Expert: James Michael Roan - 1/12/2007

Question
Thank you James, your answer did help greatly. Could I follow up with one more question? We have tried stimulant meds and strattera for our son's adhd symptoms but he cannot take any of them. They all gave him some sort of negative side effect(s). What else can we do? The most difficult symptom is his lack of focus. Thanks again, I'm thrilled I found this site! Sue
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The text above is a follow-up to ...

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Hi, our 9yr old has been evaluated by 5 experts. Ranging from Pediatric Development M.D., Psychologist', Neuropsychologist', a Psychiatrist, and Behavioral therapist. He started with an ADHD dx, added Non-verbal, changed to adhd, executive function disorder, general anxiety disorder, and deficits in social cognition. Recently, the Behavior therapist and Psychiatrist added to those Aspergers/PDD-NOS. That's 6 dx's or labels. Why so many evaluations? The school has felt because he is extremely verbal and very bright his behavior (easily frustrated, no coping skills, poor social skills, loud tantrums, to name a few) is due to bad behavior which he can control. Obviously we and MANY others believe differently. My question- all of these dx's seem to be overwhelming and we feel overlapping. If the main dx is Aspergers and anxiety disorder don't those others fall into the same "stuff"? I think the problem is he doesn't fit the typical Asperger kid. He doesn't always fixate on one subject and doesn't have OCD tendencies. Some feel his tantrums when frustrated or dealing with change are not related to Aspergers but instead anxiety. Please explain to us if Aspergers is so concrete or do kids present differently? Thanks.
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Hi Sue;

If it helps you any, your situation is more common than not. This is a typical pattern of diagnosis that I see with a child who has Asperger's Syndrome (AS). The ADHD is usually and executive dysfunction common to children and adults on the autism spectrum and is typically the first diagnosis. As the child ages and matures intellectually, their lack of social competency stands out in stark contrast to others and to themselves. This growing sense of "differentness" and social incompetency develop into anxiety. The anxiety and resulting depression expresses itself in outbursts or tantrums. Add to this mix a certain degree of concrete/literal thinking and you have a recipe for even more anxiety, etc. There is a HUGE degree of inter-individual differences among the population of children with AS. Here's an important nugget of information: The less literal the individual is, the better the prognosis. As abstract thinking increases so does adjustment and adaptation.

I hope this helps. If not, feel free to ask for clarification.

Kind Regards,
James

Answer
Hi Sue;

Please feel free to ask as many questions as you like. I enjoy what I do.

Here is my recommendation:

1. Go to Michelle Garcia-Winner's website  www.socialthinking.com and look for some materials on organization. She does the best job on this subject as anyone (see item 3).

2. Next, have the school or private psychologist thoroughly evaluate his executive functioning. I use the BRIEF rating scale parent and teacher versions because it quantifies strengths and weaknesses and helps you target the exact problem so you can then work around it.

3. Buy him an electronic organizer of his choice. By removing as much of the chaos around him you can diminish the overall stress and he will be able to cope much better with what is left.

Trust me, he will be fine. Help him to structure and organize his life, teach him social strategies, help him to find a friend and he will do well in life.

Kindest Regards,
Jim