Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for November 10th, 2010

Anxiety/Asperger’s: Not So Clear

Posted by Dr. Vollmer on November 10, 2010

    Kylie is six years old and she has no friends. She has never had friends and she complains about that. Her mother, Sandra, did not have friends either when she was a little girl, but when Sandra went to middle school she “figured it out” and she made life-long friends. Kylie is very bright;  she has an IQ of about 145. She loves to do research about people who fought in the civil war; it is an unusual interest, but she only talks about it if you ask her. Kylie does not have repetitive behaviors, but when she gets nervous she pulls at her shirt in an awkward way. Her eye contact is poor, particularly with new people. She reports “feeling funny” around other children; she is not sure they are going to like her and she says “I want them too.” “Do you think that you want friends so badly that when you are around other kids, you act in a different way, hoping to make friends, but in fact, if you acted like you normally do, then the other kids might respond to you differently?” I am aware that the complexity of the question is above most six-year olds, but I suspect Kylie understands. “Yea,” she says, “but I don’t know how to act any other way when I want other kids to like me.” The awkwardness of Kylie’s behavior might be a result of her social anxiety, and not a deficit in social communication skills. Individual psychotherapy, social skills groups, SSRI medication, these are all possible interventions for anxiety. Social skills groups is the major intervention for Asperger’s Disorder. The difference in diagnosis is profound. Anxiety disorders wax and wane; Asperger’s Disorder is more constant. There is no diagnostic test; both are clinical diagnoses. My intuition tells me that Kylie has social anxiety, but I am not completely clear. Social skills groups make sense regardless. That is a good place to start. I need to get to know her better. I do not see a rush to diagnose. I do feel the pressure to help Kylie make friends; Kylie’s emerging self-esteem needs that. I am on it.

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