CASE: Angela is an 18-year-old college freshman who made an appointment with her pediatrician because of academic and social difficulties at college. She was diagnosed with Asperger disorder at age 6 based on difficulties relating to adults and peers, perseverative patterns of interest, and normal language development.
She received special education services in middle school to help follow directions and complete assignments. She reports feeling very isolated during this time. In freshman year of high school, she insisted on discontinuing special education and managed with weekly private individual psychotherapy.
In sophomore year, Angela learned strategies to get additional help from her teachers about assignments, and her grades improved. Socially, she formed a close friendship with a classmate who was also on the autistic spectrum, and she found a group of friends through this individual. As a senior with an upward grade trajectory and good SAT scores, she was admitted to a competitive 4-year college. In a precollege consult 6 months ago, she was anxious about fitting in.
Angela began college classes without accommodations, but she now describes a challenging semester. She has not made many friends. She finds her courses difficult and does not fully understand assignments. She believes her peers dislike her. She thinks she would benefit from receiving note-taking and other services and asks you to document her disability for the college so that she might obtain accommodations.
You point out that the DSM-5 eliminates the Asperger category. Angela is concerned. She does not believe that her profile is consistent with autism spectrum disorder, and she fears that being labeled as autistic will be prejudicial at school. Yet she is worried about retaining eligibility for services on the basis of a disability. How do you counsel her?
*Arts, Humanities & Medicine Program;
†Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA;
‡Division of Neurodevelopmental and Behavioral Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY;
§Office of Accessible Education & Schwab Learning Center, Stanford University School of Medicine, Stanford, CA; and
¶Division of Academic General Pediatrics, Developmental Pediatrics and Community Health, School of Medicine, University of California San Diego, San Diego, CA.
Disclosure: The authors declare no conflict of interest.