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So--can SPD explain all this? I really thought she had SPD when she was a toddler. She chewed on stuff, bumped into things, craved stimulation, etc. Then a lot of the obvious symptoms went away when she hit around K age, though I still see some. Can SPD extend this far into other behavior?


At times I really think she is closer to ADHD than anything else, but she lacks the core aspects of either distractability or hyperactivity. She really has no issues at all with either. I mean, perhaps mildly distractible, but it seems well within the range of normal to me. Yet everything else sounds like her! Frustrating.


I do know this. But the part that doesn't seem ASD to me (and I agree, there are flags) are that she actually does quite well socially (though sometimes I feel surprised by this given her tendency to be somewhat inappropriate in many ways) and that she has never had obsessions. She also shows good theory of mind in terms of understanding characters' motivations, etc. last night we had a whole long conversation about how she was worried about what her one friend feels because she knows that friend feels hurt that she still wants to be friend with the other friend who she thinks doesn't like her and...it was pretty sophisticated. Yet look at that other stuff--the rigidity and literalism in particular look awfully ASD to me.

You see why I think she is a confusing kid! Fortunately, I do live in a university town with many specialists. But.

Ultra, I'm sure the standardized tests by specialists will help you sort it out. See if you can make sure they do the ADOS-- it's relatively systematic and provides a way to measure "spectrumish" behavior. It's not perfect, but it's much more useful than lists of symptoms for ruling ASDs in or out, because it seems to look at the overall aggregate of symptoms.

Sympathizing with you on the confused part... for sure...
DeeDee

Honestly, using high verbal reasoning skills to dissect a social situation, analyze it, and decide what the appropriate social behavior should be because you aren't sure what you are expected to do and how it will turn out is a strategy we see used around my house pretty often, frequently to good effect. It is one of the ways that bright, verbal people with AS compensate for their deficits.

I may not have explained it well. She perceived that one friend's feelings were likely to be hurt and wasn't sure how to not hurt her while also staying friends with the other girl, who wants her attention as well. I think my reaction as a child would have been "Um...these two friends both want to be friends with me and they don't like each other. Oh well." I really had no idea how to advise her!

You may sense some resistance to ASD as a diagnosis for her. That's because I have some. I see some traits, but it's shadowy and gray. How can a child with no social difficulties with peers be ASD? Isn't social impairment almost the primary symptom? At times I suspect the issue may be more our parenting or something, since most of the problems are seen at home only. It may be that we need better training as parents more than anything. Yet I feel we deal with DS, who is more typical, just fine.

The other issue I always have with high-functioning ASD discussions is that the conversation, especially in GT kids, always seem to end up being along the lines of "Well, that doesn't rule it out...that doesn't rule it out, either..." I then think--is there anything that DOES rule it out, or in? What is this diagnosis really about anyway? It seems highly fuzzy. I know the DSM stuff has been changed lately...

Ultra, you referred earlier in the thread to her tendency to do socially inappropriate things, the tendency to misunderstand social cues, to become enraged where others would not-- these are social issues. Does her dislike of teasing and tendency to misconstrue affect her relations with peers?

Often a child with ASD is sheltered in the early grades by some "mothering" peers who steer the child about what to do-- and then in 4th grade, when things become infinitely more complicated socially, the mothering stops and you see that the child doesn't have the social radar to keep up in that environment.

I frankly find it unlikely that you are an inattentive or otherwise inadequate parent. More likely that something is going on that makes her more difficult to parent.

Here are the DSM criteria for Asperger's (copied from a site not the DSM's because I'm short of time, but I think they're correct)--with my notes--

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction [NB includes things like not picking up on others' nonverbal cues or looking in the right place to gauge facial expression]

(2) failure to develop peer relationships appropriate to developmental level [may include getting by through very conscious compensation-- doing with great effort what other children do naturally]

(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

(4) lack of social or emotional reciprocity [my DS desperately wants good relationships; but he tends to make mistakes that annoy others]

B. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus [in my DS these are academic interests, and change frequently-- chemistry, astronomy, math-- this seems typical for gifted/AS]

(2) apparently inflexible adherence to specific, nonfunctional routines or rituals [can be repetitive writing, desire to pursue academic interest in a repetitive way, a love of categorizing information exhaustively]

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.


So yes, these are judgment calls-- the presence or absence of any one observed trait doesn't rule ASD in or out. But if enough of these features pile up (not necessary to have all, but some) a diagnosis is considered appropriate.

There's also PDD-NOS, which means a person has some but not all of the features for AS or autism, but that those features are enough to affect that person's functioning.

The ADOS is the best test I know of to systematize these judgment calls.

HTH,
DeeDee

I do think she is socially inappropriate at times, especially compared to girls her age, but for whatever reason she still seems to do fine socially. She makes friends easily in a variety of settings--she is very outgoing, which may help. I would say that she is immature for age; to me she seems more similar to a first-grade boy than second-grade girl (in fact, one of her best friends is a first-grade boy). But it's not that she is STRANGE, exactly. She just acts young and sort of goofy. I used to think this was because it was the only way she had found to engage with kids her age, but now I'm not sure about that.

She did have some friend drama this summer at camp, and it was hard for her. However, it seemed to be queen-bee girl stuff ("You're my best friend/now you're not my friend"), not actual ostracism.

Also, the rage is never at peers. It is exclusively at us or her brother--in other words, it does not manifest outside the home.



A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction--Maybe. POssibly. Yet I would expect to see more issues elsewhere if this were really bad.

(2) failure to develop peer relationships appropriate to developmental level--I don't think so, but possibly this is slightly impaired.


(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)--no, never

(4) lack of social or emotional reciprocity --I am not exactly sure what this means...

B. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus--I don't think so. She has intense interests, but never monologues about them, and they seem normal to me for a GT kid.

(2) apparently inflexible adherence to specific, nonfunctional routines or rituals--No

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)--No

(4) persistent preoccupation with parts of objects--No

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.

I was interested in your comment about these girls doing fine till 4th grade. Honestly, I have sort of been waiting for her to develop social problems but it never seems to happen. It would appear that she is an appealing friend to many in spite of her quirks.

BTW, another thing that felt ASD-ish to me was that her sense of humor seemed sort of...behind, for years. Then she spent a bunch of time reading comics like the Far Side and Peanuts and it was like she "got it" overnight. She now writes and illustrates her own comics, and they're quite funny. She is much funnier in conversation, too. I suppose this could be taken as more evidence that she is compensating by being a very quick study?

She is also a good actress--theater is a strong interest. I would think that this would be hard for someone with ASD.

ETA: I should look into PDD-NOS more. I thought that maybe that had been eliminated with the new DSM, though? Isn't Asperger's now eliminated or something too?

ETA: We have both ADHD and (undiagnosed, but strongly suspected) Asperger's in the family. I have mild prosopagnosia (face blindness) AND topographic agnosia (severe problems with direction-finding), which seem to be sort of related to ASD. I don't think anyone who knows me would say I am AS, though. There is some kind of brain misfiring in that area, for sure.

The home/school thing: a close relative of mine, girl with AS, is much too scared to break a rule by having a tantrum at school-- rule-breaking terrifies her. She feels safer at home, so she lets loose there. In public she presents as kind of dreamy, and hides the fact that she isn't always picking up on the social fine points by going along with other kids.

The proposed revision to DSM puts all autism spectrum disorders into one category. It's controversial. (I suspect people will still continue to informally use the label "Asperger's" to identify kids who have no cognitive deficits.)

The latest revision I know about is here-- still "proposed," not adopted AFAIK.

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94#

DeeDee

That's my dd11. She has both an ADD dx and an anxiety disorder dx. When she was IQ tested at 7, the tester wrote that she seemed upset by failure but didn't react much at all to success. She is defensive: if we try to show her how to do something, she cuts us off (even if she has asked for us to help), refuses to listen, and gets angry. She alternately claims to know how to do everything and is highly offended with any instruction and is paralyzed by fear that she is doing it wrong or poorly. She erases things over and over and wants other people to do everything for her.

FWIW my DS (w/AS) loved acting camp. He's very outgoing and likes being the center of attention. And being on stage is a highly regulated situation, same every time you rehearse, where a strong memory and sense of pattern really help. He also sings and plays an instrument: performing is an unexpected strength.

Yes, this stuff runs in families, and people who have ASD tendencies also often have something else in the mix (ADD, face-blindness, other quirks).

I'd put the family history in with your pile of other evidence and hand it to the best specialist you can find-- preferably one who's seen lots of girls with ASDs and some gifted/ASD combos. Keep a written record of "odd moments," things that go poorly, things that go well. Give your expert the raw data, tell them your concerns, and let them help you sift. This stuff is hard even for the pros. An amateur (even a devoted one such as myself) cannot diagnose. Especially over the net.

With good wishes,
DeeDee

This sounds like DD. This is an ADHD thing? Where does it "come from," so to speak (like, what is the deficit causing this)? I wondered if this sort of thing was anxiety.

I know no one can diagnose over the Internet, but sometimes comparing cases does help. I see two possibilities that bother me--1) DD gets a diagnosis that isn't really right and it colors our perceptions and others' in ways that affect her negatively; 2) DD does NOT get a diagnosis and therefore is unable to take advantage of accommodations that could help her.

I have thought about looking for a social skills group for her, but am not sure that's really what's needed. It's like she needs...coping class, more than anything. More skills to manage her emotions.