Duration of special interests in autism?

[futureapppsy2]

Most autistic patients I’ve seen in clinic as well as autistic friends/colleagues with special interests have had pretty enduring special interests—maybe not forever, but lasting for years or even decades. Recently though, I’ve also seen some autistic people (including some with clinical autism diagnoses) claim fairly “rapid cycling” special interests—for example, they’ll get really into a book, movie, character, etc, for a few months or a year (though not to the point of occupational dysfunction) and then abruptly lose interest in it and pick up a new interest a couple of weeks or months later. I wonder if these are actually autistic special interests or something else and how much they differ from, well, just typical high levels of interest, especially as they don’t cause notable dysfunction or distress. Thoughts, experiences, article recommendations?

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[calvnandhobbs68]

Most autistic patients I’ve seen in clinic as well as autistic friends/colleagues with special interests have had pretty enduring special interests—maybe not forever, but lasting for years or even decades. Recently though, I’ve also seen some autistic people (including some with clinical autism diagnoses) claim fairly “rapid cycling” special interests—for example, they’ll get really into a book, movie, character, etc, for a few months or a year (though not to the point of occupational dysfunction) and then abruptly lose interest in it and pick up a new interest a couple of weeks or months later. I wonder if these are actually autistic special interests or something else and how much they differ from, well, just typical high levels of interest, especially as they don’t cause notable dysfunction or distress. Thoughts, experiences, article recommendations?

I don't know if I have any articles about this but I agree with you that we really have to take care to differentiate hobbies/interests from actual "restricted repetitive interests that are abnormal in intensity or focus, excessively circumscribed or perseverative". This is one of those things that differentiates "autism" (and honestly I can barely put much stock into some outside "clinical autism diagnosis" anymore these days) from actual ASD (although I'm sure i'm invalidating and gaslighting thousands out there just for saying that).

Do I see interests wax and wane in ASD? Sure, absolutely, often over the course of at least several months though to more like years like you mentioned. However, I feel like there are a few other things that tend to actually differentiate ASD related RRI from more just intense interests or hobbies. One, they're often (but not universally) developmentally inappropriate (often in a younger way) which impacts them socially. For instance, I might have a 15yo obsessed with care bears or a 17yo who talks about spiderman or TMNT all day. This can swing the other direction developmentally as well, ex. a 8yo who knows every detail about every vehicle from World War I.

Now certainly there are some people in those ages that have similar interests but the other situation that tends to occur is that they don't really seem to care much about finding others with similar interests. Again, not universal but they'll often simply not care very much about others sharing these interests or not...despite often wanting to share these interests with you if you get them going on it (although I have seen multiple cases of especially older patients with a ASD who have enough insight to start getting embarrassed about their special interests and really want to avoid discussing them...it's usually then brought up by parents/peers).

This leads to another big differentiator is that patients with Level 1 ASD will often tend to bring up these interests unprompted in totally unrelated social situations and interactions and have no idea this is odd or unusual. It doesn't even have to be straight up scripting or throwing out some completely unrelated quote/fact, its can also be just awkward as they try to fit their RRI into social situations. Ex. a patient interjects into a conversation "this is just like that time in spider man when (insert some tangentially related situation)"...and everyone else is kind of just like "coooool". To me, this is overall par for the course in many social interactions for patients with ASD with this odd kind of back and forth where it doesn't flow like a normal reciprocal conversation. Thus, the social communication deficit.

Just brief ideas of the kinds of things I think about when looking at RRI but again I'm not part of the diagnostic expansionist school of thought.

 

[futureapppsy2]

This leads to another big differentiator is that patients with Level 1 ASD will often tend to bring up these interests unprompted in totally unrelated social situations and interactions and have no idea this is odd or unusual. It doesn't even have to be straight up scripting or throwing out some completely unrelated quote/fact, its can also be just awkward as they try to fit their RRI into social situations. Ex. a patient interjects into a conversation "this is just like that time in spider man when (insert some tangentially related situation)"...and everyone else is kind of just like "coooool". To me, this is overall par for the course in many social interactions for patients with ASD with this odd kind of back and forth where it doesn't flow like a normal reciprocal conversation. Thus, the social communication deficit.

Tbh, I’ve long wondered if the big differentiator between autistic special interests and regular interests is largely knowing when to shut up about them and being able to do it (e.g., not bringing them up at work, or to people who you don’t know well or who you know don’t care about them), because most people have some at least fairly in-depth interest in something but you just may never hear much about it if you are outside of that circle.

 

[Stagg737]

Assuming the patient has true ASD, I’d wonder about “pure autistic interests” vs a co-morbid ADHD situation where there may be intermittent hyper-focus on interests that are more in passing. Interests that aren’t pervasive seem less spectrum-y and more like an impulsive attention issue.

 

[calvnandhobbs68]

Tbh, I’ve long wondered if the big differentiator between autistic special interests and regular interests is largely knowing when to shut up about them and being able to do it (e.g., not bringing them up at work, or to people who you don’t know well or who you know don’t care about them), because most people have some at least fairly in-depth interest in something but you just may never hear much about it if you are outside of that circle.

Right and from my end it's actually a major indicator that someone does NOT have ASD when they come "self reporting" that they do these things...like the vast majority patients I have with ASD don't come to me going "I have all these restrictive repetitive interests that I talk about inappropriately in social situations and focus on to the exclusion of other parts of my life".

 

[Merovinge]

Right and from my end it's actually a major indicator that someone does NOT have ASD when they come "self reporting" that they do these things...like the vast majority patients I have with ASD don't come to me going "I have all these restrictive repetitive interests that I talk about inappropriately in social situations and focus on to the exclusion of other parts of my life".

So refreshing to read something from someone who actually understands ASD. I really really can't wait for this Tic Toc insanity to end.

 

[futureapppsy2]

I also wonder if there could be some Cluster B component with some of these, as I’ve also seen some patients take on these fixations as their whole personality outside of work for a few months and then abruptly discard it and repeat the cycle with something else for another few months.

 

[FatherPsychiatry]

I also wonder if there could be some Cluster B component with some of these, as I’ve also seen some patients take on these fixations as their whole personality outside of work for a few months and then abruptly discard it and repeat the cycle with something else for another few months.

Sounds about right. Reminds me of this post:

Care-seeking patients who over-identify with diagnoses

I’m a PGY-2 psychiatry resident. I wanted to ask for people's thoughts on a particular type of patient I've encountered with relative frequency so far during my training. The typical patient is a woman or a man with prominent feminine traits. She carries a growing list of psychiatric diagnoses...

forums.studentdoctor.net

This is just good old fashioned hysteria. Dramatic, emotionally shallow, suggestible patients with identity diffusion who cling to diagnostic labels to provide validation. ADHD is one of the latest hysterical diagnoses*. Behind many a hysterical patient is a dubious psychiatrist or therapist whose own narcissistic supply is provided by the imagined complexity of such patients. "special patients" need special psychiatrists who reinforce these dysfunctional patterns and create additional iatrogenic mess. The whole MPD and satantic ritual abuse scandals of the not too distant past are only one example of that.

*Which is not to say there are many non-hysterical cases of ADHD but the diagnosis has been co-opted as an identity and way of life. There is now no facet of mental life that cannot be explained by hitherto undiagnosed ADHD.

Just replace ADHD with Autism, or whatever the trending diagnosis is on TikTok three months from now.

 

[Sushirolls]

OCPD can also have bursts of interests.

 

[psychma]

For me, restricted interests have to be so intense in focus that they interfere with sleep, work, school, social obligations and even getting up to go to the bathroom or eat. You can’t drag yourself away from them even if it means you’re not taking care of responsibilities. You bring them up repeatedly during conversation. My take, though it is perhaps a little rigid. I find girls/women seem to be less verbally expressive although not always.

The problem with assessing adults is there often isn’t collateral. Parents are deceased, in another state, or no contact. They have all read DSM-5 criteria, read Unmasking Autism, and watched countless YouTube videos. My clients show up with lists 20! pages long with their autism symptoms categorized by DSM criteria and criteria they’ve found online. Apparently, liking poetry = autistic in women. Who knew? On the assessment, they know the “right” answers to give. They know not to make eye contact or facial expressions. I can often trip them up by engaging them multiple times in reciprocal conversation. But for the most part you’re just relying on someone who wants an autism diagnosis to tell you their symptoms. I do diagnose some bpd but not as much as you’d think, social anxiety, and ptsd. Taking a good clinical mental health history sometimes teases out things sometimes. For some, social development is stunted by childhood abuse or living in an unstable household. Sometimes, I just tell people that a lot of people feel like they don’t fit in and struggle with social skills, and it’s just part of the human condition. Wow, I went deep on that.

 

[smalltownpsych]

Once we get a drug that is FDA approved for treatment of autism that also hits the dopamine receptors in the limbic system, then we’ll really see an increase in treatment for it. I can’t wait. 😝.
I’m just feeling a bit too cynical during this holiday time apparently.

 

[FlowRate]

So refreshing to read something from someone who actually understands ASD. I really really can't wait for this Tic Toc insanity to end.

One of our better PhD therapists in the office recently wanted to talk to me about suspecting a shared patient has ASD. The patient has a lot going on and is certainly odd, but they cited basically a normal hobby and a side gig for earning money as "restricted interests."

The unfortunate byproduct of the TikTok insanity (ASD/ADHD fad) is essentially a propaganda effect where saying something repeatedly and publicly leads to that thing becoming "true." Thus many therapists and psychiatrists seem to have their diagnostic understanding of ASD and ADHD shifted over time.

Coming back to the aforementioned patient, she reminds me of the kids from the Turpin case, but not as severe. Basically my patient had extremely restricted socialization/opportunity for development of "adulting" and relational skills due to her extremely restrictive (abusive in that particular way) father and is trying to learn how to navigate life now that she's out on her own.

 

[Mad Jack]

Assuming the patient has true ASD, I’d wonder about “pure autistic interests” vs a co-morbid ADHD situation where there may be intermittent hyper-focus on interests that are more in passing. Interests that aren’t pervasive seem less spectrum-y and more like an impulsive attention issue.

Was going to say this- people with ADHD tend to cycle through intense interests, probably due to the dopamine induced by novel activities coupled with the poor impulse control resulting in an inability to do anything other than what is providing that dopamine

 

[clausewitz2]

Was going to say this- people with ADHD trend to cycle through intense interests, probably due to the dopamine induced by novel activities coupled with the poor impulse control resulting in an inability to do anything other than what is providing that dopamine

"I can do things that are complicated and require sustained effort iff they're new to me" is basically prototypical ADHD phenomenology

 

[Stagg737]

"I can do things that are complicated and require sustained effort iff they're new to me" is basically prototypical ADHD phenomenology

“…if they’re new to me and I find them interesting and enjoyable until I suddenly find something else new and interesting at which point I completely forget about the previous thing I was interested in and drop it like a bag of bricks.”

 

[Merovinge]

One of our better PhD therapists in the office recently wanted to talk to me about suspecting a shared patient has ASD. The patient has a lot going on and is certainly odd, but they cited basically a normal hobby and a side gig for earning money as "restricted interests."

The unfortunate byproduct of the TikTok insanity (ASD/ADHD fad) is essentially a propaganda effect where saying something repeatedly and publicly leads to that thing becoming "true." Thus many therapists and psychiatrists seem to have their diagnostic understanding of ASD and ADHD shifted over time.

Coming back to the aforementioned patient, she reminds me of the kids from the Turpin case, but not as severe. Basically my patient had extremely restricted socialization/opportunity for development of "adulting" and relational skills due to her extremely restrictive (abusive in that particular way) father and is trying to learn how to navigate life now that she's out on her own.

I don't get this at all from psychiatrists, I do see it from therapists though, which makes sense as they have far less training to cement in good learning. I also find psychiatrists use social media less than other people in behavioral health and seem to understand how dangerous the product is. Maybe adult psychiatrists, who have far less training in ASD/ADHD might be more prone, but those 2 diagnosis make up a significant portion of any good CAP fellowship.

 

[clozareal]

One of the big things in autism with restricted interests is that the parents/family members often want their autistic family member to do more, communicate more, be interested in more things but the individual doesn't care at all about more things. It's a projection of neurotypical desires and I often have to counsel parents that if they don't want to have more hobbies, it doesn't necessarily mean they are depressed. It means that they are autistic.

 

[FlowRate]

I don't get this at all from psychiatrists, I do see it from therapists though, which makes sense as they have far less training to cement in good learning. I also find psychiatrists use social media less than other people in behavioral health and seem to understand how dangerous the product is. Maybe adult psychiatrists, who have far less training in ASD/ADHD might be more prone, but those 2 diagnosis make up a significant portion of any good CAP fellowship.

Yeah I think there's more subtle but present creep particularly with adult psychiatrists as a combination the pressure from patients to "give out" said diagnoses and the various things those patients repeatedly claim to "know" that reflect the broader social drift in conceptualization of ASD/ADHD. Even trying to spend time to find good sources to educate yourself / support or refute the various claims, you're bound to come across a lot of the drift.

 

[Stagg737]

One of the big things in autism with restricted interests is that the parents/family members often want their autistic family member to do more, communicate more, be interested in more things but the individual doesn't care at all about more things. It's a projection of neurotypical desires and I often have to counsel parents that if they don't want to have more hobbies, it doesn't necessarily mean they are depressed. It means that they are autistic.

This is what I typically see with autistic patients. The patient may be “depressed” or “anxious” but it’s usually family or others close to them identifying symptoms. The patient is perfectly content playing their video games or drawing or being a furry and usually gets irritable or “anxious” when others want them to do “normal” or just other things.

I think the only autistic patients who have come to me on their own are pretty mildly on the spectrum, and I don’t think it’s ever been because they think they’re autistic. Usually they’re just distressed that “something” is wrong with them or that they might have ADHD (which sometimes they do have a little dash of AuDHD).

 

[clozareal]

I think the only autistic patients who have come to me on their own are pretty mildly on the spectrum, and I don’t think it’s ever been because they think they’re autistic. Usually they’re just distressed that “something” is wrong with them or that they might have ADHD (which sometimes they do have a little dash of AuDHD).

Agreed. I have very few autistic patients who say their problems are due to their autism. The other "autistic" patients who were later diagnosed are the ones mainly who attribute their problems due to autism. In doing so, they shorthand any sort of reflection about their experiences and making meaning out of it and instead blame it on the autism.

 

[calvnandhobbs68]

For me, restricted interests have to be so intense in focus that they interfere with sleep, work, school, social obligations and even getting up to go to the bathroom or eat. You can’t drag yourself away from them even if it means you’re not taking care of responsibilities. You bring them up repeatedly during conversation. My take, though it is perhaps a little rigid. I find girls/women seem to be less verbally expressive although not always.

So yes I would say this is overly rigid as an overarching concept in terms of level of impairment the RRI/RRB themselves have to cause. Although I do appreciate taking a more strict view of this in general, especially if your primary evaluation pool is adults coming saying they think they have "autism".

I’ve seen plenty of patients with properly diagnosed ASD who could tell me anything I wanted to know about their preferred interest and would spend large amounts of time fixated on researching things like specific models of trains or watching every episode of some specific TV show repeatedly but it didn't necessarily interfere with sleep, school, daily functioning, etc.

There are also many people who do NOT have ASD who exhibit a sort of addictive behavior around specific interests which does cause things like interference with work, sleep, school, etc.

 

[Mad Jack]

Yeah I think there's more subtle but present creep particularly with adult psychiatrists as a combination the pressure from patients to "give out" said diagnoses and the various things those patients repeatedly claim to "know" that reflect the broader social drift in conceptualization of ASD/ADHD. Even trying to spend time to find good sources to educate yourself / support or refute the various claims, you're bound to come across a lot of the drift.

I'm kind of hard on how I view it. If you don't have lack of theory of mind and a high degree of concreteness to your thought process, 99.9% chance you don't have autism on further neuropsych testing. I've yet to be incorrect

 

[psychma]

So yes I would say this is overly rigid as an overarching concept in terms of level of impairment the RRI/RRB themselves have to cause. Although I do appreciate taking a more strict view of this in general, especially if your primary evaluation pool is adults coming saying they think they have "autism".

I’ve seen plenty of patients with properly diagnosed ASD who could tell me anything I wanted to know about their preferred interest and would spend large amounts of time fixated on researching things like specific models of trains or watching every episode of some specific TV show repeatedly but it didn't necessarily interfere with sleep, school, daily functioning, etc.

There are also many people who do NOT have ASD who exhibit a sort of addictive behavior around specific interests which does cause things like interference with work, sleep, school, etc.

Yay. My pool of clients often comes from tik toc. They tell me they are obsessed with dance. It turns out, they take ballet classes which they enjoy, but don’t think a lot about or know much about. Of course, there are people who tell me recipes are their passion and I’m prepared for it to be insignificant. Turns out they have a collection of thousands of recipes, know the history of food from a variety of cultures in incredible detail, branch off into their detailed knowledge of nutrition and can’t be interrupted. The interest interferes to some degree in all areas of their lives. That is a restricted interest. I’ve also have had men say sports are their interest and I’ve been very skeptical. Then I listen to a 30 minute monologue on the history of different sports dating back to forever. All the minutia, the fact and details. This is not like just knowing all the soccer stats, it is way beyond that and they bring up diff sports facts repeatedly when you’re talking about other things. Oh, by the way, did you know…

 

[clausewitz2]

Yay. My pool of clients often comes from tik toc. They tell me they are obsessed with dance. It turns out, they take ballet classes which they enjoy, but don’t think a lot about or know much about. Of course, there are people who tell me recipes are their passion and I’m prepared for it to be insignificant. Turns out they have a collection of thousands of recipes, know the history of food from a variety of cultures in incredible detail, branch off into their detailed knowledge of nutrition and can’t be interrupted. The interest interferes to some degree in all areas of their lives. That is a restricted interest. I’ve also have had men say sports are their interest and I’ve been very skeptical. Then I listen to a 30 minute monologue on the history of different sports dating back to forever. All the minutia, the fact and details. This is not like just knowing all the soccer stats, it is way beyond that and they bring up diff sports facts repeatedly when you’re talking about other things. Oh, by the way, did you know…

Yes, if you can name a random game their favorite team played n the regular season in 2008 and they can give you a recap of the major highlights of that particular game, then i definitely buy sports as a restricted interest.

 

[futureapppsy2]

Yay. My pool of clients often comes from tik toc. They tell me they are obsessed with dance. It turns out, they take ballet classes which they enjoy, but don’t think a lot about or know much about. Of course, there are people who tell me recipes are their passion and I’m prepared for it to be insignificant. Turns out they have a collection of thousands of recipes, know the history of food from a variety of cultures in incredible detail, branch off into their detailed knowledge of nutrition and can’t be interrupted. The interest interferes to some degree in all areas of their lives. That is a restricted interest. I’ve also have had men say sports are their interest and I’ve been very skeptical. Then I listen to a 30 minute monologue on the history of different sports dating back to forever. All the minutia, the fact and details. This is not like just knowing all the soccer stats, it is way beyond that and they bring up diff sports facts repeatedly when you’re talking about other things. Oh, by the way, did you know…

The last sentence again highlights, I think, the importance of knowing and being able to shut up about interests versus not, as being important in distinguishing restrictive interests from non-autistic interests/passions. For example, I'm fairly into women's artistic gymnastics--I watch old meets while I'm doing barre workouts--and probably know considerably more than the average non-gymnast about WAG (though I avoid the internet/"gymternet" drama). However, I only talk to handful of people in my life about gymnastics, simply because I realize that in most cases it's either not topical or contextually appropriate or they don't GAF. The inability to or extreme difficulty in doing this really ties back to the social impairment inherent in autism, IMO.

 

[psychma]

Yes, if you can name a random game their favorite team played n the regular season in 2008 and they can give you a recap of the major highlights of that particular game, then i definitely buy sports as a restricted interest.

Yes. If you’ve told me so many facts and details and I can’t redirect the conversation, and you speak in a self-directed manner, and. maybe use excessive speech, and your family has told you you talk too much about the topic and I understand why that way because I think my ears are bleeding, there’s a problem. When you keep bringing it up over and over again in a 2 hour interview. Yes.

 

[mistafab]

Psychiatrist 15 minutes into an interview:
"John, John, John, John, John... Hey John, do you need a refill on your abilify?"

John, who just spent 15 minutes talking about Saved By the Bell:
"So basically, on Season 2 episode 3 "Save the Max," the radio station in the show was the central plot line where [continues talking about Saved by the Bell]."

 

[Mad Jack]

Psychiatrist 15 minutes into an interview:
"John, John, John, John, John... Hey John, do you need a refill on your abilify?"

John, who just spent 15 minutes talking about Saved By the Bell:
"So basically, on Season 2 episode 3 "Save the Max," the radio station in the show was the central plot line where [continues talking about Saved by the Bell]."

This is perfect. Someone with autism doesn't tell you they have special interests, they demonstrate it in a way that couldn't be stopped if you tried

 

[comp1]

Mental health is most accurate when a patient shows, as opposed to tells, the physician what is going. This is why I hate screening tools. Evidence based medicine is fine, but it should focus on things like ADLs, relationships, school, jobs, etc and never a symptom inventory.

 

[milesed]

I've followed a lot of ASD patients for 10-20 years and they all gradually improve in most areas over time (like other developmental delays). They seem to really make social skills improvements during the late teenage years which includes the odd obsessions. They seem to realize that they have few, if any, friends and no romantic partners, then are motivated to do some therapy work.