Welcome to the December 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 [email protected].

Q: I have a second cousin who is 19-years-old and has been diagnosed with autism. He is verbal, and his IQ is 92. What I can’t understand is that he is very manipulative. Is it possible that he could be misdiagnosed? He has anger issues and screams and acts like a “child” when he does not get his way. He can cook, wash clothes, and make his bed, but he only does these things when he wants to. My 73-year-old cousin, who he lives with, has had enough. He doesn’t want to move out or go to a group home, and even if he wanted to, I’m not sure he’d be accepted due to his anger issues and outbursts. What can be done for him?

A: Thank you for writing in. It sounds like there are two questions to answer here. First, you’re wondering if the diagnosis of autism spectrum disorder (ASD) is appropriate for your cousin because you observe his behavior as “manipulative” in some ways, correct?

Rather than think about behavior as purposeful or “manipulative,” it might be helpful to think about behavior in terms of its function. Behavior for all humans always serves one (or more) of the four purposes: Get something, get attention, avoid something, or is automatically reinforced.

Behavior therapy, like applied behavior analysis (ABA), works to determine the function of behavior and can help an individual learn to get their needs met with new, more effective behaviors.

The second question I hear you asking relates to housing resources for adults with ASD. It is possible that with behavior services, your cousin will be better able to control his outbursts and function more independently in his current living situation. However, given the age of your 73-year-old cousin he lives with, it might be a good idea to look into options for the future. Each state is different in how it handles housing for those with developmental disabilities, but keep in mind that many clients have behavioral challenges so this wouldn’t necessarily keep your cousin from being served. In Washington State, the Developmental Disabilities Administration (DDA), which is part of the Department of Social and Health Services (DSHS), is the housing authority for persons with developmental disabilities.

Q: Hello. I’ve been following this site for a while now, and I have a major concern. I’m in a relationship with my girlfriend and she has a 7 yr. old daughter. We’ve been together for four years. I strongly believe that her daughter has some type of ASD. I have a son the same age as her daughter and the stress level for him when we’re all together is very high due to her abnormal behavior. Of course my son has his moments being a 7 yr. old, but it’s easily handled. Here are some of the things that are challenging: Transitions, sleeping, public meltdowns, interrupting, attention seeking, safety issues (like darting into the street without looking and talking to strangers), noncompliance, difficulty playing alone, and hyperactivity and fidgeting. It’s like she’s being driven by a motor that doesn’t shut off. I apologize for such a long list of issues. I need help in trying to talk to her mom about it. When the issues have been brought up (by her daughter’s father), my girlfriend has shut the idea down. I really love this woman, but I would not be able to move in with her if things stayed as they are now. Please help. Thank you so much.

A: Thank you for reading our blog, and I’m glad you wrote in. This sounds like a really hard situation for you, as you’re torn between a loved one and setting boundaries for yourself and your children. I can completely understand your hesitation to take that next step (moving in), especially given the stress your 7-year-old may experience. I also understand your hesitation to speak with your girlfriend about your concerns, as it sounds like her reaction to others bringing this up in the past has been (perhaps understandably) less-than-collaborative. However, as is the case in any important relationship, communication with absolute transparency, especially about the hard stuff, is key. You might start with talking about your feelings and about how hard this is for you to talk with her about. You might also share how this issue is impacting your ability to move forward in the relationship (a hard dose of reality, but reality nonetheless). Finally, you might consider approaching this as a “let’s partner on this” issue, so that your girlfriend feels supported (rather than defensive). Best of luck to you as you work to align with your partner on this tough issue.