If it isn't AS, then what is it???

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Hi All -

I'm new and hoping that maybe someone can help me figure this out...

I have two boys, one 15 NT, the other 10 NOT NT....but what is he??? He has been dx'd by a pediatric neurologist and child psychatrist as mood disorder and AS. The neuropsych says he doesn't test AS. the neurologist says the neuropsych is full of cr@p.

Here is his story:

Hit developmental milestones for speech and walking, sitting, etc. except was late with toilet training. Still avoids having BMs which causes all sorts of problems.

Has never been able to join a group of kids - would prefer to play next to the kids. Wants desperately to have friends.
Is very affectionate to me and my husband a little
Makes eye contact and can maintain a conversation
Becomes completely obsessed with stuff, way more than other kids
Can't name his feeling beyond Great and I want to kill someone. As he's getting older, if something happens that makes him feel not great, he goes right into I want to kill someone mode and have a violent meltdown.

He can be rude and pushy BUT he is never intellectually mean on purpose. I say intellectually, because he will try to punch someone for hurting his feelings, but he wouldn't plan a witty comeback or intentionally hurt someone's feelings.

He doesn't seem to mind a change in schedule if it is for a preferred activity, but he still may melt down afterward. (so he won't complain, he'll just melt down)

Anything that would cause most people to feel anxious will cause him to rock and likely meltdown. If I ask him if he felt anxious, he would say no.

If people are noisy around him and he doesn't like it, he starts to rock or get off task and may eventually melt down. After being exposed to a very noisy place he will come home and need quiet. However, he can make noise and that's just fine.

The neuropsych says bipolar but he does not:

need less sleep (ever!)
Have pressured speech
Behave grandiosly (well maybe, but I'm not sure what is kid stuff???)
Have periods of marked highs

The neuropsych does say that he has signifigant executive dysfunction
In addition he is behind with shoe tying, and other grooming self care things.
His verbal IQ is 130, his processing speed is 88.

I mean, I really don't care or need a label. BUT to get him the right supports and education it would help. What do you all think???

Thanks for your help in advance

I am curious....what is pressured speech? That might describe me.

I'm dealing with similar issues. If not AS then what. Here is my thought process.

I am diagnosed Bipolar and my symptoms present differently than the normal "textbook" definition symptoms. I had to ask my people all sorts of questions on *why* they thought is was Bipolar. So, for your son, keep asking questions. If you finally get an explanation that makes sense to you, then it will be easier to accept Bipolar.

Asperger's Syndrome is only one slice of the pie. It is certainly the most popular term to use, and the most helpful if you go to a library to look up a book. Your son may have another Pervasive Developmental Disorder of some kind. In addition, if he doesn't fit the criteria for Asperger's, he may get diagnosed PDD-NOS, basically "not otherwise specified". If I understand it correctly. I'm hoping some other people reply to your post.

He sure seems to be somewhere on the spectrum, but I though speech delays precluded AS?

There is a term for those on the spectrum who don't fit one category or another.

Pervasive Development Disorder Not Otherwise Specific (PDD-NOS)

I want to point out something. Sometimes people see PDD-NOS as a "generic, catchall" diagnosis, which leads them to think it is less severe or less important than an AS dx. I have read articles and talked to people, and I think PDD-NOS is equally valid a diagnosis in it's own right. I have seen groups advertised for PDD-NOS.

Anyway, I just wanted to make that clear.

When you find out, please let me know.
Seriously, your son sounds similar to my daughter in quite a few ways. She does have an official diagnosis of general anxiety disorder and ADHD - and, at the time we had to switch P-Docs because of insurance issues, they were scheduling speech/language assessments and other observations to give them a few more clues before officially diagnosing PDD-NOS. Our daughter was 4 at the time.
She's 8 now - she still hasn't had a full on neuropsych work up (we have one scheduled for November) and has recieved a "probable" diagnosis of bi-polar disorder. I think primarily because I have an uncle with a history of "manic-depression", which is the old school term for BPD. Myself, I'm not so sure - we recently switched therapists, as my daughter was not making a connection with the last one, and her new therapist has indicated that she's 99% sure that our daughter has Apserger's. She did also say that it doesn't preclude an additional diagnosis of BPD and that the two are sometimes co-morbid.
Like you, however, I don't see her have "down moods" - although, in some of the reading that I have done, depression in children (which would be the down side of bi-polar) can be expressed as "irritability". She definitely is irritiable - but, that could also be caused from frustration due to Asperger's, I suppose. She also doesn't present as what I would call "grandiose" - hyper, yes, but that could also be due to the ADHD and/or Asperger's too.
Did the neuropsych do observations at school/home as part of the eval? When we were screening neuropsychologist, this was one of the things that was mentioned by the Doc that we finally scheduled with - her take is that for "difficult' cases (which my daughter's is, due to the previous diagnoses and potential for co-morbid conditions) she also likes to add in some observation time so that she can get a better picture of how the child interacts, reacts and manages. She also suggested that we try and video some of her behaviors in the interim, while we're waiting to get in for the neuropsych exam, so that she has more information from which to base her diagnosis on.
So, no real answers from me - we're still searching for answers as well. I like you would like to know if it's one or the other or both, so that we can get our daughter the help that she needs to begin to cope with her situation.

@hutchscott: Definition of "pressured speech" (from http://depression.about.com/od/glossary ... speech.htm):

@Kailuamom, what you're describing sounds a LOT like AS in SOME ways--the fact that he is affectionate with you and his dad, can make eye contact and maintain a conversation is probably what's throwing the diagnosis off.

AS manifests in different ways, and not everyone will have all of the symptoms. Also, he's already 10 years old--maybe you socialized him really well. My mom did that with me, thankfully.

If you want a "second opinion," do what I did: take an online AS test (in this case, you'd probably answer the questions for him--I don't think there's an online version for children. As such, all of the questions might not apply, but it may help point you in the right direction):

http://www.piepalace.ca/blog/asperger-test-aq-test/

There's also this one (it's much longer):

http://www.rdos.net/eng/Aspie-quiz.php

No, these are not 100%, but maybe it would give you a better idea.

PDD-NOS is also a possibility, and no, it should not be treated like a "throwaway" category that's not that serious.

I'm not a parent, and I only have a B.S. in a Psych-related field (Psychobiology) but hopefully, this helped a little.

Good luck to all of you. Let us know what you find out.

Take care.

Thanks for all of your feedback.

The 1st P-Doc who diagnosed him is an Aspie who has a bipolar/aspie son.

The pediatric neurologist who he has seen said that he has both or at least a mood disorder and AS and he thinks that the neuro psych relies too much on tests. He said to me that if you have an elephant with a funky tail, there will be some people who will look at the elephant and say, that's not an elephant because the tail isn't right. He said, you have an elephant with a funky tail. He's not textbook anything, but until you address these issues his meltdowns won't get better. AND he is not in favor of piling on the bipolar meds.

DS did not have a language delay. When I look at the DSM I go both ways...sometimes yes and sometimes no. Because his sensory stuff gets so much worse when he's anxious, the OT says he doesn't truly have sensory issues.

It is really difficult, the more opinions I get...well, the more DIFFERENT opinions I get.

The part that doesn't seem bipolar to me, is that the lack of cycling. He has had two distinct periods that could be a bipolar episode. But, both of those were caused by a bad reaction to a medication. I understand that this is often an issue with AS, that some people are more sensitive to meds than others. My kids gets every side effect possible,. So, I'm still not convinced that those episodes weren't caused by the meds.

Other than those two periods, he has meltdowns that are radical and violent (that's why everyone is saying bipolar) typically the meltdowns are caused by, an accidental surprise bonk or scare (like a ball hitting him in the head on the playground) or anxiety or frustration.

The thing that kills me is he just can't seem to communicate the anxiety or frustration until he is at meldown level.

Story of my childhood. I didn't get an AS diagnosis until I was 15 because my father would lie about me to psychiatric professionals and school officials. I would say that your son has AS, but I don't want to make an armchair diagnosis.

If you can get your son the needed support with PDD-NOS alone, then go for that. Bipolar is a strange diagnosis for your son, and I would fight it if it seems wrong to you. I would look at anxiety disorders instead. They can cause anal retention and rage attacks in boys.

OK - Took the test and he got a 39, it says over 32 is aspie or HFA. Here's the thing though, I answered questions based on my observations not based on how he would answer. For instance... I make new friends easy. Well, he doesn't, but he would answer that he does because he's completely unaware. When he is near kids he doesn't know, it is very hard for him to make friends. I wonder if his answers for the neuro psych were like that?

My daughter is only 7 but her Dev Pedi explained that we need to be very watchful for signs of BPD as a co-morbid. She explained that with BPD in youth there are not the pronounced swings as you would see with adults. They are much harder to see. As I understand it and as another poster touched on these are all pieces of a great big puzzle, many pieces being intertwined. Many of the ASD, BPD, ADHD, OCD, SPD are all co-morbid as so many these kids have pieces of some of the puzzle. In my opinion you can get so caught up in what it IS exactly that you miss the whole point: what will help your son. It doesn't matter what you "call" it the ways of dealing with it are the same. Get your son the supports he needs so that he can learn to deal with and compensate for the different way his brain is working. Pardon my bluntness but no two kids are the same and no label will tell you exactly what's wrong. You have to be the detective and learn what will help him.

IMO, that's bull****. That's the way it works for me too.



He's probably holding it all in. Again, very much like me. Mine came out in the form of nausea and inability to eat.



The test is designed for adults, who are presumably more self-aware of these things than kids. I'd say you did it right.

Take the results to the neuropsychologist and discuss them with him.

Bottom line: what Mama_to_Grace said is absolutely right. You know your child far better than anyone else, and I'd say that you will also know better than anyone else what will help him.

Also: if you can avoid meds for him do so: not only do they react differently on every person, using them on kids is still very "chancy."

Take care, both of you.

Well, first things first, welcome to the forums, I believe this is your first post. Secondly, there are a couple things to address:

Of course the sensory problems get worse when he is anxious. In reality he always has sensory problems, but when he is doing well, he has enough spare energy and capacity to properly deal with the small problems. When he gets stressed out, anxious, and overwhelmed, then he no longer has enough energy to properly deal with the issues. And thus, the sensory problems seem much more problematic. The reality is that the problem isn't any bigger, its just that his ability to handle the problems decreases as he gets stressed out, and that makes them seem like bigger problems.



Your child doesn't sound bipolar to me. It sounds like he has meltdowns, which are nothing more then a reaction to uncontrolled stress. But that is only indicative of the problems associated with trying to stuff a square peg into a round hole. Your child is stressed out, and and acting out because of it, which is typical of autistic children. Meltdowns alone are not enough to qualify for bipolar disorder.


Most likely he can't communicate his anxiety until he is in meltdown because he doesn't know he is getting anxious. Most autistic people really don't know what they are feeling at any given time, and how can he communicate that he is getting stressed out when he doesn't know himself what he is feeling?

Thanks for the replies - I agree with all of you!

Unfortunately, if you have a label to work with, appropriate interventions are easier to get in school. Personally, I don't care if we have a label or what it is, if it helps me help my child. That said, if he is bipolar with no comorbid developmental disorder, he would be put in an ED classroom with the kids that have BP, Conduct Disorder and Oppisitional Defiant Disorder and PTSD. That is a BIG concern! My child is not capable of dealing with the overt disrespect and defiance and I believe it would cause more meltdowns not less. Unless of course he figures out how to follow that behavior to make friends If he's not in a meltdown he is a nice, respectful kid. So.... Do I care what the label is, not really. Do I think it is important as I walk this journey and get him help - yep, I do.

The sensory stuff - I totally agree. I was stunned when the OT said what she said. She was horrid in a bunch of respects though. After our IEP meeting, I asked the principal if she could be removed from out IEP team, the principal replied that she was removed from our school!

The meds are a fine line. My child is 10 years old and #140. When he has a violent meltdown he can hurt people. I am terrified that he may hurt someone or be hurt. Therefore, if meds can help him - we will use them. Unfortunately, it is harder for us to figure out than most. The neurologist who we are seeing at present is pretty good about wanting the lowest possible dose. I think he "gets" what he is dealing with medically. Pediatric neurologists are a pretty small specialty, this Dr has been practicing for 30+ years, I think he has seen a lot.

I think the Pdoc, gets him too - but is heavier on the medication and is less cognicant of the negative impact.

Hope everyone has a good day!

Even if your son is BPD with no co-cormid they can't automatically put him in an ED classroom-they have to educate him as inclusively as possible (the least restrictive environment). They need to be able to tell you WHY they want to segregate him from the other children and put him with other ED kids. IF he cannot cope in a mainstream classroom, then what other options do you have? Homeschool or a good private school. That's about it. Trust me, the other non-mainstream classrooms are just as "bad" as the ED one-try to get him mainstreamed as much as possible.

Thanks Mama -

Because he becomes violent - I don't have much of a chance at inclusion right now. I believe that the appropriate choice would be a non-public option. That said, with the violence, it would be really easy for the school to push label based choices - neither are great. I recognize that the IEP must be individual - that said, if I don't have the labels "right" how can I expect them to get the interventions right? When I look at the student profile of the ED options, 100% are ecenomically disadvantaged and most of the kids are in crisis. I don't imagine that kids who have been through that much stuff, fit the profile of what we need.

I'm not saying it's not possible to get it right. What I am saying is that if my professionals can agree on necessary interventions, I am much more likely to get them. Knowing what is up with my child will help me. So "a rose by any other name will still smell as sweet" (means labels don't change what something is) but A rose planted in the snow will not bloom (means that you still need the right place to thrive, no matter what it's called, and without a name it's harder to figure out the appropriate environment).

Homeschooling is not an option. DS would never be able to focus for me, I work full time and provide the medical benefits and DH travels for a living.