Monday, March 16, 2009

Asperger's Syndrome with ADHD

Asperger’s Syndrome is sometimes overlooked when combined with ADHD unless the child, like Will, has a very high IQ. Some of the symptoms and behaviors are very much alike such as:

Ø Inability to talk or play quietly; disrupts others with talk or actions

Ø Inability to play with others (This stems from the fact they have already played out how the game is supposed to go in their minds and any deviation from how they imagined it is unacceptable.)

Ø Little to no eye contact or inability to hold someone’s gaze

Ø Seems to ignore the consequences of his actions.

Ø Inappropriate giggling or laughing

Ø Interrupts, disrupts, talks and acts inappropriately

Ø Always on the move, overactive, even during sleep

Ø Works impulsively; often makes careless mistakes: work is sloppy

This can all be summed up by the lack to control ones impulses. Both Asperger’s Syndrome and ADHD come with an inability to control even the most basic impulses that one has. When you have both, it is almost impossible.

This may present in an AS child as interrupting simply because they do not consider your feelings or what you have to say as important as what they need to tell you. It can also be quite dangerous. ADHD comes with a lack of focus or sometimes a hyper focus (which is a different kind of focusing problem). While sometimes the AS child will be unfocused and unable to concentrate enough to even repeat back to you what you just said, hyper focus is exactly the opposite and probably more dangerous to the child.

When you are hyper focused, you are so intent on what you are doing that you do not consider anything else, such as other people around you or dangers such as oncoming traffic. An AS child with ADHD can become so hyper focused on a topic or thought, that they will not consider the possible danger that they are putting their selves into.

For example, while thinking about what should be done with a lost umbrella, Will almost stepped into the road with cars coming at school. Not because he doesn’t know that he shouldn’t go into the road or because he doesn’t know to look both ways if he must cross a street, but because his mind was on returning the lost umbrella to the policeman who just happened to be standing in the road. In his mind, his only goal was to get the umbrella to the policeman because that was the most trustworthy person to return lost property to. He was so focused on this goal that he did not consider the consequences of his actions. He did not go with the intention of getting hurt or disobeying. He simply was so intent on his purpose that he didn’t consider anything else. How is this different from anyone else? Because even though he knew not to go into the road, and even though both we and school administrators talked to him about alternate solutions, he was still that afternoon focused on his task and failure to complete it (give the umbrella to the policeman) that he could not see that it was not a good choice. All he came away with is that he wanted to do this and was upset that he didn’t get to complete his undertaking. This caused him to be upset and talk about it over and over for a number of days to us at home. This was him trying to reason out what was wrong and why everyone was so upset. It was only after explaining it in a number of different ways that we finally got enough information to him to change his mind about his reasoning and get through to him.

The hyper focus can also present when he is intent on a project or assignment. If he is really hyper focused on it, you may tell him to stop or that it is time to do something else, but if he is in that state of mind, he will literally not hear you until he is done and his focus is satisfied. He may even be somewhat disoriented as to what happened between the time he started and now and why everyone around him is doing something else. If you want his attention at these times, you must gain eye contact to be assured he understands you and that the focus has been broken. Sometimes a simple touch on the shoulder will bring him back into the real world from his hyper focused activity. However, sometimes it won’t be broken until he is done.

However, there is a fundamental difference between Attention Deficit Disorder and Asperger’s Syndrome. AS children lack what doctors call "social reciprocity" or Theory of Mind (mindblindness). Theory of Mind is "the capacity to understand that other people have thoughts, feelings, motivations and desires that are different from our own."

Children with ADD have a Theory of Mind and understand other people's motives and expectations. They make appropriate eye contact and understand social cues, body language and hidden agendas in social interactions. AS children cannot do these things.

One author put it this way: children with Attention Deficit Disorder respond to behavioral modification. With Asperger Syndrome, the syndrome is the behavior.

In the next few days I will have a new blog up dealing just with mindblindness.

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