Expert: James Michael Roan - 10/24/2008

Question
QUESTION: Hello,
Sorry!  This will be long.  My son just turned 3 and has the following characteristics:  He is extremely advanced academically compared to his peers - he knows numbers into the 1000's, letters and sounds, sight reads, etc.  He loves numbers.  He likes to play with foam numbers and to watch videos on YouTube with countdown clocks.  He can be re-directed easily to do other things.  He does have his pronouns mixed up, but we have been speaking to him in the 3rd person for the better part of a year just to be clear as to whom he was referring.  In the last few days we have been correcting him and he now gets it right about 60-70% of the time.  He seems to lag behind socially, but we are not really sure about this.  He is an only child who has had very few play date opportunities and has only been going to preschool since May.  He is very sweet, not prone to tantrums at all.  He has no sensory issues that we know of and doesn't have a particular problem with transitions. We took him to a developmental pediatrician last week.  Basically we wanted to know what kind of educational environment would be best for him in light of his academic gifts and was his social level a problem.  We filled out both a TABS assessment and a "Child Development Inventory" prior to the appt.  As a caveat to that, my husband and I were simply not sure of some of the answers to the questions on the inventory.  For example, I have no idea if he can stand on one leg because we never asked him to.  Also, as we have not personally seen him interact with peers except on the occasional play date, a lot of the social questions we did not know either.  Any question we did not know the answer to we marked as "no."  Our meeting with the Dr consisted of him interviewing me and my husband while our son played nearby.  He also did a physical exam.  Based on this the Dr said he had Asbergers and gave us no guidance whatsoever as to what to do next.  We are wondering if this was a thorough enough evaluation.  Isn't Asbergers difficult to definitively diagnose at 3?  We've decided to take him next week to a therapy group that will provide an OT exam.  Is this the appropriate next step?  Would you recommend something else?  Thanks, Erika

ANSWER: Hi Erika;

Your doctor may be jumping to conclude your son has Asperger's syndrome (AS) on the basis of his hyperlexia alone, or he/she may be qualitatively observing something else such as low eye contact and/or low social behavior based on your descriptors. He/she may perceive his interest in numbers as meeting diagnostic criteria for "stereotyped, narrow range of interests." You should have a more detailed evaluation to determine if your son does, in fact, have AS before you can move forward. You must keep in mind that AS is not a debilitating condition warranting intensive intervention. Intervention is warranted, but in special ways. The goal is NOT to "de-Aspergerize" your son, but to help him appreciate his gifts as well as his short comings when the time is right, as you would do with any child. These are absolutely wonderful little boys and girls who love and want to be loved but often lack the innate skills to make and/or keep friends so they need help with that. They are not broken or "disordered."

You will want to find a psychologist specializing in the diagnosis of AS in young children. This diagnosis should really include an observation of your child interacting, or not, with peers in unstructured play situations.

If your therapy group involves adult-mediated peer play and/or Floortime (see: Stanley Greenspan), then stick with that for awhile.

Let me know whether or not you live in the U.S. It makes a difference in the advice I will give next.

Kind regards,
James







James Roan Bio:

James Roan (roanpsych@gmail.com) has been consulting in the areas of autism, Asperger’s Syndrome, and learning difficulties in the United States and in Ireland for over ten years. James Roan has traveled to Galway, Limerick, Mayo, Clare, Dublin, Cork, Waterford, and other cities and counties across Ireland assessing children and adults, and consulting with solicitors (lawyers) in defense of children with disability and with enforcement of their rights. James Roan was the consulting psychologist responsible for many of the autism and ADHD screening tools and other content for www.accessspecialneeds.com. James Roan is past president and currently on the board of directors for the Autism Spectrum Disorder Foundation (www.autismspectrumdisorderfoundation.org). James Roan consulted with the graduate department of the Waterford Institute of Technology in the development of their graduate program for the certification of private autism tutors.


---------- FOLLOW-UP ----------

QUESTION: Thank you for your response.  The therapy practice we are going to is only providing the OT evaluation at this point.  We don't have a therapy group for anything yet.  Will the OT evaluation be helpful or is it a waste of time?  I definitely want someone to observe him at preschool.  We may also videotape him in class because with a new person in the room he may act differently.  There is a psychology practice nearby that diagnoses AS, but the tone of their website is, for lack of a better word, strident, which kind of turned me off.  That is why I chose the therapy practice for further eval.  They don't diagnose, though.  We are just kind of at a loss as to what to do to definitively find out if the diagnosis is correct.  We are probably in denial because we don't want to believe it is true, but we need to be sure.  Is OT enough?  Do we need to see another dev. pediatrician?  A neurologist?  Is it possible he is just extremely gifted??? We are in the US, by the way.  Thanks again, Erika  

Answer
Hi Erika;

If the OT is going to do more than just have you complete a Sensory Profile and actually quantitatively and qualitatively evaluate his social interactions with peers, then "Yes" it would be worth it. On the other hand if they just make some generic notes about motor skills and peer relations, then save yourself the money.

As far as the psychologist you referenced, make sure you get a detailed description of what they are going to do and for how much.

It is possible that he's gifted, but the pronoun confusion is indicative of Asperger's syndrome (AS). Children with AS generally have a reversed communication profile than typically developing children: Their expressive language is far ahead of their receptive language. Their advanced speech production gives the false impression that they are also processing language at a similar level, which generally they do not.

You don't need to see: "another dev. pediatrician?  A neurologist?" You do need someone who is very experienced with young children suspected of being on the spectrum, because often it is a qualitative call. I spend about two hours reviewing assessment results with a parent while I watch the child interact with us adults. Then I watch the child in their classroom during "unstructured/structured" play times. Sometimes the child looks typically developing on paper but qualitatively AS in person. These children, however, have the quickest and best outcomes. By the way, IQ is clearly the best predictor of future success and your son sounds like he is very intelligent.

This is important: Your school district is responsible for the assessment and service delivery of students suspected of having a significant delay in motor, social/emotional, cognitive, and/or communication. Call the special education department at your school district and say you want to have your son evaluated by the Early Intervention team members in communication and social areas of development, and that you suspect an autism spectrum disorder.

P.S. If you like, run by me what your psychologist plans to do as part of their assessment of your son before you contract with them.

Kind regards,
James






James Roan Bio:

James Roan (roanpsych@gmail.com) has been consulting in the areas of autism, Asperger’s Syndrome, and learning difficulties in the United States and in Ireland for over ten years. James Roan has traveled to Galway, Limerick, Mayo, Clare, Dublin, Cork, Waterford, and other cities and counties across Ireland assessing children and adults, and consulting with solicitors (lawyers) in defense of children with disability and with enforcement of their rights. James Roan was the consulting psychologist responsible for many of the autism and ADHD screening tools and other content for www.accessspecialneeds.com. James Roan is past president and currently on the board of directors for the Autism Spectrum Disorder Foundation (www.autismspectrumdisorderfoundation.org). James Roan consulted with the graduate department of the Waterford Institute of Technology in the development of their graduate program for the certification of private autism tutors.