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My brother's socially challenged - is he autistic?

The question: Is my adult brother autistic? He's 23 years old and socially very dense, missing out on even the most blatant clues. My mom told me that she suspects he is mildly autistic or possibly has Asperger's. She said that when they were discussing symptoms, she felt as if they were describing him. After doing some of my own research, I'm inclined to agree with her. How can we tell?

The answer: We all have our unique ways of interacting with the world around us. The concern you raise is an interesting one and a very challenging question to answer. Before getting into the details, it is first important to ask yourself and, more importantly, your brother, what this diagnosis could mean for him. There can be value in identifying Asperger's syndrome (AS) as it severely affects social functioning. An AS diagnosis is often made in childhood or adolescence and it can be a relief for some in explaining why certain behaviours occur. Also, people with AS are often unfairly labelled as unempathetic, and when a diagnosis is made, it can help family, friends and themselves understand why they see and interact with the world in a different way.

So what is AS? It's a disorder that is part of a group of conditions related to developmental disabilities that affect the way the brain processes information, known as autism spectrum disorders. It is called a spectrum because the symptoms can appear in different combinations and vary in severity. In general, it is diagnosed between the ages of 5 and 9 but it can remain undiagnosed in many. AS differs from other autism spectrum disorders by its relative preservation of language and cognitive development.

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There are three hallmark features of Asperger's.

1. Developmental disability in social interactions: People with Asperger's often have difficulty making friends and connecting with others. It may be hard for them to process emotions, which can make them appear to lack empathy. They can be withdrawn in social situations.

2. Repetitive or stereotyped behaviour: They can be intensely focused on certain interests or hobbies and often excel in one specific area of interest. They may be inflexible in routines and in more severe cases may move in more stereotyped and repetitive ways such as hand-flapping, spinning, or rocking.

3. Communication: They often miss social cues, and may not make eye contact or respond to verbal and non-verbal cues. They may not respond with appropriate facial expressions and postures. Speech patterns can be monotonous and rigid.

It is important to note that there are other potential causes for your brother's behaviour including: social phobia, generalized anxiety disorder, depression, panic disorder or attention deficit hyperactivity disorder and other mental health conditions.

With these other potential conditions, AS can be challenging to identify. Diagnosis should be confirmed by a mental health professional who specializes in AS. If your brother is willing and interested in pursuing diagnostic testing, visit your family doctor to find out what resources are available in your community. While there is no cure for AS, interventions such as behavioural therapy can improve symptoms and function by addressing communication skills and repetitive routines, and help to improve social interactions. By getting a diagnosis, it can allow for individuals and their families to learn more about the condition, understand why there may be difficulties and then move forward by obtaining counselling, social skills training and face challenges that may arise with knowledge and better understanding.

Send family doctor Sheila Wijayasinghe your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

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