Diagnosing high functioning autism in an older child

[Anonymous]

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?

[Anonymous]

We had a neuropsych done with Stixrud for this and some school concerns that did not present until high school. (DC was 16 at the time.) It was very helpful and they were very good at determining that my DC's behaviors were due to anxiety. (They did agree that DC was "near" the spectrum but has several social traits that ruled it out from a diagnostic standpoint.) Anxiety meds and CBT brought us much progress in the behavioral stuff and I only wish we had gotten better advice years earlier when we had sought it.

[Anonymous]

What type of doctor is prescribing the meds for anxiety, and how was it diagnosed? Depending on how long ago the evaluation was or how thorough, it's quite possible it missed an autism diagnosis. It's not unusual for anxiety and autism to be co-morbid. And like ADHD, autism in girls often gets missed until later.

You could see a developmental pediatrician or do a full neuropsychological evaluation with a psychologist. An additional evaluation, might be helpful in understanding issues that aren't addressed through medication. It may also be helpful if your DD needs additional support in school.

[Anonymous]

Thanks for the responses. The meds were prescribed by a psychiatrist, and the therapy has been provided by a clinical psychologist (mainly CBT). Unfortunately, there is still a significant amount of anxiety and right now the therapist is very concerned about the social problems (which we had always thought were due to social anxiety). The main thing is that my child is not doing well despite the meds and therapy. The other thing suggested by the therapist was a social skills group (which she had said in the past wasn't a good fit for him).

[Anonymous]

I think it would be worth pursuing if behavior is getting worse, so your kid can get proper support, especially at school.

David Black or Ivymount Outreach might be helpful in finding a social skills group.

[Anonymous]

Girls are diagnosed later and present less typically, so if this were a daughter I'd certainly pursue it. It seems from your post that you have a son, though.

It's possible it's HFA, but it seems to me (and of course all I know is what I read in your post) unlikely, especially if your son is 12 and has been in school and working with therapists and nobody has ever raised this as a possibility AND you're reading about ASD now without any bells going off. I'm not discouraging you from an eval because maybe there are other issues it might tease out, if not HFA.

Have you tried other therapists? It sounds like your child is not responding to her strategies and therapy, and she's searching for some answers--it might be worth trying someone else too.

[Anonymous]

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.

[Anonymous]

It's quite possible the anxiety was more pronounced than any signs of autism. It's also possible the awkwardness stems from other types of LDs. I would have a neuropsych evaluation if you haven't had one in the last 3 years.

[Anonymous]

On the empathy issue this might be helpful.
https://www.autismresearchcentre.com/project_1_empathy

Remember that diagnosing ASD is to a certain extent subjective. It's often based on an interaction test called ADOS and parent and teacher evaluations or interviews.

There are some well respected autism experts that have said they would rule out ASD in a child with a very good or sophisticated sense of humor but I don't know if this is something that is typical or well known.

What is an atypical case? How would that present according to the therapist?

[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.

This sounds much more like ADHD to me. But it can be comorbid and there is a lot of crossover.

[Anonymous]

Did you try different meds for anxiety? Some kids respond to Zoloft, others to Prozac, etc

[Anonymous]

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.

[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.

This sounds much more like ADHD to me. But it can be comorbid and there is a lot of crossover.

Would ADHD cause social awkwardness?

[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.

This sounds much more like ADHD to me. But it can be comorbid and there is a lot of crossover.

Would ADHD cause social awkwardness?

It can. So can anxiety.

[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.

NVLD is not longer in the DSM.

OP, It's possible that your kid might be diagnosed with Social Communication Pragmatics Disorder. Kids diagnosed with this can seem socially awkward b/c responding to others in social situations is difficult.

If your kid has anxiety it's very possible that other things were masked by the overwhelming aspect of the anxiety. I'd do have a neuropsychological evaluation if you haven't had one in the last 3 years.