Need Answers from you experts!!!

iVillage Member
Registered: 03-27-2003
Need Answers from you experts!!!
6
Tue, 12-20-2005 - 10:14pm

My 5y--almost 6yo son was dx at 3y with receptive/expressive langauge disorder and mixed developmental disorder. At 4y----Dx with Anxiety disorder, disruptive behavioral disorder and his language disorder.(this is from a pdoc that didn't believe in childhood bipolar)
At 5yo---went to a new pdoc and he dx him with bipolar, anxiety, his language disorder which is only expressive delay now, and possible aspergers.(he met the criteria, but he's a "wait and see" kind of kid)

Today at our pdoc appt---we went over the criteria again for ASD. He went ahead and gave him the high functioning autism dx. So the poor kid is bipolar and HFA.

So-----tell me......I question my answers that I gave the pdoc. Do your kids "play" approperiately with others? Do they play pretend---and if they do---to what extent? Do they give good eye contact. Do they WANT to make friends? Do they have friends that they really play with???? How is their facial expression and tone of voice?

And-----what is the diffeence between Aspergers and HFA? I've heard its the same----but what do you guys think?

Holly
Jacob---5yo Bipolar, Anxiety, Expressive langauge disorder, HFA,
Lithium
Tegretol
Risperdal
Melatonin
ProEFA

iVillage Member
Registered: 02-24-2005
Tue, 12-20-2005 - 11:48pm

Holly,

Chase(8yo)was dx Aspergers and tourettes with mild anxiety. He does like to play with others and actually has a couple of friends from school that come over but I have to take care that his 6 yo sister is not around or they tend to take up with her instead. His pretend play is actually very good but he tends to go into a monologue and forgets that another real person is actually present and doesn't check to see if they're attending. He loves when anyone visits but becomes distraught when they leave.

He is not on any meds and attends a private school but recieves OT and social skills outside of school weekly. Most kids don't really notice any difference in him initially but extended time spent with him usually is telling.

The only clinical difference in regards to HFA and Aspergers is when they acquired language. Chase's dev. while slower than most was still in the normal range. Many kids with AS speak very early and use speech in an odd way and tend to sound like little professors. Chase used to go monotone but this has improved greatly over the past year.
His eye contact is not great but we're just working on him looking in the direction of who he is speaking to not in the eyes as this is very distracting for him.

HTH, Vicky

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Registered: 03-26-2003
Wed, 12-21-2005 - 12:03am

Well, many consider Asperger's to be HFA actually. It really depends. In theory the difference is supposed to be if a child has/had a significant language delay then they were HFA and not Aspergers. That is likely the difference for you.

My Cait was language delayed. Mixed expressive/receptive language disordered. However, by 7 her language had "caught up" on tests (though barely), though she still has trouble conversationally even now at 11. She did have single words by 2 and phrases by 3 which is the criteria for AS but there are many that would dx her with HFA instead due to the significance of her language disorder when she was little and even now.

However, she is more functional than my classically AS son who is in fact more autistic. I definitely think they should change the whole thing to "ASD" or autism spectrum disorder. Because there is such a variance it is so hard to determine which is what. AS is not neccessarily "milder" autism as it is often considered. It depends on a case by case basis especially when you are considering HFA vs AS.

Mike has trouble conversationally as well and significant problems with language comprehension.

As for the questions
1. Play Appropriately with others - Nope and that is pretty much hallmark of all ASDs. Aspergers and autism included

2. Pretend - well very differently but yes and it is more recent. It also is not natural or cooperative like other kids. Mike gets into a character and into his head. He can pretend to be a character for ever but rarely lets anyone else in on it. If he does he coordinates everything they do. Cait took years to start pretend play and then even in 2nd grade it was all about setting up the situation but couldn't get beyond that. Even now that is mostly what it is. She pretend plays as much as her younger sister would. Her younger sister leads it. She doesn't much at all anymore. But she is getting beyond that phase. It was really short lived for her.

3. Eye contact - NOPE. If Cait is nervous or trying to concentrate on what she is saying she won't even orient her body to your direction. Mike can't maintain it at all. Tends to look all over. If they are really comfortable with the person (like me or dad) and they are in a good place and it is an easy interaction (not a conversation they have to really concentrate on) then they will. But heck, I know my eye contact isn't that awesome either in stressful situations.

4. Want to make friends - Depends. What does the friend have that they can play with, lol. Actually, this year Cait is starting to make friends over the last couple months in middle school, most of them other aspies. They have had some interest on and off over the years but it typically doesn't last. Mike has more interest than Cait. Until this year I couldn't say either had any friends. They never called any kids, none called them. Playdates, etc. Cait had one girl she considered a friend but it was my friends dd and they only got together when we moms arranged it. May not seem like a big deal at Kindie age, but at 4th and 5th grade it was a huge difference from thier peers. Cait is in 6th now in a Aspie program and that has helped because she is friends with the other aspies. And now expanding her horizons as well after some positive experiences.

Do they have friends they really play with- Not really, at 5-6 definitely not. There was one boy who's house Mike was invited a few times but as soon as he got there he went into the boys room and played with his legos the whole time and had no interest in the boy. They were interested in playdates if the other child had something they were obsessed with. For Mike it was legos and for Cait it was animals. Mike still does not really play with other kids. Cait needs alot of reminders. Cait had a friend over on Saturday and had to be reminded constantly to go play with the friend. She kept sneaking on the computer to obsess on neopets and left the friend a bunch of times. Mike does that with the video games. Sometimes he will play for a while. Particularly chase but usually not.

Facial expression and tone of voice - different. Mikes are mostly exhagerated and you can tell they are scripted or learned. Mike's voice usually will take on the tone of what ever character he is, or it is a very goofy odd robot sound if hyper, or very adult monotone if he is trying to be serious. Caits is kind of monotone. When she was younger it had this odd singsong quality to it. In fact the mom of that one friend would joke that for a week after playing with us, her daughter would sound like Cait with that sing song thing.

Renee

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Registered: 03-26-2003
Wed, 12-21-2005 - 10:00am

My DS Vaughn is 7 yrs old and in the second grade...

Does he play appropriately with others.....rarely, Vaughn "thinks" he is playing with the set of twins down the street but he is often just playing next to them (parallel play) - like riding bikes....no real interaction.

Pretend play.....yes, but only trains (his obsessive interest), he has a very large table with all the Thomas/Brio accessories and he can play for hours....started at 3 yrs and continues today. He likes to set up the tracks in different orders to simulate different environments (seaside one day, coal mines the next, maybe a western town complete with bank robbers, etc.) Pretty creative. Pretend play with others....no, he does not include anyone in on his play. He has had a couple of people over to play and he will eventually lose them in his play and not even notice they are there. Does okay if they are playing video games...they other person does not notice being ignored as easily.

Does he want friends....sure, he talks about inviting so-and-so over but he forgets that the last time so-and-so was over, he stopped playing with him after 20 minutes and wanted him to go home. Talks about going to so-and-so's birthday party but the invitation never comes.

Do they have friends that they really play with....not really....he is in the second grade and he rarely plays with anyone at school during recess....he is very bad about taking turns - he is very much, it is my way or the highway type of kid - very inflexible.

Facial expression and tone of voice....very little eye contact, wooden facial expression most of the time - monotone most of the time.

HTH,
Christie

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Registered: 03-27-2003
Wed, 12-21-2005 - 1:42pm

Thanks for all your answers!!!
My son doesn't seem as bad as all you guys said. He's never "played" with toys until about 4yo. Then he used to do obssessive play---Legos for 2 weeks(they go to the bathroom with him, table, bed, etc) 24 hours/day---Legos. Then it would stop immediately and it was the Gameboy. Continual---for 2 weeks, 24 hours/day. Then that would stop. For the past 6-9 mo---its been nothing. No play obsessions. His way of playing is running around and hitting everyone with sticks. When he plays Legos with his sisters---its parallel. He will pretend to do the Star Wars thing. But it involves lite sabers and hitting. I takes about 30 sec and he ends up getting it taken away.

He talks about friends all the time. We go to peoples houses and he "plays"--but I really don't know what he does. We had a playdate once. That lasted about 10 min. He was bored.

He doesn't have the monotone speech and his face is very charming. He has good eye contact---except when he is talking. I always thought its just the anxiety thing.

He hoards everything in sight and does weird obsessions. Lately he is obsessed with numbers, counting all the time. This week he is counting the nail holes in our kitchen counter woodwork. Soon that will be gone and he will move onto something else.

I could handle the ASD tendencies---its his bipolar that is difficult. The mood swings and raging. He is in a constant state of irritability and hyperness. Because of the bipolar--he can't be medicated with ADHD meds or anxiety meds.

I'm sure my son will have a different dx next year. It really seems that is whats going on---a new dx every year!!!

Thanks
Holly

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Registered: 02-24-2004
Wed, 12-21-2005 - 2:01pm

Holly,

My son, Nathan was dx'd HFA and he'll be 7 next month. He tends to change his obsessions as well. Right now he's into Star Wars and enjoys playing with the light sabers too. Although he didn't pretend play when he was younger though...this has been a slow process. He does play with his 9yr old brother, and does pretty well. But he doesn't have any friends and usually keeps to himself at school. He wants friends but it's difficult for him to know how to approach others. He does do alot of the parallel play still. He is quite demanding, doesn't like to lose, things have to be "his" way, etc.

At home his eye contact is pretty good, unless he gets wound up then it becomes difficult. Too much going on, too much noise, anxiety, excitment, can also diminish his eye contact. Around others though, he doesn't make alot of eye contact. He really has to know the person and feel comfortable. So, again, his eye contact is generally fine at home.

As for his expressions and tone.....Nathan can be very expressive with facial expressions and can be quite funny too. But there are times where he can be expressionless. His tone also changes, depends on the anxiety, etc.

Nathan autistic tendencies surface more when he's stressed. And then sometimes they just surface. He has always been perplexing to us and his neuropsych found him quite interesting (his words!). There are many varying levels of autism which I'm sure you have come to realize, especially from reading all of our posts! Best of luck to you!

Hope this helps some!

michelle

iVillage Member
Registered: 09-09-2005
Thu, 12-22-2005 - 1:36pm

Holly,


My ds (5) is also bipolar and the pdoc just recently agreed that he also has enough symptoms to meet an AS dx.

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