Expert: Trey McGowan - 7/15/2007

Question
QUESTION: My son will be 3 in a week.  At age 2 he was only saying about 5 words, so we started an early intervention program.  He didn't make much progress until we discovered he'd had fluid in one ear for quite some time.  After we found that out, he had surgery to place tubes in both ears.  Within a month of that he was saying about 30 words. Now, about 6 months since the surgery, he says at least 200 or more words and talks in short sentences, although he is very difficult to understand.  Now that he is turning 3, the early intervention program is ending and he went to be accessed by the local school district about 1 month ago.  I was expecting that he'd just get referred to a speech therapist, but instead one of the women at the assessment center expressed concern that my son suffers from Asperger's Syndrome.  She had me fill out some sort of questionnaire and said while it's not definite that he has Asperger's, it can't be ruled out.  She said she was concerned about his obsessive tendencies.  For example, while we were at the assessment center, all he could think about/talk about was a nearby drinking fountain and refrigerator.  He kept saying, "Wa wa!"  and "Ice!" and running over to them.  She also thought that his voice intonations might indicate Asperger's.  We weren't able to finish  the assessment that day because my son was so distracted.  Since then, I have done a lot of reading on Asperger's and I am still unsure if he has it.  He makes great eye contact, he points to things, brings things to show me, etc.  When he is with kids his age, he interacts a little, but not as much as I think is age appropriate.  I had always written this off to the fact that he was language delayed.  He has a lot of tantrums, but is improving.  And as I said before he gets very obsessed with things.  He will find a subject and talk about it endlessly.  He is not very good at playing pretend, but is doing much better than he used to.  He's very intelligent, he knows his numbers 1-10, ABC's, shapes, and he has an amazing memory and sense of direction.  My question is, at what point do you just blame strange behaviors to being a 2-3 years old, or know if it's something more?

ANSWER: Hello, Jennifer!

Your main question, 'at what point do you just blame strange behaviors to being a 2-3 years old, or know if it's something more?', is essentially answered by asking yourself the exact same question. At what point do *you*, as his mother, blame strange behaviors to being a 2-3 year old?

The fact of the matter is that there isn't such a cut-and-dried answer in this case, as there was some minor hearing impairment in his life, thus giving another reason for the speech delay. The obsession with water, you make it sound like was just the once. Could it be that he was thirsty? Or is this an obsession that's happened since then? He hyper-focuses on things. 2-3 year olds tend to ask a lot of questions, and they will often, even when not Aspergers, obsess on certain subjects.

I'm not saying that there's no chance that he is Aspergers, here. However, I am saying that if you, yourself, feel comfortable on the situation? If everything seems to be focused around just the speech problems rather than the social difficulties? Then I honestly would say that you should go with your heart on this one and, while you might want to keep an eye on things in case something develops, assume that he was deaf for most of his life and therefore that is why he shows these delays.

Now, at the same time, I want you to step back and consider seriously your thoughts on this. If you are avoiding thinking about the possibility because you are afraid of what you will find? It's not easy to say 'My child is autistic', but to take the admission is the first step in getting the assistance he might need. If, however, you are saying 'He just plain doesn't seem Asperger's', well... then there's a good chance he's not.

Here's hoping that I both made sense and managed to be reassuring to you! Kudos, as I so often do, on being an attentive and loving mother to him.

Trey

---------- FOLLOW-UP ----------

QUESTION: Thanks very much for your response.  To clarify, I'm no longer concerned about his speech issues since seem to be attributed to his partial hearing loss when he was younger.  He is making fast progress now.  But I am mainly concerned about his "hyper-obsession" with things.  He has several subjects that he talks about  a lot: train tracks, rocks, and water.  These subjects are a large majority of what he talks about throughout the day, but not the only things.  For example, he calls train tracks "bump bumps" because that's what I used to say every time we drove over them.  So now any time we leave the house all he can talk about the ENTIRE car ride is "bump bumps."  He knows where every railroad crossing in town is.  And if we don't go across them when he sees them he gets upset.  This happens day after day.  What other things should I be looking out for at his age that might indicate Asperger's?

Thanks for your help.

Answer
Hello again, Jennifer!

Ah! Your second letter clears a lot of things up, and I apologize in advance for my assumptions in the original letter. I should have read it more clearly. :) Hopefully you'll forgive my brief lack of brain.

With your clarification, I look at what you're saying and while I'm not a doctor (as I say so often) I can definitely see some sterotypies. Obsessions happen with the young, as I mentioned before, so it is possible that yes, it is simply an age thing. However, if the obsession is showing up with other symptoms, then you should definitely consider the possibility.

At the age of 2, Aspergers Syndrome symptoms (if you will pardon the term used) that you will notice most intensely are the sensory ones. You mention your child has a bit of a temper. Is this triggered by really odd things? Sounds, in particular, are a very common trigger for this sort of thing. Are there specific sounds that make him cringe and cry, even if you might find them pleasant? Touch is also a very common one. Does he refuse to wear certain types of clothing, and have a fit when he comes into contact with certain things? Smells: are there perfumes that he really likes, or food-scents that he rejects? It can be harder to notice with smells because even neurotypical people have such extreme reactions to scent.

Here's a personal example, so you might get a feel for what I mean by the 'sensory' issues. Cotton balls, for me, are my extreme trigger. Even at 30, picking up a cotton ball with my hand involves a lot of actual crying because the sensation is so unpleasant to me, and getting an injection, I would scream more for the cotton than the needle (though I've learned over time to essentially 'brace' for it). There are others, naturally, but that gives a good image of how something that most people find to be very nice to touch can be literally sickening for an Aspergers child.

After the sensory ones, playing habits is a good identifier. Does he tend to play repetitively? Enjoying the same games is, if you will pardon the term, normal development. Enjoying the same game the exact same time every time, may not be. Watch for an obsession with things that spin or vibrate, or stacking toys. Give him some blocks or stacking cups of different sizes and see what he does with them. Or, give him some Duplo blocks (Legos would be a bit small and possibly dangerous at this age) and see what he makes of them.

Because of the differences in how children develop, I hesitate to call 'hyperdevelopment' in one area as a sign. However, there are times when it can be an indicator, if stacked up with a lot of other things. Precociousness in one area, particularly a surprising level of it, is not a sign in and of itself, but can be an indicator. Particularly if the precociousness is in something much more analytical than one would expect out of someone his age. His memorizing all the railroad tracks, for example, is one of those signs.

Social skills with other children are likely not to be as developed at this age, unless you take him to play groups regularly. If you do, see if you can get an idea on how he plays with others. If there are definite issues with it, try and pick out what they are. Does he appear to be misunderstanding? refusing to play anything but his own games? Make sure that you can differentiate it from just not being interested; after all, even the neurotypical just sometimes don't play well with others!

Top of the list for 'identifying Aspergers', but sometimes bottom of the list for '*recognizably* identifying Aspergers', paradoxically enough, are the social issues. Does he appear to have problems with what you would think are basic social moires? Looking someone in the eye while talking to them is probably the single most quoted, and best identified, examples of this. Eye-gazing is very intense, and for an autistic mind, it can be too much so. So they tend to look away, often very noticeably in the younger years. Try this: without directly asking him to, try to catch his gaze and see how he reacts. You can try to ask him to, but he may hold the gaze longer that way because of the 'parental obeisance' and just show discomfort in other ways. Watch his reaction to people joking or teasing. Does he seem to have a problem with it? Does he seem to miss cues that a face would hold?

Physical stereotypies aren't as common or as intense as in 'Autism Disorder', but you might still find some evidence there. Rocking or spinning himself. Flapping hands or 'sewing machine leg'. These are related to the physical stimulation issues above, but often present themselves as different enough that it's worth separating into its own little paragraph.

Here's a few links for you to add to my above comments, in case they said it better than I could have:

Good old Wikipedia: http://en.wikipedia.org/wiki/Asperger's#Clinical_features

http://www.mugsy.org/wing2.htm
A clinical view of Asperger's, and without getting too technical. It's quite understandable, though you might find that the utterly indifferent tone can chafe. This is because, as the title says, it's a literally clinical writing. The case studies in particular I find to be very enlightening.

http://www.teaam.org/asperger.htm
A FAQ on Aspergers from a very well-versed website.

Whew! Here's hoping I've made up for my original blunder, and that my long-windedness might help you find some pearls of wisdom in the chaff. ;) Good luck to you, and my kudos, again, for being a loving and concerned parent!

Trey