Sunday, September 20, 2009

Different Minds

Xantippe's Blog is having a book club on Different Minds: Gifted Children with ADHD, Asperger Syndrome, and Other Learning Deficits. I think I pointed her to this book; in full disclosure, the author, Deirdre Lovecky, was the one who evaluated my son. Dr. Lovecky hasn't mentioned the book to me at all; I found it when I was researching her before I called to arrange an evaluation for my son. And for the record, my son tested as highly gifted (IQ over 145) and having Asperger Syndrome.

I'll summarize Chapter 3, "Attention Deficits: Asperger Syndrome."

Lovecky explains that gifted children with AS have "difficulties with communication and social development." They want to have friends, but they don't really have interest in other children. They see the world as revolving around them. They're really kind of self-centered. Lovecky breaks the chapter down into 5 sections.

1. Development and types of AS

Once upon a time, AS was seen as HFA (high functioning autism). It was Hans Asperger who started to notice some differences. AS kids usually are fairly normal in language and social development but start to show deficits when they enter formalized school settings. They tend to rely more on rote memorization in interacting with the world than in processing new information and applying it in new ways to adapt to the situation. They prefer routines and order, and the lack of such leads to anxiety and depression. They lack pragmatic language skills (knowing what to say and when to say it) and they often have motor clumsiness. (My apologies for the too-close paraphrase.)
Lovecky goes into the difficulties of diagnosing AS; clinicians don't usually follow the DSM criteria. There does seem to be a genetic component, as AS seems to cluster in families.

AS co-exists with a lot of conditions, especially ADHD. Here are some ways to tell them apart:

* AS kids have more developmental delays than ADHD kids. AS kids are also especially
* AS kids have deficits in social reciprocity, two-sided relationships. AS kids have idiosyncratic behaviors that make it hard to connect with other kids. AS kids like rules and will obey them as long as the rules make sense to them.
* AS kids are more anxious about changes inroutine.
* AS kids have trouble seeing the big picture and get caught up in details.
* Both AS and ADHD kids have impulsive behaviors, lack structure/organization, and can't control or modulate their behavior very well.

Lovecky then explores co-existence with other issues such as OCD, Tourette, and other anxiety/depressive disorders.

2. Symptoms of AS
* Kids with AS have social deficits. They don't understand reciprocity and turn-taking, and they don't know how to negotiate activities. They also can be teased for being different; gifted kids have extra trouble because they're teased for their academic success. AS kids have trouble sharing interests with others; they are too one-sided. They have trouble with empathy and understanding how others feel and what others need. Their obsessive interests make it hard for them to connect with others who don't share that interest. They often have stereotypies (repetitive behaviors) as well.
* Kids with AS have difficulties communicating. They mostly have trouble with nonverbal communication, such as reading body language. Their pragmatic (social use of) language is weak. Prosody (sound of speech) can be flat and lack emotional inflection. They also talk "too much and too long" on their favorite subjects, as if they were lecturing their audience. Thus, conversational skills are weak. Since they have trouble making a coherent whole out of information (as opposed to focusing on details), they can't really follow the thread of a conversation for a long time. They don't remember things about other people that can help them make a connection. They can also lack the ability to identify irony or sarcasm.
*It's unclear whether AS kids have higher IQs on average, though there seems to be some connection. AS kids do have executive function deficits, meaning a difficulty in organizing, planning, and being mentally flexible.
*Empathy is impaired in AS kids. They also can't control their feelings/responses and they have no "language of feelings." They can also develop emotional obsessions.
*AS kids have motor functioning deficits, a lack of manual dexterity, awkward gait and balance, and "dyspraxia" (planning/controlling movement).
*Sensory functioning issues are not part of DSM criteria but are observed in AS kids. These issues involve touch (needing or avoiding it), overarousal, and mixed sensory perceptions (synaesthesia).

3. Understanding AS
There are three areas of cognitive difference that Lovecky focuses on: Theory of Mind, central coherence, and executive function.
*Theory of Mind involves the ability to understand that other people have other perspectives and apply that knowledge in social interactions.
*Central coherence involves AS kids' inability to see the "big picture." Most people can take in information and see the main points, how the information works together to form a whole. AS kids have difficulty with this because all pieces of information seem equally important.
*Executive function refers to tasks involving organizing, planning, transitioning and handling these effectively. When AS kids hyperfocus on an activity they prefer, they tend to have difficulty moving on to another activity. If they are not interested in an activity, they do not focus on it. They find it difficult to follow directions because they can't see the big picture and get bogged down in minor details. They can't be flexible and transfer information from one area to another very easily.

4. Gifted Children with AS as compared to Typical AS Kids
Now Lovecky gets into the meat of it: the characteristics of gifted children who have AS. As AS kids have many similarities with gifted kids, it can be hard to distinguish among the 3 groups: AS gifted kids, gifted non-AS kids, and AS non-gifted kids.
There has been some research on gifted children with AS, but not much.
* Gifted children with AS have more "passion to learn," a wider variety of interests they are passionate about, and more ability to make connections among the different areas of interest.
* Gifted children with AS can be imaginative and creative and involve others in their play. They also can use their visual skills to solve problems. (Note from Wendy: Temple Grandin's work comes to mind.)
* Gifted children with AS seem to develop vocabulary and reading skills more quickly.

Gifted Children with AS as compared to Typical Gifted Kids
* Gifted kids with AS may have a more difficult time making connections than Typical Gifted Kids (TGK). They may have a perfectionist approach that leads them to persevere in their field of interest. They have more difficulty communicating their imaginative and creative ideas to others. Gifted kids with AS have difficulty with *output*. They have the understanding but cannot communicate it effectively. Gifted students with AS also have trouble with interpreting literature. They also show the ability to adhere to moral rules/values but less ability to be flexible in applying them. TGK are better able to socialize than gifted kids with AS, who act immaturely in most social situations.

5. Positive Aspects of AS
Social: loyalty, dependability, freedom from sexism or prejudice, being upfront with what they think, determination and disinclination to be swayed by doubters, ability to follow patterns/rules and/or notice trends, avoidance of small talk, sincerity, truth-telling.
Cognitive: Interest in words, good verbal skills, visual thinking skills, detail-oriented, sometimes photographic memory, encyclopedic knowledge of topics of interest.
Personal/emotional: Sensory sensitivity leading to interesting perspectives, trusting of others, compassionate and caretaking nature.

Lovecky: "In helping gifted children with AS, it is important to work on the areas of deficits to encourage as much growth as possible. At the same time, it is vital that these gifted children be afforded the chance to develop areas of strength and interest. Their interests are the key to adult success."


My thoughts:
My favorite part was the section on Positive Aspects of AS because these are exactly the things I find so charming about my son. :) The more I can get into his mind, the happier I am because I love seeing the world from his perspective, and he and I share interest in words/language.

My concern is that in a (school) world where rote memorization is emphasized and the basic skills are the focus of testing, my son will be overlooked because he is already good at those things. He longs for people who share his interests, and I want for him to be able to talk with those children/people as much as possible. In those kinds of arenas, he will perhaps best be able to build some of the social skills he needs.

Another important section here was the section on Theory of Mind, cognitive coherence, and executive functioning. It's these abilities to make connections that are so crucially absent in many AS kids. Gifted kids with AS are better at that, but my experience is that I'll run across huge gaps in my son's understanding that stand out like holes in Swiss cheese.


Amy P said...

Yes, you were my inspiration for getting the Lovecky book. A few points:

1. I think it's interesting that the people who are actually experts on Asperger's take such a dim view of the DSM. And I can see why. The DSM description just seems so inadequate. Of course, we can't really replace the DSM with the entire text of Attwood's Complete Guide to Asperger's Syndrome.

2. You used the term "co-exist." I take it that "co-morbidity" was too off-putting?
3. Since C is an older sibling, I see a lot of the darker side of the Theory of Mind problem. Protecting younger brother from oppression is one of my major jobs. A typical one-way conversation from C to D goes like this: Do you like XYZ? [Desired answer not given.] Do you like XYZ? Do you want to play XYZ? Let's play XYZ! Alternately: Do you want ABC? [Desired answer not given.] Do you want ABC? Go ask mommy for ABC! Eventually the victim capitulates [sometimes after some enhanced interrogation methods] and he comes running out to ask me for ABC on C's behalf. As you can imagine, this interaction model doesn't help C deal with peers. What C wants (when she wants to play with others) isn't peers. She wants assistants and henchmen.

Wendy said...

Yeah, I didn't like "co-morbidity." :)

I've seen some of that kind of behavior in my oldest daughter and with her friends (with S being the one bullied into asking for ABC). It may be a little developmental, but enhanced a bit.

I can't believe I'm saying that because I know damned well there's a difference between totally normal developmentally appropriate bad behavior and the kind of things that gnaw on parents of Aspies, that we know is part of something else and not just "normal." (I like how Lovecky uses the word "typical" instead of "normal.") It's probably the intensity of the behavior you're seeing, or the way it's approached.

Anonymous said...

Wendy: you might be interested in this mailing list:
(GT-special). It might help as you're addressing some of these issues.

(I also post comments at 11D)

Wendy said...

bj, thanks! I subbed.

I'm realizing that MA doesn't really "do" gifted ed. There's not a lot of state funding for it, and I don't see many schools with programs.