Most children with Asperger Syndrome do not receive their diagnosis until after age 6. Usually, they are diagnosed with Attention Deficit Disorder as toddlers. Part of the reason for this is that doctors routinely screen children for ADD but not for autism. Another reason is that an Aspie’s social impairment becomes more evident once he or she begin school. Finally, doctors are reluctant to label a child “autistic.” It is okay and even a badge of honor to have a “hyperactive child,” but it is another ballgame to have an “autistic child.”
Doctors make their diagnoses based on children’s behaviors. Since children with Attention Deficit Disorder and Asperger Syndrome share similar behaviors, the two can appear to overlap. However, there is a fundamental difference between Attention Deficit Disorder and Asperger Syndrome. Aspies lack what doctors call “social reciprocity” or Theory of Mind. Theory of Mind is “the capacity to understand that other people have thoughts, feelings, motivations and desires that are different from our own.” Children with ADD have a Theory of Mind and understand other people’s motives and expectations. They make appropriate eye contact and understand social cues, body language and hidden agendas in social interactions. Aspies can not.
One author put it this way: children with Attention Deficit Disorder respond to behavioral modification. With Asperger Syndrome, the syndrome is the behavior.
Both kinds of children can tantrum, talk too loud and too much and have problems modulating their behaviors and making friends. Both face social challenges, but for different reasons.
The child with Attention Deficit Disorder knows what to do but forgets to do it. Aspies do not know what to do. They do not understand that relationships are two-sided. If an Aspie talks on and on in an unmodulated voice about his particular interest, he simply does not understand that he is boring his friend and showing disinterest in his friend’s side of the conversation. On the other hand, the child with ADD cannot control himself from dominating the conversation.
An Aspie child can appear unfocused, forgetful and disorganized like a child with Attention Deficit Disorder, but there is a difference. The ADD child is easily distracted; the Aspie has no “filter.” The Aspie sees everything in her environment as equally important. Her teacher’s dangling earring is as important as what she writes on the blackboard. The Aspie does not understand that she does not have to memorize the entire textbook for the next test. She does not “get” such rules. Aspies tend to get anxious and stuck about small things and cannot see the “big picture.” Children with Attention Deficit Disorder are not detailed-oriented. The ADD child understands the rules but lacks the self-control to follow them. The Aspie does not understand the rules.
If the unfocused Aspie is “nowhere,” the obsessive-compulsive and “Fantasy” Aspies are somewhere else. “Fantasy Aspies” retreat into a world of their own making – a world where everything goes the way they want it to. They play video games for hours or retreat into books and music. Their daydreaming and fantasizing resembles the behaviors of non-hyperactive children with ADD.
Obsessive-compulsive Aspies live a world they create from rules and rituals. Like ADD children, they appear preoccupied and distracted but for different reasons. They appear distracted because they are always thinking about their “rules.” Did I tie my shoelaces right? Did I brush my teeth for 120 seconds?
Some authors estimate that 60% to 70% of Aspies also have Attention Deficit Disorder, which they consider a common comorbidity of Asperger Syndrome. Other authors say that the two cannot exist together. Still others insist doctors have it all wrong and that the two disorders are the same. The real problem is that there is no hard science. No one knows exactly how slight differences in brain structure and chemistry cause such problems.
For this reason, getting the right diagnosis for a child who exhibits behavior problems may take years of trial and error. Diagnosis is based on observation of behaviors that are similar for a myriad of disorders. The tragedy is that the child often does not receive the correct medications, educational strategies, and behavioral modification techniques that could help him function on a higher level. He falls farther behind his peer group and loses ground when he could be getting appropriate treatments.
“Psychiatry has made great strides in helping kids manage mental illness, particularly moderate conditions, but the system of diagnosis is still 200 to 300 years behind other branches of medicine,” said Dr. E. Jane Costello, a professor of psychiatry and behavioral sciences at Duke University. “On an individual level, for many parents and families, the experience can be a disaster; we must say that.”
Carey, Benedict. “What’s Wrong with My Child? Psychiatrists Often Disagree,” The New York Times, front page, November 11, 2006.
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Lovecky, Deirdre. Different Minds. Philadelphia: Kingsley Publishers, 2004.
Myles, Brenda and Jack Southwick. Asperger Syndrome and Difficult Moments. Shawnee Mission, KS: Autism Asperger Publishing, 1999.
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Reichenberg-Ullman, Judyth, Robert Ullman and Ian Luepker. A Drug Free Approach to Asperger Syndrome and Autism (Edmonds, WA: Picnic Point Press), 2005.
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