Defenders of Reality
When parents seek help for their child, they encounter varied opinions he'll outgrow it, leave him alone, it's no big deal, he just wants attention, and so on. Many professionals try to work with the Asperger child as if his disorder is like other developmental disorders, but it is quite different. In most cases, there is a great misunderstanding by many people of the needs of these special individuals.
Diagnosis Can Be Difficult
For the inexperienced, recognizing the six defining characteristics of Asperger's as outlined in the introduction can be difficult, and misdiagnoses are quite common. This is further complicated by the fact that an Asperger child or teen has many of the same characteristics found in other disorders. These various characteristics are often misinterpreted, overlooked, underemphasized, or overemphasized. As a result, a child may receive many different diagnoses over time or from different professionals.
For example, if a child with Asperger's demonstrates a high degree of attention deficit hyperactivity disorder (ADHD), that might be the only diagnosis he receives. However, this is a common characteristic of Asperger children. The same holds true if obsessive or compulsive behaviors are displayed the child gets labeled with obsessive-compulsive disorder (OCD) instead of Asperger's. The following traits are also commonly seen in those with Asperger's syndrome in varying degrees. However, just because these traits are there, it doesn't mean that the child should be diagnosed differently; these traits should be noted as significant features of Asperger's:
- Hyperlexia (advanced word recognition skills)
- Sensory difficulties
- Motor deficits
- Difficulty with pragmatic language skills
- Social skills deficits
- Oppositional defiant disorder (ODD)
As mentioned, professionals who do not have much experience with Asperger's have a hard time identifying the defining characteristics. For example, social skill deficits may be noted by a professional, but then they are often downplayed because the child or adolescent appears to be having appropriate conversations with others or seems to be interested in other people. But with an Asperger child, the conversations are not generally reciprocal, so the child must be carefully observed to see whether or not there is true back-and-forth interaction. Also, many Asperger children have an interest in others, but you need to clarify if the objects of their interest are age appropriate. Do they interact with peers in an age-appropriate fashion? Can they maintain friendships over a period of time or do they end as the novelty wears off? These are the types of observations and questions that must be asked in order to ensure a proper diagnosis.
Another example of an overlooked area is the narrow routines or rituals that are supposed to be present. This does not always manifest as obsessive-compulsive behavior in the typical sense, such as repeated handwashing or neatness, but rather in the insistence on the need for rules about many issues and situations. These children may not throw tantrums over their need for rules, but may require them just as much as the person who has a meltdown when a rule is violated. In essence, there is no single profile of the typical Asperger individual. They are not all the same, as you will see in later chapters.
Because of these subtleties and nuances, the single most important consideration in diagnosis is that the person making the initial diagnosis be familiar with autistic spectrum disorders in particular, Asperger's syndrome. They should have previously diagnosed numerous children. To make a proper, initial diagnosis requires the following:
- You (both parents) and your child should have sessions with a psychologist where your child is carefully observed to see how he responds in various situations. This is done through play or talk sessions in the psychologist's office and by discussions with both parents. The psychologist may ask you to complete checklists or questionnaires to gain a better understanding of the child's behaviors at home and/or school. If the child is in school, the psychologist may call the child's teacher or ask her to complete additional checklists. The checklists or questionnaires used should be ones that are appropriate for individuals with Asperger's syndrome. It is important to determine the IQ level of your child as well. An average or above-average IQ is necessary for a diagnosis of Asperger's.
- The child should see a neurologist or developmental pediatrician (again, someone familiar with autistic spectrum disorders) for a thorough neurological exam to rule out other medical conditions and to assess the need for medication. The physician may suggest additional medical testing (blood, urine, fragile X, hearing).
- It is important to include a speech and language evaluation, as those with Asperger's syndrome will display impairments in the pragmatics and semantics of language, despite having adequate receptive and expressive language. This will also serve to make parents aware of any unusual language patterns the child displays that will interfere in later social situations. Again, these oddities may not be recognized if the evaluator is not familiar with Asperger's syndrome.
- Finally, an evaluation by an occupational therapist familiar with sensory integration difficulties may provide additional and valuable information.