The Misdiagnosis of Children on the Autism Spectrum
Some "Aspergers" and "high-functioning autistic" (HFA) children do not have the disorder at all, they are simply "gifted." Has your child been misdiagnosed?
No one knows exactly how many gifted kids are misdiagnosed by clinicians and pediatricians who are not trained in the unique emotional difficulties of the gifted youngster. A common belief is that gifted kids do not have any particular social or emotional problems. Yet, research indicates that up to 20 % of high school dropouts test in the gifted range.
Some gifted kids may not seem different than other “behaviorally-difficult” children in their behavior and emotions, but the underlying causes are different. Any youngster can become withdrawn, aggressive, depressed, anxious, or sad – or exhibit any number of other problem behaviors given the right circumstances. However, there are a many aspects of giftedness that create unique challenges.
Gifted kids, many of whom are “asynchronous” (i.e., developing at different rates in different areas), encounter difficulties conforming to expectations, have behavior problems due to boredom, or otherwise struggle in a school setting.
Because of their finely tuned awareness, gifted kids tend to experience life differently and more intensely than others. Unfortunately, peers and adults at school or home often do not understand these differences. Gifted kids may experience the following problems:
- Boredom and impatience
- Difficulty observing boundaries and channeling their intense energy
- Disregard for, or open questioning of, rules and traditions
- Frustration and disappointment when ideals are not reached
- Not "fitting in" with their peers
- Preoccupation with deep human concerns, sometimes leading to anxiety and depression
In a clinical situation, the youngster's intense personal traits and difficulties may be viewed as symptoms of a mental or emotional disorder. Misguided therapy or medication may follow, as the clinician attempts to suppress or "cure" the symptoms of giftedness.
Common misdiagnoses of gifted kids include:
1. Aspergers or HFA— Highly gifted kids often have different ways of interacting socially. Their unusual comments and jokes may be misinterpreted as signs of autism. Children with on the spectrum may be gifted—especially in certain specific skills—but they do not respond as well as neurotypical kids to ordinary social or emotional cues. They may not make friends readily and often prefer to keep to themselves. Gifted kids, on the other hand, often show a great deal of concern for others and are highly sociable. If your gifted youngster gets along well with both grown-ups and peers, then a diagnosis of Aspergers or HFA is very unlikely. If you are concerned about your youngster’s socializing skills, then you may want to consult with a psychologist who specializes in Autism Spectrum Disorders.
2. Attention Deficit Hyperactivity Disorder— Traits such as intensity, impatience, sensitivity, and high energy are common in kids with ADHD , as well as in gifted kids. Some gifted kids do have ADHD, but many do not. They are at a different developmental level than other kids. As a result, they may be inattentive and impulsive in certain situations.
3. Mood Disorders— Gifted kids may have intense mood swings. They notice inconsistencies and absurdities in society and in the people around them. They can feel different and alienated from others. These traits are often found in kids with depression, especially those with bipolar disorder. A gifted child who has mood swings, irritability, difficulties with anger control, etc., may not suffer from a mood disorder, but should be seen by a psychologist for proper diagnosis.
4. Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality Disorder— Gifted kids like to organize things into complex structures. They tend to be perfectionists and idealists. They can get upset when others do not go along with their ideas, appearing intolerant and "bossy." This behavior may be mistaken for obsessive-compulsive disorder or obsessive-compulsive personality disorder. If obsessive tendencies seem to be getting in the way of a youngster’s success or happiness, then a psychiatric consultation is suggested.
5. Oppositional Defiant Disorder— Like kids with oppositional defiant disorder , gifted kids frequently appear "strong-willed." However, such behavior is often due to their intensity, sensitivity, and idealism. They do not like to be criticized for their different way of thinking. They may question the rules and engage in power struggles with authority figures.
Common concerns in gifted kids include:
1. Sleep Disorders— Nightmare disorder, sleep terror disorder, and sleepwalking disorder appear to be more common in gifted kids. Some gifted kids sleep a lot less than other kids. Others sleep a lot more. In the presence of unusual sleep patterns, your family doctor can advise whether a gifted youngster needs further evaluation for sleep or psychological problems.
2. Relational Problems— Moms and dads may lack information about the traits of gifted kids. Such kids may appear to be willful, mischievous, or strange. They may be criticized or disciplined for behaviors that stem from curiosity, intensity, and sensitivity. Power struggles, tantrums, and other behavior problems may surface. Effective therapy should involve helping the family understand and cope with the youngster's intensity.
3. Learning Disabilities— Gifted kids often have hidden learning disabilities (e.g., auditory processing weaknesses, difficulties with visual perception, writing disabilities, spatial disorientation, dyslexia, and attention deficits). Gifted kids may develop a poor self-image when learning disabilities are present. They tend to dwell on the things they can’t do and may need help in developing a good self-image. Gifted kids with learning disabilities have a great deal of trouble getting needed help in their schools because their academic achievement is usually above grade level despite their disability. Most school systems require a history of academic failure before they will provide remedial services.
Gifted kids have many strengths and possess greater than average awareness, perception, and sensitivity. This may be expressed in one or more areas (e.g., art, music, language, science, math, etc.). Common traits of gifted and talented kids include:
- Ability to process information at deeper levels
- Complexity and intense inner turmoil
- Creativity and strong imagination
- Deep compassion for others
- High sensitivity
- Intensity
- Keen observation, perception, and insight
- Love of learning
- Perfectionism and idealism
- Questioning established rules, beliefs, traditions, and authority
- Strong absorption in their interests
Problems associated with the strengths of gifted children include:
Strengths: Ability to conceptualize, abstract, synthesize; enjoys problem-solving and intellectual activity.
Possible Problems: Rejects or omits details; resists practice or drill; questions teaching procedure.
Strengths: Acquires and retains information quickly.
Possible Problems: Impatient with slowness of others; dislikes routine and drill; may resist mastering foundational skills; may make concepts unduly complex.
Strengths: Can see cause--effect relations.
Possible Problems: Difficulty accepting the illogical-such as feelings, traditions, or matters to be taken on faith.
Strengths: Creative and inventive; likes new ways of doing things.
Possible Problems: May disrupt plans or reject what is already known; seen by others as different and out of step.
Strengths: Diverse interests and abilities; versatility.
Possible Problems: May appear scattered and disorganized; frustrations over lack of time; others may expect continual competence.
Strengths: Enjoys organizing things and people into structure and order; seeks to systematize.
Possible Problems: Constructs complicated rules or systems; may be seen as bossy, rude, or domineering.
Strengths: High energy, alertness, eagerness; periods of intense efforts.
Possible Problems: Frustration with inactivity; eagerness may disrupt others' schedules; needs continual stimulation; may be seen as hyperactive.
Strengths: Independent; prefers individualized work; reliant on self.
Possible Problems: May reject parent or peer input; non-conformity; may be unconventional.
Strengths: Inquisitive attitude, intellectual curiosity; intrinsic motivation; searching for significance.
Possible Problems: Asks embarrassing questions; strong-willed; resists direction; seems excessive in interests; expects same of others.
Strengths: Intense concentration; long attention span in areas of interest; goal-directed behavior; persistence.
Possible Problems: Resists interruption; neglects duties or people during period of focused interests; stubbornness.
Strengths: Keen observer; willing to consider the unusual; open to new experiences.
Possible Problems: Overly intense focus; occasional gullibility.
Strengths: Large vocabulary and facile verbal proficiency; broad information in advanced areas.
Possible Problems: May use words to escape or avoid situations; becomes bored with school and age-peers; seen by others as a "know it all."
Strengths: Love of truth, equity, and fair play.
Possible Problems: Difficulty in being practical; worry about humanitarian concerns.
Strengths: Sensitivity, empathy for others; desire to be accepted by others.
Possible Problems: Sensitivity to criticism or peer rejection; expects others to have similar values; need for success and recognition; may feel different and alienated.
Strengths: Strong sense of humor.
Possible Problems: Sees absurdities of situations; humor may not be understood by peers; may become "class clown" to gain attention.
Strengths: Thinks critically; has high expectancies; is self-critical and evaluates others.
Possible Problems: Critical or intolerant toward others; may become discouraged or depressed; perfectionist.
Lack of understanding by moms and dads, teachers, and clinicians – combined with the lack of appropriately differentiated education –all lead to interpersonal conflicts, which are then mislabeled, and thus prompt the misdiagnoses.
Gifted and talented kids often must overcome many challenges to reach their potential. They frequently need help interacting in the mainstream world, finding supportive environments, and channeling their skills. When gifted kids are misdiagnosed and wrongly stigmatized, they cannot get the type of support they need. Families, teachers, and health professionals need to be better educated about the social and emotional needs of gifted kids.
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Follow-up Question:
I have a 16 year old son who has Asperger Syndrome. He has also tested in the 99th percentile for intelligence. He learns easily and fast in most subjects. But, as is common with Aspies, he has very little common sense. He has problems making friends in the first place, but has further isolated himself from his peers by saying out loud in class (several times), “I don’t know why I have to learn this stuff that I already know. They (classmates) may need to because they are not as smart as me, but why do I have to?” Needless to say it does not go over well. If you ask him why he would say such a thing he says “Because it is true”. Also, he constantly challenges the teacher on whether what she has said is correct. Any ideas as to how to get him to understand and change this behaviour?
Answer:
Gifted Aspergers students can become frustrated in the classroom due to repetition and the lack of challenge. This may lead some kids to act-out or be disruptive. It may cause others to become disinterested and dislike school. Still others may become upset at the mere thought of going to school.
The starting point is to validate your son’s feelings—whatever they might be—and acknowledge and accept that the feelings are there. You can accept the feeling without having to accept the means of expression of the feeling (e.g., disrupting class). You need to communicate that your son’s feelings are understandable and natural, under the circumstances, and for the way that your son sees the world. You want to simply be offering an empathic narrative about what may be going on in your son’s mind and the connection between the trigger event (e.g., rehashing old material), the interpretation or meaning it had for your son (e.g., “this is so boring”), and the resulting feelings that arose in your son (e.g., frustration).
As the parent, you have the opportunity to model healthy ways of dealing with frustration in the ways that you, yourself, react when these feelings come up for you. The goal is to model that your own and your son’s difficult feelings can be observed, can be tolerated without "destroying" you or "driving you over the edge," and that they can be managed in conscious, healthy ways. Monitor your own level of frustration or anger. Learn to recognize your own internal signs for when you get close to "not being able to take it anymore," or to "exploding.” It's ok to give yourself a time out, and it's not a sign of defeat. In fact, it's modeling behavior that you want your son to use. You can say something like "I'm getting close to the point where I can't think clearly, so I'm going to take a few minutes to clear my head."
You can also work with your son on a specific technique to help him step out of automatic reactions and unacceptable behavior. Use the sequence, "Stop, Think, Choose" as the keywords for your son to use to coach himself toward more conscious choices for behavior. The trick is to develop the association of this sequence with the onset of the frustration or anger. You would work with your son during calm times to offer acceptable choices for ways to express the feelings. Then, help your son to pick a trigger or identify a "switch" that informs your son that he is starting to reach his limits of tolerance. This might involve having him recognize that he's clenching his fists or feeling tension in his body, being able to recognize and articulate "I'm angry," or anything else that will help him catch himself in the process of becoming upset.
At first, you will have to help your son to catch himself, and you might do this with comments like, "I can see that you're starting to get frustrated. Is this one of those times when you could use your 'stop-think-choose' technique?" Presenting this technique as a choice gives your son the opportunity to learn that he can exercise control over his reactions and behavior. You may still need to coach him through the process of stopping, thinking, choosing before he can manage it himself.
One of the most common sources of frustration for gifted children has to do with their perception that others' rules don't make sense, aren't logical, and things that others say or do aren't rational (and therefore need not be obeyed). They believe that the world should operate according to THEIR rules (which they believe are totally logical), and they feel outraged when the world doesn't oblige.
Their natural drive for self-determination and efforts to feel in control of -- and to exert control over -- their world bring them into frequent conflict with the "real" rules. This can create a deep sense of despair and fear that they can never be in control of their world. Some children may even feel individually punished for not being allowed to be in control, and will fight to protect their self-esteem and efforts at self-efficacy. This can explain why sometimes the smallest incident that seems unjust to them can trigger such intense distress. They're reacting to the feeling that the entire world appears irrational, uncontrollable and unpredictable to them. Think about how scary that would be!
One possible way to address this is to find some activity or environment where your son truly can set the rules and he can feel in control. This requires some creative thinking by you to construct or find such an environment. When your son can find one place where he feels that things "make sense," and feels in control, then much of the distress over not being in control in other places subsides.
Another common source of distress for a gifted child is the fear that he really isn't as smart as others say he is, and he's going to fall from gifted grace if anyone ever found out. He therefore feels very protective of his self-image as someone who is "smart," but feels fragile since he doesn't believe it's something he has any control over.
Another way you can help your son when he explodes over perceived injustices or doesn't like following rules set by others is to help him empathize. The idea is to help your son recognize that other people have different perspectives about things, and that their reasons for doing something may be completely consistent with their own perspectives, even if they're different from his own.
Aspergers children, especially, have a difficult time recognizing that other perspectives can exist in other people's minds. In fact, being able to conceive of a different belief being held in another person's mind is a learned process, often called Theory of Mind, and usually doesn't even start to develop until around age three or four. It can take several more years for the capacity to develop to the point where a child can actually understand another's behavior and reactions in terms of completely different perceptions existing in another's mind. Since this is a learned skill, it's something you can assist your son to develop.
One way to do this is by engaging him in games or exercises where you ask him to imagine what's taking place in the other person's mind, when he has been in a conflict with someone else, or has refused to do something he's been asked to do. You can ask him to tell the story first from his own point of view, and then ask him to pretend that he's the other person, and tell the story again from the other's point of view. Encourage him to explain, in as much detail as possible, what he imagines the other person's motives were, or what the other person must have been thinking or feeling that made her act the way she did. If he was in an argument with another person, then ask him to replay the argument, but to argue it from the other person's perspective.
You can encourage your son to try to imagine as many different motives as possible, that the other person might have had for doing what she did. Approach this as a brainstorming exercise and challenge your son to be creative, no matter how outlandish his responses might be. You can help by throwing in some ideas of your own and even making a game out of it where you take turns guessing at the motives and intentions of the other person.
Basically, any type of exercise that helps your son to be curious about the perceptions and intentions of others, and helps him to become accepting of different perceptions, will benefit him in numerous ways. For example, if he felt hurt by something someone did, instead of assuming that the other person must have had the deliberate intention of hurting him, he might be able to see that the other person was trying to concentrate on a task, and was annoyed at being interrupted. This could help him take things less personally in the long run.
Lastly, if your son reverts to behavior that is destructive or unacceptable when he's upset, then form a plan AHEAD OF TIME for how you're going to respond to it. You want to establish clear rules for what is and is not acceptable behavior, write them down, and post them for your son to see and remember. Then, you want to formulate clear and precise consequences when the rules are broken, write them down, and post them for your son to see and remember. The critical elements in making a system like this work are clarity and consistency.
Another angle would be to approach your son’s teacher to see if there are some advanced (new) lessons your son can be doing while the others are repeating former lessons.
Follow-up Question:
I have a 16 year old son who has Asperger Syndrome. He has also tested in the 99th percentile for intelligence. He learns easily and fast in most subjects. But, as is common with Aspies, he has very little common sense. He has problems making friends in the first place, but has further isolated himself from his peers by saying out loud in class (several times), “I don’t know why I have to learn this stuff that I already know. They (classmates) may need to because they are not as smart as me, but why do I have to?” Needless to say it does not go over well. If you ask him why he would say such a thing he says “Because it is true”. Also, he constantly challenges the teacher on whether what she has said is correct. Any ideas as to how to get him to understand and change this behaviour?
Answer:
Gifted Aspergers students can become frustrated in the classroom due to repetition and the lack of challenge. This may lead some kids to act-out or be disruptive. It may cause others to become disinterested and dislike school. Still others may become upset at the mere thought of going to school.
The starting point is to validate your son’s feelings—whatever they might be—and acknowledge and accept that the feelings are there. You can accept the feeling without having to accept the means of expression of the feeling (e.g., disrupting class). You need to communicate that your son’s feelings are understandable and natural, under the circumstances, and for the way that your son sees the world. You want to simply be offering an empathic narrative about what may be going on in your son’s mind and the connection between the trigger event (e.g., rehashing old material), the interpretation or meaning it had for your son (e.g., “this is so boring”), and the resulting feelings that arose in your son (e.g., frustration).
As the parent, you have the opportunity to model healthy ways of dealing with frustration in the ways that you, yourself, react when these feelings come up for you. The goal is to model that your own and your son’s difficult feelings can be observed, can be tolerated without "destroying" you or "driving you over the edge," and that they can be managed in conscious, healthy ways. Monitor your own level of frustration or anger. Learn to recognize your own internal signs for when you get close to "not being able to take it anymore," or to "exploding.” It's ok to give yourself a time out, and it's not a sign of defeat. In fact, it's modeling behavior that you want your son to use. You can say something like "I'm getting close to the point where I can't think clearly, so I'm going to take a few minutes to clear my head."
You can also work with your son on a specific technique to help him step out of automatic reactions and unacceptable behavior. Use the sequence, "Stop, Think, Choose" as the keywords for your son to use to coach himself toward more conscious choices for behavior. The trick is to develop the association of this sequence with the onset of the frustration or anger. You would work with your son during calm times to offer acceptable choices for ways to express the feelings. Then, help your son to pick a trigger or identify a "switch" that informs your son that he is starting to reach his limits of tolerance. This might involve having him recognize that he's clenching his fists or feeling tension in his body, being able to recognize and articulate "I'm angry," or anything else that will help him catch himself in the process of becoming upset.
At first, you will have to help your son to catch himself, and you might do this with comments like, "I can see that you're starting to get frustrated. Is this one of those times when you could use your 'stop-think-choose' technique?" Presenting this technique as a choice gives your son the opportunity to learn that he can exercise control over his reactions and behavior. You may still need to coach him through the process of stopping, thinking, choosing before he can manage it himself.
One of the most common sources of frustration for gifted children has to do with their perception that others' rules don't make sense, aren't logical, and things that others say or do aren't rational (and therefore need not be obeyed). They believe that the world should operate according to THEIR rules (which they believe are totally logical), and they feel outraged when the world doesn't oblige.
Their natural drive for self-determination and efforts to feel in control of -- and to exert control over -- their world bring them into frequent conflict with the "real" rules. This can create a deep sense of despair and fear that they can never be in control of their world. Some children may even feel individually punished for not being allowed to be in control, and will fight to protect their self-esteem and efforts at self-efficacy. This can explain why sometimes the smallest incident that seems unjust to them can trigger such intense distress. They're reacting to the feeling that the entire world appears irrational, uncontrollable and unpredictable to them. Think about how scary that would be!
One possible way to address this is to find some activity or environment where your son truly can set the rules and he can feel in control. This requires some creative thinking by you to construct or find such an environment. When your son can find one place where he feels that things "make sense," and feels in control, then much of the distress over not being in control in other places subsides.
Another common source of distress for a gifted child is the fear that he really isn't as smart as others say he is, and he's going to fall from gifted grace if anyone ever found out. He therefore feels very protective of his self-image as someone who is "smart," but feels fragile since he doesn't believe it's something he has any control over.
Another way you can help your son when he explodes over perceived injustices or doesn't like following rules set by others is to help him empathize. The idea is to help your son recognize that other people have different perspectives about things, and that their reasons for doing something may be completely consistent with their own perspectives, even if they're different from his own.
Aspergers children, especially, have a difficult time recognizing that other perspectives can exist in other people's minds. In fact, being able to conceive of a different belief being held in another person's mind is a learned process, often called Theory of Mind, and usually doesn't even start to develop until around age three or four. It can take several more years for the capacity to develop to the point where a child can actually understand another's behavior and reactions in terms of completely different perceptions existing in another's mind. Since this is a learned skill, it's something you can assist your son to develop.
One way to do this is by engaging him in games or exercises where you ask him to imagine what's taking place in the other person's mind, when he has been in a conflict with someone else, or has refused to do something he's been asked to do. You can ask him to tell the story first from his own point of view, and then ask him to pretend that he's the other person, and tell the story again from the other's point of view. Encourage him to explain, in as much detail as possible, what he imagines the other person's motives were, or what the other person must have been thinking or feeling that made her act the way she did. If he was in an argument with another person, then ask him to replay the argument, but to argue it from the other person's perspective.
You can encourage your son to try to imagine as many different motives as possible, that the other person might have had for doing what she did. Approach this as a brainstorming exercise and challenge your son to be creative, no matter how outlandish his responses might be. You can help by throwing in some ideas of your own and even making a game out of it where you take turns guessing at the motives and intentions of the other person.
Basically, any type of exercise that helps your son to be curious about the perceptions and intentions of others, and helps him to become accepting of different perceptions, will benefit him in numerous ways. For example, if he felt hurt by something someone did, instead of assuming that the other person must have had the deliberate intention of hurting him, he might be able to see that the other person was trying to concentrate on a task, and was annoyed at being interrupted. This could help him take things less personally in the long run.
Lastly, if your son reverts to behavior that is destructive or unacceptable when he's upset, then form a plan AHEAD OF TIME for how you're going to respond to it. You want to establish clear rules for what is and is not acceptable behavior, write them down, and post them for your son to see and remember. Then, you want to formulate clear and precise consequences when the rules are broken, write them down, and post them for your son to see and remember. The critical elements in making a system like this work are clarity and consistency.
Another angle would be to approach your son’s teacher to see if there are some advanced (new) lessons your son can be doing while the others are repeating former lessons.
