**7. Mats — An adolescent with combined SLI and ASD**

Mats was the second born child, with a sister 3 years older. The sister was diagnosed with high functioning autism with normal language acquisition at 5 years of age. The mother had Asperger's syndrome. Mats was evaluated at 4 years of age due to delayed language devel‐ opment. He also had severe communication problems especially with his peers but normal development regarding gross and fine motor function and nonverbal problem solving. The evaluation resulted in a diagnosis of ASD. He started at a normal school and never got any special education for the first 7 years in school. At that time he developed a severe depression with suicidal and homicidal ideation. A new evaluation by a speech and language therapist revealed major difficulties in both impressive and expressive language as well as in syntax and word mobilisation. His cognitive function was normal on performance tests but his verbal IQ was in the range of intellectual disability. This resulted in a transition to a special education class. His depression was somewhat improved but he refused to engage in any activity outside school and home. He loved watching violent Youtube scenes. He also refused to see a therapist and eventually decided to stop talking altogether. He communicated with gesture and by writing. He explained that he never could fully grasp what people were saying in a conver‐ sation and that he could not find words for what he himself would like to say, therefore he found it better to be mute.

#### **8. Summary**

**6. Anders — A young adult diagnosed with autism spectrum disorder**

Anders, 26 years old, was referred to psychiatry for depression after having tried sixteen different training jobs without success. He was living alone in his own apartment, which his mother helped him to clean every week. He had a friend, but kept in touch by e-mail and had not met the friend for 4 years. He had never had a girlfriend, and, when asked, said "I don't want a girlfriend-it would be too time-consuming since I would have to be with her in my leisure time". He had no idea why the jobs he had tried had been failures, but he remembered one of them going well for several months, whereafter he was asked to leave. He described that in the job that went well, he had a written detailed description of his assignments which he had followed precisely. However, after three months his supervisor took away the instruc‐ tion, assuming that Anders now knew what he was supposed to do. But since there was no description any more, Anders did nothing. His supervisors in this and other jobs were contacted, and they described why Anders had been asked to leave. In the workplaces he had behaved oddly in many ways – not greeting his colleagues, taking the biggest pieces of cake first in the coffee room but without socializing, intruding on others' workspace and many other things. Consistently were described misunderstandings and misinterpretations – Anders had a tendency to interpret literally and to say things that were considered rude or offensive.

Anders and his parents described that he had been quite clumsy as a small child, but the parents did not worry since he started walking at 15 months of age. He was quite late to speak, but soon developed a large vocabulary that impressed the parents. He preferred to play by himself or with his 3 years younger sister, and had no special friends at school. He disliked surprises, and became upset when routines were changed, and the family had adapted to this by e. g. never going on trips overnight until Anders was 15. The teachers had expressed some worry since Anders was always by himself, but since he did not seem unhappy, and since the father thought of himself as a "happy loner", nothing was done. Anders got fairly good grades, especially in science subjects but had relatively more difficulties in subjects where more of a social or coherent understanding was required. He was never bullied, and he liked going to school. However, after finishing high school he did not know what to do. His most intense interest was in bird-watching, especially night-active birds and he had collected large amounts

The jobs that Anders was assigned were mostly low-skilled work in offices, food shops or stockrooms. The assignments were below his intellectual skills, but he failed since he did not have any intuitive understanding of the aims, or the bigger picture of the workplace, in

The psychiatrist and a psychologist, after doing a cognitive assessment of Anders and interviewing his parents, diagnosed an autism spectrum disorder with IQ within the normal range. His depression was considered to depend on his lack of meaningful occupation, and he was referred to a job center for adults with developmental disorders and normal IQ. In the job center Anders was assigned a special job coach with experience in autism spectrum disorders, and at his last visit to the psychiatrist seemed hopeful regarding his future chances to get a part time job as an assistant in a research lab, and perhaps later study science at the university

of facts and observations concerning these birds.

88 Autism Spectrum Disorder - Recent Advances

addition to irritating his coworkers by being socially clumsy.

The development of human society is totally dependent on our ability to interact, which requires language in order to communicate. Difficulties in communication underlie many human problems and, if severe, can jeopardize a person's adaptation to society. Communica‐ tion problems are at the heart of many psychiatric disturbances, in particular ASD. Speech and language therapists have, from another perspective, studied language development and described many aspects of language such as phonology, semantics, grammar and pragmatics. A psychiatrist and clinical psychologist evaluated the case Anders, whereas a speech and language therapist evaluated the case Anna. Anders was judged to have ASD and Anna pragmatic language disorder. Could Anna have got the diagnosis of ASD if evaluated by a psychiatrist? Would a more thorough assessment have revealed problems like circumscribed interests, obsessive symptoms and/or difficulties with change so that Anna would have met the full criteria for autism? Similarly, Anders might have got a diagnosis of pragmatic language disorder if evaluated by a speech and language therapist. The status of pragmatic language impairment as either a subtype of SLI or a form of ASD has been discussed for many years [4, 38]. Given the huge complexity as well as variability and instability of symptoms involving social interaction, language and communication, it is a big challenge to differentiate and discriminate between diagnoses such as LI, SLI and ASD [20]. Since these problem areas have been suggested to share a common genetic etiology and vulnerability it might be more fruitful to ask ourselves how we can help these individuals by supporting them and preventing secondary consequences emanating from their primary vulnerability. In order to see the whole picture we need to collaborate in multidisciplinary teams and to build bridges between specialists focusing on children, teenagers and adults. What was helpful to Anders was an understanding of his problems by his employer and work mates, whereas Anna benefitted from social training as a child, but as a teenager she had severe difficulties to cope with. Mats had a combination of autistic traits and SLI. He did not get any special help during his important first tears of schooling. It is difficult to assess how much of his communication problems, which were a basis for the diagnosis of autism in reality were due to his severe language impairment. As a conclusion we will underline the central role of language and communication in each of the three diagnoses LI, SLI and ASD, regardless if the language and communication problem is a specific or a more general problem, and regardless if it is a core problem or the consequence of another one. Working together in multidisciplinary teams over time adopting a longitudinal perspective from childhood to adulthood with the goal of promoting language and communication skills, can be a key to success in helping individuals develop academic and social skills.

### **Author details**

Bruce Barbro1\*, Nylander Lena2 , Sjöberg Ingrid2 and Thernlund Gunilla2

\*Address all correspondence to: barbro.bruce@mah.se


### **References**

[1] Balfe, M., & Tantam, D. (2010). *A descriptive social and health profile of a community sam‐ ple of adults and adolescents with Asperger syndrome.* Biomed Central Research Notes, 3, 300.

[2] Billstedt, E. (2007). *Children with autism grown up. Use of the DISCO (Diagnostic Inter‐ view for Social and Communication disorders) in population cohorts.* Institute of Neuro‐ science and Physiology. Child and Adolescent Psychiatry. Göteborg University. Sweden.

pragmatic language disorder. Could Anna have got the diagnosis of ASD if evaluated by a psychiatrist? Would a more thorough assessment have revealed problems like circumscribed interests, obsessive symptoms and/or difficulties with change so that Anna would have met the full criteria for autism? Similarly, Anders might have got a diagnosis of pragmatic language disorder if evaluated by a speech and language therapist. The status of pragmatic language impairment as either a subtype of SLI or a form of ASD has been discussed for many years [4, 38]. Given the huge complexity as well as variability and instability of symptoms involving social interaction, language and communication, it is a big challenge to differentiate and discriminate between diagnoses such as LI, SLI and ASD [20]. Since these problem areas have been suggested to share a common genetic etiology and vulnerability it might be more fruitful to ask ourselves how we can help these individuals by supporting them and preventing secondary consequences emanating from their primary vulnerability. In order to see the whole picture we need to collaborate in multidisciplinary teams and to build bridges between specialists focusing on children, teenagers and adults. What was helpful to Anders was an understanding of his problems by his employer and work mates, whereas Anna benefitted from social training as a child, but as a teenager she had severe difficulties to cope with. Mats had a combination of autistic traits and SLI. He did not get any special help during his important first tears of schooling. It is difficult to assess how much of his communication problems, which were a basis for the diagnosis of autism in reality were due to his severe language impairment. As a conclusion we will underline the central role of language and communication in each of the three diagnoses LI, SLI and ASD, regardless if the language and communication problem is a specific or a more general problem, and regardless if it is a core problem or the consequence of another one. Working together in multidisciplinary teams over time adopting a longitudinal perspective from childhood to adulthood with the goal of promoting language and communication skills, can be a key to success in helping individuals

develop academic and social skills.

90 Autism Spectrum Disorder - Recent Advances

Bruce Barbro1\*, Nylander Lena2

1 Malmö University, Malmö, Sweden

2 Skåne University Hospital, Malmö, Sweden

\*Address all correspondence to: barbro.bruce@mah.se

, Sjöberg Ingrid2

[1] Balfe, M., & Tantam, D. (2010). *A descriptive social and health profile of a community sam‐ ple of adults and adolescents with Asperger syndrome.* Biomed Central Research Notes, 3,

and Thernlund Gunilla2

**Author details**

**References**

300.


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