DS ADHD Diag...Confusion?

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Hi All,

My 7-year-old 1st grade son was diagnosed this fall as ADHD. His history is very typical to that of someone with an Asperger label. I would appreciate anyone reading this novel to offer any insight or help. I feel lost.

He didn't crawl until he was 1 years old. He talked early with great detail, having he ability to have conversations with adults early on. He knew everyone's eye color at two (as in people who were no where around but were friends). He had an amazing memory/observation ability from early on. He could tell me what shape every button, vent and handle was in a car, including where they were located. Very photographic. He knew every family member and friend's car interiors in memory, along with their tail lights. He could tell me who had matching taillights and whose were different by outlining them in the sky.

At one he was into garage doors. At two he was into his imaginary friends and playing with them in an imaginative state. At 3 his interest became maps...he would hold his globe and type in a location on google earth to learn about it and observe. At 4 he was into contact lists, knowing addresses, phone numbers, etc., of many people, giving them a contact. He would also type pretend contacts based off of locations he knew how to spell. Ex. "Hawaii Texas" as a contact. At 5 he moved on to cars, Chevies in particular.

You get the point...

At 4 he also started flapping his hands and pacing back and forth about 10 feet fairly often. This behavior continued into the school year of Pre-K. I asked teacher about it and she noticed. She said he did it during center time b/c he didn't know how to be a kid in the centers. He wanted to talk to her the entire time. This teacher loved him and got him. She said that he was so beyond his peers in so many ways that he was gifted. He had one really close friend--a girl--that he got along beautifully with that year, continuing into kinder.

We took him to a Pediatric Dev. Specialist for observation. I had a hunch he might be Aspergers. He previously attended OT as a toddler for pulling out his hair, wrapping it around his fingers and sucking on his fingers. Odd I know. The OT worked AND I did a ton at home to give him other oral sensory fixes. He was dismissed. The Dev. Specialist had us fill out paperwork, along with teacher. She spent over 1.5 or so hours with him. She told us that he was extremely intelligent and needed to have a full neuropsych done at 7. She said he was NOT Aspergers b/c he was too "silly." ??? She noted that his fine motor skills were terribly behind and recommended OT again.

During OT the next year I heard every diagnosis in the book from different therapist...off the record of course. One said he was definitely SPD. Another said he was PDD. Went back 6 months later to same Dev. Specialist doc. DS was very hyper and nervous, pacing the room the entire appointment in circles. He had NEVER done this before. She mentioned NLD and ADHD as a future possibility.

Kindergarten he did well in school. He seemed to have plenty of friends when I'd be in the class. Everyone seemed to like him fine. He was still best friends with the little girl. At recess he'd sometimes play pretend things with a group of kids, and other times he'd prefer to be alone. He told me he liked to walk around and think. He told me that other kids think "thinking" is boring, but to him it's fun. We had him tested at the end of kinder for the gifted program. His score came back crazy low. Red flag low.

First grade (this current school year) we moved him to public school, knowing he could handle it. He loves it. We decided to do the NeuroPsych full eval like doctor told us to when he turned 7. Plus the test score was strange at end of last year. During the last 2 years I had chalked up his quirky behavior to being gifted. When the pre-k teacher told me that I started researching what it meant. It made so much sense regarding my DS. However when he took the test at his previous school he tested exact opposite of gifted. I was so confused again.

Testing with Neuropsych was helpful I guess. DS was extremely nervous, but I selected a doc from the Hoagie's Gifted list. I knew the doc would be good. Well unfortunately he didn't see the doc I selected, but a woman did the work that day. DS was scared but did the testing. Results showed a large scatter in IQ...not at all in gifted range. He was significantly low in Processing speed. His Matrix Reasoning score, on the other hand, was significantly high in the Very Superior range. They diagnosed him ADHD-C and told us on the exit papers that he was not ASD.

He loves public school and is doing well. He has made friends and gets invited to playdates. His interest this year has turned into watching and know all regarding seasonal sports. He also has varied his interests for probably the first time ever. I see him get home and play outside, play some minecraft, draw pics, back to outside, etc. It's the first year for this to ever happen. I should also mention that DS has NEVER gotten in trouble at school. He likes to please his teachers and is a good listener. The ADHD confuses me a little there, b/c he's not one that's ever made waves with hyperactivity, although he does like movement (the pacing to think).

Lately I've been noticing a trend in his behavior that I'm not liking. He tells our neighbor things like, "Have a terrible day." He gets ridiculously angry if he plays a game like basketball with our neighbors and they do better. If he gets out he will chunk the ball far and yell "Cheaters, Cheaters, cheaters!" real angry and loud, and they were not cheating. It was just the rules. He is also hell-bent on fairness like I've never seen. Everything must be fair, which isn't life. He doesn't get this at all. He also doesn't let things go very easily.

On another board for ADHD parents, the feedback I got was that he had more typical Asperger-type behavior and I should go to this board for behavior/social skill help. Do you guys have a kid that sounds like mine or does he just sound ADHD with a touch of the Autistic side? I could go on and on but this is already a novel.

Any suggestions to helping him on behavior? Outbursts and inappropriate humor? Does my son sound just ADHD? I'm over the Gifted thing, b/c for some reason he can't test in. I just tell myself he's ADHD with a more autistic brain that is highly intelligent. I'm not hung up on labels but it does help me to know in parenting. It helps me with research in best responses. I'm so confused to be honest.

Last edited by mamabear78 on 12 Mar 2014, 3:59 pm, edited 1 time in total.

I skimmed some parts, so forgive me if I missed something important. I think you're getting a bit hung up on the diagnosis. Mental health diagnoses are based on clusters of symptoms, and don't necessarily reflect an underlying specific category. Sort of like how the "cold virus" refers to thousands of similar viruses that have similar effects. The fact that your kid has both the ASD and ADHD diagnoses just means that he has issues with socialization and issues with attention. You already knew that without the label, so don't worry too much about the labels.

Regarding some of the behaviors, I think it may be useful to get help from a behavioral consultant or psychologist. You may even be able to get the school to pay for someone to help out with these issues in the home setting.

If you want to try to work on it yourself, it's important to make a bit of a pivot in terms of how you understand the problems. Based on your post my impression is that your understanding of the problem is: X disorder is causing Y behaviors. While this is possibly accurate, it's not really helpful for making changes. A more useful perspective is: he is doing Y behaviors, because he is missing Z skills. Professionals can then help in identifying the missing skills and teaching them to your son. You may also look into getting a book to help guide you, like this one: http://www.amazon.com/Training-Children ... ial+skills

Good luck!

Edit: That first book recommendation is focused on teaching specific social skills. If you think the problem may reflect difficulties in coping with anger and problem solving, this workbook may be helpful: http://www.amazon.com/Stop-Think-Workbo ... gy_b_img_y . It's really designed to be used by a psychologist with a child, but it's got some good exercises in there and it might give you some ideas.

Thanks so much for the reply.

He actually has never gotten an ASD diagnosis. In fact I've been told he doesn't have that twice now by professionals--Dev. Ped. Specialist and Neuropsych. It is confusing in parenting b/c when I read about ADHD in particular a book by Russell Barkley (the guru) I don't find a lot of info that sounds anything like my child. So, while I'm not hung up on labels for the purpose of him having one, it would direct me better in knowing where to go for parenting.

I will look into the books you recommended.

I do agree with you and worded it wrong--he is missing some innate social skills, causing him to have the reactions and behaviors he possesses. That's why I would like to know where (books, net, etc.) to direct my parenting research journey.

So, I'm confused "they told us on the exit papers that he was ASD" sounds like a diagnosis to me. In what other way can this have been intended?

I just can't follow, I'm afraid.

Sorry, I can see why you are confused. I edited my novel just now. I forgot a word.

The neuropsych eval said specifically he was NOT ASD. I believe they included this b/c I had given them his history, including going to pediatric dev. specialist b/c we suspected Aspergers at age 4-5.

Not to be too nosy, but what tests did they use to measure his behavior/performance (not the ones filled out by you and teachers)?
For example - it sounds like they did the WISC-IV for the IQ?

Did they do any attention measures? CPT-II, NEPSY - tower test, TEA-Ch, SCAN-3:C, etc.
Did they do any ASD measures? ADOS-2, SLDT-E, or any other measures of his behavior/social interactions
Did they do any academic/achievement measures? WIAT-III, WRAT-4 etc.

Thought it might be helpful for better understanding the dx or lack thereof.

As for the rest... welcome, and yes, it sounds as if you and your son would fit right in around here. So if you have any questions or other comments, (we don't really care if you have a dx or not - at least I don't - and I know many others feel the same), and you want some understanding comments and advice, give us a try.

Thank you so much for the welcome and reply. I will look up later for you when I have info in hands if I can find it all.

Here's what I do know: at 5 when he saw the Pediatric Dev. Specialist I'm not sure what all she did. We (husband and myself) were in the room the entire time she talked to my son. It seemed to me that she just interviewed him, getting to know him better. They had great rapport first appointment. She also had him draw some things on a testing paper, finding he couldn't cross his midline, etc. I know from that she saw the poor fine motor issues.

At 7 at the Neuropsych: WISC-iV. The results greatly surprised me. He really did pretty poor, and he is so bright. He had a scaled score of 18 on the Matrix Reasoning subtest, putting him in the 99.6 % (I think that's correct). Most surprisingly was his overall Verbal Comprehension Index score and subtests: very average to low. He is so ridiculously verbal, high vocabulary, etc. I guess that's the ADHD.

I know they did some computer attention test as well with stimuli that flashes on screen I believe? I do NOT believe they did any ASD tests at this appointment. I'm remembering tests about Auditory Processing Disorder (he did fine on this) and something else. Nothing talking about Autism.

In the diagnosis they said ADHD-C with severe symptoms. It confused me to be honest b/c he has never misbehaved in school. I say this knowing that ADHD is NOT misbehaving, but at the same time, if he had combined type most teachers would certainly view him as being disruptive. That's just not him. He's more quirky and cute. He loves to talk. He does fidget. His Processing speed was significantly low. His working memory was low average...47% I think.

While I can see the ADHD in the area of forgetfulness, procrastination, impulsivity, and processing, I don't see it in some of his more reactive behaviors. Where Aspergers has been a little harder for me to pinpoint is the fact that he doesn't have the stereotypical awkwardness that one reads about. I say that b/c I'm realizing maybe that is just a stereotype to some, but not all aspies.

Anyhow, I appreciate any help. What I want to do is best treat any social skills that he might need as he ages to best help him with life long skills in this area.

You would be surprised (or not) at what characteristics some clinicians think preclude a diagnosis of ASD. I am assuming you had high level tests, but would also think it would help to know which ones, as Eureka_C said. It is very possible that there is one or two stereotypical traits your son did not have that made them decide not to give the ADOS.

Sometimes something as simple as having one friend, liking to snuggle, or having "too much" eye-contact can make a person decide not to take ASD seriously as a possibility.

That's very interesting. He has never struggled with eye contact or cuddles. He has never seemed to care much about friends besides one little girl until kindergarten. He primarily played with his one friend or alone but made a neighbor friend too. This school year he all of a sudden cares about friends. He seems to get very embarrassed by me. I thought that happened with NT's around 4th grade at the earliest.

At 5 he was on a soccer team. He never spoke to one teammate the entire season. He wouldn't play games at practice...he'd be off skipping in grass. I would get really embarrassed in front of other parents that I didn't know. He would tell the coach "no thanks" when it was his turn to play in a real game. We once saw a teammate at a playground and he ran up to her and played with her the entire time, yet he never spoke to her during practices or games. Today at 7 he is on a flag football team and besides being uncoordinated he seems normal socially.

"Seeming normal, socially," can be misleading. Again, that could keep a clinician from delving into it. Probably to adults, I seemed socially normal, growing up. I did not have the same number of friends as peers, they were mostly opposite sex friends, and I did not do normal social things, at least not well. Disclosure: I am undiagnosed, but have no question in my mind that I am AS and was informally diagnosed as such by one of my son's diagnostic team members. (Milder on some days than others, though)

I am not trying to push you in that direction. I just want you to know that there is a wide band of possible social behavior possible under the ASD umbrella. I would be very curious if they elaborated on why your son is definitely not AS and if he was even screened for it properly, given your concerns.

I agree with you from what I'm learning. Here is what it says (found eval from this fall):

"DS has reportedly demonstrated some atypical behaviors such as motor mannerisms, odd interests, and odd social behavior (such as preferring adults over children and interacting with peers less frequently). While these types of behaviors are often seen in children with an autism spectrum disorder, DS demonstrates significant strengths that are counter0indicative of an ASD, such as strong social interest, appropriate social skills and use of verbal and nonverbal skills in social interactions; these strengths are not present in children with an ASD. DS does not have an Autism Spectrum Disorder."

*****

So from what I can tell there was no testing done to determine that, rather from our initial parent interview. However, I'm not well versed in tests. Here is what was used:

WISC4
Bender Gestalt of Visual Motor Integration
Trail Making Tests of the Halstead-Reitan Neuropsychological Battery
Grooved Pegboard Test
IVA-CPT
Test of APD-Scan 3
Children's Self-Assessment Inventory
Child and Adolescent Self-Rating Scales
Sentence Completion Test

All too many medical diagnosers focus on the social aspects of autism and Aspergers. Yes, a high proportion of us have trouble with social skills and socializing, but not all of us do. Also, even those who do will sometimes socialize to some extent. I am a very non social, hermit type of person, but I do socialize sometimes, when it suits me to do so. I am not really good at it, but I am not living on a desert island. It is necessary to have some social contact with others. I have a "howdy neighbor" policy of saying high and waving at the neighbors. Sometimes a neighbor will stop to chat while passing by. Having bad relations with neighbors can lead to problems, so I prefer to have some minor friendly contact with them all, to keep us all on a friendly basis. Also, I live alone and have health problems, so I want them to be aware of my existence in case of an emergency. Neighbors should kind of look out for each other, at least a little bit. I just read an article on the I-net a day or two ago about a house that was being foreclosed. The foreclosure cleaning crew went in and found the owner dead in the back of her Jeep in the garage. Nobody had seen her for YEARS!! ! And nobody had made any real attempt to check on her. I prefer being alone, but everyone should be at least a little friendly to the neighbors.

Keep looking into what may be your boy's problem. Knowing what's wrong may help you find ways to help him. And do keep visiting here at WP. This is a great site to get autism and Asperger's info, but it's also great for finding help with other conditions also, as many of these are co-morbids with autism and Aspergers's.

Indeed, I've also seen diagnoses go in the other direction, where a kid that does a few odd things winds up with a PDD-NOS diagnosis. I once worked with a girl with intellectual disability, who's sister had been given an ASD diagnosis. This struck me as odd as the girl was very sociable with me, and presented as completely neurotypical. Apparently she had been shy around the diagnostic clinician, and that had sealed the diagnosis.

The problem is that many diagnostic categories are actually very broad and potentially vague, and clinicians only have a limited amount of information to use in making decisions. Sometimes they hand out multiple diagnoses all at once. Sometimes they emphasize the diagnosis that they believe to be primary, and ignore other symptoms as quirks. The scientific research that goes into trying to figure out the mess of human behavior is very complex, difficult and messy. It's got a ways to go before these sorts of problems are resolved.

So as ASDMommy said, these diagnoses can vary for many reasons. If you begin treating for ADHD, and continue to see pronounced social deficits that are impacting your son's ability to make friends or function effectively in school, then it may be worth trying for a second opinion.

Others mentioned the ADOS, which is the gold standard diagnostic tool for autism. I just want to point out that while it's the gold standard, it is usually given after a screener. The screener questionnaires are somewhat error prone (since they try to cast a wide net and err on the side of over-diagnosing), but they're quick and easy. If the screener did not indicate a concern about ASD, then it wouldn't be appropriate to do the ADOS, as it is much more costly and time consuming.

edit: mamabear - I just looked through that list of tests. Some of them I'm not familiar with (or the titles you gave are a bit non-specific), but most appear to be standard psycho-educational tests. It looks like they looked into a lot of specific cognitive functioning, tested for ADHD, and (probably) gave some broad screeners for other mental disorders. I don't see any specific autism screeners in that list. It may be worth asking if they did actually test for autism when they conducted this assessment, as they may not have.

Last edited by EmileMulder on 12 Mar 2014, 7:49 pm, edited 1 time in total.

Thank you, questor, for your reply and insight. I really appreciate insight from anyone on here.

My son is very literal yet very silly social. When a meltdown occurs during a friendly game of basketball or soccer, I think he gets extremely mad if he sees something that is unfair in his mind. We made a make-shift soccer goal the other day for a backyard soccer game. Our goal was on a hill. He yelled "cheaters" to my daughter and a fellow neighbor, while collapsing and yelling after he couldn't make a goal. He likes to make rules for games and holds others accountable, but he can break those rules and rewrite a new one.

My point is that at the social meltdowns regarding sports I think he notices something that the normal joe might not even see or realize that he deems unfair in his mind. Thus when he fails at his next attempt to play he has a monumental meltdown, acting very childish to the NT.

The silly social as I'm labeling it is the rude jokes he makes that most people don't find funny. He will smile big while saying, "have a terrible day." He thinks it's hilarious to say this to a little girl as she walks in her house. He is smiling huge, thinking he just made a joke. She is walking in the house offended, because jokes are funny...that is mean.

Maybe ADHD kids do these things too. I don't know. I think I need to parent these behaviors from a Aspie-parenting standpoint in reference to where I'd find the most helpful info.

My son is also what I find to be constantly disrespectful to me. If he's Aspie-like I'm not sure he's trying to be disrespectful. I also don't know how to handle it. He mimmicks the way I talk often after I've been stern and tells me, "blah, blah, blah...that's all you ever say." I have no clue how the appropriate way to handle this is if he's more Aspergers. If he's ADHD I think he's impulsively reacting with no filter. So confusing to me!

Thank you. That's the thing...I see no reason to treat for ADHD in the manner of meds. He does fine at school thus far. Not saying he will next year, but at the moment he seems to be great. He's in the highest reading group, enjoys school and loves his teacher. His teacher says he is as active as all the other boys...very typical.

I feel like my son is one that blends in well for the most part. He has a way of getting to know his teachers in the areas of physical education, music, etc., b/c he likes to discuss sports teams and colleges. He is very passionate this year about teams, and he will let everyone know if he is for or against your team (UGH). I know he talks all the time with his PE teacher, b/c he is not into her team. So in some ways he stands out, but as for everyday in the class I believe he blends.

Now at home I see issues. I have been more scheduled with time deadlines for him which has helped. At 4:30 he has to do his homework if he hasn't already. Giving him time expectations has been good for his ADHD. I have also bought some supplements which I read good things about. Not sure if I'm buying into something ridiculous or if they help, but I'll try it. Focus Factor vitamins and these orange squeeze packs of Omega 3.

I found this pdf that may be helpful in general. It includes a section on social and emotional development as well as some good general parenting advice that may help with some of your problems.

http://www.kidsmatter.edu.au/sites/defa ... Pack_0.pdf

and here's the resource page:
https://www.kidsmatter.edu.au/primary/r ... nformation

If you need something more in depth, I'd recommend looking for books about positive parenting or positive discipline, like this one:
http://www.amazon.com/The-Power-Positiv ... 1567131751