COMMONWEALTH EDUCATIONAL MEDIA

CENTRE FOR ASIA (CEMCA)

and

NETAJI SUBHAS OPEN UNIVERSITY (NSOU)

Jointly present
Massive Open Online Course on
‘UNDERSTANDING NEURODIVERSITY’
MODULE 4

Autism Spectrum Difference/Disorders (ASD) and Attention

Deficit Hyperactivity Disorder (ADHD)
Academic Advisory Board
Prof. Anirban Ghosh, Director, CIQA, NSOU
Dr. A. N Dey, Director, SoE, NSOU
Dr. Shiffon Chatterjee, Sr. Programme Officer, CEMCA

Course Writers: Course Editor:

Dr Stephen Shore
Ms Kavita Sharma Assistant Professor, Special Education,
Educator & Activist Advocate for Persons Adelphi University, New York, USA
with Special Needs, Founder of ‘PRAYAS’

Ms Manobina Chakraborty
Inclusive Education Consultant (India and UK)
Founder, i for inclusion, Global

Format Editing
Ms Manobina Chakraborty

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 Contents

Module 4: Understanding Neurodiversity

Unit Unit Name Page

No. No.
1 Demystifying Autism Spectrum
Difference/Disorders (ASD) 3-5
2
Asperger’s Syndrome 6-9
3
Dysgraphia and Dyspraxia: Myths and Facts 10-13

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 Unit 1: Demystifying Autism Spectrum Difference/Disorders
(ASD)
Structure

1.1 Objectives
1.2 Introduction
1.3 Definition
1.4 Neurodiversity and Autism as a spectrum of conditions
1.5 Learning Styles and Autism
1.6 Competitive Autism Advantage
1.7 Concluding Thoughts
1.8 References and Additional Readings

1.1 Objectives

• To understand the condition Autism as Neurodiversity

• To provide a safe and respectful learning environment
• To identify the needs and provide equity-based solutions during education and at the
workplace
• To unfold, reinforce and harness the potentials of persons with Autism

1.2 Introduction

German psychiatrist Eugen Bleuler introduced the concept of "autism" in 1911 to characterize
a symptom of the most severe instances of schizophrenia, and it has undergone numerous
revisions since then. In 1943, Ukrainian-American psychiatrist Leo Kanner's paper on Autism
was a milestone in this regard. Many professionals have worked on Autism throughout the
years, trying to figure out what causes it. Autism has undergone a paradigm shift from how it
was first characterized to how it is presently viewed.

Figure 1 Changing Perspectives

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In the past fifteen years, Autism has been seen as a condition that involves learning differences
and preferences of a person who has this condition. According to the World Health
Organisation (WHO), about one in 160 children has ASD.
As per the Autism and Developmental Disabilities Monitoring (ADDM) Network of the
Centers for Disease Control and Prevention (CDC), about one in 54 children in the United
States has been diagnosed with ASD. Autism affects more than four times as many boys as it
does girls.

1.3 Definition

Since the types and intensity of symptoms people experience vary widely, Autism has been
labelled as Infantile Autism, Childhood Schizophrenia, a "spectrum" disorder, a handicap, and
sickness worldwide. It can affect people of all races, ethnicities, and socioeconomic classes.
People with autism spectrum disorders share the following characteristics, according to the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a handbook created by the
American Psychiatric Association and used to identify mental disorders:
• Difficulties with social communication
• Restricted interests and repetitive behaviours
• Symptoms that hurt the person's ability to function properly in school, work, and other
areas of life.

1.4 Neurodiversity and Autism as a spectrum of conditions

When Australian Social scientist Judy Singer coined the term neurodiversity in her 1998
masters' thesis, she claimed that autistic differences are authentic forms of human identity and
not things to endure or cure. Instead, she believed that these differences could benefit the world.
Neurodiversity offers many benefits for people with Autism; it encourages greater equality and
discourages seeing them as 'different to everybody else.

1.5 Learning Styles and Autism

Learning strategies can be adapted keeping in mind the Theory of Multiple Intelligence (MI)
by Howard Gardner. MI theory refers to an idea describing the different ways students learn
and acquire information. These multiple intelligences range from using words, numbers,
pictures and music, to the importance of social interactions, introspection, physical movement
and being in tune with nature.
Other annotations about the learning styles of persons who have Autism can be the following:

a. Identification of a baseline of knowledge helps in developing an individualized

model of teaching: For example, a student who is six years old is interested in computers,
tablets etc. Before we begin the work with him, we need to learn about his sitting tolerance,
alphabet recognition, and the development of laterality of the body. If the first two are age-
appropriate, then we need to work on the third, as that is required in the mouse operation.
b. Autistic persons take everything literally: If you say, “Coming in 5 minutes”, you
must come back in 5 minutes, otherwise, it will create anxiety in them.

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c. The method of instruction should be completely errorless; unlearning may be
difficult: For example, if you ask an autistic child "Can you bring a scissor and cut the
paper?” This instruction is vague as it does not state anything about the paper.
d. Instruction should be explicit: For example, a teenager was asked to make tea for
three persons for the first time; he was found to be using, three vessels, three sieves, three
spoons and three mugs. He was spoken to and corrected.
e. Sequential visual presentation of a task helps: It is observed that persons affected
with ASD work better if the environment gives them predictability; for example, making tea
can be shown through visuals step-by-step.
f. A format can be used initially to get the desired outcomes; this can be followed
by augmentation of the concept- The example cited above can be used to augment further
learning, for example, asking the person to add lemon/ ginger to the tea as a flavour. This
way, the variations can be taught.
g. Small groups help reduce the sensory overload related to sounds, smells and
vision- Persons affected with Autism move away from those situations which can cause
sensory overload to them; this manifests as so-called "Behaviours". For example, one 6-year-
old student would run to a quiet Yoga room and lie down on the mattress. When the mother
reported this, she noticed that the class size was too large and very high noise level.
h. Assistive devices and the use of computers enhance learning to generalize the
concepts: Self-Organized Learning Environment- SOLE should be encouraged by providing
technology-based tools and other resources- For example, Open book tests and referrals,
observing the nature and writing an essay, listening to lectures and making notes, watching
YouTube videos to learn technology-based operations, and problem-solving, learning musical
notes and playing on keyboard and synthesizing are some examples of SOLE.

1.7 Concluding Thoughts

A lot can be accomplished if Autism is diagnosed early. A few people with Autism have Savant
Skills, which are areas of interest in which they excel through tenacity and repetition; these
skills can be used to help them find appropriate employment opportunities.

1.8 References and Additional Readings

1. Manning-Courtney P, Murray D, Currans K, et al. Autism spectrum disorders. Curr Probl

Pediatr Adolesc Health Care. 2013 Jan;43(1):2–11. [PubMed]

2. Ozonoff S, Goodlin-Jones BL, Solomon M. Evidence-based assessment of autism

spectrum disorders in children and adolescents. J Clin Child Adolesc Psychol. 2005
Sep;34(3):523–40. [PubMed]

3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental

Disorders. Fifth ed. Washington DC: American Psychiatric Association; 2013.

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 Unit 2: Asperger’s Syndrome

Structure

2.1 Objectives
2.2 Introduction
2.3 Definition
2.4 Strengths of persons with Asperger’s Syndrome
2.5 Challenges of persons with Asperger’s Syndrome
2.6 Neurodiversity and Asperger’s Syndrome
2.7 Learning Styles and Asperger’s Syndrome
2.8 Concluding Thoughts
2.9 References and Additional Readings
2.9.1 Other Resources

2.1 Objectives

• To understand the condition of Asperger’s Syndrome as Neurodiversity

• To appreciate the strengths of people with Asperger’s Syndrome
• To provide a safe learning environment
• To identify the needs and provide equity-based solutions during education and at the
workplace
• To reveal, reinforce and harness potentials of persons with Asperger's Syndrome

2. Introduction

Asperger's syndrome is a neurodevelopmental condition marked by substantial difficulty in

social communication, social interactions and social relations as well as confined and repetitive
patterns of behaviour and interests. The language and IQ are mostly unaffected.

Asperger's Syndrome was first described in 1944 by prominent Austrian physician Hans
Asperger, although it was only listed in the Diagnostic and Statistical Manual (DSM-4) of
Mental Disorders in 1994, following which it was removed in the fifth edition (DSM-5) of the
Manual in 2013. As a result, it is now considered part of the Autism Spectrum Disorder.
Autism and Asperger’s syndrome entered the history of psychopathology with a series of
remarkable coincidences. Kanner (1943) and Asperger (1944) were the first to describe both
conditions. Both were Austrian-born physicians.

3. Definition

Asperger’s Syndrome is defined as a neurobiological condition that causes obvious deficiencies

in social skills, such as difficulty in communication and changing routines (Iwanami et al.,
2011). Gillberg defined and characterized Asperger’s Syndrome as a social deficiency, limited
interest, obligatory behaviour with no verbal communication problem (Maier et al., 2002).

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Although Asperger’s Syndrome is considered the high functioning end of Autism, there are
still some significant differences, such as average intelligence and near-normal language
development in children with Asperger’s Syndrome. There is no evidence of a different
response to treatment or a distinct cause in Asperger syndrome versus high-functioning Autism.

To date, studies on the profile of abilities and difficulties on cognitive tests have both supported
and contested distinctions between Asperger’s Syndrome and high-functioning Autism based
on, verbal-performance IQ pattern, clumsiness, theory of mind abilities, or executive functions.

4. Strengths of persons with Asperger’s Syndrome

Attention to detail, Logical reasoning, Focus, Systemizing, Consistency, Visual Skills,

Retentiveness, Repetitive Tasks, Numbers, Verbal Skills, Auditory Skills, Empathy and
Honesty are strengths of persons with Asperger's Syndrome. Most of these have proved to be
valuable skills for a workplace. These people can work in a variety of fields, including
agriculture, technology, tourism, and many others.

5. Challenges of persons with Asperger’s Syndrome

Persons with Asperger's Syndrome experience a wide variety of symptoms, and no two cases
are precisely the same.
Problems in making friends or maintaining friendships, interaction in social situations,
maintaining eye contact, interpreting gestures, recognising humour, irony, and sarcasm are all
very common in Asperger's syndrome. Also, inappropriate behaviour or odd mannerisms,
problems expressing empathy, controlling emotions, or communicating feelings, lack of
common sense, and tenacity can often be seen in people with Asperger's syndrome.
Unlike other disorders in the autistic spectrum, Asperger's Syndrome does not usually have a
speech impairment, but the persons with this particular condition do have distinct linguistic
behaviours. A programmed, stiff, or "robotic" style of speaking, lack of inflexion when
speaking, repetitive speech, difficulty using language in a social environment, and a loud or
high-pitched address are all signs of Asperger's Syndrome in a child or an adult.

6. Neurodiversity and Asperger’s Syndrome

Taking the reference of Module IV/ Unit 1/ 1.4 and the fact that Asperger’s Syndrome has been
drawn back along with Autism, all those facts applicable for Autism gel with Asperger’s
Syndrome.
We should refer to Asperger’s Syndrome within the framework of 'Neurodiversity', a more
humane and accurate lens through which to view people with Asperger’s Syndrome.

7. Learning Styles and Asperger’s Syndrome

• Asperger's syndrome affects children and adults with average to above-average

intellect. Some may struggle academically while others succeed. A superior rote
memory, capacity to understand technical or factual knowledge, difficulty absorbing
abstract material, and a tendency to focus on details, resulting in missing "the wider

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 picture" are some frequent cognitive features among people with Asperger's syndrome.

• For all kinds of learning to happen, one needs a safe and fun-filled, non-threatening
environment.
• Like others in the autistic spectrum, persons with Asperger’s syndrome need to be
taught in small groups to avoid sensory stimuli present in the environment.

It is time for teachers, parents, and skilled professionals to work on the Theory of Multiple
Intelligences (MI) given by Howard Gardner. This theory implies that traditional psychometric
views of intelligence are very limited. Gardner first outlined his approach in his 1983
book Frames of Mind: The Theory of Multiple Intelligences. It talks about eight kinds of
intelligence that a person may have. If one can assess and evaluate the interest area of a person/
child, strategies and methods can be developed to enhance that area of interest. Linguistic,
Logical/Mathematical, Visual/Spatial, Bodily-Kinaesthetic, Musical, Interpersonal,
Intrapersonal, and Naturalist are the areas of intelligence according to MI theory.

8. Concluding Thoughts

Some co-morbid conditions, each with its own set of signs and symptoms, are more common
in children and adults with Asperger’s Syndrome. Anxiety, depression, ADHD, Tourette's
syndrome, and epilepsy are examples of these.

To sum up, people with Asperger's Syndrome have a lot of positive qualities; we need to build
on them, and the sensitive areas need to be addressed through equity-based solutions.

9. References and Additional Readings

1. Romagnoli G, Leone A, Romagnoli G, Sansoni J, Tofani M, De Santis R, Valente D,

Galeoto G. Occupational Therapy's efficacy in children with Asperger's syndrome: a
systematic review of randomized controlled trials. Clin Ter. 2019 Sep-Oct;170(5):e382-
e387. [PubMed]

2. Samsam M, Ahangari R, Naser SA. Pathophysiology of autism spectrum disorders:

revisiting gastrointestinal involvement and immune imbalance. World J Gastroenterol. 2014
Aug 07;20(29):9942-51. [PMC free article] [PubMed]

3. de Giambattista C, Ventura P, Trerotoli P, Margari M, Palumbi R, Margari L.

Subtyping the Autism Spectrum Disorder: Comparison of Children with High Functioning
Autism and Asperger Syndrome. J Autism Dev Disord. 2019 Jan;49(1):138-150. [PMC free
article] [PubMed]

2.9.1 Other Resources:

1. A Concise History of Asperger Syndrome: The Short Reign of a Troublesome Diagnosis

[Link]
2. Behavioural, Cognitive and Neural Markers of Asperger Syndrome

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[Link]
3. Asperger Syndrome- a part of Autism Spectrum Disorder
[Link]
spectrum-disorder-in-the-dsm-5/
4. Global Neurodiverse Support Systems- Primary Research Findings on Key Challenges
and Optimized Solutions in Mumbai, India
[Link]

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 Unit 3: Attention Deficit Hyperactivity Disorder (ADHD)
Structure

3.1 Objectives
3.2 Introduction and Definition
3.3 Neurodiversity and ADHD
3.4 Learning Styles and ADHD
3.5 Concluding Thoughts
3.6 References and Additional Readings

3.1 Objectives

• To understand the condition called ADHD as part of Neurodiversity

• To appreciate the strengths of persons with ADHD)
• To identify a safe and respectful learning environment for students with ADHD
• To recognize the needs and provide equity-based solutions during education and at the
workplace
• To identify ways to harness the potentials of persons with ADHD

3.2 Introduction and Definition

One of the most frequent neurodevelopmental conditions in children is Attention Deficit

Hyperactivity Disorder (ADHD). It is most commonly diagnosed in childhood and lasts far
into adulthood. Children with ADHD may struggle to focus, manage impulsive behaviours
(doing without considering the consequences), or be extremely active. A few symptoms can be
as follows:
• Making careless mistakes
• Difficulty sustaining concentration due to a lack of attention to detail
• When spoken to directly, does not appear to listen.
• Failure to complete tasks and instructions
• Showing a lack of organisation
• Tasks requiring persistent mental effort are avoided or disliked
• Getting distracted easily (including unconnected thoughts)
• Forgetfulness in everyday activities
• Squirming in seat and fidgeting
• Moving needlessly
• Feeling restless when alone
• Having a hard time participating in peaceful, relaxing activities.
• Mostly "on the move" or appearing to be "propelled by a motor"
• Talking too much
• Answering in a jumbled manner
• Having a hard time waiting for a turn
• Interrupting or invading other people's privacy

Persons affected with ADHD, most commonly need help with the areas, such as,
memory, organizational skills, time management, stress, concentration, listening and taking
notes.

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3.3 Neurodiversity and Attention Deficit Hyperactivity Disorder (ADHD)

Figure 1 Strengths of persons with ADHD in BLUE/ Deficits in PEACH

Neurodiversity is an approach that supports the fact that various neurological conditions are
the effect of healthy changes in the human genome. ADHD too is a neurodevelopmental
condition, which means that its symptoms, behaviours, and characteristics are the result of a
person's brain developing differently at critical phases of development.
Persons with ADHD can create unique advantages by bringing energy and new approaches to
a classroom or a work environment. Unlike other neurodiverse conditions, individuals with
ADHD typically have abilities that are a product of their "hard wiring" rather than the obstacles
they experience. Hyper focus, creativity, enthusiasm and innovation are the strengths of
persons with ADHD. These traits can help them get jobs such as Graphic Designer,
Teacher, Computer Technician, Chef and many more.

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3.4 Learning Styles and ADHD

A child or a young person with ADHD faces greater challenges in school than the average
student. ADHD symptoms such as failure to pay attention, difficulty sitting still, and problems
managing impulses can make it difficult to succeed in school.
Schools should provide suitable accommodations to fulfil their needs.

• Behavioural classroom management: Using a reward/recognition system or a daily

report card, the behavioural classroom management strategy fosters positive classroom
behaviour while discouraging undesirable behaviour. This method is known as ABA
(Applied Behaviour Analysis) or BMT (Behaviour Modification Techniques).

• Organizational Training: Organizational training teaches people how to manage their

time, plan, and organize school resources to improve student learning and eliminate
distractions.

• Special education services-based interventions: To remediate the difficulty faced by

a person with ADHD, special education services are integrated into mainstream
schools. These are special activities that are developed through IEP- Individualised
Educational Programme to have the individual at par with other students.

• Principles of Universal Design of Learning (UDL): This can be applied to get the
desired outcomes. These principles enable an educator to involve all neurodiverse
learners in a classroom.

Setting clear expectations, delivering prompt positive feedback, and connecting with parents
on a daily basis through a daily report card have all been shown to help people with ADHD.
Working on three areas of Executive Functions will help individuals with ADHD, these are
Working Memory, Flexible Thinking and Self Control.
Play in general and a variety of board games and outdoor games are wonderful ways to get
desired outcomes. The New National Education Policy of India (NEP 2020) calls for games
and sports to be an integral part of the curriculum.

3.5 Concluding Thoughts

ADHD is now recognised as a condition that affects some people well into adulthood and has
far-reaching consequences in their everyday lives, impairing social, vocational, and relational
functioning. For effective treatment, evidence-based pharmacologic, psychological, and
psychotherapeutic interventions are available.
ADHD must receive appropriate intervention at the right time so that persons affected reach
their full potential and lead a fulfilling life.

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 6. References and Additional Readings

1. Visser SN, Danielson ML, Bitsko RH, et al. Trends in the parent-report of health care
provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States,
2003–2011. J Am Acad Child Adolesc Psychiatry. 2014;53(1):34–46.

2. Katusic SK, Barbaresi WJ, Colligan RC, Weaver AL, Leibson CL, Jacobsen SJ.
Psychostimulant treatment and risk for substance abuse among young adults with a history of
attention-deficit/hyperactivity disorder: a population-based, birth cohort study. J Child
Adolesc Psychopharmacol. 2005;15(5):764–776.

3. Biederman J, Monuteaux MC, Spencer T, Wilens TE, Macpherson HA, Faraone SV.
Stimulant therapy and risk for subsequent substance use disorders in male adults with
ADHD: a naturalistic controlled 10-year follow-up study. Am J Psychiatry. 2008;165(5):597–
603.

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