How do the "specialists" distinguish between Autism and Dyspraxia

[5inthebed]

DS2 was dx with autism last year. It was a definite dx, no doubt about it. We had his school review yesterday, and they mentioned they thought he might also have dyspraxia, so needed to make an appointment with his paed. Appointment booked for 9 April, not long!

I really want to be able to go into this appointment with a good idea of what I'm asking.

I looked up dyspraxia and it is basically DS2. So what is the difference between the two, and why does ds2 (possibly) fall into both?

dyspraxia is a motor planning disorder. It seems to overlap with autism in that people iwth dyspraxia often have social and communcation difficulties and so exhibit autism type symptoms. So, when they are younger it can be hard to distinguish between the two.
What you need to ask for is a referral to an OT who can run an assessment battery to find out what degree of motor control he has, and if it is low enough to diagnose dyspraxia. The tests run can distinguish between lack of concentration/general clumsiness and actual problems with motor planning.

I think a combination is very common. my ds1 has a diagnosis of dyspraxia but also has social and communication difficulties. We're waiting to see whether or not he will be dx with asd too. Good luck with the appointment.

Thanks for that. I hate going to see the paed, and to top it all, I think I'm going to have to drag 3 more children along, as its half term!!!

My personal view is that it's often (not always) one and the same thing. If you look at a full list of dyspraxia symptoms and a full list of ASD symptoms, you'd be struggling to find anything different other than if the child is rude and won't look you in the eye, they'll call it ASD, and if they're not, they'll call it dyspraxia. Are they always the same thing? No. Some children with dyspraxia have excellent social skills. Some children with ASD have no motor problems. But the similarities are just too amazing for it not to be hugely related:

This is a typical Dyspraxia list:

Poor balance. Difficulty in riding a bicycle, Difficulty with some sports, Poor hand-eye co-ordination. Difficulty with team sports especially those which involve catching a ball and batting, Exaggerated 'accessory movements' such as flapping arms when running, Poor at two-handed tasks, causing problems with using cutlery, cleaning, cooking, ironing, craft work, playing musical instruments
Poor manipulative skills. Difficulty with typing, handwriting and drawing. May have a poor pen grip, press too hard when writing and have difficulty when writing along a line
Inadequate grasp. Difficulty using tools and domestic implements, locks and keys
Difficulty with dressing and grooming activities, such as putting on makeup, shaving, doing hair, fastening clothes and tying shoelaces,
May talk continuously and repeat themselves. Some people with dyspraxia have difficulty with organising the content and sequence of their language
May have unclear speech and be unable to pronounce some words
Speech may have uncontrolled pitch, volume and rate
Eye movements:Tracking. Difficulty in following a moving object smoothly with eyes without moving head excessively. Tendency to lose the place while reading
Poor relocating. Cannot look quickly and effectively from one object to another (for example, looking from a TV to a magazine)
Poor visual perception
Over-sensitive to light
Difficulty in distinguishing sounds from background noise. Tendency to be over-sensitive to noise
Over- or under-sensitive to touch. Can result in dislike of being touched and/or aversion to over-loose or tight clothing - tactile defensiveness
Over- or under-sensitive to smell and taste, temperature and pain
Lack of awareness of body position in space and spatial relationships. Difficulty in planning and organising thought
Poor memory, especially short-term memory. May forget and lose things
Difficulty with concentration. May be easily distracted Difficulty in listening to people, especially in large groups. Can be tactless, interrupt frequently. Problems with team work
Difficulty in picking up non-verbal signals or in judging tone or pitch of voice in themselves and or others. Tendency to take things literally. May listen but not understand
Slow to adapt to new or unpredictable situations. Sometimes avoids them altogether
Impulsive. Tendency to be easily frustrated, wanting immediate gratification
Tend to get stressed, depressed and anxious easily
May have difficulty sleeping
Prone to low self-esteem, emotional outbursts, phobias, fears, obsessions, compulsions and addictive behaviour.

Hey, it's the same as the ASD list. Remarkable.

Thats what I was thinking Amber. They are very similar. DS2 though has no social awareness, gets right in peoples faces and touches and smacks people if they get in his way. He does have a lot of those dyspraxia "symptoms" but he also has the asd ones as well.

Why does everything have to be so bloody confusing!

Ds was assessed ( with great difficulty) by an OT at 6 years old. His motor planning, motor skills and coordination fitted the profile for dyspraxia but she felt he needed further assessments because of his 'other difficulties' (language delay, social difficulties, lack of attention span etc) . He now has a Dx of ASD and ADHD. I think what she was trying to say was that although he fitted the profile of dyspraxia a different diagnosis would serve him better. Advice from the Ot is helpful.

My Dt2 has dyspraxic and ADHD traits and I have often pondered this question when identifying that many of the dyspraxic traits are also common to ASD. My thoughts on how to distingush are that ASD is primarily a social and communication disorder and dyspraxia is a motor skills disorder. You cant be dyspraxic without having motor problems and you cant be ASD without having social and communication problems. You can be ASD without motor problems and you can be dyspraxic without the social problems. If you have social problems when having dyspraxia then I think you could be asd also or else those social problems could be a consequence of having dyspraxia, eg maybe feeling different from other kids , rather than having a pure social and communication disorder.

However there are other things that i dont really understand . Sensory problems seem to be common to both but then maybe they are common to those that have both conditions ?

paranoid2, ASD used to be thought of as a social and communication disorder, but the more they're interviewing us and staring at our brains, the more they're realising that this is only part of it, hence a full list for Asperger syndrome now including motor problems and sensory problems.

Difficult, isn't it.

Amber - you know a lot more than me but would the sensory and motor issues not be possible symptoms and not essential for an ASD diagnosis or are they planning to make them essential? I would have thought that a child would not be diagnosed with ASD if they had motor and sensory issues but no social and communication issues There are Mums( and i can think of a few here on Mumsnet) that have children with ASD that do not have poor motor skills. Not sure about the sensory issues.

btw I love your "Day in the life of Amber" posts. They are very enlightening. Hope your DH is keeping well.

My ds1 has ASD but has the motor skills and co-ordination difficulties associated with dyspraxia.

Ds2 also has ASD but has very good motor skills and co-ordination.

This seems to fit Paranoid's theory.

Paranoid, what you have said is basically whats rettling around in my head. I can never seem to put things down in writting.

I printed off the symptoms of dyspraxia for 3-5 year olds so I can take it with me for ds2's appointment.

This isn't the only reason we have made an emergency appointment, but one of my main concerns since the school brought it up. and here was me thinking this year would be less stressful that last year

paranoid2, depends on the person doing the diagnosing. Many now include motor and sensory issues in their diagnosis (they were with mine), but they still rely on there being the usual social skill deficits as a definite 'yes' and the other things as strong evidence.

But the new brain scan info is suggesting that they all need to rethink what they're diagnosing and how.

For example, the evidence now points to the brain changing throughout life anyway, so is a fixed diagnosis useful? Or an assessment at one point in time rather than a series of them over time?

There are those that suggest that people with Asperger syndrome actually often show more 'autism' (obsession with ourselves, 'maleness', apparent utter disregard for others) than those diagnosed with "Classic Autism", who are often more naturally empathetic towards others than we are, but struggle to express it more because of a low IQ. Yet Asperger syndrome is currently most often classed as as 'mild' autism because no-one's done the right research yet to find out what we truly do now mean by 'autism' rather than "behaviours and characteristics resulting from low IQ and sensory issues". As some of us with Asperger syndrome know, it isn't always mild.

When the DSM V diagnostic criteria are finally released, I suspect that much will have been changed. There are long delays to doing so because they're realising that much, much more work needs to be done.

how do they dignose asd, when i ook at the traid list my ds ticks every box and the list above to yet the devlopment paed sees him for 15 mins and says oh hes not asd

yet we go look at sn schooland within 2 hrs of our second visit,couple times the teachesr there asks me if hes on the asd

Amber thats interesting about the possibility of Aspergers people being more autistic. I thought that the low IQ associated with classic autism was more to do with the autism itself (although not exclusively) in that the severe behavoural and in particular sensory issues makes it very difficult to test iq on those who have low functioning autism

Phoenix4725, it'd take more than 15 mins to diagnose a child with an ASD, so I'm very suspicious about the dev paed's sudden view. Did they say why they thought he didn't fit the diagnosis?

Paranoid2, if they're having difficulty communicating with a person with classic autism, that could make it more difficult to test for IQ, but that doesn't make the person more 'autistic', from what I read. The actual word 'autism' means "focused on yourself". It doesn't mean low IQ or unable to communicate or having difficulty with the environment or having repetitive or extreme behaviour (though those things are usually present in those with classic autism), so if used properly, that word means those people who are utterly self-focused, selfish, unaware of the needs of others. Intriguingly, those with Asperger syndrome are apparently more likely to be self-obsessed than those with classic autism.

The high IQ we have is fairly irrelevant if we can't manage to interact with anyone in a sensible enough way to get them to make use of us or our skills, and if we can't spot or avoid dangers. And if we're perceived as really capable, of course there's usually no help, support, understanding or anything else, which is why we so often end up lonely, poor, bullied, sexually assaulted, defrauded of money, suicidal/anxious/ depressed/self-harming, treated like s**t, and told what we have is surely really mild compared to Real Autism. I know how lucky I've been with the chances I've had in life, but I'm one of very few people who have managed to beat the odds and cope somehow with all of the above. So much more to do...just SO much more.

in her words he wanted to try and communicate even though hes non verbal and he will focus ontask ,but its only with constant encouragment from a adult,though eye contact with children is still issue will with adults he knows well.

older hes getting the more i think hes on the spectrum

he struggles to read thngs if someone falls over he laughs,he onlylearnt to point the last 6 months took lot of hand on hand for that

I'd be thinking about a second opinion/a private diagnosis, anything that gives you a bit more of a clue. Seems very odd to suggest that we're not ASD because we want to try to communicate/will focus on a task.

Amber what is the research you mentioned about the brain changing?

nikos, Prof Bailey at Oxford is looking at that research at the moment. He says that when they look at scans of which bit of the brain is active when a child is thinking about something, then look at the scans for adults, they're using different bits of the brain to do that thinking. They weren't expecting that. Much more research to be done, but the brain changes which bit of it does what at different times of its life, it seems. With ASD brains, ours definitely has a different wiring pattern anyway (it mixes up the grey and white matter in the brain far more than usual), so goodness knows how ours changes over time. All interesting stuff.

Thanks Amber, my home spun theory is that early intervention is helping to 'rewire' ds brain as he genuinely seems to be thinking in 'unautistic' ways at times. Where should I start if I want to read more research on the brain and asd?

www.autismresearchcentre.com/arc/default.asp

Autism research centre is a good place to start.

www.researchautism.net/pages/welcome/home.ikml

Research Autism is another site with a lot of useful info on it.

There's also a useful recent paper by Prof Quinton Deeley on pathophysiology of autism which is published in the British Journal of Hospital Medicine, March 2009, Vol 70, No 3 but not sure if it's accessible online or not. It's not very user-friendly, but certainly summarises a lot of the research going on at the moment.

"Autism spectrum disorders are characterized by underconnectivity between components of networks subserving a variety of functions
(e.g. executive function, facial emotion processing, theory of mind, and language processing).
Structural brain imaging has revealed widespread differences in structure and developmental trajectory in both grey and white matter regions in people with autism spectrum disorder". etc

Thanks guys, I am an adult which has just been diagnosed with dyspraxia and looking on the internet, there is not much to find on the subject. I am a TA and I work with children with dyspraxia, however just found out I have it as well as dyslexic short memory too. It is really nice to here a real persons perspective views and latest research on the the area. Gives me more understanding in the area. Thanks