Psychiatrist Findings

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Hi Just exploring again, I received my son's report from the local services, He has received a dx for Aspergers privately.

I am just going to write a little of what his findings are and maybe your insight might be able to allow me to understand what it means.

I also found that the client presented with quite significant Aspergers syndrome like traits. During a separate assessment by speech and language a communicative impairment was found that, she felt, was indicative of a possible underlying diagnosis of ASD. When I reviewed the client Aspergers symptoms systematically, however I could, in particular, not find any evidence to suggest he has any specific, all else excluding, repetitive interests. Whilst he scored high on most other Aspergers trait, I feel that this particular symptom is so specific to people with ASD that I could not give him a diagnosis of Aspergers Syndrome as one, on the other hand, cannot disregard all the other symptoms that are specific to this diagnostic category, I felt a diagnosis of PDD NOS is more appropriate.

In line with the clearly Asperger like traits that he present with, he also suffers with the atypical OCD like symptoms that so many clients with ASD presents with.

My son repeats phrases over and over repetitively, he constantly twisting his hand, and does complex whole-body movements not as often as the hand twisting. He did have an interest in dinosaurs knew all there names but will only show interest now if he see them. He gets obsessed with new things he engages in and needs to do them constantly but they are short lived he gets bored and moves on to the next thing. He needs to sit on the same chair gets very distressed about this, and has to have his food separated doesn't like one food touching the other. Doesn't like to share his possession no one can touch them or move anything in his room, but doesn't understand why he is not allow to use others possessions. At the moment he has a great interest in the world war 2 and talks about it a lot.

Would these be seen as repetitive interests. I am interested in your opinion, I get confused with the findings maybe I am not understanding the criteria. Explanations as simple as you can. Thank you

It reads like the Doctor who evaluated your son was saying he did not completely fit the Asperger profile, so she went for the more general approach of calling it PDD-NOS.

wiki on PDD NOS

Is there a reason you want your son diagnosed specifically with Aspergers? To the best of my understanding, PDD-NOS is part of the autism spectrum.

Perhaps you should go back to the clinic to get more information, such as what do I do now this diagnosis, what is the next step?

Its not about the dx per se but my son already has been dx privately with Aspergers. I just get confused when I give the same information and get different results. I thought that you did not need to have a specific interest to get a dx of AS. Not sure if I am correct, also my son has a lot of repetitive interest but not a specific.

I am just one of those people that hate this type of dilemma I know things can't be a 100% but this just annoys me.

Also he had to have this assessment to get resources in school and local support that is why the second opinion. Also he saw a private S&L and her findings were Aspergers.

I am just interested to know if you have to have a specific, all else excluding repetitive interest to get an AS dx.

The characteristics of Asperger syndrome vary from one person to another but as well as the three main areas of difficulty, people with the condition may have:

love of routines
special interests
sensory difficulties.
I think you are confusing a love of routines with OCD, this means he has repeating intrusive thoughts he has to act out i.e sitting in the same chair.

the speech problem can be something as simple as 'You sit in a chair' typical of aspergers, when they should say 'I sit in a chair' under DSM V aspergers will become ASD which is PDD. Individual with aspergers have good verbal ability, with no delay in speech, this is key for the dx. Basically, if aspergers is talked about then it is valid to say he has aspergers, with co-morbid OCD. The psychiatrist is saying he as aspergers, with a speech delay/problem, but if he dx's aspergers the intervention won't include intervention for the speech delay/problem. So a dx's of ASD can include help with aspergers and speech delay/problem. in other words if I call the kid a ZEBRA he gets all the interventions he needs.
sounds like a great dx for your son and for you because you can say he has Aspergers, quite validly.

I usually find psychiatrists under rocks

I always quietly and quickly leave them be, and put the rock back nicely after

No, you do not need to have repetitive interests to be diagnosed. You do not need every single symptom. People are different. Based on your description though I would say he has them. "Special" interests is a better term for them than repetitive interests.

Perhaps the psychiatrist is using the Gillberg criteria for AS (is what they use in my country)? That criteria requires special interest and (more or less) requires "to the exclusion of other activities".

That is what I thought too. The dsm-iv requires "restricted repetative and stereotyped patterns of behaviour, 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
2, apparently inflexible adherence to specific, non-functional routines or rituals
3, stereotyped and repetative mtor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body movements)
4, persistent preoccupaton with parts of objects."

gillberg requires "narrow interest (at least one of the following):
exclusion of other activities
repetative adherence
more rote than meaning"

Tony Attwood states in his book 'the complete guide to asperger's syndrome'. " the criteria of Christopher Gillberg, who is based in Sweeden and London, remail those that most closely resemble the original despriptions of [Hans] Asperger."

Would your son still get recources in school with a PDD NOS diagnosis?
Would the private diagnosis still allow him to access local services for asprergers?

Maybe this diagnosis allows the school to be flexible and tailor his support to his individual needs?

I know what you mean though, that would bug me too.

A special interest in AS is "typical". The "majority" of individuals with AS exhibit repetitive behaviours mainly in a special interest. (Edit: At least that's what the criteria say, reality is likely quite different.)

Look here:



and here:



Different people interpret that differently.

Going by a literal interpretation of the diagnostic guidelines, a special interest is definitely not needed for a diagnosis of AS.



A less literal interpretation will probably lead to assumption that someone exhibiting other clinically significant repetitive behaviours and not just a special interest or no special interest at all doesn't have a typically case of AS.

Isn't this all moot soon anyway? Aren't they doing away with these seperate labels and using just one in future?