OK- she starts by comparing the compulsions to addiction. So he gets a cocaine type rush form indulging in his compulsions- she talks about a low salicylate diet helping. We tried that and tbh it didn't seem to help him much.
I talked about preventing him from seeing through compulsions and his distress when I stop him seeing one through. She said " withdrawal from any addiction is never painless but nor is an addict enjoying themselves... compulsion isn't want but an an addict doesn't know that....'
I told her that I tend to limit compulsions so he's allowed to indulge a certain number of times then we stop them. she said 'important, as addictions only accumulate, compound and ultimately become a bigger trap than the 'autism' ever was' I then talked about compulsions sending him 'over' - she said that ' mania is not pleasure' .. and goes onto describe being stuck in mania and withdrawal. She has written a poem Pink Street light - which described it exactly to me.
She then talks about OCD- as being different from compulsions.
She then talks about stopping a compulsion by directing anger at the compulsion (not at ds1) and saying 'naughty lightswitch ds1 is in charge of the lightswitch the lightswitch isn;t in charge of ds1' etc - this has worked surprisingly well in the past.
She goes onto suggest some biomed stuff that I might try to get into him again (compulsions have got bad again recently). Couldn't get him to take the stuff before.
I asked whether we should tackle compulsions or leave them. She said they had to be tackled. She said 'the will progressively worsen, they are addiction driven in his case and h has identified with them and sided with them. They are vocarious and will take over progressively more territory, taking the family with them.... so no this is not the place to look at this as 'culture'... stims, obsessive interests, sensory fascinations...these are culture... but co-morbid mood, anxiety and compulsive disorders are condition... you don't sit back and guilt yourself into celebrating these or they may eat up ds1's life piece by piece.'
In another email she talked about how some people fit the autism 'culture' group- think stereotypical Aspie for what she means by that, others are far more 'condition' -driven by other probably underlying metabolic problems. She then distinguishes between writing about sensory and obsessional interests which are voluntary vs ds1's behaviour with is totally involuntary.
I'd really recommend her for consultations actually- she does it by email, is generous with her time, very cheap for the autism world (60 Australian dollars last time we did it) and has been spot on.