Paul Isaacs' Blog

Autism from the inside


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A Lesson in Time – Mental Health Assessment Pre-Diagnosis

Paul 7 Years Old

Family Assessment

Tuesday 11th February 1997

Presenting Problems

Mr. Isaacs was unable to attend today as he is a shift worker and since accordingly this date he has been changed to day work. My initial impression of Paul was of a much younger lad (he is eleven in May) physically and psychologically.

Paul was eager to explain his concerns to me and at times was very insistent on not letting his mother give a more comprehensible explanation of the situations that had occurred.

Paul’s major sense of unhappiness and the reason for his referral is that he feels he is verbally bullied at school. he gave examples of being taunted primarily about 1.) The way walks. 2.) Shuffling his feet. 3.) He wears glasses – and he has been called “four eyes”. However, he feels that the teaching staff are against him . In year 4 he had an unhappy relationship with his form teacher. It does seem one particular occasion he was humiliated – but to the infants so they could show him how to behave.

Mrs Isaacs also incited another incident which seemed to have upset her more than Paul. It became apparent that when Paul was explaining his situation at school his explanations tented to be repetitions of his parents points of view.

Paul after became muddled and it seemed there gaps in connecting and associating. It was also significant that when Paul referred to “she!”- his pronunciation was really that of “he” – I did check several times, but it appears that both Paul and his mother were unaware of this – which was marked. (receptive hearing problem? speech difficulties?).

Mrs Isaacs pointed out that Paul always had difficulties “concentrating” and settling down to work – she remembers this as steaming as far back as three year of age – When he attended play-group. she also recalls at this age and ever since that has had problems with “interacting with others” (her words). Paul has not many friends and it was brought to Mrs Isaacs’ attention by the teaching staff that he was a “solitary figure” in the playground. His mother also pointed out that they lived close of approx ten houses and that there were other children of Paul’s age, but he tended to say in.

Her explanation for this was that he felt safe and secure behind closed doors. Paul did mention some of his friends, but found it hard to articulate what he felt about his friendships with them. He did admit to hitting out at people at times is was significant that he mentioned his father hit him when he was angry. Mrs Isaacs denied this. Paul’s response was “I suppose Mum must embarrassed that I said that.”

Paul’s self-perception is that his “fairly sensible” , however he admits to being influenced by others into “being silly”, but he feels other children are being “sillier” the than him – “going over the top”. He feels he doesn’t go over “the top”. Paul has recently had to go back to the very basics in Maths with one other pupil. Mrs Isaacs conveyed concern and irritation that the teaching staff had not picked up on Paul’s severe difficulties with Maths; especially in view of him starting upper school at Lord Williams East in the new academic year (Sept 1997). Paul’s reading age is estimated as that of a nine year old. it appears the only positive subject that could of was Paul’ art. Mrs Isaacs believes and feels the teaching staff convey negative messages surround Paul’s overall performance. Mrs Isaacs explained that Paul gets very “worked up” over homework assignments, Paul also stated that he cries very easily hence his vulnerability at school in being bullied. It appears Paul suffers from anticipatory anxiety and expressed his fear of commencing upper school as he has heard he will get “beaten up”. Is is of significance that Mrs Isaacs was unhappy at ‘Long Crendon Primary School’ and suffered “bullying” at ‘Lord Williams’ East’. Mr Isaacs is also being scapegoated at work – he is being ‘verbally bullied’ (Mrs Isaacs’ words) and harassed and feels under a lot of pressure.

Family History

When referring to the history of the pregnancy Mrs Isaacs requested to speak separately – she explained she told no one of the pregnancy – only her partner (whom she is married to). She had been rushed into the JR as Paul “was distressed” – he was a month premature and was in SBCU post birth. She was unable to breast -feed Paul remarking they had said “she was too big”. Transition to weening had been unproblematic. Had been slow in walking – 18 months? He was sleepy baby and had to be woken up for feeds – He had been a “good baby”. However Mrs Isaacs had fond toddlerhood difficult – his “boisterousness”. Paul has had three operations 1.) Circumcision at 2 years 2.) Grommets 3.) Adenoidectomy at 4 years – at the JR and Radcliffe. Tonsillitis – query – Tonsillectomy otherwise healthy. Mother with Paul for all operations – no significant complications

Paul would like help with “the teasing” – he said it although it had been easier recently he wants to be able to cope with it better if it worsens again. He also says he is very sensitive and works himself into a state easily. There is also much anticipatory anxiety regarding this move to Lord Williams’ East in the Autumn. In ascertaining his mood he expresses no helplessness or hopeless feeling and denies suicidal ideation or such thoughts. He does covey and sense of confusion and bewilderment over the treating of staff’s “rude words” (his words) about his self-presentation. (percistanty anxiety).

  1. Assessment from Psychologist (educational?) to check ot cognitive abilities and overall school performance.

  2. Social skills group at “The Park Hospital for Children”. (mother drives) for interaction with class.

  3. Possible Family Therapy – concerns regarding Paul;s parents and levels of depression. Re-enactment of mother’s unhappy school experience and father’s “bullying” at his workplace, especially regarding “authority figures”

Cognitive Abilities , Cognitive Impairment & “Mental Retardation”

“It became noticeable he had very slow speech”

There was a massive transition in 1993/1994 prior to this interaction before this I was echolalic, meaning deaf to large degree and unable to speak in a fluid manner. Having visual agnosias, oral apraxia and challenges around receptive language meant that getting an interpretive and expressive framework was slow, stilted and lengthy. I went through bouts of selective mutism hating my “connected” voice which then in turn triggered exposure anxiety.

there appeared to be a gap in connecting and association.

Still have complex visual and verbal blockages meant that my “cognitive abilities” were hidden and therefore not “seen” I have no doubt that the lady in question had her own frame of reference on how I was processing the information so thinking I was “retarded” was just the tip of the processing iceberg.

‘Bursting into tears quickly’ – Alexithymia, Body Agnosias and Trauma

There are many overlapping reasons why this was happening at this point – the reason in which I was at this assessment was the persistent verbal bullying from a senior member of staff at the primary school I attended. Having body agnosias meant that I couldn’t gauge or manage my own emotional states this would be related to alexithymia the inability to “know” your own states of emotion, the ability to “internalise” them and mentalise them on a “conscious” level however manner years later when I wrote my first book I came to realise that on a “unconscious” all my experiences were unlocked through typing.

(receptive hearing problem? speech difficulties?)

I was traumed from an early age by expressive language (but at times would be intermittently intrigued) due to a language processing disorder (aphasia), I was triggered by exposure anxiety, dissociated easily and would struggle to get incoming information with “meaning” living in the world of the system of “sensing” before awareness mind and the ability to make interpretive connections.

Battling Books & Formulas & Artism

He has severe difficulties in maths.

His reading age has been estimated at an average age of nine.

Not being able to mentalise in a visual – verbal way meant that I had challenges around comprehension and getting meaning from books, written words and maths. (dyslexia, dyscalculia and visual-verbal agnosias) found the process of writing very difficult the way in which I held the pencil, the ability to concentrate on letter and sentence formation. The same goes for maths.

My solace for extraction and distraction was art which was were my mind was freed and felt “at home” I started from a very young around 5 smearing paint on to a piece of paper and I was hooked from that point on then transitioning to drawing by route during this period of my development.

Prematurity & Height

“There is some evidence that babies who were born premature tend to be shorter in childhood, but they usually catch up with those born at term in late adolescence. But our study shows that women who were born very preterm fail to reach the stature you’d expect based on their parents’ and siblings’ heights.”12 Dec 2016

She noted that developmentally and that I seemed “younger” than my age from a psychological and psychical perspective there is a link between having a short stature and prematurity currently I am only about 5’8′ I do not think I will be growing vertically anytime soon.

Did I Have An Attachment Disorder?

I can assure you I was lucky that my parents gave me love, support and grounding even though they didn’t know that I was on the autism spectrum. Did they both have difficult childhoods and upbrings? Yes they did for many different reasons.

My Father had parents his whom were his primary caregivers who didn’t not show him love, affection, boundaries or a sense of meaningful inclusion both of the parents were cold and aloof and didn’t seem to understand (be it wanting or otherwise) the serious practicalities of what parenthood meant for a child’s development and emotional wellbeing.

My Mother was seen as a disappointment to her Mother who was constantly comparing my Mum to other people explaining that she needed to be more like other people as opposed to building up her own sense of self and identity, self-worth and autonomy.

The truth is I am and try to be a objective judge of character when it’s presented to me and the answer is no I did not have a attachment disorder and my parents were not to blame for anything.

My Mother fits the solitary, serious and self-sacrificing personality types she is giving, emotionally connective and generous.

My Dad fits the conscientious, mercurial and adventurous personality types he is assertive, pragmatic and forthright.

I love and value them as human beings because despite their own “shit” they didn’t fling it consciously or otherwise on to me.

Paul Isaacs 2019


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Elderly Paraphrenia and Atypical Grief

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My Nan has been diagnosed with Paraphrenia a form of late onset schizophrenia that effects 0.1 percent of the elderly. This is secondary to an atypical form of grief.

She has had auditory hallucinations for 2 years along with complex visual hallucinations the most recent episode was in the morning seeing flames all around her. Others she has experienced with people, animals, objects.

 

She has experienced psychosis and delusional thinking it is clear from my views of this states that she is very scared, confused during the lead to these events and afterwards she quite rightly views them as ego-dystonic (separate and in conflict with “self”).

Paul Isaacs 2019

 


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Living With Anomic Aphasia In The Context of Autism

paul-amber-2002-3Note that this is from a personal perspective 

Speaking to a speech and language therapist yesterday it got me thinking about my autism trajectory and what residual and very apparent markers of disability are still present and more importantly how they manifest and present themselves.

LOOKING BACK 

As a child it took me a long to time to speak and use language in a functional way this meant that both receptive and expressive language was hard to filter and decode into something that was connecting and meaningful.

LEFT HEMISPHERE & LANGUAGE

As I have stated in previous blogs part of my development was due to brain injury to the left hemisphere this part of brain is were human language is formed (although other aspects of the brain will connect with this).

THE PRESENTATION NOW 1  – VERBAL LANGUAGE 

As an adult  the type of a aphasia  (receptive and expressive) as apart of my autism would be considered residual in presentation and it effects me with I tired my words get stuck like a “blockage” and I have to consciously “find” the words which seem almost on “there” but disappear leaving me to have longer pauses or repeat “umm” for example.

THE PRESENTATION NOW 2  – VISUAL PERCEPTUAL DISORDERS & MENTALISING

Lacking visual internalisation means that I don not have a “meta-reality” which involves complex pictural referencing in other words I do not “store visual information in a coherent way” meaning that retrieval and word association when tired can be slowed down.

Having simultagnosia means I see things in pieces that has an effect on how I internalise visual information and mentalising (organising) and need to focus on movement, pattern and touch to externally map-out something rather than internally.

Anomic aphasia (also known as dysnomia, nominal aphasia, and amnesic aphasia) is a mild, fluent type of aphasia where an individual has word retrieval failures and cannot express the words they want to say (particularly nouns and verbs).[1] Anomia is a deficit of expressive language. The most pervasive deficit in the aphasias is anomia. Some level of anomia is seen in all of the aphasias.[2] Individuals with aphasia who display anomia can often describe an object in detail and maybe even use hand gestures to demonstrate how the object is used but cannot find the appropriate word to name the object. [3]

CONCLUSION THE PRESENTATION NOW 3  – ANOMIA (WORD FINDING)

It is completely understandable that not having an visual memory and having a long developmental history of language associated issues that word finding at times for me can be difficult but one much use what they have and accept what is going on. I’m glad I am in a position to understand what is going on and I hope this blog helps others who can relate to this. 🙂

Paul Isaacs 2017

 


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Not All People With Autism Are Logical Or Literal In Thought Or Presentation

20160730_102005 (2)Note This is from a personal perspective 

What Autism IS and ISN’T

Looking at the broaden the aspects of presentation in autism it is about understanding what autism is and just as importantly what it isn’t.

It isn’t is a generic stacking of black and white linear symptoms that present in every person in the same way, what it is is a stacking of conditions that are specific and personal to the individual.

The Hidden Strands Of Information

I can of course be logical that is natural human variant of thought and has nothing to do with autism (and also various personality types will overlap with overall presentation), however  I struggle with intense over a analytical  logical decoding of a situation as it is happening that leaves many things up in the air for me.

Such as emotional perception, (not knowing my bodies own reactions to the the incoming information) receptive and expressive language (word formation, extraction, relevance, understanding), lack of visual association (no pictures for words), information processing delays (incoming information not being “sorted” quickly enough to be “understood”).

Taking Things To Heart? 

As a child more prominently and now as adult the residual issues are still there such as not seeing the significance of what is being said this is before the literal. 

That means I am less likely to take things on a personal level even if I am being spoken too in a personal way.

I was asked what I thought the main different feature was between Autism and Asperger’s. I think you’ll maybe find in reading through the site on brain hemisphere specialisation that there are many Aspies who may be better at left brain stuff and many Auties who may be more right brain but not nearly recognised for the abilities they do have as much as they are recognised for the left-brain abilities they don’t have.

© Donna Williams

Introspection & External Mentalisation

I use my senses and introspection to “decode” things and sort them out from there, I don’t have pictures in my head sorting things out I have to do the reverse I have to get everything out FIRST by doing, gesture, tone, inference, movement and then go from there.

I struggle to mentalise plans so I just “do” this means that on a unconscious level I sort things out with no conscious thought at the time. When I wrote my first book I just typed and typed and typed with the basic premise being it is a book about my life.

However I am sure there are people in the world who are not on the autism spectrum who can relate this. I have of course  “non-autistic” moments of clarity for me just as there will be “autistic” moments for people off the spectrum.

Paul Isaacs 2016


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“Autism” what does it mean?

Note this is froDad and I Dancingm a personal perspective

When I was diagnosed with autism in 2010 one of the first things that I was told is that was still a “person” even if I didn’t the mechanics and/or “pieces” of my autism that nevertheless was a sage piece of advice that has stayed with me on a personal and professional level.

“Autism” is different for each person so here is a breakdown of the “mechanics”

  • Emotional perception (alexithymia) problems with recognising and verbalising emotional states.
  • Visual perception (visual agnosias) problems with perceiving faces, objects, reading words, colour and “sorting out my visual field into a “whole”.
  • Language processing (receptive aphasia) problems with processing and interpreting “meaning” and “significance” from language.
  • Auditory processing (auditory agnosias) problems with organising the origins of sounds.
  • Body perception (body agnosias and hemiplegia) problems with processing and perception on the right side of my body which affects coordination, problems with recognising pain, hunger and thirst.
  • Body and Movement (visuospatial dysgnosia) left-right disorientation.
  • Light Sensitivity (sensory integration disorder and related learning difficulties) problems with light creating distortions as well as dyslexia and dyscalculia.
  • “self” and “other” processing simultaneous information which requires this can be difficult.
  • Mental health and personality disorders.

 

PERSONALITY TYPES

I have four main personality types which intermingle with each these are human in terms of presentation but will differ form person to person – human beings under stress may develop “disordered” versions of these types affecting social and personal perception, mood management and interpersonal relationships and friendships.

  1. Idiosyncratic
  2. Mercurial
  3. Self-Sacrificing
  4. Serious  

 

NOT RELATING TO “AUTISTIC IDENTITY/IDENTITY-FIRST LANGUAGE 

I do not see my whole being as “autism” nor define myself by it. I see it apart of me, in my case the pieces are emotional perception, visual perception, language perception, auditory perception,
body perception, light sensitivity, information processing and learning difficulties
 with associated mood disorders, exposure anxiety, somatisation disorder, dissociation and personality disorders but they are not a total nor finite definition of my being. I can only speak from my perspective and that is all.

I am “Paul” first with the all the positives and negatives that come with it the likes, dislikes, regrets, dreams and the sense of just “being”. I shall never adhere to the “club” there is to much militancy, over-investing and politics. I see myself as apart of the human race – no more, no less, no more worthy, no less worthy just a person like one of the billions of people on the planet everyone has a story to tell don’t they.  😉

Paul Isaacs 2016


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Bucks Autism Conference Video 2015

Note – These are from personal and obervational perspectives

Sensory Issues in the context of Autism Bucks Autism Conference

This video is about covers these topics

 

Paul Isaacs 2015

 

 

 


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An Accessible Look At My Autism Profile – Part 1

ReceptionThis is a laymen’s terms/accessible version of my autism profile – although I have written previous blogs with technical information about the “mechanics” of my autism here is an “easy read” version of my autism which is broken down into a heading and paragraphs and/or sentences with hyperlinks attached for further information. 

As always this is from a personal perspective.

Alexithymia (Emotional Processing)

Not understanding, processing or receiving my own emotions in “real time” this also affects how I understand bodily messages such as thirst and hunger – Poetry, painting , drawing and music help me process my emotions contextually.

Aphasia (Language Processing)

I have processing delay with language this means I struggle to find words, lose them, find them again and lose them again etc – I live before literal and struggle to find significance in language – however music, bests, rhythm and gesture help me access meaningful language.

Speech Delay (Developmental Milestone)

The developmental milestone of speech was delayed noticeably during my early years (please checkout other blogs for further information).

Language Delay (Developmental Milestone)

The developmental language milestone where delay even when speech was acquired.

Speech Apraxia (Verbal Dyspraxia) (Body Disconnection/Mouth)

I had a disconnect between my body and brain so my brain would have words but my body (mouth, jaws, tongue and lips) didn’t seem to want to “join up” this lead to feeling of heightened frustration to total indifference.

Selective Mutism – (once functional speech was acquired) (Co-Condition

In times of anxiety and/or dissociation I would choose to be mute

Tic Disorder & Globus Pharyngis (Co-condition/Mental Health) – 8 Years old – was called a “Nervous Throat”

This was due to a sensation of something being within my throat this would cause me to throat clear in an abrupt and idiosyncratic (odd) fashion.

Echophenomena (Developmental Milestones – Speech, Movement, Body Language)

  1. Echolalia – Echoing of words (delayed and instant)
  2. Echopraxia Echoing of movements (delayed)
  3. Echomimia Echoing of facial expressions (delayed)
  4. Palilalia Echoing of one’s own words (instant/delayed)

Visual Agnosias (Visual Perceptual Disorders/”Seeing” without meaning and/or “Seeing” but not piecing the “wholes” together)

Semantic Agnosia (Meaning Blindness)

Not retaining what is being seen so I would tap, sniff, lick, rub, mouth and tongue to gain a reality and an experience of my environment.

Simultagnosia (Object Blindness)

Not seeing in wholes – so seeing “fragments” and not seeing the “whole picture”

Prosopagnosia (Face Blindness)

Not processing faces and/or recognising  people by their faces.

Visual – Verbal Agnosia (Comprehension Blindness)

Reading without internalising/retaining meaning

Colour Agnosia

Seeing colours but not processing/understanding or recognising differentiation between them by name (in my case I recognise red but struggle to sometimes name of colours)

Mirror Agnosia (visual processing) 

Not understanding nor processing “other” or “self”  in mirrors for example I would and still get fooled by mirrors and when I was younger used to think that was behind me was in front of me.

Form Agnosia (Visual/Cognitive/Auditory & Contextual) 

Not configuring the “whole”

Pure Auditory Agnosia (Auditory Perception)

Not processing/understanding or the “origins” of sounds and associating them when I next “hear” them.

Language Auditory Agnosia (Meaning Deafness)

A type of aphasia (Language processing disorder).

Tonal Agnosia (Atonia) (Language Processing)

I “hear” tone but sometimes do not associate with meaning.

Pain Agnosia (Body Disconnection) 

I do not process pain at all or there is a significant delay in recognition.

Visualspatial Dysgnosia (Body Blindness)

I do not recognise my body in space so I wear tight clothes, bracelets, tight shoes to get a “reference” of my body.

Finger Agnosia (Digit Blindness)

As a child I had trouble reference that I had fingers and “where they were” this was due to body disconnection.

Paul Isaacs 2015