Expert: James Michael Roan - 2/18/2009

Question
My nine-year old, diagnosed at seven with pdd-nos, will be reevaluated by same autistic center in a couple weeks.

He has never had language delays (spoke early and articulately) and is above average intelligence. At one point, his verbal was tested superior. His circumsribed interests are odd and somewhat intense, but he is able to shift topics and converse about other things.

Yet, he has had ongoing social issues that have increased and he prefers adults. He has no close friends and no playdates. He has a 1:1 aide for inattention and cueing in school and he performs below his ability due to motivational issues. His interests include office supplies, technology and series of things (Guiness Books, video games, videos).  He doesn't read voraciously, but has a large vocabulary and speaks with a loud intonation. He also seems to accumulate lots of knowledge about particular things despite not reading which is curious. He has an excellent memory for details and narrates script from video game or movie. He also talks to himself quite a bit when he's playing alone. He has always had acute visual imagery in his head (he's explained it to me). He has an excellent sense of humour and is quite insightful.

I'm curious if his diagnosis will be changed to Aspergers. Or, could he be off he spectrum altogether? If he doesn't fit pdd-nos anymore, but is not meeting all criteria for Aspergers, then where would he be? He is definitely not classic autism and is way too high functioning. This said, he's on his fourth school and he has had difficulties wiht transitions, completeing tasks, listening, inappropriate comments and behavior (socially) since preschool. His attempts to fit in are thwarted and he is at a point where he tries anything to be accepted.

He receives special education and a 1:1 aide. Team wants to know more about him, what programming would be best for him (hence the evaluation at their expense).

Thank you.

Answer
Hi Elizabeth;

My guess is he will probably meet diagnostic criteria for Asperger's syndrome (AS). The best way to know more about him is through thorough assessment in the following areas: cognitive, executive functions, attention, social cognition, social skills, social/emotional, Asperger's specific assessment (GADS, etc.), and sensory. The mystery that is Asperger's makes sense when you understand the child's complete profile of skills and limitations.

In reference to his difficulties you described: problems with transitions involves a concrete or literal thinking style and problems with executive functions. Problems with completing tasks and listening usually are a function of executive functions (EF) and attention, which is part of the EFs. Inappropriate comments and behavior are due to social cognition delays. So, when you quantify all these skills or lack thereof, you can begin to chisel away at his difficulties. The goal is not to change who he is but to understand him better and the daily challenges he faces.

If you would like more clarification just let me know.

Kind regards,
James







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Bio

James Roan is a certified school psychologist who 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 (http://www.jamesroan.com). James earned his M.Ed. in School Psychology and M. Ed. in Adult Education and receives ongoing post graduate training in autism at the University of Washington’s Autism Center. 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 disabilities. James Roan was the consulting psychologist responsible for many of the autism and AD/HD screening tools and other content for Access Special Needs.Com. James Roan consulted with the graduate department of the Waterford Institute of Technology in Waterford Ireland in the development of their graduate program for the certification of private autism tutors. James has conducted formal assessments of students in the Autism Unit in the Claddagh National School in County Galway Ireland.