Expert: Catherine Ridenour - 7/21/2009

Question
I have a nine year old son who over the years has been told he has ADHD, anxiety, and nothing really fit. He has always been a happy social kid. He did have trouble at a preschool age crying a little in preschool. He has always had trouble with sensory issues, mainly with food and has always had trouble with constipation, is also somewhat uncomfortable with loud noises. He had some mild tics starting around age three or four and now has some very unusual uncontrolled body movements (not hand flapping) more all over type. If you bring it to his attention he can stop for a period of time.  He Often is in his own imaginative world when he is doing this.  School was a disaster because he became very anxiety ridden. Again, outside of a school setting and some social issues (getting irritable or uncomfortable after a while with large groups of kids) he just seems pretty much like other kids. Developmentally other than what I already told you he was on cue. He is also quite smart with an amazing insight into things he hears and reads. A very funny sense of humor, great imagination and a big memory for everything he reads and hears. I think because of all of his movements mainly people have been wondering about him and his Dad and I have starting to wonder if ADHD or Anxiety aren't the answer. A lot of his movement does seem to come when he is bored or excited, anxious. Almost as if he uses it as a release. I do think he has some aspects of Asbergers but not a lot, yet why all the zoned out time spent in his own little world with spastic type of movement?

Answer
Hi Dana,
What you describe is consistent with Asperger's Syndrome. ADHD is often the first diagnosis for these kids. They can have both. If medication for ADHD has been helpful, then it will still help even if he has A.S.

It is also possible he has Tourette's syndrome. This disorder is characterized by sudden, uncontrolled tics, movements, and sounds. But, some A.S. kids do this too. Only a neurologist can figure this one out.

Zoning out is a defense against being overwhelmed. We all do it to some extent. A.S. and autistic kids have it down to a science. My advice about the movements is to ignore them completely. Giving attention to undesirable behavior only reinforces it.

I believe your son needs an evaluation by a pediatric neurologist. Preferably, one who does not have a bias toward diagnosing kids one way or the other. Clearly, since school is a disaster, he needs a diagnosis to entitle him to appropriate special services. In his case, this is probably mainstream classroom with vocational therapy (they work on social behavior.)

Academically, the school should play to his strengths. If he loves math, everything should revolve around it, even spelling. These kids have very specific, narrow interests and they can shine within them. As he gets older, he can branch out. You should also expect he will be emotionally behind his peers by 3-4 years. This will continue but he will "age" as he goes along. By the time he's 25, you won't know the difference between him and his peers in that way.

Don't wait. Adolescence is just around the corner and school will not get any easier for him.

Best wishes,
Catherine