Expert: Valerie Herskowitz - 3/3/2009

Question
QUESTION: We believe our 5 yo son has Aspergers (AS) and ADDHD.  He began speaking like an adult by 14 months of age.  Is it common to see children with AS have issues with pragmatics?  He sometimes says things that are out of context.  Is this common with AS or could it be related to ADDHD (he might be talking about 1 thing & his mind has jumped to something else).  He had an initial speech eval in preschool which he passed with flying colors.  I'm sure there are further language tests that could be done?  Thanks for your time.

ANSWER: I agree with your thoughts. It does sound like Asperger Syndrome to me as well. Usually, AS individuals develop great language skills and sound like adults very early. They have lots of pragmatic language issues. Topic maintenance is one of the pragmatic skills that your son seems to have issues with. He will not only pass a language screening, but be above average on one as speech and language are not his issues other than the pragmatic and social skills which are generally not included in on a screening.

There is a component of ADHD in relation to some individuals with AS. I am curious. Does he have some sensory issues ie: sound sensitivities, the need for routine, slow to warm up to new people and new situations, picky eater or doesn't like haircuts and nail clipping, etc?

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

QUESTION: Yes he has sensory issues but much improved over the few years.  Used to be bothered by loud noises, some tactile, some texture w/food, some in area of touch.  He had sleep apnea and after surgery much improved for awhile but now back to being very "hyper" by end of day.  He seems more tired than other children-toss & turns a lot (will ask for another sleep study).  Language w/saying things out of context/off topic used to happen much more freq.  Much improved now.  You had thoughts re: sensory & adhd?

Answer
It also sounds like he is having some allergy or sensitivities that are affecting his sleep and hyperactivity. Could be food related. I would also have his digestive system checked out by a gastroenterologist, which is common with our kids and could affect his behaviors.

Rather than worry about the label, you should just make sure you consult with an occupational therapist for the sensory issues and a speech pathologist for the pragmatic language issues just to keep him progressing.

Sometimes when a child improves, it confuses the parent into thinking that all is well. (I've been there!) But what you need to do is look at him today as though it was the first time you were seeing him and evaluate whether you think he has an issues that are bothering you today.

Valerie Herskowitz, MA CCC-SLP
valerieherskowitz.com