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LostInSpace
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02 Dec 2008, 1:45 am

Short description of NLD (nonverbal learning disorder) for quick reference:

Condition involving a pattern of average or advanced verbal abilities combined with deficits in nonverbal areas such as motor coordination, visual and spatial processing, and social skills.

If you want to learn more, read on:

Nonverbal learning disorder (or nonverbal learning disability) refers to a condition in which individuals exhibit strengths in verbal abilities and weaknesses in nonverbal processing. Usually abbreviated as either NLD or NVLD, this disorder was first described by Johnson and Myklebust in the late 60s. Despite the fact that the term “nonverbal learning disorder” has existed in psychology for over forty years, it has only begun to gain greater recognition in the last decade, and is not included in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The following is a short list of the strengths and weaknesses associated with NLD:

Strengths:

Decoding (word-reading)
Rote memory (memory for facts)
Verbal reasoning
Vocabulary
General linguistic ability

Weaknesses:

Motor coordination
Social skills
Ability to understand nonverbal communication
Visual and spatial processing
Sense of direction
Mathematics (especially application of abstract concepts)
Executive functioning (attention, organization, planning, prioritizing)
Writing skills (especially organization of ideas) and reading comprehension

General characteristics of NLDers:

Verbal IQ is often much higher than Performance IQ
Reliance on verbal mediation (“talking oneself through a task”)
Focus on details while missing the big picture
Difficulty with sarcasm and a tendency towards literal thinking
Preference for routine and difficulty with novelty or change
May appear naïve and gullible
Very prone to anxiety and depression

Relationship to ADHD and AS:

As you can see, NLD shares some traits with both ADHD and Asperger syndrome.
Some individuals with NLD also meet the diagnostic criteria for ADHD, but in addition to problems with executive functioning also exhibit marked difficulties with visual and spatial processing, and have difficulty dealing with change. Additionally, individuals with ADHD may have attentional deficits which are “impulsive” or “distractible” while NLDers may be able to sustain focus, but have difficulty knowing exactly what to focus on (this has been described as “desultory attention”). Finally, attentional difficulties in ADHD tend to persist across both auditory and visual streams of information, while in NLD auditory attention is usually markedly better than visual attention.

Currently, individuals who display the above NLD traits but do not exhibit the “special interest” of AS are diagnosed as NLD. Individuals with AS may have more severe problems with social skills and are more likely to exhibit “autistic” traits such as lack of imaginary play, while those with NLD may have more severe deficits in visual and spatial processing. Individuals with AS may also meet the criteria for NLD, but the AS diagnosis “trumps” the NLD one (just as AS trumps ADHD). It should be noted that some researchers believe that NLD and AS are different terms to describe the same population, and others think that AS should be included on the extreme end of an “NLD spectrum” rather than as part of the “autistic spectrum.” Hopefully improved clarity in differential diagnosis will be forthcoming as more is known about the organic and neurological components of these conditions.

Diagnosis:

The academic impact of NLD may not become visible until later elementary school, when comprehension of concepts begins to be more important than rote learning (especially in mathematics). This is also when social difficulties may become more pronounced. As with any learning disability, mild cases, especially in individuals with high intelligence who have learned to compensate for nonverbal deficits, may go unnoticed until the individual begins struggling in higher education, such as college or graduate school. In other cases, NLDers may have been misdiagnosed as ADHD, emotionally disturbed, or given the general label Learning Disability-NOS (not otherwise specified). Even today, NLD is not well known by educators (although this is changing), and the process of diagnosis can be tricky. Usually central to the diagnosis of NLD is neuropsychological testing, which examines specific cognitive abilities to identify a distinct pattern of strengths and weaknesses. Some tests which are frequently used are intelligence tests, the Rey-Osterrieth Complex Figure, the Judgment of Line Orientation Test, the Grooved Pegboard Test, and sections of the Halstead-Reitan Neuropsychological Battery, along with other tests of verbal and nonverbal ability.

NLD’s status as a distinct clinical entity is still unclear, and lack of inclusion in the DSM means that no standardized criteria have yet been developed. What is clear is that not all individuals with a recognizable NLD profile fit every single proposed characteristic, and thus various “NLD subtypes” have been suggested which take into account the different “spheres” of deficit in NLD, such as motor skills, executive functioning, visual-spatial processing, and social communication. As stated on the NLDline website: “It is important to note… that no two children who meet this diagnosis criteria are the same. For some children the problem may rest predominantly with their maths and handwriting. For others it may be more organisation, attention, behaviour and social skills. For some the motor problems are significant whilst for others they are non-existent.”

NLD will likely be included as a diagnosis in the next revision of the DSM (due to be released in 2012), at which point standardized criteria will have been created, and a decision will have been made about which traits are necessary for diagnosis and which are merely comorbid characteristics or common sequelae. As with autism and Asperger syndrome however, the diagnostic criteria of NLD will likely be evolving for quite some time.


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Last edited by LostInSpace on 03 Dec 2008, 7:20 pm, edited 1 time in total.

ValMikeSmith
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02 Dec 2008, 2:10 am

Maybe it would be useful to have a compiled "dictionary" of social NonVerbal Cues,
perhaps like Datasage Alpha Male Guide in the dating forum,
or a "Autists guide to Social-NV-Cues for Aspies".
The suggested title is meant as a joke, like those yellow books "... for dummies".

I was starting to write one myself but I stalled.
Apparently I am unable to do it myself at this time.



LostInSpace
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02 Dec 2008, 2:25 am

ValMikeSmith wrote:
Maybe it would be useful to have a compiled "dictionary" of social NonVerbal Cues


Hmmm, I bet that would be really helpful. I do want to find a good book on nonverbal communication, but some people on here might also have some good insights as to what specific traps we can fall into.


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LostInSpace
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02 Dec 2008, 11:45 am

Thanks to everyone who voted- that's 3 people so far! (plus me) Keep them coming!


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Danielismyname
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02 Dec 2008, 12:05 pm

Is there any consensus over whether it's a different disorder from AS/HFA? I don't read up on NLD much. I remember reading that Rouke said that it's closer to AS than HFA based on cognitive abilities, i.e., verbal and rote based compared to visual/mathematical as in HFA (well, mathematical skill tends to be intact in HFA). Also, those with HFA seem to differ in their inability to handle doing things without clear rules and structure, whereas those with AS/NLD seem to tolerate this better.

I know they say that 80% or so with AS also have NLD, but have there been any studies done on those with NLD and whether they have AS or not based on their behaviour and current diagnostic criteria? I mean, many people who try to differentiate the two tend to equate AS to something like HFA--the aloof child, whereas Hans Asperger pointed out that the verbal ability of the children he saw was their lifeline in society, and they also interacted with others as children, it was just of the usual one-sided and verbose lectures on a specific topic of interest.

I don't see many differences in the descriptions of AS and NLD, other than perhaps those with AS have an extremely intense interest (I know the empathy thingy comes up, but it seems like people with NLD have just as much trouble with human relations as those with AS do).

You know, the whole AS/NLD/HFA thingy confuses me.



LostInSpace
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02 Dec 2008, 6:05 pm

Yay, 9 votes total now!

Danielismyname wrote:
Is there any consensus over whether it's a different disorder from AS/HFA?


Although some researchers do think it should be subsumed into AS, or that AS belongs on an NLD spectrum, based on what I've read, it seems like most researchers see a difference between the two.

Quote:
I remember reading that Rouke said that it's closer to AS than HFA based on cognitive abilities, i.e., verbal and rote based compared to visual/mathematical as in HFA (well, mathematical skill tends to be intact in HFA).


Yes, it is definitely closer to AS. After all, people with HFA have an early language delay, while people with NLD have advanced language from an early age, which is also frequently seen in Aspies. At least some researchers have found the pattern of higher PIQ for HFA and higher VIQ for AS (the NLD pattern), even if this result is not consistently found.

Quote:
I know they say that 80% or so with AS also have NLD, but have there been any studies done on those with NLD and whether they have AS or not based on their behaviour and current diagnostic criteria?

That's a good question. I don't think I've actually seen articles on that subject, although now of course I'm going to go look for some. When I've read NLD case studies they generally do a differential of NLD versus AS (this is also what my neuropsych did for my eval)- and the AS diagnosis seems to be made or broken by the presence or absence of a special interest.

Quote:
I mean, many people who try to differentiate the two tend to equate AS to something like HFA--the aloof child

I've seen parents remark on this difference on their websites. Like for one mother with 1 kid with NLD and 1 with AS, she noted that the kid with NLD was much more interested in being social. But as you mentioned, people with AS are not necessarily aloof, so this dichotomy probably doesn't always hold up.

Quote:
I don't see many differences in the descriptions of AS and NLD, other than perhaps those with AS have an extremely intense interest (I know the empathy thingy comes up, but it seems like people with NLD have just as much trouble with human relations as those with AS do).


Yeah, it does seem like the difference is a murky one. I think once we get a better idea of what is happening neurologically, we will finally get some more solid answers. So far it does seem like for cases where the social deficits are severe, that the distinction between NLD and AS is made on the presence or absence of a special interest. However, I've read a couple of books about NLD kids with forewords by respected NLD researchers, in which the kid *clearly* has a classic special interest, so I'm not really sure what to make of that.

For me, the difference seems to be that while I have the deficits of NLD and some of the deficits of AS, I am not *autistic*. I had no problems with early milestones, including establishing joint attention or using sounds/gestures communicatively. I was very interested in interacting and playing with my parents as a baby, including traditional games like Peek-a-boo. My imaginary play was also completely normal. However, if you look at early home videos, you can see that the way I saw my world visually was not quite normal. For instance, the "castle" I would obsessively build over and over out of Legos at ages 3-5 was just a block of Legos stacked on top of each other- it did not remotely resemble a castle. And in another home video when I'm pretending to feed a baby doll, I can't find the baby bottle, which is sitting right next to my foot. My mom repeatedly directs me towards it, although I seem not to see it even when I'm looking right at it. She even points at it, and I glance towards it, and then glance away. Finally she has to pick it up and give it to me. That is totally something that could still happen today- I just don't "see" things in my environment very well. Also I had early problems with getting lost, and for instance came home and cried every day in third grade because my classroom was on the second rather than the first floor, and I found it disorienting. So although I had some weird stuff going on when I was little which would point towards NLD, it was not *autistic* stuff (except for some unusual obsessions). No one would have looked at me aged 5 and thought I was autistic. Obsessive (my parents described me at age 6 as "intense"), anxious, highly verbal and easily overwhelmed, but not autistic.

Also, while I do have persistent problems with social interaction, my visual-spatial problems are so much worse, and so much more distressing, that I identify much more with an NLD label than I would with an AS label. This is just my personal experience, but hopefully it illustrates how one can be NLD, but not autistic.
Here's a website by a girl with NLD who also would probably not meet the criteria for AS:
Tera's NLD Jumpstation


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timeisdead
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02 Dec 2008, 6:27 pm

Is it uncommon for a person to be excellent at some non-verbal aspects of intelligence and have disabilities in other non-verbal areas? If so, does that also fall under the category of NLD?



vivinator
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02 Dec 2008, 6:40 pm

I'm about to call a Psych to diagnose me.
I read once as far as emotions
NLD'ers feel the normal range of emotions but are inept at expressing them.

As'ers do not feel the normal range of emothions.

In this instance I think I fit the AS profile
I do have visual-spatial problems.
other confusing stuff which I've posted on in 1 or 2 threads in the past 2 weeks.
I voted yes. :D

calling this guy:

http://newportpsychology.com/about.html


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-as of now official dx is ADHD (inattentive type) but said ADD (314.00) on the dx paper, PDD-NOS and was told looks like I have NLD


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03 Dec 2008, 1:48 am

Can't we have this very thread made a sticky? Lots of interesting points made here, lots to expand on.


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03 Dec 2008, 1:57 am

timeisdead wrote:
Is it uncommon for a person to be excellent at some non-verbal aspects of intelligence and have disabilities in other non-verbal areas? If so, does that also fall under the category of NLD?


Can you give an example? I think it's my case too...


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LostInSpace
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03 Dec 2008, 2:27 am

timeisdead wrote:
Is it uncommon for a person to be excellent at some non-verbal aspects of intelligence and have disabilities in other non-verbal areas? If so, does that also fall under the category of NLD?


I'm not sure- "excellent" even compared to your verbal abilities? It would probably depend on what exact nonverbal skills you excelled at, and how well you fit the NLD profile otherwise. I think it would probably be the judgment of the person evaluating you whether or not you fit enough of the characteristics- hopefully it will be a little more clear after the next DSM comes out and we get some standardized criteria.

I'm excellent at some specific skills NLDers often have trouble with, like verbal comprehension, writing and some types of math, but I'm not excellent at any broad areas of nonverbal functioning.


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LostInSpace
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03 Dec 2008, 2:27 am

vivinator wrote:
I'm about to call a Psych to diagnose me.


Good luck with your evaluation!


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LostInSpace
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03 Dec 2008, 2:28 am

Greentea wrote:
Can't we have this very thread made a sticky? Lots of interesting points made here, lots to expand on.


That's a great idea. There certainly seems to be enough interest to keep the thread going.


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emc2
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03 Dec 2008, 7:14 am

When considering diagnostic labels such as mental health ones or NLD vs AS you have to look at the history of the labels themselves.

I have read that when they wrote the DSM III that psychiatrists in the UK and America were diagnosing the reverse of the other country so people who were considered Bipolar in one country were being diagnosed as Schizophrenia in the other.

So with AS if we look at NLD and AS they are very New diagnostic labels - one is in the DSM IV and the other is not.

So there may well be people with NLD who had very mild Asperger/Autistic traits as children,
There are people with dual diagnosis of AS and NLD,
Different professionals disagreeing on whether either AS or NLD should be diagnosed at all.

I was told that Semantic Pragmatic Disorder, NLD and Asperger's are the same diagnosis but diagnosed by different professionals - Speech Pathologists, and Psychologists. So the Speech Pathologist might say a child has SPD when they are in fact Asperger's.



timeisdead
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03 Dec 2008, 11:54 am

LostInSpace wrote:
timeisdead wrote:
Is it uncommon for a person to be excellent at some non-verbal aspects of intelligence and have disabilities in other non-verbal areas? If so, does that also fall under the category of NLD?


I'm not sure- "excellent" even compared to your verbal abilities? It would probably depend on what exact nonverbal skills you excelled at, and how well you fit the NLD profile otherwise. I think it would probably be the judgment of the person evaluating you whether or not you fit enough of the characteristics- hopefully it will be a little more clear after the next DSM comes out and we get some standardized criteria.

I'm excellent at some specific skills NLDers often have trouble with, like verbal comprehension, writing and some types of math, but I'm not excellent at any broad areas of nonverbal functioning.

That description matches me to a t! I'm excellent at writing, reading comprehension, higher mathematics, analyzing the main idea, the abstract sciences ( I naturally use the combination of language and simple visualization models), and the analysis of nonverbal patterns. However, I match the NLD criteria otherwise....