Diagnosing high functioning autism in an older child

[Anonymous]

Anonymous wrote:My 12 year old has been in therapy and on medications for years because of anxiety. His therapist recently suggested that she is starting to consider whether he also has high functioning autism. She says that it is not uncommon for this to be discovered around his age if it is an atypical case, though it is nothing we have ever considered and no one else has ever suggested it.

I'm not sure what to think. I've been googling for characteristics/symptoms used to diagnose and that hasn't really helped (perhaps not surprisingly). I was wondering what the process was for getting an evaluation. Who does the evaluation? Or who should we have do the evaluation? What are the criteria that are considered?

Also, has anyone mistaken HFA for general and social anxiety?

Get an ADOS and an ADI-R done. I watched my son's ADOS. It became very clear during the course of that interview that this was an ASD. It just really highlighted where he was struggling.

[Anonymous]

Anonymous wrote:OP here. Yes, it's a boy. Therapist did say that it would be an atypical case. There are some things that do resonate. But he is very empathetic (almost too empathetic because it causes him distress). He also has a very good sense of humor, more sophisticated than most kids. But he is very awkward with other kids. He is extremely disorganized and some other random things on lists I read resonated (like clumsiness, low pain threshold, extremely sensitive to his environment, can't handle crowds or weird smells, etc). But it was really the social piece that therapist focused on.

It is a myth that kids with ASDs lack empathy. They often don't demonstrate empathy because they lack the ability to read facial expressions and body language and social cues. When they understand what is happening with another person, they often have plenty of empathy. It's a perception problem, not a lack of emotional response.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here. Yes, it's a boy. Therapist did say that it would be an atypical case. There are some things that do resonate. But he is very empathetic (almost too empathetic because it causes him distress). He also has a very good sense of humor, more sophisticated than most kids. But he is very awkward with other kids. He is extremely disorganized and some other random things on lists I read resonated (like clumsiness, low pain threshold, extremely sensitive to his environment, can't handle crowds or weird smells, etc). But it was really the social piece that therapist focused on.

It is a myth that kids with ASDs lack empathy. They often don't demonstrate empathy because they lack the ability to read facial expressions and body language and social cues. When they understand what is happening with another person, they often have plenty of empathy. It's a perception problem, not a lack of emotional response.

+1 . I get so frustrated by this "lack of empathy" canard. My kid has a big, warm heart. Just absolutely no idea how to translate that appropriately to social interactions because he can't read the signals people are sending.

[Anonymous]

Look into Impaired Interactive Perspective Taker, described by Michelle Garcia Winner in "Thinking about You Thinking About Me."

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here. Yes, it's a boy. Therapist did say that it would be an atypical case. There are some things that do resonate. But he is very empathetic (almost too empathetic because it causes him distress). He also has a very good sense of humor, more sophisticated than most kids. But he is very awkward with other kids. He is extremely disorganized and some other random things on lists I read resonated (like clumsiness, low pain threshold, extremely sensitive to his environment, can't handle crowds or weird smells, etc). But it was really the social piece that therapist focused on.

It is a myth that kids with ASDs lack empathy. They often don't demonstrate empathy because they lack the ability to read facial expressions and body language and social cues. When they understand what is happening with another person, they often have plenty of empathy. It's a perception problem, not a lack of emotional response.

+1 . I get so frustrated by this "lack of empathy" canard. My kid has a big, warm heart. Just absolutely no idea how to translate that appropriately to social interactions because he can't read the signals people are sending.

+ a million

[Anonymous]

OP here. One point of clarification. The reason the therapist said it would be atypical is because he makes eye contact. She knows him well and has HFA as a speciality but just raised the possibility recently.

[Anonymous]

Anonymous wrote:OP here. One point of clarification. The reason the therapist said it would be atypical is because he makes eye contact. She knows him well and has HFA as a speciality but just raised the possibility recently.

It probably won't mean very much in terms of skill building. For example, kids with language processing issues, ASD, or ADHD can benefit from social skill groups. Diagnoses can vary, but all end up with the same need, i.e., weakness in social communication.

Did your therapist think he was in need of more testing or was just floating the issue past you? What was the point of raising the issue?

[Anonymous]

Thinks he should be evaluated. We asked what the point would be and she said it could help with getting support. He already has a 504 plan.

[Anonymous]

Anonymous wrote:Thinks he should be evaluated. We asked what the point would be and she said it could help with getting support. He already has a 504 plan.

Do you think he need more support in the school setting or beyond the school setting?

If so, I'd pursue further testing. You could ask the school, but it would probably be an uphill battle is academically he's doing okay.

[Anonymous]

My DD is 11 and we've also heard that she is near the spectrum based on some behaviors and outlooks. However, she is empathetic and gets other's jokes even if she can't yet tell a successful one herself. We are moving toward meds for the anxiety and inattentive ADD (which I think is partly a manifestation of the anxiety) and just working on the rigidity and social skills at home. Again, the rigidity seems to stem from anxiety partly.
Her father's p-doc once told him that he was autistic and her aunt was also given this diagnosis. Both were as adults undergoing inpatient treatment for severe GAD. They later saw p-docs who disagreed. A friend whose past doctors told him he had BPD and NPD was just diagnosed with autism at age 50 after a decade of decline.
I guess that I'd consider what use the diagnosis would be for us in the case of DD. She is doing well in her private school and has 2 close friendships with "non-quirky" friends. It would be hard to for me to claim she has a disability that needs services. However, if we needed accommodations for her anxiety and ADD, I'd probably want to completely rule out ASD first.

[Anonymous]

Anonymous wrote:OP, I am dealing with the same thing right now. DD fits lots of the signs, but not all. One thing you might want to explore is Nonverbal Learning Disability. Google and see if this description might better fit your son.

I second the vote to see Dr. Black.

This is exactly what I was thinking. It sounds like NVLD.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP, I am dealing with the same thing right now. DD fits lots of the signs, but not all. One thing you might want to explore is Nonverbal Learning Disability. Google and see if this description might better fit your son.

I second the vote to see Dr. Black.

This is exactly what I was thinking. It sounds like NVLD.

Which is no longer in the DSM, OP's kid won't be getting that diagnosis from Dr. Black.

[Anonymous]

OP, my son is younger than yours (7) and his therapist (for anxiety) raised some similar concerns. I would recommend getting your child evaluated, but in our case, at the end of the day, DS was not diagnosed with autism. We recently did this social skills group: http://socialskillsgroups.net/ and were happy with it. I know the locations are not convenient. However, the schlep was worth it for us because other social skills groups that we had tried closer in were more focused on skills that DS already had (joining a group, asking to play, making conversation) - this one focused on the more subtle skills that he lacked (knowing when your behavior is starting to annoy someone, standing an appropriate distance away from someone, moderating tone and volume of voice).

[Anonymous]

Anonymous wrote:OP here. One point of clarification. The reason the therapist said it would be atypical is because he makes eye contact. She knows him well and has HFA as a speciality but just raised the possibility recently.

My kid with ASD/ADHD never had issues with eye contact. His eye contact has always been normal and he certainly has ASD /Asperger's according to ADOS and neuropsych eval. Eye contact is not the "be all, end all" in diagnosing ASD.

Get a neuropsych eval with ADOS/ADI-R. Frankly, I would find another therapist if yours used eye contact solely as determining "atypical".

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here. One point of clarification. The reason the therapist said it would be atypical is because he makes eye contact. She knows him well and has HFA as a speciality but just raised the possibility recently.

My kid with ASD/ADHD never had issues with eye contact. His eye contact has always been normal and he certainly has ASD /Asperger's according to ADOS and neuropsych eval. Eye contact is not the "be all, end all" in diagnosing ASD.

Get a neuropsych eval with ADOS/ADI-R. Frankly, I would find another therapist if yours used eye contact solely as determining "atypical".

Want to add that DS got the ADHD diagnosis in addition to the ASD, which was diagnosed earlier, from Dr Black. He truly is an expert in "complicated" cases like my DS. Highly recommend.