Expert: James Michael Roan - 3/19/2006

Question
Dear Doctor,

I would very much appreciate your thoughts on my 4.5 year old son.

He has been evaluated by a neuropsychiatrist and  was thought not to have autism because he lacks some important criteria. I would describe him as having had language and social delay buy very advanced academically. Here is a summary of his differeces from typical children:

1. Language delay noticed at age 2. Has recieved intense speech therapy and now doing much better.

2. Difficulty with eye contact.

3. Delay in social interactions with other kids.

4. Stuck on routines.

5. Physically he is clumsy mainly because of a lack of interest and also not believing that he can do something such as pedaling or climbing

6. Sensitivity to certain sounds and feelings such as a fan

7. However, he has always been able to pretend play

8. He has always been very affectionate and gives and wants lots of hugs and kisses.

9. Although quite often he may not respond to us and seems to be in his own world, he defintely is listening. If we say something like "if you don't respond then we are going to the bookstore without you" then he will respond  immediately

10. He is fascinated buy letters, reading and books. He learned all his alphabet  in less than 1/2 hour at age 2.5. He is able to read grade 1 books now perfectly. He is able to add and subtract single numbers and counts to at least 100.He has tought himself to read without any teaching.

We know that he learns language by geshtalt and we have used that and also his amazing reading ability at home and at speech therapy to improve his language and his social skills. His social delay has improved dramatically but he is certainly not normal yet. He has an amazing visual  memory. He will be able to recount a scene or a picture or written words in detail long after seeing them.

We certainly know that we have a child who is not typical. But we also do not have any diagnosis after seeing many specialists. He is going for an IQ test in the next couple of weeks. Is it possible for a child to have autism and still be able to pretend play and have very good emotional responses.  We appreciated any thoughts you may have about him.

Thanks

Answer
Dear Sharam;

Please keep in mind that I do not diagnose over the internet. That having been said, I highly recommend you consider Asperger's Syndrome (AS). You will have to look for an expert in your area to get a reliable diagnosis.

There is a great deal of information on the internet. Dr. Tony Attwood is currently one of the most popular speakers on the subject of AS. AS is high functioning autism. Children who are affected generally have Average to Above-average IQs, are often hyperlexic and do well academically. Their difficulties are with social thinking and social language/communication. This social delay often makes them victims of bullying and thus places them at-risk for anxiety and depression. These children, as you would expect, have poor skills for making and keeping friends although they long for the companionship.

It is important to look at those IQ scores because your son's behavior could also be the result of a nonverbal learning disability (NVLD). A performance IQ that is significantly lower than the verbal IQ accompanied by left-side body weakness can differentiate AS from a NVLD.

Let me know if I can help you further.

Kind Regards,
James