Jeremy's World
I put together this page because of my son Jeremy who was diagnosed last year with Autism at the age of 3. He is now 4 and now exhibiting those criteria for Asperger's Disorder as well. He was a premature baby, however developed pretty much in a normal way up until he was about a year old and then started acting "abnormally"..Jeremy became more withdrawn, stopped talking, did not want to be touched or bathed, notable behavior that was bizarre. Family just blamed it on being the baby out of 4 children and him being spoiled. I knew as his mother that there was something wrong. Soon trips into town became serious. He did not want to be around people and visits into public would be very traumatic for him..anywhere but in his bedroom was actually very stressful. Jeremy would only eat or drink certain foods like peanut butter and jelly and chicken nuggets and had to be a certain brand. Potty training was an absolute NO..and at 4 he's still in diapers. Although his speech has gotten better, trips into town to the grocery store are actually a nightmare. He goes into full blown tantrums and often is unable to be consoled unless i am able to divide his focus which is usually nill to none and i just have to leave. Most of the time it just looks like he's an unruly child to most leaving me very embarrassed, but i have to deal with it as i can't leave him at a sitter's or with family member's as i have none to help out. Now with the help of the OK Dept. of Human Services, i've found several resources for help and education for my son's development as well as information for myself and other's that are interested. He will now be able to attend regular school, gets therapy and will be able to function in a normal setting as any other child and i don't have that fear of him being segregated as i did before because he has a disability.
UPDATE 11/08/07! Jeremy is now seeing Occupational and Speech Therapist on a weekly basis and will be going for a re-evaluation on the 21st of this month. He is talking alot more and interacting at home with me and his siblings as well. The Dr. believes him to have progressed to a high functioning Autism level, but we will know more after testing.
UPDATE 4/9/08 Jeremy is now attending regular Pre-School and they are mainstreaming him with a paraprofessional. He's doing pretty well actually and sees the in school Speech Therapist, Special Education Teacher, and has OT and PT Therapy as well starting soon. We've already done his IEP meeting and are geared up for his kindergarten session for next year so they will be able to meet all his needs. I am very excited for this!
UPDATE 1/15/09 Jeremy is now going to full day Kindergarten and doing really well. All his therapist see him at school and they are also working on the "potty training gig"..He had an IQ test done a week ago and scored up to a 9yr old which i'm extremely please. Jeremy is also quite the artist and hope to show some of his drawings here!
UPDATE 8/30/09 Jeremy has started the 1st grade successfully and is attending a school that meets all his needs. I'm extremely please so far. Will see how the year progresses.
What is Autism?
Autism was first identified in 1943 by Dr. Leo Kanner of Johns Hopkins Hospital. At the same time, a German scientist, Dr. Hans Asperger, described a milder form of the disorder that is now known as Asperger Syndrome. These two disorders are listed in the DSM IV (Diagnostic and Statistical Manual of Mental Disorders) as two of the five developmental disorders that fall under the Autism Spectrum Disorders. The others are Rett Syndrome, PDD NOS (Pervasive Developmental Disorder), and Childhood Disintegrative Disorder. All of these disorders are characterized by varying degrees of impairment in communication skills and social abilities, and also by repetitive behaviors. For more discussion on the range of diagnoses that comprise Autism Spectrum Disorder, click here.
Autism Spectrum Disorders can usually be reliably diagnosed by age 3, although new research is pushing back the age of diagnosis to as early as 6 months. Parents are usually the first to notice unusual behaviors in their child or their child's failure to reach appropriate developmental milestones. Some parents describe a child that seemed different from birth, while others describe a child who was developing normally and then lost skills. Pediatricians may initially dismiss signs of autism, thinking a child will “catch up,” and may advise parents to “wait and see.” New research shows that when parents suspect something is wrong with their child, they are usually correct. If you have concerns about your child's development, don't wait: speak to your pediatrician about getting your child screened for autism.
If your child is diagnosed with autism, early intervention is critical to gain maximum benefit from existing therapies. Although parents may have concerns about labeling a toddler as “autistic,” the earlier the diagnosis is made, the earlier interventions can begin. Currently, there are no effective means to prevent autism, no fully effective treatments, and no cure. Research indicates, however, that early intervention in an appropriate educational setting for at least two years during the preschool years can result in significant improvements for many young children with Autism Spectrum Disorders. As soon as autism is diagnosed, early intervention instruction should begin. Effective programs focus on developing communication, social, and cognitive skills.
What is Asperger's Disorder?
It is believed that in Asperger's Disorder
- onset is usually later
- outcome is usually more positive
- social and communication deficits are less severe
- circumscribed interests are more prominent
- verbal IQ is usually higher than performance IQ (in autism, the case is usually the reverse)
- clumsiness is more frequently seen
- family history is more frequently positive
- neurological disorders are less common
What are the Diagnostic Criteria of Asperger's Syndrome?
A.Qualitative impairment in social interaction, as manifested by at least two of the following:
(1) 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
(2) failure to develop peer relationships appropriate to developmental level
(3) 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)
(4) lack of social or emotional reciprocity
B.Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(4) persistent preoccupation with parts of objects
C.The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
D.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).
E.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.
F.Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
GILLBERG'S CRITERIA FOR ASPERGER'S DISORDER
1.Severe impairment in reciprocal social interaction
(at least two of the following)
(a) inability to interact with peers
(b) lack of desire to interact with peers
(c) lack of appreciation of social cues
(d) socially and emotionally inappropriate behavior
2.All-absorbing narrow interest
(at least one of the following)
(a) exclusion of other activities
(b) repetitive adherence
(c) more rote than meaning
3.Imposition of routines and interests
(at least one of the following)
(a) on self, in aspects of life
(b) on others
4.Speech and language problems
(at least three of the following)
(a) delayed development
(b) superficially perfect expressive language
(c) formal, pedantic language
(d) odd prosody, peculiar voice characteristics
(e) impairment of comprehension including misinterpretations of literal/implied meanings
5.Non-verbal communication problems
(at least one of the following)
(a) limited use of gestures
(b) clumsy/gauche body language
(c) limited facial expression
(d) inappropriate expression
(e) peculiar, stiff gaze
6.Motor clumsiness: poor performance on neurodevelopmental examination
(All six criteria must be met for confirmation of diagnosis.)
What are the other problems that can co-exist with Asperger's Disorder?
Asperger's Disorder may not be the only psychological condition affecting a certain individual. In fact, it is frequently together with other problems such as:
- Attention Deficit Hyperactivity Disorder (ADHD)
- Oppositional Defiant Disorder (ODD)
- Depression (Major Depressive Disorder or Adjustment Disorder with Depressed Mood)
- Bipolar Disorder
- Generalized Anxiety Disorder
- Obsessive Compulsive Disorder
Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder presents with difficulty in focusing (inattention), hyperactivity and impulsiveness. Almost 60-70 % of children with Pervasive Developmental Disorders ( = PDD or Autistic Spectrum Disorders) have severe enough inattention, hyperactivity and impulsiveness to meet the diagnostic criteria for ADHD. Technically, if a child is diagnosed with any of the PDD diagnoses (Autistic Disorder, Asperger's Disorder, PDD-NOS or others), a separate ADHD diagnosis cannot be made. However, I believe that it is important to recognize the presence of co-existing ADHD since this syndrome can respond to medication treatment, unlike the core PDD symptoms. When ADHD co-exists with Asperger's Disorder, anger may easily turn to aggression because of the individual's impulsiveness. Methylphenidate (Ritalin, Concerta, Metadate, Focalin), dextroamphetamine (Dexedrine, Adderall), atomoxetine (Strattera), bupropion (Wellbutrin) or tricyclic antidepressants (imipramine, nortriptyline and others) may be beneficial. Common complications of untreated ADHD are ODD (see below), depression (losing self esteem due to academic failure and repeated negative feedback and punishment from adults), increased likelihood of drug and alcohol use, breaking traffic rules more frequently and having more accidents, and eventually getting lower-paying jobs for not fulfilling true potential.
Oppositional Defiant Disorder (ODD)
ODD represents more of a relationship dynamic between a child and the authority figures around her or him, than a disease process itself. Symptoms include argumentativeness with adults, talking back, refusing to follow adults' requests or rules, losing temper, deliberately annoying others, not taking responsibility for one's own actions, and being touchy, angry and resentful all the time. This can happen only at home, or may start at home and may eventually spill over to the school. Most children with ADHD, if untreated, eventually develop ODD because of daily negative feedback and punishment from adults, as a consequence of their impulsive behaviors. It is important to note that depression, in children and adolescents, may present with similar symptoms, rather than the expected symptoms like looking sad and crying frequently. A Child and Adolescent Psychiatrist should be consulted to differentiate the two. There is no medication treatment for ODD. Individual psychotherapy and sometimes family therapy are the best treatment methods. If there is ADHD underlying ODD, it has to be treated with medication for psychotherapies to be effective.
