Expert: James Michael Roan - 9/23/2009

Question
I am an SLP, I started serving a 4 yo girl about 2 months ago for severe artic disorder.  She has some major red flags, but everything just doesn't add up.  Red flags are :  no eye contact, even with family, extreme sensitivity to sounds, wants to constantly strainghten things on our work table (all cards must be stacked perfectly).  Language scores are in the upper 80s to low 90s, we are not getting anywhere with her artic b/c he is so immature, almost like a 2 y.o. and there is no eye contact.  I dont want to alarm her mom, but I feel like there is more going on.  Her cognition seem to be WNL and she potties independently.  She seperates well and does not have tantrums.  She is not attached to anything.  She has some "symptoms" but in other ways she appear to be "normal".  I know you don't diagnose, but I don't know what to do.  Thank for any advice.  (she stays at home with her mom and little brother, no group daycare or preschool program).

Answer
Hi Jennifer;

You are right. I cannot diagnose for several reasons.

Is her receptive language o.k.? Does she have a noticeable left-side body weakness/atrophy?

I would investigate Asperger's syndrome (AS) or a right frontal brain dysfunction. An assessment of AS should be conducted by a psychologist experienced with AS. A neuropsychologist should conduct a neuropsychological assessment of executive functions and attention. I would investigate AS first. Girls generally go unnoticed since they are more social than boys. I would not be surprised if it is discovered that she has AS.

Are you in the U.S.? Here is rating scale by Tony Attwood, a reknown AS expert:  http://www.memphisneurology.com/pdfs/handout_aspergers_scale.pdf

Let me know if there is anything else I can do.

Kind regards,
James