Welcome to the June edition of Ask Dr. Emily!

We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Rastall, a clinical psychologist at Seattle Children’s Autism Center, will share insights in a question and answer format.

We welcome you to send us your questions and Dr. Rastall will do her best to answer them each month. Send your questions to theautismblog@seattlechildrens.org.

Q: My twins are 8 years old have ADHD and have learning difficulties. They are in 3rd grade, but are testing at a 1st grade level. They have difficulty playing in groups of children and sometimes become very upset and angry in these situations. They both have a compulsion for water playing and often flood the bathroom at home (not intentionally, I don’t think). They refuse to wear certain clothes and refuse to eat certain foods. One of my twins is very anxious and continually coughs; we have been to the doctor to get medical treatment for the cough, but it has not worked. He still coughs for hours on end. I’m wondering if this is this just ADHD, or is it something more? I am waiting on a pediatrician to see them. I could go on, but ultimately, I need an answer.

A: It sounds like you are on the right track with asking your pediatrician. Ultimately, it sounds like you may be concerned about autism, so you will want to ask your pediatrician for a referral for an autism-specific evaluation. While sensory sensitivities, social challenges, emotion dysregulation, and repetitive behaviors are diagnostic features of autism, these can also be present in other diagnoses, such as ADHD. Ultimately, you (as the parent) are an expert regarding your children, so don’t be afraid to advocate for what you think they need, evaluation-wise. Good luck to you and continue listening to your parenting instinct.

Q: I need advice and have a question I’d like answered. First, I’d like to say I’m greatly disappointed that I’ve looked all over on Google for the viewpoint of those with autism and advice/help that can be given in certain situations and all I ever get is information on how to help parents of autistic children. I was diagnosed with high functioning autism when I was 20. I’m 22 now. I live with my parents because I have no basic life skills, but I want to get out of here because my step dad and I can’t stand each other. Since I’m autistic, still learning life skills, and only recently got my first job, I really have no way to leave this house, so I’ve tried to put on a smile and work things out with my step dad. He’s only known me for a year and has never had experience with ANYONE who’s had disabilities, not just Autism. He doesn’t know how to approach me, how to talk to me, or even how to treat me. I’d tolerate just being left alone with occasional “Hello’s” and many smiles, but he, wanting to be dad, wants to be involved in every second of my life whether he’s physically there or not. As I’m autistic, I will say, I am VERY introverted and feel like my work and house life are separate and what I do in my spare alone time should be kept private, unless I completely trust the person and find them easy to talk to, such as my mom, my sister, my best friend, or my boyfriend…my stepdad, not understanding me at all, has gotten into heated arguments with me, sometimes insulting my way of thinking, and we just don’t usually get along, so how can I trust him and talk to him easily? I feel like I’m walking on eggshells around him and I’m sure he feels the same with me.

So here are my two questions:

1.) Is it an autistic trait for me to want to open up freely and immediately about activities I’ve done to only trusted people, but close up to those who actually ask or am I just an extra kind of special? (I suppose, I feel that the people I trust and spend the most time with don’t need to ask because in my desire to talk with them, I’ll just tell them regardless, but if someone had to ask, I wonder “Why? If I haven’t said anything, then it was either a very ordinary day or I really don’t want to talk about it and if you really knew me, you’d know this about me,” and then it gets awkward because I’m silent and nervous).

2.) How do I solve these issues? I don’t know if I can keep living like this.

A: Thank you for writing in. I think most people would agree that they have a trusted circle of people with whom they can be themselves and share their experiences, emotions, and thoughts.  So really, it sounds to me like you are like most humans—you want to feel you trust someone before you’ll spill your beans. For some folks, trust is easily earned and networks of trusted others are wide. For others, those circles are smaller and trust is harder earned. How much we trust someone significantly impacts how we perceive their actions.  It sounds to me like your step-dad is trying his best to connect with you, but because your level of trust in him is not as high, his actions get interpreted as “nosy” and “boundary pushing.” Those who know you best are the most trusted and are more likely to be given the benefit of the doubt.

You’re also in this awkward in-between phase where you are working toward “individuating” from your parental units. Like a lot of young adults (autism or not), you want to be on your own and making your own rules, but still need to acquire some skills, means, or opportunity to be on your own. Parents and young adults do their best to connect and communicate during this period, but often end up butting heads. While it may not come across this way, both parties have the best intentions—parents to connect and be there for their kids and young adults to set boundaries for themselves and do things independently. This transitional period can be frustrating and challenging to navigate, and as a psychologist, I often provide therapeutic support for young adults (and parents, for that matter!) during this period. A therapist or counselor can act as a non-biased third party and is a person with whom you can vent, process, and problem solve during this time. Folks who see me during this time discuss things like self-advocacy, social problem solving, effective communication, emotion regulation, interpersonal effectiveness, goal setting, and life planning.

Good luck to you as you begin your journey toward individuation and thank you again for sharing your perspective.