Expert: James Michael Roan - 10/1/2006

Question
My daughter, Kristen is 11 yrs old and currently engaged in an outpatient treatment center after numerous outbursts and problems in the public school. Her new diagnosis is PDD-NOS and Mood Disorder. It was also determined this year that she has a significant communication disorder. Although attending the since late April this year, the center deals mostly with children who have been diagnosed with ODD, ADHD, Anxiety issues, and the like.  

After being diagnosed with mood disorder three years ago, in addition to OCD a year prior to this(OCD now ruled out), I finally took her to a child Psychiatrist in February of this year for a second opinion. Kristen couldn't maintain friendships at school, crying all the time, behavioral outbursts, etc...It became unmanageable. She has been on 7 different types of atypical anti-psychotics since third grade, now considered sixth grader. Kristen's IQ is 76 and she has always had academic difficulties.

According to the DSM IV, Kristen has obviously met criteria in the social and communication areas. However, she exhibits behaviors such as licking her fingers and touching her body all over (very embarrasing to me in public). Mostly at home, but has done this while at grocery store, bank, less frequently around staff at treatment center, or wherever. Kristen is verbal with her thoughts and can be extremely brutal with words. Also, extreme sensitivity as sometimes she gets upset when i touch or bump her. Also, drawers and certain objects need to be in their place and she will throw fits if I change it. Kristen is beginning to appear odd in her representation...like how she wears her very limited choice of clothes, which will entail bra straps down the arms and pants low enough that I'm constantly reminding her to pull up as things are showing. She also requires television really loud, despite already having hearing tested normal. I feel that the professionals are minimizing these behaviors, as they don't see them as frequently as I do.

I thought Kristen was extremely hiper as a young child, always running, jumping, yelling, rough playing and unable to unwind in a timely manner. Friends and family couldn't stand to be around her for long periods of time. I have had a lot of stress since her birth...difficult delivery, ICU baby with an apgar score 1 at 1 minute. She was identified with a speech and language impairment by the age of two, however services with child development pgm ceased by the age of three as she entered pre-school.

I'm afraid that Kristen won't recieve adequate education services for autism if it's overlooked. They don't qualify her as "autistic" therfore she won't recieve the special ed under this category. The Center has goal to release her to public school for the seventh grade and I'm afraid these kids will eat her alive. She shown very little progression any since attending this center.

Question: Is it "likely" that Kristen my have high functioning Autism? Would you suggest me getting another professional opinion?

We really need answers and I appreciate your thoughts regarding Kristen's diagnosis. Your opinion will help me decide whether or not to seek further help.

Thank you,
Laura W.  

Answer
Hi Laura;

Thank you for enough data for me to respond clearly. Yes, it is very likely your daughter has high functioning autism (HFA), which is synonymous with Asperger's Syndrome (AS) and PDD-NOS. I prefer the AS label. AS in girls looks much different than it does in boys. It is very hard for most professionals to correctly diagnosis AS, so you will want some very experienced in this area. You will also need to have the psychologist rule out a nonverbal learning disability as part of the assessment. If you have a breakdown of the IQ scores, or any other assessment data, I might be able to help you further.

Kind Regards,
James