I want to raise the question - is there really psychosis or not? When there is a diagnosis of Asperger's then you already know that the individual responds differently socially as well as in sensory issues. As a result, it is often too easy for a doctor who is on automatic pilot, to diagnose psychosis where it actually is not an issue.
I am not saying that this child does not also have bipolar. But sometimes it is too easy. And everything you describe, we went through. Except possibly the voices, but there is no detail in your description. What has he said to you about them? Or have you only heard what hospital staff told you? I'm not doubting them, but if they go in asking the wrong questions, if ANYBODY asks the wrong questions of someone with Asperger's, you will get the answers you're looking for and not necessarily the answers you should have.
Example - difficult child 3 was often in trouble at school. He was often accused of starting trouble when he had not. I base my "he had not" not on difficult child 3's own statements to me, but on eyewitness accounts from other children not personally involved but definitely there to observe. The teacher would interrogate difficult child 3 as follows - "Did you hit Jake before or after you tripped over your own feet? Did you realise that Jake says he didn't push you, that he just saw you trip? So you shouldn't have hit Jake, should you?"
That said, all together, told difficult child 3 that first, it was already assumed that he had hit Jake. Second, difficult child 3's own recollection of events was probably flawed because Jake said difficult child 3 had tripped, that Jake had not pushed him. difficult child 3 being on the spectrum and basically fairly honest, assumed other people were equally honest. So when his teacher told him that because of his autism, he was unable to recognise what was really happening and what was not (very untrue - the teacher did not understand) then difficult child 3 believed this, and stopped believing his own observations. "I could have sworn Jake shoved me and tripped me up, I saw his foot sticking out as I walked past, but Mr H told me I can get this wrong because of my autism. So I apologised to Jake for saying he had tripped me."
Meanwhile another kid (who was later silenced by Jake and his buddies) had told me what he had seen - Jake and his buddies hassling difficult child 3, shoving him and tripping him up.
Another example - this is form "Life Behind Glass" by Wendy Lawson. When she was about 19, after a major struggle through school, suffering from severe depression (which is common in any level of autism including Asperger's - this is really tough to live with) she was seen by a psychiatrist. Back then Asperger's was not understood. The shrink asked her, "Do you hear voices?" and she replied, "Of course I do."
On the basis of this plus her depression she was diagnosed with schizophrenia and admitted to a locked psychiatric ward as an involuntary patient. It took quite a number of years for someone to wake up to the fact that she was not schizophrenic, and let her out of the hospital. When later asked about hearing voices, she said, "It was such a stupid question and I misunderstood, because I answered literally, as a lot of people with Asperger's would. Of course I hear voices when people speak to me. You don't see voices, or smell them."
Another possible angle to consider - when he describes hearing voices, does he distinguish them as a manifestation of his own thoughts? With Asperger's (and some other people near the spectrum) they can really work hard to understand themselves, often because (despite how it looks) they really want to fit in. difficult child 3 was 8 when he said to me one day, "I'm getting very good at pretending to be normal." That was a few months after the incident with Jake and the teacher's re-interpretation of the events.
Back to thoughts - I said on another thread (and I stand by the opinion I expressed, I know it was not popular) that when I was a young child, I remembered trying to analyse how my thoughts worked. Why did I hear my thoughts as a voice? Why did the voice actually not sound out loud for others to hear it? What was the sound of my deepest thoughts, compared to the sound of my remembered conversations with people? I could even 'model' or role-play conversations with people I knew, 'hearing' their voices in my head speaking words they had never uttered. I did it for the mental exercise of it (I was perhaps not a typical child - who knows? What child with perhaps a better social understanding than I had, would dare admit to such ideas?)
I tried to discuss this with my mother and my sisters, to be brushed off. Well, they often brushed me aside. Some years later I was regularly seeing a therapist. I'm not really sure why I was taken to see one. In there were psychiatrists too. Again, not sure why. But by then I had worked out what I understood my thoughts to be, and thankfully did not feel a need to share my earlier ideas with the various tdocs etc. I hate to think what could have happened to me if I had said something. At no time did I ever feel my thoughts were not my own. At no time (when I look back now) did I ever have a psychotic break. But I also remember the anxiety I felt while growing up, the depression, the pressure, the fear of bullies. These days I might have been given a diagnosis of Asperger's. But maybe not. It is still difficult to diagnose in girls and really, I'm still not sure I ever met the criteria fully. But I was socially inept, something I blame on an over-protected and sheltered upbringing.
What I'm saying - anybody who is diagnosing Asperger's needs to really know what they are doing. Anybody diagnosing bipolar of schizophrenia - ditto. But diagnosing bipolar in someone who also has a diagnosis of Asperger's - they need double ditto, they need to know both, plus how they connect together. Or they risk making a very tragic mistake.
Some of the medications you list, we have had problems with. I know some people do well on those medications. My older son takes Zoloft, which I know a lot of people don't like or have problems with. My younger son can't take Zoloft and reacts badly to other antidepressants too. We've just weaned him off his latest one, it has pretty much sabotaged this last year of school. And yet his older brother (Aspie) does brilliantly on Zoloft. difficult child 3 has serious problems on Strattera. If he had been seen by a psychiatrist at the time, he may well have received an erroneous diagnosis of psychosis. But he had been on Strattera for three days and over the next few days, we got our boy back.
Depression is a huge problem when you have Asperger's - the world and the people in it just refuse to conform to the rules you assess as being in existence. In the same way Isaac Newton determined the Law of Gravity and formulated his Laws of Motion, so does a person with Asperger's study their environment and determine what they understand the rules to be. But this is not always exact, and when they try to live according to those rules, they can get into difficulties, not least because other people can be very mean.
My younger three kids were involved in an award-winning feature film, "The Black Balloon". The stars of that film were two very skilled actors who have gone on to do other fine work. Neither has autism, of course. One played the profoundly autistic teen, the other played his brother. They spent time with the autistic brother of the writer/director in order to really get a feel for the roles. In order to really ensure they had the roles down well, they went out in public, in character. What they reported was chilling - yes, they were convincing. Most people were okay. But too often, every time they went out, there were always some people, either late adolescent males or adults, who would deliberately bait the 'autistic' brother especially when his carer was absent. The actor reported that this happened with sickening predictability, that as soon as the other actor left him to perhaps go to the bathroom, there would be guys (mostly) who would deliberately try to upset him so they could watch the fireworks. They reported this in TV interviews later, and also in the "Special Features" segment of the DVD.
This made me realise all the more, that what difficult child 3 experienced at school was sadly, normal. And very, very wrong.
It is awful to live with this and feel that it is the way it is done, that it is what you have to accept because it is the rule. I left it almost too late for difficult child 3 - by the time I pulled him out of mainstream, where the bullies had been allowed free rein, he had told himself that the tule where he was concerned, was - "I am autistic, therefore I must accept being beaten up. I may not hit back, but I have to let other people hit me. It is because of what I am, and who I am."
It has taken a few years but he now knows it is not true. But he had to learn, by experience, that life really is not like that and should not be like that. Later down the track he has had to learn, is still learning, how to cope with the idiots who will try to provoke him purely for their own entertainment. He has developed a lot of skills, some of them quite surprisingly novel (he has done a lot of adaptive behaviour development entirely on his own). He is good at making friends with his enemies, but he has also sadly learned to carry a grudge. it will shield him from false friends, so I have not discouraged him from this.
I am not saying it is not possible for someone to have Asperger's as well as schizophrenia, or bipolar, or anything else. Only that it needs to be assessed REALLY carefully, and checked out thoroughly. Over and over again.
With Asperger's, nothing is at face value. or perhaps everything is.
Marg
