Asperger’s: Overhype or Reality?
Regarding the letter from “A Flabbergasted Mom” (Chronicles, Jan. 31) whose 12-year old son is said to have Asperger’s Syndrome: What’s with the inordinate amount of kids these days who are supposedly suffering from one “condition” or another and, worse yet, are being medicated? How is it that in the ‘60s, ‘70s or even ‘80s terms like ADD, ADHD, Asperger’s and the like were relatively obscure?
I’m not trying to say that we were all uniformly well behaved in those days, or that we didn’t have our fair share of unruly, unmannerly and lazy kids. In fact, I remember staying far away from my best friend’s house whenever I knew her younger brother would be around. He was notorious on our block for his wild antics and I was afraid to get anywhere near him. But I can assure you of one thing: he wasn’t put on meds. And I can also tell you firsthand that he turned out just fine.
As I was reading the letter from Flabbergasted Mom, I wondered where I’d be today had my own mother taken me for a psychiatric evaluation when I was a spaced out, unmotivated kid who played hooky more often than I care to disclose.
In class I was the perpetual daydreamer and would generally opt for my own company than that of my peers.
Today I am baruch Hashem a settled and happily married family man. Though I confess to preferring a quiet night at home with my wife rather than be out socializing, we frequently host family and friends for Shabbosim, as well as for longer-term visits.
The point I’m getting at is – G-d only knows where and who I’d be today had I been placed on meds as a child.
There but for the grace of G-d…
Your combined thoughts are on the minds of many. Let’s educate ourselves a bit to clear the fog. Asperger’s was actually first recognized as an official disorder in 1992 (though it was discovered long before then by Hans Asperger, an Austrian pediatrician).
This syndrome was added to the DSM-4 (4th edition of the Diagnostic and Statistical Manual of Mental Disorders), the American Psychiatric Association’s diagnostic reference book, in 1994. Point being, we would have been unlikely to hear about Asperger’s way back when.
So what happened to all the children “on the spectrum” who grew up without being diagnosed or treated? Well, on the one hand there were far fewer occurrences of autistic children born years ago. By some estimates, autism has seen a staggering increase of 600 percent in just two decades, leading to a widely-held belief that environmental factors play a much bigger part in ASD than had been speculated.
On the other hand, for all we know adults who are today diagnosed with various so-called personality disorders might have turned out differently had they received appropriate treatment much earlier on in their lives.
Asperger’s syndrome is defined by specific criteria, the most prevalent being the lack of a natural instinct to read social cues, which makes it difficult for Aspies to interact with others. There is also the tendency to develop a passionate interest in a specific activity. They might develop rigid rituals, may appear physically awkward, are prone to speak in a monotonous, robotic manner and often avoid direct eye contact in a discussion. On the positive side, Aspies are generally very bright as well as exceptionally skilled or talented in a particular area. (Unfortunately, their quirkiness and nerdy-like persona makes them especially vulnerable to bullying.)
Displaying one or another of these symptoms is not indicative of Asperger’s; it is rather a combination of symptoms that is present in the diagnosed Aspie. (Assessing the disorder should be trusted to a professional with expertise in this field.)
The intensity of symptoms affects level of functionality and varies widely among individuals with AS. Some children show symptoms in their toddler years, while others are diagnosed much later on in their teen years. Still others discover they fit the Asperger’s mold as adults.
In answer to Flabbergasted Mom’s dilemma regarding medication, there is no known “fix” for Asperger’s. Medicine is often dispensed for the purpose of treating anxiety or depression that may co-exist with AS. The Aspie child feels different but cannot reason why, compounding the conflict of emotions accompanying the syndrome.
Dr. Mini Verter, a noted child psychiatrist, was kind enough to send us a detailed letter outlining the various meds used to treat the gamut of autistic spectrum disorders (ASD). [Asperger’s was controversially included in the new autism spectrum disorder criteria in May 2013, in the revised edition of the DSM-5.] Dr. Verter also weighs in with her sound judgment to allay some of Flabbergasted Mom’s trepidation:
What works for one child might not work with another child with the exact same symptoms. There are children/teens on high doses of several medications that do not work at all and who might need behavioral interventions that may or may not work. There are also children who have many symptoms that disappear as they grow older.
Parents need not feel pressured to always rush with medication, which may or may not be helpful. They should consider behavioral management interventions, adapted to the child in certain situations, such as buying one outfit the child likes in several sizes, social skills training, occupational therapy for sensory issues and anger management training.
Medication can always be considered if other interventions have not worked. When using medication, start with the lowest doses and go slowly with increases and decreases. Also, be well educated about ASD.
Thank you, Dr. Verter, for sharing your wisdom with us, and thanks to all of our readers who took the time to write.
Note to G.R. (whose Letter To The Editor appeared in the Feb. 7 Family Issues section):
You say you would advise Flabbergasted Mom that there’s nothing wrong with her son, that most normal kids misbehave and that he needs no therapy or medication. You boldly assume, “You have not made him stop, and so he doesn’t.” All he really needs, according to you, is discipline.
I’m glad you were there, my friend, to see first-hand what this family has been through. The only words I have for you are the words of Chazal: Al tadin es chavercha ad shetagia limkomo – do not judge your fellow until you have reached his makom, his place.