Expert: James Michael Roan - 11/6/2006

Question
My best friend's is having a difficult time with his daughter and when they came to visit for a week, I could see signs that something is just not normal about her behavior.  I hope by giving you some info and that you might help us to figure out what may be going on.  
She is 3 1/2 years old and has a younger sister that just turned 2.  She is loves to draw on her magnetic drawing pad, but only draws 3 things, and draws them over, over and over, and will not draw anything else when asked to.  She hands you the pad and ask you to draw, but it can only be those same three things.  Airplanes, Helicopters and lipstick tubes.  I tried to draw her a dog, or a tree or something else, and all she could do was say no, no and erase it and ask for one of those 3 objects.  She attends a pre-K school, and has for a few months, the teachers say she does ok, but in some things excels.  For instance, she learned all the rules the very first day and seems to love to make sure she tells the other children, what they can and cannot do.  She does not relate well to other children, or or younger sister.  she plays mostly alone and does the same activities when she plays.  Her speech is well, but when you talk with her it seems she does not really grasp what you are saying.  Like she was talking about going to the store and kept talking about going, but when we actually started to get ready to go to that exact store later in the day, she completely freaked put.  Cried and would scream to her mom that she did not want to go to the store, please don't make her, and she repeated that literally 25 times.  She gets very nervous about bath time and cries and begs no bath today or tomorrow.  She speaks in third person.... she says "her" when she should say "she".  She misidentifies gender.  She says no ma'am to me then her father corrects her and she says, no sir, she can remember that she is supposed to say no sir, no ma'am, but 100% of the time gets the gender wrong.  She is not interested in any conversation that you have, and will change it to what she is doing, or what she wants to talk about, but it is the same conversation, over and over.  She seems very bright, and we took her to the play ground.  The issue is she had unrationalized fear about being dirty or wanting her hands washed, she seems to do that often, wanting her hands washed even when she just washed them.  At the play ground her younger sister would slide down the slides even the big ones, when she would want help, or just say no....  That is another issue when you ask her anything she says "NO" but not in a defiant way, more like we would say Yes, or ok.. what I mean by that is you can say hey do you want some ice cream and she says no, but means yes.... then will say, I want ice cream, i want ice cream, but uses NO incorrectly....  she is very bad about not wanting to change any routine, and even talk about the future, for instance she was out of school the week of their visit and she must have told her mother 50 times, mamma at school next week, or were going back to school next week, right mamma..... she does not play well with her sister.  There is just something there and we cannot figure out what it might be... any advice or help would be so grateful....
thank you

Answer
Hi Jason;

Thanks for all the info. Please keep in mind I do not diagnose over the internet, however, this little girl is displaying all of the behaviors associated with Asperger's Syndrome (AS), high functioning autism (HFA), and/or Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). All three of these conditions are really the same and virtually indistinguishable from one another.

I highly recommend that you call the psychologist at the school district in which your friend's daughter resides and make a special education referral for evaluation. Tell them you suspect Asperger's Syndrome. Take their evaluation data to a psychologist or team of psychologists expert in this area for a complete diagnostic. They will be able to use some of the school's test results, which should save a little money. You can find these teams at a local university autism center or Children's Hospital. She will probably qualify for special education in the area of receptive and pragmatic (social) language at the very least and receive language services there along with other services.

Kind Regards,
James