Dear Therapist:

I am wondering if you can guide us where to turn regarding some challenges that we are having with my 7-year-old son. 

While it is hard to write everything that we notice, he is basically having problems with friends.  For example, he has a hard time getting the concept that someone can play with him one day and then play with a different kid the next day. He also is very into trains and will talk about it as well as its details to everyone whom he meets, causing him to appear strange to others. A teacher has told us that this may be Asperger's Syndrome, but when we looked this up, we discovered that this category no longer exists. 

Any help towards understanding our son would be greatly appreciated. 

Response:

It is true that “Asperger’s disorder” no longer has its own category in the diagnostic book. However, this is simply a function of the way in which symptoms of what was known as Asperger’s are categorized. These symptoms are now folded into a more general category known as “autism spectrum disorder.”

The understanding is that issues relating to the old Asperger’s disorder and those seen in autism are similar—and that differences lie in severity of symptoms and their impact on the person’s life. Essentially, the concept is that there is a spectrum on which people have these issues. Therefore, one person may have a major social impairment, and be unable to properly communicate with others. Someone else may only have very slight impairment, which may not be obvious to others. Nonetheless, they can both be “on the spectrum,” though on opposite ends of it.

When you think about it, most things exist on a spectrum, whether they be social abilities, obsessiveness, anger, sadness, anxiety, or any other emotion. If we view every life issue from this perspective, we could identify a spectrum for all problems and emotions—and we would all be somewhere on each spectrum. Theoretically, we could create a spectrum disorder for any issue or emotion. Whether someone would be diagnosed with that disorder would depend on where the lower end of the spectrum is located. This, of course, can be arbitrary.

Autism spectrum disorder includes symptoms relating to social difficulty, trouble adapting to change, and unusual actions and reactions. However, the degree to which symptoms impair the person’s life are most important. Whether someone can “officially” be diagnosed with ASD (or any other disorder for that matter) is typically less significant than the impact of the issues that affect them. In other words, it doesn’t really matter what professionals might call it—you know what the problem is.

If you feel that your son has issues that are not getting better, you should have him see someone to help him deal with the problem—not to treat an official disorder. (Remember, we treat problems, not disorders.) Whether or not there is a name for his problem, a therapist can help your son to better assimilate to his social surroundings, and to better respond to cues and changes.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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