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Ask the Mental Health Expert Archives 2001-2004

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Asperger's Syndrome

Q. I have a daughter that is 20 years old. She has always been immature and was diagnosed with ADD (attention deficit disorder) when she was 7 years old. She has been treated by numerous psychologists in her younger years, taking Ritalin on and off until her junior year of high school. She has never had any "real" friends and never had a boyfriend but she seems reasonably content. She took Ritalin again her first semester in college, but is no longer attending school. She does work full-time (with me pushing all the way).

I recently heard her talking to herself for several minutes. When I asked her who she was talking to she told me that it was her imaginary friend--she said she had always had one. When she was beginning high school, the psychologist wanted her tested because she was concerned that my daughter did not know the difference between the real world and make believe. Nothing was ever determined. She now refuses to go for further treatment, saying she is fine.

I have recently read about Asperger's Syndrome and wonder if this might be a possibility and if she will ever lead a normal life. What can I do for her if she does not want treatment?

A. I certainly understand the frustrations of trying to help someone you love, when he or she isn't entirely receptive to that assistance! Of course, I can't rule in or rule out Asperger's Syndrome (AS) in your daughter's case. This is a mild form of what is usually called autism, and is considered a form of pervasive developmental disorder in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed).

Typical symptoms in AS include: nearly life-long difficulty with social interaction, including failure to develop peer relationships, and a lack of spontaneous seeking out of others in order to share enjoyment, interests, etc. Asperger's also includes restricted and stereotyped patterns of behavior, such as inflexible adherence to certain routines and rituals.

Having AS would not preclude having problems with attention, or even having ADHD, but it is possible that AS might create the impression of ADHD while leading to a more pervasive and socially-incapacitating disorder. (As yet, we still don't have very effective treatments for AS and related disorders). As far as your daughter's imaginary friend--it's not clear that you should make too much of this, but it really depends on how much she herself understands that this friend truly is imaginary.

Although we know that even normal children may develop such imaginary companions, this is usually regarded as pathological in adolescents and young adults. However, one study (Seiffge-Krenke et al, J Adolesc 1997 Apr;20(2):137-54) found that socially competent and creative adolescents with good coping abilities were particularly prone to create such a very special friend. I think it's quite important that you describe your daughter as reasonably content and actually holding a full-time job--that's pretty impressive!

While I completely understand your wish to get her the very best care, it's not quite clear to me what problem that care would address--and if your daughter isn't motivated to seek help, it's unlikely that therapy would accomplish much. The most you can do (so long as she is not a danger to herself or others) is gently and lovingly encourage her to seek out professional mental health evaluation and treatment. Sometimes parents need to live with what their children have achieved, even when it doesn't fulfill all their hopes, dreams, and expectations.

And if your daughter is, indeed, reasonably content and managing a full-time job, you can take some real pride in that.

April 2003

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