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The Center for Adaptive Learning serves adults with neurodevelopmental disabilities. What exactly does this mean? Some of our students have been diagnosed with Learning Disabilities, Developmental Delay, Attention Deficit Disorder, Asperger's Disorder, and Pervasive Developmental Disorders. Some of our students have never been diagnosed in a way that makes sense to them or to their families. This letter explains, as sensibly as possible, the nature of the disabilities we work with at the Center.

Neurodevelopmental Disability: That's a cumbersome label. What does it mean? "Neuro," from neurological, means having to do with the brain and central nervous system. "Developmental" in a diagnosis traditionally means that the problem occurs from the beginning or very near the beginning of life, and makes itself felt throughout the person's growth and development. And "Disability" means a deficit or condition that causes an ability level to be different than what is normally expected. Put this together and think of a person who has problems in the way the brain works, and these problems persist from childhood into adulthood. In order for this label to make sense, the problems must be substantial enough that the person has not made an adequate adjustment to the demands of everyday life.

What disabilities or conditions are not included in this definition? Mental retardation is not included. Mental retardation is diagnosed when the IQ is below 70 and there are impairments in functioning in at least two areas of everyday life skills. Our students have the same kinds of life skills impairments, but they do not have the reduced intellectual level consistent with the mentally retarded.

Mental illness is also not included in our definition. Mental illnesses are conditions that can arise at any stage in life. They can be as common and well-known as depression and anxiety, or as severe and extreme as schizophrenia. To make matters more complicated, some of our students do have depression and anxiety, some have Obsessive Compulsive Disorder; and they can have situational reactions like Post Traumatic Stress Disorder just like anyone else. The difference to keep in mind is that the primary feature of their diagnosis is the neurodevelopmental disability.

If the IQ is not substantially reduced, then what causes the disabilities in everyday functioning, and the deficits that are often called Learning Disabilities? To answer this question, a bit of information about the brain is necessary. The brain is very complicated. We have barely scratched the surface of its mysteries. One fact that can be surprising if you've never thought about it is that every single thing we do, think, perceive, and feel, is processed by the brain. We know that specific skills are developed in certain areas of the brain and at specific developmental stages. But no brain cells are completely isolated from the whole; the system is a complex, interconnected net. The part that develops most slowly and is not complete until sometime in adolescence or even later is the part of most interest to our definition.

The frontal lobes of the brain slowly develop skills that coordinate and organize all the other individual skills The best way to understand the development of this part of the brain is to think about the behaviors expected of children as they grow. We know that a two-year-old child cannot tolerate frustration very well; we know that a four-year-old has a fairly short attention span and can be distractible or stubbornly repetitive in activities. We know that children who are old enough to play board games and team sports can begin to understand the need for rules and the desirability of following the rules. We know that in adolescence a strong streak of idealism is present partly because the brain has become complex enough to think abstractly. Another hallmark of adolescence is a focus on self-monitoring and comparing oneself to others.

This is a very important skill that we will examine further. The skills that have to do with organizing, planning, and monitoring successful adult life have been called EXECUTIVE FUNCTIONS. Our students, no matter what differences they may have in specific academic disabilities, physical abilities and talents, personality features, and level of depression or anxiety, all have executive function impairments. It is important to keep in mind that executive function impairments are not the same thing as not being smart. In fact, this error causes our students a lot of failure and pain in the course of their development. Because they are obviously “smart enough” to do what others expect of them, it is always a surprise to parents, teachers, and employers, when in fact they do not do what is expected in many situations. Their failures are so incomprehensible that they are usually explained away, assumed to be character flaws like lazy, rebellious, stubborn, and so forth. This is a costly and painful misinterpretation of people who truly are doing the best they can in challenging situations.

What are the EXECUTIVE FUNCTIONS? Here is a typical description of someone with executive function impairments: He has poor judgment and no common sense; he can’t manage money and he can’t make real friends, but is easily taken advantage of by unscrupulous people. His plans for the future are unrealistic because he doesn’t grasp the consequences of his behavior or learn from his mistakes. In clinical terms, the executive functions encompass initiation of behavior without cueing; abstract rather than concrete thinking; planning, sequencing, and control of attention and concentration; regulation of emotions; appreciation of consequences; use of hindsight, foresight, and insight; acute appraisal of one’s impact on others; self-monitoring and on-going self-awareness.

Nancy Perry, Ph.D.
Clinical Neuropsychologist

Neurodevelopmental Disability Impairments:

· Memory Problems

· Impulsivity

· Inability to think through decisions

· Inability to image consequences of actions

· Inability to read non-verbal cues

· Can not regulate crude/course language use

· Emotional outbursts

· Low frustration tolerance

· Unawareness of appropriate social behaviors

· Poor self-control

· Unawareness of appropriate physical/sexual boundaries

· Understanding of differences between public, private and secret behaviors

ADD – ATTENTION DEFICIT DISORDER

AD/ HD – ATTENTION DEFICIT HYPERACTIVITY DISORDER

AS – ASPERGER’S SYNDROME

ASD – AUTISM SPECTRUM DISORDERS

ASPIE – A PERSON WITH ASPERGER’S SYNDROME

HFA – HIGH FUNCTIONING AUTISM

LD – LEARNING DISABILITY

NLD – NONVERBAL LEARNING DISORDER

NVLD – NONVERBAL LEARNING DISORDER

OCD – OBSESSIVE COMPULSIVE DISORDER

PDD/ NOS – PERVASIVE DEVELOPMENTAL DISORDER

NOT OTHERWISE SPECIFIED

TS – TOURETTES SYNDROME

What is High Functioning?

We hear the term high functioning autism a lot these days. What does it mean? There are kids and adults who are diagnosed on the autism spectrum, but who don’t seem to resemble the old-fashioned profile of a person with autism.

Autism used to mean absence of language or very poor ability to communicate; lack of interest in connection with other human beings, or poor ability to connect in ways that make sense to others; fascination with unusual things or activities; self-stimulating motor behaviors; mental retardation. Certainly there are individuals who fit that description, but more and more people are being seen who have some but not all the typical expressions of autism.

High functioning autism is meant to distinguish individuals who function better, with fewer disabling factors or behaviors, than the description above. But does it mean IQ? Does it mean speech and communication? Does it mean academic performance? Much of this is a matter of opinion. Over many years of working with adults with neurodevelopmental disabilities, who are now considered to be on the autism spectrum, we have developed some ideas that we think explain what high functioning means.

We think about high functioning across a range of behavioral domains, more like a report card in each of many different subjects.

· Presentation of oneself; this is a very important domain that most people on the spectrum would not think about without assistance. What are the elements of presentation of oneself to the world?

· Grooming and dress, use of product, odor control, hair “modifications” (tattoos and piercing, wild dye jobs); adapting to the occasion; showing maturity over time

· Health: when to go to the doctor; how to use over the counter medicines; when and how to take y our own temperature, and what a temp means; what are allergies to medicines and foods; which kinds of aches and pains are significant; safe sex

· Food: planning, buying, cooking, evaluating for health and freshness, storage, binge eating or forgetting to eat

· Transportation: driving and maintaining a car; public transportation

· Interpersonal behavior– that’s too big a subject, so let’s break it down:

- Manners

- Interest in peers

- Ability to make social plans

- Ability to resolve conflicts

- Ability to make small talk

- How to behave in public: stores, movies, parks, events, appointments

- How to address and behave with authority figures: police, doctors, teachers, elders

- Romance and sexuality

- Emotional control