IG+ASD Veltmeijer, Agnes Elisabeth Johanna

19 Pages·2016·1.16 MB·English

University of Groningen

Students with (suspicion of) IG+ASD
Veltmeijer, Agnes Elisabeth Johanna
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Citation for published version (APA):
Veltmeijer, A. E. J. (2016). Students with (suspicion of) IG+ASD: A study aimed at understanding the
phenomenon of Intellectual Giftedness in co-occurrence with Autism Spectrum Disorder in relation to
(needs-based) assessment. [Thesis fully internal (DIV), University of Groningen]. Rijksuniversiteit
Groningen.
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Download date: 29-01-2023
APPENDIX A
A publication that gives insight into the theory development
prior to and leading up to the current thesis
Appendices
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144
Appendices
Giftedness and autism: R1
From differential diagnosis to needs-based approach1 R2
R3
Introduction R4
Some intellectually gifted children and adolescents are underachieving learners, who R5
behave in a peculiar way and may suffer from social isolation. Despite their intellectual R6
talents, these children do have special educational needs. Some psychologists tend to R7
stigmatize these students quite quickly as autistic. Others warn us not to confuse such R8
gifted characteristics with autistic behaviour. The twice-exceptionality of giftedness R9
(GFT) and autism spectrum disorders (ASD) is a complex phenomenon. Unfortunately, R10
dual and differential misdiagnoses often occur. Diagnostic confusion among R11
psychologists and other professionals is due to the camouflaging effect of some features R12
of intellectual giftedness, which at first glance appear to be similar to symptoms of ASD, R13
and vice versa. How can we avoid this labelling dilemma? R14
A solution lies in assessing the ‘grey zone’ between giftedness wíth and withóut ASD. R15
This grey zone is the key concept of the theory of Dimensional Discrepancies. This R16
model, developed in 2003 and theoretically substantiated later on (6,7,8,9), was recently R17
integrated with the three prevailing cognitive causal theories of autism: Theory of mind R18
(TOM), Executive dysfunction (EDF) and Weak central coherence (WCC). R19
In this paper, Agnes Burger-Veltmeijer introduces another way of thinking in order to R20
help professionals to discriminate between the qualitative differences of gifted-like and R21
autism-like traits. It encourages professionals in education and psychology to refocus R22
from ‘classification diagnosis’ to ‘needs-based approach’. This process will be illustrated R23
by means of the DD-checklist draft design and short film shots. R24
R25
Autism spectrum disorders (ASD) R26
ASD refers to disorders on the autistic continuum, that stretches from the severe diagnosis R27
Autism on one side, to the ‘lesser variants’, like PDD-NOS and Asperger’s Disorder (1) R28
on the other side. We agree with Serra et al (19) that ‘… ‘lesser’ only refers to the severity R29
or the amount of symptoms, and not to the consequences of these symptoms for daily R30
A
functioning.’ In fact, normal to highly intellectual children and adults may suffer very R31
much from their autistic impairments, as is clearly expressed by some autistic authors. R32
For example Marc Segar (18), a biochemist, who wrote a survival guide for people with R33
Asperger’s syndrome (AS). Unfortunately, it turned out he himself was unable to cope R34
with life. R35
R36
1 Published as: Burger-Veltmeijer, A. E. J. (2008). Giftedness and autism: From differential R37
diagnosis to needs-based approach. In J.M. Raffan & J. Fořtíková (Eds), Proceedings of 11th
R38
Conference of the European Council for High Ability; selected research papers cd-rom (pp. 3-13).
Prague, Czech Republic: The Centre of Giftedness/ECHA. R39
145
Appendices
R1 ASD is characterized by the following triad of (mutually related) impairments:
R2 1. reciprocal social interaction (like no friends, many conflicts, being bullied),
R3 2. verbal and non-verbal communication (like echolalia, talking but not communicating,
R4 no eye for facial mimicry, body posture, loudness of voice et cetera),
R5 3. imagination (like no fantasy play, no creative thinking, incapability to imagine what
R6 emotions, thoughts or intentions another person might have).
R7 These go together with a marked preference for a rigid, restricted and repetitive pattern
R8 of activities and interests (21), like strictly sticking to routines and rules. Moreover,
R9 several non-specific characteristics may exist. For instance sudden temper tantrums,
R10 fragmented information processing, motor problems or sensory sensitivity.
R11 According to contemporary research the criteria used for an autistic spectrum
R12 disorder diagnosis are dimensional (continuous), not categorical (yes/no) (e.g. 3,4,14,17).
R13 There is no independent biologic or psychological test to either confirm or refute this
R14 diagnosis.
R15
R16 Prevailing cognitive theories
R17 Autism involves cognitive deficits (2), including: Deficits in Theory of Mind (ToM), which
R18 includes the capacity to understand another persons thoughts, feelings and intentions,
R19 and the capacity to act appropriately on this knowledge, in the specific context in
R20 which the interaction takes place. This phenomenon is also called ‘social intelligence’
R21 or ‘empathising’ (2,3). Because ToM doesn’t explain all features of ASD, especially the
R22 stereotyped repetitive behaviours, two more cognitive theories were developed:
R23 Frith and Happé (11) introduced the theory of Weak Central Coherence (WCC).
R24 This refers to deficits in conceptual processing, the extreme focus on details and the
R25 concomitant incapability to overlook the whole picture, in a literal and figurative way
R26 of speaking. This brings about a fragmented way of cognitive and social information
R27 processing.
R28 Last but not least, the theory of Executive Dysfunction (EDF). Executive Function
R29 (EF) is an umbrella term for different interrelated cognitive skills. The mental control
R30 processes, which enable self-control in novel and ambiguous situations (13). EDF helps
R31 to explain the weak social skills, behavioural inflexibility and poor learning strategies of
R32 (gifted) children with ASD. To our experience, executive dysfunction might be one of the
R33 most important (hidden) causes of sudden unexpected underachievement when gifted
R34 children of about 12 years old change from primary to secondary school. Therefore, this
R35 concept will get extra attention:
R36
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Appendices
Executive functions R1
The three executive functions strongly associated with ASD (13) are: 1. Cognitive R2
flexibility, the capability to readjust responses and behaviour when the situation alters, R3
and to think of new and adequate strategies. 2. Inhibition, the repression of irrelevant R4
information, in order to prevent these stimuli from interfering with future goals. 3. R5
Working memory enables individuals to keep information in short term memory, in order R6
to be able to deal with intermediate processes in a task. For instance, it allows children R7
to take and retain consecutive steps in solving an arithmetic or communication problem. R8
All these executive functions enable individuals to organize and plan their social as well R9
as their intellectual actions. R10
In education and clinical settings, we see intellectually gifted children with learning R11
problems, caused by failure of these functions. This doesn’t make them necessarily ASD, R12
but it puts the cause of underachievement in another perspective, as will be explained R13
below. R14
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Emotional versus neurobiological causes R16
Learning and social problems of gifted children, like underachievement and social R17
isolation, can have different causes, as is shown in table 1. For instance, underachievement R18
at school, of gifted child without ASD, mainly has an emotional cause, like a lack of R19
motivation, due to little intellectual challenge. However, underachievement of a gifted R20
child wíth ASD mainly has a neurobiological cause, like WCC and/or EDF. The same R21
goes for problems of social isolation: in case of a gifted child without ASD, the social R22
problem mainly has an emotional cause, like low tolerance of slow thinkers or shortage R23
of interest peers. However, social isolation in case of giftedness plus ASD mainly has R24
a neurobiological cause, that is lack of empathy, of ToM. These different causes are R25
not always clearly differentiated, every gifted child with symptoms of ASD has his own R26
pattern. But before starting a therapy or special educational programme, it is important R27
to assess what causes lay underneath the problems of underachievement and social R28
interaction, in order to get a clear picture of the special educational and psychological R29
needs of any individual child. This is also shown in table 1. R30
A
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Appendices
Table 1
R1
© Problem: Problem:
R2
learning(strategies) / reciprocal social interaction /
R3
e.g. underachievement e.g. social isolation
R4
R5 GFT Cause: Cause:
R6 lack of motivation, no intellectual shortage of interest peers; lack of
R7 emotional challen-ge, never learned how to learn tolerance of slow thinkers.
or fail.
R8 cause
R9 Need:
Need: provide interest peers / like-minded
R10
intellectual challenge, compacting, friends; train social skills by appeal
R11
enrichment, acceleration, train learning to empathy.
R12 strategies.
R13
R14 ASD Cause: Cause:
fragmented/detailed thinking (WCC), lack of empathy, ToM
R15
neurobio- attention / organizing disorder (EDF)
R16
logical Need:
R17 Need:
cause special training of social skills, by
help structure: diary planning,
R18 appeal to ‘counting costs and
studying, distinguish important and
R19 benefits’
unimportant details; buddy
R20
R21
R22 Misdiagnoses of Giftedness plus Autism spectrum disorders (GFT+ASD)
R23 A gifted child with ASD has two exceptionalities. One is giftedness, which is a significant
R24 deviation from normal intelligence. Secondly, ASD is a significant exception to the
R25 average way of (social) functioning. The dual exceptionality ‘GFT plus ASD’ is a
R26 complex phenomenon that is sometimes difficult to diagnose properly because both
R27 exceptionalities have similar behavioural characTeristics, which are summed up in table
R28 2. Correct dual or differentiating diagnoses are also complex because the GFT-features
R29 and ASD-symptoms might mutually camouflage and distort one another. The following
R30 quote of Gallagher and Gallagher (12) illustrates this camouflaging complexity:
R31 ‘Consider combining the social inattention, motor clumsiness, and high verbal skill of
R32 Asperger’s Syndrome with such traits as independent thinking, constant questioning,
R33 and heightened emotional sensitivity (…). It is the perfect formula for a social pariah.’
R34 Moreover, there is no such thing as a clear-cut line between giftedness with ASD and
R35 giftedness without ASD. These two conditions are situated at both ends of a continuum.
R36 This corresponds to the currently accepted notion that the social skills and cognitive
R37 styles of autism appear on a continuum (2,4,14,17). And above all that, correct dual
R38 labelling is also hindered by one-sided knowledge and experience of many professionals
R39 (16).
148
Appendices
These interrelated mechanisms cause the following multiple types of misdiagnoses: R1
Differential misdiagnoses, like one-sided attribution of deficits to GFT or one-sided R2
attribution of deficits to ASD. And dual misdiagnoses, that is incorrect attribution of R3
deficits to both, ASD ánd GFT. R4
R5
Table 2 R6
©
R7

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Similar characteristics of GFT and ASD/GFT+ASD
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(sources: Cash, 1999; Gallagher & Gallagher, 2002; Little, 2002; Neihart, 2000; Webb et al., 2005)
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mentioned by all authors mentioned by some authors: R11

(clustered): • sensory sensitivity, hypersensitivity to R12
stimuli (Cash; Neihart; Little; Webb).
• difficulties in social interaction, R13
• intense need for stimulation (Cash).
e.g.:
• special sense of humor (Neihart; R14
• pay no attention to the other’s
Gallagher&Gallagher).
perspective or viewpoint, • visual thinking (Cash). R15
• egocentric,
• monopolize conversations, • difficulties conforming to the thinking of R16
others (Cash)
• incessantly talking or asking
• argumentative (Cash). R17
questions.
• stubborn (Cash).
• advanced memory and cognition, • uncooperative (Cash). R18
extensive knowledge base.
• intensity of focus, absorbing • resistant to teacher domination (Cash). R19
• perfectionist personalities (Cash).
interests.
• extraordinary levels of performance in a R20
• social isolation, no friends,
certain area, together with average range in
tendency towards introversion. R21
other areas (Neihart).
• precocity of language and speech
patterns, verbal fluency, large • uneven development, particularly when R22
cognitive development is compared to social
vocabulary.
and affective development at a young age R23

(Neihart; Webb).
R24
• concerned with fairness and justice (Webb).
R25
How to avoid the diagnosis dilemma R26
The objective of this paper is to show a solution to this diagnosis dilemma, the decision R27
whether a particular child is Gifted or Autistic or both. The solution is in fact a logical R28
one: Try to unravel the camouflage, by dividing the similar behavioural characteristics R29
into different behavioural manifestations: one that belongs to GFT plus ASD, and one R30
A
that belongs to GFT without ASD. Because at a closer look, when a psychologist observes R31
a child not only in a clinical or educational diagnostic room, but also in everyday life R32
situations like at home, at the playground and in the classroom, he will become aware R33
that similar characteristics show different manifestations. This will be further explained R34
in the next three paragraphs, by means of the DD-Model, the extended DD-Model and R35
the concept of the DD-Checklist. R36
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Appendices
R1 DD-Model I
R2 The preliminary design of the Dimensional Discrepancy Model GFT+ASD was
R3 developed in 2003 and improved and theoretically grounded in 2005 (6,7,8,9). Figure
R4 1 illustrates this DD-Model I, which consists of two continuous lines, which are base
R5 lines of normal curves. At the top the line of the dimension ‘cognitive intelligence’ and
R6 underneath the line of the dimension ‘social intelligence’.
R7 Giftedness in the cognitive area does not imply giftedness in the area of social
R8 intelligence, because it can be assumed that both dimensions are independent of each
R9 other (6).
R10 Our target group of individuals with GFT+ASD is located on the right side of the
R11 line of cognitive intelligence (above 2 sd’s from the middle, IQ > 130, the gifted area) and
R12 at the same time on the left side of the line of social intelligence (below 2sd’s from the
R13 middle, the retarded or ASD area). In case of an individual with IQ=130, the left arrow
R14 accentuates a theoretical discrepancy between the level of cognitive and social intelligence
R15 of 4 sd’s. The right arrow points from the cognitive gifted area to the ‘average level’ of
R16 social intelligence. It shows, in case of another person with IQ=130, a discrepancy of 2
R17 sd’s between level of cognitive and social intelligence. The DD-model illustrates the idea
R18 that gifted individuals, contrary to averagely intelligent individuals, might already have
R19 a disharmonious development (and might suffer from it) if social intelligence resembles
R20 the average of the normal population. Therefore, in this model ASD is not defined as an
R21 absolute standard for everybody. Instead, the definition is a relative one: ASD is defined
R22 in relation to any individual’s level of cognitive intelligence, his IQ.
R23 In between the two arrow points lies the transitional area of the grey zone. In this
R24 grey zone are situated those individuals, who have a cognitive IQ in the gifted area, and
R25 at the same time a social intelligence level less than the average area, but not low enough
R26 to be called ASD, considering the official criteria of the DSM-IV, the Diagnostic and
R27 statistical manual of mental disorders (1).
R28 However, these gifted children and adults may suffer from severe problems because
R29 their social capabilities do not match their cognitive intellectual capabilities. Therefore,
R30 they might be handicapped in their social life. The extent to which a child really suffers
R31 from this handicap depends on its personality and the demands of the social and
R32 occupational environment it lives in. In the next paragraph an extended version of the
R33 model will be introduced, DD Model II.
R34
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Appendices
Figure 1
R1
©
R2

DIMENSIONAL DISCREPANCY MODEL GFT+ASD R3
( DD-Model ) R4

R5
R6
Cognitive Intelligence
R7
IQ
R8
- 2sd Ø + 2sd
cognitively RET 70 _____________________ 100 ___________________ 130 cognitively GFT R9
R10

R11

R12

R13

R14
socially RET ______________________________________________ socially GFT
R15
ASD - 2sd g r e y zone Ø + 2sd
R16
Social Intelligence R17
ToM
R18
R19
R20
Extended Dimensional Discrepancy Model GFT+ASD (DD Model II) R21
Figure 2 shows the integration of the concept of the grey zone and the three cognitive R22
causal theories of ASD. At the top you see the model of the previous paragraph, to R23
which the dimensions of Executive functioning and Central coherence are added. In R24
this extended model, DD-Model II, the right light blue arrow on the EF line shows that R25
someone with a very high cognitive intelligence, but whose Executive Functioning is R26
average and therefore relatively low compared to the IQ, has a large discrepancy between R27
his IQ and the level of EF. On the left of the left light blue arrow you see the area of R28
absolute executive dysfunction (EDF). In between the two light blue arrow points lies R29
the area of the grey zone, of relative disability. The same goes for the dimension of R30
A
Central coherence, it is the grey zone in between the two dark blue arrows. R31
Each dimension has its own grey zone. These areas are accentuated in the colour grey, R32
shaded from white (the no problem area) to dark grey (the absolute deficit area). Every R33
gifted person, with IQ of 130 or more, can be placed somewhere on these dimensions. R34
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