Autism & Asperger's Syndrome Expert Forum
ASD or mood regulation disorder
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ASD or mood regulation disorder

Dear doctors!

My son is 4.5 year old, was diagnosed with ASD in April 2008 (one 2-hour evaluation), now he is in special ed 50%/50% environment; he was qualified to get help because of Developmental Delays. School district did not feel that he falls into "Autism"category..During the testing he got many of difficult questons right while missing very easy ones.....Thing is - he has good vocabulary, and knows letters, numbers, can sight read, and draws better than many children of his age.....Only it is really hard to get him to sit down and do work, he is not motivated to "show off" his skills for adult's approval. He also lacks social skills like sharing and taking turns, but always very eager to play and loves when people come over and visit him. He does engage in imaginative play, although sometimes it becomes repetitive.....he have lots of gestures and facial expressions, can be very dramatic and almost theatrical.....He likes to "play" with words and uses lines from cartoons at times...Not excessively though...He has exceptional memory.....His special ed teached does not see ASD in him. They still use everything they would use with ASD child to help him with transitions and social skills, but she is inclined to attribute most of his problems to anxiety. My DH has family history of mood disorders and addiction as well as anxiety. My son's troubles worsened once we moved and he had to change a pre-school twice (the first one, although very highly rated, went through management change and was closed for safety accidents)

Please let me know if my son sounds like ASD, or whether it is emotional issue? He was diagnosed as mild PDD-NOS, which is catch-all diagnosis....I just do not want to target autism if it is not there......


Thank you in advance
for your help

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Hi, I am a parent of a child on the autistic spectrum.
It is quite possible for a child to be on the spectrum and do well in school academically as well as things like arts.  Although he is very good with things like reading do you think he has a full understanding of what he reads the the story and what the implications of things happening within the story mean?  Can he predict outcomes etc.
Motivation is very hard with children on the spectrum because they don't have the same social rules as we do.  They do not want to perform to get approval from parents or teachers.  They don't care what everyone else is doing, they just want to do what they want to do!  Usually motivating them requires a 'first this and and then that' approach, where they would read first and then do something they have chosen as a reward eg. play with lego for 15 minutes etc.
Problems with social interaction are typical.  Not knowing how to make or keep friends.  Wanting to play, but not knowing how to start or sustain it.  Some imaginative play can be seen with some higher functioning children, but there can also be rigidity and repeitive ways of wanting to play where the child might want complete control of the game and would want other children to re-enact something they have seen on TV or to only do or say what the child with ASD has decided is the storyline etc.
If he takes words/phrases from TV or DVDs or films and interweaves them into his speech that is delayed echolalia.  This demonstrates a language processing difficulty, but also shows alot of intelligence to be able to put those phrases into his speech rather like putting a puzzle together.
Does your son have normal voice volume, intonation and pitch.  Does he speak with an accent or a monotone voice?
Those things you mention I would recognise in my own son.  So I'm not sure why the special ed teacher does not recognise these things as being on the spectrum.  If your son is at the milder end of the spectrum he will be very capable in some areas, and then be unable to do other things we might consider quite easy.
Anxiety is very typical of being on the autistic spectrum.  The more structure, routine and predictable outcomes there are the less the anxiety and stress.  He maybe showing alot of stress at school because they are not making his daily timetable and work highly structured because they think he is too able.  But the anxiety would indicate that he does infact need the structure.
I think that whether he had a diagnosis of autism, aspergers or PDD NOS the approaches they use are the same.  Anxiety is also very high in these disorders and the more his school and teachers understand that the better.  Does his current school have any other children on the spectrum and do they have experience and expertise in autism?
Sometimes it does take a while to see how your child is developing and where the difficulties are more obvious.  He is 4.5 now.  If he is having difficulties with social interaction then he really needs a Speech and Language Therapist to be putting together a social communication programme for him.  He needs to be taught how to make and keep friends.  He needs an adult to be supporting and modeling behaviour for him during break times.  He needs to learn appropriate language.  He needs supports such as lunchtime clubs and 'circle of friends' etc.  He needs to be taught how to share and take turns.  If he is doing well academically his school may not recognise the difficulties he is having in these areas, but he won't learn these skills himself.
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470168_tn?1237474845
My post was so long, I put it in two parts!

We have just completed my son's IEP.  He is 7.5 years and is at a mainstream school which has alot of experience of autism and also has an autism unit.
My son is verbal, but tends not to initiate conversations or ask for help etc.  On his IEP they have set targets whereby he has been given some picture symbols that he has been taught how to use.  The teaching staff are going to set up situations where he will need to ask for help to make sure that he is able to either ask for it verbally or use the card to request help.  Once they are sure he can do this to one nominated adult, they will generalise that learnt skill to other adults so that he can ask help of any teacher or adult within the school.  
They are going to help him to learn to initiate social interaction by sending him at least twice a day to give a simple message to another teacher, or they may send him to another teacher to ask them a simple question such as 'what is your name'.  
Later on they will need to teach him how to hold a two way conversation.  How to understand if the person you are talking to is interested in what you are saying.  How to listen to someone else even if you think what they are saying is boring.  How to take turns in conversation etc.
These are all very basic skills that children pick up very early in life.  But if your child does not have them, he has to be taught them.  Does that make sense?
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Thank you for your input

We do have social skills, initiating and sustaining play, joining play, and 3-4 conversation exchanges, and even using right verb tenses etc. goals written in his IEP
They work "social chat" training into their snack time - they are passing the juice, crackers etc. They have visual timers, picture systems, visuals, schedules, "first-then" boards,everything you can think of. They use discrete trial and other behavior management techniques. They pretty much have everything I was looking for.
Teachers appear very knowlegeable.....

He does not have any trouble asking for help - we taught him that by putting all of his toys up where he cannot reach them and he has to ask us to retreive an item every time (although he is very impatient at times - I try to make him wait a bit longer). He finally understands waiting in line and taking turn concepts.
He shares ok (well - better that some NT children who came to his B-day party), although sometimes gets very fixated on certain toy and then sharing is a problem. He has no rigid rituals, only sensory things and picky eating. He answers "when"and "where"questions most of the time, and can predict outcome in stories when I read to him, it is a lot harder for him to do at school during circle time
The area he has the biggest trouble with - telling me about his day at school (unless something extraordinary happened, like he managed to **** off a boy who usually bullies him, or they had some quests coming in, or if he was particulary pleased with what I have packed him for lunch). He also engages in avoidance behaviours in his special ed class - but it is getting better.....

Long story short - he will need to be taught those skills indeed, I would like to start some supplemental support for him (other than school), but not sure whether I should use behavior management systems or rather things specific to ASD......We had a funny thing with visuals - where we were teaching him to ask for something when he was little (3 y.o) - visual was "I WANT"card - anyway, I was asking him to do something and did not look at him - he pulled the card out and got with it in my face:) I am not big on eye contact either - it is a cultural thing:)
Well - anyway, we get IEP report card tomorrow (and they did set metrics that they will be able to quantify) - so goals are measurable:)

Good luck with your son - sounds like he has some pretty dedicated people working with him
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Avatar_f_tn
About tone of voice - he speaks in a normal pitch, and there is nothing monotonous about his speech (maybe a little bit the other way - very theatrical and dramatic)

He does rhyme words a lot, and the rhyme is almost always something he made up. He makes up words a lot, he "stims"with words, but also has pretty big vocabulary of useful words.
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470168_tn?1237474845
From all you have posted it sounds to me like he is on the spectrum.  Of course he will develop, learn skills and improve.  There is always the possibility that a child can improve enough to lose a diagnosis.  But remember that losing a diagnosis usually means losing supports.
It sounds like your son is getting the right kind of supports, because they do use similar programmes for children on the spectrum, with social communications problems, semantic pragmatic disorder, ADD/ADHD etc.
As he grows up you will begin to notice where his difficulties lie at any one time.  For example he may struggle with a certain social communication skills or the whole of the year (or years).  Then he will suddenly master it and you will move onto the next most obvious difficulty he has.
Just try to work with what is happening at the moment.  For example if he has no interest in other children there is no point pushing that.  But as soon as he begins to show an interest then you can start working in that area.  You just have to wait for the windows of opportunity.
He sounds like he may be very good and precise with language, which is good from an academic point of view.  But his expressive understanding may be greater than his receptive understanding.
During things like circle time at school, there may just be too much sensory information coming in for him to focus.  It is easier on a one to one basis.  In a group there will be any number of sounds and sound sources, smells, visual distractions, auditory information, touch and close proximity of other children etc and it may just be too much for him.
In situations like that (school assembly) my son wears ear defenders, which he will ask for himself.  He also has Irlen symdrome and wears the tinted lenses for that which help reduce visual over stimulation.  It can sometimes help to give them something to fiddle with ie. a small piece of theraputty.  He may need any carpet time instructions repeated to him one to one by a teaching assistant to make sure he has heard and understood what he is supposed to be doing.
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Sally44

You are a special parent of a very special child - he is so lucky to have you:)

Thank you do much for your input - you have a wealth of knowledge

Just got first IEP report card back - made some progress on some goals, significant progress on 2 out of 10. He has being in that school only for 1.5 months. They anticipate meeting his goals by the end of the year. I am very excited.

I may have some more questions for you as we learn and grow

Good luck with everything:)



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