January 23, 2007 Feature

A Unique Mind

Learning Style Differences in Asperger's Syndrome and High-Functioning Autism

Although the diagnoses of Asperger's syndrome (AS) and autism were first described more than 60 years ago, our knowledge about the nature of these disorders remains in its youth. There is ongoing debate and uncertainty about the differences between these disorders. In particular, the validity of AS as a unique diagnostic category continues to be called into question. Some consider AS to be a "milder" form of autism, while others feel that it is merely an equivalent label for autism in the absence of significant language and cognitive delays, namely high-functioning autism (HFA).

If we claim that there are no clear distinctions between these disorders, we may neglect to provide supports that are consistent with a child's unique cognitive strengths. In addition, if the term "mild" is used to differentiate AS from HFA, it perpetuates a myth that is inconsistent with current outcome studies of this population (Tsatsanis, 2003), while creating barriers to accessing intervention services that may be reserved for individuals with more "severe" disabilities. When meeting the daily demands of social life is a constant challenge, when achieving vocational goals is a statistical long shot, and when living a life free of mental health challenges is unlikely, we cannot consider the disorder of AS to be a "milder" form of anything.

One of the primary principles of evidence-based clinical practice in the field of speech-language pathology is to recognize the needs of the individuals we serve. There is a clear need to consider that these diagnoses may represent distinct challenges that affect social and communication skills. In addition, there is a need to consider that individuals with either HFA or AS warrant our services as speech-language pathologists, as one may not be truly milder than the other.

The answers to the following questions may clarify the distinctions between HFA and AS and serve as a guide in planning interventions.

Q: I've always been told that distinguishing between Asperger's syndrome and high-functioning autism is irrelevant, since intervention planning is the same. Is this true?

There is disagreement on this issue. Although the argument has been made that there are no relevant distinctions among individuals on the autism spectrum with high IQ, several contemporary neuropsychological studies have led to greater recognition of the potential differences in learning styles (Tsatsanis, 2004). In fact, there appear to be different learning pathways for different social learning disabilities. Individuals with AS often present with a verbal IQ that is higher than performance or nonverbal IQ, while individuals with HFA often present with the opposite pattern. In other words, an individual with AS may show strengths in verbal language and verbal memory, while an individual with HFA may show strengths in visual-spatial perception and visual memory. Additionally, an individual with AS may show weaknesses in visual-spatial perception and visual memory, while an individual with HFA may show weaknesses in verbal language and verbal memory. These distinctions will have implications for determining appropriate educational goals and learning supports; therefore, considering diagnosis as irrelevant may be problematic.

Q: Is there a diagnostic tool that SLPs can use to formally distinguish AS from HFA?

Although there are a number of observation instruments that are helpful for diagnosing autism spectrum disorders, a formal measure that reliably differentiates HFA from AS is not yet available. In fact, the current controversies regarding these distinctions have led to a variety of published definitions of AS, resulting in individuals with significant differences in learning style being identified with the same label. Therefore, every individual should be carefully assessed to determine his or her unique learning strengths and challenges, regardless of diagnosis.

Q: What are the implications of these learning distinctions on social communication?

Unique minds and learning style differences contribute to unique social and communicative profiles. Strengths in visual-spatial reasoning lead individuals with HFA to prefer more solitary play and leisure activities involving drawing, computers, and puzzles; conversely, given their strengths in verbal language and verbal memory, individuals with AS may prefer initiating verbal monologues with others. Likewise, the passive conversational style of an individual with HFA may stand in contrast to the verbose conversational style of an individual with AS. These distinctions, as well as others, are summarized in Table 1 above. Note that these distinctions represent prototypical examples of HFA and AS and may not be relevant to a particular individual.

Q: What are the implications of these learning distinctions on intervention planning?

The neuropsychological studies mentioned previously have important implications for intervention and designing appropriate learning and educational supports. Individuals with AS may prefer verbally mediated strategies, while children with HFA may prefer visual supports. If we are aware that an individual with AS demonstrates strong verbal abilities, this cognitive strength provides an ideal modality for intervention. Verbal mediation can be incorporated throughout daily routines and activities to facilitate awareness of the subtleties of social communication typically conveyed through nonverbal social cues. This "verbal decoding of nonverbal behaviors" might, for example, involve helping individuals develop verbal definitions for specific facial expressions, gestures, and body postures, so they may talk themselves through nonverbal social problem solving.

In contrast, providing static visual information is more appropriate in supporting individuals with HFA to understand social cues, language, and social conventions. For example, facilitating an understanding of the internal states of others may be accomplished with Comic Strip Conversations, a type of support in which another's thoughts are captured through pictorial representations within a "thought bubble" (Gray, 1994). Through this visual information, a concrete support is provided for considering the emotional consequences of one's actions on others. For individuals with HFA, verbal mediation may be less effective, if not disruptive, given their relatively weak language comprehension.

Interestingly, written language is a common modality for supporting social and communicative skills in individuals with either HFA or AS. While visual-spatial perception can be challenging for individuals with AS, strengths in word prediction and language can support written language skills. Individuals with HFA also may develop the ability to process the written word, as their relative strengths in visual-spatial skills and rote auditory memory contribute to phonetic decoding. Thus, a written cue card may convey information more effectively than raising one's eyebrows and gesturing toward a student's desk. Similarly, the use of a written map to illustrate information about one's conversational partners—such as what they like to talk about, what experiences they have had, and their favorite activities—could be provided (Winner, 2002).

Q: Since individuals with AS and HFA are "high-functioning," is there a role for an SLP on an educational team?

Recently, ASHA published several documents related to the roles and responsibilities of the SLP serving individuals with autism spectrum disorders, including those with HFA and AS (see sidebar, p. 21). These documents highlight a number of critical roles that we serve, including—but not limited to—screening, diagnosis, assessment, and intervention (ASHA, 2005). Nevertheless, it is not uncommon for school-aged students with AS and HFA to be denied an Individualized Education Plan (IEP) or speech-language pathology services because of their cognitive abilities, academic proficiencies, and relatively sophisticated language skills.

A student's eligibility for support services should be made as part of an educational team process as designated by the Individuals with Disabilities Education Act of 2004 (IDEA, 2004). Full consideration of the available evidence for this determination is essential. Although "high-functioning" is often ascribed to these disorders, this description is typically made on the basis of a full-scale IQ score, rather than on an individual's ability to actively engage in everyday activities. Outcome studies on these populations demonstrate that cognitive, academic, and language abilities do not ensure an individual's ability to establish and maintain satisfying relationships that foster success at school, at home, and in the community. In fact, challenges in social communication significantly compromise the ability to adjust to new social demands in academic settings and to achieve vocational goals after high school. Additionally, social communication challenges heighten risk for anxiety and depression.

These findings suggest that one of our roles as SLPs is to advocate for intervention to address the gap between the relative strengths in cognitive, academic, and language abilities and the relative weaknesses in social-communicative functioning. Areas of support to improve social communicative competence might include fostering:

  • Verbal and nonverbal communication—develop awareness of how to initiate and shift conversational topics and how to provide an adequate amount of background information.
  • Social awareness and social problem—solving skills-increase awareness of how to select appropriate topics, read and perceive nonverbal social cues, make inferences, and use language to negotiate with peers.
  • Emotional regulation—improve ability to use language to self-organize behavior across social settings, express emotional states, and develop conventional social coping strategies.

Although uncertainty may always be present during discussions related to the nature of HFA and AS, there is no uncertainty when it comes to recognizing that we, as SLPs, need to accommodate and modify intervention plans for our clients' unique minds. The greater our knowledge of how to tailor an approach to an individual, the more likely we can use this knowledge to enhance social and communicative growth in our clients.

Emily Rubin, is an SLP and director of Communication Crossroads, a private practice in Carmel, CA. She is an adjunct faculty member and lecturer at Yale University, where she has been a member of the Autism and Developmental Disabilities Clinic. She is a co-author of the clinical manual for the SCERTS Model, a comprehensive educational approach for children with autism spectrum disorders. Contact her at Emily@CommXRoads.com or visit www.CommXRoads.com.

cite as: Rubin, E. (2007, January 23). A Unique Mind : Learning Style Differences in Asperger's Syndrome and High-Functioning Autism. The ASHA Leader.

The Role of the Speech-Language Pathologist in Serving Individuals With Autism Spectrum Disorder

These documents describe the appropriate roles of the SLP as including, but not limited to, the following:

  • Screening and early detection of individuals at risk for autism spectrum disorder (ASD) and providing referrals to experienced professionals
  • Diagnosis, typically as part of a diagnostic team or in other multidisciplinary collaborations. The process of diagnosis should include appropriate referrals to rule out other conditions and facilitate access to comprehensive services
  • Assessment and intervention focusing on aspects of development critical to the achievement of social communication competence. Services should honor differences in families, cultures, languages, and resources. SLPs should also recognize the components of evidence-based practice
  • Working with families in a partnership during assessment and intervention with individuals with ASD
  • Collaboration with other invested parties to identify priorities and build consensus on a
    service plan and functional outcomes
  • Professional development to enhance knowledge and skills for service provision
  • Research to advance the knowledge base about ASD. SLPs should also keep abreast of current research
  • Advocacy for individuals with ASD in promoting social communication skills

To Learn More

The following new ASHA documents were published in the ASHA Online Desk Reference Library:

  • "Roles and Responsibilities of Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders Across the Life Span: Position Statement"
  • "Principles for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders Across the Life Span: Technical Report"
  • "Guidelines for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders Across the Life Span"
  • "Knowledge and Skills Needed by Speech-Language Pathologists for Diagnosis,
    Assessment, and Treatment of Autism Spectrum Disorders Across the Life Span"

Visit the ASHA Desk Reference to locate these documents.



Meet Artist Justin Canha

Justin Canha is a 16-year-old with high-functioning autism. He is also an artist. 

While growing up, Justin's verbal skills were compromised and his drawings were used as a means of expression and a basis for interaction. Now he enjoys talking about his artwork—especially his comics—with anyone who is interested.

Over the years, his art expanded to include still-life drawing, landscapes, portraits, and buildings in a variety of media, including watercolors, pastel, charcoal, and oils. He also taught himself how to create computer animations. The artwork showcases his sense of humor and sensitivity to human and animal relationships; his computer animations feature action-packed stories with original characters.

Justin's innate artistic ability caught the attention of the art community and he is now represented by the Ricco Maresca Gallery in New York City, where he was a featured artist in the gallery's January 2005 Autism/Asperger's Art Exhibit. He also was featured in the August 2006 issue of O, The Oprah Magazine.

Justin lives in Montclair, NJ, and attends Renaissance Middle School, a public magnet school that focuses on arts and sciences. Justin's art can be viewed on his Web site at www.justinart.com.



Table 1: The implications of learning distinctions on social communication in AS and HFA

Language

HFA–Weaknesses in language are common, as is a reliance on echolalia.

AS–Strengths in expressive and receptive language are common; however, language may be excessively pedantic.

Play and leisure

HFA–Visual-spatial strengths contribute to constructive play, reading, drawing, and music skills, while limiting parallel and cooperative play.

AS–Verbal language strengths contribute to preferences for verbal exchanges. Thus, parallel play skills may emerge as others are sought out to gain opportunities to exchange verbal information. Cooperative play, on the other hand, will be compromised.

Conversation

HFA–A more passive conversational style may be related to preference for static visual information.

AS–A more verbose conversational style may be related to a preference for verbal information in the environment.

Talents and strengths

HFA–Strengths in visual spatial processing and rote auditory memory may contribute to artistic and musical talents (as an example, see the illustration that accompanies this article).

AS–Strengths in verbal memory may contribute to “fact-gathering” topic initiations.

Prosody

 

HFA–After more creative and generative language, the quality of speech can often be monotonous and marked by a constricted range of intonation.

AS–Although prosody is variable, poor quality is noted.



References

American Speech-Language-Hearing Association. (2005). Position statement: Roles and responsibilities of speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span. Rockville, MD: author. Available online at the ASHA Desk Reference.

Gray, C. (1994). Comic strip conversations. Arlington, TX: Future Horizons.

Green, J., Gilchrist, A., Burton, D., & Cox, A. (2000). Social and psychiatric functioning in adolescents with Asperger syndrome compared with conduct disorder. Journal of Autism and Developmental Disorders, 30, 4, 279-293.

Tsatsanis, K. D. (2003). Outcome research in Asperger syndrome and autism. Child and Adolescent Psychiatric Clinics of North America, 12, 45-63.

Tsatsanis, K. D. (2004). Heterogeneity in Learning Style in Asperger Syndrome and High Functioning Autism, Topics in Language Disorders, 24, 4, 260-270.

Rubin, E. (Ed.). (2004). Asperger Syndrome and High Functioning Autism: Addressing Social Communication & Emotional Regulation. Topics in Language Disorders, 24, 4.

Winner, M. G. (2002). Thinking About You Thinking About Me: Philosophy and Strategies to Further Develop Perspective Taking and Communicative Abilities for Persons with Social Cognitive Deficits. San Jose, CA: Michelle G. Winner.



  

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