more on NLD

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--to ad-nauseum but here I go:

is NLD associated with pdd-nos? or more with Aspergers? Or both?

thx,

equinn

(my sunday fixation--ugh)

Since many NLDers are similar to Aspies in many respects but don't meet full criteria for an AS diagnosis, I would guess that many NLDers could be considered as PDD-NOS. But I don't think people generally look at it that way. Often the diagnosing neuropsychologist will conduct a differential diagnosis for NLD versus AS. I've read a few articles on the subject. When the social communication impairment is severe, generally the presence of narrow, intense interests and need for routine will clinch an AS diagnosis.

So I would say that the severity of social impairment and the presence/absence of narrow interests are probably the main crucial diagnostic differences used to differentiate AS and NLD.
Of course, there may be other differences as well. Those Aspies who have excellent visuo-spatial skills would not present as someone with NLD. So these criteria are necessary to distinguish only those Aspies with relatively strong verbal skills and impaired visual-spatial processing.

There is disagreement regarding the precise relationship between NLD and Asperger's autism. Some researchers and clinicians treat them as the same. Others do not. It may be useful to keep in mind that psychiatric diagnoses do not, unlike many physiological diseases, point to precise biological etiologies (causes). They are symptom complexes, i.e., constructs.

Here is an article which argues that the two are basically the same:

http://www.nldontheweb.org/Dinklage_1.htm

NLD is not a DSM-IV-TR category. It is a term used by neuropsychologists. A person diagnosed with NLD by a neuropsychologist might well be diagnosed by a psychiatrist or a clinical psychologist with Asperger's or, perhaps, PDD-NOS.

Last edited by nominalist on 04 May 2008, 5:30 pm, edited 1 time in total.

I think my sister has a NVLD. I know she too has a learning disability.
She is very outgoing. And has many many friends.
She has never had problems with being social or narrow interests like me. She is a recreational therapathiest.

Agreed. Rourke's white-matter hypothesis is currently the prevailing one for NLD, which would be a biological etiology if proven, but studies demonstrating white matter disturbances in the absence of NLD, and NLD with an absence of white-matter changes, have challenged this hypothesis. Currently the hypothesis is really based on what we know about the functioning of white matter and what we know about NLD, rather than any actual evidence that NLD is caused by white matter disturbances (as far as I know).

Regarding whether NLD is merely an ASD by another name, I would submit that I have NLD (officially diagnosed), and I don't believe I have the same severity of social interaction problems as those with AS. My need for routine is also much less (although I do find change difficult). I've also heard about others with NLD (Tera for example: http://www.geocities.com/HotSprings/Spa/7262/) for whom social problems are not their primary presenting symptoms. Those are just anecdotes, of course, but I personally believe that AS and NLD are distinct entities. After all, many other conditions such as OCD and ADHD often present with some social impairment. Additionally, someone with AS can have very strong visual-spatial abilities, which is not at all the NLD profile.

Currently. Hopefully it will make it into the next revision of the DSM. Until fairly recently, NLD had not received much attention, and most psychologists generally still know very little about it (less than they do about AS at any rate). Knowledge about NLD is definitely on the rise, but it's not surprising that it was not put in the last revision of the DSM, just as AS wasn't in the DSM until the 90s or so.

That is why some people have argued that NLD is really a highly nuanced category of Asperger's. As Dinklage wrote in that article I mentioned:

The inclusion of NLD in the DSM-V is unlikely, since even NLD experts are divided over whether it is simply a category of Asperger's.

Well, since my "official designation" is currently LD-NOS (the neuropsych clarified in the report it was NLD), I hope they do add it in. LD-NOS *really* doesn't capture the idea of NLD, since that can obviously include any type of learning disability which does not fall into current categories.

At least I hope it is mentioned in some form in the new DSM, even as a sub-type of AS, because it is definitely a real condition (whether it is part of AS or not), and lack of official recognition just further adds to the problems those with NLD face in getting diagnosis and treatment. I supposed we could be called PDD-NOS along with everyone else, but then we'd be grouped in with people who might have completely different neuropsychological profiles.

Plus, I doubt I would meet qualifications for an ASD diagnosis, although I have clear deficits in nonverbal processing that cause very real problems in my life. It would have sucked for them to say, "Well, yes, your visual processing is clearly disordered, and you can't find your way out of a paper bag, but you are slightly too socially competent for us- so no diagnosis for you!" I realize that is a problem many Aspies face, but I'm just glad I didn't because of my obvious processing problems. Sometimes a neuropsychological definition rather than just a plain psychological one can come in handy.

I was trying for the last sentence and couldn't get it. Oh, well. My son too thinks in pictures and never had any coordination issues. He was cutting with scissors before the age of two. So, really, it's just the social domain that would apply to him. I don't believe this is accurate from what I've read. Shouldn't he show deficits in motor and visual spatial too?

thx,

equinn

Has he been diagnosed with NLD? That would be surprising if he has strong visual processing and visual-motor coordination, since those are two of the basic characteristics of someone with NLD. It would be like diagnosing AS in someone without any problems with social communication.

It sounds more like your son has AS, since Aspies can have very strong visual-spatial skills and reasoning. Does he have special interests and a need for routine?

Here are three quotations focusing on Asperger's and NLD (NVLD):

There is clearly a great deal of overlap between Asperger’s Disorder (AD) and Nonverbal Learning Disabilities (NVLD) – so much so that it is possible that the symptoms of each diagnosis describe the same group of children from different perspectives, AD from either a psychiatric/behavioral perspective, and NVLD from a neuropsychological perspective. The specific conventions of these diagnoses may lead to a somewhat different group of children meeting diagnostic criteria, but it is not clear that this reflects something “true” in nature. That is, it may only be convention that separates these two groups.
http://www.nldontheweb.org/Dinklage_1.htm

Perhaps even more contestable is whether a distinction exists between AS and NVLD. The latter, which has not yet been recognized by the DSM-IV-TR as a diagnostic entity, has been most frequently defined in the literature by a specific neuropsychological profile. This profile can be very similar to that of children with AS. The main difference between the two disorders, as they are most frequently defined clinically, is the absence in children with NVLD of restricted interests or special skills. The diagnostic situation is further complicated, however, by the complex and still-changing definitions of the social deficits observed in NVLD.
http://www.nldline.com/bonny_forrest_asvsnld.htm

Nonverbal Learning Disabilities (NLD) are diagnosed in children who may show very impressive verbal, reading, spelling and rote memory skills but very weak motor, social, sensory, and visual-spatial abilities. NLD is a neurological disorder overlapping with and possibly occupying the same end of the autism spectrum as Asperger Syndrome.
http://specialchildren.about.com/od/get ... /g/NLD.htm

We'll have to agree to disagree, nominalist. The whole question of NLD versus AS is still up in the air. Some of the major researchers in NLD such as Rourke and Sue Thompson believe NLD is a separate disorder (as far as I know).

The neuropsychologist who diagnosed me considered Asperger's, but decided NLD was a better fit. I do not identify as autistic, nor would I feel comfortable identifying as autistic- I would feel like a poser. From what I've seen on this board, it seems like for those with AS, the most severe impediment they face is in social interaction. I do not feel this way, and nor do some others with NLD (from what I've read online). For us, the difficulty with nonverbal processing has been the major impediment in our lives. Therefore, I feel more comfortable with a diagnosis that is mainly defined by difficulties with nonverbal processing, rather than one which is mainly defined by difficulties in social interaction.

It's kind of like how those with ADHD may also have significant social problems, but for them, the major problems are with attention. Would it make sense to conflate ADHD with AS, since there are some overlap in symptoms (sensory sensitivity, social problems, etc.)? Some people do argue that ADHD should be part of the autistic spectrum. But I don't personally believe that it should. I believe the primary presenting symptom is different, and therefore it is useful to place it in a separate diagnostic category for the purpose of identification and treatment.

I was given the diagnosis NLD with ADHD. My main issues are social.. I have trouble understanding people, especially nonverbal communication and subtle social cues.. I also have a real difficult time remembering names for some reason and that adds to the difficulties socially.

My mind tends to focus on numerous things at once (ADHD) or just be spacey . Therefore, I sometimes find it difficult to keep focused specifically on what I'm talking about and will go off on tangents, often forgetting what I was originally wanting to say... So, with the NLD issues of not being able to understand alot of human interaction, my ADHD issues of focusing and staying on track, and the forgetting of people's names --- I'm pretty much ruined socially most of the time... I feel lonely so often and wish people would invite me to parties and call, etc.. but they almost never do...

I get left and right mixed up sometimes, and it is difficult to reverse directions when heading home for instance.. If I have written down the instructions how to get somewhere, it is difficult to reverse them and head back home.. I lose things alot.. clutter and disorganization.. It's a miracle sometimes for me to find something that is clean to wear, that isn't all wrinkled AND actually has all it's buttons for instance.. with no rips, tears or stains.. There is always a missing shoe or I can't find my keys, etc... So, by the time I do find myself somewhere, I might be a bit late, frazzled and then you add that to the social anxiety brought about by not being able to understand over 50% of human communications.. well--- I probably should just give up on trying to socialize... honestly.... i just wish i had more friends

For purposes of contrast, this person sees Asperger's and NLD as being almost entirely different (other than superficially).

I am just referring to what I have read. Personally, I have no qualifications in this area. In fact, I just posted a link to another article which argues that NLD and Asperger's are almost entirely different.

My point concerned the DSM-V. Since there is a lack of consensus concerning whether NLD is the same (or nearly the same), or a different entity than, Asperger's, the sources I have read suggest it is unlikely that NLD will be included in the DSM-V.