Expert: James Michael Roan - 3/5/2008

Question
I have a question about possible ASD/AS characteristics in my 7 yo daughter.

1.  My daughter (7 yo, turns 8 in May)  has been diagnosed ADD/ADHD, and
is on stimulant medication.  It helps her quite a bit with concentration,
hyperactivity, and impulsiveness.  She would not be able to function in school
without her meds.

2.  In school, she makes As and Bs, but her math skills have quickly dropped
below grade level.  She's pulled out of class for extra tutoring, but she is still
pretty far behind.  I have no idea how she is pulling low Bs in math, but I
suspect her teacher is being generous.

3.  Her major problems seem to be
a.  physical/emotional immaturity--she's 7, in 2nd grade.  
She cannot tie her shoes.  
She's ridden her bike once without training wheels, but then got scared and
refuses to try again.  
She can't really "run"--her gait resembles that of a preschooler.  
Emotionally, she does not deal well with change.
She's very quick to tears and frustration. This all seems immature to me for a
7 year old.
b.  Anxiety:  
she suffers from separation/social anxiety (i.e., she would not join Brownies
unless I agreed to be one of the leaders).  
she begs to sleep with me and my husband every night.  Cries every night
when I tell her no.  
she follows me around the house--i cannot even step out the door to take
the trash out without her panicking that I might leave
she will not stay with anyone except my mother.  
she often skips birthday parties or other parties/gatherings.  I ask if she
wants to go, she says no.  Then, a few days later, she cries because she
missed the event.   
Not sure if this is related to the anxiety or the adhd meds, but she also picks
her skin--mainly her fingers, but has now started scratching the inside of her
arms at the elbow--scratches them red (she'd do more harm if she hadn't
picked all of her fingernails off)
c.  emotional instability--she can be crying one minute, laughing hysterically
the next.  Hitting her sister, then regretting it and kissing her a second later.  
Her anger is immediate--if I tell her "no", she doesn't whine, cry, and then
escalate into a tantrum--she is immediately at "10" on the anger scale.
d.  Cognitive issues:  there are so many things that she just doesn't get, and
it's hard to make heads or tails of it.  For instance, she has NO concept of
time.  And I don't mean she's a dawdler (although she is).  She seriously has
no clue.  She doesn't understand the difference between a week and a year.  If
I tell her we'll be going to the store in a few hours, that means absolutely
nothing to her.  She can tell time on a clock, but has no CONCEPT of it.  Dh
and I went on vacation for two days--I asked her to tell me when we'd be
back, and she couldn't.  Same thing with money.  Four dollars vs. four
hundred dollars, it means nothing.  She can recognize the numbers, but has
no CONCEPT of their value.  She reads like a champ, but has very little
reading comprehension.  If she reads a story, and then you ask her what it's
about, she is not  able to tell you.  
e.  sensory issues--especially with food.  Also has had trouble with accidents
at school She has had three accidents (wetting her pants) in school so far this
year.
f.  Extremely disorganized--often cannot complete schoolwork because of
her disorganization.  I realize there are few 7 year olds who ARE organized,
but her case seems extreme.  She's obsessed with cardboard and paper.  She
cuts little pieces and saves them, almost hoards them.  Her teacher told me
that her desk and schoolbox had more junk stuffed into them than she had
ever seen in 20 years of teaching.
g.  highly verbal, but context is all off.  She often talks nonsensically.  Will
jabber non-stop after school, usually about her imaginary friends. She's had
the same two imaginary friends for over 4 years.  She shows no signs of
giving them up.  Uses vivid, highly illogical metaphors (i,e, "I'm as hungry as a
lamb in a two-story library!")  She does this all the time--usually leaves
people just shaking their heads in confusion.
h.  highly artistic--this isn't a problem, just an observation.  She has highly
developed artistic skills.  She can draw with extreme detail, and with
complete appreciation for form and dimension.

For instance: yesterday she drew a road with sidewalk chalk for her Barbie
van. The street she drew had both yellow and white lane lines. Double, solid
lines in non-passing zones. She drew a parking lot with two handicapped
spaces, complete with perfect little handicap signs. When she drew the
stoplight, she also drew the shadow that the pole cast behind it.

She also expertly uses a program on DH's computer called "Google Sketch-
it"--it's kind of like a simplified auto-CAD program. She tried to get me to
help her with it, but I couldn't figure it out, so I gave up. I came back half and
hour later, and not only had she figured it out, she's drawn three houses--
one with a portico and awnings over the windows. This is a kid who cannot
tell me what 5-2 is without using her fingers.

She says she wants to be homeschooled (not a possibility) because everything
in school just goes "too fast". Socially she seems to have a few friends, and
she has had no behavior problems since we identified and began treating her
ADHD.

If you've made it this far, bless you!  :)  Any advice or guidance would be
appreciated.

Answer
Hi Dana;

I'm not sure where to begin. Has she had a psychoeducational evaluation by her school or by an outside psychologist? Please keep in mind that I am NOT diagnosing here, just providing guidance and education. Much of her behavior could fit with Asperger's syndrome as you seem to already suspect. If you live in the U.S., you will need to call your school district's special education department and make a referral. In your daughter's case they will need to do a thorough assessment to include:

-IQ
-Academic achievement
-Executive functioning
-Bracken Early Concept Scale
-Social/Emotional
-Gilliam Asperger's Disorder Scale (GADS) or similar instrument.
-Complete language assessment: receptive/expressive/pragmatic language with peers
-Social assessment, i.e., Walker-McConnell Scale of Social Competence and School Adjustment
-Adaptive behavior
-Sensory Profile
-Full occupational therapy (OT) assessment of fine and gross motor skills

If you don't live in the U.S., let me know, I may be able to help. Let me know if you have any other questions.

Kind regards,
James