Expert: James Michael Roan - 11/2/2007

Question
QUESTION: Hi James,
My son has been diagnosed with aspergers.  He is 9 years old and is attending a very supportive school.  He has just started seeing a Dr. and receives counseling with her and the school counselor.  My son is in trouble all the time, he used to have complete meltdowns and now seems to be simply ignoring the teachers warnings all together.  Although he is not as angry, he is still disruptive.  I don't understand why he seems to be able to control his behavior certain days and other days not at all (even when he has a reward promised for good behavior).  Many times these are the worst days.  At times he also displays hyperactivity- but this is only 1 or 2 a week (at home).  Would medication help?  I'm really desperate!

ANSWER: Hi Krissa;

I know AS kids have a great deal of trouble with risperdal and its derivatives. It's usually prescribed for behavior issues. The behavior problems come from several sources. Boys with AS often have much higher levels of testosterone than their peers. They tend to have a very concrete or literal thinking style. Related to this, they have a very strong sense of justice, which cause problems when living in an unjust or unfair world.

Attention issues or "executive functioning" is also a major source of difficulty. Executive functions, located primarily in the forebrain or temporal lobe, are responsible for directing and sustaining appropriate attention. Difficulties in this area interfere with academic and social development because attention cannot be sustained long enough to connect behavior to consequences. To exacerbate this problem, children with AS do not naturally understand behavior and their consequences as their typically developing peers do, in fact, they are more at home with objects and their consequences, which is why so many people with AS move into engineering careers.

I really cannot comment on medication. That is between you and your pediatrician. I suggest you ask your school to do a functional behavioral analysis (FBA) to understand the environmental sources of his meltdowns, i.e., bullies, too much social pressure with no safe place to get away from it all, a low or unstructured classroom where rules are "situational," etc. before going down the medication road.

If you have any specific questions or would like elaboration on what I have said here, I am happy to help.

Kind regards,
James

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

QUESTION: James,
Thank you for getting back with me so quickly.  I am truly shocked by how on target you are with the description you gave.  It is exactly how I describe my son, the strong sense of justice and the "black and white" way of viewing the world.  I never knew about the higher levels of testosterone, but that would help to explain the temper.  As AS children reach teenage years, does the testosterone increase to above what other teenagers have?  I've often worried about how he will control himself and his temper when he gets older.

Krissa

Answer
Hi Krissa;

I'm sorry for the delay. I thought I answered this question a few days ago. Your son may still have anger issues, but if you stay on top of it, he will learn ways to cope. The folks that have the biggest issues are those who are undiagnosed and don't understand the source or nature of their anger.

Kind regards,
James