Transcript Asperger`s Presentation 12-13

We so often only
diagnose what we
see above the
water, the other
eighty-seven
percent remains
hidden.
William Shryer, DCSW, LCSW
Diablo Behavioral HealthCare
925-648-4800
Danville, CA
www.behaviorquest.com
Mother Goose
• Georgie Porgie, puddin' and pie,
Kissed the girls and made them cry.
When the boys came out to play,
Georgie Porgie ran away.
• Could Georgy Porgie have been
Asperger’s, or on the spectrum?
High Functioning Autism &
Asperger's Syndrome
Asperger’s disorder or “syndrome” is not a new diagnosis,
in fact it was described in the 1940’s. “Asperger's
Syndrome was first identified in 1944, but was only
officially recognized as a diagnostic category in the
DSM-IV in 1994. As a result, many children and adults
were misdiagnosed over the years as ADD/ADHD,
avoidant, Autistic, OCD, or even schizophrenic.” While
Hans Asperger was describing this disorder in Austria,
Leo Kanner was describing something else a half a world
away in Boston. Kanner described Autism at almost the
same time. The two disorders share some symptoms,
but the degree of disability can vary widely.
What is High functioning
Autism?
High Functioning Autism (HFA) is the traditional diagnosis for
individuals with severe social interaction and communication
deficits. Although the distinction with Asperger’s is blurred and
indeed, Asperger’s is often considered a subset of HFA, people
diagnosed with HFA, it was thought, tended to have a much higher
Performance IQ (P-IQ) than Verbal IQ (V-IQ).(this has recently been
proven false)HFA-ers tend to avoid social contact more, but are less
likely to feel embarrassed in social situations, being relatively
unconcerned by other people's opinions. They also tend to have
had slower language acquisition during childhood. They frequently
were late in their developmental milestones. Parent’s of these
children frequently find this true when reviewing their baby books
for information on when their child said their first word, put several
words together, and so forth.
What is Asperger’s Disorder?
Asperger's Syndrome is a neurobiological disorder
that is classified as one of the Pervasive
Developmental Disorders (PDD). It is also known
as being on the autistic spectrum. It is
characterized by “significant” impairment in
social interaction, as well as the development of
repetitive and restricted fields of interest and
activities, however this varies widely from child
to child.
While there are some similarities with
Autism, people with Asperger's usually
have average to above average IQ, and do
not demonstrate clinically significant
delays in language or self help skills.
Shared Symptoms
• Both Asperger's syndrome and autism are characterized by
profoundly disturbed social interactions and inflexible
behavior and can be identified by:
• • Deficits in nonverbal communication, such as facial
expressions, eye contact and body language.
• A preference for interacting with objects rather than
peers.
• Deep immersion in a single field of interest, such as
meteorology.
• Strict adherence to a daily routine.
• Repetitive motions, such as hand flapping or finger
twisting.
• Source: Diagnostic and Statistical Manual of Mental
Disorders (Fourth Edition, Revised.)
Screening Red Flags
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Does not respond to name
Acts as if deaf
Does not smile at others
Does not point or use other gestures by 12m
No babbling by 12m or words by 16m
Talks but does not try to communicate
Loss of any social or communication skill
Shared Symptoms
• Researchers at the MIND Institute and
others that work with these patients see
frequent mood instability.
• Aggressiveness
• Tantrums
• Family histories of mood lability are
common.
• Is there an overlap with bipolar?
They may have an extremely good
command of language and have a very
rich vocabulary, however they are unable
to use language appropriately in a social
context and often speak in a monotone
with little nuance and inflection in their
voice.
This is known as prosody of speech.
Although parents often notice problems at an early
age, diagnosis is usually made during preschool
age or later. While both boys and girls can have
Asperger's, the syndrome is more common in
boys.
Could this be due to a different presentation in
girls? This is currently under review. Could it be
that girls are missed?
Children with Asperger's may or may not
seek out social interaction, but always
have difficulty in interpreting and learning
the skills of social and emotional
interaction with others, leading to
significant impairment in relationships and
peer interaction. They are frequently
bullied and made fun of at school.
Symptoms
• “Significant” impairment in social interaction
• Development of repetitive and restricted fields of
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interest, such as schedules, bugs, dinosaurs,
vacuum cleaners etc.
Sometimes poor eye contact, but not always.
May have odd facial expressions, but not always.
May show inflexible need for a particular routine.
May show odd body movements at times.
Symptoms
• Difficulty understanding the perspective of
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others.
May demonstrate odd behaviors when excited.
May be oversensitive to taste, touch, sound or
other stimulus, such as tags in clothing, nubs in
socks. May be sensitive to loud sounds etc.
Tend to take matters too literally
Ability to use abstraction is impaired.
Likely difficulties
• Understanding cause and effect
• Understanding abstraction and other forms of
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speech.
Making and keeping friends and the likelihood of
being made fun of and treated poorly in school.
Rarely being invited to others parties.
Anger at others for their predicament.
(Frequently directed towards parents)
ANXIETY
• Most with Asperger’s Disorder have
significant distress.
• Frequently bullied at school.
• Often misdiagnosed due to poor training
by those in the Health Care Arena.
• Improper treatment causes symptoms to
increase.
Non Verbal Learning Disorder
• What is nonverbal learning disability (NLD)? Is it a
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distinct diagnostic category?
Nonverbal learning disability (NLD) is believed by some
to be a neuropsychological disability. Although it has
been studied for the past 30 years (by Byron Rourke,
Ph.D. and others), it has not yet been included as a
diagnostic category in the Diagnostic and Statistical
Manual of Mental Disorders, 4th Edition, Text Revision
(DSM-IV TR). Many characteristics associated with NLD
are similar to those that describe other, more
“established” disorders, such as Asperger’s Syndrome
and specific learning disabilities.
• What characteristics are associated with
NLD?
• NLD is usually defined by a distinct
pattern of specific strengths and
difficulties
• Individuals thought to have NLD typically
demonstrate strengths in the following
areas:
• Intelligence quotient (IQ) which is typically
in the average to above-average range. Children
with NLD tend to have verbal IQ scores that
are higher than their performance scores,
(Ozanoff et al recently reported that this is not a
valid predictor) a factor that distinguishes them
from kids with language-based learning
disabilities such as dyslexia.
• Rote verbal and expressive and
receptive language skills, such as the
ability to memorize and repeat a great
deal of information presented to them in
spoken form. They also exhibit early
language development.
• Auditory processing skills, which entail
learning better through hearing
information, rather than seeing it (visual
processing)
• Motor skills, such as graphomotor skills
(related to printing and cursive writing),
physical coordination, and balance is often
problematic.
• Complex conceptual skills involved in
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problem-solving, understanding cause-effect
relationships, and seeing the “big picture” versus
focusing on details similar to Asperger’s Disorder.
Visual-spatial-organizational skills, such as
visualizing information and understanding spatial
relations is frequently a problem area.
• Social skills, such as using and understanding
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nonverbal communication (e.g., gestures, facial
expressions), dealing with new information and
situations, transitioning between situations,
conversation skills, and understanding the
nuances of spoken language (e.g., hidden
meanings, figurative language)
Activity level: hyperactivity (when younger),
and hypoactivity (as they grow older)
Our practice finds that these are the
children most likely to have very high IQ’s
and behave oddly. They are an at risk
population and do need special attention
and awareness by the school personnel.
They meet the criteria for Asperger’s
Disorder but are less likely to have
difficulty with eye contact.
Treatment/Interventions
• Comprehensive history
• This is a genetic neurobiological disorder
that runs in families.
• The apple doesn’t fall far from the tree.
• Parent/teacher/community education
• Treatment of the child/teen and
medications if indicated.
Mood Dysregulation
• Coexists with Asperger’s Disorder.
• Often misdiagnosed as Attention Deficit
Disorder
• The wrong medications and diagnosis
makes the matter worse.
• Can look like Bipolar at times.
Interviewing Techniques
For a child with suspected
Asperger’s Disorder
• Be very concrete
• Do not use abstract examples
• Do not use multipart questions
• Engage them with the area of interest
they have
• Back off if you sense their anxiety rising
We so often only
diagnose what we
see above the
water, the other
eighty-seven
percent
remains hidden.
William Shryer, DCSW. LCSW
Diablo Behavioral HealthCare
Danville, CA
925-648-4800
www.behaviorquest.com