husband enthusiastically when he’d come home even though I still felt like crap. Now I know that you’re not supposed to “fake it”, but that acting opposite from your initial impulse might help you achieve your goals. For exaple, if I feel like crap and want to stay in my room all the time, it may be more effective if I reach out to my husband instead.

Dialectical behavior therapy also teaches me about the misconceptions about emotions I may have. One of them is that some emotions are just stupid and shouldn’t be felt. Another is that emotions come up for no reason at all. In fact, emotions all happen for a reason and as such have value. Now that I write this, I realize this is the strongest argument against fake cheerfulness. It is important to acknowledge an emotion without judging it, but also without dwelling on it too much. Mindfulness, as such, is the first skill of DBT.

Day Activities: Why Do I Seem to Have High Support Needs?

Yesterday, I had a meeting with my day activities and home support staff, my comunity psychiatric nurse (CPN) and the social consultant (local authority person who decides on care funding) in charge of my case. My mother-in-law also attended. The reason for the meeting was my trouble functioning at day activities.

I go to a day center for people with intellectual disabilities and attend a group within the center for people with severe intellectual and multiple disabilities. I don’t have an intellectual disability, but did seem to do best at this sensory-based group up until recently. Then, three new service users joined us, leading to increasing stimulation, stress and staff workloads. I was increasingly overloaded and irritable, which led to the staff cutting my hours because they couldn’t deal with me on top of the other high-support service users for a full day.

The problem is there’s no clear-cut diagnosis to back up why I function best at a low-stress, sensory-based, high-support group. I mean, yeah, I’m blind, but most people who are blind can work regular jobs. Yeah, I’m autistic, but only diagnosed with autism spectrum disorder level 1 (ie. “high-functioning” autism or Asperger’s Syndrome). Yeah, I have mild motor impairments, but my doctor doesn’t know or can’t tell me to what extent they’re diagnosable (as mild cerebral palsy or something else). Yeah, I have mental health issues, but no-one has a clue to what extent these affect me and what they’re even diagnosable as.

As a result, some professionals and non-professionals choose to deny I have high support needs and tell me it’s all dependence, manipulation or attention-seeking. I was lucky that, with one of these professionals being my former psychologist who got me in touch with my current day center, the day center staff and management were up until recently more than willing to accomodate me. For instance, I started day activities at the industrial group at this center, but was soon moved to the sensory group despite, like I said, not even having an intellectual disability, let alone a severe one.

Now that I’m even falling apart at this group, I hear different opinions on where to go from here. At one point, my home support coordinator said maybe the gap between myself and the other service users at the sensory group is too wide, so we need to look at a different kind of place, like a sheltered art shop. I disagreed and not just because my art-making skills are mediocre at best. At more “job-like” day activities places like this, there’s usually more pressure and less support. My day activities staff agreed, adding that I’d tried the industrial group already.

My CPN’s coworker suggested a care farm. As much as I love animals, I know I won’t even be able to navigate a farm without a sighted guide, let alone care for the animals without one-on-one. My mother suggested I look for day activities tailored to the blind. These don’t exist in my area. Besides, I could barely function at the leisure groups at the blindess training center I attended in 2005. My mother said I may be able to now, but I think it unlikely. These places expect a level of independence I don’t have. I mean, I’ve seen my partially sighted friend make soap completely independently after being instructed by me just once, while I still need practically hands-on support after many attempts.

I’m on the verge of crying as I write this. I completed grammar school, for goodness’ sake! Granted, I burned out the minute I left, but I did it nonetheless. Why can’t I even function at a group where people with profound intellectual disabilities can? Or am I really one giant dependent, manipulative, attention-seeking waste of resources?

My CPN is going to contact the Center for Consultation an dExpertise on me. In 2010, they were briefly involved in my case. The consultant wrote in her report that she thinks it’s weird that I’m so cognitively capable and yet cannot do simple activities of daily living such as prpearing my own breakfast. She also wrote something in the report about not knowing whether I’m eliciting care. In other words, she couldn’t say whether or not I’m just one giant dependent, manipulative, attention-seeking waste of resources either. Sigh.

Cuts to My Day Activities Hours

And again I really didn’t get to write as much as I’d like to have done. The past week was quite busy. I had my first session of movement therapy on Tuesday and a meeting with my nurse on Thursday. Actually, I would’ve had a session with my CPN, but she’s off sick. I was so grateful that my nurse asked whether I wanted an appointment with her instead, as I really needed to talk.

I’ve not been doing well lately. I’m very irritable and easily overloaded. I switch a lot between being completely in my “rational mind” and feeling terribly emotional. I try to use my DBT skills, of course. Not that I’ve come far on the formal DBT course I do with my CPN, but I’ve been doing it by myself. I do an okay job when I’m not overwhelmed, but once overwhelmed, all my skills go out the window.

I mostly find that I can’t handle this huge, gaping split between my (verbal) IQ and my emotional, practical and behavioral functioning. At day activities, this is becoming more and more problematic. The staff are telling me that my irritability upsets the other clients, who are “like a baby” and can’t understand. I tell them that I don’t understand stuff myself, either, but because I’m not intellectually disabled, I should somehow be able to be more capable.

Because I’m too much of a handful, my day activities are being reduced. I won’t get additional home support in exchange. This upsets me greatly. It feels as though, when I need more help the most, I’m punished for it by getting less. Again, the main reason is my IQ, because other people with significant behavioral challenges at my day activities, get more care.

“We don’t do psychiatry.” That’s my day activities staff’s reasoning for cutting my hours when I’m too irritable. The other staff even mentioned finding me another place to go. I don’t know where. I mean, day activities for mentally ill people cater mostly to those with psychotic disorders. I have experience with that and I run into the same crap I get here there. After all, people with schizophrenia can’t help reacting to their voices either.

For clarity’s sake, I’m not saying that people with severe intellectual disabilities or those with actively psychotic schizophrenia should just be able to hold it togehter. I know they can’t, but I can’t always hold it together either.

I know my staff try their best. The staff who decided to cut my day activities hours, got angry when I told her they’re expecting too much out of me. I know she’s never worked with a person of at least average intelligence who still has signiificant sensory issues and challenging behavior. I know the manager probably told her to prioritize her main focus group, ie. those with severe intellectual disabilities. It’s interesting that she refers to the other clients as “the clients”, not “the other clients”, when she talks to me.

However, I can’t keep from being reminded of all the great lengths to which the staff go to accommodate their other clients with challenging behavior. For one person, a staff goes to his group home to provide him day activities one-on-one. Two at my group get several hours of one-on-one too. I don’t ask for that, but I don’t ask for the other extreme, ie. being cut off my hours, either.

Attachment Disorder vs. Autism: An Overview and My Personal Experience

I am currently reading the book A Guide to Mental Health Issues in Girls and Young Women on the Autism Spectrum by Judy Eaton. I’m only halfway through the second chapter and it’s so incredibly validating. The book talks about misdiagnosis and co-occurring diagnosis of many psychiatric conditions in autistic girls and young women. I can relate to so much of it.

One concept that I found resonated particularly with me was “secondary misdiagnosis”. This refers to a situation where, while a woman was diagnosed as autistic initially, somewhere along the way, her diagnostic records “disappear” and she is rediagnosed as something else. Yes, that’s me! The book has a UK-based focus and I have been told quite often that, in the NHS, your records automatically move where you go. This is not the case here in the Netherlands: you have to transfer them yourself. Apparently though, in the UK, records can disappear too.

In the second chapter, the author discusses misdiagnosis of autistic girls as having an attachment disorder, disruptive behavior disorder or (emerging) personality disorder. Today, I will talk about attachment disorders.

In August of 2016, I demanded an independent second opinion on my autism diagnosis, which my psychologst had removed, for the first time. My psychologist told me she’d set things in motion, but would have to consult with the brain injury unit’s psychiatrist first. After all, my having sustained a brain injury shortly after birth was her primary reason for removing my autism diagnosis. As she returned, the weirdest diagnostic process I’ve ever seen, emerged: she started negotiating diagnoses with me. She said she was willing to diagnose brain injury-related personality change instead of the personality disorder she’d initially diagnosed me with, generalized anxiety disorder and an attachment disorder. I took time to think and eventualy ignored the attahment disorder thing, while reluctantly agreeing to the rest. We still used DSM-IV, after all, where you have to have endured “pathogenic care” to be diagnosed with attachment disorder.

In DSM-5 and the newest edition of the ICD, which was published in 2016, your early childhood still has to have been less than ideal, but the criteria leave room for milder forms of less than optimal care, such as your parents not having been very nurturing. I guess in my case, even with perfect parents (which I don’t have), my premature birth and three months in the hospital would suffice for the current “inadequate or inconsistent care” criterion for reactive attachment disorder.

However, the criteria for RAD say that the child cannot be diagnosed with it if they have an autism spectrum disorder. I understand this doesn’t mean autistic children and adults do not have attachment issues, since I for one do. However, when someone is diagnosable with autism, they cannot be diagnosed with RAD too. In other words, my psychologist ought to have ruled out autism – which she did a pretty poor job of doing – before trying to label me with RAD.

There are several features of attachment disorder that overlap with autism and particularly with pathological demand avoidance. For example, children with attacchment disorder as well as those with PDA can be superficially charming (in order to get what they want), indiscriminately affectionate with unfamiliar adults and inaffectionate with primary caregivers. Both are often defiant or manipulative. They also both can be controlling or bossy. Children with RAD are however more likely to be cruel to animals or other people or destructive towards property. They often show a preoccupation with such things as fire, blood, death or gore. Autistic children as well as those with RAD may avoid eye contact, but RAD children do make eye contact particularly when lying.

Judy Eaton outlines several distinguishing features between autism and attachment disorder. In the ICD-10, the following are mentioned:


  • Children who have a reactive attachment disorder will have the underlying ability to react and respond socially.

  • When abnormal social reciprocity is noted in children with reactive attachment disorder, it will tend to improve significantly when the child is placed in a more nurturing environment.

  • Children with reactive attachment disorder do not display the types of unusual communication seen in children with autism.

  • Children with reactive attachment disorder do not have the unusual cognitive profile often observed in children with autism.

  • Children with reactive attachment disorder do not display the types of restricted interests or repetitive behaviours seen in children with autism.

I definitely see how I have attachment issues. I am usually more open to strangers than to my own parents. Particularly as a teen, I’d also direct most of my aggression towards my mother. I could also be quite defiant. I however also definitely have communication oddities, repetitive behaviors and restricted interests and an unusual cognitive profile. I never “recovered”, though that could be blamed on the fact that I lived with my apparently inadequate parents till I was nineteen. Or it could be that I’m autistic.