Asperger

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Aspergers Syndrome and NVLD cognitive and
emotional profiles

• Shoshana Yaniv
• Cognitive Neurology Unit
• Rambam

Simone Shamay-Tsoory Haifa University
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Specific characteristics of NVLD (I)

1. Social problems poor peer relations
   inappropriate behavior difficulty understanding
   social situations gravitate toward older/younger
   playmates
2. Emotional problems poor understanding of
   emotional signals from others difficulty
   interpreting personal emotional experience
   inability to learn from past experience including
   social interaction risk for depression and
   isolation
3. Cognitive characteristics well-developed verbal
   abilities visuo-spatial and visuo-motor
   deficits poor handwriting difficulty with
   part-whole relationships and organizing
   information serious arithmetic problems, poor
   adjustment to change significant differences in
   Performance IQ vs. Verbal IQ with VIQ being better

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Specific characteristics of NVLD (II)

1. Motor problems left-sided symptoms on
   neuropsychological testing
2. Attention problems distractibility difficulty
   concentrating, difficulty inhibiting input,
   behavior etc. can make them look hyperactive
   although typically not hyperactive but NVLD can
   co-occur with ADHD

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Asperger Syndrome (DSM-IV) (I)

• Qualitative impairment in social interaction, as
  manifested by at least two of the following
• (1) marked impairment in the use of multiple
  nonverbal behaviors such as eye-to-eye gaze,
  facial expression, and gestures to regulate
  social interaction
• (2) failure to develop peer relationships
  appropriate to developmental level
• (3) a lack of spontaneous seeking to share
  enjoyment, interests, or achievements with other
  people (e.g. lack of showing, bringing, or
  pointing out objects of interest to other people)

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Asperger Syndrome (DSM-IV) (II)

• Restricted, repetitive, and stereotyped patterns
  of behavior, interests, and activities, as
  manifested by at least one of the following
• (1) encompassing preoccupation with one or more
  stereotyped and restricted patterns of interest
  that is abnormal either in intensity or focus
• (2) apparently, inflexible adherence to
  specific, nonfunctional routines or rituals
• (3) stereotyped and repetitive motor mannerisms
  (e.g. hand or finger, flapping or twisting, or
  complex wholebody movements)
• (4) persistent preoccupation with parts of
  objects

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Asperger Syndrome (DSM-IV) (III)

• The disturbance causes clinically significant
  impairment in social, occupational, or other
  important areas of functioning
• There is no clinically significant delay in
  language (e.g. single words used by age 2yrs,
  communicative phrases by age 3yrs)
• There is no clinically significant delay in
  cognitive development or in the development of
  age-appropriate self-help skills, adaptive
  behavior (other than social interaction), and
  curiosity about the environment in childhood
• Criteria are not met for another specific
  pervasive developmental disorder or schizophrenia

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Apples and Oranges

• NVLD is based on cognitive criteria/ NP construct
• AS is a disorder of social cognition and
  behavior/ psychiatric construct
• On the same continuum/different syndromes/ NVLD
  non-existent?
• NVLD has a definite NP profile
• AS no definite NP profile (?)
• AS seems genetic/NVLD no
• Different gender ratios
• AS deficits explained by new evidence/theories

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History of Dana

• Psychiatric hospitalization following severe
  destructive behavior, psychosis R/O
• Referred for NP assessment by hospital staff
• 83 y., slow motor development, early language
• Symbolic play, eye contact, imitation-ok
• Social difficulties/severe tantrums
• Medical Hx febrile convulsions
• School Hx underachieving, slow/poor writing
  reading comprehension, poor arithmetic, slowness,
  disorganized, attention issues

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NP profile

• High IQ
• General difficulty processing and integrating
  complex information
• Analytic, detail oriented
• Visual-spatial deficits
• Poor arithmetic
• Slow motor output
• Poor EF (attention, planning, shifting)
• Poor adjustment/behavior

FILLS NVLD CRITERIA
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Dana-after testing

• Neurological workup MRI, SPECT- ok
• EEG- abnormal Rt. Temporal activity
• Psychotherapy (group individual), Remedial
  learning, OT, school /testing accommodations
• Improvement reported 2 y., then contact lost

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Dana - 2006

• 175, 12th grade
• Academic social difficulties
• Irregular school attendance
• Overweight, depressed
• Slow, clumsy
• Difficulty w/changes
• NP profile high intelligence but uneven,
• slow, difficulty w/complexity, detail oriented,
  cannot integrate, memory ok, no ADHD, depressed,
  anxious

SIMONES BATTERY administered (ToM)
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