Expert: James Michael Roan - 9/25/2007

Question
As a baby, Noah developed very rapidly.  All physical "milestones" reached
early and was literally speaking in full (4-5 word) sentences by 12 months.  
He has always been very affectionate, expressive, sweet, and really bright.  In
preschool they told me he was "anti social" and separated himself from his
peers (not the kid I knew to be VERY social at parks, etc...) but when I went to
watch, there he was, in the corner, watching the other kids.  The school
recommended therapy and we took him to a specialist who said, "he's fine"...  
which we knew to be true in one on one situations.  Later, Noah was
diagnosed with ADD/inattentive type, though he also shows some
impulsivity.  In kindergarten, the diagnostician felt he should be tested for
dysraphia, since his obvious intelligence was not being expressed in his
writing (he would literally count the number of letters in a word before writing
it to be sure it was short enough).  We took him for academic learning testing
and they found his IQ to be 145, but told us without medication for the ADD
there were many memory and impulse tasks that had lowered his overall
score and to retest him when he was older.
Noah was teased mercilessly by his peers in private school and became
depressed and moody in first grade.  We took him out of school to
homeschool  him for several months, but one day he said, "I'm ready to go
back.  I miss having friends".  So, he started at a wonderful public school.  He
is in the gifted program with other kids like himself, and has strong
friendships that have carried over for three years.  But, social situations are
uncomfortable for him.  He struggles to make eye contact and he "clams up"
until he feels accepted, and safe.
He has some of the "quirky" autistic traits that worry me and I wonder if
people will think I am nuts for wondering about my bright, articulate,
affectionate son.  He toes walks and flaps sometimes.  More so when he is
not on his medication.  He is extremely sensitive to criticism, and his self
esteem is shaky.  He just stopped wetting the bed, although he day time
trained at 20 months.  He also has amblyopia and strabismus, eye surgery
helped
some of the toe walking and weird body posture and hand posturing issues,
and as he has gotten older, he has really
improved, but I do see the "quirks" more often when he is off his ADD
medication (Daytrana patches).  
Should I have the school test him again, or let it go?  I would think that the
therapist, the pediatrician, and the academic testing would have revealed
autism or SOMEONE would have picked up on it...
What are you thoughts?

Answer
Hi Sabrina;

I must say you're really on top of this. Professional knowledge about autism and especially Asperger's Syndrome (AS) is relatively limited. Although I do not diagnose over the Internet, I suggest you have him evaluated for Asperger's Syndrome by an individual or team with specific training and experience in this area.

It's important that your son understand what AS is and how it affects him, assuming he has AS. I suggest you first order: The Genesis of Artistic Creativity Asperger's Syndrome and the Arts by Professor Michael Fitzgerald and published by Jessica Kingsley Publishers www.jkp.com  In his book, Professor Fitzgerald speculates about people in history who probably had AS. I don't agree with the term "syndrome" or "disorder." Knowing and identifying famous people in history who were like him will help to identify with positive role models rather than thinking he has a disease or is not as good as everyone else. Prof. Fitzgerald is a leading AS and autism specialist in Dublin, Ireland. I have read dozens of his reports and he knows his stuff. It's important for people who have AS to understand that they are NOT unlikeable, just rarely socially fluent and socially competent. It's an important distinction and means everything to their self-esteem. People with AS have been around forever. Dr. Temple Grandin once said: "While all of you neurotypicals (people without AS) were sitting around the fire chatting about what to do about moving big and heavy objects, some person with AS was off in the bushes building the wheel!" That's it in a nutshell. Your son's self-esteem and thus happiness are more important than being great, although that's of value too. I am sure he will do great things. Having him know that his trouble with keeping friends is really due to low friendship maintenance skills, something that can be learned, rather than because "nobody likes me," will make the difference between being great and alone and being great with a small but meaningful social support system.

I hope this makes sense and helps.

Kind regards,
James