ADHD or Asperger's - how to tell? (long)

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Registered: 06-28-2005
ADHD or Asperger's - how to tell? (long)
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Fri, 03-30-2007 - 1:04am

Hi, I hope you don't mind my visiting here. I'm hoping you can help me gather some info that might help my oldest son. Three different people in recent months (one a parent of an Aspie, two special ed teachers) indicated that they thought my son had Asperger's. I would correct them and say, no, it's ADHD, but I can't help but wonder... I'm trying to compile a list of specific questions for his doctor.

A little background: DS is 11, very small for his age (in the 10th percentile), acts very 'young' for his age. He was evaluated at age 3 b/c of a speech impairment. "Delay" isn't quite the correct word. He was speaking words at age 2, simple phrases at age 3 but they were his own words and his articulation was poor. His hearing is fine. He's still in speech therapy at school.

At age 4 and a half, we had him re-evaluated. At that time, it was noted that on certain test that he had a "lower than average" chance of ADHD. However, at age 6, he was indeed diagnosed with ADHD. He's very hyperactive and distractible but he can focus with laser like precision on certain tasks.

He was re-evaluated a couple of years later by a different pediatric psychiatrist specializing in ADHD, who confirmed the initial Dx. He does well in school academically, and is pretty organized about his school work (that's pretty uncommon among kids with ADHD) but at this age it's becoming painfully aware that he marches to the beat of a different drummer. He takes Adderall to help manage his ADHD symptoms.

He has few friends and generally seems to prefer the company of books (or video games, which I limit). I often send him outside on a beautiful day to play with his brothers and minutes later, just find him doing his own thing. His social interactions are often awkward. Because of his speech issues, his intonation and inflection are somewhat odd. Frankly, often when he speaks he sounds rather sassy, altho' it's unintended. At this age, he still very literal. An example, he was the last one to wake one morning and his dad said, "time to get up, there's a fresh baked cinnamon roll out here with your name on it!" DS was disappointed that his name was not literally written in icing on his roll. He doesn't seem to realize that adults are not his peers and should not be spoken to as such (unless invited). His end of the conversation usually comprises of 1) teaching someone what he knows, or 2) correctly someone. Diplomacy? Forget it! True, two sided conversations are a rarity and very difficult to sustain. Eye contact is minimal. I wouldn't say that he's displays an intense interest in only a few topics. Rather he has developed a near-encyclopedic knowledge of dinosaurs, geography, the Lord of the Rings trilogy (not only the story, geography, timeline and genealogy), medieval weaponry... He's in the 6th grade, but writes at a 4th grade level, yet reads beyond a 12th grade level. He only occasionally has trouble with transitions.

I realize that these traits can be attributed to ADHD, but I also know that there are some mis-diagnoses. Part of me thinks that since two docs said it's ADHD, then that's probably what it is. I asked his ADHD doc about it once and he was rather dismissive. He didn't come right out and say it couldn't be Aspergers, but I got the sense that ADHD seems to be an educational issue whereas Asperger's is a social issue and what good is another label? Believe me, my son has enough labels, but I want to be sure he's getting all the help he needs. I've visited OASIS's website and a couple of others. I'd like to learn more, compile a list of specific questions, and approach his doc again before seeking another opinion elsewhere.

Sorry for the length and thanks in advance.

~ Lisa

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iVillage Member
Registered: 04-07-2003
Fri, 03-30-2007 - 1:33pm

Wow in many ways your son sounds so much like my son. Josh is 12 and is also very small for his age (he has some 7 year olds starting to beat him in the height and weight department.) But we went a similar route that you did. Early intervention for him a delay. And then he was going into repition. Marches to teh tune of his own drummer. Overly focused on things. Very rule oriented in many ways. Though in Josh's case he has a hard trouble with organizing.And Josh has a hard time with thinking outside the box which makes reading hard for him. Esp since now adays part of the ELA deal is to see if the kid can translate what he is reading. meaning identifying emotions, and thinking about how they affect you etc. Joshua is also one who will hang out with the adults more than his own age group amnd he seems to be a loner and not that worried about it.

But it is not impossible for a child with ADHD to have Asperger's. Esp since many symptoms can be similar. But what I find for the kids in this age group is that what I am believing now. Is that the people evaulating our kids at age 3 didn't knwo what they were looking at. The Dx of Asperger's as far as being the "in thing' only came about in 1995 and there abouts. So the people evaluating our kids really weren't "programmed to look for it so to speak" It wasn't in the news etc. Nowadays it is regonized for what it is.. An Autistic Spectrum disorder. And many of those same people who evaluated our kids only many say a couple of those case at that point. Now have probably seen a 1000 cases and if they had seen our kids now would say yes this kid has Asperger's.

I went to my local SEPTA meeting this past Wed. and the topic was about the Autistic Spectrum. And part of the deal is that our kids are harder to diagnosis because they are so high functioning. and that they were probably able to get by when they were younger. And now as the yare getting older. Their quirkiness is standing out more and all of a sudden they are being found behind the eight ball. So it is not unusual for our kids to get the dx later than the normal.
i would go to a neuropychologist and have him evaulated. It won't hurt.
By the way i am in NY. on LOng Island and trying to find other boys who speak the same language so to speak because Josh does have a hard time making friends so if you are in that area.. lwet me know..LOL

Rina

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Registered: 03-26-2003
Fri, 03-30-2007 - 1:51pm

I'm not really sure the diagnosis makes a difference so much as that he's getting the proper interventions and accomidations at school and you understand his individual needs, strengths and weaknesses. Making sure he's getting social skills training, all his speech issues are being addressed, and any accomidations he needs are taken care of can be addressed whether he's Dx w/ adhd or aspergers.

ADHD is also a social issue and an educational issue as well as behavioral, but so is Aspergers. Many children w/ Aspergers have other difficulties, too. They often have organizational difficulties, difficulties w/ writing and other assignments that have non-concrete components. Children w/ Aspergers often don't understand directions esp those given verbally.

Many of the symptoms of ADHD and Aspergers are the same. The reasons behind the symptoms are often different. The WHY of the actions and difficulties are what leads to the Dx. Your son has red flags for Aspergers but also for ADHD. Kid can have more than one Dx as well. Sometimes I think that the professionals and parents can sway the tests because they're looking for something in particular and have a preconcieved notion of what the child has/is and they don't look objectively at all the data and all the underlying reasons for the symptoms. ADHD and ASDs are specific neurological disorders yet they're diagnosed subjectively by human beings. Mistakes happen, wrong diagnoses happen. It wouldn't hurt to have another opinion, maybe from a Dr that specializes in autism spectrum disorders.

I have one son that has a Dx of ADD-NOS, he doesn't quite fit all the critria for aspergers, he doesn't fit all the criteria for ADHD, he has dysgraphia. He needed a Dx to get services at school, but he wasn't far enough behind to get resource for learning disabilities, the school wouldn't look at autism because he wasn't enough impaired. We had a psychologist that wanted him to get help so gave him this dx. He is on an IEP for other health impared w/ the ADD-- works for us. My #2 son is autistic. He didn't show the symptoms as much when he was younger he had much more severe sensory issues that often looked like ADHD and OCD-- but it's become very clear as he gets older that the autism Dx is very appropriate. the hyperactivity and hypersensitivity are sensory seeking or sensory avoiding activities stemming from his sensory integration dysfunction and autism not from ADHD

Betsy

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Registered: 06-28-2005
Fri, 03-30-2007 - 3:17pm

Thank you, Betsy. Your first sentence about it not necessarily mattering which Dx as long as he's getting appropriate help - I think that's what his ADHD doctor was trying to say. However, I'm finding that my son's services seems to be limited to ensuring academic success. Accommodations at school include extended test time (which he rarely needs), preferential seating to minimize distractions, and the like. I appreciate that.

However, because my son is not aggressive or defiant, he receives zero help in terms of his social skills. The school is happy to focus their attention on the kids who are oppositional/defiant, or those kids who seem to cause problems for others.

He sees his ADHD doctor (a ped. psychiatrist) once per quarter. We've talked about his social immaturity (for lack of a better term) and his response was to the affect that most ADHD kids mature later than their non-ADHD peers. Okay...so will he "grow out of it" and eventually catch up, or does he need greater intervention.

And you're right, looking at it like this, it may not necessarily matter how he's diagnosed if he gets the help he needs. As much as my son likes his ADHD doctor (and he's been very helpful in other areas), it might be time for a second opinion.

It's just that socially, he just doesn't pick up on the social conventions (i.e. not interrupting, making eye contact, being aware of other people's feelings, their cues that they may be offended or unhappy, etc.).

I appreciate your taking the time to respond

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Registered: 06-28-2005
Fri, 03-30-2007 - 3:38pm

Thanks, Rina. Unfortunately, I'm in southeast Louisiana but otherwise, I'd take you up on your offer. I forgot about being rule oriented. Drew is definitely that! He sees things in "black & white" - no shades of gray whatsoever.

He can be very empathetic towards others if their emotions are obvious: For example if someone is crying, he'll be the first to comfort them. However, when it comes to the more subtle cues (frowning, boredom, rolling one's eyes), it just doesn't connect with him. If he's taking to someone (usually an adult), if they do not just walk away, then he assumes they're enthralled with what he's saying. After all, if he's bored, he'll generally walk away (or mentally zone out of the conversation). If I try to explain that the reason the other person has not walked away is because they're just trying to be polite, he'll ask why. If I tell him it's because they don't want to hurt his feelings, he seems so surprised. Like it never occurs to him.

If indeed he is correctly Dx'd with ADHD, the only real area that's being addressed is academic. He'll have certain accommodations at school: preferential seating to minimize distractions, extended test time (which he rarely needs), that sort of thing. Since he's not aggressive or considered a 'trouble maker', he receives no help with socialization issues. I'm not sure what it will take to get help in that area.

He has an appt. w/ his regular pediatrician in a couple of weeks, and with his ADHD doc in May. I'll bring the subject up then, and will probably look for a second opinion during the summer.

I really appreciate your taking the time to reply.

Thanks,

~Lisa

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Registered: 04-07-2003
Fri, 03-30-2007 - 3:50pm

Josh is also not aggressive and or a troublemaker in the sense of the words. That is another issue there of his Aspergers. Some kids with ASD can be aggressive. Up here having the Dx of ASD is a way of getting services. Including speech for pragmatic skills. Social Skills, an autisitc consultant who can help with the areas you are talking about.
Check with your school district to see what services are offered if your son does recieve the Asperger's dx.
It may be worth looking at this. Because even though your son may not be suffering acedamically he is suffering in a different way in that quirky way. I am not saying we need to change them so to speak but it is more just teaching them how to interact with others.

Just so you know, Josh will also just up an flat leave if he thinks things are not the way he thinks it should be or if he is interpruting some one is being mean to him outside of the obvious means. I am talking about the difference btween joking around and true teasing. Or if a game is being playing in the neighborhood and again things are not quite going his way he will leave.

He will prefer the company of one sometimes, usually other kids of similar nature he even prefers hanging out with the toddler next door to his kids his own age. Mostly because babies are easier to please and more accepting. But the main thing is older boys and adults.

Rina

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Registered: 06-25-2003
Fri, 03-30-2007 - 8:53pm

Hello Lisa and welcome,


We are glad to have you here.


I agree with Betsy. The key is understanding the underlying reason for the behaviors. A good example is hyperactivity: Many ASD

-Paula

visit my blog at www.onesickmother.com
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Registered: 09-09-2005
Fri, 03-30-2007 - 9:54pm

Well, my son has three different dx , depending who you talk to and we finally realizing he does indeed have all three; adhd, asd and bp-nos. The AS dx was the last to arrive as everyone wanted adhd to be the IT dx. Your son dies sound like he is dealing with more than just adhd; perhaps an additional eval from your school district,...or get an independent eval from a dev ped ?

Dee

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Registered: 11-28-2006
Sat, 03-31-2007 - 3:43am

I feel a bit differently about getting a dx. I agree about not caring about the label, but I'm a bit paranoid when it comes to the school system lol.

If there's something your son might need in the future that has to do with an ASD Dx, then its best to get the Dx now if its appropiate. That way, if you need a change in his IEP, then you don't have to go thru the time and hassle to get the Dx. And we all know its not easy sometimes to get one the first time.

Lainie

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Registered: 06-28-2005
Sat, 03-31-2007 - 10:24pm

It's not that unusual for an ADHD child to engage in aggressive behavior at times - in part due to the impulsivity aspect of ADHD, and in part because of the frustration. However, since my son doesn't fall into that category, he's not receiving any assistance with 'socialization' (for lack of a better term). I should speak to his speech therapist at the school about integrating pragmatic language skills into his IEP (if they'll do that without an official Dx, other than his ADHD).

Drew often doesn't know when someone is teasing him, unless they're very blatant (name-calling, etc.) - that's tough sometimes. On one hand, ignorance is bliss, but on the other, I worry about him trusting someone whose intentions are not kind.

He's my onion-child. Every time we thing we have a handle on something, another layer is peeled away, revealing yet a new challenge to be addressed. Never a dull moment, though, that's for sure! :-)

~ Lisa

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Registered: 06-28-2005
Sat, 03-31-2007 - 10:39pm

Thanks,Dee. I do get the sense that, besides the ADHD, there is something more than we're missing. Of course I'm not qualified to diagnose him, but since it's been brought up by several Asperger's-savvy folks, I thought I'd start researching and compile a list of questions for the doc.

Beautiful baby! Congratulations.

~ Lisa

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