Expert: James Michael Roan - 12/30/2007

Question
QUESTION: My son is turning four and spins objects ie: pencils,cards video cases all day usually accompanied by a motor sound and play acting phrases. He started drumming with straws around 2 1/2 but didn't do that all the time. Around 3rd birthday started holding a shoe and twirling the strings, this started as a little break from busy play or while watching tv. This gave way to spinning a few mos later and hasn't stopped.
Pediatrician says definitely not autism as he has great verbal skills, holds conversation, an imagination that she felt was remarkable. He is affectionate, I have no doubt he understands feelings of others from their expressions.

We had to get through a lot of tantrums this year and he seems past that at this point. That only comes up occasionaly and much less severe. He will get stuck on an idea and dig in his heels, this has been the tantrum point in the past.  
He seems smart but I can't put my finger on how. His ped. thinks the he could be gifted/creative in an area an is too young to show that at this point. Perhaps that this one area is far ahead of other areas of intelligence.

My concern is that he is autistic, and even if he's not how are we going to do any formal type of learning. He learns constantly even while spinning. He seems bored with any type of pre school learning activity after the few times.
If you talk to him, he'll stop the sounds and talk to you but keep spinning.He loves imagination play and puppets. If a situation is new and engrossing, such as playing with kids his one age, the zoo, amusement park. He won't spin for hours, then may ask for something to spin as he starts to get tired.
I start a conversation with him and find he has turned the whole conversation around to the way he wants it. When teaching him a Bible verse the other day he acted uninterested then worked it around where he was teaching me the verse. He uses a kind patient teaching tone with me.
Some days I think I'm going crazy. I wish I could stop worrying, but his constant spinning is hard to ignore.
I would so much appreciate your input and I apologize for the length.

ANSWER: Hi Michele;

I trust a mother's intuition explicitly. Many of the behaviors/cognitive style fits with Asperger's syndrome (AS), which is a quite high functioning form of autism. Please note: I am NOT diagnosing here just directing your research efforts. A diagnosis requires a team or individual expert in this area and especially with very young children who may have AS. What's really needed is a full evaluation by a psychologist, occupational therapist, and speech and language pathologist. Language and behavior must be observed when your son is in a group of his peers. If you live in the U.S. you can make a special education referral to your school district. They are responsible for the assessment and service delivery, if eligible for services, for children 0-21 years of age. Tell them your pediatrician suspects PDD-NOS or AS. That way they will direct their assessment accordingly. A good assessment will include:

1. A cognitive assessment if possible.

2. A language evaluation including pragmatic (social) assessment. Also language in a naturalistic setting with a group of his peers.

3. An AS-specific test like Gilliam's Asperger Disorder Scale (GADS) or Tony Attwood's Australian Asperger's Scale (free on the Internet). There are others of course.

4. A general behavior rating scale like the BASC-II.

5. A fine and gross motor and sensory evaluation.

6. A behavioral observation by the psychologist when your son is working in a class with his peers.

Print this off to take with you to the first meeting and if the team leaves any of these off, then inquire about them.

Should your son have AS it most likely wold be subclinical or below diagnostic criteria for AS. But knowing where his skills and weaknesses are will allow you to plan for his future. I am guessing he will do just fine in school and as an adult based on your description. Feel free to send tons of data to me. The more information I have the better I can help. I chose this career because I believe in children and their families, so it's no real effort on my part.

Kind regards,
James


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

QUESTION: Hello James,
Thank you for your advice, I do have a follow up question ; what specifically stood out to you as Aspergerger behavior?  
Also, I forgot to mention that he likes to rub the tag of his teddy bear on his ears and nose when sleepy.
I have looked into Asperger's and always felt he didn't fit because he doesn't exhibit any of the social/comunication aspects. I didn't mention this but he is very social and always has been. He seeks people out by smiling, walking over to them, maybe even waving to get someone's attention, then he will talk to then, sometimes he will act a little shy if its a stranger that he has made contact with. As a baby he always found someone to "play" with while we ate at a restaurant by getting their attention and then acting like he didn't notice them.
The information I saw on pdd nos stress having some marker in the social area, that being a prerequisite.

I do appreciate your kind offer of follow up advice.

Sincerely,
Michele


ANSWER: Hi Michele;

Lost my email and will start over with this!

The behaviors you described were:

1. "Getting stuck" and having tantrums indicating a literal or rigid cognitive style.

2. Spinning.

3. Turning around a conversation to meet his agenda.

4. Teaching you Bible verse.

Many of these behaviors are found in typically developing children. It's only when a distinct pattern emerges that we look at a formal diagnosis. I honestly don't have enough information to think anything at this point.

You can download the Australian Asperger's Disorder Scale at: http://www.udel.edu/bkirby/asperger/aspergerscaleAttwood.html

And/or the Childhood Asperger's Syndrome Test at: http://www.autismresearchcentre.com/tests/cast_test.asp

I'm happy to discuss the results with you if you like.

Kind regards,
James

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

QUESTION: Hi James,
Thank you for the clarification.

I took the cast test, I answered the best I could, I wasn't sure about some of the questions re: interaction with peers as he is home with me and his 12 year old siblings. I just tried to go by the occasions when he is around kids his own age. I got score of three for spinning, pronoun reversal(this one's iffy), and turn taking in conversation. I tried to answer according to what I felt appropriate for his age. Possible score of 5 if you add eye contact and unusual phrases.
By going over these I can see how observing him with peers is crucial.
Do you think its possible that the spinning will go away, or maybe turn into something more socially acceptable as he gets older? Do you believe we should gently over time try to move him away from that? I already have times when its not allowed and he's done pretty good with those.

Sincerely,
Michele

Answer
Hi Michele;

Certainly, the spinning will go away. Remember the cornerstone of behavior theory: Never attempt to eliminate a behavior without a more appropriate "replacement behavior" clearly in mind. Behavior is triggered by and reinforced by environmental circumstances. The spinning is most likely a sensory-related behavior. Try a small trampoline and see if this could initially serve to meet his need for vestibular stimulation. Make sure he gets a sensory evaluation by an occupational therapist who can then suggest alternative behaviors/therapy to spinning.

Kind regards,
James