Clinical Presentation and Questions of Identity, Camouflaging, and Self-diagnosed Autism in a Nonbinary Young Adult.

IF 1.8 3区 医学 Q3 BEHAVIORAL SCIENCES
Aanchal Sharma, Jason Fogler, Amanda Van Scoyoc, Randall Phelps, Marilyn Augustyn
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引用次数: 0

Abstract

Case presentation: Vee is a nonbinary (sex assigned at birth: female) 16-year-old 11th grader presenting for their initial multidisciplinary team assessment (including developmental-behavioral pediatrics and psychological assessment). Vee's family first became concerned about their development when they were in pre-kindergarten. The school had concerns related to autism and provided Vee with an Individualized Education Plan (IEP) for autism-related services, although a formal medical diagnosis was never made. Vee "lost" the autism classification and associated services when they were in the first grade and no longer qualified for an IEP. However, concerns regarding social skills and identity persist 10 years later, and Vee is now questioning whether they are on the autism spectrum. Vee has carried historical diagnoses of obsessive-compulsive disorder (OCD), anxiety, depression, attention-deficit hyperactivity disorder, and specific learning disabilities-none of these diagnoses entirely explaining or satisfying Vee's long-standing sense of neither understanding nor being understood by others. Although symptoms of OCD, including intrusive thoughts, have significantly improved with therapeutic intervention, Vee still struggles with mood and anxiety. Their anxious tendencies include hair pulling and storing the hair in boxes. They "hate" school and often engage in school refusal; this has notably worsened since Vee entered middle school. Upon the start of high school, Vee disclosed that they identify as nonbinary to their parents, best friends, and school counselor.Vee struggles with social interactions, especially in novel social situations, and there is a history of bullying. They have 2 best friends, who both recently moved away. Most of their friends are in the online community. Vee has always preferred independent play, loves anime and rescuing animals, and is very imaginative and artistic. Vee has an early history of lining up items, toe-walking, and sensory sensitivities to loud noises, aesthetics of rooms and clothing, and textures of clothing. Vee can be aggressive toward their mother when they are frustrated and may even punch walls. They are not aggressive with any other individuals. Her mother wonders where "nonbinary begins and neurodiversity ends, never mind just being a teenager!"During the course of the assessment, which included Module 4 of the Autism Diagnostic Observation Schedule, Second Edition, Vee used little to no eye contact to manage their social interactions. They spoke in a flat monotone, and their use of gestures was greatly reduced for age; their gestures were also stiff and poorly coordinated. During the course of the assessment, Vee narrated their thought process in what they characterized as their "vocal stim": silly voices, catch-phrases and blurted swear-words. Vee explained how they use their vocal stim at different times to discharge nervous energy, entertain friends, and cope with challenging situations. Vee and their family are desperately seeking an answer to why they are so "different" from other young adults. Ultimately, the team conferred a diagnosis of autism spectrum disorder, much to the relief and expressed appreciation of Vee and their family. How can the team proceed from here and support Vee and their family?

一个非二元青年自闭症的临床表现和认同、伪装和自我诊断的问题。
病例介绍:Vee是一名非二元性别(出生时性别为女性)16岁的11年级学生,前来接受首次多学科小组评估(包括发育行为儿科学和心理评估)。维的家人第一次关心他们的成长是在他们上幼儿园的时候。学校关注自闭症,并为Vee提供了个性化教育计划(IEP),提供自闭症相关服务,尽管从未做出正式的医学诊断。他们在一年级时“失去”了自闭症分类和相关服务,不再有资格获得IEP。然而,10年后,对社交技能和身份认同的担忧仍然存在,维现在怀疑他们是否属于自闭症谱系。Vee曾被诊断为强迫症(OCD)、焦虑、抑郁、注意力缺陷多动障碍和特殊学习障碍——这些诊断都不能完全解释或满足Vee长期以来既不理解别人也不被别人理解的感觉。虽然强迫症的症状,包括侵入性思维,在治疗干预下有了明显的改善,但Vee仍然在与情绪和焦虑作斗争。他们焦虑的倾向包括拔头发和把头发放在盒子里。他们“讨厌”学校,经常拒绝上学;进入中学后,情况明显恶化。高中一开始,维就向父母、最好的朋友和学校辅导员透露了自己的非二元性取向。她在社会交往中挣扎,尤其是在新的社会环境中,并且有欺凌的历史。他们有两个最好的朋友,最近都搬走了。他们的大多数朋友都在网络社区。Vee一直喜欢独立玩耍,喜欢动漫和救助动物,非常有想象力和艺术感。Vee的早期历史是排列物品,用脚趾走路,对大声噪音的感官敏感性,房间和衣服的美学,以及衣服的纹理。当他们感到沮丧的时候,他们会对母亲很有攻击性,甚至会打墙。它们对其他个体没有攻击性。她的母亲想知道“非二元性从哪里开始,神经多样性从哪里结束,更不用说作为一个青少年了!”在评估过程中,包括自闭症诊断观察计划第二版的模块4,Vee很少或根本没有眼神交流来管理他们的社交互动。他们说话单调乏味,由于年龄的增长,他们使用手势的次数大大减少了。他们的手势也很僵硬,协调性很差。在评估过程中,维用他们称之为“声音刺激”的方式叙述了他们的思维过程:愚蠢的声音、口头禅和脱口而出的脏话。Vee解释了他们如何在不同的时间使用他们的声音刺激来释放紧张的能量,招待朋友,以及应对具有挑战性的情况。维和他们的家人都在拼命地寻找一个答案,为什么他们与其他年轻人如此“不同”。最终,团队诊断出了自闭症谱系障碍,这让Vee和他们的家人松了一口气,并表达了感激之情。球队如何从这里出发,支持小维和他们的家人?
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.10
自引率
8.30%
发文量
155
审稿时长
6-12 weeks
期刊介绍: Journal of Developmental & Behavioral Pediatrics (JDBP) is a leading resource for clinicians, teachers, and researchers involved in pediatric healthcare and child development. This important journal covers some of the most challenging issues affecting child development and behavior.
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