I say this because it could be very easy to mistake a quirky personality for someone with Asperger’s. Children and adults have a wide spectrum of personality styles. Many children cannot be categorized as simply extroverted or introverted. Some are artsy and creative, some are nerdy and bookish, some are shy and reticent and some are friendly and engaging. And some are just plain weird or obnoxious or unlikable (or all three). I recall watching “The Polar Express” with my son and laughing to myself about the obnoxious know-it-all. His character was SO typical of so many people I have met over the years. But I wonder that if he were evaluated by a clinician, would he be diagnosed with Asperger’s Syndrome?
Although AS (Asperger’s Syndrome) falls on the autism spectrum, it is unique in its clinical symptoms.
Autism and other related disorders are generally characterized by language delays and cognitive dysfunction of some type. This is not true with Asperger’s. The primary symptom of AS is impaired social interaction. It is also characterized by repetitive patterns of behavior. So, although there is no cognitive or language delay, the social and behavioral components of AS relegate it to the autism spectrum family.
I have written posts on ADHD, CAPD, SPD, ODD, OCD and more. Any one of these disorders could be interpreted as Asperger’s Syndrome because many symptoms overlap.
Not only do they overlap, but many children with a specific diagnosis from this array also have a secondary diagnosis from the same list. How on earth can a parent be sure that their child is evaluated appropriately and that they are given the correct diagnosis?
The first thing I want to emphasize is to be sure to get an evaluation from a clinician with extensive experience who specializes in these types of disorders. Pediatricians are wonderful for treating medical ailments, but do not have specific expertise. Differentiating one disorder from another is difficult and requires a specialist. Media and news coverage these days focuses on a couple of these child development disorders. For that reason, many people are pre-disposed to make a particular diagnosis. It is probably subconscious, but nevertheless, it is not serving your child well.
The following lists criteria as outlined in the DSM IV (Diagnostic and Statistical Manual):
1) Qualitative impairment in social interaction as manifest by two of the following
• Marked impairment in nonverbal behavior such as eye-to-eye contact, facial expression, body posture and gestures to regulate social interaction
• Failure to develop peer relationships appropriate to developmental level (i.e. hanging out with kids the right age)
• Lack of spontaneous seeking to share enjoyment, interests or achievements with other people (not showing , bringing or pointing out objects of interest to others)
• Lack of social or emotional reciprocity
2) Restricted repetitive and stereotyped patterns of behavior, interests or activities as manifested by at least one of the following
• Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal in intensity or focus (obsessing over one thing)
• Apparently inflexible adherence to specific, nonfunctional routines or rituals
• Stereotyped and repetitive motor mannerisms (finger flapping or hand twisting or complex whole body movements)
• Persistent preoccupation with parts of objects
3) The disturbance causes clinically significant impairments in social, occupational or other important areas of functioning
4) There is no clinically significant delay in language
5) There is no clinically significant delay in cognitive development or age appropriate self-help skills, adaptive behavior or curiosity about the environment in childhood
6) Criteria are not met for other disorders such as PDD or Schizophrenia
Additionally, AS occurs more frequently in boys than girls. I think this contributes to diagnostic problems.
Children with Asperger’s have problems with gross motor coordination and sequencing, and with fine motor tasks. These problems affect activities such as ball catching and running and handwriting. Even normal boys typically have problems in these domains. Another hallmark is unimaginative speech, as indicated above. But what normal boy doesn’t love talking on and on about trains or cars or any of his favorite topics?
In order to distinguish AS from the eccentric child, or from the multiple developmental problems listed earlier, the evaluator has to rule out other possibilities. Children with AS may have attentional issues, but they are related to poor social interactions. Children with ADHD can’t focus and have poor impulse control. Children with Obsessive compulsive Disorder (OCD) shift interests but have many. AS children limit their interests.
The point I am trying to make is that there is often a fine distinction between symptoms of any of these disorders. The hallmark feature of Asperger’s Syndrome is dysfunctional social interactions but without cognitive dysfunction. I encourage any parent or caregiver who suspects potential AS to seek out a qualified clinician for an evaluation. While the information in this article may help support your suspicion, it is best to have it confirmed by a specialist. Once you have the correct diagnosis, you can tailor therapy to meet your child’s needs.