Is it really a correct diagnosis?

I’m about to write something provocative, so feel free to beat me up on it, provided that you do so politely. It’s about the increasing prevalence of Asbergers diagnoses amongst children. Asbergers is a rather amorphous condition, although it’s considered to be part of the Autism spectrum. Here’s the definition from one medical website:

Asperger syndrome (AS), one of the autistic spectrum disorders, is a pervasive developmental disorder characterized by an inability to understand how to interact socially. AS is commonly recognized after the age of 3. People with high-functioning autism are generally distinguished from those with AS because autism is associated with marked early language delay. Other characteristics of AS include clumsy and uncoordinated motor movements, limited interests or unusual preoccupations, repetitive routines or rituals, speech and language peculiarities, and non-verbal communication problems. Generally, children with AS have few facial expressions. Many have excellent rote memory, and become intensely interested in one or two subjects (sometimes to the exclusion of other topics). They may talk at length about a favorite subject or repeat a word or phrase many times. Children with AS tend to be self-absorbed, have difficulty making friends, and are preoccupied with their own interests.

In my day, we all knew kids like this and we were cruel to them and called them geeks. There’s a lot to be said for recognizing the symptoms, accommodating the children’s needs and, especially, teaching them social skills so that school, a place where they often excel academically, is not a living hell. In other words, I have no doubt that Asberger’s exists and that identifying it is beneficial.

Where I’m about to get controversial is my sense that, in some cases, Asbergers is the diagnosis given to children whose parents are not parenting. I know three — count ’em, three — children who are nightmarish behavior problems. What characterizes all three of them is the uncontrollable temper tantrums they have. And I’m not talking about 2 or 3 year olds lying on the floor hollering “No!” I’m talking about kids who are 7 or 8 or even 11 or 12 and who regularly engage in scenes that involve uncontrolled screaming, hurling insults and, often, physical violence against other adults or children. Because of the scenes — and only because of these scenes — each set of parents eventually took the child to a psychiatrist. That is, the parents did not take their kids to the psychiatrists because they weren’t socializing well or because they were obsessed with a single subject at school. They took them because of those off-the-charts tantrums. In all three of the cases I know, the psychiatrists diagnosed the kids with Asbergers.

But here’s what I didn’t tell you about those three children: In each of the three cases, the parents (in my humble estimation) earn an “F” for structure and discipline. The common pattern in each of those households is that one or both of the parents feels an almost excessive sympathy for the kid when he (or she) is frustrated or unhappy. What the child wants, the child gets. One of the children I’m thinking of ruled the whole household. She dictated what was eaten, what wasn’t eaten, where people went, what they did, what bed time was, what toys and games were bought and rejected, etc. The parents thought that they were making her happy, but to an objective observer, the child was miserable. It was way too heavy a burden to place on a 10 year old, and she was a frenzied, hysterical tyrant who was unable to cope if anything didn’t go her way.

What also characterizes all of these parents is that, when the child has a tantrum, regardless of how awful it is, and what havoc it creates, the parents respond, not with discipline, but with sympathy: “The poor little thing. He couldn’t control himself. He was so upset I didn’t have the heart to punish him.” And in each case, this sympathetic response to the child’s tantrums worsens after the diagnosis. Now the parent is not only sorry for the child, but he’s convinced that the child is “sick” and must be handled with ever greater care.

As it happens, I know a child who was diagnosed with autism, although it’s not entirely clear that this is an accurate diagnosis. What is apparent is that his speaking skills are extremely limited, to the point where only those closest to him can understand him, and his body often doesn’t respond to his brain’s signals. With a child like this, you might excuse the parents for treating him as something other than an ordinary child. But they haven’t. Instead, in addition to all the work they do to get him beyond his disabilities, they also treat him like a real child: the expect certain behaviors from him (good listening, good manners, etc.), and if he doesn’t live up to those behaviors, he gets the same consequences any other child would (loss of privileges, time outs, etc.). The result is that this child has turned into a delightful human being. The rigorous structure has also enabled him to blossom at an intellectual level, and he’s demonstrated an over-the-top IQ and the academic abilities to match. Had his parents let him turn into a screaming monster because “they felt sorry for him,” he never would have been able to develop this potential.

Now here’s the question for you: Do I sound like a smug parent who (blessedly) has developmentally normal children and lacks compassion for those who are not so lucky? Or have I spotted a trend where parents who cannot create boundaries between themselves and their children are aided by a therapeutic community that either cannot bring itself to call parents on their behavior or that has itself lost a sense of a child’s need to be treated like a child?