Unifesp outpatient clinic offers diagnosis and treatment for autistic adults

Daniel Zibordi, 24, speaks slowly, reflecting before each sentence. Larissa de Souza, 23, uses her ability to articulate in favor of diversity and access to health. Paulo Fernandes Junior, 19, offers sincere answers while analyzing the expressions of his interlocutor. Very different from each other, they have one thing in common: they are autistic adults.

The three are part of an initiative by Teamm (Marcos Mercadante Social Cognition Outpatient Clinic), from Unifesp (Federal University of São Paulo). The space was created in 2007 aimed at training health professionals to care for autistic children, but in recent months it has also started to receive adult patients.

The adult outpatient clinic, located in Vila Mariana, south of the city of São Paulo, is open every Monday afternoon, from 1 pm to 5 pm, with two face-to-face groups: one focused on social skills and the other on the job market. This week, the virtual group for family members also begins.

Psychiatrist Gracielle Rodrigues, vice-coordinator of Teamm, and psychologist Vera Papais mention that in the meetings, patients learn how to initiate and maintain conversations in different environments, from the elevator to the bar. They also learn to read other people, inferring their feelings, if they are being appropriate or if it is time to stop talking. “Many have a history of rejection when they try to join a group and can’t understand why they don’t know how to do this reading”, says Vera.

In addition to the difficulty of social interaction and understanding the signals of others, autistic adults may have sensory changes, such as hypersensitivity to light and sounds, which makes environments such as crowded auditoriums and noisy meetings uncomfortable, especially if they did not have treatment in childhood. Migrating from one task to another, such as leaving the computer to go to lunch with co-workers, and dealing with unforeseen events are also challenges.

In order to better deal with situations, in the outpatient clinic, patients have theoretical discussions about social skills and the work environment, stage and train moments of interaction, says psychologist Thais Priore Romano.

While classes are taking place, a part of the professionals carries out a diagnostic evaluation. The idea, says psychiatrist Daniela Bordini, coordinator of Teamm, is to train psychiatry residents for the diagnosis of autism in adults and offer the opportunity to identify the disorder for SUS users. And the search for women has drawn attention.

Historically, studies on autism show a prevalence of cases in males, but researchers say they believe the difference may be underestimated. They consider that case descriptions are focused on boys and that it can be more difficult to diagnose the condition in women due to their ability to mask symptoms and stereotypes such as shyness.

“They are more likely to reach adulthood without a diagnosis. If a woman realizes that eye contact is important, she makes an effort. little more. And that comes at the cost of a lot of suffering. Camouflage, in both men and women, is associated with depression and suicide attempts,” says Graccielle.

Larissa agrees. “Historically, the woman is a domesticated body. We silence our speeches and interests because we don’t know what can happen, how they will look at us. We adapt to fit in some places and the autistic woman does this twice. repress them. It’s already so automatic that sometimes I don’t even know I’m camouflaging.”

In her assessment, the media reinforces the stereotype of the autistic person as an upper-middle-class white boy or man, with easy access to health professionals, when the picture is much broader. “Autism is not blue, it’s all colors. It doesn’t have social class, it doesn’t have ethnic groups.”

Camouflage, however, is not the only difficulty in diagnosis. In Daniel’s case, the psychologist raised the possibility of ASD, but did not want to go into depth, assuming that confirming the disorder would have a negative impact. It was necessary to change professionals to have a new approach.

“It was good to find out. It clarified several doubts I had, such as my difficulty in interacting with people. I wondered why it was so difficult to talk to people, why I had to wonder what to say and then I didn’t leave.”

Paul was another who had to insist. The sadness he felt at age 13 would not go away and he asked his mother if it was depression. Since then, the situation has worsened and suicidal thoughts have emerged. Even so, the diagnosis of ASD only came two years ago, after the younger brother was identified with the disorder, the mother became interested and autism became a family matter.

“I always had a hard time looking you in the eye. I was always very shy. My teachers said I was special, different, so for me autism was a certainty, but not for my mother. She said: ‘You don’t have it’. But that was more out of a wish that I didn’t have it than because she actually believed it.”

Larissa also suffered from the family issue. She had problems at school when she was a child and was referred to Caps (Psychosocial Care Center). The plastic artist was welcomed, but her mother did not accept to take her for consultations and only when she was 18 years old, already working, she was able to seek care.

The physician raised the hypothesis of ASD and requested a neuropsychological evaluation. “He read the almost 20 pages of the assessment and said, ‘You are an autistic person’. I was very emotional. I knew there was something different about me”, she shares through tears.

For her, the diagnosis is not a delimiter and guarantees rights. It was also the first step towards a process of self-knowledge and appreciation. “I was a victim of capacitism and accepted the situation because I didn’t know myself, didn’t understand my limits. The diagnosis was also important for that and we need to remember that not everyone has access to it. I was only able to make the assessment because I was working”, he says.

“Autistics are everywhere, but access to mental health is not. When I received the diagnosis, I started to seek care and there are few services and professionals who treat autism in adults, especially when there are socioeconomic restrictions. outpatient clinic: it is a quality service, for adults and free of charge”, he praises.

Teamm – Unifesp

The clinic is part of Caism (Center for Integrated Attention to Mental Health) and is located at Rua Major Maragliano, 241, in Vila Mariana. Information about scheduling can be obtained on the website https://www.caism.org.br/agendamento, by email [email protected] or by phone (11) 3466-2100.