Expert: Dr. Sharon A. Mitchell - 1/29/2012

Question
Hi,My name is Tina and I am the mother of 5 children, 3 bio and 2 adopted.  I have one son 8 who has asperger's disorder (HFA) and anxiety disorder, my second son is now 6 he was evaluated at the age of 3 years becasue we thought he was displaying symptoms of asperger's of his older brother.  At that time his syptoms for asperger's were thought to be copied of older sibling.  It was excused as possible ODD or ADHD and to be revisited in the future.  Now my son is 6, he is very impulsive, sensory issues, aggressive, non redirectible at times, consequences for his behaviors do no change his behavior, he has a huge issue for quite some time grabbing his brother in the crotch and hurting him, this happens several times a day and requires constant monitoring and Nick is not left alone with his brother.  Nick does not like to look you in the eyes, Nick is very oppositonal and things need to be his way or he latches out, name calls,gets aggressive, Nick likes to have things in a certain order or he gets mad.  Nick is always very loud while speaking almost like yelling, nick is a moody child and it is hard for him to regulate his emotions.. My gut points to High functioning aspergers not ADHD because he does not display this in kindergarten and is able to hold it together until home.  Which is not uncommon because my 8 year old keeps it together right until he walks in the door.  Nick is obsessed with video games and he has always been a fore head tapper on the dog, objects, people, Nick is verbal, he is only 40 lbs, he is a picky eater, not a big meat fan, prefers to drink more than eat, likes v-8 and healthy choices.  Soo is it Asperger's? Thanks

Answer
Hi Tina,

Without meeting your son, I am unable to give you a definitive opinion as to whether or not your son has Asperger's. But, from what you describe, I do think it is worth revisiting the possibility with your physician or diagnostician that saw your boys a few years ago.

I can see why they would have deferred a diagnosis when Nick was 3 years old, given the fact that many of his behaviors could well have been learned from interactions with his brother. But, now that he's 5 and mixing with more kids in school, he might mimic his brother less and be more influenced by his peers. Despite this exposure to more kids, Nick is still showing concerning traits.

Not always is a diagnosis needed, especially when symptoms are mild and the child is managing well. But, the child you describe, is a little boy who is struggling with a number of issues.

A few of the things concern me from an education stand point. Some of the things you mention may make school difficult for him, such as:

- impulsivity
- sensory issues
- needing constant monitoring
- oppositional behavior
- difficulty with self-regulation
- lashing out
- becoming aggressive

I realize that you mentioned that he holds it together at school, which is great. This makes it hard on mom, but home is a safe place and often kids try to manage in public but let out their built-up tension at home.

I presume that Nick is in kindergarten. The atmosphere is such programs is looser than in grade one classrooms. There is more time to play and exploration and doing your own thing. Once Nick hits grade one, he might find it more difficult to adapt to the increased demands of the structure and expectations.

You mention that you don't think it is ADHD. Well, maybe. Most kids on the autism spectrum, (Asperger's falls under the umbrella term of the autism spectrum, along with PDD-NOS#, have some degree of attentional issues. Some take medication typically given to kids who do have ADHD and find it helpful in curbing some of the impulsivity, allowing the child a moment to pause and reflect on his options, rather than reacting or lashing out. So, whether or not your little boy does have Asperger's does not rule the possibility of attentional issues.

You have experiences some of this with your older son, a diagnosis of both Asperger's and anxiety disorder. Anxiety is often present in kids with autism spectrum disorders, particularly when there are sensory sensitivities.

Given the difficulties you describe, I can see how a possible diagnosis of ODD was considered, as well. But, I would guess that you don't really care what the specific label is. You just want your little guy to feel more comfortable within himself and to have a relaxed home life with happy, productive kids.

Sometimes a specific label brings with it associated services #if they are needed#. Sometimes the label presents us with a series of strategies that are generally helpful for kids with that diagnosis.

But, many of the strategies are applicable to kids with a variety of diagnoses. There is no harm is trying some, whether or not your son has a label of Asperger's or ADHD or ODD.

One such strategy is using visuals. Most kids with ASDs #autism spectrum disorders# take in information that they see more readily than information they hear. This is also true for kids with fetal alcohol syndrome,, some children prenatally affected by drug exposure, some kids with learning disabilities and some with attentional difficulties. Show, rather than tell is a good rule of thumb. A nice website that explains and gives examples is www.do2learn.com. You could also try usevisualstrategies.com.

Here's a book I really like, for it's practicality and user friendliness: Visual Strategies for Improving Communication : Practical Supports for School & Home #http://tinyurl.com/844ffn7#

Here's another little book that may help you: Asperger's Syndrome and Sensory Issues: Practical Solutions for Making Sense of the World #http://tinyurl.com/7o3rked).

The strategies suggested in both these books will not harm your child whether or not he has Asperger's. In fact, the suggestions could be implemented in your whole house, with all your kids.

One last thing. You said that your gut points to "high functioning Asperger's". Maybe we'll take just a minute to talk about that. You will from time to time hear the term "high functioning autism". Although not a medical diagnosis, this often refers to someone who has a diagnosis of autism, but along with it has intellectual ability nearer to or within the average range. (About two thirds of people with an autism diagnosis also have an intellectual disability). "High functioning" and Asperger's are not words that are usually used together because simply having a diagnosis of Asperger's implies that the person has average to above average intelligence because part of the diagnostic criteria for having Asperger's is that there is no delay in cognitive or in language functioning.

Nick sounds like a little guy who is not happy within himself, whose social interactions may become limited due to his behaviors and whose family is in turmoil trying to help him manage these behaviors. This must be so difficult on the rest of the kids and particularly on you, watching what your child is going through and trying to protect the other siblings.

Yes, I do think you should look into an evaluation for your son. Observations and reports from the school would also be helpful, whether or not they are currently seeing the same things as you. Over the next few years, the school may be your greatest ally and you'll need to work together to help your son reach his potential.

All the best to you and your family,

Dr. Sharon A. Mitchell
www.autismsite.ca