Q: How do I explain this? My twelve year old son is extremely intelligent – tests advanced above grade level (he’s in the 6th grade) in all subjects, especially Math, where he tests at the college level. Despite this intelligence, he can’t seem to execute simple everyday tasks without being given specific instructions. Example, “which comes first, Mom, the cereal or milk in the bowl?” To tell him to “get ready for school” is not effective. I have to say, “Brush your teeth, get dressed, put your shoes on, get your backpack together…” If I don’t give him specific instructions, he will be at a total standstill – not knowing how to proceed. If I tell him to “go read” his library book for required reading from school, he is overwhelmed with the task. If I say, “Go read pages 125-145″ he does it without question. He seems to have difficulty with anything that is abstract. It’s as if I can literally see his brain grind to a halt and short-circuit if he is not given these specific instructions on how to proceed with any given task. He can follow a recipe to make brownies, but to ask him to make a peanut butter sandwich leaves him clueless. I have to say “Get a knife, get two pieces of bread, spread the peanut butter on the bread…”.
He has no problems in school. He is well mannered and makes friends easily.

Some interesting tidbits from his childhood that may or may not be related…He didn’t talk until he was three years old, and then it was a complete sentence the first time I heard him. Until then, he had his own “language” that we had to decipher. He had difficulty learning to tie his shoes and ride a bike. He actually learned how to ride a bike at the age of 8 by WATCHING his 5 year old brother ride – not by trial and error as his brother was doing. He watched his brother for a week ride around the yard, falling and getting back up again. Then, after that week, he got on his own bike and took off – never falling once. Is it possible to learn how to ride a bike just by observing someone else do it first? I guess so. He had difficulty in engaging in “pretend” play. He repeats HIMSELF when talking. For example, he will end the conversation with a sentence and then repeat that sentence quietly to himself about two or three times. I could go on and on about things that I can see that might be related. What is this? Is this something that I need to seek help with or is this just the way he is and nothing to be concerned about?

A: This is indeed mysterious. I think you should take your son to a neuropsychologist for testing. Since I can’t ask you and your son the many questions I have, I’m referring you to someone who can. Share your letter as a place to start.

Among the possibilities that occur to me is some kind of dysfunction in the frontal lobe of the brain. The frontal lobe is responsible for planning, strategizing, and sequencing.

On the other hand, some of what you describe is consistent with Aspergers syndrome. His ease with making friends seems to rule that out but, again, I don’t have enough information.

At age 12 he should be able to manage the simple tasks you describe, especially since his academic intelligence is high. Early diagnosis and treatment is often the key to turning problems around. Please don’t ignore your concerns. Trust your instincts and get your son an assessment.

I wish you both well,
Dr. Marie