Expert: James Michael Roan - 4/19/2008

Question
QUESTION: Hi James,

I have a question about my son who just turned 3 a week ago. My question is similar to some recent posts. My son sounds alot like the 4 year old you just discussed only he is 3. He has sterotypies esp when oversitmulated or stressed. They are spinning, flapping and jumping. He was diagnosed with Developmental Coordination Disoder and has very low muscle tone. They suggested maybe some mild CP. I'm wondering if I can account the behavior to this or something more.

Here are the good things:
High IQ- very superior range
Expresses "I love you" "Don't be so mad mommy" "why are you so stressed out mommy" "if I eat my sister's donut will she be mad" types of questions so he definitely understands others have thoughts and feelings. The other day he even told me he didn't think another kid liked him b/c he said "ugh with a negative tone" to him
- Pretend plays with symbolic and elaborate play schemes
- Plays well with those he knows his own age
- very verbal/understands the concept of changing your mind and other advanced things
- examiners say he is well related and verbal
- No obvious obsessions
- No lecturing AT people
- Good conversation skills
- shows empathy, asks other kids to borrow, is not bossy, and shares

Concerns:
- Shuts down around too much stimulation. If too many people are in the house he will intermittently interact and then go into his own "pretend play" world and spin now and then
- Will interact with his sisters 2 year older friends but can't keep up with the pace of changing ideas, running here, running there type of thing. Could this be normal b/c he is 2 years younger and b/c of his muscle tone?
- Horrible motor skills
- Can get focused on something and ignore others-sometimes it is hard to get his attention- need to call 3 or 4 times
- at times low arousal
- falls out of chairs, delayed self help skills
- some degree of general anxiety
- main concern lately is that he LOVES to pretend play.Instead of coloring he would rather have the markers be "guys" and have them go on an adventure together. His own pretend land is preventing him from doing more conventional types of activities. I feel like he is more comfortable in pretend land than in reality. He spends more than 2/3 of the day pretending. I have heard pretend play means he is not autistic and is actually teaching him social skills, but if it interferes with normal interaction is that still true? Please address this question. It is so confusing to me.

I've been told that the majority of these things are a sensory deficit related to his muscle tone. Could this be something like a bi-polar issue of does it sound like Aspergers or nothing! I feel like the theory of mind is too intact to be Aspergers but could I be wrong?

Thanks



ANSWER: Hi Kay;

Asperger's, like any human trait, is on a spectrum or continuum. I am not diagnosing here, but my thoughts are that he exhibits mild aspects of Asperger's syndrome (AS) such as social anxiety and poor social competence. Low muscle tone and low vestibular development will result in children sliding out of chairs. Many children with AS develop quite good pretend play, but in boys it usually is around super heroes. Contrary to popular belief, children with AS do have reasonable theory of mind and can read body language. They just have trouble keeping up with the changes in topic and anticipating the direction of the conversation. They look typical around adults and siblings, even around neighborhood pals they have known for a long time. It is in a school and around groups of peers where they fall apart and can't keep up. You alluded to this with your observation: "but can't keep up with the pace of changing ideas, running here, running there type of thing. " This having been said does not mean your son has AS. He may simply have a social delay in addition to his other developmental delays. Social cognition is on a spectrum also and you don't have to be on the autism spectrum to have trouble with it.

To rule out the likelihood of a nonverbal learning disability, tell me if he has any noticeable left-sided body weakness or if he gets lost and disoriented easily (spatial difficulties).

Kind regards,
James

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

QUESTION: I agree that he does exibit some characteristics like the social anxiety and the sterotypies. I have to be honest though, your definition scares me a bit. That would mean that at least 1 in 5 kids I know would fall into that category. Alot of kids have trouble in groups and do better with 2 or 3 kids. I can't see how that could possibly make them autistic. I hope with time my son can keep up with the pace of other kids. With his own age peers at birthday parties most of them are on their own and some don't even follow along in adult led games-such as circle time. My son actually tries to verbally engage his peers and follows in a group led by an adult better than 70% of his peers. If you are judging a 3 year old based on sophisticated social competency like playing well in groups, then I think that is a grave error. Also, a child that can play pretend with anything, *not just role playing*, I've read over and over that it is nearly absent in Aspergers. My son plays pretend with anything. My concern was the isolation factor. How can your description be so loose compared to diagnostic guidelines?

Answer
Kay;

This not an assessment. The topic of autism spectrum disorders is to broad for me to cover in this sort of forum, so I try and key in on the essential points. If you are not concerned then do nothing. If you are, then take him to a professional. Good day.
James