Does this sound like Aspergers? Tips on getting diagnosis?

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My son Zeke is 6 and in 1st grade. He has been diagnosed with sensory processing disorder as well as severe ADHD. But every teacher he's ever had (5 in total) has told me that Zeke shows a lot of red flags for autism, namely asperger's. Three of these teachers have extensive experience in autism spectrum disorder. Our pediatrician has voiced some concerns on this, too, recently. Up until about a year ago, my husband and I didn't think autism was fitting for his symptoms, but now...I don't know if we're just noticing more now or if we've always noticed these behaviors but they seemed more age appropriate or just park of his quirkiness...but we're finally seeing these red flags.

Things that point to Aspergers:
-Wants badly to make friends, but is way too exuberant and invades personal space, talks to loudly, says awkward things...he just overwhelms people, and they get this deer in the headlight look on their faces and try moving to another area away from him, but he's oblivious to his awkwardness and the fact that they're trying to escape, and he follows them. If there's a group of kids, he gravitates to the youngest child. He plays with my 2-year-old niece when we visit family, even though the other kids range in age from 4-8. He also gravitates to playing with girls.
- He's gotten in trouble for name calling at school (calling a boy named Billy "Billy Goat" or calling random people "Donut Boy", etc.). He doesn't understand how this could possibly hurt someone's feelings.
- Has A LOT of meltdowns. They can be sparked by not getting his way, a change in plans, things deviating from the rules/picture he has in his mind, etc. He is aggressive during these tantrums. He's aggressive a lot. When he gets upset, his instinct is to hit or kick or bite or scratch, rather than use his words.
- I don't think this could count as a restricted interest, but maybe echolalia (?), but he has been obsessed since at least August with randomly inserting the word "donut" into conversation. He says he does it to be funny, but he continues to do it even though my husband and I ignore it and he has actually gotten sent to the office over it at school. And a lot of times it seems more habitual and not him trying to be funny. This continues to baffle me.
- He makes high pitched noises sometimes, especially at school. His teacher says he does this every day at 2:30.
- He doesn't do this often, and it doesn't last long, but he'll do things like clap his hands together or clap his hands on his sides or wiggle his fingers or stomp, and he doesn't realize he's doing it. Stimming?

Things that don't point to Asperger's:
- He doesn't really seem to have any restricted interests. He loves to learn facts about wildlife and science related things, but he's not obsessed with any one thing.
- He does pretty good with eye contact. He does stare off into space, lost in his own world more than most people do, but it's not terribly frequently.
- He doesn't speak monotone. I mean, I notice monotone or odd voice inflection here and there (especially if he's sharing a fact with me), but it's not predominant. I have noticed his speaking is often very loud, and he doesn't seem to notice that it's loud. I try to get him to find his inside voice, and he can't.

Does this sound like Aspergers? We're doing a screening in April, but I'd love to know what you all think. Also, do you have any tips for me on making sure we obtain an ASD diagnosis (if that is indeed what we're dealing with)? I worry that the developmental specialist will miss it because he does so well with adults. I don't think they would really see the symptoms without observing him around his peers. I'm desperate to get this diagnosis because he is struggling a lot, and I feel ABA therapy would help tremendously. But insurance won't cover ABA without the diagnosis. TIA.

Sounds like it's worth getting an evaluation. Ideally you want someone who is certified to test him using the ADOS (autism diagnostic observation schedule). Even better would be if there is a team that includes a speech and language therapist (SLP) and an occupational therapist (OT).

My son, who has Aspergers and ADHD dx, also did not have a particular special interest, made good eye contact with familiar people, and did not speak in a monotone (but did have trouble judging the volume of his voice.)

Few children are going to fit everything on the checklist. My son does not have a monotone voice, either. It is not a necessary condition for a diagnosis, and nor is obviously noticeable issues with eye contact.

They also do not have to have one special interest. My son is pretty well-rounded interest wise for someone with an AU diagnosis, but he usually has at least one technology interest, one typographical/font interest and one kind of miscellaneous one. he also loves science and math and those have always been special interests as well.

Special interests are part of the repetitive category and stimming falls in that category. The categories are more important to the diagnosis than getting every line item, if that makes sense. They is an array of items in social/language and repetitive categories that a diagnostic team will ask about. The ADOS is the gold standard of testing, which we were lucky in that our school district used that and we did not have to have it done privately.

i think that you a have enough concerns to get an evaluation, and even if it is not autism, or you choose not to give him a label for whatever reason, he will need help socializing, based on what you have typed. My son is much as how you describe, socially, and no one really helped him in school and it was a disaster b/c he could not socialize appropriately with other children without active help. When he is around kids, I help him, and I don't give a rat's you-know-what how helicopter mom I look b/c if I do not interfere it gets bad.

Thank you, both. That was helpful.

ASDMommy, it never occurred to me that special interests would fall into the repetitive category. That makes sense, though. And, yes, feel like Zeke needs a lot of help socially at school, too. In fact, I think he needs more emotionally and behavioral help, too. The I.E.P. we have in place just doesn't seem to be enough. I'm the helicopter mom, too, when we go out - he just seems to need so much help. And I personally need to figure out how to not let people judging my child and myself not bother me. I hate that I'm so painfully shy and sensitive that I just don't even want to take him out around others because of the judgement. I mean, I do take him out of course, but it's I worry about what others are thinking every single moment.

Zette, I'll have to check and see what tools the developmental specialist we're going to uses for diagnosis. We actually did a Full Circle evaluation a couple months before Zeke turned four. There was a team of professionals like you talked about , and at the end they were adamant that he does not have an autism spectrum disorder. That has always been in the back of my mind every time I begin to wonder about all these red flags. "But that team was very clear that he DOES NOT have autism..." BUT 1) Like I said, he does so much better with adults and 2) He was young enough that something like Asperger's on the high end of the spectrum was probably not as obvious as it is now.

You might try the SocialThinking website to see if they can recommend a therapist in your area who does the Social Thinking curriculum by Michelle Garcia Winner. That therapist might be able to recommend where to go locally for a diagnosis, and that program would probably be very helpful for your son.

You might also see if you can find someone familiar with mild autism who can do an observation of your son in a social setting (recess, park, playdate, etc) and write a report that you would give to the person doing the autism evaluation.

Does he have a lot of sensory issues? That is now also included in the "repetitive" category. When your son was evaluated at age 4 they would've been using the old criteria.

Oh, those are great ideas! Thank you! I've not heard of the SocialThinking website. I will check that out. I also wondered if getting short videos of some of these things might be helpful. I just never seem to get the timing right, and I'm unorganized and not tech savvy, so I'll have to find a way of saving videos from my phone into a file of some sort. But it's an idea...if I get a patient doctor who is willing to watch these videos.

He does have sensory issues. Auditory has been one of the big ones, with him being scared of loud noises, especially smoke detectors and loud bells and such. But it's gotten better over time. Hmm...or maybe it's just not so obvious because he doesn't hold his hands over his ears and scream and cry. I do wonder if he reacts to loud noises now by getting uncontrollably hyper and making noises himself. Proprioception is a big one - he's a sensory seeker and is always running, crashing, jumping, stomping, hitting.... In his evaluation at age 3, he also showed probable difference in tactile and visual sensitivity, but he's improved in these areas. Other findings included low muscle tone and delayed fine motor performance (which has also improved). I wonder if, since there has been improvement in so many of these areas, if it would still fall under the repetitive category. ?

Here's the diagnostic criteria http://www.cdc.gov/ncbddd/autism/hcp-dsm.html

As others have said, lack of eye contact, narrow interests, and monotone voice aren't necessary for a diagnosis.

I'm curious about what ABA for a verbal 6-year-old w/o intellectual disability would entail.

Funny doesn't have to mean it has to be funny for anyone else.
It can also mean fun(ny) for himself.
Sometimes i enjoy playing thought games or other games by myself.

Thank you for the link, PlainsAspie. That puts me more at ease since he fits all of the criteria, so maybe it won't be as hard as I thought to receive the diagnosis. As far as what we'd like to see ABA therapy help him with...1)Social skills - he's been unable to make any friends because of the challenges I shared in my above post. 2) The very frequent meltdowns and aggressiveness. He does very well verbally, but when he's upset, his first instinct is to be aggressive and/or have a meltdown, rather than trying to communicate through words. 3)The adherence to routines, rituals, and rules in his head (that no one else is aware of) 4) Constant defiance and arguing with my husband and myself and his teacher....these are just a few things that stand out to me that he's struggling with significantly every day.

When you're interviewing ABA therapists, ask a lot of questions about how they address this, and make sure they treat a lot of high-functioning kids. Sometimes this is better addressed by a speech therapist who works on social communication. Also look for groups called something like "Friends Club". If you can find a therapist using the Social Thinking curriculum, definitely go there.



The focus here should be on solving the issues that are causing the meltdowns, not on getting him to use words when he's upset. Good resources for this are The Explosive Child and Lost at School by Ross W. Greene, and the videos on his website LivesInTheBalance.org



Parenting Your Asperger Child by Alan Sohn has some tips on this.



This may be a pragmatic language issue, where he's not understanding some of the more subtle points of communication, so more help from a speech therapist. Or it could be addressed with the techniques in the Ross Greene books.

The diagnosis is only a first step. Often it opens doors to an IEP and insurance coverage, but you still have to find the right therapists and approaches to help your kid.

Thank you so much, Zette! I'll go to Amazon and buy the books you recommended. I never thought about a speech therapist being able to help with social issues and defiance issues. That's interesting. So I guess ABA therapy is not always the answer then. It sounds very overwhelming - trying to find just the right help for your child's specific challenges. How do you know what all kind of help is out there, what kinds of problems each of them help with, which one is the best fit for your child? I guess there's probably not really an answer to this.

You pick what seems good that you can find where you live that's available and affordable to you.

Not everyone would probably agree but I think of ABA as more very basic skills. Speech therapy for pragmatic language deficits is good when your child has some basic skills, but it can help almost anyone with problems communicating IF the therapist has the skills and understanding needed.

I would suggest also exploring OT because you said some sensory issues and a lot of meltdowns, can help him regulate if he's having sensory issues and as important, can help you understand how to help him with sensory issues so you are a source of calm rather than frustration and that might do wonders for helping him trust you enough to be cooperative.

Waterfalls, I agree with you about O.T. being a good option. He really needs to O.T., but we live in a very small town, and the nearest O.T. is a couple hours away. I was actually shocked to find out there is someone in town who does in-home ABA therapy. We are very limited on what we have where we live. It's frustrating since we use to live in a much bigger town with everything available to us. It's enough to make me seriously think about relocating, if that was even an option.

Travel for an evaluation if you can and if he hasn't had this recently enough to help, there may be recommendations you can implement or that could be useful if the local ABA therapist is at all eclectic and open to what may work.

One aspect of speech pathology is pragmatic speech therapy; speech therapy doesn't just involve speech--it involves language as well. Pragmatic therapy addresses language USE within social situations. Certain speech pathologists are trained in this. I have a bachelor's in speech pathology.

My only suggestion is make sure you have an ABA therapist who believes in remediation, not normalization. You'll find lots of stories form autistics who were traumatized by BCBA's who believed in the latter.