Can anyone shed some light? ADHD or Aspergers?

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Hi, everyone. I'm new here, and I just kind of wanted to share my story and see if you guys think. I apologize in advance because this will probably be lengthy and a little disordered, but my thoughts *are* disordered right now.

My son Zeke is 6 1/2 and in 1st grade. He's always been a very intense and sensitive little boy. He's incredibly smart, with an I.Q. of 134 (had to do an I.Q. test for IEP at school). We first sent Zeke to school when he was 3, and from the first day, his teacher approached me with a deer in the headlights expression and told me she saw a lot of red flags for autism. I felt like the wind had been knocked out of me, especially since just the week before our pediatrician suggested we take Zeke to see an occupational therapists, due to him being so scared of loud noises that it was giving him nightmares. Fast-forward a couple months...we finally got in to see an O.T., where she diagnosed him with some sensory processing issues - auditory, visual, proprioception, vestibular - nothing too major, but enough to impact his daily life. We also found out he was about 2 1/2 years behind on fine motor skills, such as pencil grasp. A few months after this, we decided to go ahead and do a screening for autism. Granted we didn't know a lot about high functioning autism, but we didn't really think that was what we were dealing with. BUT his preschool teacher has a daughter on the spectrum, and she also works part time at as an O.T. assistant, so we figured it was best to be safe since she knew more than we did. At the screening, a team of doctors - child psychologist, developmental doctor, O.T., etc. played with Zeke for a couple hours (after collecting paperwork from us), and at the end they said that he DOES NOT have an autism spectrum, but that he does have ADHD.

Social - Zeke is now 6, and we have since been told that his ADHD is severe. But over the past year, my husband and I are seeing more and more signs of Asperger's traits. He wants badly to make friends, but he is very awkward. He doesn't seem to understand personal space, he's way too hyper, tries too hard, gets inches from people's faces often when trying to engage, says awkward things, and he overwhelms people. They try to move to a different area to play away from him, but he's oblivious to this (and to all the behaviors I just shared with you) and follows them. His teacher has commented that he follows one particular girl around at school. And through conversation, it seems to me that one little girl is trying to play tag with him, but he thinks she's running away to be mean, so he may not always understand play? He's gotten in trouble at school for name calling, like when he called a kid in class whose name is Billy "Billy Goat". He didn't understand how this could possibly hurt Billy's feelings. In fact, his teacher has commented he doesn't seem to understand others' feelings. He does well with adults, and when we travel home to see our extended family, I have noticed he will try playing with the youngest child at wherever we are, rather than someone closer to his age. Sometimes he just plays by himself and says it's more "peaceful" that way.

Emotional and Behavior - He has A LOT of meltdowns. This can be caused by not getting his way in something, a change in routine....During these tantrums, he is aggressive. He gets in trouble a lot for arguing and being defiant. He often says mean things to his sister, like, "I wish you weren't in our family. I don't like you, stupid girl."

Misc. - He's set in his routines, and going off the routine can (but not always) spark meltdowns, like the time I picked him up early from kindergarten and he had a meltdown because we weren't exiting from the same door he usually exited from at the end of the day. And I can tell sometimes when he's playing that he has his own rules in his head that on one else is aware of, and deviating from those rules can cause a meltdown - like the time at the doctor's office when he was playing with giant blocks with other kids. I could tell he had a picture in his head of what the finished product should look like, and he was close to a meltdown because other kids were climbing on the blocks or moving them. Also, we had to stop going to church because he would cry and cling to us before Sunday school every Sunday. A month before he turned 6, it finally just got to be too much for us, and we stopped going.

Quirks - One odd thing is that , while he does not have an obsession with any one interest (as far as gathering facts and such, though he does love to gather facts about a wide range of things) he has been obsessed since at least this past August with saying the word "Donut". He inserts the word randomly (and very often) into conversation. I think he's trying to be funny, so would that still count as a restricted interest? He says a lot of off the wall things (think Dr. Seuss). He makes high pitched noises fairly often. His teacher says he does this every day at about 2:30. He doesn't speak monotone all the time, but I have noticed it here and there, and one thing I have noticed about his speaking is that it is very 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. He does pretty well with eye contact, but his teachers have commented that he doesn't make eye contact as much as he should. And he does stare off into space more, lost in his own, world fairly often. He does things like clap his hands on his sides or clap his hands together or wiggle his fingers or stomp his feet, etc., without realizing he's doing it. He tells me when I pick him up from school often that he looked inside so-and-so's mouth at school or picked them up and squeezed them, odd things like that. He's always thinking when we're out and about that he sees a certain child or teacher from school or even one of his grandparents, and he'll call out to them, and I have to tell him it's not who he thinks it is. Very hard time with facial recognition.

Does this sound like Asperger's? Every teacher he's ever had, and now his pediatrician, says he shows a lot of red flags. We're scheduled to do an evaluation in April, and I'm so afraid they're going to miss it because he does well with adults. It's especially when he gets around a group of kids that it becomes very evident. Will the developmental specialist observe him around other kids? I really need this diagnosis if that's what we're dealing with because without it, our insurance will not cover the ABA therapy.

No way to say for sure without actually observing him, but it sounds like your concerns are justified, so it's good that you're seeking a second opinion. Both ADHD and SPD tend to be comorbid with autism though, so it's understandable why he was given those diagnoses.

However, I did notice a couple things:
"He inserts the word randomly (and very often) into conversation. I think he's trying to be funny, so would that still count as a restricted interest?"
That could be him being a typical child or it could also be echolalia, which is considered part of the restricted/repetitive interests and behaviors. I think it's worth looking into. Perhaps see if he knows why he says it.

"He does things like clap his hands on his sides or clap his hands together or wiggle his fingers or stomp his feet, etc., without realizing he's doing it."
That could be considered stimming, which also goes along with the restricted/repetitive interests and behaviors category.

Did you tell those who assessed him this? Since he's a child, I would've thought they would have spent extensive time with you asking questions about his behavior in certain situations (and I don't mean just having you fill out forms).

Good luck with your upcoming appointment. Hopefully you get the answers you're looking for.

I have asked him why he says "donut", and he told me he's trying to be funny. But he keeps saying it over and over, even when he gets in trouble for it at school (it's to the point where it's a disruption in the classroom) and is sent to the office over it. And it seems to me that he doesn't always realize he's just said it, so I'm not sure that would be considered a habit or if it's echolalia...it's baffling.

As for the possible stimming behaviors, we didn't tell the team who evaluated him this because he was only 3 when we did the screening, and we weren't noticing these behaviors then. I don't know if they just weren't present then or if they were always present but didn't seem all that out of the norm for a 3-year-old's behavior. At any rate, it's only in the last year that my husband and I have noticed these behaviors.

Perhaps it could even be both? Maybe it's a subtler form of echolalia, so he can control it sometimes (when he wants to be funny). I haven't researched echolalia extensively though, so I'm not even sure if that's possible. I do know that some stims can be verbal though, and it is possible to be able to control those at times and not at others. (The only stim I'm aware I do is twirl my hair. I've been doing it since I was a newborn, so at this point it's mainly autonomic, but if I realize I'm twirling it, I can stop myself.)

Ah! I didn't realize he was assessed at age 3. I might have skimmed over that. Since you're just noticing these behaviors, then it's definitely good that you're getting a second opinion.

If you're really concerned about the diagnosis not being picked up, then why not take a look at the diagnostic criteria for ADHD and ASD and see which fits your son better? If you feel like ASD fits better, it may be helpful to come in with a typed document explaining which of his symptoms fit the criteria. It's worth a try.

So. I have a 7 year old daughter dxed with asd and an almost 5 year old daughter dxed with adhd. I have to be super honest, they ain't all that different. I honest to God don't understand how these are classed separately.... at all they're so similar. One main difference is that my 5 year old is balls to the wall the most hyperactive and impulsive child I have ever met in my 36 years on planet earth. How she is still alive is utterly beyond me. She's so hyper that you can't even tell if she has good eye contact or not. Her social skills are crap... but is it because she's hyper, impulsive and overly sensitive? Or is it because they're just behind? She doesn't listen to us and often doesn't respond.... it's it because she's distracted due to autism or distracted because of add? And the daughter with asd, is she not responding or following directions because she's autistic or could it be a whopping case of add(with out the h, she doesn't seem hyper). Another big one, is that my asd child doesn't seek out companionship of any type. Her circle is small. She has no friends and doesn't lament her lack of them. She loves being alone and I'm pretty sure if she never saw another human besides me and her dad... she might be ok with that. The other one... opposite. Wants everyone to be her friend, constantly seeks out others, tries to talk to strangers, she's socially inappropriate frequently, and gets very upset even kids aren't her friends and often thinks other kids are making fun of her when they aren't. Is this due to social skills or hyperactivity? I don't effing know!! !! ! The last big one is empathy. They're both children so in my opinion, neither child actually has true empathy. I dont think any children really develop empathy till much older, but that's my personal opinion. I think nt children simply learn to show fake empathy at a young age due to social pressure.However my older child makes zero attempt to fake empathy or any interest in faking it and is honestly puzzled by empathy in general. My little one does "show" it.

So I have no idea if the little one has aspergers underneath all that hyperactive energy... it almost doesn't matter since right now her biggest roadblock is the hyperness and impulsivity. I also have no idea if the older one has just autism, just add, or autism plus add her psychiatrist admits she can't tell either at this point. Again it doesn't matter as long as we work on her issues.

So my suggestion is to pick out the areas he needs the most help in. Determine if those areas would be better suited to getting help through an asd diagnosis or an adhd diagnosis. Then go get that diagnosis. There is so much overlap, I've no doubt you could get either one or both.

I feel your pain. It really is so incredibly hard to tell a difference, and then when you throw sensory processing disorder in there, it's enough to make your eye twitch. I agree with you on trying to get a diagnosis for whichever has the issues you most need help with. With the diagnosis for severe ADHD, we have tried changing diet, we've tried essential oils, we've done counseling, and then as a last resort we turned to medicine. Medicine seemed to be the only thing that helped at all, but even with that, there is still so much he's dealing with that it seems to me ADHD may not be the right diagnosis, or at least a big piece of the puzzle is missing. The only other thing I know to do is ABA therapy, and I have high hopes for that. But alas...the only way our insurance will cover it is if we have an autism diagnosis. And I am so afraid they will miss it in the screening since he does so well with adults. I just wish part of the screening was observing him with other kids. I feel like doctors miss A LOT by not doing that since that's where so many of the difficulties lie.

At least your insurance will cover aba with an asd dx. ours will not. We live in Ohio...