Expert: Jene Aviram - 2/25/2010

Question
Hello...
I am wondering, and overwhelmed with anxiety (to be honest) about my son, who is 3 years, 4 months, and am concerned about Asperger’s  Disorder. Sorry if this is long, but I hope these details help. (I live in Canada, where the socialist system means long waits for assessment, which is painful).
The main “red flag” for AS is the fact he can read (probably like a 5- year old, maybe a bit higher), and seems to still parallel play in nursery school. Our Pediatrician, without asking much details, suggested we read about AS when she saw him read a sign in her office, and asked us to find out about nursery school. (Her assessment, otherwise, was nil, so her opinion means nothing here). He had been there for about 5-6 months, and we were surprised he stood out as not really talking to the other kids. There were no other obvious behavior issues, but simply lack of socializing. He has a 1.5 year old brother, who is just coming to life language –wise, and he seems to engage him, but it’s hard to at how meaningful given their differences. He did do some baby talking for a while, but this is passing now. He loves socializing with us, and family or most adults, and seems enamored with some kids older than himself.
So, naturally, I have been obsessing about looking back, analyzing him, etc, and am lost as to when/if certain things are red flags. Here are some things I have concerns about:
Stims? At 2 (to late 2 years old), he was obsessed about playing with the steering wheel at the park, and would choose this first. He would really love it, make an occasional face while doing it, maybe a visual stim here and there ( a grimace with eyes closed, maybe partially open), but hard to say, and maybe play for 10 minutes or more, than move on, and maybe come back later. He loved steering wheels in general, noticing them on cars (including toys, especially when he was first getting into them), but never did any other repetitive spinning of objects, including at home. It seemed isolated from a repetitive spinning point of view.
With his new dinky cars, he loved to run them, one by one of the edge of the couch, and crash them onto the floor, maybe the wall. This eventually stopped, but was his favorite/main way of playing with them for some time. He has never lined things up, stacked obsessively, etc.
Currently, he likes to jump up and down 2-3 times, intermittently (for example, when playing, he will do some activity, maybe build a Lego thing, then stand up, jump a few times and go back to it; or maybe when bored, and in the kitchen with us, and kind of moving around doing things). He has never done this for a prolonged period, and it is not too often, but is daily, and more when he is excited or has some energy to burn.
Finally, he will occasionally, especially in afternoon, seem to want to run up and down the hall, from kitchen to front door, or in basement back and forth, maybe 5-10 times. He seems distractible when doing it, but likes to do it. I t seems he needs to just burn a little energy, but I am not totally sure. From my reading, I am having a hard time understanding when something is a “stim” or not. He has never flapped hands, twirled, used his hands in a funny way, verbally stimmed, etc. Just the above behaviors.
His development seemed normal to us, but being first time parents, there has been little reference until the little brother came along, and he himself is just accelerating, trying to do everything his big bro does. Always had good eye contact, smiled early, babbled early,, responded to us, loved (and still loves) hugs and cuddling. He spoke words by one, progressed well, and now speaks in sentences which seem normal for his age. Sometimes a little disjointed in his wording, but he corrects himself quickly. He could count early, to 20 in his mid-2s, but we did a lot of counting especially going up stairs (we have a lot of them). He knew his ABCs and numbers early, but, again, saw a lot of them. He picked up reading somewhere at about 2.5, but I don’t know if that is precocious, or was skewed by my persistent pointing out of every word, with sounding, I read to him, many books a day, from about 5 months and on. (I was determined to make him a good reader!) He did seem to memorizes the names of a lot (maybe 25) of his dinky cars right away (like Honda civic, Acura, BMW, etc), I think maybe by sound at first, but he was able to eventually read the names on the bottom. He loves cars, but never obsesses about them. He has tons of books, loves reading together, but will chose toys over them , likes if we read to him more than reading himself, and seems to follow the pictures/gist of the story well. But if you ask him, and push him, he can read those words and sentences. The only odd language thing we notice is he will sometimes repeat a question a few times in a row (2-3), even if answered, although not on any repetitive topics. He does ask questions a lot, and often will do that instead of referring to an observation directly (for example, ask “What does he have on his head?” instead of just saying what is on the persons head). So, is this repetitive questioning? There has been no echolalia, or strange manner of speaking that I can tell. He sings some songs, and at one point seemed to pick up nursery rhymes rather quickly, but we didn’t hear about them for long. He knew the planets, in order, quickly, mainly because we started reading a book about them, and he was pretty interested in them for a while, but only really knew their names, order and  a brief detail I taught him about each (I.e. Venus is brightest, etc), but he hasn’t talked about them since we stopped talking about them . (I mention this only because I keep seeing that damn astronomy thing come up as an obsession in so many references!)
He walked at 11 months, runs well, climbs and jumps well, can throw a ball, catch ok (not great);still struggles with a tricycle, but we haven’t pushed him much on it since age 3. He occasionally likes to skip when running. He can do pretty big puzzles now. He does not like drawing too much, and resists much attempts at learning to draw/write (a poor circle now, at best). Potty training still a struggle, but are just pushing him over last few months, as he never seemed interested. No tantrums (the odd, typical one for certain situations, wants, etc., and  nothing odd or in public), routine obsessions (although what kid doesn’t have routines every day?). He’s fine in crowds, groups, noisy places. Plays alone happily, and seems to have some imaginary play. Has sometimes struggled to stay still in group sing- alongs, but sometimes can. Briefly didn’t like the vacuum,   or my drill (at 2-2.5), but no overly weird reaction, and tolerates now. He is scared of dogs (not sure why, although my dad had a big dog which overwhelmed him when he was just 2), but no other big fears.
So, sorry for the length, but I have been in a panic. It all seems to boil down to poor socializing, advanced reading, some repetitive behaviors, of which I have no idea how significant they are, and poor drawing (both ability and desire). ANY opinion you can give would be greatly appreciated.
Cheers
KSY

Answer
Hi there,

I'm impressed with your detailed post and I know that you are concerned.  Firstly let me say that your son has some incredible skills and this is really wonderful.  If he does qualify for a diagnosis of Aspergers (and that's a big if) you can be sure he's on the very high end of the spectrum.

Early reading is not actually a red flag for Aspergers.  Reading so young is called Hyperlexia.  And while many people with Aspergers do have hyperlexia, there are just as many that don't.  Type hyperlexia into Google as you'll find a wealth of information including symptoms and I think it will help you greatly.

Stereotypye or self-stimulatory behavior refers to repetitive body movements or repetitive movement of objects. It doesn't have to be lining things up or stacking things.  It can be tapping, rocking, blinking, saying something repeatedly, repeating a sound, repeatedly throwing a ball down the stairs, running objects up a wall.  Basically it's a repetitive behavior that most typical kids would get bored of doing.  Jumping up and down intermittently on a consistent basis is generally considered a self stim behavior.  Running up and down the hall consistently could be considered a stim as well.   

I was a little unclear about what you meant he did when it comes to questions.  However, repeating a question frequently (although he knows the answer) is fairly common in children with AS and hyperlexia.  They enjoy hearing the answer and will ask again and again in order to hear the response.

It's impossible to diagnose over the Internet and especially with someone like your son who is so on the edge.  He has remarkable skills and sounds like a terrific kid.  Your son is so young and even some of the AS traits he displays are often only developed later in kids with Aspergers.  Your son is way ahead of the game and I would bet he's going to do well in life, AS, hyperlexia or not.

Just a quick note on the drawing and writing.  I wouldn't be too concerned about this.  There are many kids that don't like penmanship activities, and even if your son does have a fine motor delay this is something that can easily be worked on with a good OT.

Another note on the concern you have with obsessions.  Most people with Aspergers develop obsessions a bit later than 3 years old.  It usually begins like this. (I will use dinosaurs as an example.)  At three years old they like dinosaurs.  They like doing dinosaur peg puzzles and memorize the names to a number of dinosaurs.  They like looking at books of dinosaurs.  They might move onto other subjects and are not particularly obsessed by dinosaurs although the interest was evident.  At 5 years old the interest is sparked again.  Now they can tell you about countless dinosaurs and the era they lived in.  By 7 years old they can basically tell you everything about dinosaurs that there is to know including which one's were herbivores and carnivores, what they looked like, who discovered them, how they disappeared off the planet, what era they lived in.... etc.  By 10 years old, just when you thought you knew everything there was to know about dinosaurs, what do you know, you learn from the child a host of other information.  To be honest, being a parent of a child with Aspergers can be quite a fascinating journey!  At this point when your son is 3 years old, it would be a little tough to see any clear obsession with one topic.

I know it's such a mission to go through the evaluation process.  And I realize that the system is different in Canada and the waiting list is long.  But I do think it will be worth it.  Your son might not get a diagnosis, I can't possibly say by reading your post, but he might qualify for services regarding socialization, fine motor skills etc.  This will help him progress forward which is essential.  He has so much potential!  It might also be a good idea to contact the Autism society of Canada.  They can put you in touch with professionals in your neighborhood and perhaps have some tips for navigating through the system much faster.

One last thing.  I think it's worth you reading the article called "How do I know if my child has autism?"  This article will tell you all the traits you are likely to see and I think you would find it helpful.  You will either be able to relate to it, or not.  You can find it at http://www.nlconcepts.com/autism-howdoyouknow.htm

Good luck with getting that evaluation.  My guess is that your son has a bright future ahead of him.  

I wish you great success and I hope this has been of some help.

Jene Aviram
http://www.nlconcepts.com