This article by Yvonna Fast is an  excerpt from her forthcoming still untitled book which should be out next year through Jessica Kingsley Publishers.

AS and NLD:

Descriptions, Differences, and Similarities

AS and NLD are neurologically-based developmental disorders which affect the way the brain processes information. Neurological issues are intricately interconnected in ways that exceed our understanding. AS and NLD are based on a cluster of observable symptoms due to brain abnormalities, not emotional trauma. People with NLD or AS generally have average to superior intelligence and above average verbal ability, yet have significant difficulty with job performance and social interactions. Because our society values social competence above knowledge or intelligence, such deficits often cause NLD/AS individuals significant, life-long challenges in relationships, work, and recreational pursuits. Though the issues may change over time, the problems don't go away. Hans Asperger wrote in 1944:

"In the course of development, certain features predominate or recede, so that the problems presented change considerably. Nevertheless, the essential aspects of the problem remain unchanged. In early childhood there are the difficulties in learning simple practical skills and in social adaptation. These difficulties arise out of the same disturbance which at school age cause learning and conduct problems, in adolescence job and performance problems and in adulthood social and marital conflicts." (1991, Uta Frith,)

Although AS or NLD doesn't prevent it's sufferers from having a "normal" adult life, there's little information about the eventual outcome for most children with AS or NLD. Some NLD/AS adults have been able to achieve a level of personal and professional success in various jobs including teaching, writing, even sales. AS adults are often drawn to a career that relates to their own areas of special interest, and may become proficient. Thus childhood fascinations may form a basis for an adult career. With the right supports and accommodations, adults with AS / NLD can be successful, contributing citizens and employees. Some of the brightest individuals with AS or NLD represent a unique resource for society, having the single mindedness and consuming interest to advance our knowledge in many scientific disciplines. Many of these will never seek diagnosis; since their differences do not cause insurmountable problems at work or in relationships, they simply accept their idiosyncrasies. Gillberg estimates 30-50% of all Aspergers' go undiagnosed (Gillberg, 2002), and the same is probably true of NLDers'. Often, successful adults became aware of their condition only after having children similarly afflicted.

In many cases, however, adults with NLD / AS have several college degrees, yet are unable to find or keep work that matches their strengths and abilities. The reason for this is the disparity between a high verbal and a relatively lower performance IQ score of NLDers and ASers. While verbal IQ is most indicative of academic achievement, performance IQ points to the ability to achieve success at work. Thus, though they attain high levels of education and skill, they may fail to hold down a job and earn a living. A high percent are either unemployed or underemployed. Just 12% of Asperger Adults are in full time employment, and only 3% live independently (Barnard et.al., 2001). There is no current data on the employment of individuals with NLD, but almost half of those I know with the disorder are unemployed, and many others underemployed. It's appalling that so many who are educated, articulate, skilled, honest and hard-working remain chronically unemployed.

Because of their high degree of functionality and their naivetť, those with NLD / AS are often viewed as eccentric or odd. Subtle differences cause difficulty in social interactions and workplace relationships. For example, their inability to read nonverbal signals makes interpersonal communication a challenge. Their rigid style and peculiar perspective exacerbate the problems. Because the AS/NLD employee has trouble with eye contact, he can be perceived as inattentive, evasive, or rude. Difficulty with modulating volume and tone of voice can make him appear angry. Problems with understanding body language, social cues, or even facial expressions makes it hard to know what is expected and often leads to misunderstandings. Until he's verbally told, he may not be aware whether the boss is happy with his work or is disapproving. At that point, it is usually too late.

Though they appear intelligent due to their verbal ability, the struggle with performance issues. While their colleagues at work may be less intelligent, in a heavily performance based work environment they get the job done better and faster. Difficulty understanding idiomatic expressions or directions that are not explicit and step by step can cause problems at work. Their need for verbal mediation, or talking oneself through tasks, is viewed as crazy.

Part of the problem is a lack of understanding. People are threatened because NLDers and ASers seem different. They face a societal fog of indifference and misperception. They are seen as being lazy, clumsy, socially inept, spacey, underachieving, incompetent, impulsive, talking heads who lack emotional insight. They are berated, written-off, and apt to slip through the cracks. When they try to explain these differences to colleagues and bosses, they're berated for making excuses.

Jen comments: "How can I compete against NTs (neuro-typicals) when I might be perceived subtly as being different or odd? It seems like so much is stacked against us that we can't perceive or do anything about. Often we don't even realize it's there."

There is a large amount of variability in the symptoms that occur in an individual with NLD or AS and the degree of severity of those symptoms. No two people display the same problems to the same degree or in the same way. With persistence and determination, many NLDers and ASers find that their difficulties seem less obvious.

Though there is no question that the two are different disorders, there are many similarities in social interaction and information processing.

Defining NLD

There is no entry for NLD in the psychiatric diagnostic and statistical manual (DSM-IV-TR), and researchers are still debating what exactly constitutes the disorder. Therefore, coming up with a definition is difficult and arbitrary. It is still uncommon and misunderstood, because it's not a disorder that causes people to be nonverbal. Rather, NLDers have a diminished ability for learning information that is presented non-verbally. NLD has been defined as a specific neuro-psychological profile. According to both Rourke and Thompson, NLD is a syndrome with certain strengths and weaknesses tied to the underlying cause, which is alleged to be white matter damage in the right side of the brain. (Rourke, 1995 ; Thompson, 1997) The strengths include strong verbal skills, attention to detail, and a good rote memory. Problem areas involve social interaction, motor clumsiness, organizational and executive abilities, and visual/spatial tasks.

Cognitive and Verbal Strengths. Individuals with NLD generally have exceptional verbal skills, do well in tasks requiring decoding and encoding (like spelling), have excellent auditory attention and memory, and learn primarily through verbal mediation. Most NLDers talk and read early. As adults, they are prolific talkers and tend to be quite articulate. Many learn foreign languages with ease and are excellent writers. On the other hand, NLDers may have difficulty with higher level abstract or nonverbal reasoning, with inferences, and with making part-to-whole connections. That is, they may have problems recognizing relationships between an object and its component parts. The common analogy is not being able to see the forest for the trees. NLDers learn best by repeated practice of detail until they can apply the concepts.

Visual Spatial and Perceptual Skills are the major problem area. The crux of NLD is a visual perceptual deficit, and many of the other difficulties revolve around this weakness. Many NLDers have problems with remembering what they see (poor visual memory). Other problem areas include faulty perception of space and objects within that space.

Most people are familiar with visual skills like visual acuity (The ability to clearly see, inspect, identify and understand objects) or color vision (the ability to differentiate colors). Most people are unfamiliar, however, with visual processing, or perceptual, abilities. Visual processing refers to how the brain interprets information taken in through the eyes. Individuals with perceptual disorders have trouble "making sense" of information taken in through the eyes. Some visual skills that depend on the interaction between our eyes and brain include:

Tracking: The ability to follow a moving object smoothly and accurately with both eyes, such as a ball in flight or moving vehicles in traffic

Convergence and Eye Teaming Skills: The ability of the eyes to aim, move and work as a coordinated team.

Fixation: The ability to quickly and accurately locate and inspect with both eyes a series of stationary objects, one after another, such as moving across a sheet of paper while reading.

Focusing Skills: This is the ability of the eyes to maintain clear vision at varying distances, allowing the viewer to look quickly from far to near and vice versa without momentary blur, such as looking from the chalkboard to a book or from the dashboard to cars on the street.

Stereopis (Depth Perception): The ability to judge relative distances of objects and to see and move accurately in three-dimensional space, such as when hitting a ball or parking a car.

Peripheral Vision: The ability to monitor and interpret what is happening around you while you are attending to a specific central visual task; the ability to use visual information perceived from over a large area.

Binocularity: The ability to use both eyes together, smoothly and equally, simultaneously and accurately.

Maintaining Attention: The ability to keep doing any particular skill or activity with ease and without interfering with the performance of other skills.

Visual Form Discrimination: The ability to see the difference between two similar objects and determine if two shapes, colors, sizes, positions, or distances are the same or different.

Visual Figure Ground: The ability to see or perceive an image within competing background, like finding the saltshaker on the dinner table, or picking one line of print from another while reading.

Visual closure: The ability to identify or recognize a symbol or object when only a part of the object is visible.

Reversal Frequency: Confusing letters or words (b, d; p, q: saw, was; etc.)

Visual Memory: The ability to store and retrieve visual information.

Object recognition (Visual Agnosia) is the ability to visually recognize familiar objects. Problems with this may be due to deficits in visual memory or inability to integrate visual stimuli into a recognizable whole.

Visual Motor Integration: The ability to use sight to guide movement, combining visual input with other sensory input. This refers to both gross motor and fine motor tasks, affecting hand and body movements and includes the ability to transform images from a vertical to a horizontal plane (such as from the blackboard to the desk surface). People with this problem have a tough time orienting themselves in space, especially in relation to other people and objects. They are clumsy, bump into things, place things on the edges of tables or counters where they fall off, "miss" their seats when they sit down, etc. Difficulty with fine motor integration effects writing and organization and can interfere with social, academic, and athletic arenas.

Visualization: The ability to form mental images in your "mindís eye," retain or store them for future recall, or for synthesis into new mental images beyond your current or past direct experiences.

Many individuals with NLD have problems with some, or all, of these skills. Form discrimination, visual memory, visual motor integration, and visualization are among the skills most severely affected. These deficits don't have to do with the eyes, but with the way the brain interprets visual information. They cause problems with getting lost, finding an object in a cluttered area, remembering what was seen, recognizing and remembering faces, and problems with sports.

A related area to visual perception is Spatial Perception. Size, distance, volume, order, space, and time are important to spatial understanding. Examples are the space between people in a line, the arrangement of items on a desk, the location of one's seat in a room, the order of events in a schedule, or the layout of a publication or letter. The spatially challenged person can't keep track of belongings or time, gets lost, and is often late. Creating and maintaining order in a desk or room, estimating how long a task will take, or organizing the content of an essay are common problems. Some people react by learning and imposing rigid, inflexible order on their world, while others reject order, living in chaos and disarray.

There are two types of spatial skills. Visual-spatial performance describes how we use sight to differentiate objects. People with visual-spatial problems have trouble with things like copying from the board, understanding dimension, reading maps, spacing letters and words, paragraphing, and math operations like subtracting.

Motor-spatial performance describes physical movement through space and time. People with motor-spatial problems are klutzy. They may have problems writing legibly, playing ball, staying in step in a dance or march, tying ropes, riding a bike, walking across a room without bumping into people or objects, or reaching for and turning a doorknob.

Many daily activities require spatial skills. Some require a combination of visual-spatial and motor-spatial abilities. Time is spatial. Math requires visual-spatial understanding for tasks like place value or fractions and motor-spatial ability for ordering complex hierarchical tasks in virtual space. Reading comprehension necessitates following meaning through place and time in the story. Writing and drawing require knowing where to send the pencil (visual spatial) and making the pencil go where you want (motor spatial). Making change requires both visual-spatial and motor-spatial ability in handling the money. The person with spatial difficulties may have problems in social situations. He / she may invade others' personal space or be rigid and inflexible in their interactions with others.

Social Skills are another problem area. The visual-spatial difficulties noted above are often the basis of the NLDer's social troubles. Problems understanding nonverbal communication can lead to difficulties, since 65% of interpersonal communication is nonverbal. Social problems related to work issues include failure to recognize or acknowledge colleagues and customers.

Deficits in social judgment and social interaction (Thompson, 11) can cause further problems. Although individuals with NLD are eloquent and have good rote language skills, they may have problems with pragmatic speech, including tone of voice, inferences, facial expression, and gestures. For example, they may have problems entering conversations. Although they often have an excellent vocabulary, they may tend to ramble and have problems with the rules of conversation.

 

NLDers often have difficulty adjusting to transitions and novel situations (Thompson, 11). They need ample advance notification of changes that will occur in the work environment.

Motor Skills are a problem. This includes visual-motor integration as well as both gross and fine motor issues. To varying degrees, individuals with NLD have problems with coordination and balance. They are clumsy and awkward. They lack the muscle coordination for many tasks. Their writing is sloppy; they tire easily with pencil and paper tasks. As youngsters, they often have difficulty learning to ride a bike, participating in sports, learning to eat with a knife and fork, tying shoes, or using scissors or glue. Most adults stay away from arts and crafts, needlework, and other pastimes requiring visual-motor coordination.

Information Processing issues. Many NLDers have problems with the synthesis of information and information synthesis speed. Because their brain takes longer to process nonverbal information, they require more time than the average person to complete tasks.

Executive functions, the mental processes which allow us to monitor behavior and make decisions, are another problem area for many NLDers. Rourke (1995a) has identified deficits in executive functioning among the primary impairments in NVLD (Strang & Rourke, 1983). Roman, however, feels that such deficits are more common in severe cases of NLD, but rare in more subtle cases. (Roman, 1998)

Problems with executive function include difficulty with organization, planning, problem solving, prioritizing, focusing on a task, completing assignments, obeying social rules and monitoring behavior. Executive function issues include organizing time, organizing materials and belongings, and organizing thoughts. In a nutshell, executive functioning is the ability to grasp a problem and come up with feasible solutions. The deficit can make it difficult for an NLDer to organize his work, plan and manage projects, initiate tasks, and follow multi-step instructions.

Defining AS

Although first described by Hans Asperger, an Austrian pediatrician, in 1944, Asperger Syndrome was only recently recognized by the medical community, and was not included in our medical diagnostic manuals until the fourth edition of the DSM (Diagnostics and Statistical Manual) came out in 1994. Today it is still relatively unknown and not clearly understood, even among professionals. Therefore, many adults and children struggle through life, remaining undiagnosed. According to NIH statistics, one in 500 people in the US have AS, a higher incidence of occurrence than Down's Syndrome (www.N.H.gov or www.nih.gov). A population-based epidemiological study, carried out by Gillberg's group in Sweden, concluded that nearly 0.7% of the children studied had a clinical picture either diagnostic of or suggestive of AS to some degree. (Gillberg, 1989)

While researcher Uta Frith, describes individuals with AS as "having a dash of autism" (Frith, 1991), Klin and his colleagues demonstrate that the cognitive profiles of people with autism and Asperger Syndrome differ significantly (Klin, Volkmar, Sparrow, Cicchetti, & Rourke, 1995). Individuals with autism display a relative strength in performance abilities with a relative weakness in verbal tasks, while individuals with Asperger Syndrome show the exact opposite pattern: verbal strength with a relative weakness in performance. Also, while autistic persons are more than content to be loners, Aspies actively seek out social interaction, although with little success. Asperger Syndrome has been conceptualized as a "Non-Verbal Learning Disability" (Klin, et al., 1995). A comparison of NLD and AS individuals revealed 20 out of 21 similarities, including a verbal over spatial discrepancy. (Klin, et al., 1995). Stephen Bauer, M.D., M.P.H., Director, The Developmental Unit, The Genesee Hospital, Rochester, New York, writes: "it is not at all clear that Asperger syndrome is just a milder form of autism or that the conditions are linked by anything more than their broad clinical similarities."

Individuals with AS show deviations or abnormalities in three main areas of development: social skills, communication, and odd behavioral characteristics (Bonnet & Gao). They have deficits in fine and gross motor skills, visual motor integration, visual-spatial perception, nonverbal concept formation, and visual memory (Forrest). Language skills are usually normal (Klin, Volkmar and Sparrow, 2000). Asperger's may also be characterized by a strong desire for perfection, a special interest or talent, a fondness for routine, poor coordination, high cognitive skills, low organizational skills, and uneven processing of sensory input--being more or less sensitive than most. AS individuals show serious deficiencies in social and communication skills. They often have obsessive repetitive routines and preoccupations with a particular subject. Although they're intelligent and capable, they tend to be naÔve, and are often perceived as odd by their peers. As children, they were often a target for bullying.

Social Relations

Although Aspies use language to communicate, they have poor social and pragmatic skills. AS Adults might avoid eye contact, misunderstand instructions, dress oddly, lack good personal hygiene, or talk about seemingly irrelevant subjects. They view the world differently. Some social behaviors, like using appropriate tone of voice or facial expression, are beyond them. They tend to see the world in black and white and may have difficulty carrying over what they learn in one situation to another. Indeed, they may seem to lack common sense.

Aspies may have inappropriate responses to stress. For example, they may laugh when another person is crying. The often have problems following directions related to physical movements, and have sensory integration problems that prompt strong, unusual responses to touch, smell, sound, taste, and visual stimulation.

Motor Issues

Many individuals with Asperger Disorder are clumsy. This includes both fine and gross motor skills. (M. Ghaziuddin, Butler, Tsai, & N. Ghaziuddin, 1994).

Verbal skills

According to the DSM definition, Aspies must exhibit normal to superior language development. In spite of this, some problems with communication do exist. They tend to be very literal and want to talk only about their narrow interests. ASer's often have unusual verbal prosody. They have problems controlling or being aware of intonation, inflection, rate, and tone. They can have a stilted, formal manner of speaking, and sometimes exhibit "telegraphic speech" -- abbreviated speech in which words not essential to the meaning of a sentence are omitted. Sometimes their unusually loud, high or monotonous voice can be annoying to others.

Odd Behaviors

Asperger Syndrome is characterized by repetitive motor mannerisms, obsessive interests, and rigidity. Frequently, ASers have a tendency to rock, fidget or pace. They have a limited but intense range of interests, and often become fixated on one subject or object. They may be very inflexible about specific routines or rituals. They can be overly sensitive to loud sounds, lights or odors.

Similarities and Differences

The ASers profile of neuropsychological assets and deficits (Forrest) is very similar to the NVLD profile described by Rourke (1995). Both have neuro-developmental abnormalities involving functions of the right cerebral hemisphere. (Brumback, et. al.) In both disorders, there is no delay in cognitive development and speech. In fact, NLDers are often extremely verbal and early readers. Aspergerís syndrome has been called an extreme form of nonverbal learning disability (Brumback, et. al.)

Both NLDers and ASers seek out social interaction, yet are not accepted.

A related problem shared by both disorders is the inability to perceive or understand nonverbal cues, such as facial expressions or body language. For example, normal people (NT's) use eye contact appropriately and understand that you can tell how someone feels by looking at their face. Such cues are "invisible" to those with AS/NLD. They can't perceive subtle differences in facial features, tone of voice, and gestures that make up nonverbal communication.

For both NLDers and ASers, the largest problems are in the area of social relationships, whether at work or at home. They're often misunderstood. They're accused of rudeness, laziness, a lack of caring, or a poor attitude. Exclusion and rejection become part of life. They are unable to "connect" socially. Wanting to make friends and fit in, but unable to, they may respond by withdrawing, "acting out" with emotional outbursts, or refusing to cooperate. Living with this social disability and constant rejection often leads to a lowered self esteem and psychological disorders like anxiety and depression.

It is in the affective area that NLD and AS diverge. NLDers have normal emotions but are inept in expressing them and in recognizing them in others, to the extent that they are expressed non-verbally. Aspies, on the other hand, do not feel the normal range of emotions, have a flat aspect, and have difficulty with initiating or experiencing normal social relationships.

AS individuals generally have greater social problems. Their highly restricted interests present an additional obstacle to their social functioning. These restricted interests seem to be peculiar to Aspies; they're not mentioned in the literature about NLD. This is the main difference between the two disorders, as they are most frequently defined clinically (Forrest). The ASer's odd behaviors, like rocking or flapping, can also contribute to their social problems. These are unique to AS and not present in NLD. In contrast, the NLDer's social ineptness is mainly due to their inability to read nonverbal communication, such as facial expressions and gestures.

AS literature doesn't mention problems with visual spatial issues, which are a major problem area for NLDers. In fact, many ASers respond well to visuals and diagrams, and are visual learners. In contrast, NLDers don't respond to physical demonstrations and may not understand diagrams. They can't learn by watching, and need everything explained in words.

There are similarities, but the two syndromes are different. AS and NLD each have unique characteristics. Each syndrome possesses terrific attributes as well as great challenges.

 

AS and NLD: Similarities and Differences

 

Characteristic

NLD

AS

COGNITIVE DEVELOPMENT:

No Significant Delay

Always

Always

Clinically significant impairment in social,

occupational, or other important areas of functioning

Mostly

Always

VIQ > PIQ (above average verbal, impaired nonverbal skills)

Mostly

Mostly

Good rote memory; Unusually accurate memory for details

Mostly

Mostly

Impaired executive function and organizational issues

Mostly

Sometimes

Problems with synthesis of information & speed

Mostly

Mostly

Slow processing speed

Mostly

Mostly

Nonverbal reasoning less developed than verbal

Mostly

Rarely

Learn by verbal scripts rather than visual diagrams

Mostly

Sometimes

Trouble seeing the big picture

   

LANGUAGE:

   

Early or Normal onset of language

Mostly

Mostly

Articulate

Early and avid readers

Always

Always

Good spellers

Always

Mostly

Strong rote language skills like phonology and syntax

Always

Sometimes

Weak pragmatic or conversational language skills

Mostly

Sometimes

Trouble differentiating between abstract and concrete

Mostly

Sometimes

Literal in speech and understanding

Always

Always

Difficulty with figurative language (nuances, inferences, etc.)

Mostly

Mostly

Trouble understanding things they have heard or read

Mostly

Mostly

Unusual Speech patterns (repetitive and or irrelevant remarks; talking out of turn)

Mostly

Mostly

SOCIAL INTERACTION:

Mostly

Mostly

Impairments in the use of nonverbal communication, such as eye-to-eye gaze, facial statement, body postures, and gestures to regulate social interaction

Rarely

Mostly

Problems with peer relationships

Lack of social or emotional reciprocity (inability to respond emotionally to what someone says)

Always

Always

Viewed by others as odd; Socially awkward and clumsy in relations with others

Mostly

Mostly

Compulsive, rigid

Sometimes

Mostly

NaÔve and gullible

Always

Always

Inappropriate body language or facial expression

Sometimes

Mostly

Unaware of others' feelings

Mostly

Mostly

Tend to misread social situations

Mostly

Mostly

Difficulty adjusting to transitions and other social situations

Sometimes

Mostly

Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people

Sometimes

Sometimes

BEHAVIOR:

Sometimes

Mostly

Intense, limited interests, abnormal in intensity or focus

Mostly

Sometimes

Repetitive Motor Mannerisms, like rocking or flapping

   

Inflexible adherence to specific, nonfunctional routines or rituals

Rarely

Mostly

VISUAL SPATIAL PROBLEMS:

Never

Mostly

Problems with Spatial skills - knowing where an object is in space in relation to other objects

Rarely

Mostly

Problems with Visual Motor Integration - coordinating visual and motor tasks

   

Inability to find an object in a cluttered area

Mostly

Rarely

Visualization - the inability to form mental pictures

Mostly

Sometimes

Problems maintaining attention on visual tasks

Mostly

Never

Problems with Visual Memory

Mostly

Never

MOTOR ISSUES:

Mostly

Never

Gross Motor:

Mostly

Never

Clumsiness

   

Problems with sports

   

Balance issues

Mostly

Sometimes

Fine Motor:

Mostly

Sometimes

Poor graphomotor skills

Sometimes

Never

Poor arts & crafts

   
 

Mostly

Sometimes

 

Mostly

Rarely

 

The ICD 10 system (International Classification of Diseases, 10th edition, World

Health Organisation, 1992)

The DSM IV (Diagnostic and Statistical Manual, 4th Edition, American Psychiatric Association, 1994)