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Question 72: My 17 year old son was diagnosed
with NLD two years ago and has a certain behaviour that troubles me....[It]
started ever since he could sit up and he would take a shoe lace and
flick it back and forth in front of his eyes. From that point on R.
would perform the same action with other items....ie. straws, fishing
line, string. R. now has what he calls his "flicking shirt",
a long sleeved t shirt he wears with one sleeve pulled down over his
hand in which he holds a peice of fishing line and waves it in front
of his eyes very fast clapping his hands together. He does not do
this in public but I do notice him walking towards the car when I
pick him up at school and he will be snapping his fingers up almost
at eye level with one hand. I really would appreciate your thoughts
on this "flicking" behaviour. It is something R. must do
every day. I've been an advocate for R. ever since they told me in
junior kindergarten that R. just doesn't do what everyone else does
and that something is amiss. Thank you, J.M., ON, Canada.
Good day
J.M.:
I will provide some thoughts on this "flicking" behaviour,
but I must stress that I am not by any means providing a diagnostic
opinion. I am merely suggesting some potential avenues for pursuit given
limited information and no familiarity with your son whatsoever. My
words should be in no way be taken to substitute for or compete with
R's doctor's (either his physician's or Psychologist's) opinion.
Clinicians are trained to immediately think about the autism spectrum
(Pervasive Developmental Disorders) when they see or hear of unusual
or repetitive play like what you've described. Given that a nonverbal
learning disability profile is typically part of an Asperger's diagnosis,
I would at least consider having your son assessed with this condition
in mind. Things you would want to think about include:
-is his intelligence level average or even above average in some ways,
or does he have a cognitive delay. While intellectual functioning is
low in autism, it is not necessarily so in Asperger's syndrome.
-does R. engage in any other odd play activities, such as looking at
things from all angles, flicking the eyes on dolls, or smelling or licking
toys? Does he rub toys on his face or put toys to his ear to listen
to them?
-is he attracted to shiny or noisy toys, or toys that can spin? Is he
only interested in the activities of others if the activity they are
engaging in is loud (such as sawing, vacuuming, or mowing the lawn)
-are his behaviours, activities, or interests very restricted and/or
narrow in scope (does he have only one or two likes, but takes these
likes to an obsessional extreme?)
-is he an awkward or clumsy child?
-while R. would have difficulty with speech that is more abstract (i.e.
non-literal) are there significant language delays?
-does R. ever engage in stereotyped motor mannerisms such as hand-flapping,
head-banging, rocking (either while standing or sitting), or clicking
sounds with his tongue?
While this is not an exhaustive list of things that should be asked
in an assessment for a pervasive developmental disorder, it will nevertheless
help prepare you for the directions that you should be thinking about
and perhaps logging in preparation for a future appointment.
I hope this helps! Take good care,
Dr. Dunc.
Postscript:
Hello
Dr. Dunc,
I had written to you about my 17 year old son, (question 72) and just
wanted to give you an update as we saw R.'s pediatrician today. Dr T.
believes that R. has Asperger's syndrome....I really wanted to let you
know that your mention of Asperger's was right on the mark. Now the
challenge is to find a place for R., or to help him find his place after
highschool.
I wish you every success in your work, and again Thank you,
J.M.
