Thursday, May 14, 2009

Ella was Diagnosed with Aspergers Today

I am dead dog tired, but wanted to let you know that we got the results from her autism spectrum testing back. I feel more validated and relieved than upset, especially since my husband would probably also fall under that diagnosis.

Here is the summary of information from her psychologist, let me know if you have any questions for me. I am lucky to have formed these few complete thoughts.

We had an initial visit with her that lasted 90 minutes where she mostly talked to us together, but talked a little to Ella by herself and about a half hour to me by myself. Dr. H also spoke to Ella's 3rd grade teacher.

has an age appropriate vocabulary
her vocal tone, articulation, and cadence of speech seem normal
  Ella takes longer than usual to form her thoughts into words
  Ella has difficulty extracting the most relevant information to tell about an experience or story
  Ella has difficulty organizing a story into a beginning, middle, and end that makes sense
  Ella uses some emphatic and descriptive gesture to enrich the quality of her communication
Ella's facial expression is congruent with content of what she is saying, but her facial expression seems pretty basic (i.e. happy, sad) and lacks subtlety and variability many children her age might demonstrate.
In a test where she was asked to tell a story from a picture book, Ella had difficulty telling about what was happening, as opposed to labeling items in the pictures.

  Ella seems to understand most language
Given her mastery and use of language, she seems to struggle with the inferential components of receptive language (e.g: she mentioned that she used to have kittens. One night, she fed the kittens some pizza crusts. I asked her why she got rid of them, and she thought I was talking about getting rid of the pizza crusts, not why she got rid of the kittens)
  Ella has difficulty interpreting non-literal language (sarcasm), tending to take it literally
  Ella has difficulty processing multi-step instructions, needing them to be broken down into individual steps

  Ella reports rich, imaginative play with peers
In the ADOS adminstration, Ella struggled considerably with imaginative play. She appeared shy and inhibited, which was a sharp contrast to her almost overly-comfortable behaviour in the office setting (i.e: coming in and taking her shoes off, playing with her toes). She would follow my lead in play; but would not use her characters to enrich or build on the play. Her engagement appeared reluctant, which does not seem to be consistent with her interactional style in other ways.
  Ella reports make believe play in which she takes the role of a character
During the ADOS administration, Ella was bashful about acting out a scene, even after it was demonstrated to her by the examiner.

Social Interaction
Conversation tends to be on Ella's terms. She can talk at length about topics of interest to her and responds to questions and comments nicely; however she fails to follow up on conversational leads, (e.g: I have dogs too, and they do things that are really funny!"). At those times, Ella appears uncomfortable as though there is some recognition that she should say or do something; but does not know what.
  Ella has friends with whom she gets along well; but struggles to identify characteristics that make a friend a friend. She seemed to find this question stressful. She initially stated that children of similar age are friends, and then drifted into talking about birth dates. When encouraged to find other reasons, she noted that common interests made a friend a friend.
  Ella was able to talk about her emotional experiences (although she appeared to be somewhat uncomfortable and tentative in the interaction); however she struggled to consider how her bahaviour might affect others (e.g.: What do you think you do that might annoy other people?). She could not come up with an answer about herself, instead talking about what her younger sister does to annoy her mother.

Restricted Interests and Repetitive Behaviours
Used to walk on tip toe/toe walking
Unusually focused on dates and birthdates
Transitions were easier as a child,but around age 7, she started having more difficulty with change.. needs a lot of warnings, needs to review expectations, can fall apart if plans change (e.g.puts hands on head as she struggles to think about what else she might eat for lunch of all ingredients are not present for the meal she had planned to have)

Associated Features
Sensory sensitivity
Dislikes sticky hands/fingers
Tags in shirts
Food textures
Clothing Textures

Cognitive Style
Literal Thinker
Difficulties with sequencing and organizing
Detail oriented at the cost of the "whole"
Abstraction, both receptively and expressively

Diagnostic Impressions:
Provisional Diagnosis of Asperger's Disorder

  Ella is not a "perfect fit" for an Aspergers's diagnosis. She has some terrific social and communicative skills that are often not seen in children with Asperger's. That said, she has extraordinarily savvy parents who have likely helped her develop strategies to compensate effectively for some areas of weakness. Her deficits in the areas of social communication and flexibility are subtle, but present. It appears most likely that a diagnosis of Asperger's Disorder is appropriate for her; however given her complex developemental history, it would be valuable to view these results within the context of a more comprehensive psychoeducational evaluation to see if there are underlying features of her thinking style that might meaningfully contribute to the diagnostic picture. Barring another more comprehensive explanation for the difficulties outlined above, a diagnosis of Asperger's Disorder appears to be the best fit available.

Other possible diagnoses: Expressive and Receptive Language Disorders, Non Verbal Learning Disorder

Other tests that may be used: WISC IV (Wechsler Intelligence Scale for Children), WIAT II (Wechsler Individual Intelligence Test), DKEFS (Delis Kaplan Executive Functioning Scale), NEPSY (Neuropsychological Test)


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