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.