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ASD - mild, moderate, severe, Classic, HFA, AS...

(94 Posts)
lougle Thu 20-Dec-12 15:29:11

Can someone clarify something for me?

I saw on other threads that HFA is ASD without language impairment.
AS is ASD without language impairment at age 3?

Is that so?

Say DD2, who is being seen in January, is dx'd with ASD, but it's taken until she's 5 for us to be sure there is something not quite right and she most likely has some disordering of language...what would that be?

Would she be likely to be classed as HFA because in many areas she can pass for NT to the untrained eye? Or would she be classed as ASD but mild, because she has language disordering? I'm all confused

Dev9aug Thu 20-Dec-12 15:36:31

As far as I know, if the child was verbal before the age of 3, the it will be AS and if non verbal then HFA or HF ASD, which I think is the same thing.

Dev9aug Thu 20-Dec-12 15:39:56

Why do you think ASD? It could be a language disorder. I know zzzzz linked to a paper about how SLI can sometimes present as ASD.

PolterGoose Thu 20-Dec-12 16:02:15

Message withdrawn at poster's request.

Handywoman Thu 20-Dec-12 16:10:38

Agree with PolterGoose. Is it in the ICD-10?

In your case, Lougle, you may have a way to go if the language issue is only just being flagged. A full language assessment must be required to explore all avenues (for example to exclude SLI). By the time a diagnosis is reached the DSM-5 criteria may be in full effect, in which case AS may no longer be applicable and it will be a moot point!

Clear as mud eh?!!

Handy xxx

sickofsocalledexperts Thu 20-Dec-12 16:16:43

Aspergers used to be autism with zero speech delay and a normal IQ. But next year they are doing away with the term i believe and its all just autism. I did not realise, btw, that 50% of autistic children also have Learning Diffs.

I think we are going to find out one day that there are maybe 60 different genes implicated in this huge broad "thing" we call autism. And of course that would explain why all our DC are so different: for instance, my boy might just have genes 1 , 12, 45 and 59. Yours might have 3, 7 and 9. The possible permutations are endless.

For me, hf autism is when the child can talk normally and has a normal IQ. My boy is therefore severe, as has neither. For him, the problems are very clearly cerebral and not physical, hence dietary changes won't work. I don't believe his autism is anything o do with his gut.

And yes the studies do seem to show that a minority of autistic kids just have a spontaneous congenital developmental delay/ autism - science--speak for they haven't got a clue where it came from, or simplex.

lougle Thu 20-Dec-12 16:24:49

Dev9aug - I'm not sure what it is, to be honest. But some things which I've noticed about her behaviour don't, to my untrained eye, sit neatly as language issues.

For example, she came home today from the pantomime and said 'Cinderella did look like Miss X (her teacher) but she didn't have golden hair.' DD2 always identifies people by their hair. She rarely describes or indicates how they look, but she always comments on whether their hair is the same as someone significant to her. She doesn't seem to notice their appearance.

I saw a boy approach her yesterday. He clearly said her name and walked towards her smiling as she entered the classroom. She just looked at him, blankly, for about 3-4 seconds, then simply turned away and walked to the cloakroom. There were no words, no facial expression, no greeting of any sort...just nothing.

She's got odd language, yet she's so precise. When I said that DD3 had hit DD2 with her feet, DD2 said 'Mum, was it actually her bones?'

I'm not bothered with how the issues I'm seeing are identified, as long as they are identified, I was just wondering what the significance of 'high-functioning' was, and I guess also wondering why language is the determining factor of diagnosis.

Handywoman, I'm not sure the language issues are only just being flagged, tbh. I think that a) her school don't see it because she simply doesn't say too much and she is young. b) her preschool thought she was copying DD1 whenever her behaviour was unusual. For example, she always played alone. Always. But preschool decided that was because she had sisters at home so didn't need company at preschool confused. c) We thought she was developing well because DD1 is so behind, but now that DD3 is developing, we can see how different a NT child is.

lougle Thu 20-Dec-12 16:27:42

Interesting, sickof.

The other thing, Dev9Aug, is that DH has many ASD traits remembers the time I collapsed on the floor in the hallway and because I mumbled 'just give me a pillow' DH did, and went to bed leaving me there , as does DH's father and DH's brother, and my brother (none diagnosed).

sickofsocalledexperts Thu 20-Dec-12 16:59:55

I think they call what you are describing the autism phenotype Lougle - ie other family members have spectrummy traits but not autism itself. My DSd says and does things just like your DH and the pillow. And one of my biggest pleasures in life is messing up my DH's lovely straight lines of flickers and glasses case on the table in front of him. Putting one of them out of line or at an odd angle to the others really upsets his little tidiness vibe. I also had to tell him once that it is traditional human behaviour, when your wife is crying, to put your arm around her. He has now installed that behavioural update on his hard drive. He is not autistic, just has bits of the phenotype, or is that in fact Baron-Cohen's theory - that autism is just extreme maleness. Who knows!

lougle Thu 20-Dec-12 17:03:34

I'd bet my bottom dollar that FIL has ASD. He's seriously bad socially. We once had dinner with an ex-music teacher and talented violinist. FIL had decided to get a book on viiolins, then spent the whole evening lecturing this man on how violins were made.

DH's brother is much more flexible now, but when we were teens, I remember he was offered tickets to a concert one of his favourite bands were playing at. He was really conflicted, because it was for that Saturday, and he'd already planned that he would wash his car on Saturday grin

Handywoman Thu 20-Dec-12 17:10:54

Sorry, Lougle, by flagged I mean investigated. Has an SLT referral been made? How odd that your dd2's nursery thought having a sibling meant a child would not need to interact with other children confused indeed. Hope the Jan appt is productive and will shed some light.

Handy xxxxxx

lougle Thu 20-Dec-12 17:18:55

SLT referrals here come via the paediatrician unless they are under school age and HV involved, so hopefully when we see him on January 2nd he'll do that.

Yesterday, we had the following conversation:

Me:“DD2, I need to check there are no nits in your hair.”
DD2: “And eggs?” (Her sister had nits a few weeks ago, so she heard us talking about eggs)
Me: “Yes, and eggs. We definitely don’t want that.”
DD2: “Especially not cracked eggs, Mummy!”

She thought the 'eggs' I was looking for were chicken's eggs.

zzzzz Thu 20-Dec-12 17:29:53

My understanding is,

AS precocious/"at least normal" acquisition of language, plus triad of impairments

ASD triad of impairments
HFA triad of impairments, delayed and disordered language acquisition of language to totally non verbal, and normal to high IQ.

LFA triad plus low IQ

So the high in HFA relates to your intelligence not how severe or moderate the Autism is.

I believe that the criteria for SLI is that ASD must be ruled out before language disorder can be diagnosed not the other way around.

Realistically if your social communication is impaired because you ability to communicate is impaired, you will share many of the same issues/red flags. (eg children who can't make themselves understood or understand what is being said to them may withdraw into themselves). There is a huge overlap in symptomes and a huge overlap in the interventions that might help.

Needathickerskin Thu 20-Dec-12 17:34:51

Hi lougle - the thing you wrote about your dd recognising certain features such as hair and failing to recognise her classmate - you may like to read about prosopagnosia or face blindness. My father has this as a stand alone issue, but I suspect my ds who has ASD has this too (it is apparently more common among people with ASD). Although my DF doesn't have an ASD he is a stereotypical geek smile

zzzzz Thu 20-Dec-12 17:36:59

lougle perhaps Prosopagnosia is part of the picture?

zzzzz Thu 20-Dec-12 17:37:43

Great minds think alike!

sickofsocalledexperts Thu 20-Dec-12 17:38:22

Someone explained to me once that speech delay and ASD speech delay are different in the "intention or desire to communicate". A speech delayed child will still use eye contact or gestures or pointing, just not words. It will still be very clear what they want, as they will interract in a thousand little ways. With ASD, they just don't seem to have the need or urge to communicate. That always stuck in my head.

lougle Thu 20-Dec-12 17:38:48

That's much clearer, thanks. I've been on these boards for years, but I think that now I've got worries with DD2 it's all become muddled in my brain.

Needathickerskin, that's interesting, thanks for the link. I have to say I have noticed that if I see people out of context, I can really struggle to work out how I know them or what their name is blush

Handywoman Thu 20-Dec-12 17:54:21

Lougle, re the eggs conversation: my dd2 would have said exactly the same thing. It's spooky!!!

cheekkatb Thu 20-Dec-12 18:12:51

My son had moderate to severe ASD according to paed, verbal before 3 and average in maths, above average in computers but below average in other areas.

Strongecoffeeismydrug Thu 20-Dec-12 18:31:59
DS has a DX of classic autism,he was verbal before the age of 3 but his speech was only used to get his needs met.when he was 4 he was given the DX above as all the proffesionals involved thought due to his severe learning difficulties he presented as a classically autistic child.
So even tho he had speech before 3 he's still classically autistic with an extra DX of atypical speech disorder as well!
Like I say

zzzzz Thu 20-Dec-12 18:36:12

Speach refers to the ability to make words.
Language to how those words are put together to produce a sentence.
Delay implies the language is acquired in the normal order just slower.
Disorder that the acquisition is not in the normal order.

The confusion with pronouns is a very ASDish trait in language.

A language disordered child will make his needs known but if making eye contact with people causes them to talk at you more and become more enraged when you don't comply with the words you can't understand, you soon learn to look away. sad.

I found descriptions of "blindisms" very interesting. I beleive many of the behaviours we concidering to autistic type behaviours are those produced when children are stressed because they are isolated by their disability. I think that is why the same behaviours where present in the Rumanian orphans.

lougle Thu 20-Dec-12 18:37:35

"With ASD, they just don't seem to have the need or urge to communicate. That always stuck in my head."

See, I wonder where DD2 fits in that sentence. She does communicate, she has the desire to communicate, but I find it's only on her own agenda. If someone is talking to her and she isn't interested, she doesn't do anything to communicate that, she simply ignores the speaker. She only interacts on her own terms, I think, unless I specifically say 'DD2, DD3 is speaking to you, don't be rude.' Then she will say 'I'm busy watching tv, thank you, DD3' and ignore her again.

lougle Thu 20-Dec-12 18:40:50

However, when she wants to communicate, she is very insistent and won't take a hint that someone is busy. She went into class yesterday and wanted to give her teaching assistant a present. The TA was busy with children, doing craft. She incessently tapped the TA's arm, saying 'Mrs X, Mrs X, Mrs X, Mrs X, Mrs X, Mrs X, Mrs X....' Mrs X put her hand out on DD2 and continued what she was doing, but DD2 still continued 'Mrs X, Mrs X, Mrs X, Mrs X,'. Eventually she turned around and DD2 presented her gift to her - eye contact and a smile.

She thanks the lollipop lady beautifully now. Big smile, direct eye contact and 'thank you!', but she said to me one day 'Mummy, I said thank you and smiled because you told me you like me to do that because it is manners.'

moondog Thu 20-Dec-12 18:45:58

It is confusing.
The parameters change all the tim, assuming that they can be set up to differentiate one 'condition' from another, which I don't think they can in any case.

The most important thing to remember (and I say this with both my professional hat and parent one) is not what 'it' is called but what is gonig to be done about it.

It's easy to get distracted from the fact that most available help for issues of this sort is, frankly speaking, pathetic. So don't focus on semantics, focus on SMART input (of which there isn't much).

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