Expert: James Michael Roan - 11/6/2008

Question
QUESTION: I have a 3 1/2 year old. A year ago she was diagnosed with developmental delay. Mainly speech with physical issues as well. She has is in early intervention, she has speech, physical, and occupational therapy and her speech as improved from 10 words to 100. She exhibits these behaviors; she stacks blocks and puts her toys in rows, she licks almost everything, chews on cloth, and eats paper. She doesn't initiates contact with other children but will follow and play if they come and get her, but loses interest with them. She gets very involved with her children's show. Often screaming and crying when the characters are in some distress.  She cries sometimes without me knowing the cause. She gets distressed when things are out of their place, not throwing out of control tantrums, but small fits, until its fixed. She has little eye contact will hold contact maybe to count of three. She toe walks with her shoes off. She repeats words and says mom constantly with no response to me when I approach her. She loves to cuddle with me, but she will only allow others to make contact when she wants it.  If you kiss or hug her and she doesn't want it she will wipe it off or hug her and she will push you away. She needs to be in the same room with me and has a little pretend play. She doesn't flap her hands or play for hours with an object.  She recently was given the score of 91 on the Autism Index. She was tested with the GAS.  She score 100 in verbal IQ, 128 Performance IQ and 115 Full Scale IQ using the Wechsler Preschool and Primary Scale of Intelligence. My question am I over reacting are these traits found in a she toddler or is the diagnoses correct of very likely autisic ?  Thank you for your time. Dori

ANSWER: Hi Dori;

Yes, many of her behaviors are characteristic of high functioning autism/Asperger's syndrome (AS). It is also possible that she has speech delay with mild OCD behaviors, which can produce similar behaviors that you have described. Was she given any autism/AS specific assessments? If so, provide me with details.

Kind regards,
James

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

QUESTION: James-
     Thank you very much for your help.  The only score I was given was: Gilliam Autism Scale- 91 on the Autism Index score.  I have not received a detail report or breakdown. They also conducted the Wechsler Preschool and Primary Scale of Intelligence, Woodcock Johnson III test of achievement and the Vineland Adaptive Behavioral Scales.  I have those breakdowns if you would like them.

Dori

Answer
Hi Dori;

I am very familiar with these assessments. I use the GARS and GADS, The GADS is the Gilliam Asperger's Disorder Scale. If she has an autism spectrum disorder (ASD), by definition due to her high intelligence, it would be high functioning autism/Asperger's syndrome. With any ASD you have to look at a profile of characteristics, not a few scores. What I am trying to say is, keep the diagnosis as a tentative picture of your daughter as a tool to drive early intervention but not a definition of who she is. When I conduct an assessment I use multiple overlapping measures, observations of a client among peers as well as detailed parent interviews. Even then sometimes I find myself on the fence.

Here is the good news. In EVERY case, intelligence is the key variable that determines outcomes for these children. Your daughter will do very well based on that fact alone. The second variable is gender. Again, girls are naturally more social than boys and have less testosterone levels as well. Both of these variables play in her favor. High testosterone levels have also been implicated in problematic behaviors associated with AS.

If you like, you may call me to discuss her behaviors in detail or you can provide them here in this format. My personal email is: roanpsych@gmail.com.

Kind regards,
James