Asperger's syndrome and ADHD

[BananaHammock]

Is there anyone here who has been diagnosed with one or both of these? Does anyone have a loved one with one or both?

My eleven year old son was diagnosed at 4 with high functioning autism/asperger's syndrome. It has been tough but he has been able to function in a "normal" classroom setting with limited modifications. He has always done well academically but has had problems with the social dynamic. Now that puberty has started to set in we have started to have some serious problems. His behavior became very unpredictable (trying to leave school, running away from home, making threats against me, stealing and mood swings) and we had him admitted to KU Med, here in the Kansas City area. It was hard but he had become a real threat to himself and is old enough now that I don't want to try to physically restrain him. He is doing well and is feeling better. The doctors seem to think that he has ADHD on top of everything else. I kick myself for not seeing it. His younger sister has that and, with the right meds, is doing very well now. We can't wait till he gets back home.

[BananaHammock]

My son comes home tomorrow. He is now receiving meds for his ADHD and we will start behavioral therapy.

[Wiry Pyruvity]

is he very rule-bound in his thinking, and doesn't really get other people's humour?

[BananaHammock]

is he very rule-bound in his thinking, and doesn't really get other people's humour?

Yes very rule-bound. He is very black and white. Grey areas cause him to become very frustrated.

He does get some humor but most of the time he is just faking it when people make jokes.

[Suzy Brown]

My neice, my BFF from high school's son, and my current BFF's son all 3 have Aspergers. Another girl I have known my whole life, her son too. Its maddening to see these poor kids, robbed of their potential, and just as sad to see the parents struggling to give their all.
Only 1 out of those 4 was able to get his more under control with Aderol (sp).

[Suzy Brown]

I'm very sorry to hear that your life has been so upset by this UK.

[BananaHammock]

My neice, my BFF from high school's son, and my current BFF's son all 3 have Aspergers. Another girl I have known my whole life, her son too. Its maddening to see these poor kids, robbed of their potential, and just as sad to see the parents struggling to give their all.
Only 1 out of those 4 was able to get his more under control with Aderol (sp).

Me and my wife believe our son will be able to have a very productive and meaningful life. He will never be "normal" but we know he has the ability to live and function in the "normal" world.

[Suzy Brown]

I doubt my neice will ever be able to live alone, or be able to hold a job. She looks normal but can't really have much of a conversation, answer questions, look a person in the eye. She's intelligent tho. She reads chinese and is very good at math.

[BananaHammock]

I doubt my neice will ever be able to live alone, or be able to hold a job. She looks normal but can't really have much of a conversation, answer questions, look a person in the eye. She's intelligent tho. She reads chinese and is very good at math.

My son, for an aspie, is a people person. It is good and bad. It drives him to be part of the group, to seek out relationships but those same relationships can cause him a lot of frustration.

[Suzy Brown]

That's one of the things about Asperger's -- lots of foibles and every kid is different.

[Tatyana]

I have had to do a bit of research into Aspberger's and Autistic Spectrum disorder for my psychology degree.

My neighbour is an educational psychologist, and for a number of years, children with autistic spectrum disorder were her main focus, so she did help me understand more about this condition.

Here is the essay I wrote a year or so ago, hope this helps.

I can also ask her if she is aware of any good support groups.

You should also make sure that he is seen by an educational psychologist, they will make sure he gets the additional tutoring that he needs in school, and that he isn't excluded from mainstream classes.



Autistic spectrum disorder (ASD) is a troubling developmental disorder (Frith, 1989), ranging from the ‘classical’ infantile autistic disorder, through semantic-pragmatic disorder to Aspberger’s Syndrome (Bishop, 1989). The presentation of ASD is widely varied between autistic individuals, and variation of the symptoms within an individual may occur over their lifespan. Etiological origins for autism are rare, there is no widely accepted biological marker or ‘medical’ diagnostic test, and there is no known treatment (Baird et al, 2003). This enigmatic disorder is on an increased occurrence in its diagnosis (Baird et al, 2003). In 2003, the National Autistic Society estimated that one in eighty six children have ASD in comparison to one in 2500 five years ago (Webster, 2003). Recently MMR (measles, mumps and rubella) immunisation was thought to be responsible for this increased frequency. The outcome of the media exposure of one scientifically and statistically invalid paper with the author having conflicting interests has resulted in a decreased uptake in MMR immunisation. The concurrent increased infection with these previously controlled childhood infections may actually lead to a further increase in ASD. Prenatal intrauterine insults, such as maternal rubella infection, is one of the few known causes of autism. Rubella, as well as maternal anticonvulsant therapy, the genetic disorder PKU (phenylketonuria) and post natal brain infections (encephalitis) have been found to be responsible for six to ten percent of the cases of ASD (Baird et al, 2003).

Autism is defined medically as a behavioural disorder, characterised by observable impairments in social skills such as interpersonal interactions, communication and imagination, repetitive behaviour and mannerisms and frequently a heightened sensitivity to sensory or environmental stimulus (Baird et al, 2003). Common to all individuals with ASD is a lack of empathy for others, or the inability to infer the thoughts and motivations of others. This characteristically human ability, known as the theory of mind (ToM), was first described by Premack and Woodruff in 1979 (Smith and Stevens, 2001), and developed into the Sally-Anne Experiment by Wimmer and Perner in 1983 (Frith, 1989). This and the ‘Pen in the Smarties box’ are thought to be a measure of ToM and used in the diagnosis of autistic children. (Frith, 1989). The subsequent development of similar tests for young people and adults with ASD, such as the ‘Strange Stories Task’ and ‘Reading the Mind in the Eyes’ Test. While these tests have revealed mind-reading difficulties, they have also resulted in ceiling effects that does not reflect the lack of social understanding in ‘higher functioning’ autistic individuals and individuals with autistic spectrum disorder (Heavey et al, 2000).

The intention of this paper is to critically review the research conducted on Awkward Moments Test and its usefulness in the diagnosis of ASD in adults and any possible further information it may provide into the etiology of autism.


The Awkward Moments Test, a new measure of ToM in adults, was being developed and investigated, the modified Strange Stories Task was also performed. The Strange Stories Task has been used clinically and in research for a longer time, and was used to compare, correlate and basically, as an ‘overall’ control for the experiment. In addition to the two ToM tests, psychometric (IQ) tests were performed on each of the participants. Fatigue effects were considered by performing the series of tests in the same order. While the test (n=16) and control (n=16) population was not large, they were age, sex and IQ matched to a very high order, where possible, within the constraints of the disorder. A significant difference in the comprehension and reading comprehension was noted, however the reading and comprehension abilities of individuals with ASD is a well documented feature of the disorder. This confounding variable (and others) was addressed in the statistical analysis employed ANCOVA, or analysis of covariance.

The Awkward moments Test is a series of 8 short video scenarios, mainly derived from British television commercials, each having a control and test question with four possible multiple choice answers. Great care was given in the design of the test. Order effects were considered and the video clips were run from 1 to 8 or 8 to 1 for equal numbers in both the control and test group. Consideration was even taken for the randomisation of the correct answer on the computer screen, it appeared twice in each of the four possible locations over the course of the test.

Ethical consideration in selection of participants was also paramount as IQ testing was performed. The regression extrapolation of IQ from the short WAIS-R test revealed that some of the participants had an IQ far below the average score of 100 (Eysenck, 2000), the minimum being 58 and 76 for the test and control groups respectively. While great detail was given for the design and methodology of the actual Awkward Situation Test, only information on where the control group participants was given, not any specifics as to how they were approached or briefed. This information, included in an appendix, may have been useful for researchers interested in replicating the experiment, as finding an appropriate sample population is often one of the most challenging tasks in research.

Care was also taken to ensure that previous exposure to the commercials used in the analysis did not result in a confounding variable. The results of the analysis supported the experimental hypothesis, that individuals with ASD would not perform as well as the control group on the ToM measures in the experiment. These results were found to be highly significant, it may be stated within 99% certainty (p=0.001) that the differences in the mean number of correct answers between the test and control group was not due to chance. A significant difference was also found with the response time to the questions, both groups took a longer period of time to answer the test questions (ToM questions) rather than the control questions. The authors also claim to have found a correlation between intellectual ability, based on WAIS-R test, and ToM performance. However, in this analysis, and despite the rigorous matching of the participants, two of the test or ‘autistic’ participants, and two of the control or ‘normal’ participants were excluded on the basis of having the lowest or highest IQ scores, respectively. The exclusion criteria was not made clear. The valid statistical method usually employed is that scores or measures that lie three standard deviations from the mean may be excluded from analysis. This criteria was not met, and the authors note that this correlation should be viewed with caution. The Strange Stories Task predictably revealed that the autistic group would not perform as well as the control group on the ToM measures. Pearson’s correlation was also performed to examine the relationship between the two ToM tests. While the control group demonstrated a slightly better correlation, that is the responses were more similar for each of the three measures considered, the two tests did not exhibit any significant correlation.

The small number of individuals may be forgiven when the high level of matching of the control and test groups is considered. The number of individuals that would have to have been tested for selection in the study would have been far greater than the number of individuals included in the study. The Awkward moments test will prove to be useful in its naturalistic approach in the diagnosis of adults with ASD. A larger study population, including more participants with Aspberger’s syndrome, may be useful in a research capacity, and assist with the understanding of the very subtle differences in the mind-reading abilities of people with higher functioning autism and Asperger’s. The experiment also revealed that the test group demonstrated a significant difference in their ability to answer two of the nonsocial control questions. The researchers suggest that further manipulation of the control questions in the Awkward moments test may further reveal some of the cognitive differences in autism.

One of the ethical responsibilities in developing any new diagnostic test is the impact that the diagnosis will have on the individual. Not only may the test be applied inappropriately, and be used as a measure of intelligence or as an educational or training tool, it may also make a diagnosis where no previous diagnosis of autism existed before. The introduction and increased use of ToM tests may have been responsible for the increased incidence of ASD, or it may just be revealing a current epidemiological trend. In either case, is it appropriate or moral to diagnose more cases of ASD or subtle cases of ASD. Applying a label that implies a deficit to individuals who have been able to function fully in society despite their social difficulties raises a number of ethical questions. The old adage, ‘if is it not broken, don’t fix it’ may apply.

At one point in time, autism was thought to be the result of neglectful parenting and was termed frozen mother or ‘refrigerator’ mother syndrome (Frith, 1989). For these families, the discovery of a genetic link for ASK must have provided a welcome relief to the stigma ‘it was something that I did wrong that made my child this way’.
Critical thinking, and subsequent thorough examination of the scientific and statistical rigor of research is an essential skill that needs to be taught to more people. If more people are trained in this type of literacy, the agony of the blame in ‘refrigerator’ mothers and the more recent MMR scare may have been avoided.









References
Baird G, Cass H, Slonims V, Clinical Review: Diagnosis of Autism 2003 British Medical Journal 327: 488-93

Bishop DVM, Autism, Asperger’s syndrome and semantic-pragmatic disorder: Where are the boundaries? 1989 British Journal of Disorders of Communication 24: 107-121

Eysenck M, Psychology A Student’s Handbook 2000, Psychology Press, East Sussex pp 762

Frith, Uta Autism, Explaining the Enigma 1989, Blackwell Publishers, Oxford pp 1, 159

Roth I Chapter 6 The autistic spectrum: from theory to practice 2001 IN Brace N, Westcott H [eds] Applying Psychology, The Bath Press, Bath, pp
243-307

Smith B, Stevens R, Chapter 2 Evolutionary Psychology 2002 IN Miell D, Phoenix A, Thomas K, Mapping Psychology, The Bath Press, Bath pp 126

Webster A, Research into Practice, May 2003 1-7, http://www.communitycare.co.uk

[Youngguns]

I just went through the check list.

Not pick up on social cues and may lack inborn social skills, such as being able to read others' body language, start or maintain a conversation, and take turns talking.
Dislike any changes in routines.
Appear to lack empathy.
Be unable to recognize subtle differences in speech tone, pitch, and accent that alter the meaning of others’ speech. Thus, your child may not understand a joke or may take a sarcastic comment literally. Likewise, his or her speech may be flat and difficult to understand because it lacks tone, pitch, and accent.
Have a formal style of speaking that is advanced for his or her age. For example, the child may use the word "beckon" instead of "call" or the word "return" instead of "come back."
Avoid eye contact or stare at others.
Have unusual facial expressions or postures.
Be preoccupied with only one or few interests, which he or she may be very knowledgeable about. Many children with Asperger's syndrome are overly interested in parts of a whole or in unusual activities, such as designing houses, drawing highly detailed scenes, or studying astronomy. They may show an unusual interest in certain topics such as snakes, names of stars, or dinosaurs.2
Talk a lot, usually about a favorite subject. One-sided conversations are common. Internal thoughts are often verbalized.
Have delayed motor development. Your child may be late in learning to use a fork or spoon, ride a bike, or catch a ball. He or she may have an awkward walk. Handwriting is often poor.
Have heightened sensitivity and become overstimulated by loud noises, lights, or strong tastes or textures. For more information about these symptoms, see sensory-integration-dysfunction[[COLOR="Black"]URL="http://www.webmd.com/hw-popup/sensory-integration-dysfunction[/URL]. [/COLOR]

I think I have it too.

[Youngguns]

Here is an all natural alternative that is non-addicting, almost NO side effects and produces a much better result for your child with ADD or ADHD.

[Dr Pangloss]

I have a brother with genius IQ and 2 PHd's but his Aspergers gets in the way of social capabilities. He lives with my MOM and helps her out so I guess that's a plus. He drives, does alot of things but his "peculiar" demeanor puts him at a distinct social disadvantage.

it's so sad that in the end, it comes down to that.

[Tatyana]

I have a brother with genius IQ and 2 PHd's but his Aspergers gets in the way of social capabilities. He lives with my MOM and helps her out so I guess that's a plus. He drives, does alot of things but his "peculiar" demeanor puts him at a distinct social disadvantage.

I work with a man like that, PhD as well.

He was hard to deal with initially as I remain quite calm in all the high stress situations at work.

He thought I wasn't concerned about things as I didn't show it on my face or in my voice.

Then I realised he is so clever he has learned to link facial expressions to emotions, so I started to exaggerate mine.

He is fab, one of my fav people in the lab and we get on fantastically now.