Diagnostic Criteria for Aspergers Syndrome
- Qualitative impairment in social interaction, as manifested by at least two of the following:
- Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
- Failure to develop peer relationships appropriate to developmental level
- A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
- Lack of social or emotional reciprocity
- Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
- Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
- Apparently inflexible adherence to specific, nonfunctional routines or rituals
- Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
- Persistent preoccupation with parts of objects
- The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
- There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
- There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.
- Criteria are not met for another specific pervasive developmental disorder or schizophrenia.
Since Eric's diagnosis, I literally have been liberated. I think because of the validation in my feelings and frustrations I've had in the last 6 months of "not knowing" as we were waiting to see a reputable child psychologist. I feel like I can move forward, especially knowing that it could be a lot worse. Eric is such a joy and though it is hard to believe at first glance that he is an aspie, when you look at the diagnostic criteria, it is obvious (on paper) that he is. I'm just going to go through the criteria and describe Eric in those context...
A1. Eric is described as "serious" by Cris our Au Pair. He also has an incredible ability to relax every muscle in his body which makes him extremely flexible but also make it extremely hard to move him as it is dead weight! He tends to slump over as if he is disappointed in inappropriate times. Like I'll say, aren't you excited about ____, and he'll just slump over like he's depressed and he may or may not answer. We do have problems with eye contact UNLESS it is something that interests him, namely Thomas the Tank Engine, or his favorite board game, book, etc. When I do get eye contact it is hard to maintain it through a sentence. However the "impairment" for this criteria I'm not sure I would describe as "marked." I lot of observations in the past year I have written off as "childish ways" until I began my research once his OT saw his ASD tendencies.
A2. I don't think that this describes Eric. He has 3 friends that he will mention by name when asked to name his friends and those boys love Eric just as much. His only drawback was that he bit his best friend several times before we physically separated them for weeks until he got evaluated for behavioral problems back in December 2006.
A3. This totally describes Eric up until a few weeks ago. Eric was so content to be by himself, play by himself, not needing social approval (and his Dr noticed this too in the evaluation). Now he points out Thomas or trains or racecars or anything with wheels at the drop of a hat. However I've begun to notice lately that he asks me to play with him, sit with him, etc and also asks his dad to as well.
A4. This is probably the most difficult thing to deal with for me. I am the kind of person who needs feedback and conversation and Eric (nor his dad) are naturally inclined to do this. (His dad has learned that that is what I need and has adjusted, sometimes with prompting, nicely to my love language!) However, with Eric, in order to get feedback from him, you often have to pose it in a multiple choice fashion. Ask a questions and offer choices of possible answers. When there isn't a choice, then I usually end my words with "ok?" and repeat that until he says "ok"back. What is hilarious is that now that he is talking more (Speech Therapy is amazing) he ends all of his sentences and requests with "ok?", for example, "Mommy, we gotta play Clue, ookay?" Imagine it drawn out-cracks me up!
So he meets 1 and 2 halves of these criteria in my opinion.
B1. See A3. Anything with wheels (we've caught him watching NASCAR on TV) but mainly trains. Thomas and Friends is his favorite but any train will do. His other obsession is Letters, Numbers, and signs or warning labels especially with the red universal "no" circle with the slash through it, but if it is a sign he HAS to stop to read it. It began with Stop signs at age 2, then went to No Parking signs, to Exit and Enter signs, Men and Women restroom signs, to aisle numbers at the grocery store, to anything that has a Letter or Number on it. Pretty impressive to see a 3 year old read.
B2. He has his routines and rituals that he enjoys. He used to be inflexible and get really stressed out and throw tantrums when he was thrown off schedule, but now with proper explanation and logic he copes much better.
B3. Finger twisting is his thing. I like the way his OT described it....Imagine crumpling up a piece of paper or crumbling a piece of cake, but there is no paper/cake there. (His dad was a hand flapper as a child and as an adult when we first got married but he adjusted - I must have fussed at him enough about it, because I viewed it as rude, but now I know it was a neurological reaction.) He also does complex body movements but I can't honestly say I think it falls under this criteria.
B4. Two things come to mind when I read this. Eric's obsession with strings - pulling and picking them out of clothing, bedding, throw pillow, furniture. Drives me mad! We have fluff falling out of every pillow and my jacquard comforter is "hairy" from all the broken strings hanging out of it. The other thing is his intense fear of buttons, though his dad and I just realized that it might be the button holes he dislikes. We might have to test that theory.
C. The main thing that impairs Eric is his sensory integration issues. He refuses to eat or touch certain colors, textures, patterns. It's like it gives him chills or sometimes makes him gag. He has supersonic hearing and can hear a train miles away but he cannot stand public restroom's loud toilet flushing and hand dryers or anything else that is "too loud." We bought him earplugs but it "tickles my ears, mommy, I'll just use my fingers." I am not seeing a lot of social impairment right now but I can see that without therapy, how it could really be affected later in life especially the adolescent years.
D. True. We actually didn't start seeing "issues" until a few months before his 3rd birthday. The month before his 3rd birthday is when the biting started happening and then shortly afterward it became ridiculously challenging. The only things he really said where repeated words, or sentence structures that we taught him but he didn't start developing his expressive language skills until he started Speech Therapy in March, which worked wonders.
E. True. Very bright at a very young age. We actually would "show him off" to friends and family..."Look what Eric can do..." Even now, his nonverbal reasoning is at the same level as a 7 year and 4 month old (98th percentile of children his age).
F. True. He doesn't meet the full criteria of another PDD. There is a lot of overlap, like with OCD, but typically there isn't a fear attached to not having his routines.
There is so many different nuances about the autistic spectrum and I'm learning them slowly. The good news is that he has had 6 months of therapy and his dr sees him fully integrated by kindergarten!
See A More Down-to-Earth Description by Lois Freisleben-Cook on the OASIS Website at http://www.udel.edu/bkirby/asperger/
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