Expert: Paul Johnson - 3/2/2010

Question
My son turned 3 about 2 months ago and based on his behavior at his well-child, his Dr wants him to see specialists with the idea he may have a PDD such as Asperger's or PDDNOS. I'd just like to see what others may think.

The appt started with a brief wait in the waiting room where Dillon wanted to play with the toys. He screamed and cried as I carried him down the hall and into the room. As soon as i took his coat off, he began screaming "my coat, my coat"... same thing with his shoes then pants. We left his socks, diaper and shirt on to weigh and measure him. He kicked and flailed his arms while on the scale and grabbed onto me for dear life. We attempted to measure his height which prompted the same tantrum. During this tantrum, he broke the piece of the ruler that moves and rests on their head. Once placed on the table, he continued to scream, "my pants, my pants." The Nurse, Doc and myself tried to console him by talking to him and letting him know that this visit was for fun and we were going to play... continued to scream "my pants." Doc asked if this happens a lot, i explained that it's not frequent but his tantrums tend to be pretty dramatic or exaggerated. He said he thought his behavior and lack of reasoning was closer to that of a 2 year old, rather than 3.

I've listed the questions/answers and/or examples that concerned the Doc.

1.)Family History of Depression or Bi-polar? Yes, few members with Depression. One member with Bi-polar, my uncle. Advised I take 20 mg of Celexa daily as anti-anxiety medication.
2.) Mentioned son would not make eye contact with the nurse or Doc. (Could this just be b/c he was already upset?) He makes and keeps eye contact with me fine. Sitter said he doesnt make much eye contact w/her.
3.)Concerned that even though he was upset, he wouldn't stop to even listen to what we were saying to him.
4.)When he was 'stuck' on his pants, he didn't say what he wanted done... Dr asked "what do you want us to do with your pants" and he just kept saying 'my pants"
5.)They asked if he flaps his hands... I said that he does a lot of different like quirks but that i hadn't noticed flapping. *Throughout the appt, he did what i considered just shaking his hands (not completely open or closed) but the Dr said that was flapping.
6.)He repeats things that I tell him or ask him... but not always. I'm curious if he's only repeating things that he doesn't know the answer to. If i ask what color is the circle and he answers but I ask what color is the triangle and he repeats me... did he just forget that color? He will also repeat things that I know he's had to hear from something but he repeats it randomly. He'll walk in the Kitchen, pick up the letter E and say "E is for elevator" but if I say "what starts with the letter E" he'll repeat what I say.
7.)His sitter said that if she corrects another child, he will get upset and think he's in trouble. You can tell him its not him but that doesn't console him. He has done the same thing with me if I correct the dog... but tends to stay upset until I hug him or make physical contact to let him know its ok.
8.)Sometimes he seems confused... if I point to a piece of paper (or another item), he may look at my hand or past the object or seem to look right at the object then look at me and say "paper?" If I continue to ask or help him and he doesn't understand, he'll get upset. BUT he doesn't always do this. There are times when he understand and responds correctly. He will usually get his shoes when I ask him to.
9.)I think how smart he is really sealed the deal here. I told him he knew his ABCs, letter sounds and letter recognition by 2. He can count to 30 (and did while we were there), can count backwards from 10, knows about 12-15 shapes including the difference between a pentagon, hexagon and octagon (usually) and his colors (including brown, black and white. He is now working on writing his letters and spell short 3-4 letter words (w/help from new toys and activity books that I do with him).

I'm sorry this is so long. I'm just worried that once they 'planted that seed'... I'm 'finding' things that I think are off.

Thanks for your input!

Answer
Hey Heather,

Thank you for your important and challenging question. From the information you have provided I am just a bit confused. His age such which pediatricians are beginning to look for full scale Autism.
Usually individuals on the higher level of the Autism scale will begin to exhibit difficulties closer to the onset of adolescence.

I agree with the apparent thinking of Dillon's doctor. He is demonstrating enough symptoms where he could use the ruling out of him being on the Autism Spectrum of Disorders. It would not hurt to rule out that he is Autistic on some level. At his level there are many reason for odd or unexplainable behaviors. Children can have quirks that they grow out of.

My prediction is that there is likely enough there for the clinicians to diagnose but he is too intelligent to be fully Autistic. So he might receive a diagnosis of Pervasive Developmental Disorder. It is important to continue the diagnosis because PDD-nos is not a real diagnosis.