When Colin walked through my door in 2016 for a psychological evaluation, he’d already received two previous psychological evaluations. If his parents asked him to clean his room, he’d fly into a rage and destroy it beyond recognition. He had a best friend whom he didn’t see often, and otherwise didn’t seem interested in socializing. At home, he spent all his time playing video games in his room by himself. Other days, he’d make it inside but call his mom after two class periods, complaining that his stomach hurt so badly that he needed to come home. Although he insisted that he wanted to go to school, some days, he couldn’t get out of bed if he did get out of bed, he’d sometimes have an hour-long panic attack in the car and couldn’t make it in to the school. Colin’s parents had drilled manners into him, and he was polite and quiet in public. Most importantly, you’re sure that you’re missing something.Īs a clinical psychologist, the first client I had who fit a profile like Anna’s was Colin,* a 14-year old school refuser who was prone to explosive mood swings and meltdowns that seemed to come out of nowhere. On your end, you don’t think a Generalized Anxiety Disorder diagnosis truly explains the complexity of Anna’s struggles. Her mother is crestfallen with the test results, as she just wants a name for what is happening and to find a way to stop her daughter from keeping the entire family hostage with her moods. Anna does not meet criteria for OCD despite being an obsessive thinker (her obsessive thoughts are not linked to compulsions, and they seem to calm rather than impair her). She concludes that Anna is gifted and that her tantrums at home are related to being bored all day at school. The psychologist who tests her concludes that Anna’s social communication skills seem neurotypical, so ASD is quickly ruled out. Utterly perplexed by this seeming mix of contradictory traits, you wonder if Anna might have Obsessive Compulsive Disorder (OCD), or maybe mild Autism Spectrum Disorder (ASD), so you refer her for psychological testing. If they don’t knock on her bedroom door three times and invite “Hermoine” to dinner, Anna will remain in her room without eating, and ignore them until the following morning. After her tantrums end, she typically retreats to her room to obsessively organize her stuffed animals and refuses to come down for dinner unless her parents refer to her as Hermoine from Harry Potter. Maybe her parents report that Anna is impeccably-behaved in public, but begins swearing and throwing things at her sister as soon as she gets home from school, sometimes for hours at a time. Have you ever seen a child in your clinic who presents as “a little autistic, but not quite”? Perhaps nine-year-old Anna* makes good eye contact, speaks eloquently, and greets you like a talkative “little adult,” but, when you ask her if she has a best friend, she ignores your question and instead ruminates for ten minutes about a specific peer who bullied her in preschool.
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