Hello:
I'm very familiar with mild autism. The clinical term for this
condition is Asperger's, aka AS, aka "high-functioning" autism.
I read a lot about neurobiology because I have Attention Deficit
Hyperactivity Disorder and, ADD, like most neurobiological quirks,
contains strains of other disorders; or can manifest in symptoms of
several different disorders. For instance, many ADDers have traits of
Obsessive/Compulsive Disorder (OCD); Social Anxiety Disorder or
general anxiety; Oppositional Disorder; tactile defensiveness
(profound reactions to fabric; this is often symptomatic of autism or
Tourette's, too), and dysgraphia (difficulty wielding a pen or
pencil).
So, I know a little about various disorders, and I know you can have a
hodge-podge stew of strains of several disorders mixed together on top
of one core disorder, and so on, and so on.
Not only can *I* not make a diagnosis (I am NOT a trained scientist),
it is actually downright challenging -- and in some cases, outright
impossible -- for doctors and behavioral scientists to pinpoint the
precise neurobiological root causes of any set of symptoms.
The first thing you should do is start searching for an excellent
child psychiatrist in your area who is well-trained in neurobiology or
biopsychology (different terms, same thing). Most younger
psychiatrists have had far more training in behavioral science/biology
than have their older peers. It is essential that you have a therapist
who excels in biology! Look for someone who specializes in treating
Asperger's, ADD, OCD, and Social Anxiety and general anxiety
disorders, and Oppositional Defiant Disorder, etc. Your daughter has a
neurobiological disorder and she needs to be treated from that
standpoint.
Please understand: none of these disorders are anyone's fault! You and
your spouse didn't do anything to make her this way; this is the
result of DNA and brain wiring and nothing else. What's more, IQ (and
your daughter's is clearly quite high) is utterly irrelevant to many
neurobiological disorders: they occur along the entire IQ spectrum.
The great thing about these neurological problems is, once they're
understood and the "patient" begins to take control of the disorder,
they also begin to maximize the creative gifts these brain wiring
"quirks" bring. Quirky thinking is what gives us inventions and art.
Whatever your daughter has, it brings with it pluses, as well as
minuses.
ASPERGER'S
Let's look at the standard symptoms of Asperger's, aka, "AS, "mild
autism," and "high-functioning autism":
Btw, the first thing I always tell parents is, behavioral scientists
always refer to Bill Gates as the poster child for Asperger's -- and
he turned out okay.
From O.A.S.I.S. (Online Asperger's Syndrome Information & Support):
http://www.udel.edu/bkirby/asperger/aswhatisit.html
See several abstracts:
"What Is Asperger Syndrome?" by Barbara L. Kirby
"Persons with AS show marked deficiencies in social skills, have
difficulties with transitions or changes and prefer sameness. They
often have obsessive routines and may be preoccupied with a particular
subject of interest. They have a great deal of difficulty reading
nonverbal cues (body language) and very often the individual with AS
has difficulty determining proper body space. Often overly sensitive
to sounds, tastes, smells, and sights, the person with AS may prefer
soft clothing, certain foods, and be bothered by sounds or lights no
one else seems to hear or see. It's important to remember that the
person with AS perceives the world very differently."
Below that, see:
"Diagnostic Criteria For Asperger's Disorder:
A. Qualitative impairment in social interaction, as manifested by at
least two of the following:
marked impairments in the use of multiple nonverbal behaviors such as
eye-to-eye gaze, facial expression, body postures, and gestures to
regulate social interaction
failure to develop peer relationships appropriate to developmental level
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)
lack of social or emotional reciprocity
B. Restricted repetitive and stereotyped patterns of behavior,
interests, and 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 either in intensity or focus
apparently inflexible adherence to specific, nonfunctional routines or rituals
stereotyped and repetitive motor mannerisms (e.g., hand or finger
flapping or twisting, or complex whole-body movements) persistent
preoccupation with parts of objects . . . ."
Then scroll down to the abstract "A More Down-to-Earth Description,"
by Lois Freisleben-Cook.
Here's my own rules for recognizing someone with mild autism:
1): Monotone or slow, arch, precise speaking style. (Not applicable to
*everyone*; some are mumblers.)
2): Do they laugh or smile ONLY when it dawns on them that everyone
else in the room is laughing?
People on the autism spectrum can't recognize or interpret facial
expressions or tone of voice. Not only do they fail to recognize
humor, they also fail to recognize when someone is angry or frustrated
with them. (Those of us with ADD also are often oblivious to such
social cues, as our attention spans fluctuate wildly from boredom to
obsession.)
3): Completely Literal. I've quoted this saying many times: If you
tell an autistic, "You really get my goat," he will go and get you a
goat.
4): Ritualistic: there is a protocol for everything and deviations
from those patterns are unacceptable to an autistic. Autistics develop
rituals and protocols and then hold onto them like life-preservers --
because that's what they are. But you also see that trait in people
with OCD.
5): At least one total obsession. It may be computers, it may be model
trains, it may be something more intellectual. (I know one person with
Asperger's who reads theology books by the barrel -- he doesn't read
any other genre of books -- and he has done this since childhood.
People with ADD also have a profound obsessive streak, but ADDers
switch obsessions quite frequently, whereas people with AS maintain
the same obsession for eons; even throughout their entire lifetimes.)
The fact that she's prone to glomming onto one person may be
suggestive of mild autism. Not surprisingly, even those with very mild
autism struggle socially and are more comfortable one-on-one or in a
very small group. But I don't think this is, in and of itself, enough
for a psychiatrist to say yes, she has Asperger's. (This also sounds a
little like non-hyperactive ADD.) She could well have a disorder other
than Asperger's that results in some struggles in socializing.
The fact that you've noted her great sense of humor and her chattiness
-- these are traits that are NOT at all associated with Asperger's.
They are, however, traits associated with Attention Deficit
Hyperactivity Disorder, and with Fragile X, a genetic cause of
neurological disorders, including autism.
*****
FRAGILE X SYNDROME:
http://www.fragilex.org/html/behavior.htm
"Children with fragile X syndrome often have many positive behavioral
characteristics. They are described as sweet and loving, with a
strong desire for social interactions. Children with fragile X often
have good senses of humor and enjoy jokes and humorous situations."
Note, too, how the symptoms of Fragile X are similar to ADD.
However, Fragile X manifests with physical symptoms too:
http://www.fragilex.org/html/facial.htm
Checking the photos and descriptions of Fragile X facial features may
enable you to rule this out right now, or consider having to rule it
in.
If you want to read more, see this interview with Elizabeth
Berry-Kravis, M.D., Ph.D., at Ivanhoe's Medical Breakthroughs:
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=8276
*****
OCD:
Things like her obsessions with the seams on socks; the ritualistic
aspects of her problems, are suggestive of autism, yes, but also of
OCD.
At the "Anxiety Community":
http://anxietyhelp.org/information/ocd_def.html
See the symptoms of OCD as defined by the DSM (Diagnostic and
Statistical Manual of Mental Disorders), which is published by the
American Psychiatric Association.
Read about OCD in more depth, here at the Healthy Place:
http://www.healthyplace.com/Communities/Anxiety/children_ocd.asp
"Obsessive-Compulsive Disorder in Children and Adolescents," by Carol
E. Watkins, M.D., published January 2001.
ADD:
Go to C.H.A.D.D (Children and Adults with Attention
Deficit/Hyperactivity Disorder):
http://www.chadd.org/
See the DSM's symptoms of ADD:
http://www.help4adhd.org/en/treatment/dsm
Also read the article "ADD and Hypersensitivity: Is There A
Connection? A Follow Up Report," by Mary Jane Johnson
"Sensory Integration Newsletter states, 'Adults with tactile
defensiveness commonly report strong clothing preferences and
avoidances, and aversions to clothes with tags, jewelry....may also
feel uncomfortable with wool or synthetic materials against the
skin....and may be bothered by these aversions to an extreme
degree....
'Along those same lines K. wrote in that, 'I have to keep my shoes
tied tight on my feet... If they are not tight I get frustrated... I
find that I constantly re-tie my shoes as tight as possible, during
the day.' And D. relates, 'I agree completely about the elastic... I
also do not like sleeves, high collars, knee socks that fall down,
tags on the inside of shirts, anything touching my skin that isn't
soft or cottony, slacks too tight in the crotch... I hate panty
hose... I don't wear my coat in the car, I have a nice thin vest with
lots of pockets that I wear while shopping. . . .' "
I've noticed that many articles on ADD focus too much on ADDers'
problems with focus. ADD spans a myriad of quirks, often including
hypersensitivity to temperature, textures, and sounds. Also, re: your
daughter: ADDers can be quick to form a sort of hero worship and
attach themselves to someone to the point of dependency, aggravating
the object of their worship. (That isn't a constant symptom, but it is
a tendency.) ADDers also tend to laugh easily, especially at
ourselves. (We ADDers screw up a lot; we either lose our tempers in
frustration or laugh.) You said your daughter has a great imagination
-- that is associated more with ADD than with autism; however it's
worth noting that both ADD and autism are associated with invention.
(People with ADD tend to be creative and imaginative in artsy ways,
whereas people with mild autism tend to lean toward science &
technology -- but I am generalizing there.)
*****
Dyssemia:
Essentially difficulty reading social cues, but this has become a
Mulligan's Stew label applied to kids who clearly have a
neurobiological or learning disorder, but just what the cause is isn't
clear. "Dyssemia" is sometimes the diagnosis for kids who seem to have
a little ADD, a dash of autism or Asperger's, and anxiety, and/or
verbal and/or social disorders all rolled into one.
Dyssemics struggle to verbalize their feelings, but can be quite
verbal about pursuits that interest them. I've met diagnosed dyssemic
children who can sit there and tell you in detail about the 500
careers they're considering.
The problem with dyssemics is they that can't quite "read" what is
being said back to them; they don't "get" the nuances of words. That's
the similarity to Asperger's and autism: the failure to read social
cues: the person you're talking to is tired of this subject (or game),
and wants to move on to something else. (I've noted a great book for
you on this disorder at the end of my answer.)
As for some of the other symptoms:
Disruptiveness:
This is a hallmark of ADD and Oppositional Defiant Disorder. Read
about the latter disorder in this article from the American Academy of
Child & Adolescent Psychiatry:
http://www.aacap.org/publications/factsfam/72.htm
It's important to realize that most disruptive kids hate that about
themselves. They hate themselves for not being able to bring
themselves under control, and for having problems that disrupt a
household. Being disruptive, and the resulting self-loathing, are
reasons in and of themselves to seek professional help immediately.
The one thing in my answer I can guarantee you is, this disruptiveness
is only going to be worse. Once your daughter begins therapy, her
psychiatrist will likely want your entire family to attend some
sessions so that you, as a family, can learn how to minimize this.
Dysgraphia:
See the National Health Institute's page on Dysgraphia:
http://www.ninds.nih.gov/health_and_medical/disorders/dysgraphia.htm
I have dysgraphia and, to this day, my penmanship remains downright
childlike. Wielding a pen is, for me, tortuous. Yet, I'm a
professional journalist. (The notes I take while on the job are
indecipherable to everyone but me. But as long as I can read them, no
problem!)
Your daughter was born into a keyboard-oriented world; don't worry
about her penmanship. You may find that, as she gets older, that she
may struggle with the keyboard, too. (That sometimes happens.) In that
case, you and her psychiatrist might want to shift her over to
voice-activated software. IMO, dysgraphia is a battle not worth
fighting.
Fabric:
I have "tactile defensiveness" which is an echo of Tourette's. (I
don't have Tourette's; I have ADD, but again, echoes of various
disorders show up in other disorders -- think of wires being crossed.)
As a child, I became violent whenever my mother attempted to dress me
in wool or tweed. (I'm from New England, which remains a
wool-and-tweed-centric culture.) To this day, the feel of certain
fabrics is as upsetting to me as is the sound of a screeching
chalkboard. I can't wear turtlenecks or a cowl neck because I feel
like I'm being choked to death even if the shirt is actually loose.
See the "Kids Can Learn" page on "tactile defensiveness":
http://www.kidscanlearn.net/tactile.htm
I'm recommending this site because it promotes a therapy called
"Neurodevelopment! Neurodevelopment is a process of stimulating the
central nervous system to eliminate the dysorganization [sic]
normalizing sensory input."
I have no idea if this treatment works, but I wanted you to know about
it. Frankly, I would spend the money on a psychiatrist and let him or
her map out treatment for tactile defensiveness. But I can tell you
from personal experience: it's likely this particular battle can never
be completely won.
I say let her dress for comfort and, as long as she doesn't go out the
door looking like Christina or Brittany, just live with it. When you
get upset, remind yourself that Diane Keaton won an Oscar for dressing
funny.
I have a friend whose son (who has been diagnosed with nearly every
neurobiological disorder and learning disability on earth) insisted on
wearing outfits he deemed "comfortable," that the rest of the world
deemed "bizarre." (Actually, he wore ridiculously long, over-sized
pants, which, I understand, are now quite popular. It turns out he
wasn't weird, just a few years ahead of the fashion curve.)
Anyway, his unusual attire resulted in him getting bullied. The
school's principal advised my friend to make her son dress "more like
the other kids, so that he fits in, and then they won't bully him." My
friend's kid refused on grounds of not giving in to bullies. He cared
more about being comfortable than being cool. (Stubborn, yes, but also
suggestive of good, strong character.)
Today, that kid is a happy young adult, who's now on his way to
becoming a professional lighting and sound technician.
Forget the funny outfits and horrible penmanship. Here's why you need
to take action: if unchecked, your daughter's case of what appears to
be OCD (the sheets must be flat, the quilt tucked in just right) could
take over her life even more. In the worst case scenario, she could
end up -- and this is the kind of thing that happens in worst case OCD
scenarios -- unable to leave the house because of fear of germs, or
because she has to touch every doorknob in the house before leaving
and if she thinks she missed one, she has to start over again, and on
and on.
If she has mild autism, her stunted social skills could not only hurt
her socially but professionally, unless she ends up in a profession
where she doesn't have much interaction with people. But do you want
her to have to avoid social situations?
If she has ADD or anxiety disorders, she may never get her life
on-track or, it may take her years to get caught up to her peers in
terms of career and social skills and achievements, despite the fact
that she is very bright.
At this point, you can see that you need to bring a psychiatrist into
this picture; I really, really believe you need expert help here. All
I can do is point you toward the likeliest root causes of your
daughter's behavior. You need a professional to get her on-track.
Whatever she has, a psychiatrist can treat her very successfully with
medications and behavioral and/or cognitive therapy. Call your school
and ask to speak to the guidance counselors for recommendations about
local psychiatrists. Also call your local hospital's referral line, if
they have one. If you know of kids in your neighborhood who've been
successfully treated for things like ADD or OCD, don't hesitate to
call their parents and ask who treated them.
Networking with other parents will be a great help, especially if it
leads you to a good local support group.
I do think your daughter clearly has some problems that are based in
brain wiring problems. (And btw, no one has a perfectly wired brain.
If we did we'd be boring and un-creative.) But mostly, I think your
daughter is a very intelligent, very creative, and a highly
individualistic little girl whose brain quirks will enable her to
become a creative, intellectually curious adult. I wouldn't be a bit
surprised if she wound up in the arts or the sciences.
Here are some helpful books. Amazon.com's "Search Inside The Book"
feature will enable you to scan them to see which ones seem most
appropriate:
"Helping The Child Who Doesn't Fit In," by Dr. Stephen Nowicki and
Marshall Duke. (Peachtree Publishers; June 1992.)
http://www.amazon.com/exec/obidos/tg/detail/-/1561450251/qid=1086722575/sr=1-1/ref=sr_1_1/002-8037898-8645653?v=glance&s=books
Nowicki is universally recognized as the leading expert on dyssemia (I
believe he coined the term), and his book introduced the term and the
disorder to the world.
"Asperger's Syndrome: A Guide for Parents and Professionals," by
Attwood and Wing. (Publisher: Jessica Kingsley, January 1998):
http://www.amazon.com/exec/obidos/tg/detail/-/1853025771/qid=1086724204/sr=1-2/ref=sr_1_2/002-8037898-8645653?v=glance&s=books
"The OASIS Guide to Asperger Syndrome: Advice, Support, Insight, and
Inspiration," by Bashe and Kirby. (Crown; 1st edition; November,
2001):
http://www.amazon.com/exec/obidos/tg/detail/-/0609608118/qid=1086724204/sr=1-1/ref=sr_1_1/002-8037898-8645653?v=glance&s=books
"The Boy Who Couldn't Stop Washing," the all-time classic on OCD,
written by psychiatrist Judith L. Rapoport. (New American Library;
Reissue edition, July 1997):
http://www.amazon.com/exec/obidos/tg/detail/-/0451172027/qid=1086723707/sr=1-1/ref=sr_1_1/002-8037898-8645653?v=glance&s=books
"What to Do When Your Child Has Obsessive-Compulsive Disorder:
Strategies and Solutions,"
by Aureen Pinto Wagner, Ph.D. (Lighthouse Press; (September 2002):
http://www.amazon.com/exec/obidos/tg/detail/-/0967734711/ref=pd_sim_books_3/002-8037898-8645653?v=glance&s=books
"Driven To Distraction," written by *the* gurus of ADD: Drs. Edward M.
Hallowell and John J Ratey. (Touchstone Books; Reprint edition; March
2, 1995.)
http://www.amazon.com/exec/obidos/tg/detail/-/0684801280/qid=1086724024/sr=1-1/ref=sr_1_1/002-8037898-8645653?v=glance&s=books
This is the absolute bible for those of us with ADD. It delves into
the various kinds of ADD, including non-hyperactive, and it's also a
good primer on other disorders and how disorders can overlap.
The article "Socially Awkward Children: Neurocognitive
Contributions," written by Herbert Schreier, M.D., published in the
Psychiatric Times, Sept. 2001:
http://www.psychiatrictimes.com/srchild.html
The article "Help Your Child Make Friends: Experts agree that social
skills are just as important to your child?s future as the three R?s.
But where do you start? ," by Gabrielle Bauer, Reader's Digest Canada,
(publication date: unknown):
http://www.readersdigest.ca/mag/2002/10/friends_kids.html
Search Strings:
diagnostic OCD children
diagnostic Asperger's children
fragile x autism
diagnostic ADD children
ADD AND "tactile defensiveness"
diagnostic dyssemia children
children dyssemia
I hope my research is of help to you. If you have any questions or
require a clarification, please post a "Request For Clarification,"
PRIOR to rating my answer.
Best Regards,
nancylynn-ga
Google Answers Researcher |
