Is this autism?

[narkij]

For the past few years, my brother has been getting progressively worse mentally.

He has had trouble communicating his thoughts before and attempts to write down his thoughts on pieces of paper, often and lately on his arm and other parts of his body.  The messages are getting increasingly simple in structure (ranging from "kiss me", to "hear them" after I asked why he randomly flicked off people off).

He has been having a few delusions ("destroy all of my pictures or the world will end"), but no hallucinations that we know of (so we don't think it's schizophrenia) except when he just started metazopine and a few other medications in the past (but which he no longer takes).

He has had much mania in the past (broke furniture, broke many pairs of glasses, screamed out on the streets, screamed out in the forest in the middle of the night waving a broom around with stones in his pocket, screaming for the devil to go away).

He has many desires to achieve small goals, accompanied by failure in achieving them (wanted to go inside a bar -- dad took him but then he didn't want to go in; wanted a lady across the street to be his girlfriend and call him, but she was middle-aged and she called the police).

He has told us that he is tired of living and wants to reincarnate as a snake.  He has attempted suicide a few times, including through suffocation with a bag.

He needs olanzapine to go to sleep (if he doesn't have it, he can never sleep, due to severe anxiety), and he is currently simultaneously taking metazopine as an [attempted] mood booster.  However, after a few weeks of taking both medicines, he has suddenly gotten worse in all of the ways described previously, along with no appetite, extreme difficulty in verbal communication, extreme lethargy (very hard for him to walk fast), heightened desire for achieving goals with failure to accomplish them (e.g. constantly wants to "take a walk" but then just sits down outside, lacking energy to go further).

(continued...)

[Rachel Thompson, Ph.D., BCBA]

I understand your frustration regarding difficulties in finding appropriate diagnosis and, more importantly, intervention for your brother. To me, your description does not seem consistent with an spectrum disorder, but in-person assessment is required for diagnosis. If you have not done so recently, consider having your brother reevaluated by a new mental health professional and be sure that all relevant information is shared. Given, his "freezing" episodes and apparently involuntary movements, it might be useful to see a neurologist as well. I am concerned that your brother is engaging in some very dangerous behavior including threats of suicide. It will be important that professionals with whom you meet are made aware of the seriousness of the situation.

[narkij]

Also, to add to the list above, anxiety disorder (certain).

[narkij]

I am trying to be thorough in describing his behavior here because I want to ensure that we can increase the chances of getting as accurate of a diagnosis as possible; I don't think we much to afford more in terms of this -- it is draining us mentally and emotionally.

Once again, thanks for the help.

[narkij]

I forgot to say that he has also recently carried random stuff around in his pockets that he seems to have no use for (scotch tape, half-eaten apple, stones, knife, etc.), and often goes out for hours at a time -- he has gotten lost many times (there have been several helicopter searches), but the police have gotten tired of looking for him and even recently considered him a suspect in a middle night incident in which a few girls were reportedly molested (even though we're certain he didn't do it and wouldn't do such a thing).  When they found him, he is usually not that far from the house, just standing around.  He sometimes picks up slugs or half-eaten food off of the ground and eats it himself.  Recently his movement behavior is such that he often sits or stands for long periods of time just doing nothing, hunched over.

[narkij]

One of his goals is to stop taking the medicine for awhile.  There is sometimes slight improvement in behavior or so in the next week (decreased lethargy, seemingly reduced depression, etc.), but in all of the attempts he has tried, was always followed by a much worse bout of mania or extreme anxiety that necessitated more hospitalization and the need to go back onto the medicine.

As a child, he was slightly weird (showed his penis to random people in the playground in elementary school, banged his head against the wall sometimes during junior high school [and did it a few times recently, really hard]).  However, we never suspected he had autistic spectrum disorder.

He was always a good artist and drew extremely well when he was younger, but hasn't drawn much at all in the past few years.

Over the past few years he has been in and out of the hospital for reasons such as the above.  At the hospital, he has had conflicts with the staff (showed his genitals to the nurses, sleeps outside on the field even though he has a bed, ran away from the hospital [necessitating helicopter searches], etc.).

He sometimes have bouts where he moves his arms and legs in weird ways and seems to have little control over keeping them still, during which he cannot communicate well (we ask him "what are you doing?" he says "i ... can't ... " and has a lot of trouble completing the sentence, often swearing).

We have tried therapy but he did not communicate with the therapists, so they gave up.  We have tried counselling -- same result.  We have tried many types of medication, none of which seem to be perfect for bringing him back to his old self.

What we have considered him having (** = certain, ? = unlikely):
Asperger's Syndrome
Autistic Spectrum Disorder
Bipolar Disorder
Depression **
Rett's Syndrome? (seems like something that occurs since childhood)
ADD
Tourette's
Schizophrenia
Delusional Disorder
Insanity

Please help; we have tried for the past few years and we still don't know exactly what he has; the doctors don't know either (they have labelled him as having autistic spectrum disorder but nothing beyond that).  It is starting to drive us insane as well, especially with recent behavior.  Thank you...