Trans Aspie Transgender and in the autism spectrum

ASK • As with any of my programs, ASK questions• Or comment• Or this will get boring!• If it gets boring A it is your fault or B tell me to get to the good

part (assuming there is one)

Why Autism Spectrum • Abnormal Psychology • Tempil Grandin Squeeze machine

Transgender fiction • Tight clothing!• Bondage…

Why would you want an AS Diagnosis

Now it makes sense!

The Name• Hans Asperger • Appears to have exhibited features of the condition named

after him • A remote and lonely child, who had difficulty making friends • He also liked to quote himself and often referred to himself

from a third-person perspective • Asperger died before his identification of this pattern of

behavior became widely recognized • The term "Asperger's syndrome" was popularized in a 1981

paper by British researcher Lorna Wing • From the early 1990s, his findings began to gain notice.• Asperger's Syndrome is recognized as a condition in a large

part of the world

Very brief overview of ASD throughout DSM history

• DSM-I (1952) and DSM-II (1968)• “schizophrenic reaction, childhood type”

• DSM-III (1980)• “infantile autism” strict, monothetic criteria (one critical element)• “child onset pervasive developmental disorder” (mixed bag)

• DSM-III-R (1987)• Autistic disorder, became polythetic (more elements) sharing a number of

characteristics which occur commonly in members of a group

• PDD-NOS (Pervasive developmental disorder not otherwise specified)

• DSM-IV (1994) and DSM-IV-TR (2000)• Autistic disorder, Asperger disorder, PDD-NOS, Childhood Disintegrative • Disorder, Rett syndrome (progressive neurodevelopmental genetic disorder that

affects females usually during infancy)

Aspergers DSM IV short version

• A. Qualitative impairment in social interaction, as manifested by at least two of the following:

• 1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction2. failure to develop peer relationships appropriate to developmental level3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. by a lack of showing, bringing, or pointing out objects of interest to other people)4. lack of social or emotional reciprocity

• B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

• 1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus2. apparently inflexible adherence to specific, nonfunctional routines or rituals3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)4. persistent preoccupation with parts of objects

• C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning

• D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)

• E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood

Changes between DSM-IV and DSM-5

• Creating a more “dimensional” classification system

• Separating constructs of impairment and disorder (e.g., with the use of severity scales)

• Reducing “-NOS” diagnoses in favor of broad categories with dimensional specifiers

• Representing greater reflection of (and easier incorporation of) neurobiological findings

• Parallel process in ICD-II (scheduled for 2015 release)

Benefits of DSM-5 revisions

• Flexible, “example-based” criteria and text guidelines intended to improve upon DSM-IV in sensitivity to certain populations

• Eliminate confusion over within-spectrum differential diagnosis

• Better reflection of research findings (over DSM-IV)

• Language delay/lack no longer a criterion of ASD

• Three domains down to two based on factor analyses

• “Softened” onset criteria

• Elimination of Asperger syndrome, CDD (Childhood Disintegrative Disorder)

• Inclusion of sensory criterion

DSM-5 criteria for ASD• Single broad category “Autism Spectrum Disorder” replaces PDD• AD, AS, PDD-NOS, CDD subsumed into “ASD”• (Rett, if associated with ASD, is now specified as “known genetic condition”)• Two core symptom domains instead of three:

• (1) Deficits in social communication and social interaction• -• (2) Restricted, repetitive patterns of behavior, interests, or activities

• ASD Diagnosis requires evidence of both

• Diagnosis includes a severity modifier for each symptom domain

• Requires Support

• Requires Substantial Support

• Requires Very Substantial Support

• Criteria may be met “currently or by history” (APA, 2013)

• ONSET: Symptoms must be present in “early developmental period” but possible that “may not become fully manifest until social demands exceed limited capacities” and/or “may be masked by learned strategies later in life” (APA, 2013).

• Specifiers included for:

• intellectual disability

• language impairment (include description of currentlanguage functioning)

• known medical/genetic conditions or environmental factors

• other neurodevelopmental, mental, or behavioral disorders

• Comorbidity: ASD may be diagnosed with other disorders such as ADHD, Language Impairments

Social Criteria in DSM5

• Developmentally sensitive (but non-exhaustive) examples provided for each

• These include deficits in: Social emotional reciprocity

• e.g., abnormal approach; failure of back and forth conversation; reduced sharing of interest or affect; failure to initiate or respond

• Nonverbal communicative behaviors used for social interaction

• e.g., poorly integrated V and NV behavior; abnormal eye contact and body language; poor understanding and use of gestures; lack of facial expressions

• Developing, maintaining, and understanding relation ships

• e.g., difficulties in adjusting to social context, sharing imaginative play, making friends; absence of interest in peers

Restricted and Repetitive Behavior Criteria in DSM-5 “ASD”To qualify for ASD, must meet 2 out of 4 RRB criteria (Restrictive and Repetitive Behavior).

• These include:

• Stereotyped or repetitive motor movements, use of objects, or speech

• Insistence on Sameness, inflexible adherence to routines, ritualized patterns of verbal or nonverbal behavior

• Highly restricted, fixated interests that are abnormal in intensity or focus

• Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment

Example of recording a “simple” ASD clinical diagnosis

• 299.00 Autism Spectrum Disorder;• Requiring substantial support for deficits in social

communication;• Requiring support for restricted, repetitive behaviors;• Without accompanying intellectual impairment; Without

accompanying language impairment – fluent speech.

Historical figures. • Michelangelo Buonarroti 1475-1564 loved solitude • William Henry Gates III• Alfred Joseph Hitchcock• Sir Isaac Newton• Jane Austen• Albert Einstein• Charles Robert Darwin• Satoshi Tajiri (Pokémon)• James Maury "Jim" Henson • Thomas Jefferson• Charles Monroe Schulz• Dan Aykroyd• Thomas Edison

How many Are There?• The good the bad and the How many are there really! • Frequency of ASD diagnoses has roughly tripled since the

1980’s. • Which does not necessarily, reflect an increase in prevalence. • Broadening of diagnostic criteria between DSM III, DSM IV and

ICD 10• Note: Early diagnosis was often associated with a mental

health issue other than AS

How Many • Prevalence in the general population.• About 1 in 68 children has been identified with autism spectrum

disorder • ASD is almost 5 times more common among boys (1 in 42) than

among girls (1 in 189).• Prevalence in the transgender community.• Well In excess of 1 in 10 and perhaps 4 in 10 among F to M.• We are about 5% 13.5 million.

Diagnosis Leaks • It may look like something else.• You can be a little AS/aspie.

• The lack of research regarding cross-gender behavior in individuals with autism may be due, in part, to “interpretation of cross-gender behavior as a ‘usual’ part of ‘unusual’ interests of autistic individuals by clinicians”

• One theory.• cross-gender behavior in children with autism could be considered a

preoccupation. These preoccupations are generally described as a restricted range of interests with a repetitive quality or marked intensity. It has also been suggested that cross-gender preoccupations may serve the primary function of seeking sensory input with objects that happen to be feminine, such as silky fabrics, a flared skirt, or shiny jewelry

• Williams et al. acknowledged that most preoccupations in children with autism are ascribed to specific objects versus a broad range of traditionally feminine interests; however, these researchers believed that subjects’ cross-dressing and cross-gender role-play could be best understood as an “inherent predisposition towards unusual interests,” and not likely indicative of gender identity confusion

Gender Identity• Cognitive, psychoanalytic, and social learning theories have

been used • How do children become gendered beings? • Cognitive theory: children are active agents in deciphering

their social world. • Psychoanalytic theory, is nuts• Environmental cues are thought to combine and form gender

understandings gender identity and gender stereotypes.

Social learning theory • Positive and negative reinforcement of gender behavior, from

infancy on, shape gender!• Gender identity is produced by imitation, reinforcement for

sex-typed activities, and modeling peers and adults.

You May Be AS if

• I prefer to do things the same way over and over again

• I frequently get so strongly absorbed in one thing that I lose sight of other things

• I often notice small sounds when others do not.• Other people frequently tell me that what I’ve

said is impolite, even though I think it is polite• I tend to notice details that others do not.

• I tend to have very strong interests which I get upset about if I can’t pursue

• When I talk, it isn’t always easy for others to get a word in edgeways.

• When I’m reading a story, I find it difficult to work out the characters’ intentions.

• I don’t particularly enjoy reading fiction, (except for).

• I find it hard to make new friends. • I notice patterns in things all the time.

• I frequently find that I don’t know how to keep a conversation going

• People often tell me that I keep going on and on about the same thing.

• I like to collect information about categories of things (e.g. types of car, types of bird, types of train, types of plant, etc).

• I like to plan any activities I participate in carefully. • I find it difficult to work out people’s intentions.• New situations make me anxious

Autism and Asperger’s are different… at least on EEG• Under the new DSM-V, published in May, Asperger’s is

included under the general “autism spectrum disorders (ASD)” umbrella. This has raised concerns among families who feel their children with Asperger’s have unique needs that won’t be met in classroom programs designed for autism.

• N = 430 children, ages 2 to 12, with “classic” autism and comparing them with 554 neurotypical controls.

Is there a difference between aspergers and autism?

This histogram separates children with Asperger’s (in red) from those with autism spectrum disorders (green) based on EEG coherence variables.

Not comfortable in my own skin

• Client experience• Experience with internship • Difficult cases!

Functional differences between autism and aspergers • Autistics tend to be more content with being by themselves,

living in their own world. • Aspies tend to desire contact with others.

Treatment• You can treat what may accompany AS

• It can be a bit crazy making • On top of being transgender

• it can be a lot crazy making• Psychiatric medications…• CBT (Cognitive Behavior Therapy)

• Learning rules

How to Compensate • Internal and external ecosystem • All of us are very very different!• What works for me may or may not work for you!• Change the world to suit you!

• NSS examples• Learn workarounds.

• Ultrasound math• Intuition

• Can it be learned

Easier for intelligent AS people than they are for Non AS people

• AS people can be especially good at learning facts, skills and talents.

• When • (A)they want to and (B) when the right sources are available

to them. This can provide good career prospects.• Useful gifts that AS people might have include photographic

memories, musical talent, heightened awareness of visual logic and extraordinary potential for computer programming.

• To show consistent punctuality in the workplace and to produce meticulously accurate high standard work, always meeting deadlines... I always over estimated the time it would take for a task…

• Having not been bound all your life by the unwritten rules of society may have made you a highly original thinker. Thinking not just outside the box but in no box at all.

• In many situations where muggles might be provoked or feel intimidated, AS people can be unaffected and keep a clear head.

• The problem with this however, will be that you may also immune to danger signals.

As one frog said to the other, "how time is fun when you are having flies"

1. There were two men painting a church and they were getting to the end of the job and they were starting to run out of paint so since they were using latex paint (water soluble) they decided to water it down to make it last so they added some water and finished the job. didn't look real good so the decided to thin it out a bit more and go over it again where upon they heard a voice from on high that said "repaint and thin no more".

2. What's the difference between a psychologist and a magician? A psychologist pulls habits out of rats

• There are a lot of adults who were not AS diagnosed as children• Who as adults experience enough distress to seek therapy, and who

continued to be misdiagnosed • Often highly anxious• Underemployed• Having difficulty making and sustaining friends and romantic

relationships• Seen as treatment resistant, personality disordered, or depressed • Misdiagnosis has resulted in treatment that missed the mark.• When these clients seek help, depression, discouragement and in

our case gender dysphoria often overlay the problems of AS

The Risk For Our Community• What is modeled

• By our community• Media

• Going Down the Wrong Path

You may be a red neck tranny if1. You wear combat boots with a minidress.2. You wear jeans with a belt buckle that's bigger than your fist.3. You braid the hair that sticks through your fishnet stockings.4. Wear a black John Deere baseball cap with pearls. 12. You keep spare ammo in your bra.5. You get a run in your stockings while changing a tire on your motor home.6. Your makeup case is a toolbox.7. You pluck your eyebrows with a pair of needle nosed pliers.8. You store your lipsticks in a socket-wrench box.9. You use duct tape to keep your "tuck" in place.10. You use a pocketknife to sharpen your lip and eye liners.11. Your favorite leather skirt was made from the moose you shot last Fall.12. Your new sandals are made from truck tire re-treads your found on the road.13. You wear a pair of C-clamps as screw-on earrings.14. Your nail enamel is made by Rustoleum.15. You use paint thinner to remove your makeup.16. If you have tried to convince your SO that wearing pantyhose is better than wearing insulated

underwear to work17. If the discount dress store knows you by name (drab or fem)18. If you get preferred customer advertisements in the mail from womans clothing stores19. If you remove your leg hair with duct tape.20. Your earrings double as fishing lures.

The red and black dots indicate electrodes. Red lines between the dots indicate increased coherence between pairs of signals in the Asperger’s group, and blue-green lines indicate decreased coherence in the Asperger’s group.

• Duffy hypothesizes that Factor 15, indicating reduced connectivity in the arcuate fasciculus, a brain structure involved in language, indicates a language deficiency, but that the Asperger’s brain compensates for this with increased connectivity in the left temporal region (Factor 3), allowing children to acquire language skills.

• “Children with Asperger’s have very unique aspects to their language,” says Duffy. “The difference in coherence may account for their more stylized, literal use of language.”

• As for Factors 33 and 40, which each show reduced coherence values in the Asperger’s group, Duffy proposes that they correspond to differences in visual-spatial functioning and in right-hemisphere areas thought to be involved in perceiving social and language nuance.

DSM IV TR Aspergers Clinical Information

A childhood disorder predominately affecting boys and similar to autism (autistic disorder). It is characterized by severe, sustained, clinically significant impairment of social interaction, and restricted repetitive and stereotyped patterns of behavior. In contrast to autism, there are no clinically significant delays in language or cognitive development. (from dsm-iv)

A disorder most often diagnosed in the pediatric years in which the individual displays marked impairment in social interaction and a repetitive, stereotyped pattern of behavior. The individual, however, displays no delay in language or cognitive development, which differentiates asperger syndrome from autism.

Asperger's syndrome (as) is an autism spectrum disorder. It is milder than autism but shares some of its symptoms. It is more common in boys than girls.an obsessive interest in a single subject is a major symptom of as. Some children with as have become experts on dinosaurs, makes and models of cars, even objects as seemingly odd as vacuum cleaners. Their expertise, high level of vocabulary and formal speech patterns make them seem like little professors. Children with as have trouble reading social cues and recognizing other people's feelings. They may have strange movements or mannerisms. All of these make it difficult for them to make friends. Problems with motor skills are also common in children with as. They may be late learning to ride a bike or catch a ball, for example. Treatment focuses on the three main symptoms: poor communication skills, obsessive or repetitive routines, and physical clumsiness.

Neuropsychiatric disorder whose major manifestation is an inability to interact socially; other features include poor verbal and motor skills, singlemindedness, and social withdrawal.

Syndrome or disorder usually first diagnosed in childhood, characterized by severe and sustained impairment in social interactions and restricted, repetitive patterns of behaviors, interests, and activities.

DSM IV TR Aspergers • (I) Qualitative impairment in social interaction, as manifested by at least two of the following:• (A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial

expression, body posture, and gestures to regulate social interaction• (B) failure to develop peer relationships appropriate to developmental level• (C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g..

by a lack of showing, bringing, or pointing out objects of interest to other people)• (D) lack of social or emotional reciprocity• (II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at

least one of the following:• (A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is

abnormal either in intensity or focus• (B) apparently inflexible adherence to specific, nonfunctional routines or rituals• (C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex

whole-body movements)• (D) persistent preoccupation with parts of objects• (III) The disturbance causes clinically significant impairments in social, occupational, or other important

areas of functioning.• (IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years,

communicative phrases used by age 3 years)• (V) There is no clinically significant delay in cognitive development or in the development of age-

appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.

• (VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia."

DSM 5 Autism

• Diagnostic Criteria• A. Persistent difficulties in the social use of verbal and nonverbal

communication as manifested by all of the following:• 1. Deficits in using communication for social purposes, such as greeting

and sharing information, in a manner that is appropriate for the social context.

• 2. Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on the playground, talking differently to a child than to an adult, and avoiding use of overly formal language.

• 3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.

• 4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).

• A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):

• 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

• 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

• 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

• B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

• 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

• 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).

• 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).

• 4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).