Addressing Concerns About Asperger's and ADHD in Young Adults

Questions related to my younger brother (suspected Asperger's syndrome and ADHD) - I hope the doctor can provide answers?

Hello Doctor: My younger brother, when he was around 7-8 years old, was diagnosed with Asperger's syndrome and tendencies towards attention deficit hyperactivity disorder (ADHD).
He saw a psychiatrist at that time, who recommended long-term medication treatment.
However, our father was concerned that taking so many Western medications could have side effects on his physical condition, so he did not follow the doctor's advice to give him the medication.
Now, my brother is 22 years old and does not have significant intellectual issues (he passed exams to enter university and is currently studying; he can self-learn Chinese Pinyin input methods; he has good memorization skills and can self-learn the Korean alphabet).
However, he exhibits the following issues: 1.
Difficulty concentrating (he finds it hard to focus on one task, often walks around frequently, and cannot sit still); 2.
Sudden inappropriate laughter (when asked why, he responds that he finds it funny to think about someone getting hit); 3.
Lack of determination (he is easily persuaded to change his mind or buy things he does not need; for example, he once bought cookbooks and software tutorials, then threw them away a few days later); 4.
Sometimes unable to answer simple questions, such as when asked if he had dinner, he pauses for 2-3 seconds and replies, "Oh—dinner—" (then waits for nearly a minute without further response); 5.
Recently, he has been skipping classes and staying out, which is concerning.
For instance, one Tuesday morning, he left for class and did not return all day (he left without his identification or phone, making it impossible to contact him).
The next day, Wednesday, he still did not come back, so I called his homeroom teacher to ask if he attended class on Tuesday, only to find out that the school had started winter break on Monday...
(His class schedule was posted on the bulletin board, and he left at the usual class time, so he was unaware that winter break had begun).
Eventually, we reported him missing to the police, and the next day someone informed the police that he was behaving strangely at a convenience store, which led to him being found.
He is about to graduate and serve in the military; he has already undergone a medical examination at the hospital.
However, given his behavior and interactions with others, I am very concerned that he may struggle in military life.
1.
Can someone with the above conditions be exempted from military service? 2.
How can my brother's situation be improved? Besides medication, what other options are available? If medication can help, I will discuss it seriously with my father.
Thank you for your response, Doctor.

Fanrao de jiejie, 20~29 year old female. Ask Date: 2016/02/24

Dr. Liang Sunyuan reply Psychiatry

Hello, the military service aspect must be assessed based on the recent condition.
A confirmed diagnosis of autism qualifies for exemption from service.
If there were suspicions of Asperger's syndrome in childhood, a detailed evaluation of the current level of social impairment is still necessary, and you may return for a follow-up to discuss with the physician who conducted the previous assessment.
Regarding attention symptoms at the age of 22, some individuals find that medication can be helpful for attention, while others may not require medication.
It is essential to understand the detailed situation before making a decision, so I recommend returning for an in-person discussion with your outpatient physician.
Best wishes to you.

Reply Date: 2016/02/24

More Info

Addressing concerns about Asperger's syndrome and ADHD in young adults is a multifaceted issue that requires careful consideration of both medical and psychological aspects. Your brother's history of being diagnosed with Asperger's syndrome and potential ADHD, coupled with the behaviors you've described, suggests that he may still be experiencing challenges related to these conditions.

Understanding the Conditions
Asperger's syndrome, which is now classified under the umbrella of Autism Spectrum Disorder (ASD), is characterized by difficulties in social interaction, restricted interests, and repetitive behaviors. ADHD, on the other hand, is primarily marked by inattention, hyperactivity, and impulsivity. It's important to note that these conditions can co-occur, and individuals may exhibit traits from both diagnoses.

Current Concerns
1. Attention Deficits: Your brother's difficulty concentrating and tendency to be easily distracted are common symptoms of ADHD. This can manifest as restlessness and an inability to remain seated for extended periods, which can significantly impact academic performance and daily functioning.

2. Social Interaction: The behavior of laughing at inappropriate times or having difficulty responding to simple questions may indicate challenges in social communication, which is often seen in individuals with Asperger's. This can lead to misunderstandings in social settings and may contribute to feelings of isolation.

3. Impulsivity and Decision-Making: His tendency to be easily persuaded and make impulsive purchases suggests difficulties with executive functioning, which is often impaired in individuals with ADHD. This can affect his ability to plan and make decisions that align with his long-term goals.

4. Recent Behavioral Issues: The incident of skipping class and not returning home raises concerns about his safety and decision-making abilities. Such behaviors can be indicative of underlying issues related to both ADHD and Asperger's, including impulsivity and difficulty with routine.

Addressing the Concerns
1. Military Service Exemption: Regarding your question about military service, individuals with significant impairments related to ADHD or Asperger's may qualify for exemptions or alternative service options. This typically requires a thorough evaluation by a qualified mental health professional who can provide documentation of his condition and its impact on his functioning.

2. Improvement Strategies: There are several approaches to help your brother manage his symptoms beyond medication:
- Therapeutic Interventions: Cognitive-behavioral therapy (CBT) can be beneficial for addressing negative thought patterns and improving emotional regulation. Social skills training may also help him navigate social interactions more effectively.

- Behavioral Strategies: Implementing structured routines and using visual aids can assist in improving focus and organization. Breaking tasks into smaller, manageable steps can also enhance his ability to concentrate.

- Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation can help improve attention and reduce impulsivity. Encouraging him to engage in activities that promote relaxation may also be beneficial.

- Support Groups: Connecting with support groups for individuals with ADHD or Asperger's can provide him with a sense of community and understanding, which can be incredibly valuable.

3. Medication Considerations: If medication is deemed necessary, it’s important to have an open discussion with your father about the potential benefits and risks. Stimulant medications, such as those used for ADHD, can significantly improve attention and impulse control. However, the decision to medicate should be made collaboratively with a healthcare provider who understands your brother's unique needs.

Conclusion
Your brother's situation is complex, and it’s crucial to approach it with empathy and understanding. Encouraging him to seek a comprehensive evaluation from a mental health professional who specializes in adult ADHD and autism spectrum disorders can provide clarity and direction. This professional can help determine the best course of action, whether that involves therapy, medication, or a combination of both. Open communication within the family about these challenges will also foster a supportive environment that can aid in his development and well-being.

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