The Case of the Missing Words

I’ve mentioned my “missing word problem” here before. You may have noticed it in reading the blog or my comment replies–my tendency to skip over a small but necessary word when I write. This is more than a simple problem with typos, which I can easily catch and fix when proofreading.

The mystery of the missing words had proved intractable enough that I’d given up on solving it.

Until now, that is! I’m reading “The Mind’s Eye” by Oliver Sacks and right there in Chapter 2 is a potential answer: aphasia.

Aphasia is a disruption in expressive or receptive language. It can be as severe as a complete loss of understanding of language, including the inability to speak or think in words. (Aphasia usually affects all forms of language, not just speech.) “Global aphasia” often results from a brain tumor, stroke, traumatic brain injury or degenerative brain disease.

However, milder forms of aphasia are characterized by:

  • difficulty in finding words (especially nouns, in particular proper nouns)
  • a tendency to use an incorrect word without a change in sentence structure

In discussing notable case histories of aphasia, Sacks mentions the English writer Samuel Johnson, who experienced aphasia after a stroke at the age of 73. While Johnson eventually regained the ability to speak, he “made uncharacteristic mistakes, sometimes omitting a word or writing the wrong word” in his writing and correspondence.

marbles

Adding Up the Evidence

I omit words when I write–more often than the average person it seems–at a rate of about one missing word per one to three hundred words, more if I’m tired (yes, I’ve started keeping track).

The missing words are small but important, like not, an and the. I need to proofread multiple times to catch them, often in an alternative format, because my brain likes to help me out by pretending the missing word exists and skimming right over the omission.

I sometimes use the wrong word without noticing. In writing, it tends to be a word that is close in spelling or sound, though not necessarily in meaning, like bring instead of brain. When speaking, my substitutions are more entertaining. For example, last night The Scientist was using a kitchen towel to clean up a mess.

“Put that in the dishwasher when you’re done,” I suggested helpfully.

He looked at the towel and frowned. “You mean the washing machine.”

Right. That’s exactly what I meant. And what I thought I’d said. This happens a few times a week and I rarely notice that I’ve done it until someone points it out. It’s more common when I’m fatigued or in a setting with a lot of distractions.

I have trouble with retrieving words, especially names of people and things:

“I’ll recycle the, the  . . .” I’m staring at the newspaper and pointing at the newspaper and I cannot for the life of me come up with the word for it. All I have is a blank–a tangible, almost physical hole in my mind where newspaper should be. “I’ll recycle that that  . . . thing after I finish reading it. $%&*! WHY ARE THERE SO MANY DIFFERENT WORDS FOR THINGS?!”

I’d been attributing the increasing frequency of gaps in word retrieval to getting older. It’s frustrating, especially when I’m trying to find the right word for a written piece and it refuses to surface. Sometimes it will be hours before I can come up with the word I’m looking for; fortunately I’ve learned how to set the problem to process in the background. This often results in me randomly exclaiming things like “dichotomy!” at inappropriate times.

Is Aphasia the Answer?

If this is indeed mild aphasia, then I finally have an explanation for some minor but annoying language difficulties. Perhaps my auditory processing delay is a form of receptive aphasia?

Then again, this could all be tied to Asperger’s. I’ve heard others on the spectrum mention difficulty with finding words at times. Our issues with processing spoken language are widely known. The missing word problem, though? Does anyone else experience that to the degree that I do?

Eager to learn more than what Sacks presents in his brief chapter, I Googled aphasia and instantly regretted it. Here’s what I found at that reliable bastion of truth, Wikipedia:

“Acute aphasia disorders usually develop quickly as a result of head injury or stroke, and progressive forms of aphasia develop slowly from a brain tumor, infection, or dementia.”

Ruh roh.

My language glitches have become frequent enough in the last 2-3 years that I can no longer ignore them. The missing words. The struggle to retrieve words. The odd, unpredictable substitutions. The Scientist says that my receptive language difficulties seem to have gotten worse in the past year too. I ask him to repeat himself a lot, especially when he’s not facing me and I don’t have the advantage of watching his lips.

And this is where I think it pays to stop Googling and back slowly away from the neurology textbook.

The language oddities I’ve described here are firmly in the “inconvenient” category for me right now. Unless that changes, I’ll consider the similarities to aphasia symptoms an interesting bit of trivia. Stay tuned . . .

**In proofreading this multiple times, I found 7 missing words (my, their, a, I’m, an, the and of) and 1 incorrect substitution (ever for even). There may be others that I missed.

Taking the The Systemising Quotient (SQ)

This week for Take a Test Tuesday I took the revised Systemising Quotient (SQ-R) test.

Systemizing refers to the drive to understand, construct, predict and/or control the rules of a system. Simon Baron-Cohen, in his desire to wedge autistics into his extreme male brain theory, contrasts systemizing with empathizing as the two primary ways in which humans make sense of their worlds.

The basic premise of the extreme male brain theory is that neurotypical males are better at systemizing and neurotypical females are better at empathizing. Hence, brains can be classified as either male or female according to these aptitudes. Autistic males and females are both better at systemizing, therefore, autistic people have “male brains” and autism is a condition of extreme male neurology.

Using that logic you could also make the case that female basketball players have “male bodies” (i.e. male bodies are on average taller than female bodies, female basketball players have taller bodies on average than females in general, therefore, female basketball players have “male bodies”).

Setting aside the extreme male brain theory, what can we learn from the SQ? The SQ is the subject of several research papers and each time the data show people with ASD generally scoring lower on the EQ and higher on the SQ.

The SQ attempts to measure systemizing in daily life, asking questions about how organized you are when it comes to your financial records, collections or favorite books/music. While the creators tried to avoid introducing bias in terms of subject matter, the test is still vulnerable to this. For example, I want to know the specs of new computer because that’s a topic I’m fairly familiar with.

I’m less interested in the specs of my car’s engine because that’s a subject I know (and care) little about. The same goes for knowing the species of animals and trees or the make-up of committees and governments. Those aren’t subjects I find highly interesting so regardless of how much of a systemizer I am, I’m only going to have a passing curiosity about them

Much of this still relies on personal interests, though perhaps it balances out in the end. The questions about how I bag my groceries and what my closet looks like made me laugh. I bag groceries by type because that makes them easier to put away at home. I hang my clothes in the closet by type so I can find what I’m looking for quickly.

My theory about systemizing? It all comes down to the fact that when you’re autistic, systemizing isn’t simply a preferred way of thinking, it’s a survival mechanism. Without systems and routines, we’d be constantly getting lost in the details.

One final note before we take the test. A lot has been written about gender bias in the EQ and SQ. It struck me as very telling that when the SQ was revised to remove some of the questions that were in “traditionally male domains” and add more questions that might be relevant to females, they removed questions related to investing, religion and culture and added questions related to shopping, cleaning, music and clothing.

Taking the Test

You can take the SQ-R (2005 revised version of the SQ) at the Aspie Tests site. Click on The Systemising Quotient (SQ) link and follow the prompts to get to the test page. I’m assuming you know the drill by now. There are 75 questions and you’re required to choose among strongly agree, slightly agree, slightly disagree and strongly disagree. Positive “strongly” answers score two points and “slightly” answers score one point. Possible scores range from 0 to 150.

It took me a little over 10 minutes to complete.

Scoring the Test

I scored an 85. Not surprising. I’m super organized, have a good memory for details and am insatiably curious about how things work.

I don’t think the SQ is binary in the way that EQ is. For example, on the EQ a positive answer to “I get emotionally involved with a friend’s problems” suggests empathizing. A negative answer suggests remaining detached or perhaps taking a logical problem-solving approach to the friend’s problems. This could be roughly construed as systemizing if we continue to look at it in a strictly binary way.

On the SQ, a negative answer to “I do not follow any particular system when I’m cleaning at home” suggests that one prefers using a system for housecleaning. But what does the opposite answer suggest? Certainly not anything to do with empathizing.

However, the EQ-SQ model sets the two tests up as “complementary” and goes so far as to demonstrate that a composite of EQ-SQ scores is steady across all groups (i.e. my EQ+SQ will be relatively equal to yours and everyone else’s, across all neurotypes). That suggests a strong negative correlation between the two tests.

When you look at the relationship between the AQ, EQ and SQ, it becomes evident that both the EQ and SQ act as a sort of proxy for AQ scores. In other words, they aren’t tests of empathizing and systemizing so much as they’re tests of the traits of autism. Of course autistic people will score higher than average on a test that asks a lot of questions closely related to core autistic traits and lower than average on a test that asks a lot of questions about social skills.

For reference, here are the mean scores from the 2005 SQ-R study:

ASD Male 77.8
ASD Female 76.4
ASD Total 77.2

Typical Male  61.2
Typical Female 51.7
Typical Total 55.6

(I prefer looking at the means from the original studies because the means provided by the Aspie Test site are based on self-reported neurological status, which may not be accurate.)

The Bottom Line

The SQ is an interesting measure of how dependent an individual is on routine, systems and categorization, but the use of the SQ as “proof” of the extreme male brain theory is highly suspect.

Adult ASD Evaluation: The Diagnostic Interview

This is Part 8 in the I Think I Might Be Autistic series

The morning of my appointment, I was incredibly nervous. My biggest fear was that I would go through this process and be told that I was officially not autistic–that I wouldn’t come across as “autistic enough” for a clinical diagnosis.

Fortunately, it turned out that I’d found a doctor who has worked with adults enough to know that we have many coping mechanisms and workarounds. He didn’t expect me to present the way a five-year-old boy would. He acknowledged that being an adult autistic doesn’t necessarily mean not attending your cousin’s baby shower; it can mean going to the baby shower and spending a good part of the afternoon hiding out in the kitchen (one of his examples).

The Diagnostic Interview

The first part of my evaluation was a diagnostic interview. I turned in my questionnaire to the receptionist and when Dr. H called me into his office, he’d obviously reviewed it. He started off by asking me to talk about why I suspected I have Asperger’s. I was nervous so I rambled around a lot. Looking back, I probably should have looked at my notes and used them as a guide, but my brain was going a hundred miles an hour.

Once my initial thoughts fizzled out, Dr. H. started working through the questionnaire, confirming symptoms I’d answered positively and asking clarifying questions. As I relaxed a little, the conversation became less structured. We talked a lot about my childhood, with the doctor encouraging me to give examples or tell stories to illustrate certain points. Gradually, he began inserting comments about Asperger’s, explaining how some of my symptoms were typical and how they fit into the diagnostic picture.

The interview lasted about an hour. By the end of it, I felt like we’d hit on all of the key points I wanted to talk about as well as some that I hadn’t considered important. Dr. H concluded the interview by explaining that he wanted to evaluate me for ASD, ADHD and Social Anxiety Disorder. The second one was a surprise but I was glad that he was forming his own hypotheses in addition to the one I’d presented.

He then explained a little about how cognitive testing works and about the qualifications of B, the ASD testing specialist who would administer the tests.

The Part Where I Provide Plenty of  Autistic Behavior for Observation

When we moved to B’s office, I got a chance to demonstrate two of the symptoms I’d described in the interview: face blindness and delayed auditory processing. Dr. H introduced me to B and she cheerfully said, “Yes, we already met–you asked me where the restroom was when you came in.”

Completely thrown by the fact that I didn’t recognize her, I said “Really? Okay.”

As I was kicking myself for that useless reply, Dr. H asked, “Got plurdled gabbleblotchits on a lurgid zoo?”

I reflexively replied, as I always do when I have no idea what someone has said, “Sorry?”

“What would you like to be called?” he repeated.

I probably could have gone home at that point because not recognizing that I’d already met B, not being able to smooth over the awkwardness that followed, not greeting her with my name, not understanding what Dr. H was saying, being more focused on orienting myself in the room than connecting with the person I was going to work with–in less than 60 seconds, I’d exhibited a boatload classic autistic behavior, much of it as a result of struggling to switch activities/environments, which is in itself textbook.

To her credit, B quickly put me at ease. She spent about ten minutes “getting ready” while I sat, mostly silent, and studied the colorful barcode prints on her wall. Honestly, I wouldn’t be surprised if the time she’d spent puttering around with her supplies was more for my benefit than hers. By the time we started on the cognitive testing, I was feeling reasonably focused again.

Next up: Cogntive, ADHD and Psychological Screening Tests

Autistic People Are Everywhere

This post is a part of today’s “Autistic people are . . .” flashblog. You may have seen the news this week that Google has promised to eliminate the problematic “Autistic people should” autocompletes in response to last week’s flashblog. They’ve said it will take time to engineer, so while the hateful autocompletes are still appearing, hopefully they’ll soon be gone.

We can make a difference by speaking up.

——-

Autistic people are everywhere.

We sit next to you at school and on the bus. We give your dog his rabies shot, teach your kids, make your latte and sweep the floor at your grocery store. We pass you on the sidewalk and stand beside you on the subway. We eat in the same restaurants, shop in the same stores, go to the same gyms that you do.

We are mothers and fathers, husbands, wives and partners. We are sons and daughters, sisters and brothers, aunts, uncles and grandparents.

We are everywhere, all around you.

*

If you don’t see us, it’s because we’ve mastered the art of hiding in plain sight.

We don’t come neatly labeled. Many of us don’t “look” autistic. You can interact with us and not realize you’ve talked to, worked with, studied with, played with, cursed out, fallen in love with, or are related to an autistic person.

We often don’t share our neurological status unless we feel that we absolutely have too, and even then sometimes we don’t.

There is no payoff for calling attention to our differences. There is no reward for being openly autistic. The risks are real.

Many of us remain quietly, even silently, autistic.

We are everywhere, sitting beside you, walking past you, interacting with you. Do you see us?