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?

26 Responses

  1. I believe you have spotted a trend, much like the trend that saw a supposed explosion of ADD in this country, complete with pharmaceutical intervention, that looks to the non-professional for the most part like improperly diagnosed rambunctiousness.

  2. BTW, it is my OPINION that the Boomers were, as a generation, lousy parents, and their children are even worse.

  3. You are absolutely correct. Ours is a society which wants to avert blame for its faults. We do this, in part, by creating “conditions” upon which we can heap the blame for imperfections in ourselves. It is all part of the “victim” culture. If the problem is a medical condition, then we don’t have to look at ourselves in the mirror too hard.

    This is perhaps not as bad as the rampant diagnosis of ADD and ADHD, and the concomitant prescription of drugs such as Ritalin, but it’s getting close.

    Of course, the real danger of accepting these diagnoses too readily is the risk of the medical equivalent of the Boy Who Cried Wolf. Those kids who do suffer from the condition will not get as much attention and care as perhaps they really need.

  4. This reminds me of advertisements I’ve seen on TV for medications to treat shyness. I’m no doctor, but that seems nuts to me. If they weren’t trying to sell pills, would anybody be calling shyness an illness?

  5. Hi Book,

    Disclaimer: This is based on personal experience and not any type of well-researched theory.

    My younger half-sister has Asberger’s, and she is one example that doesn’t support your theory. In her case, it IS real, and they really didn’t recognize it for what it is until a few years ago. Searching for a diagnosis, the docs put her on so many drugs when she was little, including Ritalin, that she won’t even take aspirin now. Her parents were EXTREMELY strict (way more strict than mine). The fact that they were finally able to recognize that she saw the world in a fundamentally different way from the average joe gave us all a chance to help her live a normal life.

    Of course, her older brother was drugged up on Ritalin when he was little for no good reason. So while I agree that things like ADD, ADHD and Asperger’s can be over- and mis-diagnosed when it’s actually bad parenting at fault, I’m also grateful that increasing recognition of Asberger’s led to my sister’s diagnosis.

  6. I agree with you, Lissa. It is a real syndrome, and I’ve known kids who have it and suffer from enormous frustration as a result of their failure to connect. I’m just concerned about those kids whose parents use the problem as an excuse for their own avoidance of boundaries. It seems to be that, as to those children, the medical profession is complicit when it keeps prescribing pills, but never teaches the parents how to say “no.”

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  8. Bookie,
    I was once standing in a line in a post office in my full Navy Commander get-up (lunchbreak) when a rather large woman came in with two young boys about 5 and 8. The 8 year old quickly got bored and started telling his Mom about all the posters on the wall about the new stamps. “Oh, airplanes – that one is cool.” “Flowers, I don’t want that.” All the time she avoided eye contact with him – me, no problem. Me and the boy started making faces at each other (though he made noises to go with his face). I started to laugh a bit because the kid reminded me of him at his age; doing the tenth BORING trip with Mom on a off-day and a no-fun sibling to boot. The Mom and I caught each other’s eye and I said with a light-hearted tone in my voice because she looked at her end, “Don’t worry, he’ll grow out of it … ” before I could say, “…because I sure did.” She came out with a full throated belt, “No he won’t. He has Autism and will be that way his entire life!”

    Well. The 5 yr old shrunk back behind his brother like a shadow – the 8-yr old all of a sudden turned his back and started playing with his brothers hair – and the entire post office was looking at me.

    Well, in about 30 seconds, the boy started to talk at his brother about the different boxes, Mom looked the other way at a corner of the wall – and I just sat there quite as a mouse waiting to send my packages and thanking all that there is to thank that I married the women I did.

    Maybe I wasn’t that bad as a 8-yr old – though I knew some who were. They are fine adults now. One, I think is a rather good CPA. And yes, geeky like you read about – but in a way so was I until I shot through 6’+, got a car, and girls realized that I was a tad exotic. Then I was just a dork.

  9. Heard of ODD? Oppositional Defiant Disorder. Like it sounds, it’s when a kid doesn’t want to do anything that anyone tells him to do. I don’t have the energy to even begin to give my opinion on that.

  10. Heather, please tell me you’re kidding.

    Thanks Book, I didn’t meant to imply that you were. I guess a better response would be 1) Yes, I think Asperger’s might be the new ADHD as far as mis-dagnosis and avoiding the real problem, bad parenting; 2) I’m less irked than I would be if I hadn’t benefitted from the increased common knowledge that came about with it

  11. Heather – Our daughter was diagnosed with ODD when she was a teenager. It is in the book as a bonafide disorder and in reading the associated behavior she herself agreed with everything listed. Looking back now I’d say what she really ‘had’ was a disposition to raise the middle finger at her parents who finally figured it out!

    On a similar note, I also do not believe that alcoholics have a disease. People may be more or less inclined to become dependent on alcohol, but that doesn’t make it a disease – calling it a disease just creates somewhere else to place the blame other than the person taking the drink. Like BW, I too have compassion for people who are dependent on drugs or alcohol, but please let’s not make everything – including obesity and bad behavior, for God’s sake – a disease.

  12. Glad you said it rather than I…

    I am compelled to agree with you, and with Chris: the Boomer generation has worked out to be the worst parents in the history of reproduction.

    But shrinks don’t get paid for pointing that out – and neither do schools. “Take him home and smack him one,” while it may often be excellent advice, doesn’t bring extra funding in for the schools, or the school-funded shrinks.

    Is Asburger real? I don’t know. Is ADD real? Inclined to doubt it, but I don’t know. Is HD real? Doubt it – but I don’t know. Is AD-HD-M-O-U-S-E real? Got me. But I do find it odd that the literature and clinical experience with this stuff was pretty much zero 75 years ago, yet now, amazingly enough, over 50% of the kids are somehow afflicted. How that happened, so completely and so quickly, frankly eludes me.

    And it inclines me to suspect that there might be something else at work here, like pathetic parenting.

    Very politically incorrect, I know.

  13. It sounds as if we’ve found another “diagnosis” to go along with ADHD. My sister’s oldest was diagnosed with ADHD. What the familt saw was a child treated with kid gloves, never disciplined, who called the shots.

    He’s still living at home, with few if any prospects for a decent future. His parents claim he’s looking into this career or that career, but he’s just playing on his computer.

    Asbergers seeems like a bad condition, when it exists, but as with ADHD, it’s probably over-diagnosed rather than a doctor actually treating the underlying problems. And the parents are probably milquetoasts. My sister and brother-in-law fit that to a “T”.

  14. Count me among the ignorant. I can relate to the concept of mild retardation (ie “he’s kinda slow”) compared to severe retardation, where an adult never progresses beyond the mental cognition of a young child.

    I suspect Aspergers is the same way: There are mild to severe cases. Lissa could enlighten us as to the range, I think!

    A severe case of Aspergers SOUNDS to this uneducated ear to be similar to what, in an adult, we would call extreme obsessive-compulsive disorder:
    “clumsy and uncoordinated motor movements, limited interests or unusual preoccupations, repetitive routines or rituals, speech and language peculiarities, and non-verbal communication problems. ”

    I could see such a child sitting on the floor, repetitively stacking the same four blocks on top of each other for hours, in complete silence, for example. Or having his or her attention grabbed by a fork, and holding it a few inches from the eyes and slowly turning thefork around, over and over, for hours. Or perhaps, in the rituals area, emptying the toybox and carefully repacking it, over and over…

    That kind of behavior, repetitious day after day, especially when caught in intense preoccupation and silence, would certainly be disabling.

  15. “one or both of the parents feels an almost excessive sympathy for the kid”

    Yeah, I think we’ve all seen a lot of that. It’s often the same people who talk about their child being their best friend. These people are so afraid that the kid will not like them that they enforce no discipline.

    Don’t have children and then abdicate all parental responsibility. If you need to be liked so much, get a dog.

  16. Marguerite, I’m right there with you. Shrinks do what their customers want, and their customers are the parents.

    I know a little girl who was diagnosed with Oppositional Defiant Disorder by a shrink. Drugs were prescribed and they tried to turn her into a zombie. Finally, she was removed from her horrible mother and now she has no problems. She excels at school, she is pleasant to be around, and she is just an all-round great kid. The shrink acted based on what the mother said and the mother was a horrible piece of trash.

    The problem with labeling things as disease (including “alcoholism”) is that people aren’t held responsible for diseases. We would be much much better off if shrinks would focus on behaviors and freely label them “good” or “bad” or “right” or “wrong.” But, horror of horrors, this is a value judgment and we can’t be doing that!

    I do believe Asperger’s exists. There are people whose brains don’t work quite right. But none of it should be an excuse for having no standards of behavior at all.

  17. 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.

    This, I suspect, is one of those reasons I provided for why you don’t like Peggy Noonan’s writings. While she is far more proactive and in favor of order than the Left, she isn’t quite up to the Jacksonian war party standards.

  18. I do believe Asperger’s exists. There are people whose brains don’t work quite right. But none of it should be an excuse for having no standards of behavior at all.

    Agreed.
    In Augusten Burroughs’s autobiography ( or fictionalized one, as the case may be),Running With Scissors, he describes his brother’s brilliant but odd behavior. At the end of the book, Augusten says that his brother has Asperger’s . Definitely some affinity w obsessive-compulsive.

  19. While everyone has witnessed a child totally lose it in public and a parent who does not react according to what you consider is the best parenting tactic, what none of you has considered is what you do not see. What you do not see is a child with completely messed up senses. A child who is so sensitive to sounds and light that the trip to Walmart can be pure torture. A kid you just can’t leave with a sitter.
    So when he falls apart in the checkout line and his mother buys a gumball just to get through the trip, don’t be so smug. You have no idea what their day has been like.
    So go a little easier on them both.

  20. Janey: I’m not talking about the mother I see on a bad day in the grocery store. I’m talking about people I know well, in whose homes I have stayed, and who consistently allow the child to dictate the agenda, and to make poor decisions without consequences. It is these children who I believe need more structured parenting and are, instead, given a diagnosis that gives the parents an excuse for even less structure.

  21. Children gain the strength of their parents. It is natural evolution and survival, for if a set of genes and circumstances favored the parent then it would logically also favor the child if the parent is around to provide it.

    In this case, the parents are useless. Better than the UN, but still, useless.

  22. ” I’m talking about people I know well, in whose homes I have stayed, and who consistently allow the child to dictate the agenda”

    Book has described the REAL 21st century horror movie “Children of the Corny”. Where the parents have voluntarily given up being parents, given up being “The Adult”, because their own inner child is so wanting. Perhaps they cannot trust themselves because they know that they are over 30.

    “I want to be my own child’s best friend” is a phrase to strike fear into the hearts of responsible adults everywhere.

  23. I didn’t see this posting until today. Too bad as it is right up my alley- professionally and personally. But I will say that many mental health professionals have no training in parenting and they see the kid alone without seeing the family dynamics that shaped him. So, they miss a lot.
    Like Margeurite said, giving in to a kid who gives the middle finger to her parents only encourages the child to continue to take control in this manner. If tantrums get the kids what they want, they will have more of them. Lots of kids are sent to therapists to play and draw, when what these kids really need is competent parents. Very often I have worked with families who have oppositional kids who were in individual therapy for years with no progress. After working with the parents on parenting- limit setting, argument ending, teaching values, creating a warmer relationship, lo and behold, the parent and child are getting along, the child is doing better because he sees parents who actually lead and guide, and the original diagnosis no longer is applicable.

    BTW, the “flavor of the month” diagnosis I see most often is bipolar disorder.

  24. I had a feeling, Lulu, that you’d recognize the kind of parenting deficit that I’m thinking of. As it is, I don’t doubt that many of the children diagnosed as Aspergers do have something. I just think that their most serious behavior problems are often a result of the parenting, not the syndrome.

  25. […] based on my real life, real time observations: (1) no matter the child’s objective deficits, structure and discipline (by which I do not mean abuse and insults) make a huge difference in contro…; (2) some kids, especially boys, are slower than their peers in developing impulse control; (3) […]

  26. […] Posted on February 2, 2008 by Bookworm A few months ago, I did a post about out-of-control children who seemed to be the product, not of biological pathology, but of boundary-free parenting.  A […]

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