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Asperger’s Syndrome and NVLD cognitive and emotional profiles

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).

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Asperger’s Syndrome and NVLD cognitive and emotional profiles

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  1. Asperger’s Syndrome and NVLD cognitive and emotional profiles Shoshana Yaniv Cognitive Neurology Unit Rambam Simone Shamay-Tsoory Haifa University

  2. Specific characteristics of NVLD (I) • Social problems:poor peer relations; inappropriate behavior; difficulty understanding social situations; gravitate toward older/younger playmates • 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 • 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

  3. Specific characteristics of NVLD (II) • Motor problems:left-sided symptoms on neuropsychological testing • 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

  4. 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) (I)

  5. 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) (II)

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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)

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