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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by thuso on July 5, 2005, at 18:15:38
I don't even know how to begin explaining this without writing a novel, but I'm going to try for your sake. hahaha!
I'm currently a student, so I decided to take advantage of that and get a full battery of tests done for some LD's I suspected myself of having. A graduate student did all the testing and wrote the report with several dx's. I was working for a child psychiatrist and he sat down with me to go over the report. He looked at the results and knew right away that it was a grad student who wrote it. He then goes on to tell me she should have added a few other dx's based on my numbers. But two of his added dx's were based soley on his observations of me over the 2 years I worked for him. One of those dx's was GAD which doesn't require any testing, but the other dx was Asperger's. From what I understand from other people who have been dxed AS, there was testing involved and plenty of interviews about their childhood. Granted the Dr. did learn some of my history from general employer/employee conversations, but no real interview like would normally happen for a dx. On the other hand, one of his specialties is autism, so he knows what he's looking for in terms of behavior and thinking patterns. He ended up writing me a letter on his letterhead with his opinion of my dx's. I'm just not sure if I should take that letter as an "official" dx or just as a suggestion of what I might have. His letter basically says that in his opinion I fit the category for disorder x, y, and z. Would that be considered "official" even though we didn't have a patient/doctor relationship and I did no testing?
Phew! I actually managed to compress that to a readable amount. I'm so proud of myself! hahaha!
Posted by alexandra_k on July 5, 2005, at 18:29:05
In reply to What makes a dx official?, posted by thuso on July 5, 2005, at 18:15:38
Hrm. I would take anything as their humble opinion. Even experts disagree. I won't burden you with all the dx I've had over the years...
Why do you want / need an official dx?
What would it mean to you / how would it benefit / harm you and your perception of yourself if you did / did not have what they say you have?My suspicion...
Is that in general dx does more harm than good.
Posted by thuso on July 5, 2005, at 19:12:42
In reply to Re: What makes a dx official? » thuso, posted by alexandra_k on July 5, 2005, at 18:29:05
> Why do you want / need an official dx?
> What would it mean to you / how would it benefit / harm you and your perception of yourself if you did / did not have what they say you have?Since I'm no longer in a position to get help for my dx's, they aren't a need. My whole question really is focusing on whether or not I should take the AS dx as "official". The rest have numbers to back them up. Right now a large majority of adults who say they have AS are self dxed, not by a professional. I'm not one to call myself something based on how I read symptoms since I have very little or no experience to be able to compare myself with other similar people. Just the fact that I wasn't expecting him to give me an AS dx shows how unqualified I am to make a judgement.
There actually are some benefits to having the AS dx official. I'm an enigma to people (especially friends and family), and being able to explain to them why I am the way I am would be a heck of a lot easier if I had a name for it. And it would be helpful to me because then I could work with someone on my weaknesses and tailor it to the way an AS brain is wired. It would also be helpful if any of my kids exhibit similar symptoms because then I'll have a history of AS dx to back up any of my suspicions.
> My suspicion...
>
> Is that in general dx does more harm than good.In this case, I don't believe that to be true. In fact, it's been very liberating having the dx's. After all these years of no one believing me about my struggles, I now have proof that I was never lying. I just happened to be very good at compensating when I was young, so I never caused any red flags. I just never was able to perform to my potential.
I just wasn't expecting the AS dx from him, so I am not sure whether to take it as "official" or not. In the end the consequences would be good and bad.
I guess if I was asked by someone if I was dxed as AS, right now I wouldn't know how to answer them. That's what I'm trying to figure out, so I'm asking what people's opinions are of what makes a dx official.
Posted by alexandra_k on July 5, 2005, at 19:26:34
In reply to Re: What makes a dx official? » alexandra_k, posted by thuso on July 5, 2005, at 19:12:42
A dx is just a DESCRIPTION of a cluster of symptoms. It doesn't explain the symptoms. It just describes them.
> Right now a large majority of adults who say they have AS are self dxed, not by a professional. I'm not one to call myself something based on how I read symptoms since I have very little or no experience to be able to compare myself with other similar people.
Ok. What are the symptoms you are finding problematic? I can understand if people want a dx if they need a dx to get help with their symptoms.
> There actually are some benefits to having the AS dx official. I'm an enigma to people (especially friends and family), and being able to explain to them why I am the way I am would be a heck of a lot easier if I had a name for it.
I don't see how. I don't see how a dx offers you an explanation. It just redescribes the problem.
>And it would be helpful to me because then I could work with someone on my weaknesses and tailor it to the way an AS brain is wired.
??? You need to find out what is helpful to you and to the way your brain is wired. I don't see how it is helpful to consider your brain MUST be wired a certain way because you have a dx or MUST NOT BE wired a certain way because you don't have the dx. Clinicians should assess YOU not make assumptions about you on the basis of dx. It is true that most do not extend that courtesy. :-(
>It would also be helpful if any of my kids exhibit similar symptoms because then I'll have a history of AS dx to back up any of my suspicions.
???
But if they have the symptoms then that sounds like a problem - regardless of your dx or history.
> After all these years of no one believing me about my struggles, I now have proof that I was never lying.I don't see how having a dx is proof of that.
> I guess if I was asked by someone if I was dxed as AS, right now I wouldn't know how to answer them. That's what I'm trying to figure out, so I'm asking what people's opinions are of what makes a dx official.
Ok. I guess dx doesn't matter to me. My symptoms matter to me. They are the problem. I want people to work with ME and assess ME and stop with the trying to see me as a representative member of whatever clinical population.
But then the spectrum of disorders I have been dx'd with may be a little different.
Posted by thuso on July 5, 2005, at 20:52:15
In reply to Re: What makes a dx official? » thuso, posted by alexandra_k on July 5, 2005, at 19:26:34
I’m still just looking for a yes/no/I don’t know answer and why.
Below is just a more detailed explanation to your questions. All my information below is from either my own research or from talking to the pdoc I worked for. I just forgot to ask him about if I should take it as an official dx. Oops! :-P
> A dx is just a DESCRIPTION of a cluster of symptoms. It doesn't explain the symptoms. It just describes them.
> I don't see how a dx offers you an explanation. It just redescribes the problem.I know that the DSM is just a description of symptoms, but a dx basically puts you in a category. Since so much research has been done and books written about different disorders, by having a dx a person can point a family member or friend to a book (or website) that will make your behavior and actions more understandable to them. I understand that a dx in of itself is not an explanation for behavior, but with AS it would explain why my brain works and functions the way it does. That’s what people keep telling me they don’t understand.
> ??? You need to find out what is helpful to you and to the way your brain is wired. I don't see how it is helpful to consider your brain MUST be wired a certain way because you have a dx or MUST NOT BE wired a certain way because you don't have the dx. Clinicians should assess YOU not make assumptions about you on the basis of dx. It is true that most do not extend that courtesy. :-(
>Whether or not you are on the autistic spectrum is really a yes or no answer because either you are or aren’t born with it (I’m not including the whole autism/immunization debate). The reason I brought up the idea of the wiring of the brain is that those with AS approach problems and issues differently then everyone else. It’s much more systematic in nature. This means that if I need to change an aspect of my behavior, the method of change would need to be shaped in a way that my brain can process the information and then turn it into action. Just because a person doesn't have an AS dx doesn't mean their brain doesn't work this way. It’s just with an AS dx it would bring much more understanding (at least for me) as to how my brain works and how I need to approach things. It’s really hard for me to explain.
For example, a symptom that people with AS often have is social isolation/awkwardness. For a non-AS person the goal would be to get out more and make friends or deal with the person’s social anxiety. It may be suggested to join a club or volunteer somewhere to make friends. It’s different for a person with AS. Ultimately, it is going to be the same goals, but one of the issues a person with AS has is that they have a very hard time understanding social cues and non-verbal communication. Those are two things that most people take for granted. To teach an AS person how to not be so socially awkward and isolated is to show them how to recognize certain non-verbal clues. Then how to take all that information and analyze it (the whole systematic thing I was mentioning) to try and figure out a person’s motives. Basically, a person with AS often needs a different approach to problems because of the way their brain works and doesn’t work. That’s why knowing how my brain is wired can really help me understand how to approach problems that I need to fix.
You'll often hear AS described as having an extreme male brain. Being a girl, the first thing people will associate me with is having a female brain (ie. more empathetic), which is the extreme opposite of me. It's sometimes shocking to people when I don't show empathy or when I analytically process a problem better than a majority of guys. It’s great to out analyze a guy because it humbles them really quick. They don’t’ like when girls beat them at things. Hahaha! :-D Ok...back to the questions...
> >It would also be helpful if any of my kids exhibit similar symptoms because then I'll have a history of AS dx to back up any of my suspicions.
>
> ???
> But if they have the symptoms then that sounds like a problem - regardless of your dx or history.
>After working for a child pdoc, I saw exactly what the poor parents of these kids have to go through to get help from the government. It’s not as easy as just saying the kid has symptoms. If my kids are like me and don’t cause any red flags, then having a documented history of my problems can be helpful in pushing for testing to be done on them. I don’t want my kids to go through any of the hell I went through in school.
> > After all these years of no one believing me about my struggles, I now have proof that I was never lying.
>
> I don't see how having a dx is proof of that.I was referring to my LD’s, not the AS. The numbers are my proof, which are what those dx’s are based on.
Does this answer your many questions? ;-)
Posted by alexandra_k on July 5, 2005, at 22:03:47
In reply to Re: What makes a dx official? » alexandra_k, posted by thuso on July 5, 2005, at 20:52:15
> I’m still just looking for a yes/no/I don’t know answer and why.
Yeah. I don't know. Thats the best I can do ;-)
Maybe... When there is disagreement with different clinicians saying different things... Maybe thats because you are a kind of borderline case. I mean, meeting dx criteria is only artificially cut and dried (because of an arbitrary threshold). In reality there are more or less severe cases. More or less clear cut cases. Sometimes people are on the borderline. In the grey area. One clinician may have a lower threshold for making a certain dx another clinician may have a higher threshold for making the same dx. There may be no answer to your question beyond what a particular clinician thinks...
> Since so much research has been done and books written about different disorders, by having a dx a person can point a family member or friend to a book (or website) that will make your behavior and actions more understandable to them.Yeah. Though the book could be helpful if you exhibit those symptoms regardless of whether you have the official dx or not.
>I understand that a dx in of itself is not an explanation for behavior, but with AS it would explain why my brain works and functions the way it does. That’s what people keep telling me they don’t understand.
Okay. I think I get you.
> if I need to change an aspect of my behavior, the method of change would need to be shaped in a way that my brain can process the information and then turn it into action. Just because a person doesn't have an AS dx doesn't mean their brain doesn't work this way. It’s just with an AS dx it would bring much more understanding (at least for me) as to how my brain works and how I need to approach things. It’s really hard for me to explain.Ok. I think I get what you are saying.
> For example, a symptom that people with AS often have is social isolation/awkwardness. For a non-AS person the goal would be to get out more and make friends or deal with the person’s social anxiety. It may be suggested to join a club or volunteer somewhere to make friends. It’s different for a person with AS. Ultimately, it is going to be the same goals, but one of the issues a person with AS has is that they have a very hard time understanding social cues and non-verbal communication. Those are two things that most people take for granted. To teach an AS person how to not be so socially awkward and isolated is to show them how to recognize certain non-verbal clues. Then how to take all that information and analyze it (the whole systematic thing I was mentioning) to try and figure out a person’s motives. Basically, a person with AS often needs a different approach to problems because of the way their brain works and doesn’t work. That’s why knowing how my brain is wired can really help me understand how to approach problems that I need to fix.Ok. So... I would say... Have you tried the first solution? How did it work for you? Not very well? Well then it might be time for a change in strategy...
I think I hear what you are saying, though. Dx does set the agenda for treatment. IMO that is a real shame. But I am fairly anti-dx. But I won't get started on the politics of opression...
> You'll often hear AS described as having an extreme male brain. Being a girl, the first thing people will associate me with is having a female brain (ie. more empathetic), which is the extreme opposite of me. It's sometimes shocking to people when I don't show empathy or when I analytically process a problem better than a majority of guys. It’s great to out analyze a guy because it humbles them really quick. They don’t’ like when girls beat them at things. Hahaha! :-D Ok...back to the questions...
:-)
:-)
I thought you were a guy!!!!
Te he!
Lots of people feel the same way about me.
> > >It would also be helpful if any of my kids exhibit similar symptoms because then I'll have a history of AS dx to back up any of my suspicions.Yes. To get them prompt treatment. To have your concerns taken seriously right from the start. It is unfortunate, but things do tend to work that way :-(
> Does this answer your many questions? ;-)
Yeah. Thanks for having the discussion with me and not getting offended :-)I like asking questions.
Posted by thuso on July 5, 2005, at 22:46:47
In reply to Re: What makes a dx official? » thuso, posted by alexandra_k on July 5, 2005, at 22:03:47
> :-)
> :-)
> I thought you were a guy!!!!
> Te he!
> Lots of people feel the same way about me.hahaha! Pretty much everyone thinks I'm a guy until they see a picture of me. The way I write and process my thoughts is not very girl-like (if that's even really a word). :-P I'm so analytical and logical in my thinking that it's almost impossible for me to view anything a different way. Sometimes it's fun to be different and sometimes it sucks. Oh well...it's my parents' fault. It's their DNA that created this person. HAHAHA!
Posted by Emily Elizabeth on July 5, 2005, at 23:12:10
In reply to Re: What makes a dx official? » alexandra_k, posted by thuso on July 5, 2005, at 22:46:47
Whoa! Did you say that the child pdoc was your EMPLOYER that said you were AS??? In my opinion (and I believe the American Psychological Association) that sort of behavior is extremely unethical. If he is not your doctor, he should not be giving you a diagnosis. That sort of dual relationship is a problem b/c since he knows you in a different context, he is likely to be biased in a unique way. He has his own (probably more complex and less neutral) opinions about you that are influencing his diagnosis.
As for the grad student who did testing, in probably all cases they are supervised by an experienced licensed psychologist. And, as a grad student who has done a lot of these type of assessments, I can tell you that they are typically MORE thorough than your average assessment. AND at least two (if not more) people are thinking about the information that the testing provides. It is possible that the grad student did a poor job, but I'd say that it was also pretty unprofessional to be so dismissive of another professional's work. Perhaps it was part of the pdoc's insecurity?
A side note...there can be a lot of hostility between psychology and psychiatry. Each seems to always want to prove that they are better and they can be pretty rude to each other. I myself have experienced a lot of disrespect from pdocs (not my own, she is great--pdocs that work w/ my clients). I know that is something that psychologists at all levels of education complain about.
I know I've gone off a little here, but I REALLY don't want to see you hurt by someone's lack of professionalism. As I mentioned, I am a grad student and I work with psychologists. In pretty much every example I can think of--when a colleague or boss throws out their own diagnosis it is destructive. My advice is that if you want a 2nd opinion you should go see a private psychologist and/or pdoc.
As for your question about "official dx"...kmy sense is that it matters what you need it for. For sometings you need an MD to sign off, but I would think that most mental health professionals would respect a well-written and thorough report (assuming that is what you have).
I hope that this helps. Your post just really set off some alarm bells for me...
EE
Posted by thuso on July 5, 2005, at 23:48:54
In reply to Wait a minute!!! » thuso, posted by Emily Elizabeth on July 5, 2005, at 23:12:10
I was trying not to get into too much detail in my original post so that it didn’t turn into a novel. This is what I get. :-P I’ll address all your concerns though.
> Whoa! Did you say that the child pdoc was your EMPLOYER that said you were AS??? In my opinion (and I believe the American Psychological Association) that sort of behavior is extremely unethical. If he is not your doctor, he should not be giving you a diagnosis. That sort of dual relationship is a problem b/c since he knows you in a different context, he is likely to be biased in a unique way. He has his own (probably more complex and less neutral) opinions about you that are influencing his diagnosis.
>My employment ended with him on NYE. I finally got my results in Feb. I sat down with him to go over my results in March, so he was no longer my employer at that point. He offered to sit down with me to go over my report to answer any questions I might have. He didn’t sit down with me to diagnose me with anything. That wasn’t the intention.
> As for the grad student who did testing, in probably all cases they are supervised by an experienced licensed psychologist. And, as a grad student who has done a lot of these type of assessments, I can tell you that they are typically MORE thorough than your average assessment. AND at least two (if not more) people are thinking about the information that the testing provides. It is possible that the grad student did a poor job, but I'd say that it was also pretty unprofessional to be so dismissive of another professional's work. Perhaps it was part of the pdoc's insecurity?
>He didn’t dismiss her work. In fact, he agreed with the dx’s she made, but thought she was way too conservative and said she should have also added a couple other dx’s. And in regards to the AS, that was not what we were testing nor did it ever come up. We focused on whether or not I had certain specific LD’s that I suspected myself of having. He definitely didn’t dismiss her work. Based solely on the scores of some of my tests, he concluded that I had a couple more dx’s that she didn’t include in her report.
> A side note...there can be a lot of hostility between psychology and psychiatry. Each seems to always want to prove that they are better and they can be pretty rude to each other. I myself have experienced a lot of disrespect from pdocs (not my own, she is great--pdocs that work w/ my clients). I know that is something that psychologists at all levels of education complain about.
>Don’t worry, he is not disrespectful in any way towards psychology. He works very closely with psychologists in treating patients.
> I know I've gone off a little here, but I REALLY don't want to see you hurt by someone's lack of professionalism. As I mentioned, I am a grad student and I work with psychologists. In pretty much every example I can think of--when a colleague or boss throws out their own diagnosis it is destructive. My advice is that if you want a 2nd opinion you should go see a private psychologist and/or pdoc.
>
> As for your question about "official dx"...my sense is that it matters what you need it for. For somethings you need an MD to sign off, but I would think that most mental health professionals would respect a well-written and thorough report (assuming that is what you have).
>The whole AS thing came up at the end of our meeting. I found out that he had strong suspicions about me and AS for months (never mentioned anything to me), but it was looking at my test scores that sealed the deal for him (very different V/P scores with 2 individual scores standing way above the rest). That’s why he mentioned his feeling that I had AS. The whole written thing by him was not a report. It was basically a page long note for any future psychologist or psychiatrist I saw as an addendum to the report written by the grad student, not to replace her report.
>If he is not your doctor, he should not be giving you a diagnosis.
That’s my quandary. This note he gave me isn’t a diagnosis in the sense that most people get one. That’s why I’m not sure if I should take it as “I have AS (dx’ed)” or “a pdoc thinks I have AS (not dx’ed)”. That’s why I was asking what people think constitutes a dx.
Does this all make sense? And I hope this helps your alarm bells calm down at least a little bit. :-) I know this isn’t the traditional way of doing things, but this is how it happened for me.
Posted by Emily Elizabeth on July 6, 2005, at 0:27:08
In reply to Let me calm your fears.... » Emily Elizabeth, posted by thuso on July 5, 2005, at 23:48:54
Okay, I've calmed down a bit. ;) I just feel protective of my fellow babblers.
As for the "official dx" issue. I'm trying to think of when you would need an "official dx" of AS. For an LD, you need an official dx for accomodations, so that makes sense. For AS though, it seems like the dx would just be informative for you and for any future health care providers. I would think that any T or pdoc would take the description of the problem and their own interaction with you seriously. The dx from the pdoc might just provide extra info. So I guess to me, if you think it fits your experiences, then it is an official dx.
Some professionals choose to write conservative reports due to some of the issues that alex brought up. A psychiatric dx is really a complex thing and can be stigmatizing in certain situations. If your symptoms did not show clearly through the assessment and it did not seem like it would add anything, she might have left it out.
One thought is that if you have further questions about how the report was written or how AS might fit in or not, you could recontact the person who did the assessment. In most cases, they would be happy to sit with you and explain any further questions that have come up.
I must say that I can relate to feeling some relief when a name is given to what you experience. I suffer from major depression and when my pdoc wrote it down on paper, it finally felt like, "Yes! I'm not making this up. It is real!"
Best,
EE
Posted by GreySkyEyes on July 6, 2005, at 12:37:15
In reply to What makes a dx official?, posted by thuso on July 5, 2005, at 18:15:38
If I may jump in here with my own partially educated opinion...
An "official" diagnosis of AS is very useful to have if you are planning on taking advantage of any benefits. My brother was diagnosed AS and thus is able to qualify under the Americans with Disabilities Act (ADA)... but this is assuming you're in the U.S. so my apologies if you're not and I mean no offense, I'm still trying to figure everyone out. So he is protected from being fired due to his disabilities as long as he is upfront about them. Also, he's been able to take advantage of free vocational training/ counseling/ placement in his state. So in this case, a diagnosis is a good thing.
For me, having the diagnoses brought about an "aha" moment. As in, well that explains everything, and now I can research all I can about it and work on it in therapy. And while I know these diagnoses can be subjective, I had 2 doctors 12 years apart come up with the same diagnoses (major depression + BPD) so I tend to think they are fairly accurate in my case.
Just my 2 cents...
This is the end of the thread.
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