When involved
with solitary play with dolls, the girl with Asperger’s Syndrome has total
control and can script and direct the play without interference and
having to accept outcomes suggested by others. The script and actions can
be an almost perfect reproduction of a real event or scene from a book
or film. While the special interest in collecting and playing with dolls
can be assumed to be an age appropriate activity and not indicative of
psychopathology, the dominance and intensity of the interest is unusual.
Playing with and talking to imaginary friends and dolls can also continue
into the teenage years when the person would have been expected to mature
beyond such play. This quality can be misinterpreted as evidence of hallucinations
and delusion and a diagnostic assessment for schizophrenia rather than
Asperger’s Syndrome.
The most popular
special interests of boys with Asperger’s Syndrome are types of transport,
specialist areas of science and electronics, particularly computers. It
has now become a more common reaction of clinicians to consider whether
a boy with an encyclopaedic knowledge in these areas has Asperger’s Syndrome.
Girls with Asperger’s Syndrome can be interested in the same topics but
clinical experience suggests their special interest can be animals and
classic literature. These interests are not typically associated with boys
with Asperger’s Syndrome. The interest in animals can be focussed on horses
or native animals and this characteristic dismissed as simply typical of
young girls. However, the intensity and qualitative aspects of the interest
are unusual. Teenage girls with Asperger’s Syndrome can also develop a
fascination with classic literature such as the plays of Shakespeare and
poetry. Both have an intrinsic rhythm that they find entrancing and some
develop their writing skills and fascination with words to become a successful
author, poet or academic in English literature. Some adults with Asperger’s
Syndrome are now examining the works of famous authors for indications
of the unusual perception and reasoning associated with Asperger’s Syndrome.
One example is the short story, "Cold" in ‘Elementals: Stories of
Fire and Ice’ by A.S. Byatt.
Finally, the
author has noted that some ladies with Asperger’s Syndrome can be unusual
in their tone of voice. Their tone resembles a much younger person, having
an almost child like quality. Many are concerned about the physiological
changes during puberty and prefer to maintain the characteristics of childhood.
As with boys with Asperger’s Syndrome, they may see no value in being
fashionable, preferring practical clothing and not using cosmetics or deodorants.
This latter characteristic can be quite conspicuous.
These tentative
explanations for the apparent under representation of girls with Asperger’s
Syndrome have yet to be examined by objective research studies. It is clear
that we need more epidemiological studies to establish the true incidence
in girls and for research on the clinical signs, cognitive abilities and
adaptive behaviour to include an examination of any quantitative and qualitative
differences between male and female subjects. In the meantime, girls with
Asperger’s Syndrome are likely to continue to be overlooked and not to
receive the degree of understandinand resources they need.
Asperger's:
Distant Lives
From The Good Weekend: Sydney Morning Herald Magazine: May 25, 2002
"They may
be able to rattle off the train timetable or arcane footy stats, but when
it comes to interacting with others, people with Asperger's Syndrome haven't
got a clue. Jane Cadzow reports on the growing prominence of a once - obscure
medical condition."
Sam Wells
is a 13 - year - old Melbourne boy with a hesitant smile and a head full
of football statistics. Ask him the result of any AFL game of the past
three years - a total of more than 500 matches - and he can tell you which
team won, by how much, at which ground. How does Sam do this? He doesn't
really know, though he says it feels almost as if he has a video clip of
the final moments of each game imprinted on his brain. " I can kind of
see what the players were doing when they won," he says. "And then I can
remember the score." Sam is a promising footballer himself, and a champion
cross - country runner. He excels at art, math's and chess. But despite
his many talents, he has a hard time at school. "He gets teased a lot,"
says his mother, Judy Wells. "Other kids tell him he's weird, and that
upsets him." Eight years ago, Sam was diagnosed with Asperger's Syndrome,
a cousin of Autism and sometimes called the "little professor syndrome"
because of its links with IQ and prodigious powers of recall. Recent studies
suggest that it affects as many as one in 500 children. In California's
Silicon Valley, the condition's prevalence in the offspring of computer
tech - heads has led to the coming of another term - the Geek syndrome.
Asperger's seems to have come from nowhere. After languishing in obscurity
for more then half a century, having been first described by Austrian pediatrician
Hans Asperger in 1944, it is suddenly the disorder on everyone's lips.
"Asperger's Syndrome!", says a friend when I tell her that I am working
on this story. "I hadn't heard of it three months ago. Now two children
I know have been diagnosed with it. What's going on?"
Around the
world, researchers are scrambling to account for a surge in the past decade
in recognized cases of Asperger's and other disorders within the autism
spectrum. In California, the number of children within the spectrum seeking
social services has more then quadrupled in the past 15 years. In Australia,
no official count is kept, but psychologists and state autism associations
report increasing numbers of children and adults freshly diagnosed with
Asperger's walking through their doors looking for help. "We've got a deluge
of genuine referrals coming through," says Brisbane clinical psychologist
Dr. Tony Attwood, who has seen the condition - he sums it up as "a different
way of thinking" - in hundreds of individuals of widely ranging ages and
abilities, from preschoolers to professors. He contends, however, that
the boom is in diagnosis rather than incidence. "We are uncovering what
has always existed," he says.Professor Bruce Tonge, head of the center
for developmental psychiatry at Monash University, agrees that "what is
happening is that professionals are now better trained to detect and diagnose
the disorder. As a community, we're better able to pick it up." Dr Hans
Asperger's study of a group of Viennese boys with sharp, unusual minds
and no playmates - his "little professors" - was largely ignored for decades.
His thesis wasn't published in English until 1991; the syndrome named after
him didn't enter the diagnostic manuals until 1994. But the idiosyncratic
cluster of characteristics Asperger identified is now the subject of a
burgeoning number of books and research papers. Such is the appetite for
information that Attwood author of the best - selling "Asperger's Syndrome:
A Guide for Parents and Professionals", spends 18 weeks a year on the international
talk circuit. This year, he will make five lecture trips to the U.S alone.
The exact relationship between Asperger's syndrome and autism is
unclear, though people with Asperger's are sometimes described as having
"a dash of autism". Classic autism is characterized by language impairment,
unresponsiveness and an inclination to repetitive behavior, usually accompanied
by some degree of intellectual disability. The terms "Asperger's syndrome"
and "high - functioning autism" tend to be used interchangeably to refer
to people with autistic traits and normal - or even superior - intelligence,
but Bruce Tonge argues that they actually describe two distinct conditions.
Children with high - functioning autism learn to speak late and have ongoing
language problems; those with Asperger's Syndrome do not. "And that's very
significant," he says, "because it points to basic differences in the brain."
Still the two groups have much in common. Both have extreme difficulties
with social interaction. Both have a crippling dependence on ritual and
repetition. As Tonge says, Asperger's and high - functioning autism
can be severely debilitating. Yet both groups include individuals with
extraordinary abilities in areas such as math's, music and art. Some have
almost supernaturally good memories. "I have a patient who can tell me
what tie i was wearing on the 4th of May 15 years ago," says Tonge. Many
think visually: US animal science academic Temple Grandin explains at
her web site that she translates both spoken and written words "into full
- color movies, complete with sound, whicch run like a VCR tape in my head".
A leading designer of equipment for the livestock industry and author of
"Thinking In Pictures", an insiders account of high - functioning autism,
Grandin says her brain operates like a fancy computer graphics program:
when she is working on a design, she can "view it from any angle, placing
herself above or below the equipment and rotating it at the same time ".
Like Grandin, Sam Wells looks at things from a different angle from the
rest of us, literally. While other kids in his primary school class were
drawing a swimming pool in a conventional way, he was depicting it from
directly above, as if from the viewpoint of a flying bird. His fresh take
on familiar objects has always delighted his art teachers. "Sam's creativity
leaves us mind - boggled," says his father, Kim. Seeing the world slightly
differently from others can have advantages. "Many advances in science
and art have been made by people with Asperger's syndrome," says Tony Attwood,
naming Mozart, Thomas Jefferson, philosopher Ludwig Wittgenstein, mathematician
Alan Turing and pianist Glenn Gould as likely candidates for retrospective
diagnosis. But people with Asperger's and high - functioning autism
lack some skills that the rest of us take for granted. Crucially, they
have little intuitive understanding of the way others think and feel. They
cant read body language or facial expressions: to them, a raised
eyebrow is just a raised eye brow. (Cambridge University psychologist Simon
Baron - Cohen once asked three academically brilliant adults with Asperger's
syndrome - a physicist, a mathematician and a computer scientist - to identify
the emotions conveyed in photographs of people's eyes. They couldn't.)Oblivious
to the unspoken signals we send each other, they are equally floored by
the myriad unwritten rules governing social behavior: "Don't stand too
close, don't talk too loudly, give the other person a chance to speak ..."
Most of us do these things automatically; because those with Asperger's
have no such instincts, their attempts at social interaction are inept.
Classmates and work colleagues tend to avoid them. They're the office oddball,
the college nerd, the gauche young boy/girl who is never invited
to birthday celebrations. Not that children with Asperger's like parties:
too many people, too noisy, too hectic. To them, the world is a stressful,
confusing place, as it is with those with textbook autism. Attempting to
impose order on the chaos, they line their toys up in rows and adhere rigidly
to routines. "Some might have to wear specific clothes - for example, only
orange shirts," says Bruce Tonge. "Or they may have to do things in a particular
order: for instance, they always have to brush their teeth after they've
had a glass of water." At the same time, they develop intense, obsessional
interests in subjects ranging from astronomy and marine biology (a couple
of Sam Well's past enthusiasms) to trains, dinosaurs and ancient
Egypt. Their overall academic performance may be patchy - most are of average
intelligence and many have great difficulty in concentrating in class
- but because they absorb so much informaation on their favorite topics
and share their knowledge with anyone who will listen, they can give impression
of startling precocity. Bus timetable, sport results, the Titanic's passenger
list ......cataloging and data gathering comes naturally to these kids.
What's difficult is relating to the rest of the human race. Sam sometimes
goes into his bedroom and makes lists of things he must remember to do
in order to get better with his classmates. "smile," he writes carefully.
"Ask them about themselves. Talk about what they want to talk about.
Compliment them." He hankers for friends but is only gradually winning
acceptance at the private secondary school he started attending this year.
"I get left out of games," he reports without rancor. In lunch breaks,
"I mostly just walk around and try to find a game."Although people with
Asperger's syndrome never outgrow the condition, they hone their survival
skills as they get older and gradually become more socially adept. Already,
Sam has earned that's it's best to keep a brave face in the school yard.
"When people are teasing me. I try to take it as a joke," he says. But
Judy Wells knows how hurt and bewildered the taunts leave him. "I cry at
least once a week," she says. "And so does my son."
Wendy Lawson
used to open all her conversations with, "Did you know.......?" She was
well into adulthood before she realized she got a better response from
people if she started with "Hello" or "How are you?" Now 50, with two university
degrees, she is the first to acknowledge that she will never be able to
make small talk. "I don't see the point of it and i cant engage in it,"
she says. But at least she conducts dialogues rather than monologues these
days: "I've learned a lot more of the rules." Lawson was 42 when told she
had Asperger's Syndrome. As a child, she'd been labeled intellectually
disabled. In her teens, she was diagnosed as schizophrenic - and she realizes
how the mistake happened. "The psychiatrist could see that I seemed to
be living in a different world," she says. "He could see that I didn't
relate to people. He asked me questions like "do you hear voices?" Now,
if someone is autistic or has Asperger's syndrome, they're very literal.
So I said to him, "yes I hear voices." He interpreted that to mean I had
auditory hallucinations." A pleasant, unassuming woman, Lawson lives in
Warrnambool, on the south - western Victorian coast, in a house painted
in primary colors. She says the vivid interior decor is not just cheering
but practical: like many others on the autism spectrum, she has difficulty
differentiating between foreground and background. The use of contrasting
shades on walls and doors helps her avoid bumping into things. Where she
still stumbles is in social situations requiring her to skirt the truth.
People with Asperger's and high - functioning autism are hopeless at deception:
in most circumstances, their guilelessness is part of their charm, but
Lawson knows her honesty can be disconcerting. "If someone gives me a present
and I've got six already, instead of saying "that's lovely thank you",
I say, "I've got six of these, can I change it? Have you got the receipt?"
That's the sort of thing that gets me into trouble."She particularly regrets
a faux pas she made at the funeral of her son, killed in a car accident
three years ago. Concerned that a couple of hundred mourners who had missed
out on pews in the small chapel were standing out in the rain, she pointed
out to them that there was plenty of space to sit on the floor near the
coffin. "I said to them, "come on in. He's dead. He won't bite." And people
got upset with me because that was insensitive ...... I misread situations
sometimes."People with Asperger's don't dwell on the past; they live in
the tangible present. So, though Lawson loved her son, she recovered quite
quickly from his loss. "My daughter still cries over his death," she says
wonderingly. "I move on ........ It's almost like, if i can't see it it
doesn't exist." One of Lawson's surviving sons has Asperger's. The other,
a gifted musician she describes as "an amazing young man ...... he came
third in the world in a math's competition at the age of 12", seems to
her to have a few "Aspergery" traits. "It's not a problem for him," she
adds. "He doesn't need a label because he's doing very well." Superficially,
Sam Wells and Wendy Lawson could not be more different. Sam is a lithe,
athletic 13 - year - old with rapid, occasionally indistinct speech. Lawson
is a middle aged woman with the flat voice and slow, awkward gait sometimes
found in people with autism spectrum disorders. But after spending some
time in their company, I'm struck by their similarities. Both have open,
trusting faces. Their vulnerability is frightening, their honesty disarming
(we're so inured to conversational subtexts that it's quite exhilarating
to encounter people with no hidden agenda, who say exactly what they mean
and no more). But despite their directness, I feel as if I'm talking to
them across a divide. They're on one side of some invisible wall, and I'm
on the other. Describing their sense of isolation, people with Asperger's
Syndrome say they feel as if they come from another planet. What is it
that separates them from the rest of us? Despite intensive research both
Asperger's and autism remain a profound mystery. Abnormalities in the structure
and electrical activity in the brain are consistently found in people with
the disorders, but we don't know what causes them or why they seem to be
more common in males. What we do know is that predisposition to the disorders
runs in families. Tony Attwood points out that when a child is diagnosed
with Asperger's, there's an almost 50 percent chance that a close relative
will have an Asperger's personality type: they're likely to be socially
- and in many cases, physically - clumsy,, totally immersed in subjects
that enthrall them, and good with numbers. Dr Jacqui Roberts of the New
South Wales Autism Association notes that in the families of children diagnosed
with Asperger's, "we see a disproportionate number of people who are involved
in the computer industry, accounting or engineering". The genetic link
is well established: recent research suggests that several genes interact
to create susceptibility to Asperger's and autism. But what triggers their
development? Debate rages over possible environmental causes, including
exposure - before or after birth - to drugs, infections or heavy metals
such as mercury. The measles - mumps - rubella vaccine used to be high
on the list of suspects but "there's good evidence now that it is not due
to the MMR vaccination," says Bruce Tonge.
In previous
eras, a person with the Asperger's profile was likely to lead a solitary
life. He/she was the eccentric bachelor uncle/aunt you saw only on Christmas
Day, when his/her turkey got cold as he/she talked on and on about the
life cycle of the dung beetle or the history of the steamengine, blissfully
unaware of people yawning and rolling their eyes. Or the unemployed cousin
who lived with his/her elderly parents, tinkering with machines in the
garage by day, and tending his/her huge science - fiction comics by night.
But geekiness has gained a measure of respectability in the past 20 years.
In the information technology industry, particularly, Asperger's type personalities
seem to thrive. Back in Vienna, Hans Asperger noted that the boys in his
case study were attracted to complex machines and highly organized systems:
computers might have been invented just for them. Microsoft boss Bill Gates
is rumoured to bristle with Asperger's characteristics (reclusive, emotionally
detached, obsessed by technical detail, tuneless speech, rock back and
forth under pressure) and he's the richest man in the world. The foot soldiers
of the IT revolution have prospered, too: people who might once have been
dismissed as walking encyclopedias with no social graces are now making
$300,000 a year with stock options. These days, notes Attwood, "nerds drive
Mercedes". They also marry and have children. There's a theory that the
growth in Asperger's cases is explained partly by the fact that people
with the condition are reproducing at a greater rate then in the past.
But most experts lean towards the view that the biggest contributor to
the increase in diagnoses is heightened awareness of the syndrome. Jacqui
Roberts says clubs and community groups lap up her talks on Asperger's.
"People are really interested," she says. "You see them starting to think
about Uncle Fred. Quite often they will identify somebody in their family
who they think definitely fits that picture."The danger, of course,
is that the amateur psychologists will decide anyone a bit bookish or introverted
needs professional help. As Roberts says, "You Don't have to be in the
autism spectrum to have poor social skills." Most people have some Asperger's
traits in their make - up. Most of us take comfort in sameness and routine,
for instance, but it's a matter of degree. "How many of you need to sit
down on the path outside of a supermarket and do breathing exercises because
they have changed the tinned soup aisle?" asks Wendy Lawson, who so urgently
requires constructure and predictability in her life that she wears a watch
on each wrist - just incase one of them fails. Lawson writes lucid
books about autism spectrum disorders but cannot cope with the vagaries
of public transport: she needs to be driven to and from the autism workshops
she runs, feels safest tucked away in her multi colored house. "I have
a lot of problems negotiating the outside world," she says. As a child,
she would sit transfixed while she watched a bicycle wheel spin or ran
pebbles through her hands. She still takes solace in repetitive actions
such as rubbing her fingers against the soft insides of her pockets. Monash
University's Bruce Tonge says ritualistic, obsessive behaviors are an attempt
to beat back the acute anxiety felt by many people with Asperger's and
autism. "while they're rocking back and forth, the anxiety provoking world
is at bay," says Tonge, whose research confirms overseas findings that
adolescents with Asperger's are particularly prone to depressive illnesses.
This may be partly genetic - depression occurs with unusual frequency in
their relatives - buts it's also due to acute awareness of their difference
from their peers. "A lot of these kids really cop an enormous amount of
teasing," he says. Tonge's study also shows and increased risk of delinquency
in teenagers with Asperger's. He attributes this partly to anger and frustration,
partly to a lack of understanding the consequences of their actions and
partly to their tendency to be easily led. If other kids tell them to go
into a shop and take a packet of chewing gum, they are likely to do it
"because they've learned that to have friends, you've got to do what they
say". Brisbane writer Josie Santomauro says her 12 - year - old son has
trained himself to conceal many of the outward signs of his disorder. "I
call it the mask," says Santomauro, president of the Asperger's syndrome
support network in Queensland. " He can put on such a good act that he
appears normal." But keeping the mask in place at school is a strain. "He
holds it together all day then comes home and takes it out on me and his
sister," his mother says ruefully. "His release is to get on the computer
and play for hours." Like Santomauro, Judy Wells finds it dispiriting when
all well - meaning acquaintances protest that her son seems perfectly "normal".
She can't help resenting the implication that Sam's problems are largely
in her mind. "He isn't the same as everybody else," Wells says. "Just come
to our house for one week and you'll know." People with Asperger's get
so good at imitating ordinary behavior that it's easy to fail to appreciate
what a serious disability it can be. Tony Attwood cites the case of an
exceptionally skillful office - machinery repairman - "he almost had the
intuitive ability to work out what was wrong with a machine and fix it"
- who was promoted to management with dissastrous results. "The man was
brilliant at repairing photocopiers," Attwood says, "but the moment her
had to manage more than 20 other technicians, he really didn't know what
to do, because that meant dealing with minds rather than machines." So
traumatic did the repairman find office politics that eventually he attempted
suicide. "He tried desperately to cope," says Attwood, "but it was so much
beyond him that he questioned the value of life."
Ron Hedgcock's
friends were amazed when he was diagnosed with Asperger's last year. For
Hedgcock, 66, the reaction was pure relief. For as long as he could remember,
he'd had an unnerving sense of disconnection from other people. At last
he had an explanation for it. "If only I'd known 40 or 50 years ago!" he
says. "It would have transformed my life." Through three failed marriages
and a lackluster career as a clerk in the lower reaches of the public service,
Hedgcock had puzzled over his difficulties with tasks that others seemed
to accomplish effortlessly and his apparent inability to form lasting relationships.
"Am I mad, bad or just disgustingly thoughtless?" he asked himself. Now
he accepts that both his intellectual limitations - he's incapable of switching
his attention quickly from one subject to another, for instance - and his
difficulties in bonding are part and parcel of his neurological condition.
"I still have no concept of what it means to know another person," He says.
"If anything, I find people more unknowable the longer I associate with
them." Hedgcock relates better to cats, three of whom live with him 90
minutes drive from Melbourne in a bungalow crammed with books on art history,
philosophy and the theatre - "my aspie fads", he says. (People with Asperger's
refer to themselves as "Aspies" and to the rest of us as "neurotypicals".)
The good thing about feline companions is that they're self reliant and
unsentimental: "Cats have a lot in common with us. They're honest. They
don't play games." Much more confidant and articulate then, say,
Wendy Lawson, Hedgcock hopes to carve out a second career as an actor.
"Just to give you an idea of my Shakespeare, this is out of Macbeth," he
says, leaping to his feet and assuming a dramatic pose in the middle of
the lounge room. "Is this a dagger which I see before me?" A natural performer,
he is enjoying himself immensely: "There's nothing like showing off."Acting
seems an odd job choice for a person with Asperger's. Don't you need empathy
to portray different emotional states? Not at all, says Hedgcock. You just
need to be a keen observer with a flair for copying others' behavior. Tony
Attwood agrees: he says Asperger's people are not infrequently drawn to
the stage and screen. "Quite a few have found acting at high school an
excellent way to be taught body language, posture and tone of voice," he
says. In fact, Attwood suspects Hollywood is full of borderline Asperger's
cases. A script that tells you what to say and a director who tells you
how to say it: to Attwood that sound like Asperger's heaven. US academic
Temple Grandin has described NASA as an encalve for people with autism
spectrum disorders. After visiting the US space agency, where she met a
lot of people who reminded her of herself, Grandin concluded that it was
probably their fierce concentration, dogged perseverance and fanatical
attention to detail that put men on the moon. She joked that if it had
been left to neurotypicals, we'd still be sitting around talking about
it over lunch. Similarly, Wired magazine writer Steve Silberman wonders
if "the first tools on earth might have been developed by a loner sitting
at the back of a cave, chipping at thousands of rocks to find the one that
made the sharpest spear, while the neurotypicals chattered away in the
firelight". We need people with Asperger's, agrees Tony Attwood. Apart
from anything else, our society would be duller without them. What's important,
says Attwood, is to encourage and extend their talents, thereby bolstering
their fragile self - esteem. Education departments are starting to respond
to the challenge: a few schools now offer special support for children
with autism spectrum disorders, training them in social skills and providing
sanctuaries - quiet rooms equipped with computers - where they can escape
the mocking voices in the playground. "The problem for kids with Asperger's
is other people's attitudes," says Judy Wells. "It's not them. It's the
way the world reacts to them." Attwood agrees. He says he knows many smart,
successful Asperger's individuals, "and I know one or two who would exchange
their Ph.D. for a friend".
Source:
http://www.tonyattwood.com/paper1.htm
Blinded
By Their Strengths: The Topsy-Turvy World of Asperger's Syndrome
"I've come
to the frightening conclusion that I am the decisive element in the classroom...
As a teacher, I possess a tremendous power to make a child's life miserable
or joyous... In all situations, it is my response that decides whether
a crisis will be escalated or de-escalated and a child humanized or de-humanized."
- Haim Ginott
Few could
disagree with the sentiments expressed by Ginott, at least in theory. Unfortunately,
theory doesn't
always translate into practice, at least not for children with the enigmatic
and
complex disorder
known as Asperger's Syndrome (AS). Thus, when a crisis occurs, or worse
yet escalates,
it is often the child who is held accountable, and the teacher who is exonerated!
Consultants
are rarely asked to look at what the school staff needs to know and do
to better
understand
and address the challenges that accompany Asperger's Syndrome. Rather,
they are
all too often
directed to focus their efforts on "fixing" the child, as though his or
her actions are
the result
of behavioral decisions, rather than the reflection of a neurological impairment.
Could it be
that Ginott's words were intended only for teachers of typical children?
That is most
unlikely.
Then what is there about AS that "invites" placing the burden of responsibility
with
respect to
aberrant behavior on the children who manifest the disability, rather than
on those
who have
the wherewithal to operate with far greater freedom and flexibility (i.e.,
their teachers or
caregivers)?
One parent's
search for answers to a particularly distressing school situation led her
to
characterize
the plight of her 8 1/2 year old son with AS thusly: "The good news is
he's bright,
and the bad
news is he's bright!" This revealing description makes a poignant, and
sadly
accurate
statement about an educational system that not only fails to understand
the child with
Asperger's,
it fails to recognize that such understanding is in fact necessary if positive
change
is to occur.
An analysis of what this parent meant by her statement gives one a window
on the
topsy-turvy
world of Asperger's syndrome.
In most disorders,
descriptors such as "more able" and "high functioning" are excellent
prognostic
indicators - hence, the good news. How then can intelligence be considered
bad
news? The
answer to this question lies in the paradoxical nature of Asperger's syndrome
itself.
Individuals
with Asperger's are cognitively intact. That is, they possess normal, if
not
above-average
intelligence. This creates an expectation for success. Further, the pursuit
of their
restricted
repertoires of interests and activities often results in the amassing of
impressive facts,
and in an
expertise beyond their years. Therein lies the problem! Given their enormous
strengths,
and the expectation that they generate, and given the fact that intelligence
is a
highly-prized
trait in our culture, intellectual prowess in the child with Asperger's
syndrome
virtually
eclipses the social-emotional and other deficits that are at the heart
of the unusual
behavior
and interests are often seen.
Stated more
succinctly, unmindful of their neurologically-based weaknesses, teachers
and/or
clinicians
get blinded by the strengths of these children. This situation inevitably
leads to a
mental set
that can be summed up as follows: "If he/she is that smart, shouldn't he/she
know
better?"
The answer to that question is a resounding "no". In fact, because of the
social-emotional
and communication deficits, as well as the presence of symptomatology
unique to
Asperger's syndrome, these children can't "know better" until they are
taught simply
to know (i.e.,
to understand).
Consequently,
in order to create an hospitable environment for children with Asperger's
syndrome
in a world that is often inhospitable to their needs, it s vital that teachers
and other
caregivers
employ direct teaching strategies to address the following specific areas:
Perspective-taking
Sociocommunicative understanding and expression
Reading/language comprehension
Executive dysfunction (i.e., problems in organizational skills/planning)
Problem solving
Together,
these target areas constitute a kind of life skills curriculum for the
more able student.
Their inclusion
in the student's IEP can help to ensure that each of these important skill
areas
gets the
attention it deserves. After all, life skills are far too important to
be left to chance!
Nonverbal
Learning Disorders
An Introduction
There is no
question that most scholastic accomplishments are measured and defined
through
language-based
communication. Yet, it has been found that more than 65% of all
communication
is actually conveyed nonverbally. We are all familiar with "non-verbal
communication,"
but few professionals have been specifically trained to look for deficits
in this
area. Although
intelligence measures are designed to evaluate both the verbal and nonverbal
aspects of
intelligence, educators tend to ignore evidence of nonverbal deficiencies
in students.
Or worse,
they brand students with nonverbal learning disabilities as "problem" children.
We are all
aware of the important role language plays in human learning. The competence
of an
individual,
in our present-day society, is most often judged by their verbal proficiencies.
A
person who
speaks eloquently and has a well-developed vocabulary tends to be accorded
more
credibility
than an individual who makes constant grammatical errors and demonstrates
a
limited vocabulary.
A student who has innate difficulties reading, spelling, and/or expressing
herself stands
out in most classroom situations. And likewise, a student who is a top
reader,
achieves
excellent spelling scores, and expresses herself articulately usually does
not prompt
her teacher
to consider a learning disorder. But, this is often exactly the presentation
a child
with nonverbal
learning disabilities (NLD) syndrome manifests in the early elementary
grades.
Nonverbal
learning disorders (also called "right-hemisphere learning disorders")
often go
unrecognized
and unaided by teachers and other professionals for a large part of a child's
schooling.
Overall, there has been an inadequate awareness of the underlying causes
for the
difficulties
these students encounter in school. There are currently few resources available
for
the child
with NLD syndrome through schools or private agencies. It is still difficult
to find a
professional
who understands nonverbal learning disabilities. These children are often
labeled
"behavior
problems" or "emotionally disturbed" because of their frequent inappropriate
and
unexpected
conduct, but NLD is known to have a neurological rather than a deliberate
and/or an
emotional
origin.
The NLD syndrome
reveals itself in impaired abilities to organize the visual-spatial field,
adapt to
new or novel
situations, and/or accurately read nonverbal signals and cues. It appears
to be the
reverse syndrome
of dyslexia. Although academic progress is made, such a student will have
difficulty
"producing" in situations where speed and adaptability are required. Whereas
language-based
learning disorders have been shown to be genetic in origin, heredity has
not, as
yet, been
linked to NLD. It is known that nonverbal learning disabilities involve
the performance
processes
(generally thought of neurologically as originating in the right cerebral
hemisphere of
the brain,
which specializes in nonverbal processing).
Brain scans
of individuals with NLD often confirm mild abnormalities of the right cerebral
hemisphere.
Developmental histories have revealed that a number of the children suffering
from
nonverbal
learning disorders who have come to clinical attention have at some time
early in their
development:
(1) sustained a moderate to severe head injury, (2) received repeated radiation
treatments
on or near their heads over a prolonged period of time, (3) congenital
absence of the
corpus callosum,
(4) been treated for hydrocephalus, or (5) actually had brain tissue removed
from their
right hemisphere.
All of these
neurological insults involve significant destruction of white matter (long
myelinated
fibers in
the brain) connections in the right hemisphere, which are important for
intermodal
integration.
Hence, current evidence and theories suggest that early damage (disease,
disorder,
or dysfunction)
of the right cerebral hemisphere and/or diffuse white matter disease, which
leaves the
left hemisphere (unimodal) system to function on its own, is the contributing
cause of
the NLD syndrome
(definitely not dysfunctional home lives). Clinically, this learning disorder
classification
resembles an adult patient with a severe head injury to the right cerebral
hemisphere,
both symptomatically and behaviorally.
Nonverbal
learning disorders appear much less frequently than language-based learning
disorders.
Whereas it is approximated that about 10% of the general population could
be found
to have identifiable
learning disabilities, it is thought that only 1 to 10% of those individuals
would be
found to have NLD (or between 1.0 to 0.1% of the general population). Unlike
language-based
learning disabilities, the NLD syndrome affects females as often as males
(approximately
1:1 sex ratio) and incidence of left-handedness is uncommon.
Even though
NLD is, by definition, a "low incidence disability," there are indications
that, as
school assessment/intervention
procedures improve, a higher proportion of children will be
identified
with the NLD syndrome. The low rate of occurrence (as low as 1 out of 1,000),
is no
excuse for
the lack of identification and services victims of this devastating impairment
currently
receive.
The symptoms are distinct and display themselves early in a child's development.
The discovery
of the NLD syndrome began in the early 1970s, with research involving groups
of
children
with learning disabilities identified by discrepancies between their verbal
and
performance
IQs. It is unfortunate that 25 years later, even professionals in the field
of education
are largely
uninformed about and/or unfamiliar with nonverbal learning disorders as
these
disabilities
can be much more devastating to a child than language-based learning disorders
in
the long
run.
Since diminished
access to and/or disordered functioning of the right-hemisphere systems
impedes all
understanding and adaptive learning, it is fair to say (as Helmer R. Myklebust
did in
1975) that
nonverbal learning disabilities "are more debilitating than verbal disabilities."
The
specific
central processing abilities and deficits that characterize this syndrome
are now well
defined.
Still, nonverbal learning disorders remain predominantly misunderstood
and largely go
unrecognized.
A child's
earliest mode of communication should be nonverbal. Both parents and teachers
will
often suspect
that "something is amiss" early on, but they can't quite "put a finger
on it." Three
categories
of dysfunction present themselves: (1) motoric (lack of coordination, severe
balance
problems
and/or difficulties with fine graphomotor skills), (2) visual-spatial-organizational
(lack of
image, poor
visual recall, faulty spatial perceptions, and/or difficulties with spatial
relations), and
(3) social
(lack of ability to comprehend nonverbal communication, difficulties adjusting
to
transitions
and novel situations, and/or significant deficits in social judgment and
social
interaction).
Early consultation
with a school psychologist or family physician typically only serves to
dismiss or
minimize a teacher's or parent's worries about this child. More often than
not,
parents are
assured that everything is fine; perhaps their child is "just a perfectionist"
or
"immature"
or "bored with the way things are normally done" or "a bit clumsy." Rarely
are a
parent's
or teacher's concerns given any credence until the child reaches a point
in school
where he
is no longer able to function given the limitations of his disability and/or,
in some
cases, the
child suffers a "nervous breakdown" (or worse).
The child
with nonverbal learning disorders commonly appears awkward and is, in fact,
inadequately
coordinated in both fine and gross motor skills. She may have had extreme
difficulty
learning to ride a bike or to kick a soccer ball. Fine motor skills, such
as cutting with
scissors
or tying shoe laces, seem to be impossible for this child to master. She
"talks her way
through"
even simple motor activities. A young child with NLD is less likely to
explore her
environment
motorically because she cannot rely upon her kinesthetic processing and
spatial
perceptions.
This child learns little from experience or repetition and is unable to
generalize
information.
In the early
years, such a child may appear "confused" much of the time (he is confused)
despite a
high intelligence and high scores on receptive and expressive language
measures.
Closer observation
will reveal a social ineptness brought about by misinterpretations of body
language
and/or tone of voice. This child is unable to "look and learn." He does
not perceive
subtle cues
in his environment such as: when something has gone far enough; the idea
of
personal
"space"; the facial expressions of others; or when another person is registering
pleasure
(or displeasure) in a nonverbal mode.
These are
all social "skills" that are normally grasped intuitively through observation,
not directly
taught. If
a child is constantly admonished with the words, "I shouldn't have to tell
you this!,"
this should
alert everyone that something is awry because you do have to tell them
(everything).
The child's
verbal processing may be proficient, but it can be impossible for her to
receive and
comprehend
nonverbal information. Such a child will cope by relying upon language
as her
principal
means of social relating, information gathering, and relief from anxiety.
As a result, she
is constantly
being told, "You talk too much!"
The child
with NLD often develops an exceptional memory for rote material; a coping
skill he has
had to hone
in order to survive. Since the nonverbal processing area of his brain is
not giving him
the needed
automatic feedback, he relies solely upon his memory of past experiences,
each of
which he
has labeled verbally, to guide him in future situations. This, of course,
is less effective
and less
reliable than being able to sense and interpret another person's social
cues (because
of the vast
array of differences in human nature).
Cumbersome
monologues are another trait of a child with nonverbal learning disabilities.
Normal
conversational
"give and take" seem to elude her. Teachers complain of a child who "talks
incessantly"
and parents resolve, "She just doesn't seem to know when to be quiet!"
Owing to
visual-spatial
disturbances, it is difficult for this child to change from one activity
to another
and/or to
move from one place to another. A child with NLD uses all of her concentration
and
attention
to merely get through a room. Imagine the frustration produced when attempting
to
function
in a complicated and/or new social situation. Owing to her inability to
"handle" such
informational
processing demands, she will instinctively avoid any kind of novelty.
The importance
of identifying and servicing children with nonverbal learning disorders
is
especially
acute. Overestimates of the child's abilities and unrealistic demands made
by
parents and
teachers can lead to ongoing emotional problems. A favorable prognosis
seems to
depend upon
early identification and accommodation. The child with NLD is particularly
inclined
toward seriously
debilitating forms of internalizing psychopathology, such as depression,
withdrawal,
anxiety, and in some cases, suicide.
Dr. Byron
P. Rourke of the University of Windsor and his associates have found that
nonverbal
learning
disabilities "predispose those afflicted to adolescent and adult depression
and suicide
risk." The
child with NLD is regularly punished and picked on for circumstances he
cannot help,
without ever
really understanding why, and he is in turn often left with little hope
that his
situation
will ever improve. After amassing years of embarrassing and misconceived
unintentional
social blunders, it is not too difficult to comprehend how a person with
nonverbal
learning
disorders could come to the conclusion that his environment is not structured
to
accommodate
him.
Identifying
Nonverbal Learning Disorders
Whereas language-based
disabilities are usually readily apparent to parents and educators,
nonverbal
learning disorders routinely go unrecognized. Many of the early symptoms
of
nonverbal
learning disabilities instill pride, rather than alarm, in parents and
teachers who
ordinarily
applaud language-based accomplishments. This child is extremely verbose
and may
"speak like
an adult" at two or three years of age. During early childhood, he is usually
considered
"gifted" by his parents and teachers. Sometimes the child with NLD has
a history of
hyperlexia
(rote reading at a very young age). This child is generally an eager, enthusiastic
learner who
quickly memorizes rote material, only serving to reinforce the notion of
his
precocity.
Extraordinary
early speech and vocabulary development are not often suspected to be a
coping
strategy
being employed by a child who has a very deficient right-hemisphere system
and
limited access
to her nonverbal processing abilities. The child with NLD is also likely
to acquire
an unusual
aptitude for producing "phonetically accurate" reproductions of words (spelling),
but
few adults
will consider this to be a reflection of her over-dependence upon auditory
perceptions
(as opposed
to visual or tactile). Likewise, remarkable rote memory skills, attention
to detail,
and a natural
facility for decoding, encoding, and early reading development do not generally
cause red
flags to go up. Yet, these are some of the important early indicators that
a child is
having difficulty
relating to and functioning in her world nonverbally, and a warning that
she has
developed
an excessive reliance upon her verbal strengths.
Dr. Rourke
and his associates have found that the dysfunctions associated with NLD
are "less
apparent
at the age of 7 to 8 years . . . than at 10 to 14 years," and that they
become
"progressively
more apparent (and more debilitating) as adulthood approaches." Although
this
child has
a history of poor coordination and was probably slow to acquire motor skills,
typically
initial academic
concerns will generate from the fact that he is not completing and/or turning
in
written assignments
during his late elementary school years. This child produces limited written
output and
the process is always slow and laborious for him.
When the skills
for organizing and developing written work don't advance at the expected
rate for
this student,
finally the red flags go up. However, by this time, the child may have
already "shut
down" or
become locked into an oppositional struggle, as a coping mechanism to deal
with the
academic
pressures and performance demands which have been placed upon him by
unsuspecting
parents and teachers and which he is unable to meet.
The three
broad aspects of development in which NLD presents deviations and abnormalities
are
(1) motoric,
(2) visual-spatial-organizational, and (3) social. If a child has right
hemispheric
dysfunction,
deficits in these areas should be quite evident to an observer during the
child's
early years,
despite his valiant efforts to compensate for them. The more novel the
psychomotor,
visual-spatial, and/or social situation, the more evident his impairments
will be.
Following
are some of the early adjustment problems to be aware of in each category.
Motoric:
This child
generally has a history of poor psycho-motor coordination. Motor clumsiness
is often
the first
concern his parents observe. There may be a recognizable difference between
the
dominant
and non-dominant sides of the body with more noticeable problems on the
left side of
the body.
He will avoid crossing his body midline. Later, in school, he may exhibit
problems with
dysgraphia
and impaired tactile-discrimination abilities, including finger agnosia.
His lack of
motor control can manifest in social rejection, as this child is constantly
"getting in
the way,"
bumping into other people and objects, and is generally unaware of the
position in
space his
body encompasses. In addition to social ostracism, his motor disabilities
(along with
spatial misconceptions)
put him at an increased risk for personal injury.
As a toddler,
she will be hesitate to explore her environment motorically, instead she
explores
the world
verbally by asking questions and receiving verbal answers to her questions
about the
environment.
Extreme vacillations with balance are often first evident when the child
is learning
to walk.
She may appear "drunk" in her early attempts at walking. An unusual amount
of falling
will cause
this child to be reluctant and to cling to objects and/or a parent's hand
to gain
stabilization
long after this would normally be expected. She may also have a fear of
heights
and avoid
climbing up on the jungle gym. It is believed that because of these deficiencies,
this
child receives
little benefit from the sensorimotor period of development, which consequently
hinders her
development of higher-order concept formation and problem-solving abilities.
Often, when
the toddler with nonverbal learning disorders is set down after being held,
it takes
several seconds
for him to cognitively secure his equilibrium. As this function of the
central
nervous system
is not integrated for him through the right hemisphere, his body will not
automatically
resume a position of balance. The child must "remember" a previous experience
of equilibrium
and restructure that memory cognitively to achieve a position of bodily
balance.
His everyday
experience is similar to the unbalanced sensation a well-integrated adult
encounters
when stepping off of a boat onto "solid" land after a time at sea.
These faulty
balance perceptions will make learning to ride a bike laborious beyond
belief. A
child with
NLD takes years, not days or weeks to conquer riding a two-wheel bicycle
unaided.
At the dinner
table or (upon entering a school situation) at a desk, this child needs
to muster an
extraordinary
amount of determination to remain seated in her chair. And, as soon as
she
diverts her
attention to the task at hand (i.e. eating or school work), the cognitively
maintained
balance is
gone, and over she topples. This child naturally prefers to eat and do
school
assignments
on the floor, where she senses more security and support.
Simple athletic
skills cannot be mastered in early childhood. When this child lifts his
foot to
kick a soccer
ball, while concentrating on the ball rather than his balance, he will
subsequently
lose (forget)
his balance and tumble over. When jumping up to shoot a basket, he cannot
land
solidly on
his feet. When attempting to do "jumping-jacks," it is impossible to coordinate
the
two sides
of his body. The ridicule suffered by this child is catastrophic, even
at the hands of
possibly
well-meaning "coaches" and P.E. teachers.
Fine motor
skills are also impacted. The NLD toddler resists eating with a spoon or
fork owing
to the lack
of dexterity in his fingers. Learning to tie her shoe laces can take years
and she will
have to "talk
herself through" the process well into adolescence and beyond. Using scissors
can be a
difficult to hopeless task, as is holding a pencil correctly. This child
will adapt a "static
tripod" pencil
grip and press very deeply in an attempt to control her writing, often
producing
dark, heavy
lines.
It has been
said that such a child always "draws" and never actually learns to "write"
(it's not
too difficult
to imagine the consequences this causes in school). The child with NLD's
handwriting
may be quite neat, but the process remains slow and arduous for him. His
daily
experience
with fine motor skills has been likened to an adult who, after a stroke
or being
prescribed
a muscle relaxant, have extreme difficulty controlling their handwriting.
Visual-Spatial-Organizational:
Problems with
spatial perceptions; spatial relations; recognition, organization, and
synthesis of
visual-spatial
information; discrimination and recognition of visual detail and visual
relation-ships,
visual-spatial
orientation (including right-left orientation problems); visual memories,
coordination
of visual
input with the motoric processes (visual-motor integration); visual form
constancy;
gestalt impressions;
and concept formation are rooted in basic deficits in visual perception
and
visual imagery.
This child does not form visual images and therefore cannot revisualize
something
he has seen previously. He focuses on the details of what he sees and often
fails to
grasp the
"total picture."
Visual-spatial
confusion underlies many of the unusual behaviors which are evident in
a young
child with
nonverbal learning disorders. This child will endeavor to "bind" to an
adult, through
continuous
dialog, in order to stabilize her position in a room. She needs to "verbally"
(albeit
subconsciously)
label everything that happens around her, in order to memorize and try
to
comprehend
the everyday circumstances which others instantly and effortlessly recognize
and
assimilate.
Experiences are stored in her memory by their verbal labels, not by visual
images or
by propreoceptive
recall. She will have a relatively poor memory for novel and/or complex
material
and/or material which is not easily verbally coded.
The child
with NLD must employ intense forethought to label everything he comes into
contact
with in his
environment. Owing to faulty perceptions, these labels may be incorrect,
but the child
perseveres
because this is his only accessible means of processing the information.
He does
not form
the visual images which help the rest of us to recognize and comprehend
something
we've seen
or a place we've been before. This causes extreme difficulty for him in
trying to find
his way in
new places.
Spatial reference
is often neglected entirely (i.e., the child may recall many distinct details
of a
house she
has just visited, but she will not be able to describe its location in
reference to other
houses on
the same block and/or to her own home; she cannot conceptualize the details
she
has memorized
in an integrated fashion to form a holistic view). This child, naturally,
is not
drawn to
building or construction toys. Once in school, she will have difficulty
figuring out where
and how to
place written responses on a sheet of paper and/or how to get back to her
classroom
from the nurses' office. Specific problems in arithmetic can result from
deficits in
visual-spatial
reasoning and visual perception. She will commonly have problems aligning
columns of
numbers, observing directionality, and in organizing her work.
The child
with nonverbal learning disorders constantly "talks himself through" situations
as a
means of
verbally compensating for his motoric and visual-spatial deficiencies.
Although he may
be unaware
of the spatial position his house occupies in the neighborhood, he will
find his way
back from
a friends house by counting homes which come in between, labeling environmental
markers,
and/or recounting a sequence of details which he has taken pains to label
and commit
to verbal
memory.
Such a child
is able to achieve a limited degree of comfort in her environment through
well-developed
rote memory skills. This coping technique, however, breaks down whenever
the
child encounters
novel or highly complex situations. She is conditioned to prefer predictable
situations
in which she has had some previous success. Tossing in a new variable to
an already
fairly constant
situation (such as a substitute teacher taking over the control of a classroom
where the
child has previously gained a certain degree of stability with his regular
teacher) can
totally disrupt
this child's coping strategies and generate an increased level of anxiety
for her.
Along with
the aforementioned graphomotor and pencil grip problems, the child with
nonverbal
learning
disorders may have difficulty remembering the shapes of letters (visual
memory) and
using the
correct sequence of strokes to form letters (visual-sequential memory).
He will have
difficulty
with the concept of visual form constancy; the ability to perceive that
an object
possesses
unchanging properties, such as specific shape, position, and size, in various
representations
of its image. All writing tasks will be slow and arduous. Copying accurately
from
the board
or a book are impractical and agonizing for this child.
Social:
Deficits in
social awareness and social judgment, though the child is struggling to
fit in and her
actions are
certainly not deliberate, will often be misinterpreted as "annoying" or
"attention
getting"
behavior by adults and peers alike. It is clear that these students are
motivated to
conform and
adapt socially, but sadly, they perceive and interpret social situations
inaccurately.
The blunders
committed are usually not flagrant in nature, but rather incessant and
tenacious;
hence the
label "annoying." Social competence disabilities are an integral component
of the
NLD syndrome
and this aspect of the impairment may lead to an overdependence upon adults
(especially
parents).
The social
indiscretions frequently committed by the child with NLD are representational
of his
inability
to discern and/or process perceptual cues in communication. The aforementioned
visual-spatial-organizational
deficits cause him to be ineffective at recognizing faces, interpreting
gestures,
deciphering postural clues, and "reading" facial expressions. Conventions
governing
physical
proximity and distance are also not perceived. Changes in tone and/or pitch
of voice
and/or emphasis
of delivery are not noticed or distinguished. Likewise, this child will
not
appropriately
alter his expression and elocution in speech. This can be evidenced in
what may
appear to
be terse or curt response styles.
The importance
of nonverbal signals and cues was noted previously. It has been shown that
more than
65% of the intent of an average conversation is conveyed nonverbally. However,
the
child with
nonverbal learning disorders will try to resolve all quandaries by employing
her strong
verbal skills.
She has to piece together the meaning of a conversation or directive from
this
approximately
35% (verbal) that she actually receives and processes. She totally "misses"
the
large amount
(majority) of relevant content which is being conveyed nonverbally and,
as a result,
much of her
conversational responses don't "fit" with the tone and mood of the occasion.
This
child is
likely to become withdrawn in novel social situations and/or to appear
"out of place."
The impairments
of NLD also lead to a preponderance of very literal translations which,
in turn,
precede continuous
misjudgments and misinterpretations. The child with NLD is naively trusting
of others
(to a fault) and does not embrace the concept of dishonesty (even in terms
of white
lies) or
withholding (even inflammatory) information. He also will not recognize
when he is being
lied to or
deceived by others. Deceit, cunning, and/or manipulation are beyond this
child's scope
of assimilation.
He assumes that everyone is friendly who displays that front verbally and
that
the intentions
of others are only that which they expose verbally. This inability to "read"
the
intentions
of others often results in a lot of unfortunate "scapegoating" of this
child. He needs to
be taught
to question the motives of others - he won't learn from experience.
A child with
nonverbal learning disorders is very "concrete" in her translations, expression,
and
outlook of
the world. Her social relationships tend to be routinized and stereotyped.
Everything
is seen in
terms of black or white - true or false. "Hidden meanings" have to be pointed
out to
her - they
will not be intuitively detected or conceived. She may be regarded as a
"smart aleck"
because of
her constant misinterpretations. This child is frequently reprimanded with
the words,
"You knew
what I meant!" when, of course, she didn't have a clue. She had no way
to access
what was
"meant," but not actually said.
Perceptual
cues serve in the same capacity as traffic signals; they govern the flow,
give-and-take,
and fluctuations in our conversations. The child who cannot "read" these
nonverbal
cues is frequently determined to be ill-mannered, discourteous, curt, immature,
lacking in
respect for others, self-centered, and/or even defiant. This child is none
of the above.
Like the
color blind driver who cannot respond appropriately to traffic lights,
this is a child who is
utilizing
all of the resources available to him in order to try and make sense of
a world which is
providing
him with faulty cues and unreliable information.
It is currently
difficult to locate a professional who understands nonverbal learning disorders,
but
such professionals
are out there. If a child exhibits the developmental deficiencies described
above, she
can be helped to lead an easier, less troublesome life. An effective remedial
approach
incorporates constantly and explicitly "spelling out" to this child what
other children
would be
able to pick-up or infer intuitively with a strong verbal component because
this is the
only way
the child will process and assimilate accurate observations of her environment.
Appropriate
accommodations will have to be made by the family and the school staff
working
with this
child to lessen the likelihood of shattering consequences resulting from
the disability.
Professionals
in the field of Special Education must hone their diagnostic skills in
order to
identify
and provide services for NLD students at an earlier age.
Servicing
Nonverbal Learning Disorders
Nonverbal
learning disorders are often overlooked educationally because the student
is, as a
means of
compensating, very verbal. He has a highly developed memory for rote verbal
information
so early reading and spelling skills usually constitute a strong domain.
If you
observe all,
or most, of the early adjustment problems detailed earlier in this article,
an
intelligence
screening may support your suspicions. An IQ measure, such as the WISC-III,
which reveals
a performance IQ (PIQ) scale score depressed (by 10 - 15 points or more)
relative
to the student's
verbal IQ (VIQ) score, denotes a deficient right-hemisphere system.
It is not
relevant to the diagnostic process whether one or both of these scores
is above the
norm; the
crucial determinate is the relative discrepancy between the VIQ and PIQ.
It is not
unusual for
a child with nonverbal learning disabilities to have a VIQ in the very
superior range.
When subtest
scores are grouped, the verbal conceptualization cluster will generally
be the
strongest
for the child with NLD while the spatial cluster will be the weakest.
Depending
upon the severity of the disorder, and also upon the child's intelligence
and the
coping techniques
which she has already put into place, the discrepancy can be 20 points
or
more. This
is severe and warrants immediate attention no matter what the child's full-scale
IQ
(FSIQ). You
are not merely discovering that the child has a dominance of the left cerebral
hemisphere,
but rather that she is having difficulty accessing the processes specialized
in the
right cerebral
hemisphere. A 10-point discrepancy is generally considered significant.
Once a child
has been diagnosed, parents should not accept the rationale of some
well-meaning
professionals who may tell them that NLD will play a minor role in their
child's
ability to
perform well in school. Physicians and psychologists may assume that a
child with
superior
expressive language skills can easily compensate for a deficit in nonverbal
skills. This
assumption
is true only in relation to the child's capacity to "parrot" back school
work in the
early grades
and does not address the child's inability to "flow through life."
As the child
moves into the higher grades, where less and less will be "spelled out"
for him, he
will reach
a point where functioning in school is impossible without specific compensations,
accommodations,
modifications, and strategies (CAMS). The incredible rote memory which
served this
child very well in the lower grades, before he was asked to interpret and
evaluate
information,
fails him when academic demands shift to more complex applications.
At this point
he may cease to try or "burn-out" attempting to succeed under the impossible
demands now
being placed upon him. Recognizing this eventuality and employing interventions
early in
the child's schooling is certainly preferable to waiting until junior or
senior high to
accommodate
his disability when he finally "bottoms out." Early implementation of CAMS
will
maximize
his success in school. Unless appropriate CAMS are initiated during the
elementary
years, prognosis
for success in school is poor for this child.
A child with
NLD is especially inclined towards developing depression and/or anxiety
disorders if
the nonverbal
learning disorders are not recognized early and accommodated in a
compassionate,
responsible, and supportive fashion. If the child is continually being
told by the
adults around
her, "You could do better, if you really tried," or, "You're just not applying
yourself"
(both false observations in this case) her level of frustration will naturally
intensify and
her self-image
will plummet. It is not unusual for the child with nonverbal learning disorders
to
become increasingly
isolated and withdrawn as failures in school multiply and intensify.
At this point,
the child may be treated for the secondary complaints which now overshadow
the
underlying
primary disorder of NLD. Misdiagnosis, or an incomplete diagnosis (many
learning
disorders
have a comorbid-morbid relation), will only serve to compound the problems
a child is
experiencing.
It is not uncommon for a child with nonverbal learning disorders to be
misdiagnosed
with conditions such as Attention Deficit Disorder (ADD) or emotional
disturbance.
Even when
a child has been correctly diagnosed with NLD, it may still be difficult
for him to
receive the
program modifications and accommodations he needs in school. After all,
he is
probably
performing at or above grade level on most academic achievement tasks which
are
routinely
measured at school, especially during the early elementary years. Although
the
deficits
in motor, visual-spatial, and social skills may be obvious to any interested
and observant
persons,
these impairments will not necessarily evoke the concern and/or compassion
of any
but the most
caring of teachers.
If the "formula"
for language-based (specific) disabilities is called upon, parents may
be told that
their child
does not "qualify" for the Special Education services because there is
not a "severe
discrepancy"
between the child's intelligence and her achievement in the academic areas.
In
fact, the
child's level of accomplishment in academics may even appear to go beyond
her
potential
if the measurement techniques are largely verbal (oral/written). "Overlearning"
is
common in
individuals with the NLD syndrome.
Nonverbal
learning disorders constitute a dysfunction in the basic cerebral processes
and, as
such, denote
a disability which warrants specialized support and program modifications
for the
student.
"Traumatic brain injury" was added to IDEA by the Education of the Handicapped
Act
Amendments
of 1990. Since this child's condition seriously interferes with his ability
to perform
in school,
an Individualized Education Program (IEP) can and should be developed and
implemented
for this child. Or, since this child's NLD impairments "substantially limit
one or
more major
life activities," a 504 plan can be drawn up to help define appropriate
accommodations
for him.
This child
will often have already been mislabeled by unenlightened adults at her
school. Today,
thankfully,
intelligent parents are not so quick to accept educators' misguided declarations
that
their child
is "lazy," "purposefully disruptive," "a troublemaker," "disturbed," "defiant,"
and/or
merely "being
annoying" as if these presentations were a diagnosis rather than an indicator
of
symptoms
to be considered within the context of a syndrome. It is always wise to
locate the
underlying
cause of behavioral observations (i.e., a disorder of the central nervous
system) so
that appropriate,
helpful, and nonpunitive measures can be implemented, knowing that the
child's behavior
is not deliberate and that mistakes and misdeeds are the result of her
disability
and are unintentional
on her part.
Parents should
be especially leery of self-righteous educators who use the superficial
psycho-babble
"he chose" implying that this child has made a conscious choice to put
himself
in a position
of disadvantage. If a child has been determined to have NLD, it is important
for
everyone
to understand that this impairment is neurological in nature and there
is no choice
involved
for that child. No child chooses to fail. To dismiss or label the adjustment
problems
(which are
symptoms) as "attention getting" behavior, is as harmful as it is unprofessional.
The child
with NLD can usually be accommodated in a "fully-included" mainstreamed
educational
setting if her unique academic and social needs are understood by her parents
and
her school
staff. A comprehensive and detailed Individualized Education Program (IEP)
put
together
by a team of informed experts will aid in a successful outcome. The more
extensive the
IEP, the
less likely the child will encounter unforeseen roadblocks and/or fall
through the
cracks. She
may also benefit from some Special Education support services such as speech
and language
therapy for deficiencies in linguistic pragmatics and occupational therapy
for gross
and fine
motor skill concerns.
All too often
though, the coping behaviors of the child with NLD are misinterpreted by
uninformed
adults as
"emotional" and/or "motivational" problems. However, when this child's
verbal
strengths
are capitalized upon and her teachers are flexible and receptive to her
needs, she can
be quite
successful in school. It is so easy for adults to punish and to try to
put the
responsibility
back on the child, but a true professional will recognize that if a child
is not
fulfilling
expectations, it is due to faulty planning on the part of the educational
team, and is in
no way a
reflection on the child.
The child's
parents have probably already gained an intuitive or learned appreciation
of what
works best
for their particular child with NLD. Often this child prospers at home
because of his
parents'
insightful adaptive strategies, while continuing to struggle at school.
It is wise for
educators
to benefit from the knowledge that these parents can offer regarding their
child.
School staff
and parents should work closely together in planning to accommodate this
child's
unique needs.
Although often
suggested, "insight-oriented," dynamic psycho-therapy has proven to be
counterproductive
as a model of intervention for an individual with NLD and is not advised.
Individuals
with NLD are often assumed to be very perceptive because they display
well-developed
verbal skills. Since their symptomology can appear to be emotionally-based,
insight-oriented
psychotherapy is frequently attempted. Dr. Byron P. Rourke has found that
"formal educational
intervention" is the treatment modality most likely to "increase the NLD
youngsters
probability of success." Treatment within a class or center for the emotionally
disturbed
is also not recommended, as therapeutic approaches to emotional problems
are quite
different
from those which have proven effective for the NLD syndrome.
The child
with NLD requires individualized approaches to educational intervention
in order to
succeed in
school because her right-hemisphere systems are dysfunctional or inaccessible
to
her. The
left cerebral hemisphere processes information based upon fixed systems
of rules and
is not equipped
to deal flexibly with problem-solving strategies. Effective remedial methods
include direct
verbal training in planning, organizing, studying, written expression,
social
cognition,
and interpersonal communication.
Unlike Individualized
Education Programs in which the primary goal is to master a continuum of
curricular
skills, the educational program for the child with NLD consists of providing
additional
coping skills,
practical support, and CAMS. Interventions for this child are not curative
in nature,
but rather
designed to offer compensatory skills and to lessen the daily stress he
encounters.
Some of the
specific compensations, accommodations, modifications, and strategies which
should be
employed to help this child follow:
Compensations
1.This child will have difficulty with internal and external organization
and coordination.
Tardiness is something he may struggle with (despite great pains to be
punctual) and
this should not be treated as a misbehavior. Help this child by allowing
him extra time to
get places and by giving him verbal cues to navigate through space. Continually
assess
his understanding of spatial and directional concepts.
2.Never underestimate the gravity of this disability. Dr. Rourke states,
"One of the most
frequent criticisms of remedial intervention programs with this particular
type of child is
that the remedial authorities are unaware of the extent and significance
of the child's
deficits" and he emphasizes that "the principal impediment to engaging
in this rather
slow and painstaking approach to teaching the child with NLD is the caregiver's
(faulty)
impression that the child is much more adept and adaptable than is actually
the case."
Dr. Rourke also warns that: "Observers tend to overvalue the intelligence
of NLD
adolescents…(and) this is the principal reason for an unwillingness to
adopt an approach
to formal educational intervention that would increase the NLD youngster's
probability of
success."
The naiveté of parents and educators regarding the significance
of the NLD syndrome
inevitably leads to inappropriate expectations being placed upon this child.
Expectations
for this child should always be applied with flexibility, taking into consideration
the fact
that she has different needs and abilities than her peer group. (Note:
This individual's
progress is almost always further impeded by anosognosia-the "virtual inability
to reflect
on the nature and seriousness of [her own] problems").
3.Do not force independence on this child if you sense she is not yet ready
for something
(trust your instincts and be careful not to compare her with other children
of the same
age). It is detrimental to isolate her, but don't make the mistake of thinking
she can be
left to her own resources when faced with new and/or complex situations.
Give her verbal
compensatory strategies to deal more effectively with novel situations.
The world can be
very scary for someone who is misreading 65% of all communication and she
will
naturally be reluctant to try new things. The social skill development
of this child has
been delayed by misconceptions which may have caused serious issues of
insecurity to
evolve.
The myth of the "overprotective mother" needs to be dismissed; parents
and
professionals must both assume a "protective" and helpful role with the
child with NLD.
Dr. Rourke states, "Although sensitive caregivers are often accused of
'overprotection', it
is clear that they may be the only ones who have an appreciation for the
child's
vulnerability and lack of appropriate skill development." Care and discretion
need to be
taken to shield the child from teasing, persecution, and other sources
of anxiety.
Independence should be introduced gradually, in controlled, non-threatening
situations.
The more completely those around her understand this child and her particular
strengths
and weaknesses, the better prepared they will be to promote attitudes of
personal
independence. Never leave this child to her own devices in new activities
or situations
which lack sufficient structure.
4.Avoid power struggles, punishment, and threatening. This child does not
understand rigid
displays of authority and anger. Threats, such as "if you (do this), then
(something
unfortunate) will happen to you," only serve to destroy this child's sense
of hope. The
goals and expectations assigned to him must be attainable and worthwhile.
Remember
that taking away "privileges" will not cure a child of a neurological disability
(but may very
well establish him on the path to depression). This is an inappropriate
intervention model
on the part of the adults involved and it is detrimental and damaging to
this child's
development and well-being. The "confusion" and social awkwardness he displays
are
real and unintentional; they should not be viewed as conduct to be penalized.
5.All adults owe it to this child to always assume the best - to always
take a positive rather
than a negative approach. As we have seen, life is very demanding and difficult
for the
child with NLD. Most of her unusual behavioral responses serve a purpose
and usually
represent the child's own attempt at compensation. It is wise to try to
uncover the reason
for the behavior and to help the child devise an appropriate (more acceptable)
replacement behavior (usually through a detailed verbal explanation). Parents
and
professionals need to make the effort to have the child explain his dilemma
and to try to
determine what purpose the behavior might be serving. Then serve the child's
need rather
than punishing her resulting behavior. Remember, as with all children,
at least 90% of
your interactions with this child must be positive in nature!
Accommodations:
1.School assignments which require merely copying text need to be modified
or omitted,
owing to the visual-spatial nature of such an exercise. Active verbalization
and/or
subvocalization are the best memory approaches for this child.
2.Test answer sheet layouts and the arrangement of visual-spatial math
assignments need
to be simplified (no credit should be lost for a correct answer placed
in the wrong column
or space). Whenever possible, use of graph paper is recommended to keep
columns
aligned in written math assignments or consumable math texts should be
provided for
this student.
3.Paper and pencil tasks need to be kept to a minimum because of finger
dexterity and
visual-spatial problems. Occupational therapy is a consideration for the
younger child.
Verbally mediated practices to improve handwriting may result in improvements
in control
and fluency, but the process will remain laborious. Use of a computer word
processor is
highly recommended for all written school assignments, as the spatial and
fine motor
skills needed for typing are not as complicated as those involved in handwriting.
4.The global confusions which underlie nonverbal learning disorders also
result in limiting
the student's ability to produce the quantity of written work normally
expected of her
grade-level peers. This child requires continuous assistance with organizing
information
and communicating in writing. Adjustments must be made in teacher expectations
for
volume of written products. Additional time will be needed for all written
assignments.
5.Tasks requiring folding, cutting with scissors, and/or arranging material
in a visual-spatial
manner (maps, graphs, mobiles, etc.) will require considerable assistance,
provided in an
accommodating manner or they should be eliminated entirely.
6.Any timed assignments will need to be modified or eliminated. Processing
of all
information is performed at a much slower rate when you are compensating
for any type
of cerebral dysfunction. Time constraints often prove to be counterproductive,
as this
student is easily overwhelmed by the unrealistic expectations of his teachers.
7.Adults need to check often for understanding and present information
in plain and clear
verbal terms (i.e., "spell out" everything). A "parts-to-whole" verbal
teaching approach
should be utilized. This child will need to ask a lot of questions, as
this is her primary
means of gathering information.
8.All expectations need to be direct and explicit. Don't require this child
to "read between
the lines" to glean your intentions. Avoid sarcasm, figurative speech,
idioms, slang, etc.,
unless you plan to explain your usage. Write out exact expectations for
any situation
where the child may seriously misperceive complex directions and/or proper
social cues.
Feedback given to the student should always be constructive and encouraging
or there
will be no benefits derived.
9.This student's schedule needs to be as predictable as possible. He should
be prepared
in advance for changes in routine, such as assemblies, field trips, minimum
days,
vacation days, finals, etc.
10.This
child needs to be assigned to one case manager at school who will oversee
her
progress and can assure that all of the school staff are implementing the
necessary
accommodations and modifications. Inservice training and orientation for
all school staff
that promotes tolerance and acceptance is a vital part of the overall plan
for success, as
everyone must be familiar with, and supportive of, the child's academic
and social needs.
Modifications:
1.This child needs to be in a learning environment that provides daily,
non-threatening
contact with nondisabled peers (i.e., not a "special" or "alternative"
program) in order to
further his social development.
2.This child will benefit from cooperative learning situations (when grouped
with "good role
models"). Active verbalization is an important element in how this child
learns. She
usually has extensive verbal information to share with the others and can
be exposed to
the "give and take" of a miniature social environment in a non-threatening,
controlled
milieu. Obviously, the child with nonverbal learning disorders would not
be expected to be
the "scribe" in a cooperative grouping - her contribution should be in
the verbal arena. The
least effective learning model for this child is isolation. She must be
allowed to verbalize
and to have verbal feedback in order to learn.
3.Transitions will always be difficult for this child so he will need time
during the school day
to collect his thoughts before "switching gears." This may mean: extra
time before and
after breaks to disengage and readjust to the changes in pace; less changing
of rooms
and more time spent with one teacher; a study hall that is built into the
student's
schedule at middle and high school levels; and/or a carefully selected
non-NLD peer
"buddy" to help guide him through the day.
4.Placement must be in an environment which has a well-established routine
because this
child will not decipher non-verbal cues. She cannot adjust well to constant
changes in
routine (this child lacks the ability to "wing it" in times of doubt) and
has learned to fear
all new and/or unknown situations and experiences. She needs to know what
will happen
next and to be able to count on consistent responses from the staff who
work with her.
5.Special presentation procedures need to be adapted for those subjects
requiring
visual-spatial-organizational and/or nonverbal problem-solving skills.
Or, as Rourke
suggests, "avoid such material altogether."
Strategies:
1.Do tell this child everything and encourage her to give you verbal feedback.
The most
effective instructional procedures are those that associate verbal labels
with concrete
situations and experiences. "I shouldn't have to tell you" does not apply
- assume you do
have to tell her. She cannot "look and learn."
2.Verbally teach (don't expect the child to observe) cognitive strategies
for the skills of
conversational pragmatics (the "give and take" and comfortable beginnings
and endings
of a conversation, how and when to change the subject, formal versus informal
conversational idiosyncracies, tone and expression of voice, etc.) and
nonverbal body
language (facial expressions, correct social distance, when the limit or
cut-off point has
been reached, etc.). this child will not perceive that he is trying someone's
patience until
that person verbally explodes! Give him some additional verbal cues before
the boiling
point because he does not "sense" tension or displeasure.
3.Observe and expand the coping techniques that the child has already acquired
on his/her
own. Focus on developing flexible concepts and time order.
4.Group the child with "good role models" so that she can label and learn
appropriate
behavior. Remember she won't differentiate between appropriate versus inappropriate
behavior unless the distinctions are verbally pointed out to her. Isolation
is the "kiss of
death" for this child.
5.Adult role models should "talk their way" through situations in the presence
of this child
in order to give him a verbal view of someone else's "internal speech"
process. In
essence, you will be making your internal speech external so that the child
can pick up
the skills needed to coordinate his own problem-solving approaches. Help
the child
devise a sequence of steps for self-questioning and self-monitoring, verbalizing
each
step.
6.Isolation,
deprivation, and punishment are not effective methods to change the behavior
of
a child who is already trying his best to conform (but misinterpreting
all kinds of
nonverbal cues). If inappropriate behaviors are causing problems at school,
a functional
analysis and behavioral intervention plan detailing a course of action
which is designed to
be useful and nonpunitive in nature may need to be a part of this child's
IEP or 504 plan
Source: http://www.udel.edu/bkirby/asperger/
