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That’s Not Autism

Therapist Enrico Gnaulati contends that we are overdiagnosing autism spectrum disorder. Excerpts:

I have followed William in my therapy practice for close to a decade. His story is a prime example of the type of brainy, mentally gifted, single-minded, willful boys who often are falsely diagnosed with autism spectrum disorder when they are assessed as young children. This unfortunate occurrence is partly due to defining autism as a “spectrum disorder,” incorporating mild and severe cases of problematic social communication and interaction, as well as restricted interests and behavior. In its milder form, especially among preschool- and kindergarten-age boys, it is tough to distinguish between early signs of autism spectrum disorder and indications that we have on our hands a young boy who is a budding intellectual, is more interested in studying objects than hanging out with friends, overvalues logic, is socially awkward unless interacting with others who share identical interests or is in a leadership role, learns best when obsessed with a topic, and is overly businesslike and serious in how he socializes. The picture gets even more complicated during the toddler years, when normal, crude assertions of willfulness, tantrums, and lapses in verbal mastery when highly emotional are in full swing. As we shall see, boys like William, who embody a combination of emerging masculine braininess and a difficult toddlerhood, can be fair game for a mild diagnosis of autism spectrum disorder, when it does not apply.

Gnaulati goes on to describe the behavior in young William that resulted in a diagnosis of Asperger’s. It’s behavior that’s very close to what we dealt with in our family with our son. And then William’s parents brought him to Gnaulati, who in a single session with him knew this kid was not on the spectrum:

Fast-forward to the present. William is now a high school student who is very active in student government. He is quite at ease with other teenagers who share his level of intellect. He continues to demonstrate the same thirst for knowledge that he had as a toddler. When classroom subjects interest him, his academic performance is stellar. When they don’t, William’s grades suffer. His report cards often contain peaks and valleys of As and Fs, which is immensely frustrating for his parents. His interests are not highly obscure and detail oriented, characteristic of autism, such as memorizing the names of dinosaurs or the serial numbers on Ford trucks. He is an abstract thinker who labors to understand issues more deeply. For instance, he has a complex understanding of different forms of government, and he is able to articulate the arguments for and against democratic, fascist, and oligarchical arrangements. This conceptual, philosophical way of acquiring knowledge tends not to be autism-friendly.

Granted, William is far more comfortable isolating himself and studying political geography and rock-and-roll memorabilia than he is hanging out at the mall. In addition, he can still explode emotionally when he is forced to switch activities, such as applying himself to his homework rather than researching Fender guitars or the geography of Iceland on the Internet. Moreover, he’ll only incorporate new food items into his diet when he has tried them at a fancy restaurant that doesn’t have kiddie foods such as pizza, hot dogs, or peanut butter sandwiches on the menu. However, these traits and behaviors don’t mean that he’s autism spectrum disordered. They reveal William to be a brainy, somewhat introverted, individualistically minded boy whose overexcitement for ideas and need for control cause problems with parents and peers.

As we shall see, boys with these traits and behaviors are often falsely diagnosed with autism spectrum disorder, especially when they are assessed at younger ages.

Read the whole thing. When Gnaulati says that kids who are truly on the autism spectrum typically don’t get humor, I immediately thought about how our son, allegedly an Aspie, has an extremely well-developed sense of irony, and is one of the funniest people we know. Listening to some of his sophisticated jibes, I’ve wondered from time to time how an Aspie can be so hyperaware of subtleties necessary to make those jokes and observations. Now I wonder if he was simply misdiagnosed. That doesn’t mean he doesn’t have special needs — boy, does he! — but that they come from a slightly different place. Gnaulati says a misdiagnosis can lead us to seeing a child’s odd gifts as a flaw that needs treatment rather than a gift that needs to be encourage:

Boys like William don’t need to be channeled into unwanted and unnecessary social-skills classes to obtain formal instruction on how to start and sustain normal conversations. They don’t need to be prodded to be more sociable with the neighborhood kid whose mind works completely differently from theirs. They need unique school programs that cater to the mentally gifted in which others will not be chagrined by their intense love for ideas and where they have a shot at making true friends and therefore have the opportunity to feel truly sociable.

Man, I saw so much of my young self in this piece, especially the part about making As in the subjects I was interested in, and failing those I wasn’t. I want to read Dr. Gnaulati’s book now.



about the author

Rod Dreher is a senior editor at The American Conservative. He has written and edited for the New York Post, The Dallas Morning News, National Review, the South Florida Sun-Sentinel, the Washington Times, and the Baton Rouge Advocate. Rod’s commentary has been published in The Wall Street Journal, Commentary, the Weekly Standard, Beliefnet, and Real Simple, among other publications, and he has appeared on NPR, ABC News, CNN, Fox News, MSNBC, and the BBC. He lives in Baton Rouge, Louisiana, with his wife Julie and their three children. He has also written four books, The Little Way of Ruthie Leming, Crunchy Cons, How Dante Can Save Your Life, and The Benedict Option.

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