Asperger Syndrome and the Difficulties of Diagnosing and Treating Related Conditions

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In the April issue of Exceptional Parent (EP) magazine, readers of the military section met Jose Cotto, 13-year-old son of Captains Ada and Victor Cotto of Fort Benning, Georgia ("Building Life Skills for Children with Asperger Syndrome," by Eileen G. Pollack, MA, and Dennis C. Russo, PhD, ABPP). Before being diagnosed with Asperger syndrome, Jose had been misdiagnosed with anger management issues and attention deficit hyperactivity disorder (ADHD). An accurate diagnosis and effective treatment for his symptoms have made a world of difference--helping him control his temper, focus his attention, and improve his communication skills. Once angry and isolated, Jose has made significant academic progress as well as many new friends. Yet there is much to be done for children with a diagnosis of Asperger syndrome.

Not all children and adolescents with Asperger syndrome are as fortunate as Jose. Misdiagnosis is common. So is a lack of understanding that Asperger syndrome is often accompanied by other disorders. Estimates vary, but as many as 40 percent of individuals with Asperger's also have another condition. This secondary condition is referred to as a "co-occurring" disorder. Many co-occurring disorders are psychiatric in nature and require attention from parents, teachers, and professionals. The most common co-occurring disorders are ADHD, obsessive-compulsive disorder (OCD), and mood disorders such as depression and anxiety.

Diagnosing co-occurring disorders in children with Asperger's can be challenging (see sidebar). These youngsters may have difficulties with communication, self-expression, and social interactions, and may be unable to easily share or describe their feelings. Diagnosis is also challenging because Asperger's and some of these other disorders share common characteristics. Unless a thorough evaluation is conducted, it can be difficult to distinguish between the disorders or to identify co-occurring conditions.

A proper diagnosis of a single or co-occurring disorder should be made by a qualified professional such as a pediatrician, psychiatrist, or psychologist. This specialist will provide a diagnosis based on direct observations of the child's behavior, interactions with the child, and reports from family members and teachers. And the sooner children and teens with Asperger's and co-occurring conditions get an accurate diagnosis, the sooner they can begin to receive effective treatment that will help them lead happy, productive lives.

ADHD and Asperger Syndrome

Young people with ADHD often have difficulty listening, following instructions, or finishing tasks. They may fidget and squirm, interrupt others, and have difficulty sitting quietly. These symptoms are also common in children and adolescents with Asperger's. In fact, there is a high incidence of co-occurring ADHD in children and teens diagnosed with Asperger syndrome. Because of the similarities in these disorders, however, children with Asperger's are sometimes misdiagnosed with ADHD.

It is not surprising that Jose, then, was initially misdiagnosed. He finds it challenging to focus his attention and stay organized. So does his friend Justin Brewer, another 14-year-old with Asperger's featured in EP's April issue. But both boys have made great strides in this area thanks to the efforts of their therapist, Jade Lewis, MEd, BCBA (Board Certified Behavior Analyst). Jade is a behavior analyst who serves Fort Benning families in Columbus, Georgia, through the Southeast Regional Autism Center, a program of May Institute. She uses the principles of applied behavior analysis (ABA), to help Jose and Justin develop better organizational and attending skills. ABA methodology includes teaching in small steps, using positive rewards, providing structured assistance, and offering lots of opportunities to practice.

Supportive family members can also play a critical role. …