Monday, November 16, 2009

Weighing in on Asperger's

With the DSM-V powers-that-be thinking about removing the Asperger's diagnosis from the DSM next edition, it's time for all of us to weigh in our two cents. Here's mine.

The Asperger label is critical to the people who are diagnosed as such. With the label, researchers can more readily target them as a group for study and treatment. Employers see the label and understand the constraints. Therapists see the label and can get right to work on appropriate therapies.

Let's look at it. There are 3 categories of autism that make a difference to me when I treat children:

- True autism with it's social and communication issues.

- PDD-NOS - a form of high functioning autism in which children can get rid of many, many symptoms with multiple therapies to the degree that you can no longer tell that it's autism.

- Asperger's - the other form of high functioning autism with good language skills, the desire to interact with others and a lack of understanding social rules (making interaction very challenging).

The authors of the DSM complain that it is difficult to distinguish Asperger's from autism and that that is the reason that the diagnosis can be removed. I disagree. A child with Asperger's has very good language skills (and in fact can be a chatterbox). Also, he/she lacks social skills in a different way than a child with typical autism does. The child with autism does not typically care to have social interaction and is content in his/her world. The child with Asperger's desperately wants friends but is often clueless on how to get and keep them.

These are easily observed differences. I say leave Asperger's in. And by the way, the same set of arguments are going to apply to PDD-NOS. Leave it in, too.

On another day, I'll talk about the impact of sensory, modulation, ADHD and obsession/compulsion comorbidity.


Marla J said...

What are your thoughts on teaching SPD 6 year olds about self-regulating their voices? One of my daughters is having some trouble in this area. She's one of those very emotional SPD kids, very smart and very tactile sensitive, poor motor planner, etc. We can manage her sensitivity to loud noises with headphones, etc, but she seems to have little ability to regulate herself.

Teresa said...

Does the loudness come from excitement and anxiety or from not hearing how loud she is? If it is the hearing, you might try a sound therapy program (Therapeutic Listening, AIT, Samonas, etc.) to see if it helps her to auditory processing. It can also help with anxiety.

If it is anxiety, you may want to look into the source, which could be touch and auditory sensitivities (like above), food allergies, or a variety of other things. Food intolerances such as milk commonly cause anxiety. A doctor I work with recommends stopping milk (including butter, cheese, whey and yogurt ... read labels) for 2 weeks.

Marla J said...

It's hard to tell...she seems unaware of how loud she is being until it is pointed out to her, generally when she is playing or excited. She mentioned to me that other kids have pointed out to her that she's very loud

Teresa said...

The question I forgot to ask is have you had her hearing checked. Does she have ringing in her ears. Hearing loss and/or tinnitus can make it hard for a person to regulate their own voice.

Marla J said...

She hasn't had anything beyond the regular school testing that they do...we've started talking about it more and I think having some awareness has helped, "Sophie do you know you're being loud now?" type of it's pure emotion.

Now I just have to get the other one to get her 'motor running' right.

Teresa said...

It's great that pointing it out to her is working. Have you heard of the Alert Program "How does your engine run?" (I mention it, because it sounds like you are using it for your other child). That could be adapted to work with Sophie. You or a therapist could work with her on making her track her volume level while playing an exciting game. As she gets real excited, she's going to have to track her voice level and keep it calm. Doing that about 5-6 times should do it, with just occasional reminders afterward.