Expert: James Michael Roan - 2/14/2007

Question
Thanks James. Well, you just described every man on my side of family. Socially adequate but if left to their own devices perfectly happy with a spouse/girlfriend or a few friends and their own company. Not regarded as socially awkward but not considered social either. Most have found sports (golf or running) as a retreat from a large family gathering and too much commotion has caused some adult tantrums. This has always been "normal" to me and in all my life I have never considered any one of them (well maybe one) to not be functional, although my mother is not handing out husband of the year awards. I guess I just fear with this expanding spectrum that these sub-types (like my family) could one day wind up getting labeled unnecessarily. And,as you may have guessed, I don't want that for my son. Actually, those that I have met who fit this description are usually very successful, perhaps due to the narrow focus and the fact that they are a bit non-compromising. I'd be scared to see the world without those people in it.
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Interesting! I know 2 different6 year olds, one diagnosed Asperger's and one HF autism and their diagnosis were different based on when they aquired language. The one with HF after 2 1/2 and the AS at 8 months (all rote memory) but later no conversational skills. Both are very intelligent, hyperlexic etc. However, both had many features of the spectrum in addition to being self-directed and the parents knew something was wrong early on. My son is self-directed but increasingly less so. What has been amazing to watch is that as he develops more and more language he is less self directed and more willing to participate and happy when engaging with others. I guess they are now throwing every loner (or the type I knew growing up) under this category and it's altogether confusing. Is there truly a way to distinguish between those who are less interested in people and in those who have a neurological disorder? EI stands for early intervention or birth to three.
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Hello James,

I have a couple more questions for you about my son. The last opinion you gave was sub-clinical Asperger's. Wondering if you thought it was still heading in that direction.....Anyway, my son has been working with EI since 15 months. He has gone from being defiant with instuctors (little interest in toys, people) to asking for them and calling their name out the window and cyring when I tell him they are not coming that day. Most days he enjoys his sessions completely and can attend for as long as 30 minutes if he likes the task. During this time he went from no bi-labial sounds at 17 months to having nearly all his sounds and putting 2 or more word phrases together. He'll say "where did mommy go?" when I'm not in the room and always knows possesion for ex. "dada's shoes and will try to put them on his feet, more chips, cookies etc.. He can name 6 colors and knows most shapes. I'd say he is well over 200 words now. Like I mentioed, he is fine socially with those he knows now, but with other kids I would say he is still a bit different. He is completely non-aggressive. Although alot of the other kids hit, he has never but does go up and kneel down and look directly at their face (when the child is sitting) to see their faces and often gives them hugs (I find this odd). He will use socially appropriate phrases like "mine" with other kids though. I recently had him at my daughters friend's birthday party with 4 year olds. He looks like a small 3 1/2 year old (36 inches and 29 pounds) so I could tell some of the older ladies at the party thought something was wrong due to his pre-occupation with the room and thinking he was at least 18 month older than he is. At the party there was a strob light and very busy walls. For the first, 30 minutes he would not seem to be interested in anything the older kids were doing. he was facinated with his surroundings and explored them throughly. During this time though he would point to the Blues Clues drawing from across the room and look at us and name it, including the colors he saw, clock etc so he was clearly interacting with us during this. After he was satisfied with the room he tried to play hokey pokey with the kids, and at least watched their activity. At school he has become more social saying hi and bye to other kids but at times won't join in and will do his own thing. My question is...Is any of this still age appropriate? Could he just be a little slower socially or grow up to be a little different without having Asperger's or being just under the criteria?
He has come so far in the last 9 months it is unbelievable. I should mention too that he has mild hypotonia, so he's clumsy. He can't spoon feed himself and he just learned to stack 5 blocks. He can't go up and down stairs unassisted and he does have tactile defensiveness although he has never had a tantrum (avoidance is his coping method). His OT is the worst so not much progress in that area. Motor planning as you may remember has always been an issue. He is just now doing things he should have been doing months ago. He has great attention to detail. He did notice that I went a different way to daycare the other day. He did not object or freak out at all but simply said" where you goin mommy?". I have read that that memorizing directions is direclty linked to motor planning. as far as other concerns go, he sometimes talks to himself in the crib, soemtimes repeats words like "hi mommy to me" several times etc (appropriatly but obsessively) and jumps when excited. EI says this is fine and just part of him expressing his newfound language skills. Also he pretend plays very well. FYI: EI's take on this is that he WAS sensory disordered to begin with but this is resolving. their belief is that Asperger's is similar to the social development of HF Autism and that he does not meet that criteria. Just wanted your thoughts.


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Hi Katie;

"Could he just be a little slower socially or grow up to be a little different without having Asperger's or being just under the criteria?"   Yes.

High functioning autism (HFA)/Asperger's Syndrome (AS) is VERY difficult to assess under the age of 4 or 5. Even then, you have to have a lot of experience in observing this population over the next several years to be able to look back at behaviors common to children who later received a diagnosis of HFA/AS. Early detection is not a science yet, it is still an art.

The thing that stands out most for me for boys aged 4 and older, and may be true of younger children as well, is that they follow their own agenda when playing with others and are happy to work on a task of choice rather than interact with peers for the pure pleasure of social interaction and engagement. Very little smiling is observed during this self-directed play.

Children with AS typically have problems with eye contact, vocal intonation, volume, and pitch. They have problems with pronouns. These may begin to emerge later on and are probably not occurring now.

To be honest, I am not hearing anything of real concern.

I'm sorry, what does EI stand for?

Kind regards,
James
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Hi Katie;

The only way to distinguish low-social personalities is to use a system that has an arbitrary cut-off like the Diagnostic and Statistical Manual-Fourth Edition (DSM-IV). The Gilliam Asperger's disorder Scale (GADS) is a norm-referenced parent questionnaire and compares individual scores (ages 3-22) to a normative group of individuals who have an existing diagnosis of AS. It really is on a continuum and folks who are (this my own terminology) "high functioning Asperger's or "subclinical Asperger's" are probably considered neurotypical but who share many of the Asperger's traits but are not socially or emotionally disabled by them. I probably fit into that category! I have a narrow range of interests-but not too narrow! I get my daily social needs met in the first half hour of the morning! I prefer social interaction with only 2 or 3 others and cannot tolerate parties or the holidays where there are a lot of people. They exhaust me.

I think your son is probably fine. As long as he grows up feeling loved and valued by significant others around him, he will do just fine.

Kind regards,
James

Answer
Hi Katie;

I agree with you 1000%!. If you are ever interested, check out one of two books authored by Professor Michael Fitzgerald of Dublin Ireland on Amazon.com. He has AS (not sure if he knows it though) and diagnoses dozens upon dozens of kids every month. He's written two books dealing with historical figures he thinks probably had AS. He has gone as far as to blame the industrial revolution on them!

Take care.

Jim