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ASD: Not to Be Confused with Depression or Grief

January 18, 2022

A psychologist shares how autism symptoms can be misunderstood in undiagnosed children.

ASD: Not to Be Confused with Depression or Grief

Sammy was 14 years old when I first met him. He came to my office because he had been truant from school for the past three years. 

About three years earlier, Sammy’s mother had died. Afterward, he simply became reclusive and refused to attend school. The school psychologist assumed that Sammy’s withdrawal was indicative of depression subsequent to the loss of his mother.

Most of Sammy’s days were spent on the computer, where he focused on topics that were of personal interest. Out of sheer desperation, Sammy’s dad traveled for three hours to my office because he had heard that I was a psychologist who hit it off with quirky kids.

When we first met, Sammy was fascinated by anything that had to do with missiles and rockets. His technical knowledge of missiles was incredible. He gladly explained to me the intricacies of how a rocket engine operates and shared some ideas that he believed could improve the accuracy and efficiency of rockets. 

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When we discussed rockets, Sammy was vibrant and lively. On the other hand, if I tried to discuss any other topic, a glazed look came over his eyes and he seemed to space out. He was clearly not interested in talking about his family, school, or friends. 

After about half an hour, Sammy said to me: “How can you tolerate the sound from that light?”  I didn’t know what he was talking about, but after he mentioned it, I noticed that what was, to my ears, an almost imperceptible hissing sound from a fluorescent fixture was causing Sammy distress. I turned off the light and Sammy and I continued discussing missiles.   

Throughout this time, I noted that Sammy made sporadic eye contact with me. When he spoke, it was as if he were addressing a large crowd, rather than having a one-on-one conversation.

Although I did not conduct a formal assessment, I was convinced that Sammy was a high-functioning child on the autism spectrum. I was quite certain that Sammy was not suffering from prolonged childhood depression, but was an ASD child who had never been diagnosed. 

Sammy’s father took him to a psychologist who specialized in assessment, and my hunch was confirmed. In fact, Sammy had presented with many symptoms of high-functioning autism spectrum disorder (ASD) before his mother’s death. 

He had always been a loner, sensitive to fabrics, sounds, and temperatures. He had always preferred the safety and comforts of his room over the relatively noisy and unstructured external world.

Sammy registered in a small high school that was willing to be compassionate and catered to his individual needs. His family moved so that Sammy could be close to the school, and I met him twice weekly for therapy sessions. Our early sessions focused on understanding ASD. We watched many short films on YouTube in which ASD was depicted. Sammy was able to recognize a great deal of himself in the ASD models. 

We worked on developing basic social skills that were essential for joining a “neurotypical” society. I particularly remember one discussion in which I was trying to teach Sammy the benefits of wishing people “Good morning.” Sammy questioned the sense of this and stated that whether a person was going to have a good or a bad day was not going to be influenced by him saying “Good morning.”  He pointed out that there were so many unpredictable variables, that his greeting could not really influence the outcome of one’s day. 

I countered by saying that people like to wish each other well and this forms a bond. As Sammy and I developed trust, he would actually practice making eye contact and wishing others good morning. He actually started enjoying the ritual, although I suspect he secretly found it somewhat absurd.

Sammy and I also dealt with the advantages of engaging in social relations. He was troubled by the unpredictability and complexity of people and would often state that getting involved with others wasn’t worth the trouble. I tried to help Sammy see some of the benefits and pleasures that can be gained from social interactions and suggested that he might want to form a friendship centering around an area of common interest. 

As Sammy was quite interested in science fiction, he actually asked another science fiction aficionado from his class to see a new sci-fi movie that had just been released. It was quite a step to see Sammy get out of his house and go to the cinema with another human. 

They began seeing movies as a joint venture and would spend hours discussing the complexities and details of each flick. After a few movies, they realized that the evening could be even more pleasurable if they would discuss the movies over burgers.

Today, Sammy is in a prestigious university studying engineering. He is still interested in rocket science. He has a circle of close friends who share his common interests.

As a clinical psychologist, my work with Sammy reminded me of how complicated and confusing human behavior can be. At the time of his mother’s death, Sammy had little access to his emotional life. He was operating on an intensive and narrow intellectual band that had no room for feeling or interpersonal contact. 

Only after recognizing that Sammy had symptoms of high-functioning ASD were we able to bring him to the point where he could actually deal with the emotional experience of his mother’s death. After three years of treatment, Sammy began to reprocess the loss of his mom. He cried in my office. It was the first time that he cried since his mom’s passing. 

He told me that it is painful to feel things and that a part of him preferred the sterility of life without emotional turmoil. I agreed with every word and offered him the compassion that one human can provide another. We both agreed that sharing mutual suffering in a compassionate and accepting manner is ultimately what defines our humanness.

This article was featured in Issue 125 – Unwrapping ABA Therapy

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