It’s really great that you’re seeking help and talking openly about this! Encopresis is too often shameful and kids suffer when parents don’t speak up.

There’s lots of conflicting advice out there and I strongly recommend you find pediatric autism specialist if as all possible. A generalist MD or therapist is not likely to be knowledgable about this topic.

This website, despite the sales pitch, has good information and a detailed manual. It might be worth reading. https://www.encopresis.com/encopresis-manual/

Editing to add that interoception may be part of the issue. People with ASD often have more distant perceptions of internal bodily sensations than allistics, so your son may only perceive his need to defecate at a 1/10 where another kid might feel it at a 7/10. Teaching body check ins and mindfulness can be helpful, but is tricky with young kids.

Thanks for the additional detail here! I knew I was making a broad generalization with “ground up” and don’t mean to imply that if you start with details (ground) you never make it to the big picture. As you said, more data and examples are necessary and while the overarching structure can eventually be seen, autistics are less like to wave away outliers as quickly as neurotypicals.

Still, I think it’s been well documented that in general autistics much more likely to utilize inductive reasoning whereas neurotypicals rely more on deductive reasoning. Both have strengths and downsides and work best in combination.

It’s almost as if we need each other and should cherish the differences that make us better together! In my experience, that means NTs need to adjust more to autistics because autistic people are constantly adjusting to a society that overvalues NTs.

It’s no so much stacking that’s a notable symptom, it’s collecting, arranging, sorting and displaying, often without playing with the toys as intended. Instead the focus is more on neatly sorting by color / shape / size etc. and sometimes preferring to keep them in that configuration over playing with them.

This is similar to the tendency for some autistics to focus on the part of a toy, like spinning the wheels on a toy truck, instead of playing with the truck doing truck things.

While these are commonly associated with autism, these two examples are neither necessary or sufficient symptoms to diagnose autism. Meaning that you can see this symptom in an allistic (not autistic) person and it does not mean they have autism and you can have autism and not have these symptoms.

One thing common to many autistic people is ground up processing. Their minds do incredibly well with details (the spinning truck wheel, the defining characteristics of the toys they sort) but sometimes don’t see “the big picture” as easily. It can be an incredible strength in many ways, especially when embraced and harnessed instead of shamed and “corrected.”

If a professional is required by law to make these reports, and makes you aware of these duties at the start of your care, then there is no valid ethics complaint and no violation of trust. The therapist must tell you in their informed consent about these limits to confidentiality and should have done so before any personal information was disclosed to them.

While there is a potential of some harm due to this disclosure, therapists are not in a position to investigate and determine if abuse / credible threats of violence occurred and are explicitly not supposed to do so. They are supposed to make a report and allow other state agencies to investigate. If OPs family ended up hurting someone and the therapist was drawn into legal proceedings, they could equally be sued for having this information and not following their duty to warn.

OP, these issues do belong in therapy and you should be able to get support for them.

Yes, which is the point. Face valid, self-report measures for rare psychiatric disorders are extremely problematic and subject to misinterpretation. Lie to doctors for fun all you want, but if you actually want an answer to this question you’ll need to be clear about your symptoms and you will need a qualified professional to walk you through the diagnostic process.

Please get a better assessment and differential before you make any conclusions about yourself. The HARE is very old. The PCL-R is more recent and draws from some of the original HARE development. Even so, that instrument alone is not enough to make a diagnosis like that and you’d need convergent validity from other measures and at least a clinical interview. Again, true psychopathy is exceedingly rare and because of it’s nature, less studied than other conditions.

There are also many things that can look like psychopathy and aren’t including trauma, severe attachment issues and narcissistic personality disorder.

While autistic people do have some struggles with perspective taking, the “theory of mind” concept is still hotly debated. Is it still a theory of mind issue if an autistic person does not engage in perspective taking automatically, but can do so with intentional attention and / or coaching? That symptom is neither necessary or sufficient for an autism dx.

And for your other comment, lying happens for so many reasons it’s not a useful symptom either. Neurodiverse people lie all the time to get neurotypical off their back or avoid explains why, for example, trying to converse over the rattle of the fridge motor makes them want to punch things.

I don’t think this will answer your question directly, but Misdiagnosis Mondays has a good series on differential diagnoses and is generally good information.

https://neurodivergentinsights.com/misdiagnosis-monday/?srsltid=AfmBOoq306GEP_3YnMoTEwI--5eAwjVxqTfYpcHV3xicFTS9yrIAV85X

Don’t forget to include base rates in your calculations. Autism estimates can be as high as ~1 in 20 or 30 (for AMAB) depending on how you measure it and Psycopathy is far lower even accounting for measurement challenges. Also, the HARE, even the updated one, is more than 40 years old. I would be very suspicious of people using that measure clinically.

Anecdotally, autistic people can be prone to overly concrete / dichotomous answers on some measures, which leads some to endorse actions or thoughts they have had, but occur extremely rarely, when the measure is asking about a prominent and repeated symptom.

It is possible to be both, but there are many things that distinguish the conditions. Also, if a person is autistic and has not had that understand or proper accommodations, then “antisocial” habits that develop out of self-protection may be misconstrued as pathological personality traits.

This is a deep and nuanced conversation and it would be worth deconstructing your answers on the HARE with a therapist or someone who knows you well to see if your perceptions of your symptoms match with other’s perceptions.

I’m not in Europe so I don’t have a whole lot of knowledge about the healthcare system or how to direct you unfortunately. In terms of books I like Devon Price’s Unmasking Autism (one of the best for describing the experience of adults on the spectrum) and for younger AFAB folks I like Spectrum Girls Survival guide. I have skimmed and liked Field Guide to Earthlings but haven’t read it completely.

Also it’s a small organization but Autism Learning Lab is building some nice resources and education. I still believe a full formal social developmental assessment is helpful, but it’s expensive and if you don’t find the right practitioner they can still miss the boat. I tend to advise people to ask a lot of questions about their clinician’s expertise and experience with autism. Learning subtle signs beforehand and asking if they are aware of the “pink flags” etc. described here could help.

https://pubmed.ncbi.nlm.nih.gov/34121610/

I work in the field and am constantly shocked at the number of otherwise skilled practitioners that have a huge blind spots for autism, especially mild or low support need individuals.

The thing about masking is that it can also hide “impairment” so a good diagnostician should ask about the ways you might mask and the physical and emotional costs of the masking. Sure you can socialize with the best of them, but are you a hollowed out shell at the end of the day? Does the masking leave you with zero resources for your hobbies, less capacity to deal with stress, and burnout? High maskers tend to have higher burnout because they are working hard to function in a world that expects them to appear counter to their nature. All too often someone can appear to function typically but a few times a month or a year they have epic drops in functioning and can’t get out of bed or leave their dark room. They’re diagnosed with depression, which admittedly can be exacerbated by burnout. However, treating burnout with depression coping skills might miss the mark. Anyway, this is a huge frustration for me professionally and I’m sorry you are dealing with it.