Expert: James Michael Roan - 6/20/2006

Question
Today is my daughter’s 4th b-day.  She has a long history of developmental delays and sensory issues.  She only started eating solid food a few months ago at age 3.5.  Prior to that she wouldn’t tolerate texture of any kind and lived on Pediasure and stage 1 baby foods.  By the time she was 6 months old, I knew something about her was off.  She wasn’t rolling over either way, was still very fussy, wasn’t able to transfer objects between hands, did not interact well, etc.  Shortly after this, I noticed that she did not use her right hand.  That’s why she never banged blocks or transferred objects.  She could pick up toys, but only with her left hand.  At her 9 month checkup, she still wasn’t rolling, not trying to crawl, etc, so she was referred for OT and PT evaluations.  As well as the eating issues, she was very orally defensive and would freak out if anything came near her mouth.  She never put anything in her mouth of even up to her mouth.  She would also freak out at coughing, sneezing or vomiting.  I described her as a touchy baby.  They recommended she start in OT and PT, which she did at 10 months.  She was referred to a developmental pediatrician who she saw around 14 months. He was mostly concerned about her lack of eating, not using the right hand, lack of speech and fine/gross motor delays.  We then saw a neurologist and had an MRI, which was normal.  He recommended she start in Speech Therapy as she was not saying any words. She started rolling at 10 months, crawling at 12 months, walking at 18 months.  The OT was also able to get her to use her right hand starting around 18 months.  She is most definitely a “lefty”, but has no issues using her right hand now.  Also she started hand flapping which she continues to do today.  She has continued in speech, OT and PT since that point.  Her speech was a little late to develop, but when it did she progressed very rapidly in that area.  She was in an early intervention program and when she turned 3 was referred to the school district.  In school, she was in a regular 3 year old class (18 kids) for ½ day and a special needs class (7 kids) for ½ day.  She got ST, PT, OT and resource.  She did great in school for the most part.  Her interaction with peers is still awkward as she really has trouble with imaginative play.  She definitely prefers to interact with adults.  She is able to hold conversations although sometimes questions she asks are not appropriate to the given conversation.  She also uses repetitive speech a lot.  She is very outgoing and loves being around people.  She is not uncomfortable in large groups or in new situations.  Academically she is very bright.  She knew all of her colors, numbers and letters by age 2.  She also has an incredible memory.  Honestly, her memory is almost scary.  She knows everyone in her school.  She made friends with the janitors, cafeteria workers as well as other teachers.  She was very obsessive with routines at school.  For example, if the teacher had not put up the day’s line leader, she would repeat, “please put up the line leader” until it was done, getting more and more agitated.  If the teacher forgot to do something, she would always remind her.  She was the first in the class to know all of the kids’ names and the first to recognize all of their printed names.  She would always be able to tell you who wasn’t there, who went to time out, etc.  She speaks in complete sentences and is not at all difficult to understand.  She did not use pronouns at all until recently and had great difficulty with that concept, but now uses them normally.  She is almost always happy and smiling.  I can’t believe the progress she made in school this year.  We recently sat down and reviewed her IEP and set goals for next year.  She will be in a full day regular class, spending one hour a day in the “autism  lab” (ABA) and will be pulled out of class for resource, PT, OT and speech.  I feel like she is getting great services in school and overall doing really well.  My current concerns are 1.  The school has told me that she is “on the spectrum”, but very high functioning, but she has never been diagnosed with anything other than developmental delays.  She has her 4 year checkup in a few days as well as an appointment with the developmental pediatrician next week.  Should I ask for more testing or push for a diagnosis on the medical side?  2.  She still does a lot of hand flapping, but as that has lessened, she is now opening and closing her hands all of the time as well as blinking her eyes a good bit.  Are these also self-stimulation?  3.  My gut tells me that we are dealing with Asperger’s, but she does not have the fit/temper tantrums.  She does have tantrums, but I would say that they are typical of any 3 / 4 year old.  Is it still possible for it to be Asperger’s?  I would really appreciate any insight you could give me.  Please let me know if you need additional information.

Answer
Hi Ame;

You are very astute. Please keep in mind that I am not diagnosing anything here, just commenting. Even Asperger's has its own range of severity. My guess is she could even be what we call: "subclinical Asperger's." By your description, she does appear to be very high functioning. My guess is she will do well in school, although she may have a little trouble socially.

How does she respond to "who, what, and why" questions? Most importantly, how does she look when she is around her peers? Is she smiling, looking at them, interacting? What does she do with them and how does that look? How is her eye contact? Does it continue throughout a verbal exchange or just initially?

Kind Regards,
James