Reader’s Question

Our son is 13 years old and has been diagnosed as having ADHD (4 years ago). He is on Metadate for this. What I’m really concerned about is his awkwardness in social situations. It’s very noticable by his body language and almost painful for me to watch him even walk out of school. He’s awkward and unsure, like he’s in a daze and hopes no one will notice. He’ll move his arms awkwardly or turn his head funny. He has a real flat affect and doesn’t open his mouth to talk. It’s kind of a rolling mumble and very low. He does smile and laugh and articulate well when he’s in certain situations or here at home. Sometimes you’ll say something to him and he’ll just look at you like he’s not really hearing you or can’t look at you and his eyes wander. He is clumsy at times and does not like to go anywhere. We have to make him go. He’s always liked soft clothing or silky shirts; he says others make him feel funny (itchy, or hurting). When he was younger up until about a year ago he would twirl his hands together and make a sound. He’d do it anytime anywhere to the point his grandmother said you’re getting too old to be doing that. He seems very naive and childlike in some of his behaviors and other times he can smart off like a typical 13-year-old. He has only one friend that he hangs around with and this boy comes from a real troubled home. My question is, is this Asperger’s or social anxiety? I was painfully shy at his age and would not talk or speak up to people. I still have social anxiety disorder and am doing cognitive therapy. I just would like to know if in his case it may be something more than just social anxiety.

Our Clinical Psychologist’s Reply

As you describe, your son has some features associated with Asperger’s Disorder. If we think about it, ADHD and shyness typically don’t go together. The other factor here is the late diagnosis of ADHD. In my experience, we identify most ADHD youth under the age of six years…well, actually the school, relatives, neighbors, etc. identify him/her. ADHD youth are typically too social — not socially shy or anxious. The additional features you mention are not typically found in ADHD but are often associated with Asperger’s Disorder. These features such as tactile hypersensitivity (reaction to clothing), flat affect, hand twirling, sounds, etc, are also not typically found in Social Anxiety.

I’d recommend consultation with a pediatric psychiatrist. If we have the wrong diagnosis and he’s not ADHD but has Asperger’s Disorder, the use of Metadate will amplify his hypersensitivity and irritability, thus increasing his social difficulties.