Tag Archives: Social Skills

Autism and Friendship #Write31Days

Welcone to day one of #Write31Days for 2017. This month’s theme on my blog is autism. One of the most characteristic impairments in autism, at least according to diagnostic criteria, is an impairment in social interaction skills. In DSM-IV, the diagnostic manual under which I was originally diagnosed, failure to develop peer relationships appropriate to developmental level was one of the impairmetns under the social interaction deficits criterion. “Peer relatioships” refers mostly to friendships, though I reckon it can refer to romantic relationships in adolescents and adults too. Today, I will discuss how autism impaacts my understanding of friendship.

Many years ago, I read an article by famous autism expert Tony Attwood on the topic of development of friendship skills. A typically developing child starts to develop friendship skills at around age three. They realize that friendship requires some level of turn-taking but their approach to this is egocentric, based on for example sharing of material goods or playing together. When someone asks why a person is the child’s friend, the child at this stage would typically respond: “Because they live next door.”

Children between age three and six are typically at this level. Autistic children (and in a way even adults) typically remain at this level longer. When I was nine, for example, I’d consider someone a friend because they gave me candy. Admittedly, I’m still at this level in a way, though I realize this is inappropriate. For example, when my now husband said that he was in love with me, I wasn’t sure whether to reciprocate it, since I didn’t know whether I liked him just because he was the only one who’d visit me in the psychiatric hospital. Also, I still can’t sem to move away from materialistic aspects of friendship like sharing candy.

At around age six, typically developing children move into the next level of friendship skills, which is based on shared interests and games. When asked why someone is a child’s friend, a child at this stage would say: “Because they let me play the games I want to”, “Because they’re nice to me”, etc. I relate to this level of friendship too.

Another criterion of autism in DSM-IV was lack of social reciprocity. This means that an autistic person doesn’t understand age-appropriate rules of give-and-take. Many autistic people can come across rather self-centered. So do I. For exampel, I rarelys hared candy (here we go again!) in the institution, even thoug I did accept it from others when offered. Give-and-take, however, seems not just based on material things and there aren’t many clear-cut rules for it.

I have a rather literal interpretation of reciprocity: when my husband, for example, gives me something, be it material or immaterial, I have to give him the same back. As such I feel extremely bad about being dependent on my husband for many things, like transportation, food, etc. He says that I give him love in return, but I barely understand the concept of love.

Avoidant Personality Disorder (AvPD) #Write31Days

31 Days of Mental Health

Welcome to day 16 in the 31-day writing challenge on mental health. I am still tired and a lot is on my mind today. Still, I am resuming my writing on personality disorders today. After we’ve discussed the cluster B personality disorders (well, all except for borderline personality disorder, since I’ve discussed that a lot before), it’s now time to move on to cluster C. (I will discuss the personality disorders in cluster A after I write about psychosis and schzophrenia later this month.) People with cluster C personality disorders are predominately anxious or fearful. The most well-known personality disorder in this cluster, which I’ll discuss today, is avoidant personality disorder.

Avoidant personality disorder (AvPD) referst o a pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to criticism. People with AvPD meet four or more of the followign criteria:


  1. Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection.

  2. Is unwilling to get involved with people unless certain of being liked.

  3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.

  4. Is preoccupied with being criticized or rejected in social situations.

  5. Is inhibited in new interpersonal situations because of feelings of inadequacy.

  6. Views self as socially inept, personally unappealing, or inferior to others.

  7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.


Individuals with avoidant personality disorder avoid work, school or other activities that might lead them to be embarrassed or criticized. As a result, they often live an isolated life. When they do engage in social interacitons, they are often hypervigilant to the actions of others. This may in turn elicit criticism or ridicule, which then worsens the AvPD sufferer’s hypervigilance. For clarity’s sake: AvPD sufferers do want to have friends and often feel extremely lonely. The problem is they feel too anxious to attempt to make friends.

Avoidant personality disorder occurs in 2.4% of the population. It commonly co-occurs with social anxiety disorder (social phobia). It is not clear in fact whether social phobia and avoidant personality disorder are distinct conditions or essentially fall on the same spectrum.

Avoidant personality disorder may also co-occur with or be confused with panic disorder with agoraphobia, major depression, or dependent personality disorder, which I’ll discuss later on. It is often confused with autism spectrum disorders. After all, people with AvPD, especially if they already had social phobia when growing up, may have developed social skills problems because of their lack of involvement in social situations.

Loneliness in Autistic People #AtoZChallenge

Welcome to day twelve in the A to Z Challenge on autism. Sorry for being late to publish my post again. Today, my post deals with a common experience in autisitc people: loneliness.

Autistic people by definition have trouble forming friendships, especially with non-autistic people. For this reason, many autistic people feel isolated and lonely. I am no exception. Other than my husband, I have no close friends, though I have a ton of Facebook friends. Most I don’t really know.

in adolescence particularly, I felt lonely. I remember writing in my diary a month into starting secondary school that I realized everyone had built friendships already and I hadn’t. In elementary school, I had usually had one or two friends, though I had trouble interacting with them too. Most of my elementary school friends were themselves quite isolated too.

It is a myth that autistic people are not affected by loneliness. In fact, many adults with autism experience depression and low self-esteem because of their lack of quality friendships. However, depression and anxiety also commonly cause autistic people to feel lonely and to self-isolate. I, for one, did not attempt to socialize anymore after I realized I clung too much to peoople who didn’t in fact considier me a friend. By the end of eighth grade, I was seemingly fine with the fact that I had no friends, but was actually quite depressed.

Even autistics who do have friends, can feel lonely. This is because autistic people have a different perception of friendship than neurotypicals. For example, neurotypical people usually associate friendship with affection, companionship and intimacy. Autistic people often don’t experience these qualities, or experience them to a lesser degree, in their friendships. They may therefore be lonely because of having a poorer quality friendship. For example, I sometimes refer to some of my Facebook friends as actual friends in conversation, but I recognize that the relationship I have with them is not as close as that of other people with their friends.

There are many ways to cope with loneliness. For example, autistic people might want to connect to other autistic people. There are play groups for autistic children and social and support groups for teens and adults with autism in most urban areas. This not only will help autistic people connect to others, but they wil also be able to find someone whose experience is similar to theirs. Hence, they may feel less disconnected from their environments, which can also be a form of loneliness.

Of course, it is also important that autistic people develop their interpersonal skills. In the Netherlands, many mental health agencies provide specific programs for adults with autism, where they can also follow social skills training. This may help them build and keep friendships and thereby lessen loneliness.

Lastly, many autistic people find that pets can help them feel less lonely. I for one don’t have a particularly close connection to our two cats, but that is possibly because they’re at our apartment, where my husband primarily cares for them.

Defining Myself

One of the March writing prompts on the SITS Girls site is “what defines you?”. I could write an essay on this, and in fact, in 2002, I did this in response to the “defining yourself” prompt on a disability website I visited at the time. I wrote an essay on the ways in which I was different from most other people: being blind, being in the intellectually gifted range and (I thought at the time) being a lesbian.

I no longer identify as a lesbian obviously, but the other minority statuses still apply to me, and so do many more. I am autistic, mentally ill, unemployed, etc.

Do these minority statuses truly define me? I don’t think so. Rather, I think I am defined by the core of my personality. Having a poor self-image makes it hard to define myself as such, but I will try.

1. I am intelligent. I don’t like my intelligence in a way. I embrace my giftedness as a minority status, although to be honest I don’t think I’d like to be part of elitist high IQ societies. I am part of a few Facebook groups that define giftedness as asynchronous development and often also link it to high sensitivity. These groups do not see giftedness as all positive, like the high IQ societies do. They rather see it as a distinctive but value neutral characteristic.

As a more abstract quality, I however don’t embrace my intelligence. It is so often used to define the core of my abilities, as if I can’t be impaired with such a high IQ. I realize that intelligence is what allows me to write relatively coherent blog posts, for example, but if it’s connected to social skills or practical independence, that’s just not okay.

2. I am stubborn. Sometimes, people say I am a go-getter. Other people say I give up way too easily. It all depends on the situation. In a way, my stubbornness can be seen as rigidity: if I’ve got something in my mind, it’s got to go this way. I just today remembered pushing my father to vote for a particular political party when I was too young to vote (around sixteen). I don’t remember the details and am not 100% sure he ended up voting for that party, but I do remember being quite adamant that at least one of my parents was going to vote for my party.

3. I am sensitive. I want to firmly distinguish this from being empathetic, as in knowing how to react to people’s emotions. However, I do sense and absorb people’s emotions very easily. This sometimes leads to overload. I am also, of course, sensorially reactive, wich can also lead to overload.

4. I am socially awkward. Back in like 2003, I used to own an E-mail group (one of the many inactive E-mail groups I’ve owned) called something like Socially_Awkward. This was how I defined myself in the midst of suspecting I had autism but also being aware that others saw autism as an inherently negative thing that an intelligent person like me shouldn’t associate with. The fact remains that I’m socially awkward. I can converse semi-normally when the situation is familiar, but I often have to be taught explicitly how to handle unfamiliar social situations.

These are but four of my characteristics. I undoubtedly have many more, but it is hard for me to think of them. There are also many other ways in which I could define myself. As I said, I could go with my minority statuses. People could also define themselves by their jobs or roles. In this case, I’d be defined as for example a wife and a blogger. Then there are probably many more ways to categorize and thereby define people. I am curious to know how you define yourself and what categorizations you use to define others.

Halloween or St. Martin: My Experience (Includes Social Story)

This week’s spin cycle prompt is to write about your Halloween. Since we don’t celebrate Halloween much here in the Netherlands, and I certainly didn’t do anything for it this year, I have a hard time telling you about my Halloween specifically. We do have a similar celebration though, St. Martin, which is celebrated on NOvember 11. On St. Martin, kids go from door to door as on Halloween, only they carry a lantern and aren’t dressed up. They sing a St. Martin’s song and then get a treat.

I did follow a lot of Halloween-related posts over the past few weeks, and one was a Halloween-based social story (unfortunately, I forgot where I found it). For those not familiar with them, social stories are like little tales you tell kids with social-cognitive difficulties such as autism so that they know what to expect and how to behave in certain situations. They often include both written “instructions” and pictures. Reading this social story reminded me of my own most embarrassing St. Martin’s experience, when I could most definitely have used a social story.

I was about thirteen, which I think is way old for trick-or-treating, but my classmates were still going too and so was my younger sister. None of my classmates lived in my neihgborhood and my sister didn’t want me to go with her and her friends. I went alone, which was hard enough given that I’m blind and couldn’t always find the doorbell. However, the embarrassing thing was that, though I did start going from door to door at the same time my sister did, being alone, I had no clue when to return home. So at one point I had been trick-or-treating for I don’t know how long and I rang the umpteenth doorbell, and someone told me that I was way late and should be home by now. That sure was embarrassing!

Most Halloween-based social stories are catered towards younger children who can’t go from door to door independently, so they include stuff like “I will hold Mommy’s hand”. I realize however that for special needs kids especially, it may still be good to participate in Halloween or similar festivities when they’re older. Here is a St. Martin’s social story for those old enough to walk the neighborhood independently. You can modify the traditions and date to make it Halloween-based.

It is November 11, which is St. Martin. On St. Martin, kids go from door to door singing a song in exchange for candy. After dinner at 6:45, I get my lantern and get ready to go from door to door. I go outside at 7:00 and make sure to take my lantern and a bag for the candy I’ll get. I ring the neighbors’ doorbells. When they open the door, I show my lantern and sing one of the St. Martin’s songs I’ve been taught. Then the neighbors give me candy. I go to the neighbors in my own street only and finish off no later than 7:30. I am home no later than 7:45. I get to choose and eat one piece of candy tonight. St. Martin sure is a treat-filled celebration!

Ten Things About My Husband #TuesdayTen

This week’s Tuesday Ten is all about friendship, in honor of National Friendship Day. Lisa of The Golden Spoons explains the origins of National Friendship Day. Like most holidays, it’s higly commercialized. Unlike others, it actually originated as a commercial celebration, having been invented by Hallmark. It’s apparently formally recognized by the United Nations now.

Like Lisa, I am quite introverted. I don’t have anyy good friends, unless you count my husband. My problems with friendship usually come down to reciprocity, or the lack thereof. I either share too little, ask too little about the other person, or I pour my heart out too soon.

Consequently, I, too, will have my husband as my best friend. It’s not that he doesn’t have to put up with my lack of reciprocal interaction, but apparently, he loves me anyway. Here are ten things I love about him.


  1. He is patient. He kept coming to the locked psychiatric unit when I was there and we weren’t officially in a relationship yet. He patiently waited for me to answer that I loved him too.

  2. He is funny. Usually. Sometimes though, his politically incorrect jokes drive me batty.

  3. When he’s determined to do something, he goes for it. He’s sometimes frustrated when I give up too quickly in his opinion.

  4. He plays and dances with me when one of my inner children is out.

  5. He handles my mentally ill moments really well.

  6. He is usually honest but gentle.

  7. He has a lot of knowledge and is a great debater.

  8. He helps me out when it’s noisy or I can’t communicate clearly for another reason.

  9. He loves me in spite of all my quirks.

  10. He can usually fix my computer. 😉

The Golden Spoons

We Don’t Stop Playing Because We Grow Old

This week’s spin cycle theme is “grow”. Ginny Marie over at Lemon Drop Pie asks: “Are your kids growing like weeds? Are the weeds growing in your garden? Does your garden have vegetables growing? Or are the veggies in your fridge started to grow mold?” Since I don’t have kids, a garden or a fridge, I need to invent another topic to post about. After reading Ginny Marie’s contribution, I thought of something. I want to write about growing up, too, but I struggle. As a kid, I always feared growing up, because it’d mean I needed to stop playing.

For a long time, from around age twelve on, I thought playing meant you were childish and being childish meant you were bad. When I was eleven, the school psychologist wanted me to become a residential student at the school for the blind. My mother explained to me that I was troubled because I had too many toys. I till this day don’t see the connection. Sure, I had quite the toy collection, but so did other kids. Sure, I had trouble making friends, and my interests were not the same as those of my age peers. I doubt they were all into books, which my mother said I had to be into in order to fit in. Books or music. While my age peers in the neighborhood were into music, I didn’t fit in once I listened to the music they were into and had Backstreet Boys posters covering my walls. Not that this period lasted long, because I’d quickly had enough.

Besides, I wasn’t troubled because I had few friends. That wasn’t the reason the school psychologist wanted to institutionalize me. The reason was my meltdowns and tantrums, and I have no clue what they had to do with toys. Sure, I had a tantrum when my Barbie doll’s leg broke off, but I had and still have similar outbursts when my computer crashes. Maybe that means computers aren’t the right interest either.

However, I internalized the idea that to play is to be childish and to be childish is bad. I remember when I was thirteen I kept track of my behavior problems, like tantrums, and soon added any sort of childlike behavior, including playing with Barbie dolls. I was going to regular education in a month, and it had become very clear to me that regular kids my age don’t play with Barbie dolls.

Once at regular school, I listened to the right music and read the right books. It didn’t change my outcast status. It didn’t lessen my meltdowns. It didn’t make me not fear growing up. It did make me grow old. We don’t stop playing because we grow old, after all, but we grow old because we stop playing, according to George Bernard Shaw.

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Depression in Autistic People

When I first learned about Asperger’s Syndrome and high-functioning autism in 2002, I read an interview with Tony Attwood in a New York disability awareness newsletter. For those who don’t know, Tony Attwood is an Australian psychologist and expert on Asperger’s Syndrome. In the interview, Attwood explained that many people with Asperger’s Syndrome suffer from depression in adolescence because they are aware of their differences but cannot change their behvior on their own. While I have not personally suffered with clinical depression, I can relate to lower-grade depressive symptoms that originated for me at around age twelve when I was first becoming aware of my social differences.

Depression in autistics is often missed, because it overlaps with certain autism symptoms, such as social withdrawal, repetitive/obsessive thoughts, and black-or-white thinking. Also, some autistic people’s depression is mistaken for improvement in behavior. I remember reading in a Dutch book on autism about a young man who had had an obsessive interest that he was constantly talking about. When he stopped talking about his special interest as much, people thought he was improving. In reality, he was severely depressed.

It is often hard to treat depression in autisitcs, especially if the autism is undiagnosed. I mean, people can get their depression in remission throguh cognitive-behavioral therapy, medication or both, but their social differences will not subside. Social skills training may help, but even so, autism cannot be cured, and I’ve found social skills training that was aimed at more general populations particularly frustrating given the lack of practical instruction and the underlying idea that people with depression or other general mental health conditions do essentially possess social skills. One sort of social skills training that I’ve found some use in, is the Liberman module on social relations. Liberman modules were originally developed for people with schizophrenia. They use a lot of repetition, roleplaying etc. rather than just telling the participatns they need to listen, ask questions and reflect on the other person’s feelings. Unfortunately, the training also assumes cognitive deficits, so that for example each of the participants in my group were asked to repeat the goal of the module. I found myself being annoyed by this.

Please realize that insistance on changing socially inappropriate behavior may make an autistic person more depressed. A few days ago I wrote about my diagnostician insisting I unlearn to twirl my hair. When he said this, I was in my first month on the psychiatric ward with significant suicidal ideation. That was not the time to insist on social skills. Therefore, it is my opinion that someone who is still depressed, should not be put into a social skills program. It’s important that depressed autistics (and every autistic for that matter) learn that they are acceptable for who they are.

Empty

I’ve been feeling kind of empty lately. It’s as though, since my diagnosis was changed from a dissociative disorder to BPD, my alters (if they existed) have gone into hiding, and I’m not sure what’s left of me. I’ve been feeling a bit depressed for about two months, and, while I am currently experiencing a few days of more (hyper)activity, my mood is not better. I also feel a deep s adness within me, but I cannot reach it except by going through anger first. This is not unusual fo rme, but often I can at least feel that I’m sad, while now, I merely know. We were talking in therapy yesterday about the needs a growing child needs to have met, and I was talking about what I felt I’d lacked in some of these areas, without really feeling much of anything. Ultimately we ended up talking about social skills. That topic may need addressing too, but really, I felt like I couldn’t access or process my feelings.