Expert: Catherine Ridenour - 4/9/2006

Question
Hi there, thank you for your quick reply to my question.  I have thought about it greatly over the past week.  I want to add some additional info and see if you still think AS.  I am wondering about perhaps OCD or something like that.

My daughter has good eye contact in conversations where my son had to be taught this.

She was also slow to start talking.  She didn't say her first words until 17.5 months of age.  (The doctor told me that if she didn't speak by 18mos we would have to investigate).  I have read that with AS the norm is early language acquisition.  (But I cannot remember where I read that).

She has very good imaginitive play - she teaches my son how to use his imagination when playing. She often gets frustrated with him when she is using her imagination and he corrects her because what she is doing is not logical to him.

I would appreciate any feedback you have given this additional input.  I am at this point hesitant to go to the pediatrician for fear he will think I am a hypochondriac.  On one hand I feel that maybe I should wait and see.  On the other hand, I feel that by not taking her we could be missing out on some services that are not available after she is 6 yrs old.  I find the whole process of diagnosis, etc very daunting.  We are just starting to get a handle on my son's DX (the process of diagnosis started in September).  I don't know how we will handle doubling the doctor's appointments and tests, etc.  

I guess I just need some reassurance from an outside source that my thoughts on this are not that off the wall.

Thank you for any advice, etc.

Tracy
(a frazzled mom)

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Followup To
Question -
Hello. I have a 3.5 year old daughter who has some behaviours that I am concerned about, and I wonder if these are typical preschooler behaviours or not.  (I have an 8.5 yr old son who has Asperger's, but her behaviours are somewhat different from him, yet some are the same).

Her traits are as follows:

1. Talks excessively - really, I mean she talks all the time that she is awake (that I am with her, anyway - I can't vouch for how she is when I am not there).  She is aware, too, if she is talking to you and you are not paying attention, or don't respond right away.  She keeps calling "mommy, mommy, mommy, etc" until she gets your attention.  She also switches topics constantly.

2. She is sometimes bossy to the kids at her daycare, telling them how to clean up their toys, or how to follow the rules.

3.  She is very "rule aware", and daily tells me what the rules at her daycare are (I don't inquire, by the way, she does this quite freely and voluntarily!).  She also tells me what the consequences are for breaking each rule, and then proceeds to tell me who broke what rules at the daycare today.  If there were any injustices against her, she tells me what the consequences were to that person and what the teacher said to her and to the offending rule breaker.

4.  She seems to be like a sponge, absorbing knowledge, and tells me every day in great detail what the topic was that they were learning about in daycare at circle time.  She talks as if she is the teacher - it is as if she has memorized what the teacher has said word for word and gives me a little "lecture" about the topics -ie. community helpers, the solar system, the farm, etc.  The teacher says that she is almost the only child who participates at circle time.

5.  She has terrible temper tantrums which turn violent (towards me or my husband) if we try to pick her up or move her to her room.  She can turn at the drop of a hat, but usually the tantrums are caused at a transition time. (ie. moving from playing to bath, or bed)  

6.  She is very set on her morning and after school/bedtime routines.  If they are altered she becomes emotionally distressed and wails/weeps. (for example, if I have to go out to a meeting in the evening and won't be there at her bedtime, Or, if I try to get her to brush her teeth BEFORE putting on her PJ's).

7.  She is often times hyperactive seeming, moving quickly from one activity to another, or just running (read, bouncing) around from one location of the room to another.

8.  She is frightened by appliance sounds (like the vacuum cleaner), although this has improved some in the last year.

9.  When she is playing she often becomes fixated on playing with a certain toy (or set of toys) in a certain way, and if anyone interferes she has a tantrum.  

10. Sometimes when playing she seems to go into a "zone" and it is hard to snap her out of it.  For example, when she was 2 she would play "night night elmo" and lay her elmo doll on the floor and proceed to carefully lay one blanket after another onto her doll, until she had a stack of about 20 blankets or so carefully piled up.  IF one of the blankets was wrinkled, she would make a distressed sound, then lift and straighten the blanket.  If she was interrupted in this process, she would become near violent towards the person interrupting her.  When she was done with the blanket process, she would remove them all and start again.  The only time we could move her to another activity was after all the blankets had been piled, and before she removed them to start over.

11.  She is excessively "touchy feely" and is often climbing all over me, or touching my hair or face.  She has a very high pain tolerance and is oblivious to most bumps and bruises.

12.  She has developed little rituals that seem bizarre to me, like when she is done brushing her teeth she announces "you are my best friend mommy" and proceeds to very deliberately place her toothbrush right next to mine in the toothbrush holder.  Also, when she is kissing/hugging me goodbye at daycare, she hugs me and then bends down and kisses and hugs my knees (she does this to my husband too when he leaves the house).

Many of her behaviours (except the rule monitoring and bossiness) are opposite of my son who has Asperger's.  But, I am not certain that they are neuro typical, either.  My son also has some quirks and weird habits, but they present differently from hers.

She can also be aware of how others might be feeling.  For example, if I stub my toe and say Ouch, she will ask "are you ok mommy?"  Whereas my son doesn't seem to notice these things, or inquire as to my well being.  (even though he does seem to notice if his SISTER becomes injured and asks if she is ok.)

I would appreciate any feedback from you to see if this is normal or if I should be concerned about aspergers, autism or anything else.  I chose to ask you this question because I saw you have a daughter with asperger's.

THanks for reading all of this,
Tracy

Answer -
Hi Tracy,

With the exception of the constant chatter, which many 3-4 year olds do, everything you describe fits the definition of Asperger's Syndrome.

In fact, if you did not tell me you were describing your child, I would think you were telling me about my daughter.

With a brother already diagnosed, chances are good she has it also.  I do believe there is a genetic link.  

Have her evaluated and don't accept "she'll be ok because she's so bright."  That rule monitoring and bossiness will not go away as she ages without some social skills training.  She will need support in school particularly as she gets older and her rituals start to interfere.

Best wishes,
Catherine

Answer
Hi Tracy,

Obsessive-compulsive behavior is often a component of Asperger's Syndrome/High Functioning Autism.  

While it is true that early language is typical in Asperger's, second children may not always talk as early as a first born and that may skew the evidence a bit. Eighteen months is not that late in second children.

I know that you dread the process, but better to find out and intervene now.  Even if it is "only" OCD, this is also a serious problem that requires help.

Best wishes,
Catherine