Transcript Specific characteristics of NVLD

Asperger’s Syndrome and NVLD
cognitive and emotional profiles
Shoshana Yaniv
Cognitive Neurology Unit
Rambam
Simone Shamay-Tsoory
Haifa University
Specific characteristics of NVLD (I)
I. Social problems: poor peer relations; inappropriate
behavior; difficulty understanding social situations;
gravitate toward older/younger playmates
II. 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
III.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
Specific characteristics of NVLD (II)
IV. Motor problems: left-sided symptoms on
neuropsychological testing
V. 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
Asperger Syndrome (DSM-IV) (I)
A. 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)
Asperger Syndrome (DSM-IV) (II)
B. 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
Asperger Syndrome (DSM-IV) (III)
C. The disturbance causes clinically significant
impairment in social, occupational, or other important
areas of functioning
D. There is no clinically significant delay in language (e.g.
single words used by age 2yrs, communicative
phrases by age 3yrs)
E. 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
F. Criteria are not met for another specific pervasive
developmental disorder or schizophrenia
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
History of Dana
• Psychiatric hospitalization following severe
destructive behavior, psychosis R/O
• Referred for NP assessment by hospital staff
• 8;3 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
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
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
Dana - 2006
 17;5, 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
SIMONE’S BATTERY administered (ToM)