Can a child have ASD and be "very social"?

[Anonymous]

Anonymous wrote:
3. The DSM III actually did say that children with autism had no interest in people. That was the standard until the 1994 DSM-IV changed it. However, the wording a severe is absolutely in the DSM iV:

PDD NOS
This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills or when stereotyped behavior, interests, and activities are present but the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder, or avoidant personality disorder. For example, this category includes "atypical autism" ? presentations that do not meet the criteria for autistic disorder because of late age at onset, atypical symptomatology, or subthreshold symptomatology, or all of these.

I am not quibbling with severe. (Though look at the severity levels in the new DSM). I'm quarreling with absolutely no desire to interact socially. That hasn't been an element of the definition for a very long time. The child who will walk up to strangers and start talking about Star Wars wants to be social, but he has a serious impairment. You know the "creepy guy" in high school who said all the wrong things and was teased and had no friends? It wasn't for lack of trying but that guy had a serious impairment that interfered with his life. Its a very tough thing when you want to be a part of teh wider world but everyone else seems to know the rules about interacting, and you don't.

[Anonymous]

14:02 here. I'm not getting into quibbling over definitions of ASD and whether it's overdiagnosed. I would just emphasize to OP that regardless of what the label or diagnosis is, good therapists and doctors look at your child's strengths/weaknesses and the overall picture and tailor intervention. Whether or not my son has ASD and who knows (I tend to think he won't meet the criteria), the reality is that he is a little different and needs help in some areas. I'm not worried about him just being quirky. Especially boys with these kinds of deficits really get left behind in school and society and expectations are only increasing. I don't want to wait until there are big problems or until DS himself is aware of it. I really feel that we've made a big difference already, I can see it. We have learned so much from going through the process and we would not have known what to do without it. What I'm saying is, OP, please don't just "wait and see".

[Anonymous]

I agree w/ 15:19 -- at 4 my child is already teased and excluded because of his social behavior and intense interest that frankly other kids his age don't understand or care about. However, he still reaches out and doesn't understand that the other kids don't care. He is high-functioning- so what does this mean- that these kids that Greenspan and others question are just personality types that happen to fit a pattern?
I remember a teacher last year who meant well but didn't grasp the big
picture say that at least he will make a lot of money like Bill Gates! Okay, there are plenty of AS people barely supporting themselves or living with their parents- they are not all successful in life! I have been reading research on outcomes and it is not pretty without intervention at an early age, even for high functioning people because they never received support- people just labeled them weird.

[Anonymous]

Anonymous wrote:

Anonymous wrote:A kid can be a true extrovert and also have an ASD. What you would most likely see is the social intent - trying to engage - but problems in the execution - indiscriminate hugs, not differentiating between different people. For kids on the higher functioning end of the spectrum this is what makes diagnosis difficult - it isn't until social interactions become more nuanced that the deficits become more obvious.

Thanks. That's kinda what I was thinking. So if we do end up with an ASD diagnosis, it probably won't be until on the late side. Which is fine, but I keep reading about how important early intervention is. We are going to seek help for the language delay if things don't change soon, he is close to walking and we are waiting to see if the language takes off once he masters walking, but other than that, I guess we just take a wait and see approach.

You can start working with him at language at home now. There are several good programs that teach parents to do this. A speech therapist is only with a child about an hour a week, while you are with him 24/7! There's the Hanen Method with It Takes Two to Talk, and there's James D. MacDonald's Communicating Partners. http://jamesdmacdonald.org/Articles/MacDonaldStart.html. He also has a Yahoo group, and he's often on there, talking to parents.

EI can be good, or it can be a disaster. It's a real mixed bag. It just depends on the staff and their training. One thing that can be helpful is to find out what your child's receptive language is. A child with very low receptive language can look pretty quirky and can easily be misdiagnosed as something else.

Good luck!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:A kid can be a true extrovert and also have an ASD. What you would most likely see is the social intent - trying to engage - but problems in the execution - indiscriminate hugs, not differentiating between different people. For kids on the higher functioning end of the spectrum this is what makes diagnosis difficult - it isn't until social interactions become more nuanced that the deficits become more obvious.

Thanks. That's kinda what I was thinking. So if we do end up with an ASD diagnosis, it probably won't be until on the late side. Which is fine, but I keep reading about how important early intervention is. We are going to seek help for the language delay if things don't change soon, he is close to walking and we are waiting to see if the language takes off once he masters walking, but other than that, I guess we just take a wait and see approach.

You can start working with him at language at home now. There are several good programs that teach parents to do this. A speech therapist is only with a child about an hour a week, while you are with him 24/7! There's the Hanen Method with It Takes Two to Talk, and there's James D. MacDonald's Communicating Partners. http://jamesdmacdonald.org/Articles/MacDonaldStart.html. He also has a Yahoo group, and he's often on there, talking to parents.

EI can be good, or it can be a disaster. It's a real mixed bag. It just depends on the staff and their training. One thing that can be helpful is to find out what your child's receptive language is. A child with very low receptive language can look pretty quirky and can easily be misdiagnosed as something else.

Good luck!

OP here, checking in for the first time in a while. I actually think his receptive language is quite good, though I don't know where it is supposed to be. He understands quite a lot, thoughnowhere close to everything as some of my friends state about their similar aged kids, though not sure if that's an accurate assessment on their part either. In any event, I tihink I may call EI or a developmental pediatrician to get on the calendar.

[Anonymous]

I have 3 children, ages 9, 5 and 3. I cannot tell you the number of times I really had to trust my gut, and really push to be the best advocate for my children. My middle son was briefly evaluated at 4 by FCPS early intervention. We did this as there were quite a few social/emotional concerns (very rigid play, lack of eye contact, major difficulty with any changes in the day or transitions, just to name a few). We put in for early eval when a county social worker working with other children in his class suggested it to his teacher on numerous occasions. In any case, this first year, they had some concerns, but he will still within normal range (albeit on the VERY edge of normal). Though he had quite a few traits of Asperger Syndrome, we left it as perhaps these were behaviors he would grow out of.

Fast forward one year, to when he was 5. Teacher suggested we start early intervention again one month into school. We had things on the radar already. This time, one year later we had no issue having him found eligible once they ordered the full range of testing. In our case that was speech/language/hearing-passed, cognitive-average-above average, observation by county psychologist (saw many concerns, suggested the observed behaviors were suggestive of Asperger's), and many questionnaires filled out my myself and his preschool teacher. The end result was his social/emotional development scores were WELL below normal, around 2-5%ile for his age. Ultimately he was found eligible for Special Education services. The actual eligibility meeting took 10 minutes.

So my advice is, go ahead and start the early intervention process. You may or may not make it past local screening (at least that was what they called it for Child Find, we were beyond the Infant Toddler program age) the first time, if you are looking at mainly social/emotional issues, but it sounds like you had some other concerns as well. For us, we started in November last year, and Eligibility was not until April.

Like your child, my son can be social, in particular with adults. Once we pay close attention to it, we realized it was always on his terms/interests. He got a few months of service in his preschool, and has an IEP for K this fall. GL

[Anonymous]

13:01, do you mind sharing in general what supports Fairfax is giving your DS in K? We have not been satisfied with what's been offered for our SN DS (also starting K, and kicked out of private preschool for behavioral problems).

[Anonymous]

13:01 here. Happy to share. He will start K this fall, so short of the few weeks of preschool services he got at the end of the year, I cannot speak to how well the IEP will be implemented. I will say I was very impressed with the K and Special Ed. Staff who I met at our IEP meeting (held at his K school).

All goals are social/emotional. In summary, they deal with eye contact, completing non-preferred tasks, responding appropriately to peers (ability to focus on different topics), sportsmanlike behavior.

He will get 2 hours/day (10 hrs. week) of Sp. Ed services

Also listed as accommodations are

Clearly Defined Limits/Expectations
Group Size (listed separately for testing also, I assume this means small group)
Visual Cues

They also ordered an OT evaluation once he starts school.

Lastly, the IEP committee will reconvene 1 month into school to determine if needs are being met. HTH

[Anonymous]

Getting back to OP's original post, I think the issue is that many, many small boys are obsessed with light switches, DVD buttons and doors. In fact I would go so far as to say that this is almost a developmental stage. It can't be considered a "sign" of ASD. We've all focused in on the notion that the OP's pediatrician has said that the boy can't be social and have ASD, but really, sit back and look at what the so-called symptoms of ASD are here -- they really are not there.

[Anonymous]

13:01 here again. I agree with the PP, sorry if my response to another poster took this thread in another direction. I believed my response was to another poster, and did not think about the original post. For my son, his most pronounced deficits are social (eye contact, peer and adult interaction, extremely rigid). It was not until he was much older than OP's child that these deficits really began to become very apparent. Many of the behaviors he has were "typical" until he reached an age where most if not all were growing out of these tendencies that the teachers, myself, and the county evaluators felt he could not cope without intervention. That said, he can be social at times, and in fact, with certain familiar people, very much so. This, combined with a strong desire for joint attention (ie. mommy, look what I made) has our Dev. Ped to put our ds on the spectrum just yet. We have the IEP in place, and are keeping any eye on things. Plus, she seems very knowledgeable regarding the changes in the DSM, so will be keeping us updated.

I think, from experience having 2 children who have developed typically, and one who did not, there is a marked difference. That said, I am still unsure whether we will receive an ASD diagnosis ourselves. For now, we are working on the deficits he has. But, we did not have any intervention at 16 mos, as in our case, there were not any sufficient delays to warrant intervention. In fact, thinking back to 16 mos, I do not believe I had any concerns.

[Anonymous]

Thanks 1301, that is really helpful. Does the iep specify
whether the special Ed help will be in the general class vs pull outs?

[Anonymous]

13:01 again. It does not specify on the IEP, though we did talk about it. They indicated that his hours would be mixed between in-class assistance and pull outs for things like social skills, or small group. I am curious to see how it all pans out when he starts. The teacher at his K came to his private preschool this Spring twice to observe him/talk to his teachers. I do not know if this is the norm, but I really appreciated that they made an effort to get to know him. I think the reason they added having the IEP reconvene after 1 month into school was to see if the way we set it up was working. Fingers crossed.

[Anonymous]

My ASD DD7 is described as "socially motivated."

[Anonymous]

I'd like to add one thing to this discussion, directed at the parents who are arguing over what symptoms are indicative of which disorder and who are referring to DSM for the answer. At the end of the day, DSM is not the result of conclusive scientific research that ties the etiology of a disease to its symptoms. The causes of these disorders are unknown, and therefore the categories in which DSM and its subsequent versions have subdivided them are completely arbitrary classifications based on educated guesses by a committee of psychiatrists.
There is a New Yorker article entitled "The Dictionary of Disorder" (http://www.newyorker.com/archive/2005/01/03/050103fa_fact) which depicts the process whereby DSM-III and up were developed, and on the whole it's not pretty, and it's definitely not science. It would not be surprising at all if many of these labels go the way of the the oedipal complex when the molecular roots of these problems are finally elucidated someday. Here's a telling excerpt from the article:

...There was just one problem with this utopian vision of better psychiatry through science: the “science” hadn’t yet been done. “There was very little systematic research, and much of the research that existed was really a hodgepodge—scattered, inconsistent, and ambiguous,” Theodore Millon, one of the members of the DSM-III task force, says. “I think the majority of us recognized that the amount of good, solid science upon which we were making our decisions was pretty modest.” Members of the various committees would regularly meet and attempt to come up with more specific and comprehensive descriptions of mental disorders. David Shaffer, a British psychiatrist who worked on the DSM-III and the DSM-IIIR, told me that the sessions were often chaotic. “There would be these meetings of the so-called experts or advisers, and people would be standing and sitting and moving around,” he said. “People would talk on top of each other. But Bob would be too busy typing notes to chair the meeting in an orderly way.” One participant said that the haphazardness of the meetings he attended could be “disquieting.” He went on, “Suddenly, these things would happen and there didn’t seem to be much basis for it except that someone just decided all of a sudden to run with it.” Allen Frances agrees that the loudest voices usually won out. Both he and Shaffer say, however, that the process designed by Spitzer was generally sound. “There was not another way of doing it, no extensive literature that one could turn to,” Frances says. According to him, after the meetings Spitzer would retreat to his office to make sense of the information he’d collected. “The way it worked was that after a period of erosion, with different opinions being condensed in his mind, a list of criteria would come up,” Frances says. “It would usually be some combination of the accepted wisdom of the group, as interpreted by Bob, with a little added weight to the people he respected most, and a little bit to whoever got there last.

Because there are very few records of the process, it’s hard to pin down exactly how Spitzer and his staff determined which mental disorders to include in the new manual and which to reject. Spitzer seems to have made many of the final decisions with minimal consultation. “He must have had some internal criteria,” Shaffer says. “But I don’t always know what they were.” One afternoon in his office at Columbia, I asked Spitzer what factors would lead him to add a new disease. “How logical it was,” he said, vaguely. “Whether it fit in. The main thing was that it had to make sense. It had to be logical.” He went on, “For most of the categories, it was just the best thinking of people who seemed to have expertise in the area....

...During the production of the DSM-IV, the American Psychiatric Association received funding from the MacArthur Foundation to undertake a broad reliability study, and although the research phase of the project was completed, the findings were never published. The director of the project, Jim Thompson, says that the A.P.A. ran out of money. Another study, whose primary author was Spitzer’s wife, Janet Williams, took place at six sites in the United States and one in Germany. Supervised by Williams and some of the most experienced diagnostic professionals in the world, the participating clinicians were given extensive special training before being split into pairs and asked to interview nearly six hundred prospective patients. The idea was to determine whether clinicians faced with the same client could agree on a diagnosis using the DSM. Although Williams claims that the study supported the reliability of the DSM, when the investigators wrote up their results they admitted that they “had expected higher reliability values.” In fact, Kutchins and Kirk point out, the results were “not that different from those statistics achieved in the 1950s and 1960s—and in some cases were worse.

Reliability is probably lowest in the place where the most diagnoses are made: the therapist’s office...

Read more http://www.newyorker.com/archive/2005/01/03/050103fa_fact#ixzz1VDygk3x0”

[Anonymous]

Anonymous wrote:My ASD DD7 is described as "socially motivated."

same for my ASD DS6! He "wants" to socialize, but he has a hard time doing it.