Education and Counseling for Individuals Affected by Autism Spectrum Disorders


Asperger's or NVLD: Has Your Child Been Misdiagnosed?

Since young people with Nonverbal Learning Disabilities (NVLD) and Asperger’s (high functioning autism) share similar traits, it is tempting to say that they meet the diagnostic criteria for either classification – but this is not the case. Learning disabilities and Asperger’s are significantly different disorders. Also, different types of assessments and interventions need to be selected to address the distinct - and sometimes overlapping - features of each.

Kids with Nonverbal Learning Disabilities are described as showing signs of:
  • Social isolation (e.g., not being sure of how to join a group or initiate social interaction)
  • Social intrusiveness (e.g., standing too close to someone; following someone around during casual conversation; not knowing when or how to join a conversation; having a hard time engaging in the “give and take” of “small talk”)
  • Physical awkwardness (e.g., not knowing what to do with their hands during casual conversation; showing anxiety-induced behaviors in public that often result in embarrassment)

The argument could be made that the signs listed above are also indicative of Asperger’s. The overlap between Asperger’s and Nonverbal Learning Disabilities significantly complicates the diagnostic process. Further complicating the diagnosis is the probability that teachers and professionals view certain behaviors through different lenses (e.g., some looking at language and cognitive skills, and others looking at social and behavioral concerns). In addition, teasing apart Asperger’s and Nonverbal Learning Disabilities is complicated by the fact that there is no single battery of tests or uniform profile for either of these disorders.

Due to the fact that Nonverbal Learning Disabilities are often difficult to recognize, many kids with the disorder get mislabeled as being lazy or unmotivated. Some of the traits of Nonverbal Learning Disabilities (e.g., problems with organization, motor planning, problem solving, and social adaptation) are also present in kids with Asperger’s. And while both groups demonstrate areas of significant weakness, they also have specific areas of extraordinary talent. Most experts seem to agree that these two groups differ in severity, with Asperger’s usually showing more serious challenges than Nonverbal Learning Disabilities. However, the degree of severity in both disorders can range from mild to severe.

The similarities between with Nonverbal Learning Disabilities and Asperger’s (high functioning autism):
  • Both are oblivious to nuances of appropriate spatial distance.
  • Both are often misunderstood by others (e.g., accused of rudeness, laziness, lack of empathy, poor attitude, etc.). 
  • Both have difficulty perceiving subtle differences in facial features, tone of voice, and gestures that make up nonverbal communication.
  • Both have neuro-developmental abnormalities involving functions of the right cerebral hemisphere.
  • Both have problems in social relationships, whether at school or at home. 
  • Both have the inability to perceive or understand nonverbal cues.
  • Both live with social anxiety that often leads to uncertainty, confusion and insecurity, which they may try to relieve by creating routines and rituals – and if these things are not addressed, a lowered self-esteem and psychological disorders (e.g., anxiety, depression) may result.
  • Both respond to peer-rejection by withdrawing, "acting out" with emotional outbursts, or refusing to cooperate. 
  • Both seek out social interaction, yet are often not accepted by their peers.
  • In both disorders, there is no delay in cognitive development and speech. 
  • Kids from both groups are socially awkward and pay over-attention to detail and parts, while missing main themes or underlying principles. 

The differences between with Nonverbal Learning Disabilities (NVLD) and Asperger’s (high functioning autism):
  • Asperger’s kids generally have greater social problems. Their highly restricted interests present an additional obstacle to their social functioning. These restricted interests are not mentioned in the literature about NVLD.
  • Many children with Asperger’s respond well to visuals and diagrams, and are visual learners. On the other hand, children with NVLD do not usually respond to physical demonstrations and may not understand diagrams. They usually don’t learn by watching, and need everything explained in words. 
  • Due to their visual learning style, many Asperger’s children excel in math and find work in computer fields, engineering or architecture. Conversely, children with NVLD tend to become wordsmiths (e.g., teachers and writers).
  • NVLD kids have normal emotions, but are inept in expressing them and in recognizing them in others, to the extent that they are expressed non-verbally. Conversely, Asperger’s kids do not feel the same range of emotions (e.g., though they may feel very deeply about many things, they may not cry or smile when it's deemed appropriate; they often have a flat affect).
  • Odd behaviors (e.g., rocking, flapping) can contribute to social problems for children with Asperger’s. These behaviors are not present in NVLD. 
  • The literature on Asperger’s does not mention problems with visual spatial issues, which are a major problem area for children with NVLD.

There are two distinct types of learning disabilities:
  • Non-verbal: The child has great difficulties with problem solving that do not involve written or spoken language. He or she struggles staying organized in terms of time and space, while having good language skills.
  • Language-based: This involves poor speech and/or language skills, difficulties with vocabulary and speed/accuracy of performance on language-related tasks, and overall problems with reading and writing.

What are the signs of Nonverbal Learning Disabilities?
  • Anxiety
  • Attention to detail, but misses the big picture
  • Concrete thinking
  • Depression
  • Difficulty making and keeping friends
  • Difficulty with math, especially word problems
  • Excellent memory skills
  • Fear of new situations
  • Great vocabulary and verbal expression
  • Low self-esteem
  • May be very naïve and lack common sense
  • May withdraw, becoming agoraphobic 
  • Messy and laborious handwriting
  • Physically awkward
  • Poor abstract reasoning
  • Poor coordination
  • Poor social skills
  • Predisposition to memorize and repeat large amounts of verbal information, but a pronounced weakness in knowing how and when to share this knowledge in socially appropriate ways
  • Taking things very literally
  • Tendency to talk excessively, using age-appropriate and even advanced sentence structures
  • Trouble adjusting to changes
  • Trouble with nonverbal communication (e.g., body language, facial expression, tone of voice)
  • Uncanny ability to read and spell single words

Thinking about the clusters of strengths and weaknesses that typify Nonverbal Learning Disabilities, it is apparent how children affected by the disorder pose unique challenges to parents, teachers and professionals. Adding to the challenge is the fact that the features of the disorder change for the worse as the youngster gets older (e.g., a young child with the disorder may demonstrate strong verbal skills and be expected to know how to apply these skills, but over time, given the weaknesses in organization, abstract thinking and social cueing – in conjunction with apparent early strengths in isolated skill areas – this same child may quickly fall behind and be perceived as lazy).

How parents and teachers can help a child with Nonverbal Learning Disabilities:
  1. Be logical, organized, clear, concise and concrete.
  2. Avoid jargon, double meanings, sarcasm, nicknames, and teasing.
  3. Be very specific about “cause and effect” relationships.
  4. Make sure your child is not on the receiving end of bullying at school. The school must make every effort to prevent it. If talking to your youngster's teachers and principal does not put an end to the victimization, ask your physician to write a letter to the school, and pursue the issue up to higher channels in the school district if necessary.
  5. Encourage the youngster to develop interests that will build his self-esteem and helps him relate to peers (e.g., if he is interested in Pokémon, pursuing this interest may open social doors for him with classmates).
  6. Get the youngster into the therapies she needs (e.g., occupational and physical therapy, psychological, or speech and language to address social issues).
  7. Have the youngster use the computer at school and at home for schoolwork.
  8. Help the youngster learn coping skills for dealing with anxiety and sensory difficulties.
  9. Help the youngster learn organizational and time management skills.
  10. Help the youngster out in group activities.
  11. Keep the environment predictable and familiar.
  12. Learn about social competence and how to teach it.
  13. Make use of the youngster’s verbal skills to help with social interactions and non-verbal experiences (e.g., giving a verbal explanation of visual material).
  14. Pay attention to sensory input from the environment (e.g., noise, temperature, smells, too many people around, etc.).
  15. Prepare the youngster for changes, giving logical explanations.
  16. Provide consistent structure and routine.
  17. Reassure the youngster that you value him for who he is. (Note: It will be a challenge to help the youngster improve social skills, while at the same time nurture his confidence to hold on to his unique individuality.)
  18. Try to find a small-group social skills training program in your school system, medical system, or community. 
  19. State your expectations clearly.
  20. Steer the youngster toward a playmate she has something in common with, and set up a play date. This is a way to get some social skills experience in a small, controlled, less-threatening way.
  21. Talk to the youngster in private after you have gone with him to a group activity. Discuss with him how he could improve the way he interacts with peers (e.g., point out that other kids don't feel comfortable when he stands so close to them). Also, help him practice the social skills you explain to him through role-playing.
  22. Teach the youngster about non-verbal communication (e.g., facial expressions, gestures).
  23. Work with your youngster’s school to modify homework assignments, testing, grading, art and physical education.

As you might have guessed by now, the tips above would also have great benefit for children with Asperger’s and High-Functioning Autism. There is clearly a significant overlap between Nonverbal Learning Disabilities and Asperger’s. In fact, it is possible that the symptoms of each diagnosis describe the same group of young people from different perspectives. Studies reveal that up to 80% of kids who meet the criteria for Asperger’s also have Nonverbal Learning Disabilities.  While there is no research on overlap in the other direction, most kids with the more severe forms of Nonverbal Learning Disabilities probably have Asperger’s as well. In a nutshell, doctors, therapists and other professionals reserve an Asperger’s diagnosis for kids with more severe social impairment and behavioral rigidity. 

The Aspergers Comprehensive Handbook

1 comment:

D Marcotte said...

Our daughter was diagnosed with both NVLD and Aspergers. We found the books by Ted Arnold to be a lot of fun to read and helped our daughter understand idioms.

My child has been rejected by his peers, ridiculed and bullied !!!

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