the difference between SPD and Asperger's?

[earthmama369]

DS is nearly 5 and was diagnosed with SPD a couple years ago. At his well-child visit a few weeks ago, his doctor mentioned that he sent up a couple red flags in his interaction with her and that maybe we should pursue another evaluation. His preschool teachers have also mentioned the same thing in the past couple of weeks. I've been reading up on Asperger's and I'm finding it difficult to separate the sensory symptoms from other aspects of Asperger's because so many people on the spectrum also have SPD/SID. If I were looking at a 4.75-year-old boy who we already know has sensory issues, what additional clues would make you take the (admittedly blurry) leap to Asperger's?

[HollyBearsMom]

Honestly I would get a full neuro-psych work up.

My son has SPD (dx about age 4) and I had worried about aspergers.  He had many of the "classic" signs: poor social interactions, obsessions, odd speech patterns. Basically what I learned is that I should have started with a professional who specialized in kids with SPD, ADD/ADHD, Aspergers, etc. instead of all the futile stuff I did trying to figure it all out on  my own. I wish I could get the last 2 years back.

My son ended up not having Aspergers and was not even anywhere near the spectrum.  But he was diagnosed with some pretty severe learning disabilities and has borderline auditory processing issues. If I had the work up done when the "red flags" started my son would have gotten the help he really needed when he started first grade, not in 3rd grade.

[BetsyNY]

We-e-ll, let's see...I'm hoping SBGrace pops in, she has some good websites with checklists...but I'd start with autism or Asperger's Syndrome is recognized by the DSM-IV whereas SPD/SID is not. I would pursue the evaluation based on your doctor's recommendation--it will be harder to get your child accommodations (IEP, 504 plan) with a dx of SPD than it would with a dx of Asperger's or autism. If your son had autism, SPD would be part of it--most kids on the spectrum have sensory needs/issues. 

Asperger's is sometimes used interchangeably with high-functioning autism. Either way, here's what I'd look for:

Can your son hold up his end of a conversation, ie, back and forth exchanges? Does he have "pet" interests that tend to be obsessive (trains, dinosaurs, mathematics)?  If he converses with new people, does he tend to bring the conversation around to his pet interests?  Does he have any strange, repetitive movements like hand flapping, or vocal stims like squeals? Does he walk on his toes? Does he avoid eye contact--my son, for example, will walk around in circles while he's talking to me--or is his eye contact fleeting?  

Here are the diagnostic criteria for Asperger's:

http://www.autreat.com/dsm4-aspergers.html

[Emmeline II]

Originally Posted by earthmama369 

 I've been reading up on Asperger's and I'm finding it difficult to separate the sensory symptoms from other aspects of Asperger's because so many people on the spectrum also have SPD/SID. If I were looking at a 4.75-year-old boy who we already know has sensory issues, what additional clues would make you take the (admittedly blurry) leap to Asperger's?

That is what a neuropsych evaluation does, though your son is young for an Asperger's diagnosis. My son was 6y11mo when he had his evaluation, but the Dr. was not willing to give a definitive Asperger's diagnosis at his age--she did recommend some therapies that we are pursuing and he will be reevaluated next year.
 

[Linda on the move]

I don't think that parents should try to dx their own children based on what they read on the internet, and I agree that your son is VERY young for an Asperger's DX.

One of my favorite books is "Quirky Kid: Understanding and Helping Your Child Who Doesn't Fit In -- when to Worry and When NOT to Worry" by Klass. It's a great whether your son just has sensory issues, or has something more going on.

I agree about getting an eval and going from there. Is your son currently in therapies? Is there a social skills class for kids his age where you live? The social skills class that my DD didn't require a particular dx. It's something else you could look into while working on getting an eval.

[earthmama369]

Thanks for the replies. In response to some of the points raised: He's a quirky kid. I'm not sure how to categorize his quirks. He doesn't toe-walk -- he's got variable type SPD, but more sensory seeking than avoiding, and the resulting of all that seeking is that he's got pretty good coordination and balance and strength when he's having a good day. (When he's not, he can turn his head and fall down from just doing that.) He's doing a lot of perseverating right now. He's got these obsessions -- he talks about his upcoming birthday *constantly*, will stop anything to go watch dh or I if we play a certain video game on the computer and can't stay away from it, and insists that we stay in the car to finish listening to any song by Mumford & Sons or Taylor Swift if it's on the radio when we get where we're going. (OK, that last one's pretty darn cute.) Socially -- he's been at the preschool for about two months now, and can identify by name maybe three kids out of twenty. He still parallel plays a lot; he'll play near kids but won't often initiate or participate unless something catches his interest and he can play with it the way he wants to. 

He has days where he's just ON -- able to focus, a joy to converse with, happy to play, able to transition, etc. And he has days where everything is very unpredictable, eye contact is fleeting, he can't focus on anything, he struggles with transitions and eating and sleeping and dealing with people and how his body feels. And we have days in between, where the morning might be rough but the afternoon is smooth sailing. So it's hard for me to peg exactly what's going on.

At this point in time, neither dh nor I are particularly concerned in getting a diagnosis. But he does qualify for kindergarten in the fall (he turns 5 in June), so we do want to check in with the local school system and get an evaluation through them, so we can see what services they might be willing to offer. From there we'll decide what's best for him right now -- another year of preK, kindergarten, or going back to homeschooling (if I can physically manage it -- I'm currently disabled). We're also planning to check back in with his speech therapist from a couple years ago and see where he is there, so if there are any potential issues with literacy (learning to write, read, etc.) we can catch them on the earlier side. I think we're going to save the full neuro-psych work-up until he's a bit older -- 6 or 7 seems to be the age where something like PDD-NOS or Asperger's might be diagnosed, if that is an issue with him.

I'd definitely

[joensally]

...6 or 7 seems to be the age where something like PDD-NOS or Asperger's might be diagnosed, if that is an issue with him.

This isn't quite it.  A child can receive a PDD-NOS diagnosis at any age when a diagnostician believes that a child is likely on the spectrum.  Asperger's is typically held until 7-8+.  I really like the Oasis Asperger's book, but I agree with Linda that this is tricky business and it's best to get professional insight rather than trying to figure it out on your own.

I would phone around and make some inquiries.  School district staff may not be able to diagnose spectrum - it depends on your jurisdiction.  Typically, it's a medical system process.  I would also ask the school system what services your child might be eligible for with a diagnosis of SPD versus an ASD diagnosis.  If there are greater services with an ASD diagnosis, I don't see a reason to hold off on an assessment if you believe he may have an ASD.  There may also be a waitlist for assessment, so it might be an idea to get on it.

Is your son receiving OT services now for his SPD?

[Linda on the move]

Originally Posted by joensally 

This isn't quite it.  A child can receive a PDD-NOS diagnosis at any age when a diagnostician believes that a child is likely on the spectrum.  ...

 I would also ask the school system what services your child might be eligible for with a diagnosis of SPD versus an ASD diagnosis.  If there are greater services with an ASD diagnosis, I don't see a reason to hold off on an assessment if you believe he may have an ASD.  There may also be a waitlist for assessment, so it might be an idea to get on it.

this is a good post. The reason that Asperger's is dx'ed later is that all of the traits of asperger's can appear in typically developing children, but most kids outgrow them. With PDD-NOS, that isn't the case. If your child qualifies for PDD-NOS, he most likely isn't going to outgrow it. My DD's dx was pdd-nos when she was younger, but was switched to asperger's as she got older. (it's very clear that she's on the spectrum, but figuring out exactly which spectrum label is most appropriate has been tricky)

SPD doesn't qualify a child for ANY accommodations at school. Nothing. An ASD disorder, on the other hand, does. And frankly, at this point, I really don't care what my DDs label is as long as she gets what she needs. If your child *might* qualify for an ASD disorder and *might* need accommodations due to sensory issues, then getting the dx is just jumping through a hoop that your kid *might* need you to jump through.  The sensory issues are the primary issue for my DD at school, followed by communication issues.

An eval is like a snap shot in time. Different snap shots look different, but you can tell that it's all the same kid. I think eval are kinda like that -- if your child has something significant going on, chances are you will end up with different evals at different ages that all show a pattern. Getting more information about him (like you would with a good eval) might help you figure out the good days and bad days.

Have you requested an eval from the school district in writing? These things can take time. It's not like you just call and they have you pop in the next week.

Have you checked the wait times in your city for a private evaluation? In some cities, the wait is a year. Personally, I think that putting off an eval under the impression that when you decide it's time, that it will just happen and you'll have the information is a mistake. My DD was on a wait list for a year for her last eval, then they didn't get all the testing done on the first day and it was another month before they could squeeze her in again, and then it took a couple of months for the report. So my experience was that if you want some really solid answers in 18 months, you should start making phone calls now.  I'm sure lots of times it goes quicker than that.

Also, kids with special needs are not generally held back, but are kept with age mates because being older doesn't fix special needs. I think that if you are hoping that your child will outgrow this in a year, then you may have some denial going on. I wonder if the real reason you want to delay an eval is because you don't want the answer.

I've never heard of a school evaluating a child and recommending that they wait a year for school. Rather, they talk about what therapies and accommodations they can offer.

I'm not a fan of homeschooling kids on the spectrum because it was our experience that it was impossible to meet my DDs need for positive social interaction through homeschooling, and she needs teachers besides me. She needs a host of people working at interacting with her.  If your child *just* has sensory issues, homeschooling is more doable because schools can't accommodate any way and your child is capable of making friends through normal homeschooling channels, being involved in community activities, etc. Our experience was that homeschooling a child with autism was very isolating both for my DD and for me. She is much better off in school with teachers who know how to work with her.

[Arduinna]

Originally Posted by BetsyNY 

Here are the diagnostic criteria for Asperger's:

http://www.autreat.com/dsm4-aspergers.html

apologies for thread crashing

Thank you for posting that, I hadn't seen it before and it was very helpful.

[kme]

This is the same question I have had for a couple years now.  My son is 7 and has definite SPD, mostly sensory seeking.  Asperger's has come up as a possibility but was eventually ruled out because he did not meet the diagnostic criteria.  More specifically, he doesn't have serious obsessions and is pretty flexible.  However, he is right on the edge of the spectrum and I have pretty much given up wondering "Does he or doesn't he?"  He gets the help he needs at school and that is the most important thing.  I feel he is just "short" of an Asperger's dx.  He doesn't quite meet the criteria but he has significant sensory processing difficulties so I don't feel he is "better off" because he probably doesn't have Asperger's. 

The best thing to do is have your child evaluated by a professional who specializes in ASD.  These people generally know Asperger's when they see it.  I was told my son's difficulties had a different "flavor", if that makes sense.  If you get a good professional, they can really help weed through the symptoms to figure out what is going on.

[LynnS6]

A third (or 4th) vote for professional evaluation. It's just so hard to tell, and even the professionals can't always give a definitive answer.

I'm one of those parents with an SPD kid (mostly sensory avoiding), but who's not on the autism spectrum. That being said, he's very close to it. Remember that 'typical' is a spectrum too. Ds is typical, but pretty darn close to the autism spectrum. His cousin, who's 18 months older, has got autism, but is pretty darn close to typical. However, I don't think that we could have diagnosed either boy at 4 1/2 or 5. We had ds evaluated when he was 7 (mostly for anxiety, but I wanted to know if it was related to autism). His cousin was diagnosed at 8.

Ds has always had the sensory issues (would never nurse in public, wouldn't sleep in public, wouldn't go without shoes and socks, didn't like to be dirty, hypersensitive to noise, hated the beach..). His ability to identify emotions in other people was delayed (he couldn't do it at age 5 very well). He's actually pretty flexible, but resistant to new things (slow to warm up).  He's an introvert, so he never really sought out other kids to play. I swear half of our neighbors didn't think he could talk until he was 5 because he would never respond to them. He's still Mr. Monosyllable with people he doesn't know very well. He was in daycare and so he played with some kids there, but not really until he got close to 4 1/2, and then with his best friend only. He's always had obsessions. Age 2-3: Garbage trucks. Age 4-5: Fire trucks. Age 5-7: Buses. Age 8+: Penguins and sports. He's becoming a baseball fanatic. He and dh have done a fantasy baseball team this year. His interest in baseball is as obsessive as his interest in buses was, but it's somehow more socially acceptable (every single one of my uncles has a fantasy baseball team!).  All of these things could be signs of Aspergers.

So, what's kept him from an Aspergers diagnoses? His ability to have reciprocol conversations (i.e. his desire/ability to share information rather than to either request something or impart information ('lecture')), and his ability to understand other people's points of view. During the family 'interview' with the psychologist who did the assessing, the psychologist asked ds what made him afraid. Before ds answered, he looked at dd and said "Is it OK if I talk about this?" I don't remember what it was, but he knew that it scared dd too, and he checked in with her before he started talking about it. His language and communication skills are simply too good to be diagnosed Aspergers.

Now ds still isn't great socially, but I've seen huge improvements in the last 2 years. He's still an introvert. He's still slow to warm up. He dreads days when they tell the kids there's going to be a fire drill because he hates the noise. But he now seeks out other kids to play. He actually holds his own in negotiating play and he can compromise and  understand other people's points of view. He does sometimes choose to play alone rather than play things he's not interested in. I'm OK with that. He's got strong intrapersonal skills (sense of himself). He will always struggle with sensory stuff, even with OT.

I guess my whole point of the long post is that there are differences between SPD and Aspergers, but they are indeed very close. Usually, you get both, sometimes you get one.