How would you diagnose this child in 2012?

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Here are some excerpts from teacher conferences, report cards, and specialist reports circa 1980. The prognosis at the time was simply "gifted" (but keep in mind Aspergers did not exist as a diagnosis until 1994). How would you diagnose this kindergarten-age child in 2012? NT? Aspergers? ADHD? Elsewhere on the "spectrum"? Something else entirely? More information needed?

When given the "draw a person" test, the figure is extremely distorted (tiny head with minimal facial features, long thin neck, enormous feet and hands) and his name is "do you know what his name is" (parroting the teacher's question).

"holds pencil so tight hand hurts"

"somewhat anxious, talkative, wants to do well, particularly in writing, reads [other students'] names on [specialist's] schedule to see who he knows, perfectionist"

"We have many concerns in the the emotional area. He arrives home each day acting tense and aggressive. He complains of boredom in school and is particularly irritated with some of the work papers. He is concerned why he meets with [the reading specialist and speech pathologist]; he thinks it has something to do with being 'dumb.'"

Wechsler IQ test of 155 verbal/142 performance; psychologist adds: "He is a most happy boy who seemed to enjoy the test, often asking questions about the questions... he was consistent and confident... I was astonished at his level of comprehension with concepts... all answers were given within four seconds... he seemed to enjoy the block design and mazes subtests the most. His visual-motor integration, to take parts and make them whole when the goal is known, as measured by block design, was truly remarkable. He saw relationships at once."

"Encourage to be one of peers and develop peer relationships. Clinging to one boy. Wants to be liked. Angry at little boy: 'keep that up and I won't invite you to my house.' Close to a stutter. Uncomfortable in large groups. Cut into lunch line saying: 'I have to stay with [best friend], I can't keep up with kids.' Doesn't have many friends."

"Uncomfortable in new situations."

[Reading Assessment] "His Instructional level was levels 2 and 3 and his Frustration level appeared in the 4th level passage; his comprehension level was 35%, however, this may be due to lack of interest in what the stoory was about. His comprehension returned to 70% on passages 5 and 6, both of which he enjoyed... problems appear when asked to explain vocabulary words. He is able to read (or word call) more words than he has concepts for... Many of his errors may be due to speed. He reads extremely quickly and this speed results in omissions, substitutions and loss in comprehension. He also has a consistent problem with the sound of 'th' as in mother or through; he pronounces this sound as an 's'." Reading comprehension questions answered incorrectly include: "How did Joe think Dad and Mom would feel about the goat?" "Why did Harriet want to see her friends?" "What did Peter's grandfather mean by the words 'And then, Snap! No more Peter.'?" "Did Pete's mother approve of his father telling him what the newspaper said?" "How did Mother feel when she followed Susan and Father into the elevator?"

"Needs improvement speaking clearly, controlling scissors/pencil, showing self-confidence. Poor fine-motor control and mixed-dominant handedness but showing improvement"

"well-liked, enjoys playing with peers, at this time, seems to want to do and be like the other boys, speech still hesitating when talking in front of groups, dislikes being singled out. Concerns: trouble sitting still and concentrating when worked with individually, needs encouragement and support to finish work especially written work"

"Does not respect others' ideas; I was concerned when he kiddingly put down a classmate's work a few times."

I could keep going but my fingers are tired from typing... can provide more info or answer questions as needed. Pleased to report this little boy is all grown up and has become a member of wrongplanet.

Autism.

Thanks for the reply, diniesaur! Any explanation of how you arrived at that conclusion, or is it just plainly obvious to you?

I am struck by the inability to answer questions like:

At the time, the specialist interpreted these wrong answers as a failure of reading comprehension. I realize now the root problem may have been "mind-blindness" towards others' thoughts and emotions.

Sounds like you have many traits of Asperger's, but they aren't nearly as severe as what some people have.

Asperger's, most likely.

The drawing has nothing to do with it. Kindergarten-aged kids tend to be horrendous artists. I assume he did not have a cognitive delay [did not start speaking or regressed slightly with speaking].

"Needs improvement speaking clearly, controlling scissors/pencil, showing self-confidence. Poor fine-motor control and mixed-dominant handedness but showing improvement"

I hope that the "showing improvement" doesn't refer to his dominant handedness.

"Does not respect others' ideas; I was concerned when he kiddingly put down a classmate's work a few times."
Seeming not to respect others' ideas, or actually not respecting others' ideas? Kiddingly putting down a classmate's work a few times...does that mean he repeated the same thing or repeated different things?

Thanks for the replies!

Lenny, I do not think I was delayed speaking (will ask my parents next time I see them), and I was an early reader with a big vocabulary (see my companion thread on hyperlexia).
I don't remember the specific incident with not respecting others' ideas, but generally speaking, I have never been tactful about correcting other peoples' mistakes.

Some of the problems with reading can result from convergence issues with the eyes. It is common to miss words or letters out, or misread passages. It is also common for those with this problem to have trouble absorbing what they are reading.

I am an A average at University, scoring around 90% to 100% for many of my assignments....but have similar problems to the above when reading due my eyes. They don't converge properly and this causes problems with 3D vision, depth perception, judging distances (making me clumsy with poor hand eye coordination) and reading/reading comprehension especially if I try to read quickly. My eyes will miss words out, misread words, substitute words for similar ones (ie county as country and vice versa) and I will often have trouble remembering what I just read after just one reading (mostly because my attention was focused on trying to read the actual text rather than its content).

Outside of my eye problem though I have no reading issues and can read well if I can see properly!

I just think it might be worth getting his vision tested, but not just with a regular 20/20 vision test eye chart. That kind of test will not pick up this problem. A person can have 20/20 vision and still have convergence issues. It's a separate test that you can discuss with an optician.

Last edited by bumble on 30 Mar 2012, 10:38 pm, edited 1 time in total.

Insightful comment bumble! I was indeed a nearsighted child and started wearing glasses in the 2nd grade (first in my class, cause of some teasing/bullying). Will ask my eye doc about convergence.

Late speaking does not make or break an aspergers diagnosis

"Gifted" would still be an accurate description of your intelligence, given the WISC scores. Aside from that... Much of what you've described is perfectly ok for a 5 year old. I don't really see any evidence of a reading issue or a speech issue. (Not pronouncing "th" at that age is normal. I don't know why they'd even mention it.) From an educational perspective, if this were in 2012, I'd speculate that you'd have been in general education, although you may have received some occupational therapy.

As for a diagnosis... I can usually get a sense about which students in my class may be on the spectrum, but it's very difficult to tell from just anecdotes. I'd need to have observed you in person to give any kind of answer there. (And only a licensed psychiatrist could give a definitive answer.) So I will have to go with "Gifted" / "Not Enough Information". It does sound like there were some issues with fine motor and pragmatic language, but it's just not enough to go on.

Gifted, hyperlexic, dyspraxic, some speech/language issues.

I wouldn't know about autism in general because there's not enough info about how this kid interacts with others. There are some autistic traits--the speech/language issues and problems with novelty. Since there is some significant impairment involved, and because there are definite language issues as well as problems with novelty and large groups of people, I'd probably say PDD-NOS, with a note to possibly revising the diagnosis to another ASD if the traits become more well-defined as developmental demands increase, or dropping it entirely if the speech/language and social issues resolve themselves. The diagnosis would be mostly a gateway to getting some useful classes for the kid. Also, somebody needs to tell him that special ed doesn't mean stupid. (You do know that now, right? )

Last edited by Callista on 31 Mar 2012, 2:41 am, edited 2 times in total.

I would not know. I would think he has some disability but I wouldn't be sure. It be too quick to assume AS because being a loner does not always mean someone has AS, same as when they have a hard time with their peers.

Two separate issues, really. Special ed is based on a classification, which is separate from a diagnosis. A diagnosis of PDD-NOS would only be given after considering and ruling out many other possibilities. There is no classification for either Asperger's or PDD-NOS. But you're right - Special ed isn't based on intelligence, either.

Thanks, all, for your insight!

Now an adult 30 years later, our hero has every single trait on this list: http://www.help4aspergers.com/pb/wp_4a3 ... 112c8.html and scores medium-high on self-diagnosis tests (159 aspie score for example). He thrived in the rigidly-structured school environment (eager to please teachers--in fact he often felt they, and not his classmates, were his peers--good grades and test scores), but he has not adjusted well to adult life and, while not profoundly impaired (he has proven capable of working and living independently in the past), he currently has no job or structured routine/activities. He feels like he missed some Secret Lesson that wasn't on the curriculum that everyone else understands except him. The career, social, and relationship failures of someone who is otherwise very bright & driven are baffling to himself and those who know & love him motivating him to evaluate his past and present, looking for answers. He discovered wrongplanet recently, when a family member was diagnosed with Aspergers, and immediately identified with the other members here, like members of a long-lost tribe.

Do the above early-childhood school reports support, or contradict, the adult diagnosis?

Support it, yeah. Enough traits there for PDD-NOS, and later on the traits got clearer and showed up as Asperger's.

PDD-NOS can be used as a provisional diagnosis like that, where it isn't clear yet whether a child has some traits because of his age or environment. I would probably have been given PDD-NOS as a diagnosis when I was six, because my language issues were covered up by the fact that I was just learning English as a second language that year, and my lack of interest in social interaction could have been explained by the culture gap just as well as an innate social-skills delay.

Don't give up on the career thing. I'm 28 years old and I've been trying to get through college for ages, and it just took me so long to get the hang of it. But finally I am--I'm due to graduate in just a little over a year, and have been told I'm well-suited for doing PhD research in a graduate program. Things took longer for me, and probably always will. But I think that just because things are hard, doesn't mean they're impossible, and doesn't mean that you can't defeat the obstacles and learn how to work around your own weaknesses.

Thanks, Callista, that cheers me up. Maybe I should just go back to school (I live in a college town).

School was easy for me academically but hard for me socially due to cliques, peer pressure, sensory overload, etc... is PhD school better than high school/undergrad?