When moms and dads seek help for their youngster, 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 Aspergers (high-functioning autistic) youngster 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.
For the inexperienced, recognizing the six defining characteristics of Aspergers as outlined in the introduction can be difficult, and misdiagnoses are quite common. This is further complicated by the fact that an Aspergers youngster or teen has many of the same characteristics found in other disorders. These various characteristics are often misinterpreted, overlooked, under-emphasized, or over-emphasized. As a result, a youngster may receive many different diagnoses over time or from different professionals.
For example, if a youngster with Aspergers 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 Aspergers kids. The same holds true if obsessive or compulsive behaviors are displayed – the youngster gets labeled with obsessive-compulsive disorder (OCD) instead of Aspergers. The following traits are also commonly seen in those with Aspergers in varying degrees. However, just because these traits are there, it doesn't mean that the youngster should be diagnosed differently; these traits should be noted as significant features of Aspergers:
• Anxiety
• Difficulty with pragmatic language skills
• Hyperlexia (advanced word recognition skills)
• Motor deficits
• Oppositional defiant disorder (ODD)
• Sensory difficulties
• Social skills deficits
As mentioned, professionals who do not have much experience with Aspergers 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 youngster or adolescent appears to be having appropriate conversations with others or seems to be interested in other people. But with an Aspergers youngster, the conversations are not generally reciprocal, so the youngster must be carefully observed to see whether or not there is true back-and-forth interaction.
Also, many Aspergers kids 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 kids 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 Aspergers 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, Aspergers. They should have previously diagnosed numerous kids. To make a proper, initial diagnosis requires the following:
1. An evaluation by an occupational therapist familiar with sensory integration difficulties may provide additional and valuable information.
2. It is important to include a speech and language evaluation, as those with Aspergers will display impairments in the pragmatics and semantics of language, despite having adequate receptive and expressive language. This will also serve to make moms and dads aware of any unusual language patterns the youngster displays that will interfere in later social situations. Again, these oddities may not be recognized if the evaluator is not familiar with Aspergers.
3. The youngster 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).
4. You and your youngster should have sessions with a psychologist where your youngster 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 moms and dads. The psychologist may ask you to complete checklists or questionnaires to gain a better understanding of the youngster's behaviors at home and/or school. If the youngster is in school, the psychologist may call the youngster's teacher or ask her to complete additional checklists. The checklists or questionnaires used should be ones that are appropriate for individuals with Aspergers. It is important to determine the IQ level of your youngster as well. An average or above-average IQ is necessary for a diagnosis of Aspergers.