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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Autism, Mentalising & Gestalt Perception

Note this is from person perspective

Gestalt perception can account for both strengths and weaknesses of autistic perception. On the one hand, they seem to perceive more accurate information and a greater amount of it. On the other hand, this amount of unselected information cannot be processed simultaneously and may lead to information overload. Autistic people may experience gestalt perception in any sensory modality.

Olga Bogdashina 2014

About a month ago I was a friend of mine who is a speech and language therapist who works with people with autism, brain injuries (associated with language processing) other other neurological conditions.

Visual Perception & Memory

She asked me about how I mentalise the world around despite having challenges with visual-verbal connections and the ability to “marry” words and images together. This made me think about how I piece my “world” together and what tools I have used to do so. So she suggested about a simple memory comparison which was to see in the mind’s eye a generic church figure which she could.

Sensory Associative Memory

I said that when I think of a church I think of the feel and texture of the grass, the feel of the aged stone walls, the loud squeak of the wooden door, the musky smell of the aged church. She said can you bring all the those senses (experiences) together. I said I cannot as I think of them one sense at a time.

There appear to be multiple pathophysiological mechanisms that result in apperceptive visual agnosia. These may be related to the misperception of shapes due to defects in representing the elementary properties of curvature, surface and volume149 or failure to integrate multiple elements into a perceptual whole.150 Patients with severe apperceptive agnosia usually have extensive and diffuse occipital lesions and tend to have residual field defects.151

D. Tranel, A.R. Damasio, in International Encyclopedia of the Social & Behavioral Sciences, 2001

Conclusion

It’s clear that I have documented about having faceblindness, object blindness and meaning blindness which of course leads to “blindisms” in visual surroundings in which one has “context blindness” in which objects, faces and places lose their significance and visual-verbal meaning.

However it is clear from this conversation that the way in which I store memories through fragmented pieces of information bring about and evoke an emotional connection with what I am talking about.

Paul Isaacs 2019


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A Journey With Exposure Anxiety

 

Exposure Anxiety comes in 3 levels:

  • Specific: Targets only specific environments, activities and interaction with particular individuals.
  • Generalized and other-directed: Effects all areas of life which directly involves others.
  • Generalized and both self and other directed: Effects all areas of life which directly involves others but is also present when alone.

Copyright Donna Williams 1991, 2003, 2008

Image result for exposure anxiety

 

Residual “Exposure Anxiety?

If we think about exposure in a residual (non syndromic sense) those moments of embarrassment, aware of being aware, aware of your own self-awareness of the situation meant that you froze clammed up or even ran away meant that this “feeling” you wanted to escape, remove, and disappear.

 A Personal Look at Exposure Anxiety And Me

If you turned the “volume-up” on this condition you may find that it fits in the realms of being called “Exposure Anxiety” a feeling on a chronic level that falls into the three subtypes above. I would say that in my early years I had the 3rd one throughout my child and teenage hood as I grew into my twenties and was at the tail end of being employment in my mid teens I was thrust into a world of expectation from a social perspective that in many ways never let up. I never the less “kept going” and now at the age of thirty two I can say that the claws of this condition have shortened, nails smoothed and hands made smaller.

I would say it has an impact on me in specific areas so that is going from 80% to now at a more comfortable 30% and below I can show more of “myself”, be, share and talk in a more “connected manner” than I did even 10 years ago. Other things have changed to my environment, my purpose, life is but a rolling journey and that is the joy we can all celebrate and question at different stages in our lifetime.

My information processing being meaning deaf and meaning blind have changed, the tints have aided in those areas of visual perceptual challenges, and my meaning deafness is around 30% so I can keep a better track on conversation around me. My emotional processing and perception are still delayed that is a work in progress and I seek not to compare but to be the closest version of “me” I can be.

When we look at other people’s autism “fruit salads”, we begin to wonder what is the “driver” to what I am seeing? Is it sensory perceptual? Is it dietary disabilities? Is it seizure related? Is it emotional perception? Is it language processing? Etc. By looking at the person’s “systems” you are dealing into those areas of honest and humble questioning, what will you find and how will you adapt?

Common Threads Of Humanity?

Do people with autism have much more in common with those without? My answer is yes they do the only difference is the areas of that person’s “autism” that is challenging some to smaller more residual degrees others to more severe and/or profound degrees it is not the matter of it being a linear spectrum from “classic” autism to “asperger’s syndrome” but the also the palette of grey and what is specific to that person is what matters. All human beings have “system” it may be just that I have taken the time (which anybody could choose to do in my circumstance) and work out “what that is”.

Looking At People As People?

If one ignores the poison of the autism militancy which is political and unhelpful in its projection and reasoning one must look at the person and what “autism” is for them and means for them.

Paul Isaacs 2019


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What if Life Was One Big Metaphor?

Image result for melting pot

Language and the use of it can be varied to the point that if you tried to think about all the language that people process and the variety of differing ways people interpret, receives, express, share, not share, avoid, connect, disconnect etc it is rather big and somewhat scary!

I can rote learn fun lines from advertisements, jingles, songs. Metaphors are some of these funny lines. I can learn metaphors as fun lines just like any other. And I commonly jumble them or use them in the wrong places, boldly certain I’m being linguistically creative and sounding like a total pratt. It is many the time I have looked at a supressed giggle or cringed at the overt ones as I fall over metaphors. I like metaphors, they are funny, but there’s a difference between learning language through rote and grasping, retrieiving and applying it based on interpretive understanding.

But to say Autistic people can’t understand metaphor is also a myth.

I may struggle with metaphors I haven’t had fully explained to me but boy oh boy… my entire life is like a metaphor.

Donna Williams

My late Grandfather was literal, pragmatic and had social emotional agnosia so he had a very linear, direct and conscientious in his way of expression. I have met others who are very much non-linear with their language tumbling, with neologisms, idiosyncratic and poetic . I have meet people who sense rather than interpret and other who interpret rather than sense.

It is in the end a massive melting pot of expression.

Paul Isaacs 2018


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Atypical Features & Androgyny

I have atypical eyelids, shaped eyebrows, a crooked mouth and nasal bridge however people have told me either I look like a woman and/or have features of a woman for which I am flattered by their optical observations of my variants of my somewhat fruitful and irregular visage.

Androgny can be a look as much as an attitude a timely peek into someone who is a mixture of masculine and feminine.

I am not perfect and that is what should be cherished a feeling of unshackled non-perfection I find solace and tempered grounding beneath my limbs in these thoughts and I can smile freely. 😊

Paul Isaacs 2018.


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Autism – The Crossover from “Sensing” to “Meaning”

Sensing vs Interpretation 2918 image

 

Note this is from a personal perspective

Talking yesterday to friend about speech and language I thought it was interesting to see progression the inner feelings of someone who has gone through significant challenges in receptive and expressive language. I can remember a whole host of disconnected emotions that came flooding towards my person when speech slowly developed in terms of expression, a whirl wind of patterns, phonics and placements in my collective unglued memory and figured out by the ages of eight a system of external placement, phonic placement and movement sequences that helped me connect with the outer world around me.

However what was challenging from both emotional and integration point of view was taking a step away from the system of “sensing” (Donna Wiliiams 1998) a state of pre-consciousness, patterns, thematics and “feelings” that answered and questioned, that supplied and didn’t demand, that sang but didn’t shout, that gave and took in relevance of the moment it was captured. A place which “being” was the name of the game and “storing information” was redundant and futile.

It was a world in which in my own way I had found connects through external sensory modulation as explained so switching my “systems” was much a painful and frustrating experience as I can ever remember my connected chatter annoyed and scared me and the connected words would then bring upon the attention of connected response to which I was not readily to respond.

So was it like losing a friend well at that point yes I was making subtle yet significant transition into the world of interpretation, cladding, hierarchy and applied meaning for someone who was profoundly meaning deaf and meaning blind to those concepts it certainly makes sense why I wanted to “go back” into a world of “sensing” it was in reflection both a prison and sanctuary, solitude and disarray and home and wilderness all at once.

We (human beings) all come from the system of “sensing” however my personal experience is being “there” for a longer allotted period and many ways I am still there with reflective gaining and personal developmental progressions that have come with it.

Paul Isaacs 2018


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Autism – Communication Beyond Speech? Sensing A System Before Interpretation With Sharon King

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Sharon King Speech is only the tip of the iceberg. There are many more ways to communicate

Paul Isaacs I have had many a good conversation about Sharon with regards to the “system” of “sensing” a world before “you”, “I”, “self”, “ego” etc. All human beings go through this developmental phase some people on the autism spectrum stay (to varying and differing degrees) in this framework. A world before cladding and concepts that build on to some degree intellectual understanding vs. introspection. If someone is still in this system they may well pick up on things/situations/emotions that are raw, they may see other functions for things rather than its “interpretive use”. 🙂

Paul Isaacs For example I would use the toilet an its flush system as a “toy” a place to contextualise, a place to feel and get “sensory/chemical highs”, I used shaving foam, litres of bubble bath to create patterns on the tiled surfaces for hours and hours, would/do take in the smells of nature around, its textures, its feeling. I have learnt that some people want to know how you are feeling this moment, at this time and in which order that doesn’t make their system wrong as it is system they are using just as much I am using mine so I think there are more degrees of humanity between people who are on and off the autism spectrum than people actually think. Boxes only muddy the issue. I also think there are many people off the spectrum who live in this system of sensing as well.

My World = One’s Own World. This is our first world. Before all of its later cladding and contortions, it is at first a place of sensing, beingness, the preconscious mind and unknown knowing. It is the place where we understand self in others and others in self through the skill of mergence.

The External World = The physical world known through our sensory experiences as processed through our bodies/brains and experienced as sensations, thoughts, emotions, connections. This is a directly hands on world where sensing and beingness may be relatively strongly intact.

The Interpretive World = the world of applied meaning to incoming experiences that progressively builds mental structures and frameworks that ultimately filter our direct sensed experiences of the physical world and develops conscious mind as the primary guide.

Ego World = Ego contortion that further clads, alters and filters the logical meaning we get from experiences of the physical world and further buries our original capacity for sensing and beingness. This can be indoctrination, culture, economics, identifications, rewards, honed addictions and competition for social, economic, cultural ‘currency’.

Donna Williams

Sharon King Sometimes I wonder if feelings are more real than the external reality as they are our first point of contact being ‘within’ and everything else is ‘without’ to be filtered through our senses.

Paul Isaacs I FEEL before I interpret so its almost like a translation with knowing on a conscious level translating. The main difference I see between auties and aspies is the the system of sensing (to some degree) is far more “there” this also is taking into account the information processing blockages that come with that.

For example my Father is very much OPPOSITE he build up frameworks first, concepts first and then feeling and reflections come second. Its in the end a differing system of understanding information around you.

Paul Isaacs 2018