*****FROM ABC NEWS MEDICAL UNIT*****

Hi Shelly36567 and thank you for your question. Here is an answer to your question from Naomi Swiezy, Ph.D., Program Director, HANDS in Autism at the Riley Hospital for Children and IU School of Medicine:

Thank you for the opportunity to answer this multi-faceted question. The various levels and complexity of the question certainly reflects the complexity of the disorder and differential diagnosis with the many potentially overlapping and often confounding conditions. In answering this question, there appear to be four main areas of concern and they will each be addressed individually yet broadly. As Shelley mentions, it is not possible to provide diagnostic clarification based upon the information given nor without a full history and meeting with the individual of concern. However, some general points regarding the questions asked can be addressed.
• What is the core difference between individuals with early onset Bipolar Disorder as opposed to an autism spectrum disorder?
• As mentioned, Bipolar Disorder is considered when an individual has rapid shifts between moods and energy. This can often be noted in children as significant and sometimes rapid cycling in moods of happiness and irritability. When these mood shifts occur, it can appear to be unprovoked, sudden, and intense. Oftentimes, parents may see similarly with their children with an autism spectrum disorder (i.e., seemingly unprovoked, sudden and intense behavioral and emotional changes). However, though the irritability and depressive symptoms may be a function of both disorders, there are some core and distinct differences as well. Namely, the distinguishing feature of an autism spectrum disorder is that these children have very distinct difficulties in the areas of social-communication. Whereas a child with Bipolar Disorder may know how to ask for basic needs and understand the basic social rules of relating, children with an autism spectrum disorder may not have these skills and need to have them broken down and very gradually and explicitly taught. In addition, a child with Bipolar Disorder may be able to and know how to make friends easily when irritability symptoms are controlled (though others may be tentative to make friends with the individual due to his/her unpredictability), a child with an autism spectrum disorder will have difficulty in making and knowing how to make friends even if irritability symptoms are controlled. A child with an autism spectrum disorder may also have interests that are very different than those of others their same developmental age, making relating an even more arduous task.
• Can individuals with an autism spectrum make improvement over time?
• Individuals with an autism spectrum disorder can absolutely experience improvement over time but that they have a very unique learning style that must be addressed to allow for the child to reach his or her highest potential. For example, we know that individuals with an autism spectrum disorder:
i. Process information better when presented visually rather than audibly
ii. Learn material better when presented in chunks of information rather than being presented as a whole concept
iii. Do not generalize information learned
iv. Learn best through repetition
v. Need assistance with and thrive on structure, routine and predictability
vi. Have varying levels of abilities even within topic areas
vii. Perform best when their interests/motivations are incorporated
These are just a few of the general pointers for teaching children with an autism spectrum disorder. However, we do know that individuals with such a spectrum disorder can learn and compensate well for their challenges, particularly if provided with tools and intervention at the earliest age possible.
• Can a child with Asperger’s Disorder and ADHD present with fixed interests?
• Children with Asperger’s Disorder can certainly present with fixed interests. In general, children with such a diagnosis will show some intense focus with particular topics, objects, and/or parts of objects and often to the exclusion of other things as part of this disorder.
• Does differential diagnosis between Bipolar Disorder and Asperger’s Disorder matter?
• This is an excellent question in that, in the end, it is the behavioral symptoms of the disorder that are explicitly treated and not the disorder itself. That is, specialists will assist in identifying a treatment plan for a decrease in irritability symptoms, increase in specific daily living and social skills and so on—not for a cure of the particular disorder. However, in the case of an autism spectrum disorder, the differential diagnosis can be extremely important at minimum in:
i. Providing a shared understanding of the challenges that will need to be addressed (e.g., social communication skills, restricted interests and activities) and the skills that need to be taught (e.g., conversation skills, play skills, general social engagement skills) for specialists working with the child and family
ii. Providing the family with support networks that can be of most assist
iii. Understanding the specific learning styles and supports necessary for the child to be successful
iv. Oftentimes understanding that behaviors that might have appeared to be aspects of many different disorders can really be conceptualized as all a part of autism rather than of several different disorders.

Thank you again for the opportunity to address these questions.

Dr. Swiezy

Note: Top medical experts on autism answer questions like these on the ABC News OnCall+ Autism site: http://abcnews.com/autism .

*****FROM ABC NEWS MEDICAL UNIT*****