Running Head: ASPERGER’S AND COGNITIVE NEUROSCIENCE
Understanding Asperger’s Syndrome And The Cognitive Neuroscience Model
Diana M. Hamar, MA
Capella University
Fall 2003
Abstract
Understanding why and how individuals with Asperger’s Syndrome (AS) process information about their world differently than those without AS is paramount to correct diagnosis and treatment. Individuals with AS, may have neurobiological differences that create a significantly different manner of cognitive processing with a variety of different outcomes. With more individuals being diagnosed with Asperger’s, members of the professional community as well as the AS individual’s family and educational community, will benefit from understanding the neurocognitive differences, so that behaviors may be anticipated and handled appropriately. A team approach to therapy would be very beneficial to the Asperger child and the family. Research confirms that early identification of individuals with AS is vital to helping the AS individual overcome the damaging tendency to be socially inept that plague the person with Asperger’s Syndrome.
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Table of Contents
Introduction Page 4
Issues or questions related to course content Page 5
Asperger’s Defined Page 6
Imaging the Cognitive Processes Page 7
Nuerobiological Differences in Individuals with Asperger’s Page 10
Assessment & Identification Page 13
Conclusion Page 15
Literature That Does Not Support This View Page 16
Relevance & Application Page 17
Discussion Page 18
References Page 20
The headline on the December 2003 issue of Disability Compliance for Higher Education warns secondary institutions to “Get ready for an influx of students with Asperger’s.” With reports of 370% increase in students with Asperger’s being enrollment K-12 in the United States, it is going to be increasingly important to train personnel at educational institutions to recognize and understand how individuals with Asperger’s Syndrome (AS) process information about their world differently than those without AS. With cognitive neuroscience drawing a correlation between certain anatomical structures in the brain and specific psychological processes, it is essential to consider that the brain of AS individuals may have a different structure that dictates their cognitions. Because AS individuals employ an unusual manner of problem solving, they are often misunderstood by educators and may appear willful and defiant when they do not conform to the normal formats for written work, formulas for mathematical problems and rules for scientific experiments. Although many AS students tend to be highly intelligent they lack simple social skills and may respond to correction in a manner that exacerbates certain situations. Without training, educators may lack the skills to anticipate such reactions and miss an opportunity to help the AS student excel where they are gifted and learn social skills as they mature.
While understanding as to how AS individuals processes information is vital to appropriate treatment and interaction by members of the educational community, it is also important to educate both the AS individual’s family and professional community. Individuals with AS, may have neurobiological differences that create a significantly different manner of processing information about their environment, which are often misunderstood by family members. Behaviors such as, insistence of sameness or negative responses to an environment in which sensory overload is experienced, may be anticipated and handled appropriately, rather than abusively. Individuals with AS may be taught how to communicate about those differences in a proper social manner in order to compensate for the propensity to be misunderstood.
Research
is showing that early identification of individuals with AS by the professional
community is an important step in gaining appropriate treatment that will have a
significant impact on how an AS individual not only processes information, but
will also aid in developing positive family and social interactions (Woods &
Wetherby, 2003). Family therapy and
occupational therapy may be indicated in a team approach to help the
Asperger’s individual become better equipped to manage life in world that
expects normalcy. Building a
treatment plan requires more than knowing the DSM-IV behavior characteristics.
A professional must understand how those characteristics play out in
everyday life, in order to provide the family and educational community with a
viable responses that do not exacerbate the situations.
Issues Related to Course Content
From the neurocognitive science perspective, the parallel distributing processing model (PDP), proposes that cognitive processes take place as a result of neural information being conducted in parallel, rather than sequentially as in the information-processing model. In other words, several areas of the brain may be involved at one time using processing networks that are distributed throughout the cortex (Solso, 2001). This paper focuses on how the neurocognitive processes of individuals with AS may differ both academically and socially than those without Asperger’s. There is a need to develop an evaluation instrument that would help professionals identify Asperger’s sooner than three years of age. There is hope for individuals with Asperger’s to successfully socially interact if the neurocognitive symptoms could be identified at an earlier age and the family consents to participate in an appropriate therapy plan that is recommended and provided.
Asperger’s
Defined
Asperger’s Syndrome is defined by Uta Frith, as “a neurobiological condition characterized by sustained impairments in interactions and social relatedness, and the development of restricted, repetitive patterns of interest and behaviors” (1991). Asperger’s Syndrome is classified under the Pervasive Developmental Disorders in the DSM-IV. It was thought to be part of the Autism Spectrum Disorders (ASD) at one time since an individual with AS manifests the first three criteria of ASD that include 1) impairments of social interactions, especially in terms of lack social reciprocity, 2) impairments nonverbal communication, such as eye to eye gaze, facial expression, body postures and gestures to regulate social interaction and 3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities (American Psychiatric Association [APA], 1994). However, Asperger’s is set apart from autism in that there is no clinically significant delay in language or cognitive development (APA, 1994). There are other Asperger symptoms that do not meet the criteria for Autistic disorder.
Social ineptness stands out as an Asperger tendency, which underscores the main concerns for educational institutions. In trying to answer the question of whether an Asperger individual could be taught appropriate social skills, a study by Ropar & Mitchell (2001) was done to determine if individuals with AS use prior knowledge when pairing various stimuli. It was found that individuals with Asperger’s did use prior knowledge and that it is possible to teach social skills, and see an improvement in behavior if the individual is of normal intelligence. Over a period of two years it was observed that a student with Asperger’s learned to reciprocate greetings with college personnel when entering and leaving offices. When he first arrived on campus, he merely shuffled in and out of offices with a hood covering most of his face and said little to anyone. When he graduated, he was appropriately greeting others with eye-contact.
In the Ropar & Mitchell (2001) study mentioned above, it was also found that Asperger individuals often have visual and auditory processing deficits. Some people with Asperger’s have difficulty processing common features of an object, and yet they are able to define unique features more quickly than those without AS. AS individuals commonly have difficulty with figure ground processing, both visually and auditorily. Visually, locating an object from amongst another objects in a cluttered drawer can be an extremely frustrating experience for a person with Asperger’s. Being unable to differentiate their name from other noise in a classroom or while watching TV is example of auditory figure ground dysfunction. If a parent or teacher is aware of these processing deficits, they may use more positive means of communicating with an Asperger child rather than lose patience concerning the inability to find lost items or respond when their name is called.
Imaging the Cognitive Processes of Individuals With Asperger’s
Evidence supports the hypothesis that AS individuals process information differently in a variety of situations. In a study using Magnetic Resonance Imaging (MRI), individuals with and without AS were given a functional MRI, which measures tissue signal changes in cerebral activity during a task. Such a test may reveal functional disturbances and consequently, neurobiological differences in cognitive processing (Oktem, Dcedliren, Karaagaoglu, & Anlar, 2001). In a study with 9 boys that had been diagnosed with Asperger’s Syndrome and a group of 8 boys without AS were asked to respond to two questions from the WISC-R that they had previously been given without the MRI. Then routine MRI’s were also given prior to the functional MRI’s and were found to be normal in both groups. However, the functional MRI revealed that frontal activation or suppression was noted during the task with 5 of the 9 AS boys, in comparison to all 8 of the boys in the control group. After the task, all 8 of the boys in the control group showed a definite change in the frontal signal intensity while only 4 of the 9 AS boys responded (Oktem, et all, 2001).
The failure to change signal intensity may indicate continued brain activation or suppression along the lines of processing the information from the previous question asked. This might also be a clue as to why AS individuals have difficulty managing change from one subject, activity or plans to other activities. It has been observed that some AS individuals have difficulty communicating for at least an hour after playing a video game. The inability to adjust to change is known as, “preservation of sameness” and is a behavior that can be quite frustrating for families of unidentified AS individuals (Cole-Marshall, 2002). In other imaging studies Single Photon Emission Computed Tomography (SPECT) scans indicate that adults with Asperger’s syndrome have “left occipital, right cerebellar, or diffuse right hemispheric hypoperfusion (Ozbayrak, Kaypuco, Erdem, & Atlas, 1991). Hypoperfusion is a lack of fluid or nutrients in the brain tissue. More research is needed to discover why the brain lacks fluid or nutrients in these areas specifically and how that might impact neurological processing.
It has been asserted that many AS individuals also have sensory integration dysfunction which causes them to either over react or under respond to environmental stimuli (Frith, 1991). Individuals with Asperger’s also have a problem in the area of visual and spatial perception. The distortions of the visual perception create not only awkwardness of physical movements, but also may alter spatial perceptions, thus affecting normal social interactions. Constantly standing too close to others, bumping into people unintentionally and/or avoiding being hugged or touched may indicate this sensory dysfunction is present and cause a great deal of social friction. Individuals without Asperger’s, experience discomfort when their personal space is invaded.
Other “images” that may aid in the external identification of Asperger’s are the Rorschach Protocols. Since AS individuals are considered to have normal to high intelligence, another study using Rorschach protocols appeared to be valid in clinically identifying AS individuals. It was hypothesized that the DSM-IV criteria could be observed on the Rorschach variables (Holaday, Moal, & Shipley, 2001). Differences in processing information about human interaction were demonstrated in a Rorschach Test which found that AS boys underreported human content, human movement, and cooperative movement in humans and animals and individuals as compared to a contrast group of boys of the same age without AS. The contrast group had severe emotional problems or deviant behaviors but did not qualify for special education. The results of this test confirm that cognitive processing in terms of normal human awareness is in some way hindered in the brain of a person with Asperger’s. Even what the Asperger boys said about the inkblots was significantly different between groups (Holaday, et al, 2001). Discovering the root of this difference through further research may lead to the source of the socially inept behavior.
The first DSM-IV criteria for Asperger’s Syndrome is a “qualitative impairment of social interaction” as manifested by several criteria, one of which includes a “marked impairment in the use of nonverbal behaviors as eye-to eye gaze, facial expression, body posture, and gestures to regulate social interaction” (APA, 1994). In terms of neurocognitive processing, the question must be asked if this impairment in reading social clues and the resultant social ineptness is in part due to the inability of the brain to neurologically process this information. Do neurological impairments prevent the AS individual from focusing attention on the person they are communicating with? Most Asperger individual’s will claim that they are looking at the person’s face and making eye contact with the person they are conversing with, when in fact there head position is incongruent with normal face to face conversation. In a study on “The mutual influence of gaze and head orientation in the analysis of social attention direction,” it was found that when the gaze was incongruent with the orientation of the head, the individual’s social attention was indeed influenced (Langton, 2000). Individuals with AS often do not make normal eye contact with the individual they are speaking to. What this study signifies is that without the normal eye-to-eye gaze, the AS individuals will not be able to follow the direction of another’s gaze in order to fully comprehend the intention of a conversation, thus missing important social cues in the conversation.
Neurobiological Evidence of Asperger’s
Research supports the idea that there are a neurobiological abnormalities which cause a difference in cognitive processing. Rumelhart & McClelland proposed that information processing takes place through the excitation of processing elements called units (as cited in Solso, 2001, pg. 29). Perhaps these so called units could be further defined anatomically. It was suggested earlier that several areas or units of the brain may be involved in processing information at one time by using processing networks that are distributed throughout the cortex. An interesting study on “Asperger’s Syndrome and Neuropathology” by Casanova, Buxhoeveden, Switala, & Roy (2002), focused on three cortical areas in the right hemisphere of the brain. This paper will only focus on area labeled as Area 21, which is located in the middle of the temporal gyri on the lateral surface of the right hemisphere. After digitizing images in the right hemisphere of the brain, it was found that the minicolumns in area 21 were smaller, and their component cells were more dispersed than normal. A minicolumn is defined by Casanova et, al as: “…vertical clusters of large neurons delimited on either side by cell sparse areas. Imaginary lines through the sparse areas partition a field into polygonal regions. We refer to such a polygon together with the totality of small and large neurons contained within it as a minicolumn segment…”(2003).
What Casanova, et al, (2002) discovered is that the average cell column in the AS individual is smaller and its component cells more dispersed than normal. This would affect the feature extraction process involved in sensory perception of the macrocolumns that are comprised of many minicolumns. Casanova, et al, believes that the “minicolumnar changes provide a possible link to receptive field abnormalities and a useful clinicopathological correlate to Asperger’s syndrome” (2002). Since the parallel distribution process (PDP) is the underlying concept of neuroanatomical functioning it makes sense that AS individuals would be in some way be sensorily impaired if they are deprived of the ability to process all of the sensory information simultaneously throughout the brain according to the connectionism or PDP model.
The above information demonstrates that there very well could be a neurological abnormality that contributes to the sensory integration deficits that a person with Asperger’s disorder often encounters, causing and over reaction to minute details such as a change in plans, inability to tolerate certain textures and many other negative responses to sensory stimuli. Could this slightly different anatomical feature also be what allows them to over-focus on one subject or topic so intensely? We know that some Asperger tendencies appear to border on obsessive- compulsive behaviors at times and that these behaviors are often referred to as “brain hiccups.” Could this processing deficit also be the source of frustration that causes outbursts of anger or temper tantrums that appear to be “going overboard” to the person without Asperger’s? One more point concerning the effect of the anatomical abnormality of the minicolumns must be considered.
Although it was not well received, the original feature integration theory (FIT) was a stage theory which held that processing at the first stage was preattentive and that the “All separate features are coded independently and in parallel using populations of feature detectors for such stimulus dimensions as color, size, and shape (Quinlan, 2003). What if the visual feature integration theory (FIT) were reviewed in terms of both sensory encoding and attentional control (Quinlan, 2003)? Perhaps the minicolumns and macrocolumns are the source of the “populations of feature detectors” in the FIT. And perhaps the stimulus dimensions extend far beyond that of color, size and shape. Other stimuli that include the tactile sense, proprioceptive sense (where ones body is in relation to space) and vestibule sense (which has to do with balance) might also be included in the stimulus dimension. If the nervous system of individuals with Asperger’s does distort the sensory perception process, as these studies demonstrate, is there any wonder that they appear socially inept and awkward? The most important work to be done for the Asperger individuals is to develop a sound method of diagnosing the disorder so that treatment may begin early while the neurological system is still malleable and before families have developed a negative pattern of interaction around Asperger behaviors. While it may be difficult for some to diagnose Asperger’s Syndrome apart from autism because of so many similarities, others hesitate to accept the new DSM-IV definition of Asperger’s, which will be discussed later. Perhaps there are other ways to diagnose Asperger’s syndrome besides using the DSM-IV criteria.
Research supports the fact that there are similarities in behavior and information processing deficits in adults with right hemisphere brain damage and individuals with AS. Studies by Molloy, Brownell, & Gardener (1990) in right hemisphere damage (RHD) to adults demonstrated that they missed the point of humor and jokes which is exactly an AS trait. Asperger children are often the victims of cruel jokes, because they just do not understand when others are joking and making fun of them. They often misunderstand another’s conversation because they take every word so literally and think in very concrete terms. Individuals with right hemisphere damage also adopt a literal interpretation of what is said and do not understand metaphorical language or figures of speech.
Another
Asperger trait is the failure to discriminate emotional cues from facial
expressions, narratives, pictures, or express their own emotions. They may often
be mistaken as being depressed, due to the lack of facial expressions and
communication of emotions and are medicated as a result of this mistaken
diagnosis. Many use a monotone voice and lack variability in pitch and loudness.
They may also lack the normal head movements and gestures normally used
in communicating with others. All
of these features may be evident to one degree or another in individuals with
right hemisphere damage. The correlation of RHD and similar Asperger tendencies
was considered in a study done by Weintraub & Mesulam (1983). According to
Bradshaw and Mattingly (1995), there are studies to support the right hemisphere
of the brain is concerned mediates speech in social, situational and pragmatic
aspects of speech. Damage to this
areas is manifested identically to that of an Asperger behaviors in terms of
irrelevant changes in topics, concrete and literal interpretation, the
inability to understand metaphors and of course, the lack of humor.
Assessment and Identification of Asperger’s Syndrome
Outside of the DSM-IV diagnostic criteria and postmortem examinations, there are very few ways to identify Asperger’s. Many therapists have difficulty differentiating the symptoms as they are often reported by the parent in terms of ADD symptoms and or as oppositionally defiant because of the apparent refusal to comply with requests that are out of the comfort zone of the individual with Asperger’s. Teachers often report the oppositional behavior in terms of assignments and the refusal to do work as assigned and often assume the behavior to have an ADD origin that needs to be medicated. Even worse, the Asperger student may be labeled by the non-professionals, in the school setting, as having an “Emotionally Behavior Disorder” (EBD). The criteria for EBD, has yet to be agreed upon on a state or national basis. And yet many children are labeled accordingly in the cumulative file that travels with them from grade to grade, tainting their reputations before the teacher has an opportunity to get to know them individually.
One teacher reported that he had a standing battle with an AS student who insisted on flicking a pencil back and forth in his fingers, though he was told repeatedly to stop the behavior and disciplined accordingly. The teacher did not realize that the student was looking for sensory input and used the pencil to meet that need. Providing another, less dangerous object would have satisfied both and stopped the “battle.” This is why training educators on all levels not only helps prepare the teachers to approach students with Asperger’s with more understanding so as not to get sucked into control issues and negative behavior patterns. It also but helps the Asperger student learn alternative methods for getting sensory needs met.
In continuing to search for a valid instrument to screen for Asperger’s Syndrome, perhaps there are some designed for other uses that could be adapted. As stated before, many of the symptoms noted in right hemisphere brain damage are very similar to the DSM-IV criteria for Asperger’s Syndrome. Unlike many acquired brain damaged (ABI) individuals, the child diagnosed with Asperger’s has hope of improving their behavior and overall functioning with the right therapeutic program. While there may not be a formal assessment for Asperger’s apart from the instruments used to evaluate for autism, there are assessments for right hemisphere brain damage. The Mini Inventory of Right Brain Injury (MRBI) may be useful in assessing individuals with Asperger’s because the 10 categories it tests match Asperger tendencies. Brookshire (1997) lists these ten categories as: visual scanning, integrity gnosis (finger identification, tactile perception), integrity of body image including neglect, serials 7, clock drawing, affective language (repeating a sentence with happy and sad intonation), appreciation of humor, incongruities, absurdities, figurative language, similarities, affect, and general behavior (examiners’ rating if distractibility, impulsivity, and eye contact). More research is needed to determine if the correlation is strong enough and if this test could be used to specifically identify Asperger’s Syndrome. This test would certainly reveal that presence of brain abnormalities in the right hemisphere, which could indeed point to the specific category of behavior to target for treatment.
If the assessments identified a specific category that matches the Asperger tendencies, perhaps this information might be correlated with neurocognitions that could be linked even more specifically the sensory information processed by the macrocolumns and minicolumns that are defective. More research is needed to determine if these targeted minicolumns respond to stimulation in terms of increasing in size and processing potential. Perhaps through occupational therapy combined with family therapy a child with Asperger’s may develop hope in overcoming some brain-processing problems that cause social ineptness.
Conclusion
The cognitive neuroscience view of psychology helps to provide a framework of understanding how the neurobiological origin of behavior may be traced to the neurocognitive processing taking place in the sensory systems. An AS individual’s response to sensory input may be so acutely uncomfortable that they live on the verge of panic when faced with certain sensations, whether it enters their awareness through the ears, eyes, or skin. Finally a bridge may be provided between the neurological abnormalities in the brain, possibly the smaller minicolumns and behavioral manifestations of Asperger’s Syndrome. Dr. Jeffery Cummings states that here has been “limited attention to the relationship between neuropsychological test performance and functional capacity in activities of daily living, occupational competence or success in returning to school” (1996). With the right testing instruments, thoughtful family therapy approaches, and special occupational therapy, perhaps there is hope in developing the social skills of Asperger individuals and improving their quality of life if identified early enough.
Literature That Does Not Support This View
There is very little, if any, literature does not support this view of the neurocognitive source of Asperger’s Syndrome. An article, which questions whether Asperger’s really exists takes the position that Hans Asperger really did not discover anything other than high functioning autistic individuals (Mayes, Colhouse, & Crites, 2001). These authors came to this conclusion by testing 157 children that were diagnosed with autism or Asperger’s using an instrument titled, “A Checklist For Autism In Young Children” (Mayes, Colhouse, & Crites, 2001). The instrument proved exactly what it was intended to prove, that there were autistic symptoms in all 157 of the children. It was stated before that an individual with Asperger’s might have at least 3 of the criteria that autistic individuals have. Yet the autistics may not have any Asperger tendencies. How could the two possibly be the same diagnosis? Unlike the autistic, the true Asperger case does not have a significant delay in language and cognitive development. The instrument did not measure language and cognitive development and is therefore invalid to use in testing for Asperger’s.
Asperger’s is often missed or an inappropriate diagnosis is made because not all professionals know what Asperger’s looks like, outside of the DSM-IV description. It is difficult to diagnose in a few office visits. Mayes, et al, (2001) also failed to take into consideration that there are many other Asperger tendencies or characteristics that the DSM-IV does not list, but are well known to those who have lived with an individual with Asperger’s. There may also be varying degrees of Asperger manifestations, depending on the home environment, the extent of the neurocognitive differences and the therapy that the child with Asperger’s and their family members have had the opportunity to participate in.
Although sensory integration therapy was rejected a few years ago, because it was tested on the wrong population in California, professionals are finally recognizing its validity and that it does indeed change how a child responds the their world neurologically. The noted improvements in behavior speak loudly for the validity of this therapy, especially when coupled with family therapy to improve the pattern of interaction among family members.
This topic is extremely relevant whether my degree specialization is Educational Psychology, General psychology or even Counseling Psychology. In the educational arena, I am extremely interested in training educators how to manage the behaviors of students with Asperger’s in a positive manner. I have witnessed many misconceptions of the purpose of behaviors that are directly tied to the way in which a student processes information neurocognitively. I have also seen teachers unwittingly model negative responses to the AS students to the whole class, causing even more problems with social interaction on the playground. These same teachers were able to undo that damage, once they understood Asperger tendencies. If teachers both understood and anticipated this behavior, they would have a more successful interaction with an AS student and set an excellent example for the class.
If I change my specialization to either the General Psychology or Counseling Psychology specializations, my focus would also be on the early identification of Asperger’s and the development of a family therapy approach. Identification Asperger’s is usually difficult prior to three years of age, when children often begin to enter day care. Many Asperger behaviors at home are often managed or mismanaged on a situational basis, and are usually viewed as obstinate or stubborn behaviors in the home environment. Children with Asperger’s usually do not experience major social problems until after they enter school. It is my hope to develop early identification and a treatment to prevent family and social dysfunction.
However, parental training to understand the significance of certain Asperger’s behaviors could begin early if there were a neurobiological way to identify this syndrome early. In fact, the earlier occupational therapy begins the more hope there is in improving sensory perception for the neurobiologically challenged child. After identifying the specific Asperger tendencies that the individual and family might deal with in everyday life, the therapist and the family would develop goals together to help educate and anticipate the interactions one is likely to encounter. Parental training in anticipation of behaviors is key to eliminating dysfunctional ways that families may respond to the AS child with.
Discussion
Discovering the research that has already been done to answer the question of what is different about the neurobiological of an individual with Asperger’s was exciting to say the least. The findings on the Rorschach Protocols in which the Asperger boys did not acknowledge human content in any of the inkblots was a surprising way of defining Asperger individuals, but ultimately explains why there appears to be a missing element of need for human contact with Asperger. Further research to understand what element is not processing in the brain concerning a connection to the human species would be very interesting. The MRI studies that revealed the lack of signal intensity change also intrigued me, but again these findings provided a new possibility as to the reason a person with Asperger’s cannot change gears and be spontaneous. Stubbornness may not be at the root of resistance to change with an Asperger’s individual! It was encouraging to find information that confirms that cognitive neuroscience research is being done and that there may actually be neurobiological reasons why a person with Asperger’s has the behavioral tendencies they do. This new information cautions me in the development of appropriate therapy and diagnostic tools. It is my hope that this new research will aid the helping community in developing a therapeutic approach to deal with the 370% increase of Asperger students that has been forecast for the coming years.
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