Health

Saturday 23 August 2014

Should my daughter's Asperger's have been diagnosed sooner?

MY DAUGHTER was diagnosed with Asperger's Syndrome last year when she was 16 years old. My husband and myself referred her to a child psychologist when she was 11 years old.

At one of the meetings I attended with the psychologist I queried whether or not our daughter had Asperger's Syndrome and was told by the psychologist that she didn't have it.

Our daughter left school after the Junior Cert and refused to return. In the absence of a diagnosis, she isolated herself from her peers and they in turn excluded her from their activities, parties and such like.

I just wonder why the psychologist did not listen to our concerns as parents and arrange to have her assessed for Asperger's Syndrome.

Is it difficult to diagnose this condition in children? We believe if she was diagnosed sooner she would still be at school as she would have been given support by the school.

We would value your professional opinion.

THE simple answer to your question is that yes it can be difficult to accurately diagnose Asperger's Syndrome (AS), just like it can be complicated to accurately identify any autistic spectrum disorder.

Part of the difficulty lies in the fact that the diagnosis of AS is based entirely on clinical judgment. There are no blood tests, brain scans or definitive physiological symptoms that will prove or disprove that a child or teenager has AS.

I am of the opinion that AS, like other autistic spectrum disorders is best diagnosed as part of a team-based assessment with perhaps psychologists, psychiatrists, speech and language therapists and occupational therapists involved.

Because a diagnosis is based on clinical judgment, it requires, therefore, that the assessing clinicians have a good expertise in, and knowledge of, autistic spectrum disorders generally.

That expertise only comes from experience, study and supervised practice.

Most child psychologists will have a general understanding of AS. They will be aware, for example, that it is usually characterised by social interaction and/or communication difficulties and perhaps by repetitive or restrictive patterns of behaviour or interests.

In their practice, however, they may not have met many children or teenagers with AS.

Consequently, clinical psychologists who work with all age ranges of children and the full range of social, emotional and behavioural difficulties that children present with, are unlikely to have had enough exposure to autistic spectrum disorders to develop the expertise to accurately and consistently diagnose something like AS.

There are many "what ifs" attached to your musings about the missed opportunity you felt you had when you spoke to the psychologist when your daughter was 11.

It must feel very disappointing and upsetting to think that supports or interventions could have been tried several years earlier, had you been clearer about the nature of the her difficulties. I can only assume that the psychologist you attended back then gave you the best clinical judgment they could with the information they had.

Perhaps you felt dissuaded from pursuing a further assessment yourselves after that consultation? Perhaps you accepted the assessment and opinion of the psychologist because it fitted well enough with your daughter's presentation at the time?

It is entirely speculative and hypothetical to try to determine what might have transpired had the psychologist referred your daughter for further assessment back then. Equally, what might have happened had you been sufficiently dissatisfied with that consultation that you had decided to pursue a second opinion when she was 11?

From your query I take it that you decided, when she was 16, to further investigate the difficulties she was having socially and/or emotionally.

The diagnosis of AS that she received then certainly seems to explain, to you, why she struggled so much in school.

There seems to me to be two pieces of learning that you, and others can take from your experiences.

The first is that autistic spectrum disorders are not simply and easily identifiable and diagnosable. So always pursue an assessment with a team of experts in the field.

The second is that, as a parent, if your intuition about, and knowledge of, your own child leaves you dissatisfied with the clinical opinion of any professional, then it is probably worthwhile getting a second opinion.

Irish Independent

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