NLD, Asperger’s, and OCD

 

How is Non-Verbal Learning Disorder different from Asperger’s?

 

If people with NLD tend to “rely on routines” and people with Asperger’s tend to have “rituals” aren’t these both really similar to Obsessive-Compulsive Disorder?

 

These are frequent questions I hear and read about, especially when a person first gets their NLD diagnosis. It was one of the first really challenging concepts I ran into as I was trying to comprehend. Unfortunately, there is so little information that a person without massive background in learning disabilities can actually comprehend that they appear almost in-differentiable.

 

To start, I’m not an expert, but I have spent time with people with Asperger’s and NLD (to the greatest extent possible, which is mostly chatting online and over Skype in video chat) and spent hours reflecting on my own situations, digging through my past and digesting as much information in academic journals as I can stomach. And as a basic disclaimer, I am talking in broad trends and generalizations, there are always individuals that don’t fit everything  just right.

 

When it comes down to it, as far as I can tell, people with Asperger's tend to have a physical self-stimulation behavior, called “stimming” by many which at times can certainly look like OCD. They also tend to have a very specific field of expertise the jargon is “restricted interests,” which can also look kind of like OCD. People with NLD can be prone to over-learning and routines as coping mechanisms, which can SEEM like OCD but are also not.

Actually, neither really has OCD by definition. If you break it down obsessions are things you are incapable of not thinking about and compulsions are things you have no ability to NOT do.

 

*Asperger’s*

People with Asperger’s will have rituals and routines (e.g. counting (anything), touching corners, my mom pulls her rings on and off her fingers). But these are not things that are really obsessions so that they cannot do other things, actually these small activities are typically soothing or calming.

 

Nor are they compulsions, most people with Asperger's are quite capable of controlling these activities, although they are frequently not conscious of them.

They also have an obsessive-like interest, usually in only one very very specific area (e.g. trains, cars, numbers). Many times, especially in kids, it almost seems like they are cataloging lists of information. Though you can't really call it a compulsion nor does it have any sort of routine or ritual about it.

 

*NLD*

On the other hand, people with NLD tend to use over-learning and routine as relatively effective coping mechanisms. This can look like OCD because they may get easily ruffled when routines get broken, but seldom does it lead to an out-right break down/tantrum (though people with NLD will get there with enough stress).

People tend to focus on describing how people with NLD tend to approach gaining competency as over-learning. In reality it is a poor way to describe how and why people with NLD need to learn in the first place. The over-learning idea makes it look like a person with NLD will just learn all they can about something in a rote way without really understanding what they are doing.

But really, since people with NLD have difficulty with reliable “gut feelings,” putting things together on an abstract or intuitive level, and are pretty bad at prediction, they usually need to understand something from the ground up to form a solid enough knowledge base to really work with an idea with any sort of competency.

So, they may fixate and, yes, obsess about ideas or subjects that interest or confuse them. Over-learning, however, is not typically a very specific topic that will be directed at memorizing as much as possible. It tends to be focused on a interest, need or problem the person is faced with.

 

 

 

Getting away from the overlaps with Obsessive-Compulsive Disorder, there is a VERY distinct difference in the social functioning of people with NLD and Asperger's. 

 

*Asperger’s*

People with Asperger's tend to feel that they are almost of a different species or are aliens. My friend with Asperger's was afraid he was a sociopath before he was diagnosed because he felt like he might be the only 'real' person in existence or as if other people were just things going through odd little motions.

 

Interestingly enough, the FIRST description of Asperger's by Dr. Asperger himself, described children with this disorder as being  "Autistic Sociopaths" (I don't remember where in the description he discussed something as to their much higher level of function from most people with Autism).

What I have noticed is that people with Asperger's seem to have a decent ability to CONSCIOUSLY LEARN social norms and function in them.  It is almost as if the emotional feedback needed to learn normal non-verbal communication doesn’t connect with everything else as it should.

 

*NLD*
On the other hand, a person with NLD, in the social arena, tends to come off as "clueless" "spacey" "slow" "immature" "inattentive". They often know that they are missing something but never quite know what. They feel the need to respond, but are not able to see or interpret the social cues contained in non-verbal behavior well enough.

 

They can improve by learning specific cues and rules, but typically will always have difficulty in real-time social situations because the deficit is in seeing and interpreting the vast amount information contained in all the signals and context that happens in a typical interaction.

I hope this can help people’s understanding, and, if I am lucky, stir up some discussion.

Invisible Disability: Is There a Normal?

 

From birth, I looked ‘normal’, sure there were exceptions, but all seemed things a ‘normal’ person might do or say, now and then. I was treated as a normal kid, but by second grade, I had learned a hate of myself so deep, I’m lucky to simply be alive today.

 

This post stems from a few recent conversations I have had with people about the relative definition of disability, and some articles I have read by people who think that disability is just an artificial construct that people use to exclude others.

 

Now, A generally accepted definition is that, a dysfunction or disability is something that seriously interferes with a person's ability to live a normal life. There are many philosophical discussions on the definition of normal and abnormal, and even on how much variation within normal is in fact normal.

For example, some people can walk without tripping or falling, some people can sprint miles, some people have prosthetic legs that work better than average, and some have difficulty navigating stairs, but others have legs so crippled that they are bound in a wheelchair forever. Can we say they are relatively normal when you are touring the Rocky Mountains?

 

Unfortunately, it seems that these discussions seem to minimize the basic meaning and needs of those who lie outside this ineffable ‘normal’.

The line may seem blurry, as in those who have clear skin and those who have acne; but what of those who have permanently disfigured faces, the kind that few have the ability NOT to stare at?

 

Maybe it would not matter to a person who is blind, but most of us are not blind.

I can only speak now for myself, and of my experiences as far as this idea of normalcy is concerned.

 

I spent my childhood failing, working hard, focusing, sacrificing hours to keep up, but it was no use.
I can remember the hours my Mom spent trying to get me to memorize spelling and math facts from flash cards.

I remember crying in shame as my Father tried his best to teach me about things that were important to him. From car and home maintenance to hiking and bowling to driving jeeps and sports cars to understanding how to smooth talk a sales person. I failed them all.

And no matter how I tried I could NEVER convince anyone that there was something wrong.

"Why would there be? Carrie is so smart when she wants to be."

There was always the assumption that I wasn't trying hard enough, that I wasn't paying attention, that I was failing on purpose. I have always felt like I failed the people who invested so much in me.

Really, if only I could put as much into my school as I did in reading... I would ace all my classes. By the time I was seven I remember the first stirrings of what would haunt me to this day;

"Maybe there ISN'T something wrong, you need attention so bad you made this all up, you are so screwed up you can't even decide to stop doing it anymore, you don't deserve anything!"

There may be many grays of normal, in fact, I have well above normal verbal abilities. In ways, this was the proverbial “nail in my coffin.” Once people saw me being ‘smart’ there was no excuse for when I was being flat-out moronic, other than assuming I was acting-out or not trying hard enough.

I need to have a way of telling the world that I don't work right, that something about my brain is broken, that I am doing my best and trying my hardest.

Because now, when I fail, and I do often, I can stop feeling selfish, and disgusting, as if I just am not trying hard enough. Now, I can ask for help, or let it go, or try something else.

With this ability to say I am NOT normal, I am not even a gray area around normal, I can finally start talking to those pieces of myself I have locked away, beaten, and starved for the last 23 years of my life.

 

For the first time in my life, I can hope that maybe I can forgive myself, and that I might someday feel like a whole person.

The Autism Spectrum

The placement of NLD (Nonverbal Learning Disorder) in the Autism Spectrum is frequently a controverted point, and I felt that I needed to get my opinion of the matter out on the table, before much more discussion of NLD takes place.

It seems to be a point of controversy which hinges on the basic question:
What is the purpose of diagnosis and categorization?

Feel free to disagree, but as far as I can tell the common consensus is:
To provide better accommodation and treatment to the individuals affected.

By extension, increased service, can be directly served through finding a common cause, which allows for more efficient treatment.

Thus, where groups of symptoms seems to deviate from similar treatment and accommodations AND where symptomology ceases to imply a common cause, the disorders become different.

Thus, the presence and broad use of Autism Spectrum, defeats the purpose of categorization in the first place. And, disorders which significantly deviate from the symptoms of Autism, while potentially informative in comparison of each other, should not be included within this label.


Characteristics of Autism Spectrum Disorders

Catch-All:
There is no single behavior that is always typical of autism and no behavior that would automatically exclude an individual child from a diagnosis of autism" National Research Council, 2001, p 11

Impaired Social Relationships
Difficulty in:
Perception of emotional state of others
Expressing emotions
Forming Attachments and relationships
Social gesture use (pointing things out to others, gesturing or nodding to others; gestures used lack social component)
Joint attention (in young children; adult and child use gestures and gaze to share attention with respect to objects or events)

Communication and Language Deficits
Typically have severe language delay
Presence of Echolalia - verbatim repetitions of things they hear in noncontextual speech without communicative purpose.
Concrete/Literal processing of verbal information

Restricted, repetitive, and stereoptyed patterns of behavior, interests and activities
repetitive behaviors - rocking, twirling, flapping, humming, visual fixation for hours, spinning objects, clicking pens etc. (the key is small repetitive activities which extend for hours to the point of obsession)



So here's a few problems - using these definitions, everyone and most ALL learning disabilities will fall into one or more of these requirements, and since the catch-all says that no behavior can exclude and no behavior is always typical, it is a pretty useless diagnosis to start with.

Generally, Autism will fit all 3 categories.

Asperger's is included because they have difficulty emotionally relating to others and they engage in repetitive behaviors described above. Aspies, though, have typically above average intelligence and no language delay.


Now, let's look at some other disorders:

Depression, Schizophrenia, Bipolar Disorder, OCD, Social phobias, Sociopathy -
All of these can happen in very young people (though it is not common overall, it may be more common than the incidence of Autism) All of these display a significant degree of social dysfunction in both social and linguistic communication, the majority will display repetitive behaviors and restricted interests with a difficulty understanding a larger picture.

Any Learning Disability -
Typically a disability present at birth. Most all learning disabilities create emotional distress, which can easily create difficulty with social function, and lead to many of the previously listed emotional disorders. Even from birth, a child with Dyslexia, for example, who doesn't process the sounds of words, can easily have a linguistic delay. And since Learning Disabilities are, by definition, a discrepancy in ability and achievement, individuals with LD's will tend to restrict their interests to those things they have strengths in, and will vehemently oppose or violently react to engaging in activities which are in their weaknesses especially if they are outside the expected routine.

So the question is where do you draw the line?

If the purpose of diagnosis is to provide accommodations and services - then defining all of the above would be best done through symptomology only. Since there is such significant variation, the treatments and accommodations for various Autism subtypes vary as widely as the symptoms, then grouping them together only serves to obscure the problems.

If the purpose of diagnosis is to illuminate a possible common causality then the catchall should not be present, and groupings should reflect the logic involved with including symptoms for example:

In Autism, frequently the severe delay in language is caused by the lack in emotional bonding to other individuals. In individuals who build an emotional bond with animals, they will start to pick up the language spoken around them.They tend to use phrases they hear without intent to communicate or apparent knowledge of their meaning. And the restricted activities would be logically caused by whatever difficulty they have in emotionally connecting to people.

In Aspergers, there is NO language delay, and since language development necessitates emotional connection (many peer reviewed studies back this one up), it can be assumed that the primary dysfunction of people with Aspergers is not through emotional connection. In examining the disorder, it seems that they have difficulty feeling social pressure, they can usually see and learn nonverbal communication, and intellectually recognize socially appropriate behavior, but it is not something that happens subconsciously. Aspies, along with Autistics (and MANY other disorders) engage in repetitive restricted behaviors. Many of which involve repetitive sensory stimulation.

The conclusion I draw between Autism and Aspergers is that Autism involves some lack of emotional connection to individuals and Aspergers involves a lack of emotional connection to group behavior.

NLD differs entirely from both.

NLD'ers will resist change in routine, but in the same way all people with dysfunctions (in general) will, because a change in routine brings the potential for unpredictable encounters with the more traumatic aspects of their life. NLD'ers typically have sensory integration issues, but seldom if EVER display repetitive sensory stimulation behaviors ('stimming' - this repetitive behavior calms and focuses the individual). As I can tell, this type of behavior is MUCH more likely to INCREASE stress, frustration, and dysfunction in an NLD'er.

NLD'ers have difficulty understanding social cues, and I find that this seems to directly relate to the inability to PERCEIVE social cues and facial expression - more akin to right hemisphere damage, than any difficulty in emotional connectivity. Often, if a social situation is explained sufficiently to an NLD'er they will distinctly feel the normal social pressures and have no difficulty emotionally identifying with individual and situational emotions.

NLD'ers tend to be hyper verbal because integrating meaning and emotions into a linguistic (auditory-motor process) expression, is far more accurate and useful, than integrating visual-spatial information (a VERY high demand on white-matter task) which may boarder impossible for lack of visual discrimination.

Additionally, lack of visual discrimination, and visual-spatial processing, is SELDOM seen in Autism, in fact, this tends to be a real strength for them.

New Pencast!

This one is a broad overview of the ideas I want to include in my book with some details, it is sort of me just spitting my thoughts and having Ryan take notes and give me some feedback.

I want to warn you guys though, I think I dropped the F-bomb in there somewhere, I was getting worked up and just want to apologize ahead of time. I'm working on watching that when I am blogging.

Also, if you guys have feedback for me, think I missed something or should add something, please feel free to comment publicly or privately.

Pencast 2
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Goals and Themes

Welcome to the first pre-writing session on my book-in-progress. Today I hashed out the really important underlying issues I have come to feel really strongly about since I have been involved in working with people having difficulty learning.

You are welcome to listen to the pen cast of Ryan and I discussing the ideas:

Book Blog 1
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Pencast: 1

Some John Dewey Quotes:

“The only freedom that is of enduring importance is the freedom of intelligence, that is to say, freedom of observation and of judgment, exercised in behalf of purposes that are intrinsically worth while. The commonest mistake made about freedom is, I think, to identify it with freedom of movement, or, with the external or physical side of activity.”

“Man is not logical and his intellectual history is a record of mental reserves and compromises. He hangs on to what he can in his old beliefs even when he is compelled to surrender their logical basis.”


“Such happiness as life is capable of comes from the full participation of all our powers in the endeavor to wrest from each changing situations of experience its own full and unique meaning.”


“The aim of education is to enable individuals to continue their education ... (and) the object and reward of learning is continued capacity for growth. Now this idea cannot be applied to all the members of a society except where intercourse of man with man is mutual, and except where there is adequate provision for the reconstruction of social habits and institutions by means of wide stimulation arising from equitably distributed interests. And this means a democratic society.”

Saturday 5/9/09 Education and Standards
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Gettin set up during finals season... good idea?

Welcome, the lucky few of you who get around to reading my first post. I appreciate your show of loyalty to me. I hope this will pan out into a valuable resource for people who have learning challenges, people who are family/friends/coworkers of people with learning disabilities, teachers, psychology and education professionals.

My vision for this blog is to begin to open up the little box that we are packing learning disabilities into. I want to open a cross discipline and cross community discussion about all students who have difficulty learning in the American "mainstream" classroom.

To lay it all out, this is a discussion about any aspect of learning and education in the context of my experiences and discussions with members of my community.

Inspiration comes from a variety of experiences:

My experiences as an adult with a recently diagnosed learning disability, have changed who I am, who I want to be and what is most important to me.

Growing up undiagnosed irreparably damaged me in some aspects, and provides me an endless sea of determination in improving myself and in making all my resources available for others.

I have seen my abilities and my sense of self grow more in the recent year than it has in my whole life and I want to share that.

I spend much of my time discussing my learning disability, NLD (Nonverbal Learning Disorder), with the online community on face book. The individuals I have met through the group forums are constantly challenging me to synthesize and research more information about learning and the human mind as a whole, and it is an endeavor which I take great pride and enjoyment from.

I frequently have to branch out of my NLD in my research and problem solving because my fiance (who I hope will become a co-author to this blog in the future) has ADD (Attention Deficit Disorder), and we are regularly challenged to accommodate both of our neurological problems at the same time.

If I look around at my closest friends, I have found that I have surrounded myself with people who have other neurological deficits, who all provide me with a rich source of experience that allows me to put a firm context to the often convoluted academic information that I get from my research.

And education is likely to be a frequent theme in this blog, because both my fiance and I are students in a university setting and aspiring teachers. He has one more semester of courses before his student teaching in secondary physics education, and I am pursuing a degree in special education with an emphasis on learning disabilities.

Generally you can expect hot political ideas to surface relatively frequently because we are immersed in the battles of the day. Some examples off the top of my head, English as a Second Language, School/Public policy, Standardized Education, Curriculum Development, Progressive vs. Traditional Pedagogy Practices, the list goes on.

I want to encourage my readers to comment and message me, whether you have a question, you are upset about something, you just want to say hi, or you want to chat. Typically, my best ideas and inspirations comes from the questions and comments I get from other people.

For those interested, here are some links to the discussion forums I regularly participate in.

http://www.facebook.com/notes.php?imported#/group.php?gid=83530935976
http://www.facebook.com/notes.php?imported#/group.php?gid=5817612058
http://www.facebook.com/notes.php?imported#/group.php?gid=2237450434