Is My Kid Ok?


Q: My son is a 2nd-grader. He seems far smarter than average, but the school complains he is inattentive and disruptive. He likes school but has no friends and even gets teased by the other boys at times. He doesn't seem unhappy, but I worry because he has no interest in sports or friends. He spends all his time with Pokemon cards, organizing them, collecting them, drawing pictures, talking and fantasizing about them. How can I get him to have a better balanced social life?

A: From what you describe, your child may fit the definition of Asperger's Disorder.

Asperger's at its most basic refers to a condition where the child has trouble understanding what other people think and feel. They do not pick up on social cues including body language and facial expressions. Consequently they seem "odd," "eccentric," "left field." They tend not to have peers as friends. Adults generally accept and like them better, so they tend to gravitate toward adults. They usually stand out most in instructional situations with groups of children. Many prefer being alone and are uninterested in friends.

Asperger's is classified as the highest functioning form of autism, but there is no great certainty that there is much of a connection. What has been classically called "autism" is a very extreme condition as compared with Asperger's.

Children with Asperger's share a range of communication deficits, but there is still a broad range of personality styles. There are intellectual strengths and weaknesses that make each person with this disorder different. Asperger's is often more a "personality style."

The typical child with Asperger's has normal to above average intelligence, is clumsy and has poor handwriting skills. When excited, he may resort to repetitive hand flapping or other similar repetitive behaviors. Verbal skills are normal. The range of interests is very narrow. Lack of social skills is very apparent. They have trouble integrating information. Consequently, they focus excessively on otherwise unimportant details and do not see the big picture. Verbal communication with other people — even children — requires a lot of very fast integration of material with which these children cannot cope. That leads to avoidance of others and easy frustration and anger when they feel "not understood." They may seem somewhat robotic at times.

An excellent book for parents and teachers is Tony Attwood's "Asperger's Syndrome," which includes an Australian Scale for Asperger's. Some examples of behaviors measured on that scale are: lacking understanding of unwritten rules of social play, making personal comments without realizing they are offensive, lacking empathy, needing excessive reassurance when things go wrong, having no interest in sports, not understanding figures of speech such as "looks can kill." The speech can sound strange, monotone or nasal. They have trouble with all transitions. They can fall apart when there are unexpected changes. They frequently like science or math. They can have excellent long- term memory for esoteric things such as phone numbers and train schedules. They frequently focus on special interests to the exclusion of others and can be very boring in their wish to tell others all about these interests in extensive detail.

Many of these children have sensory integration problems. For example, they can't tolerate certain sounds, being touched, how clothes feel, seeing certain things, crowds and food textures. Some can ignore low-level pain.

What to do? Have an evaluation first by a child psychiatrist. In this area, definitive evaluations are done by TEACCH. Common diagnoses that look similar are receptive-expressive language disorders and combinations of various learning disorders. The disorders that frequently overlap are Attention Deficit, Obsessive-Compulsive, Bipolar and Tourrette's Disorders.

The major intervention is teaching social skills. This is done in every part of the child's life at home and school. In general, direct, concrete, immediate and frequent interventions are necessary. Schools must be on board. Allowances have to be made for eccentric behavior, helping prepare well ahead of time for any transitions, constant teaching and reinforcing of social skills, dealing with meltdowns and patience with unwillingness to learn what is expected as opposed to what they want to learn.

There is no one medicine that treats Asperger's, however, three broad categories of medications can be helpful. The first group is medications for ADD. The second group is the antidepressent/anti-anxiety medications called SSRIs. They can help with anxiety, taking the edge off overactive behaviors, and help with relaxation in social situations, as well as treating depression. The third group consists of atypical antipsychotics that can help with OCD-like behaviors, impulse control, meltdowns, letting-go, making transitions easier and social relaxation. The overlapping disorders should be treated if they significantly interfere with adjustment and development.

If your child has any of the characteristics of Asperger's, I would seek an evaluation. These children can grow up to be well-adjusted, successful adults with families and productive lives.

Please submit your questions to "Is My Kid OK?" via e-mail to clearpixel.gif Gerald Taylor, M.D., is a psychiatrist with Moses Cone Behavioral Health Psychiatric Associates. clearpixel.gif
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