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Diagnosing Adult Autism: Case Study

Lukenotes, Spring 2017

Sister Monica received a message from her superior, asking her to meet later in the day about something that was very important.

Immediately, Sr. Monica began to feel anxious. She had a good relationship with Sr. Mary. She found her compassionate, but she could tell by the tone of her voice that the meeting was serious.

Sr. Monica finished up her paperwork at the parish and headed to her house where she could retreat to her room.

She thought about having a drink before the meeting to calm her nerves, but knew that this was not a good idea. However bad it was, things would be worse if Sr. Mary smelled alcohol on her breath.

Once home, she politely said hello to the other sisters before heading upstairs. Sr. Monica had learned it was far easier to say something polite quickly rather than not say anything at all. As a child, not responding had earned a good deal of teasing. In her room, she lay down and tried to relax, though unsuccessfully.

The Meeting

Later that afternoon, Sr. Monica nervously walked into the meeting with Sr. Mary, who jumped right into the issues. A number of people had reported concerns about Sr. Monica. The pastor, Father John, complained about her chronically tardy paperwork. He reported that when he raised the issue, sometimes angrily, she simply stared at him blankly.

The sisters she lived with said she rarely spent time with them, refusing invitations to dinner, movies, and even skipping out on meetings, household duties and communal prayer. They had expressed concern that they sometimes smelled alcohol on her, as well. Sr. Mary asked Sr. Monica directly what was happening and if she was all right.

Sr. Monica shared that the past several months had been very hard. She had no friends in community, felt awkward and was overwhelmed by tasks at work. She was trying her best to get things done and fit in, but no matter what she did, something never felt quite right and people either ignored her or became frustrated. This had happened most of her life. She had been hopeful things would be different when she took on this new ministry and living situation. As a way of coping with the anxiety, she had started drinking daily.

Finding an Answer

Sr. Mary contacted the community’s health administrator, who referred them to Saint Luke Institute.

Sr. Monica came to Saint Luke for a one-week evaluation. During one of the interviews with a therapist, she talked about her background. She did not speak until she was two years old. Even after that, it was difficult for her to communicate with others. She was relentlessly teased throughout elementary school for being so quiet, for having a hard time reading aloud and for a habit she had of rocking back and forth when she was upset.

During high school, a school psychologist suggested she had ADHD and dyslexia.

Raised in a devout Catholic family, she felt called to a religious vocation and she had come to love the sense of community and dedication she gained from religious life.

After interviews, neuropsychological testing and medical and psychiatric consultations, the evaluation team at Saint Luke diagnosed Sr. Monica with autism spectrum disorder, generalized anxiety disorder, persistent depressive disorder, and alcohol use disorder. This was the first time anyone had suggested autism.

Given the complexity of issues, the team recommended residential treatment. While at Saint Luke’s Talitha-Life program for women, Sr. Monica learned more about ASD. She was relieved to feel that it was not that she was stupid or lazy, but that her brain simply worked differently.

In individual and group therapy, she learned how to better communicate and interact with other people. She learned to identify healthy ways of coping with stress and anxiety and, working with her therapists, identified sources of support to help her continue to stay healthy after residential treatment.

Saint Luke’s continuing care team assisted both Sr. Monica and her community with her transition back to ministry, with a re-entry workshop, support team and follow-up care. This provided Sr. Monica and the community leadership great relief.

Disclosing her Diagnosis

After discussing the issue with her therapists and support team, Sr. Monica decided to disclose her diagnosis to her community. Several members approached her to offer words of support. While there are still moments of challenge and frustration, Sr. Monica has come to see her experience as one of learning and perseverance.

She began teaching and assisting sisters at their retirement home, a better fit for her than the heavy administrative position she had at the parish. When Sr. Monica looks back, she regrets the years of not knowing. Still, she is grateful for the opportunity now to understand herself better and, with the right support, to continue living out and sharing her vocation in a meaningful way.

Tasha Dorsey, Psy.D., is a therapist for the residential program at Saint Luke Institute.

To ensure confidentiality, names, identifying data and other details have been altered.