There was an article (http://www.additudemag.com/slideshow/78/) from Additude magazine about Asperger's often being misdiagnosed as ADHD. I was wondering if anyone has experience with that, or information on it? I did the m-chat when DD was younger and she scored "at risk" but my concerns were pretty much dismissed because she's so outgoing.
I have a friend whose DD was initially diagnosed with ADHD in second grade, and at age 11 was diagnosed with Aspergers. I really wish they had separate criteria for girls.
Post by mrsbuttinski on Mar 1, 2015 11:30:38 GMT -5
It used to happen a lot in the days when Aspergers was new to the DSM-IV R and not many practicing clinicians were familiar with it. It was more common when DS was dxd to have gotten an ADHD dx initially at about 6 and finally get the Aspergers one closer to 11 or 12 after tanking in the intermediate of middle grades.
I think the criteria are the criteria. Clinicians and teachers need to be more observant.
It's more of a challenge because girls with Aspergers are less likely to have the disruptive behaviors that trigger a dx in a boy. Girls, as a group, tend to shut down rather than act out which doesn't always concern teachers.
Girls also, as a group, tend to slightly more socially with it than boys with the same dx. I've seen studies that suggest the IQ of girls with AS is a bit lower than boys with the same dx, so it could be the "little professor" behaviors are not seen.
Also, girls as a tribe will support and scaffold for little girls with AS which can mask their social difficulties until about age 10.
Also, girls with AS tend to have special interests that are less arcane than those boys with the same dx have. They often glom onto reading, horses or other animals which can look really typical until their peers outgrow it.
The criteria don't address things like the meltdowns or nature of special interests.
Girls also, as a group, tend to slightly more socially with it than boys with the same dx. I've seen studies that suggest the IQ of girls with AS is a bit lower than boys with the same dx, so it could be the "little professor" behaviors are not seen.
I have never heard that before. Why do you think that is? Is it a true statement, or is it more a function of girls with higher IQs being able to compensate more and thus eluding the dx? Or conversely that boys with high but not as high IQs would present in different ways, such as a speech delay, that would present more as HFA vs AS?
Girls also, as a group, tend to slightly more socially with it than boys with the same dx. I've seen studies that suggest the IQ of girls with AS is a bit lower than boys with the same dx, so it could be the "little professor" behaviors are not seen.
I have never heard that before. Why do you think that is? Is it a true statement, or is it more a function of girls with higher IQs being able to compensate more and thus eluding the dx? Or conversely that boys with high but not as high IQs would present in different ways, such as a speech delay, that would present more as HFA vs AS?
I was talking specifically to Aspergers- so no delays in speech or adaptive skills and with the usual curiosity about the world intact.
I do think a piece of it is that really bright girls have slightly better social reasoning skills and more peer support early on that can mask it and pass for quirky or shy.
But I also think that when you're looking at IQ scores, the sort of subsets on which those on spectrum excel are the ones where males tend to outperform females as a group- the spatial and block design type stuff. If those on spectrum tend to do better than their same sex NT peers, it stands to reason males on spectrum would score higher. This is kind of in line with Barron-Cohen "extreme male brain" concept.
That makes sense but you misunderstood the point of the speech delay. Suppose a girl has an IQ of 115 and has AS. Perhaps a boy has the same IQ but doesn't have AS because at that IQ threshold he is more likely to have a speech delay, which means he doesn't have AS but rather HFA. Thus the average IQ for boys with AS specifically could be higher than the average IQ for girls with AS specifically.
I'm just talking really. No idea if that is a factor or not.
Girls also, as a group, tend to slightly more socially with it than boys with the same dx. I've seen studies that suggest the IQ of girls with AS is a bit lower than boys with the same dx, so it could be the "little professor" behaviors are not seen.
I have never heard that before. Why do you think that is? Is it a true statement, or is it more a function of girls with higher IQs being able to compensate more and thus eluding the dx? Or conversely that boys with high but not as high IQs would present in different ways, such as a speech delay, that would present more as HFA vs AS?
In my vast research ( and I mean googling constantly for the last three days). Asperger's is less diagnosed in girls (1 in 4 kids diagnosed are girls). One of the theories is basically what you said. They are slightly emotionally more intuitive, so they tend to be able to "fake" social interaction better. They also often tend to be less aggressive and will often find friends that are more nuturing, so sometimes these extreme social issues aren't as blatant. Also, their talents tend to gear more towards hyperlexia and artistic inclinations. Whereas boys tend to do the little professor behavior with math and science. So the typical hallmarks of AS aren't always there in girls like they see them in boys.
Like my daughter, (assuming the AS diagnosis is correct) seems to be atypical in that one of her gifts is in math. And although she is probably hyperlexic (she taught herself to read at 4), her grasp of math and numbers is what really stands out. But on the other hand, her social impairments are REALLY obvious. She may be easier to identify because she doesn't compensate as well as other girls with AS might.
That makes sense but you misunderstood the point of the speech delay. Suppose a girl has an IQ of 115 and has AS. Perhaps a boy has the same IQ but doesn't have AS because at that IQ threshold he is more likely to have a speech delay, which means he doesn't have AS but rather HFA. Thus the average IQ for boys with AS specifically could be higher than the average IQ for girls with AS specifically.
I'm just talking really. No idea if that is a factor or not.
TBH, the OP was about AS and ADHD, so I wasn't considering HFA in the question. Most, but not all the kids I know with HFA, had a speech delay- so they got identified pretty early on. A few others got this because they were particularly aloof or delayed in adaptive skills.
That said, in my small circle of friends who have sons who've grown up alongside DS I've not seen that speech delays related to IQ one way or the other. Some really smart kids had a speech delay and some pretty average ones- like DS- didn't.
Jake* is the oldest, he had early speech and adaptive skills (potty self-trained at 18 months), missed a single question on his SAT, PhD candidate- has always had an Aspergers label
DS spoke as early as Jake, average for adaptive skills, high average IQ- Asperger label
Zack was language delayed, got a 2300 on his SATs- missed 100 points in reading- Autism (HFA)
Aiden, Zack's little brother- speech delayed, pronounced ADHD, learning differences, average IQ- labeled Autism at 3, unlabeled at 5 and labeled Autism again at 8.
Bill*has no speech delay, very bright (attends a selective STEM magnet) labeled Aspergers
Doug has no speech delay, labeled Aspergers, he was identified at 8 when his sister was evaluated for ASD. He's pretty average in terms of IQ, struggled a lot socially and organizationally in high school and earned a GED after dropping out. He takes a couple college courses at a time and seems to be handling them
Bill#2 had a speech delay, and was labeled with Autism. He's gifted (130+ in his district) and kicks ass in math but struggles to read.
Ethan was a super preemie, he had no speech delay and has an Aspergers dx. He's bright average and is currently taking a couple courses at a time at the local community college
Leo* has no speech delay, is pretty average and has an Aspergers label
Teddy had a speech delay and was initially given and Autism dx. He spent elementary in a self contained class where the school gave him an upgrade to Aspergers. He seems pretty bright and is a local chess champion
Teddy #2 has an Aspergers label and pretty average IQ; he was in the 4th decile in his graduating class
FTR- The 3 with an asterisk attended private or magnet schools that preclude IEPs so they never got supports or services in school.
Zev had a speech delay and HFA dx. His IQ was off the charts genius- the kid was doing college level physic in middle school.
Of this group, I would put Zev at the top, followed by Jake and then Zack and Bill #1 and Bill#2.
DS, Leo, Ethan, Doug and Teddy #2 probably all score within one STD dev of each other in the middle; Aiden and Teddy #1 are hard to place- they're younger and their moms aren't reliable reporters.
Sigh. Sometimes the too literal thing makes conversations like this tough.
The question/hypothesis was two-fold: 1) Girls with very high IQs may not be dx with AS (or any ASD) due to superior adaptive skills - thus lowering slightly the average IQ of a girl with AS dx, and 2) Boys with IQs that are high enough to be in range of AS but lower than that of the average AS boy may, for one reason or another (of which a different presentation is one possibility, and of that a speech delay is one possibility) may be dx with HFA or other ASD instead - thus raising slightly the average IQ of a boy with AS dx.
Try not to get bogged down in the specific possibility listed.
akafred, I get what you're saying about girls with high IQs and a little more with-it-ness being able to fly under the radar. If they understand social behavior on a cognitive level they might be able to fit in even if they don't have the intuitive understanding that an NT girl would.
Sigh. Sometimes the too literal thing makes conversations like this tough.
The question/hypothesis was two-fold: 1) Girls with very high IQs may not be dx with AS (or any ASD) due to superior adaptive skills - thus lowering slightly the average IQ of a girl with AS dx, and 2) Boys with IQs that are high enough to be in range of AS but lower than that of the average AS boy may, for one reason or another (of which a different presentation is one possibility, and of that a speech delay is one possibility) may be dx with HFA or other ASD instead - thus raising slightly the average IQ of a boy with AS dx.
Try not to get bogged down in the specific possibility listed.
I will endeavor not to get bogged down. But I have ask why you're so invested in this. Are you looking for some special education gender equality where perhaps there isn't any?
It's pretty well recognized the boys are the more fragile sex- go into any special education setting and do a head count. DS's first grade class of 16 "lost" 5 kids to public and therapeutic schools for sped services- all boys. In 2nd, his class of 10 had 3 girls, in 3rd had a dozen boys. 4th-6th resource was Colleen and 4 boys. In middle school Colleen got booted up to inclusion and the other boys went to a more restrictive learning support group.
To point 1) that could be true of individual boys as well. I'm thinking of my late cousin who got a dx at 40 and my PCP's brother who was over 50.
2) You're assuming, I think, that boys with speech delays on spectrum have lower IQ than boys without. I'm not sure that's true. And a quick stab at google scholar isn't yielding any studies that suggest it either. I have never seen anything that supports this in print or in my personal experience. I'm not a researcher, but I do get a lot of what comes on on the subject.
akafred, I get what you're saying about girls with high IQs and a little more with-it-ness being able to fly under the radar. If they understand social behavior on a cognitive level they might be able to fit in even if they don't have the intuitive understanding that an NT girl would.
IRL, I see a fair number of girls with HFA and Aspergers first identified between 5th and the end of middle school. Often when their peers move onto more mature interests we associate with tweens and teens, these kinds of girls hit a painful wall when they're abandoned socially.
akafred, I get what you're saying about girls with high IQs and a little more with-it-ness being able to fly under the radar. If they understand social behavior on a cognitive level they might be able to fit in even if they don't have the intuitive understanding that an NT girl would.
IRL, I see a fair number of girls with HFA and Aspergers first identified between 5th and the end of middle school. Often when their peers move onto more mature interests we associate with tweens and teens, these kinds of girls hit a painful wall when they're abandoned socially.
That makes sense. Like I said, my friend's DD was diagnosed at age 11. Her SI is Pokemon. Not exactly something that middle school girls are going to be into.
Lol I'm neither invested nor making assumptions about IQs. I am just trying to have a conversation when generally I would have given up by now.
When there is a statement of fact made, like "girls with AS have lower IQs than boys with AS", there are 3 possibilities. 1) This is a true statement with no qualifiers, and that boys with AS really do have higher IQs than girls with AS, or, grouping 2 and 3 together, it is possible that boys with AS don't have a higher IQ than girls with AS but rather boys with an AS *diagnosis* have a higher IQ on average than girls with an AS *diagnosis*, which could be as a result of either 2) There is some factor driving up the average IQ for boys regarding dx, such as being dx with a different related dx for one factor or another, or 3) There is some factor driving down the average IQ of girls with an AS dx, such as those on top of the IQ are not diagnosed or some other factor.
I just find it an interesting stat and like to explore the different angles.
How's she doing now that she's dxd? It's not always easy for find social skills for girls this age. DS's middle school SLP had one girl with ASD; the boys were very dismissive of her as a member of their social skills group. The SLP started a small ADHD girls group, but that wasn't ideal because the girl with ASD needed more instruction around what was expected in addition to self regulation. Her special interest was horses which was OK when she was at the barn. I suspect, like DS, she is more comfortable as an adult than child.
I remember Pokemon. Not uncommon when DS was younger.
She's really struggling. After the diagnosis, her mom homeschooled her for half a year while they were transitioning to a better school district. She's back in public school, but she has severe social anxiety and has been having a tough time. Her mom has a good support system though, and they are able to supplement what the school provides with private OT and social skills groups. Her step-dad volunteers at Lego club at the school because that's the after-school club that she was willing to try. She's a sweet girl, and it makes me really sad to see her having such a hard time.
There are other possibilities. There's a notion that perhaps being female and having two x chromosome is somehow protective against ASD, in much the same way it is for those with Fragile X. Boys with FX are generally profoundly impacted by it, girls might have some mild learning differences. Some feel that ASD might be triggered by something environmentally in utero; a version of the old genetics loads the gun, environment pulls the trigger. Boys having higher IQs might be a function more girls escaping ASD and only more impacted ones having ASD. This might look very much like girls not getting a dx, but it could be because they don't have ASD.
Ot it could be the old theory that what we call ASD is a collection of syndromes that have some overlapping symptoms but different antecedents; this could easily explain why Zev was freakin' brilliant but devoid of any empathy or self control while DS is pretty average but very concerned with preserving an appropriate public image. It's funny, in a lot of respects, DS's ASD presentation is more like one associated with females- he's never been one to tantrum, he's pretty socially curious and observant, he's got the LD piece and he doesn't test well as a rule. His psych and dev pedi were both surprised his IQ comes back where it does.
The other piece is that IQ is not a perfect approach to measuring intelligence. People tend to fixate on a single number. LOL, I always notice moms of kids with AS report their kids' VIQ which should be the higher of the two subscores rather than FSIQ which is generally brought down by PIQ. But an IQ score is a bit like an EDD- it really represents a range. For an EDD it's =/- 2 weeks. An IQ score exists within a standard deviation- any given number +/- 14 points would be pretty much as valid.
I'm glad your friend was able to get a better school placement. The intermediate and middle school years can be hard. Kids are so hardwired for conformity at this age, life can be hard for those who are different. Having a "club" is critical; it provides a layer of protection socially against the worst bullying.
DS got bullied a lot in 5th-9th grades. His scouts and band buddies really helped keep him safe in ways the school couldn't. The first week of middle school a bully came to DS's lunch table and started some shit. A dozen 7th and 8th scouts from DS's troop (who were unknown to the bully as they attended a bunch of different schools prior) stood up and surrounded this kid and shut it down. He never bothered DS again. They were instrumental in helping me shut down the Marching Band FB fiasco, too.
Things got a whole lot better in high school as they do for a lot of kids. It seems like their peers let go of the groupthink and become more thoughtful beings. Most high schools are larger which means the likelihood of finding someone with her interests is greater. I would really encourage her to try an activity like music or drama as she gets older- these are usually pretty forgiving groups that are more socially active and supportive of each other.
And it's important to keep in mind that these are only what is normally seen. Not everyone is going to conform based on gender.
Like I was reading this book called AspienGirls last night. And honestly, my DD doesn't sound as much like these girls they described. They seemed to have more empathy and were more artistically inclined than my DD is.
And it's important to keep in mind that these are only what is normally seen. Not everyone is going to conform based on gender.
Like I was reading this book called last night. And honestly, my DD doesn't sound as much like these girls they described. They seemed to have more empathy and were more artistically inclined than my DD is.
Your descriptions of your DD sound more like a classic male presentation of Aspergers.
The math thing especially. I don't think I know any girls who have math as a special interest- I know a few who are very into music and biology- but not math.
Of all the books on Aspergers and Girls, I like the Tony Attwood one best. FWIW, I am on the mailing list of a couple publishers and get mos of the new books about ASD ahead of release. The Attwood book has an even more impressive list of co-authors.
And it's important to keep in mind that these are only what is normally seen. Not everyone is going to conform based on gender.
Like I was reading this book called last night. And honestly, my DD doesn't sound as much like these girls they described. They seemed to have more empathy and were more artistically inclined than my DD is.
Your descriptions of your DD sound more like a classic male presentation of Aspergers.
The math thing especially. I don't think I know any girls who have math as a special interest- I know a few who are very into music and biology- but not math.
Of all the books on Aspergers and Girls, I like the Tony Attwood one best. FWIW, I am on the mailing list of a couple publishers and get mos of the new books about ASD ahead of release. The Attwood book has an even more impressive list of co-authors.
There was an article (http://www.additudemag.com/slideshow/78/) from Additude magazine about Asperger's often being misdiagnosed as ADHD. I was wondering if anyone has experience with that, or information on it? I did the m-chat when DD was younger and she scored "at risk" but my concerns were pretty much dismissed because she's so outgoing.
Are you still pursuing it? I don't know your story. But does she have an ADHD dx?
Again in my vast (**sarcasm**) experience, many people that don't know a lot of autism, even your general pediatrician, often go based on most basic impressions of what an autistic kid should act like. Even our former daycare provider is in disbelief when I told her that our DD probably as AS because "she's so friendly" and "she makes eye contact."
People just don't understand that for kids with HFA and AS, one of the markers is being OVER zealous about engaging people. The lack of stranger danger and the tl;dr-ing, if you will, with no concept of whether it is appropriate or appreciated.
I have to had to explain to people that, yes she's friendly, but she's over the top and she makes eye contact initially, but usually looks away. She can only make eye contact in short stints.
You know your kid best. So If something doesn't feel right about a lack of diagnosis or the diagnosis she has, push it.
mrsbuttinski, thank you so much for the book rec! I just ordered Asperger's and Girls. Thrilled to see that it is co-authored by Temple Grandin. I just watched her Ted talk from 2010 yesterday and was just so moved.
There was an article (http://www.additudemag.com/slideshow/78/) from Additude magazine about Asperger's often being misdiagnosed as ADHD. I was wondering if anyone has experience with that, or information on it? I did the m-chat when DD was younger and she scored "at risk" but my concerns were pretty much dismissed because she's so outgoing.
Are you still pursuing it? I don't know your story. But does she have an ADHD dx?
Again in my vast (**sarcasm**) experience, many people that don't know a lot of autism, even your general pediatrician, often go based on most basic impressions of what an autistic kid should act like. Even our former daycare provider is in disbelief when I told her that our DD probably as AS because "she's so friendly" and "she makes eye contact."
People just don't understand that for kids with HFA and AS, one of the markers is being OVER zealous about engaging people. The lack of stranger danger and the tl;dr-ing, if you will, with no concept of whether it is appropriate or appreciated.
I have to had to explain to people that, yes she's friendly, but she's over the top and she makes eye contact initially, but usually looks away. She can only make eye contact in short stints.
You know your kid best. So If something doesn't feel right about a lack of diagnosis or the diagnosis she has, push it.
This is what I'm seeing in my kid as well, which keeps prompting me to think that we're going to be looking at a dx soon, and if we don't get one I'm going to be very surprised. She really doesn't have a sense of stranger danger, and she keeps proving that every time she runs up to adults in the grocery store etc. and starts telling them random things about what she has and all. She does it with adults and teens at church, too, but doesn't maintain eye contact for long after it.
And mack, I think we're in a similar boat with the mathematical concepts. My kid isn't adding or subtracting often yet, but within the last 2 weeks she did prove that she can fluently count well past 100, and even started counting into negative numbers after counting backwards. Her interest in math kind of surprised me, but I did notice that she's been taking an interest in numbers, measuring, etc., along with keeping her interest in reading.
Are you still pursuing it? I don't know your story. But does she have an ADHD dx?
Again in my vast (**sarcasm**) experience, many people that don't know a lot of autism, even your general pediatrician, often go based on most basic impressions of what an autistic kid should act like. Even our former daycare provider is in disbelief when I told her that our DD probably as AS because "she's so friendly" and "she makes eye contact."
People just don't understand that for kids with HFA and AS, one of the markers is being OVER zealous about engaging people. The lack of stranger danger and the tl;dr-ing, if you will, with no concept of whether it is appropriate or appreciated.
I have to had to explain to people that, yes she's friendly, but she's over the top and she makes eye contact initially, but usually looks away. She can only make eye contact in short stints.
You know your kid best. So If something doesn't feel right about a lack of diagnosis or the diagnosis she has, push it.
This is what I'm seeing in my kid as well, which keeps prompting me to think that we're going to be looking at a dx soon, and if we don't get one I'm going to be very surprised. She really doesn't have a sense of stranger danger, and she keeps proving that every time she runs up to adults in the grocery store etc. and starts telling them random things about what she has and all. She does it with adults and teens at church, too, but doesn't maintain eye contact for long after it.
And mack, I think we're in a similar boat with the mathematical concepts. My kid isn't adding or subtracting often yet, but within the last 2 weeks she did prove that she can fluently count well past 100, and even started counting into negative numbers after counting backwards. Her interest in math kind of surprised me, but I did notice that she's been taking an interest in numbers, measuring, etc., along with keeping her interest in reading.
Oh yes, Kenz has been measuring things and counting long before she could actually do any arithmetic. And keeping track of dates and how many days until x.
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