Asperger’s disorder

By on August 30, 2012
My 3 year-old son has been diagnosed with Asperger’s Disorder. Can you help him?

This is a common inquiry in recent years. Some parents and adult patients believing these kinds of children are gifted almost enjoy having been told they have this problem thinking it makes their child special or gifted.

In children who clearly have some kind of problem, however, it may actually be more of a way to deny having a more uncomfortable mental illness diagnosis like depression or attention deficit disorder. As in all psychiatric illnesses, there is no test to prove someone has Asperger’s (psychiatric diagnoses are based on a subjective evaluation of symptoms and/or behaviors), and the criteria for Asperger’s (i.e., marked impairment in social relations, often with stereotyped motor movements, and a vast or savant knowledge of some esoteric topic) are usually not really met. In addition, the incidence of Asperger’s is extremely low (about 3-4 in 10,000) compared with other disorders whose symptoms overlap with Asperger’s (i.e., ADD/ADHD which may affect up to 10% of children). In addition, the reliability of a diagnosis like Asperger’s is poor because the diagnostic criteria (behaviors and symptoms) for Asperger’s overlaps with so many other possible diagnoses.

On examination, most of these children have symptoms suggesting ADD or ADHD, some have depression or anxiety, and some a shyness or awkwardness that may be normal or may evolve into social anxiety disorder later in life, on rare occasion some do look like high-functioning autistic children, but there is still no way to prove a diagnostic label. The symptoms of these more common diagnosis, i.e., inattention, low mood, shyness etc. is the likely cause of impaired social relationships. The challenge is to get parents or adult patients to accept having a diagnosis other than Asperger’s. Only treating the symptoms can really ascertain what other symptoms that could be Asperger’s might remain. Otherwise it would be like making a first-time diagnosis of asthma in a child with pneumonia.
Giving young children a working diagnosis is ok, but the parents need to be clear this does not mean this is what their children will seem to have (or had) when they are older and we can see their longitudinal course. Once a child gets a diagnosis in their educational record, it tends to have a life of its own as definitive, and neither parents, educators, or even psychologists or psychiatrists, endeavor to change the record.

Dr. Berger and his staff  at the Meguro Counseling Center in the Shibuya-Ebisu area provide mental health care for individuals, couples, and families, in both English and Japanese.

The discussions herein are meant as general information and advice only. Each person needs to make their own personal life decisions and to contact a mental health professional for consultation if deemed appropriate. Send your comments to:

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