Expert: James Michael Roan - 4/1/2009

Question
My son is 5 1/2 years old.  He currently attends a special education preschool communication class.  He fits many of the criteria for ADHD, and also for Aspergers (attentional difficulties, intense focus, preoccupation with certain subjects/topics, poor pragmatics (fleeting eye contact, difficulty maintaining topic of conversation, etc), lack of social skills, rigidity/inflexibility), preference to play alone rather than accommodate another child, hoards toys, superior vocabulary, odd mannerisms and odd ways of saying things, difficulty with motor skills (he receives PT for gross motor delay, and is below average in fine motor skills).

However, he doesn't seem to fit either category accurately.  He does have a tendency to get 'obsessed' with certain things (Star Wars, Legos, Robots, etc), but most of the time they come and go fairly frequently.  He'll do nothing but Star Wars stuff (computer games, making his 'set ups' etc) for a few days, and then he's on to building robots with Tinker toys for a few days.  He's had various obsessions that were his primary interest, but they usually only last a few months at a time.  This has gone on since he was one.

Additionally, we have a major problem with toileting.  And its my understanding that in order to diagnose Aspergers there cannot be any delay in self help skills.  My son trained late -- at about 5 years old.  He was trained for about 4 months, and then went on Christmas break at school and totally regressed.  He continues to have several accidents daily, despite prompting, scheduled potty times, and a reward system.  Would this prevent an AS diagnosis?

Additionally, his pretend play -though previously practically nonexistent, has really started to develop and he's been doing much better wish this of late (though its still very different from the play of younger brother).

He does have various sensory issues -most of which we've become fairly accustomed to: he's sensitive to touch (avoids hugs and kisses)- has difficulty with hair cuts, brushing teeth, anything gooey, bright light (sun), mixed textures in food, etc.

We are waiting on an evaluation with a child psychiatrist, but it will be several months before we get in.  It would greatly help to have an idea of what to expect --whether AS would be a likely diagnosis, or ruled out based on his difficulty with self-help skills, and emerging pretend play.
Thank you!
Thank you for your assistance!

Answer
Hi Jen;

It is hard to predict what another clinician will think. It depends on their training and experience. Executive functions, of which attention is a central feature, are almost always impaired in children with Asperger's syndrome (AS); in fact, the same part of the brain is affected in AD/H and AS, the right frontal cortex. Many of the children I assess have both AD/HD and AS. As part of your son's evaluation you will want the psychiatrist to rule out a nonverbal learning disability. Although the behaviors are very similar, the causes are not. An assessment should go beyond getting a label and should seek to understand the full psychological profile of skills so effective interventions can be designed.

When we talk about self-help or adaptive behavior, we are talking about several skills not just toileting. I suspect the regression in his toileting skills is due to the context-dependent nature of learning in autism spectrum disorders along with some degree of executive dysfunctioning. Pretend play is a frequent attribute of individuals with AS, not so with typical or classic autism.

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.