004 - ASD

​To better manage my tics and mood, I see a psychiatrist, a behavioral therapist, and a neurologist. The team shares notes with each other, and I’ve gained a lot of traction thanks to them. My anxiety has decreased, and I’m able to relate differently to my obsessive thoughts, realizing they are not beneficial. On the other hand, my neurologist doesn’t seem to see much of an improvement in the tics themselves, commenting that they’re still very severe and discussing the option of brain surgery (I’ll probably write about the surgery in a later post). He pointed out that throughout his career, he’s seen several cases like mine, in which the anxiety decreases but the severity of the tics doesn’t follow along like it should. Then, my neurologist, Dr. Juncos, revealed that those patients like me all ended up having ASD.

ASD stands for autism spectrum disorder, which is a cornucopia of related disorders ranging from mild to severe. For example, ASD includes Asperger’s and of course autism. The symptoms often include, but are not limited to: social deficits, sensory issues, and stereotyped behavior. When Dr. Juncos first mentioned it, I went into a state of denial, arguing that none of my friends and mentors ever thought I was on the spectrum. But then I thought about it some more, and I remembered that my maternal cousin has severe autism. Since I share 12.5% of my DNA with my cousin, is it plausible that I might have inherited genes that predisposed me to ASD, or downright caused ASD?

It makes some sense if you know me and if you think about it. Sometimes I mess up reading social cues, and I almost always prefer to be alone than with a group of people. I honestly didn’t make many friends in college until I started being a teaching assistant and gained rapport with my students. And my tics could be the example of the stereotyped behavior so often associated with ASD. Finally, although I’ve told no one this before, I am very sensitive to loud sounds such as fireworks, popping balloons, or even audio in a movie.

There is no way to know for sure, and this uncertainty is an emergent property of the Diagnostic Statistical Manual (DSM), a really thick book that outlines how to diagnose certain disorders. The problem is that there is no biomarker available for physicians to accurately diagnose a patient; the physician needs to rely only on behavioral observations and an educated guess. For these disorders, no one can say, “Well the patient’s levels of substance X are below the threshold of Y, therefore patient must have disorder Z. Moreover, psychiatric disorders rarely stand alone—they tend to bleed into each other, which makes an accurate diagnosis much more difficult.

Having ASD wouldn’t be the end of the world. In fact, it might just open more avenues for treatment and for my doctors to advocate for me in my situation with Emory. A diagnosis of ASD could explain many things, from my tics to my sensitivity to loud sounds. I would appreciate your opinions on whether a diagnosis of ASD would make sense, given what you know about me. I promise I won’t feel offended or take it negatively, and you’re welcome to use a fake name when you leave a comment!