I know that Aspergers is more like Autism... your comment about paranoia makes me think schizophrenia or bi-polar disorder.  Many disorders don't appear until early adulthood, so it's possible that he has something going on.

I am not sure how to approach that, but you might want to ask a professional who can point you in the right direction.

Not much you can do if he won't get help, Sassy.

Talk to him and see if you can get him to realize that talking to someone might be a good idea.

I know that you are right.....he won't listen...everyone's tried....it's sad and frustrating! Thanks for letting me vent and try for answers that seem impossible right now!

Tam...thanks for the websites!

WWIT, that was my thought too!!  Great minds and all...  When my DD was at the treatment facility her counselors told me to be prepared for a dx of BPD as she nears adulthood (they can't diagnose it until older, I was told).  A wonderful book on this is "Stop Walking on Eggshells" by Paul T. Mason and Randi Kreger.  The sub-title is "Taking Your Life Back When Someone You Care About has Borderline Personality Disorder" so even if he continues to deny help at least this could help the people surrounding him.  My DD doesn't have this dx and hopefully never will, but some of the principals apply to handling her bi-polarism.  The paranoia symtoms you describe unfortunately (as you probably know being a nurse) can fall under many diagnoses, and often times disorders overlap.  Rarely do you see a bi-polar or BPD person that doesn't have at least traces of what looks like other disorders.  Another site on BPD is http://members.aol.com/BPDCentral .  To cut it down to the bare, here's the DSM-IV Criteria for BPD per that book I mentioned:
A pervasive pattern of instability of interpersonal relationships, self-image, and affects [moods], and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).
2 A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, shoplifting, reckless driving, binge eating).  Note: Do not include suicidal or self-mutilating behavior covered in (5).
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). [Dysphoria is the opposite of euphoria.  It's a mixture of depression, anxiety, rage, and despair.]
7. Chronic feelings of emptiness.
8. Inappropriate, intense, anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or sever dissociative symtoms.

Well, there's my 2 cents and then some  .  I can never manage a short reply even when I try.  I hope that makes it easier to rule out BPD or not.  Here's a big ((((((((hug))))))))) for you, I know it's exhausting at times to live with these issues.   

   

Sassy    , I hope things go well for you and your family!  I will keep you and your family in my prayers and hope the time passes quickly without too many problems.

Sassy - I don't know how "helpful" this may be but thought it might give you some insight.  Jerry Newport has asperger's.  He is able to perform extremely difficult mathematical calculations and even from the age of 7 he was able to calculate complicated roots in his head.  He is known internationally for his books, his humor, his TV appearances and speaking engagements.  Jerry and his wife are the subjects of the Movie "Mozart and the Whale" based on the brilliant book written by the Asperger couple. 

Jerry's Interview (Received today via e-mail from autism group)

What age are you?  Between 35 and 45?  46 to 55?  56 to 65?  Over 65?
I will be sixty on 8/19/2008, making me exactly two years younger than Bill Clinton!

What age did you start talking and did you receive any diagnosis as a child? 
My family had a pet crow, Blackey, whose cage hung near my room. I said my first word "Hello" between one and two, learning it from the crow. I had no inflection and my family used to joke about who taught me to talk.
I had no diagnosis but my old report card shows comments like "He is a remarkably bright child in a world of his own" (grade one) and "Not performing to potential, daydreams a lot (grade six).

What age did you become interested in making friends and how old were you when you had your first friend?
I had a friend in kindergarten.

How could people have helped you to become more engaged with others when you were a child?
I needed coaching on social boundaries. For example, I went to visit a friend and when nobody was home, I let myself in to use the toilet.  I got into trouble for this without understanding what I did wrong.  I used to say things I thought were funny with no sensitivity for other people's feelings.

What would have helped you to feel more comfortable in social settings when you were a teen?
I needed to learn some structured ways to meet girls and how to propose activities with them. I was absolutely clueless and afraid of rejection. Once I finally had enough nerve to ask women out for dates, I was so obsessed with "conquests" that I didn't have the patience and sincere interest to keep any woman interested in me. I needed a lot of common-sense social advice.

Were you close to your siblings as a child and do you have a close relationship with them now?
Most of the time they seemed to tolerate me but they were also very protective.  I think we are closer now but they live far away.

Did you/do you have problems making eye contact with others? 
Yes I had a lot of difficulty making eye contact and even today it's sometimes difficult.

Can you explain why it?s difficult?
It is hard for me to concentrate on what to say when I look somebody in the eye.

Do you think children on the spectrum should be ?taught? to make eye contact?
I think far too much emphasis is placed on eye contact.  I often look at a person's temple instead of their eyes.

How many pets do you have? 
We have thirteen now: One Goffin's Cockatoo, one dove, six parakeets, four cockatiels and one poodle.

In what ways do you think pets contribute to your life and if parents want to purchase one pet for their child, which one would you recommend?
They are fun to watch and hear. The poodle is the one who spends the most time with us.  He is very loyal and his love is unconditional.  He loves giving and getting attention.  Pets should be durable enough to let your kids know if they are not being handled correctly and they should be free from disease, something which reptiles are particularly prone to.  I think dogs, cats and guinea pigs are best for our kids.

I understand you have savant skills.  Can you explain these skills and how they contributed to your life?
My savant skill with numbers is a mixed blessing. Since age seven, I have been able to do just about anything you want me to do with numbers. It made people less likely to abuse me as a kid but it seemed to also fool people into thinking this would make up for all the stuff I couldn't do.

In addition to your remarkable talent with numbers, what other fascinations and obsessions have you/do you have?
I enjoy music, humor, sports, politics, animals, genealogy and being outdoors.

Have you ever tried vitamins, diet or other biomedical approaches that are thought to help people on the spectrum?
Yes. I think the best thing that ever worked for me was daily vigorous exercise. I ran track and cross-country and it helped me calm down and focus better.

Is there anything parents can do to prevent depression in their autism spectrum kids or how can they recognize the early symptoms?
There are some good websites on this subject and they include common signs to watch for. Parents should not allow us to become total computer hermits. They should make us participate in at least one club or activity where we have a common interest with age appropriate peers.

Are you currently employed?  What work do you do/have you done in the past?
I write and drive a taxi part-time. I have also done accounting work, income tax returns, library work, cashiering and been a teacher's aide. There is a new convention center opening in Flagstaff.  I'm excited about this potential opportunity since I feel at home in conventions.

Do you have any accomplishments you'd like to mention? 
I was a member of the Central Committee of the San Diego County Democratic Party. This was a result of my volunteer work on campaigns, membership in several unions and reforms I achieved in the local taxi industry.
Of course, I am proud to have helped start and run AGUA, the support group where I met my wife, Mary in 1993.

Are you married?  If so, did you ever think this was a possibility and is your spouse on the spectrum?
I have been married, divorced and remarried to Mary since 1994. I gave up on this possibility before I met Mary. She is also on the spectrum and has two grown, independent sons who show symptoms with no diagnosis. Mary is also a grandmother of a girl and boy.

People on the spectrum are often known to follow their routines rigidly.  Do you think being married to another Aspie forces you to be more flexible?
Yes. You also have to understand that you can't always act the way you did when you lived alone for years.

If you could change one thing about neurotypicals, what would it be?
There would be fewer of them.   Seriously, they should not be so afraid to see the autism in some of the things they do.

If you could advise parents about one thing, what would it be?
Accept the fact that there are many ways to become happy.  Your child may find a way that you never would have wanted for yourself.

If you could advise teachers about one thing, what would it be?
Don't lower standards because of a diagnosis. Don't give away grades to raise self-esteem. Teach accountability as much as you can.