Difficulties in Diagnosing Adults with Asperger’s Disorder

Because Asperger’s Disorder (now included under the umbrella of Autistic Spectrum Disorders, as per the DSM-V) consists not only of a particular cluster of symptoms but also a degree of symptom expression, sometimes it can take some time to realise or understand that your boss/partner/sibling/parent has this disorder.

While some cases are quite pronounced and obvious at first meeting, other sufferers of Asperger’s are far more subtle, thus leaving the friends and family of the sufferer at a loss to know why their loved one behaves the way they do.

Let’s look at the case of Jye. Jye excelled academically at school, particularly in mathematics and science. He decided on a career in engineering, and had an on-off relationship with a foreign exchange student at the university he attended. She did not speak English very well. She ended up dropping Jye for reasons that his parents did not know, but as Jye seemed untroubled, they did not concern themselves about the issue. Besides, Jye was only 19.

However, Jye is now 29. He has graduated and works for a mining company where he was quickly promoted in his first two years as a new graduate. But his career has now stalled, he is caught up in a long-term on-off relationship and his parents are now worried about him.

Jye was never one to confide in his parents, but again, they thought that this was normal adolescent behavior. And it is. But Jye is no longer an adolescent and neither his mother nor his father can have a conversation with their son that lasts more than one minute. But it was when his parents met up with the parents of his girlfriend that it became apparent that Jye has problems.

The girlfriend’s parents expressed concerns for their own daughter as she had become depressed and withdrawn within about six months of meeting Jye. They clearly liked each other, and Jye would do anything for his girlfriend, but something was not working. The couple had met at university and at that point in time had had a lot of things in common. But they were now on diverting career paths and the relationship was under strain – but not according to Jye.

Most couples do not work in the same field and that is not a source of problems for the relationship. But in this case, it meant that the girlfriend could no longer have any meaningful conversation with Jye. As much as she pumped emotional energy into the relationship, it did not evolve and the level of emotional intimacy dropped. The girlfriend tried even harder and at times, after watching a great movie together or having a nice meal, she caught a glimpse of having a sense of togetherness. And then it would vanish. Ultimately, she ended up seeing a counsellor because she became depressed and it started to interfere with her job as a merchant banker, which also required her to be intellectually alert and not be overly diverted by worry and doubts.

After one session of clinical testing, which his girlfriend insisted upon, Jye was diagnosed with Asperger’s Disorder. Jye had so many good qualities – he would do almost anything that was asked of him, he earned a good salary, he played a number of sports, he was good looking – but he was unable to be emotionally intimate with anyone, including his girlfriend. But because Jye didn’t do anything that was actually wrong, it took many years, decades in fact, for an accurate diagnosis to be made.

The girlfriend’s mother noticed that things weren’t as they should be after trying for eight years to sustain a conversation with Jye for more than a minute without success. If the conversation went for more than a minute, it was because she, or her husband, was pumping a lot of energy into the “conversation” which basically degenerated into something akin to a game of “20 questions” in order to sustain any sort of contact.

When the daughter rang her mother in tears stating that she felt she “couldn’t get past a certain depth with Jye”, the mother knew exactly what her daughter was talking about. Because Jye’s girlfriend travelled a lot as part of her job, her parents invited Jye repeatedly to their house for meals, hoping that with their daughter absent, and Jye older and now longer a student, they would finally get to know him.

After some months, it was obvious that this was never going to happen. Also the “relationship” was particularly skewed. Although the young couple had been dating for eight years, and repeated meals were offered and accepted, there was no reciprocity on the part of Jye. He couldn’t even offer to bring something as humble as a takeout for his turn at entertaining, even though he was on an income in excess of $100k per year. It simply didn’t occur to Jye that he was not considered to be part of the family, because he didn’t act as the de facto husband that he actually was. Yet, in therapy, Jye was oblivious to this as being abnormal behavior.

When his girlfriend started suffering from clinical depression and she wanted to talk to him about it, Jye was all for it. But when attempts were made to have “meaningful” discussions, Jye was unable to do so and could not be emotionally present for his partner. She became upset and frustrated. Jye became confused and said he loved her, but then got angry when confronted with the fact that he was unable to share his feelings or even know what it was he was supposed to do. Arguments ensued. Jye tried harder and harder to do the “right thing” and was very helpful to his partner in a practical sense. He would take her shopping, pay for meals, make appointments when she couldn’t. On paper he was doing everything. Except for the one thing that was really important to his partner, the lack of which was making her sicker and sicker. He could not talk in a meaningful way about his feelings, he could not understand her feelings, and he could not change.

This situation arose and continued for so long without being discovered because, when they were students together, they had a lot in common and had no life stressors. It was a cycle of parties, assignments, exams and more parties. It also became obvious as the relationship progressed that Jye was only comfortable in the presence of many people and could not sustain conversations for more than a minute or so on a one-on-one basis, even with his own friends. There had to be a group present so that he could avoid intimate conversations. Or there had to be a football game on that would take the focus off any hope of a meaningful conversation.

Jye could present company talks in front of groups of 200+, but he could not talk to his loved ones at all about anything real. When his girlfriend’s mother, frustrated from years of trying to interact with her de facto SIL, asked her daughter what Jye’s hobbies were, she said there was really only one – “fantasy league.” It was then that things began to drop into place for the girlfriend.

She realised that her partner had one hobby that he was totally fixated on, but as she was not interested in it, they didn’t talk about it. When she confronted him that they “never talked”, Jye went and bought her flowers. When confronted over this action, he became very angry and said that he paid for all the groceries and then recited off a list of all the things he did for her. On explaining to him that he couldn’t talk about any subject to any person, he looked genuinely perplexed. It was then that Jye’s girlfriend realised that he didn’t understand what she was trying to tell him.

Jye’s job, which involved communicating in meetings and conferences, gave those around him the false impression that he was a good communicator. However, Jye admitted that he knew very little about anyone because he found people to be “boring”. As it is not possible that every person on the planet is boring, it became apparent that Jye had intimacy problems. His father had spent years trying to talk to his son with limited success, because Jye considered his father to be “boring” as well.

Jye also admitted to “hating old people”, yet these generalizations were a front to Jye’s real problems – that he could not relate to people at all and was not interested in sharing his life with others or with listening to others share their lives with him. His girlfriend became even more distressed as she carefully observed the person who she thought was the “right one” with her eyes open. She concluded that she could not consider having children with a person who could not relate to anyone in a meaningful way, and in knowing that, inflict it on her children-to-be.

The problem for other people who knew Jye was that they came away from interactions with him feeling happy if there was a group situation present. This format allows Jye to socialise without realising that he has serious relationship problems, as long as he hides in a group format or stays on work topics. People who interact with him and are momentarily forced into a one-on one basis find that they come away either exhausted or bored or exasperated from trying to talk to Jye. When this situation is repeated over time, people avoid him.

But Jye is social enough to understand that he likes to be with a group of people and so avoids one-on-one, which he finds extremely uncomfortable. Any initial thoughts that Jye is shy are dashed when he is observed either in the workplace giving conferences, or he is interactive in a team sport situation where he speaks, but only in terms of the game involved. Once the game is over, there is no more talking.

In fact, when he visits his in-laws with his partner, they have changed their habits of a lifetime of talking around the table, to having to always watch a movie, because the presence of Jye actually forces the family to have to put on “entertainment” otherwise he will want to go home if conversation ensues. In the early days of his relationship with his partner, he commented that he couldn’t’ understand why she and her family wanted to sit around and talk. This was an early warning sign of problems to come.

Jye has had opportunities to find other women since his partner is away with work so often. He plays different sports most weeknights. If he has ever found women that he is attracted to, it has not lasted. His first girlfriend who ended the relationship, came from a large Mediterranean family and Jye’s good looks soon paled once she found out that Jye had severe social limitations.

Currently his partner is rethinking her future with Jye. She regrets losing so much time hoping that he will change. Because Jye is high-functioning, it has taken almost three decades to work out exactly what the problem is. Because Jye will not undertake long-term therapy, the diagnosis is not wholly confirmed but anecdotal evidence suggests there may be a co-morbidity present, meaning a second disorder. In Jye’s case, schizoid personality disorder.

At present, Jye’s parents are confused and devastated, and without a formal diagnosis he won’t engage with services that could help him.

Jye is blind to his problems, however he doesn’t have the skills to understand. The tragedy is for his parents who, because of his excellence at school and in the workplace, have not been able to see past that to the fact that he is socially gauche. It is likely that they would have attributed this type of behavior when he was younger to an “adolescent phase.” This is completely understandable.

Sadly the window of greatest opportunity for intervention has come and gone for Jye. His parents have yet to come to grips with the full implications of his disorder, and that he may pass it on to their grandchildren. Hopefully, as history repeats itself with his personal relationships, Jye will come to see that a problem exists and he can access the help he needs to better function in social situations.

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