All posts by musingsofanaspie

Taking the The Systemising Quotient (SQ)

March 5, 2013 musingsofanaspie 39 Comments

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.

Diagnosis

Adult ASD Evaluation: The Diagnostic Interview

March 4, 2013 musingsofanaspie 28 Comments

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

Acceptance

Autistic People Are Everywhere

March 2, 2013 musingsofanaspie 9 Comments

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.

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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?

Health

My Anxiety is Not Disordered

February 28, 2013 musingsofanaspie 77 Comments

Bringing this post back for this month’s Down Wit Dat T21 Blog Hop

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I’ve been thinking and reading a lot about anxiety recently. When I was diagnosed with Asperger’s, I was also diagnosed with Social Anxiety Disorder.

Here’s how I feel about that: Social Anxiety? Yes. Disorder? Not so much.

Disorder implies that my social anxiety is irrational. Is it? Consider this:

“Anxiety at appropriate levels is important for adaptive functioning. There are many environmental hazards that must be avoided and these are often learned through the process of anxiety induction. The resultant anxiety response is learned through the association of certain stimuli with unpleasant consequences.” (from “Autism and the Physiology of Stress and Anxiety”, Romanczyk and Gillis)

Anxiety, like fear, protects us from danger. It raises our guard and makes us wary. In this way, it’s healthy. Without it, we might be less motivated to get an education, to work, to care for our loved ones and ourselves.

What is Anxiety?

Anxiety is a state of worry, concern or dread related to something that hasn’t yet happened and may, in fact, never happen. Think about some things that we typically feel anxious about:

committing to a relationship
giving a major presentation for school or work
becoming a parent
meeting a partner’s family
starting a new job
learning to drive
flying on an airplane for the first time
traveling in a high crime area

When you feel anxious about an upcoming event, you spend more time thinking about it and preparing for it than you would for a more mundane activity. You examine the possible consequences and give extra attention to your actions to ensure the best possible outcome. Anxiety heightens your awareness; heightened awareness sharpens your focus, increasing your safety.

It’s important to note that here and throughout this piece, when I talk about anxiety, I’m referring to appropriate levels of anxiety, not paralyzing anxiety. An appropriate level of anxiety is one that is manageable. I feel nervous in the days before giving an important Powerpoint presentation, but I manage my anxiety and complete the presentation to the best of my ability. An inappropriate level of anxiety is one that prevents a person from completing a necessary or desired activity. For example, if I got so anxious about the presentation that I ended up sick in bed, fainted in the conference room, or lied to avoid presenting.

Not all anxiety is healthy and it’s important to recognize where your anxiety falls on the healthy/unhealthy continuum.

The Function of Social Anxiety in ASD

So that’s how anxiety works in the typical brain. But what about in the autistic brain?

From childhood, autistic people know that we’re missing key information in social situations. We often have difficulty interpreting facial expressions, tone of voice, body language, and non-concrete speech. Some people also struggle with auditory processing and sensory overload in public or group settings.

The results of our social communication challenges can range from inconvenient (missing a joke or not following a conversation) to dangerous (being bullied, taken advantage of or assaulted). There are also negative health consequences–many autistic people need hours or days to physically recover from prolonged or intense social interaction.

Over time, “through the process of anxiety induction,” we realize that certain social situations are “environmental hazards that must be avoided” (as Romanczyk and Gillis described). In other words, because of a very real hazard, we develop anxiety that for us has a very real cause. It isn’t disordered. It’s a defense mechanism, developed through “the association of certain stimuli with unpleasant consequences.”

Social anxiety is, therefore, not only “important for adaptive functioning” in autistic people, it’s essential.

Red Light, Green Light

Autistic social anxiety is not the same as neurotypical social anxiety. If a person with intact social communication abilities has severe anxiety about social situations, then they have a disorder because their fear is irrational. When a person with impaired social communication abilities has anxiety about social situations, they are like a poor swimmer who is anxious about boarding a boat. The perceived risk is real and rational.

If fear is a red light–a glowing “stop” signal in our brain–then anxiety is a yellow light. It’s the feeling that says, “slow down, caution, stop and pause a moment before continuing down this road.”

We should heed this feeling, not cure ourselves of it.

Appropriate vs. Inappropriate

But, some will say, too much social anxiety and you’ll become a recluse! A hermit! The little old lady shouting at those darn kids to get off her lawn!

Well, yes and no. First of all, allow me to horrify the more socially oriented among you by saying this: people aren’t all that interesting and the rewards of socializing are sometimes overrated. Consider the possibility that all of the following (fictional) people are meeting their needs for social interaction:

the person who lives alone, works at home and in the evening participates in role-playing games, an acting workshop and a drumming circle
the person who lives with a partner and has lunch once a week with a close friend
the person who attends classes full-time and prefers to socialize online in text-based formats outside of class hours
the person who chooses to spend time at home with family and only goes out for necessary errands or events
the person who works around people all day and likes to spend their evenings alone

The social preferences of these people may differ from the majority of their peers, but they aren’t exactly in Grey Gardens territory.

Being anxious about socializing is not the same as completely avoiding social situations. It’s possible to manage social anxiety in the same way we manage anxiety about other things. Someone–NT or autistic–might feel anxious about starting a new job, but that doesn’t mean they won’t do it. Most people have strategies for managing anxiety and autistic people are no different.

What is different is that our social anxiety is automatically pathologized and then “treated” with therapy or medication. We’re told that our fear is irrational and we need to change the way we “think about” social interaction. We’re told that if we just “relax a little” we’ll find social interaction much more enjoyable.

What would be far more helpful is to acknowledge our anxiety as valid and support our right to socialize at our preferred level, in our preferred ways, without being stigmatized for it.

What Anxiety Tells Us

So how does social anxiety keep us safe?

First there is the obvious example: when you have difficulty interpreting nonverbal cues, it can be hard to know when another person is a threat. This can be especially true for autistic women and girls, increasing our chances of becoming the target of sexual assault, sexual abuse or domestic violence. The autistic woman who feels anxious about dating, intimate relationships or venturing into unfamiliar situations has good reason to–the statistics for violence against autistic women are alarming.

Autistic people are also often victims of bullying. The autistic boy or girl who is anxious about recess or the school bus has a large databank of negative interactions feeding that anxiety. Their anxiety tells them that unstructured activities with limited adult supervision are a potential danger zone.

Those are both reasonable examples, right? But what about the anxiety-inducing holiday party, trip to the mall, or vacation? Surely that’s irrational?

Not if you’re forced to think about every social activity in terms of cost. There are many analogies for this concept: spoon theory and the social cup vs. bucket analogy are the most popular. I’ll spare you a new analogy and give you an example instead.

Last spring my nephew and his wife came to visit for a long weekend. He’s one of my favorite nephews and I was looking forward to meeting his new wife. Still, I was anxious. Having two additional people in the house for three days would mean a disrupted schedule, unfamiliar noises and smells, a loss of my precious alone time and lots and lots of talking.

The Scientist and I came up with a schedule–scheduling is essential for me to get through three days of company–and then I set about thinking of ways to conserve my resources. I volunteered to drive because I find it relaxing. We scheduled downtime for me on Saturday afternoon while everyone else went out. I suggested we visit a historical site that I knew well, because it would mean a familiar environment plus the chance to infodump in a socially acceptable way.

We had a great time. They enjoyed the places we visited and the meals I cooked. We laughed a lot and had meaningful conversations. Things couldn’t have gone better. And still, Saturday night as everyone sat around the dinner table talking for hours after the meal was finished, I found myself shaking uncontrollably.

Even with all of my planning, even though I was enjoying myself, the day’s socializing had overwhelmed me. I knew it was coming, had felt myself shutting down as the evening wore on, but I ignored the warning signs. I didn’t want to end a great day on a bad note.

Unfortunately, it’s not about what I want. Social interaction has a real physical cost for autistic people. If I don’t listen to the voice of caution in my head and limit my interactions, my body will eventually take over and limit them for me.

When I’m in a situation where I feel comfortable, I can handle longer interactions. If I have to deal with unstructured activities, unfamiliar places, new people, rapid shifts in conversation partners or topics, or any of a long list of other things I find challenging, I’ll hit my limit sooner. An hour might be all I can deal with before I start feeling a strong need to escape.

Since being diagnosed with Asperger’s, I’m getting better at “reading” myself. The anxiety, the need to escape, the withdrawal that precedes the uncontrollable shaking–these are not things I need to be cured of. They are signs that I need to take care–yellow lights to be heeded–and I’m learning to listen to them.

Asperger's Tests

Taking the CAM Face-Voice Battery

February 26, 2013 musingsofanaspie 67 Comments

This week for Take-a-Test Tuesday I took the Cambridge Mindreading Face-Voice Battery (CAM) which is another test of the ability to recognize emotions in others.

The Cambridge Mindreading Face-Voice Battery (CAM) tests recognition of complex emotional states. It consists of short audio and video clips in which actors convey 1 of 20 different complex emotions through either their voice or their facial expressions.

The theory behind the CAM is that autistic people are able to read basic emotions but have difficulty interpreting complex emotions. Basic emotions are the ones that we learn early in life: happy, sad, angry, surprised. Most people learn these by age 6.

Complex emotions are sometimes described as combinations of basic emotions or as basic emotions plus cultural conditioning. They include mental states like stern, intimate, guarded, admiring, submissive and vibrant. There are hundreds of complex emotions and it takes us years to learn them. Generally, most people can recognize the majority of complex emotions by the time they reach adulthood.

Robert Plutchik's Wheel of Emotions is one of many ways of thinking about the relationships between basic and complex emotions — Robert Plutchik’s Wheel of Emotions is one of many ways of thinking about the relationships between basic and complex emotions

According to the CAM creators, the emotional states presented in the clips are “higher order” emotional concepts:

6 concepts from level 4 (concepts understood by typical 15–16 year olds)
13 concepts from level 5 (understood by typical 17–18 year olds)
1 concept from level 6 (words understood by less than 75% of typical 17–18 year olds)

The purpose of the test is to examine whether autistic people grasp these more complex emotional states. It includes both negative and positive emotions as well as subtle and intense emotional states. Each of the 20 emotions is repeated 5 times.