What age would they diagnose AS?

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Hello, not sure if this is the right place yet. I have a 4 year old daughter who seems to fit a lot of the criteria for AS. She has social difficulties. She has poor motor skills. She's repetitive. Her preschool teachers say she will interact with the other kids, but has to be encouraged to do so. She would rather talk to the teachers or play by herself. She has no idea how to assert herself if a child is doing something she does not like, such as try to tickle her. She seems to try to make conversation, but doesn't quite know how. She always asks questions that she already knows the answer, and she repeats questions all the time. She also repeats back things we say way more than seems normal for her age. She has a great memory; she's memorized dozens of books that we have read to her, some are pretty long. Sometimes out of the blue she'll start quoting passages from a book or dvd.

Another issue is that she does have a hearing loss in one ear. A hearing aid would not help with her type of loss. I have read that kids with hearing loss, even mild ones, can look like they are on the spectrum because they miss a lot of the social cues that they would otherwise just pick up naturally. That is the main reason why I'm hesitating bringing up AS with her pediatrician. I don't want a mis-diagnosis because her social difficulties are caused by the hearing loss, not a neurological condition.

I know that they usually catch AS in elementary school, but my question is would they diagnose AS in a younger child? Would anyone care to speculate if they could separate the effects of a hearing loss and neurological differences?

Thanks for reading this.
-C

Looking back, from birth it was blindingly obvious. Why did every little thing seem like such a battle/nightmare? Why did I feel so stressed when other mothers looked so relaxed? He freaked out if I used a hairdryer or a vaccumm cleaner. Freaked out at bath-time etc etc etc..... Was it like that for you? Yes, my son repeated huge chunks of text even months after he heard it. Yes, my son enjoyed asking questions that he knew the answer to, over and over again. But there was much, much more.

We got a diagnosis at 3 years 8 months but, from the age of 3, the staff at my son's nursery school and the dentist he saw for about 2 seconds thought that he was and begged us to get a diagnosis but we were freaked and waited for it "to go away" but finally we agreed and got it diagnosed after 8 months of waiting.

If these are your daughter's only symptoms it would seem to me that she, if she does have AS, is a very mild case. Perhaps you could describe any difficulties you may have (such as; refuses to clean her teeth/brush her hair/takes 45 minutes for you to get her dressed for school/noisy or disruptive in class/has rituals etc etc etc, if any, which might she further light on the likelihood of her having AS or not. For instance, what was she like as a baby.

We really had to get a diagnosis for our son because he could not stay at nursery without an aide. He was biting, hitting, breaking stuff etc. It was all pretty dire.

So, my son is 6 next month and is at mainstream school (with a full-time aide) and it looks as though he will go on to live a full and independent life. I went to his class assembly today and he was banging a drum while everyone else sang. He was in heaven and he is clever and happy and got a certificate for being friendly yesterday. When I go into the playground, he is surrounded by about 5 kids who seem to spend the whole lunch hour chasing him and catching him, which he loves. He is adorable. Good luck on your journey, wherever it takes you, but don't worry!! !!

I have a son who diagnostically approached AS but fell short of the criteria for an AS diagnosis. He didn't show any signs of speech differences/delays until about age 4-4 1/2. He was social in that he wanted to interact with other children but favored obsessive activities. He had some motor skill issues but compensated well for them. He was very bright--excellent memory and started reading when he was 2 (Hyperlexia) Even where he landed diagnostically I was extremely glad that we pursued diagnosis when we did. It enabled us to get going with speech therapy, look towards the ASD camp for help in handling behavioral issues, understand sensory problems, etc. It also helped us to know the reasons behind some issues such as anxiety and to take them seriously when those arrived. Finally, when he started school it was far to his advantage to have staff who understood where his issues were and could help encourage and direct him. We've had a really tough year in there due to anxiety but otherwise he's done great, but I don't think he would be nearly where he is now had it not been for a joint effort between home and school.

Yes, they can diagnose a preschool child but it's a good idea to consider that first diagnosis a "working diagnosis", that is enough to get services or therapies a child may need but not necessarily the diagnosis that will stick. Live with it awhile, educate yourselves, and hang out online with parents of children with similar dx's and you'll get a feel. When I started the diagnostic process I didn't think my son had AS traits at all but after listening to other parents for a few months it became clear the doctor was right on target. Five years later I don't think most of my son's initial dx's would be accurate anymore.

I don't know a lot about the area of hearing loss so I couldn't speculate on the causes of those social issues. But I'm all from borrowing from whatever camp has the knowhow to address problems and there's a lot of good social skills training from the area of ASD's that I bet could be helpful to tap into.

These are some red flag areas in play behaviors. How does she line up with these? In younger children these can be better early indicators than the social skills observations.
2) Does/did the child
oa. Favor objects for play that aren’t typically used as toys by their peers (such as wheels, sticks, magnet letters, etc.)?
ob. Seem fascinated or obsessed by objects/topics that aren’t typical for kids of their age (such as numbers, the alphabet, words, math, geography, mechanical things such as air conditioners or vacuum cleaners, things with motors, etc)?
oc. Play “differently” with toys or household objects (such as spin them, line them up in straight lines, set them up in formations, etc.)?
od. Exhibit weak or unusual pretend play skills (such as act out memorized scenes from books/films/TV/DVD instead of creating situations and dialogue, move toy trains around but not pretend to be the engineer/go places/pick up passengers, arrange pretend people or action figures but not create imaginary situations with them or have them interact with each other, etc.)?
oe. Display behaviors and/or routines that seem unusual or quirky?

You also may want to look into sensory issues:
http://www.tsbvi.edu/Outreach/seehear/f ... ensory.htm

Thanks for the replies. They relieve me a bit, though I still have concerns.
While she does pretend play, I think she does play with her toys a little bit "differently." She likes to pretend to be a doctor and give check-ups. So far, so good. She will use her toy doctor kit, but lately she seems to prefer to take random toys from around the house, and use those instead. She just touches us (her father and me) with the toy. When we ask what that is for, she says it's to check your arm, or leg, or wherever she placed it.

She will also take these same toys and put them on the table for "decorations" then put them away over and over. She will usually say when asked that they're for someone's birthday.

As for her behavior, she's generally well behaved in school. Her teachers all say she's doing good, except for her reluctance to play with the other kids. No one is bugging me to run out and get her diagnosed with anything. She doesn't have frequent tantrums/meltdowns like I have seem described here and elsewhere. But I just feel like something's not quite right.

I don't know how much you've researched the speech/language area but the repetive speech and quoting back passages from books and DVD's is called echolalia. It's very common in ASD's and not so common of a speech difference outside of ASD.

Is she putting those objects on the table in lines or patterns or insist on having them in the same place each time?

You'll want to observe pretend play carefully. A lot of times what parents realize in hindsight is that what looked like very creative imaginary play was actually mimicing something the child has seen somewhere. I even have a friend with a degree in Early Childhood who was fooled.

I've seen a lot of parents and kids through assessments and honestly if the parent ha suspicions, most of the time there is something going on. If this were my kiddo, I'd see my pediatrician and ask for a multidisciplinary evaluation. This would be an outpatient eval at a facility such as a Children's hospital or university hospital and would include a developmental pediatrician (or pediatric neuropsychologist), OT and speech/language. The thing with assessment/diagnosis/labels is that you don't have to agree nor do you have pass the info along to schools, doctors, etc. unless you agree.

http://www.patientcenters.com/autism/ne ... _diag.html

It doesn't seem to matter to her if they are lined up, or if they're in the same place. If I tell her she needs to stop (because we need to do something else), she may protest mildly, but nothing out of control. We see her pediatrician tomorrow for her 4 year check-up. I guess I will see what she has to say.

My autistic son never lined things up but played with toys or things like that. He became obsessed with birthdays after somebody had a birthday. For quite a while he was turning out the lights and singing. He's still very interested in birthdays (after Alice in Wonderland, it's been unbirthdays) and cakes.

If you're not concerned enough to request the whole nine yards in terms of evaluation (and pediatricians usually need urging, as they rarely will recognize AS early) consider at least requesting a referral for private OT and speech evaluations. Those are two areas where it's far better to get early help while the child is young and the neural pathways are still developing like wildfire.

we were told that kids with aspergers couldn't possibly have an imagination, and that because our daughter pretended that different items were animate~she didn't fit the dx

Well, you were right, her ped didn't seem too concerned. She, of course, was acting quite social and cooperative with her, demonstrated hopping on one foot and volunteered she could also do a somersault. She just learned how to do that and is quite proud of herself. I briefly brought up pretend issues, but again she didn't seem too concerned about it, especially since I can redirect her attention without a major meltdown. I said "maybe she has an easy-going type of Asperger's." She replied there's no such thing.

As for speech and OT/PT, she actually received services thru early intervention. But when she turned 3, although they of course said we could continue with the school district, neither the SLP or the PT were sure she would even qualify. We were happy with her speech for the most part, and we were not really sure that the PT was doing her much good. She seems to eventually learn the motor skills, just at a slower pace than normal.

A year later, of course we could have her evaluated again, but since we are most likely moving to another school district in the spring, I'm thinking we get her evaluated then. In the meantime, work like crazy role-playing, modelling appropriate conversation, more playdates, etc.

I've always "pretended." I still do, acting out scenes from my favorite movies/TV shows (this is actually some form of echolalia because I mimic the actors' facial expressions and inflection/intonation of how the lines were spoken) and making up scenarios between the cartoon characters I created. It's just another way that I talk to myself. I talk to myself all the time. I played with Barbies as a kid, but it wasn't "normal" play, just another way for me to do the scenes that I did when I didn't have a doll with me. Plus, the storylines were "mature" and I never actually played with the dolls after I dressed them. I'd line them up on the stairs and talk as one of them, switching characters, but I'd talk while the dolls weren't in my hand. I also had lots of other toys that were used for imaginative play, but I'd line them up, too, or put them in some sort of order (like how I used to separate play food into the different food groups, rather than pretending to eat it). However, Aspies can have an imagination. I have a huge imagination. We just use it in different ways, is all.
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confused- It is quite possible to see it in a preschool age child. I'm 19, so Asperger's wasn't known about when I was a child (it wasn't even put into the DSM-IV until I was 7), and thus, I wasn't diagnosed until this year, but it was extremely obvious. I know that, had I been a toddler nowadays, a diagnosis would've been inevitable. I displayed all of the symptoms, from hyperlexia to obsessive fixations to poor motor skills.
-OddDuckNash99-

I think we only need to look around us to see that a lot of Aspies have wonderful imaginations. My son fell inbetween AS and NT as a child and he was highly creative, although often bringing in short bits of phrases he'd picked up into his play.

Your pediatrician's reaction is no surprise--the average age of an ASD diagnosis in the US is around age 6, partly due to a lot of pediatricians blowing off parent's concerns. I'm not saying your daughter does or doesn't have AS, but since you're looking for info this article describes that half the time pediatricians fail to recognize it.
http://www.aan.com/professionals/practi ... 0autism%22

If you have insurance it might be good to consider having a private speech and OT evaluation done. Usually they are FAR more thorough than the screeening done by the school districts.

i absolutely agree 100% that aspies have an imagination~the idiot dr does not agree.....

My daughter certainly has imagination - however she does not seem to be able to assume another persona entirely. Example, she is "Cowgirl Lucy", or "Chef Lucy", or "Lucy The Ghost". Apparently this is quite typical among the type of imaginary play that AS children have I've read.

AS is a relatively newly recognized problem that used to be almost always misdiagnosed as ADHD. I have it. My son has PDD-NOS. Unfortunately, high functioning kids often don't get diagnosed until almost the teen years, when it is glaringly obvious that they are different and cant' socialize normally. ASers WANT to sociailize--they just have no idea how to do it and, as an adult Aspie, I can guarantee it doesn't get better if you don't get the right help for the child. ASers DON'T have speech delays. I spoke at ten months, and sounded very grown up and used big words. As for an imagination, Aspies often have huge imaginations; they are just different than what NT's do. I love to write. It's an obsession of mine. I'm an e-pubbed author twice and going to try for NY. There are so many fallacies about AS that I highly recommend calling your nearest autism society and seeing the professional that they trust. So many don't know a thing about ASD. For my son, I had to almost beg for the diagnosis I knew he had. He was 11 before he got it, and it's so obvious with him. He even had a speech delay. There are also people who are so close to being on the Spectrum, yet not diagnosed--but they may as well have the diagnosis--they have the same problems. You want to err on the side of caution, imo. I know a PDD-NOS kid who had a hearing loss. The hearing loss was not a part of the PDD-NOS, but he has them at the same time. Most kids with hearing losses can still socialize normally and appropriately. They can read faces and see social cues. ASD kids can't. Hearing aids can bring hearing almost to normal.

my son was 6 years old 2 months shy of his 7 th brithday and i can looking back
i can see aspies signs all the way back to his birth,
but i didnot know what was going on till i was talking to a friend and she has a daughter with aspie to and it was on the nose .
so yes i understand to