Comparing Nonverbal Learning Disability (NVLD or NLD) and autism (Asperger’s) is like comparing apples and oranges. Asperger’s (now called autism spectrum disorder level 1) is a medical psychiatric diagnosis. An autism diagnosis is made by taking a careful history, observation, and sometimes questionnaires or interactive protocols. A deficit in social relationships is among the top criteria. NLD is not a psychiatric or medical diagnosis listed in the DSM-V; it is a neuropsychological diagnosis from testing. NLD isn’t really a learning disability. It’s a pattern of strengths (verbal) and weaknesses (visual-spatial) found on neuropsycholocial testing. Both Aspergers and NLD would be considered “neurodiversity,” a different way of having our brains be “wired.”
People have studied NLD and there are books and papers dealing with NLD; people have studied Asperger’s syndrome and there are books and papers on Asperger’s syndrome. The question is how different are NLD and Asperger’s, and do they overlap? Some researchers in the autism field have started asking this question; many people with Asperger’s have an NLD neuropsychological profile.
Both people on the autism spectrum and those with NLD have difficulties in reading the nonverbal cues that are most of social emotional communications. Both have difficulty with social relationships, pragmatic language, fine and gross motor challenges and can have sensory hypersensitivity. Both can have co-existing challenges such as OCD and ADHD. Both are navigating a world that requires processing rapid complex nonverbal information, and develop compensatory strategies (including inflexibility in how to do things) to deal with the complexities of day to day life.
Asperger’s is an autism spectrum disorder diagnosis and NLD is not, and many with NLD would not be diagnosed autistic. However, some neuropsychiatric research has shown that people with NLD and Asperger’s have a similar pattern of altered functioning on the right side of the brain, while those with high functioning autism have left sided challenges.
A difference in diagnosing autism is the presence of repetitive behavior, which can take the form of areas of intense interest. These interests can be more “normal” than expected, such as interests in computers, programming, art, and activities. Repetitive behavior can refer to what is called non-functional behaviors; people on the autism spectrum describe behaviors such as hand flapping or rocking as self-calming, helpful and very functional.
Why is it important to think about the overlap between NLD and Aspergers’s? An important reason is that the availability of services and therapy depend on the label or diagnosis given.
Because deficits in social understanding and social communication are core to an autism diagnosis, social skills groups are usually available through schools or privately for children on the autism spectrum. Social problems result in teasing, anxiety and depression, so therapy is often a necessary part of treatment for those with autism. Insurance may cover group or individual therapy because those with autism have a medical diagnosis.
Children with NLD are identified by testing that shows visual-spatial weaknesses that contrast with their verbal strengths. Social skills aren’t part of the diagnosis. However, children with NLD also need help with social skills and therapy for anxiety or depression. Parents usually don’t find groups designated for children with NLD, and often can’t find clinicians who even have heard of NLD. Another diagnosis such as anxiety or depression would need to be used to get insurance to cover treatment.
The visual-spatial deficits of NLD are often associated with problems in writing, math, higher level language skills, getting main ideas and executive functions. Children with NLD often need help in breaking down homework assignments and study guides, They get academic help for documented learning issues. Children with autism often have the same learning problems but their learning challenges are frequently ignored because people assume all their problems are simply due to autism. If they aren’t willing or able to write or do homework, it’s often considered a behavior problem.
I used think to distinguishing between Aspergers and NLD was an easy question. When I was trained eons ago, the NLD children were the ones who had social problems but desperately wanted friends and who had less “weird” interests. They had empathy. They didn’t look like the stereotypical idea of an autistic person. The children on the autism spectrum were thought to have less interest in relationships and to have unusual intense interests, such as train schedules or taking apart mechanical devices. It was assumed that they lacked empathy, even though their parents often described them as sweet kids who were caring and showed empathy for family members.
Over the years, I’ve learned that these ideas about children and adults on the autism spectrum couldn’t be more wrong. There is a stereotype of autism based on a particular model in boys. People who are diagnosed with autism often don’t look like any stereotype. Many teenagers and young adults who have many autistic traits are told they “can’t be autistic because they’re not like Sheldon,” an autistic character on TV. Autistic children (and adults) often are lonely. They want relationships, but find it difficult to understand social behavior considered normal, and “normal” children didn’t understand their efforts to relate or their behavior. People who are on the autistic spectrum can be extremely empathic, although they might show empathy differently.
The diagnosis of NLD is also undergoing rethinking. There is a debate as to whether NLD is a legitimate diagnosis in the sense of having a single underlying etiology, and since different individuals with NLD might have different aspects of the syndrome and seem unlike each other. Parents of children diagnosed with NLD might find a school to be familiar with the diagnosis or they might find a complete lack of knowledge.
Increasing sophistication in neurobiological research should help clarify these diagnostic questions about Aspergers, NLD and autism more generally. Meanwhile, there is a need for all these children and adults to get the help they need across social, emotional and academic domains. Right now, depending on the label given, some but not all needed help is available or is even considered necessary and supported. Parents are often at a loss to find clinicians who understand the neuropsychological aspects of their children’s problems.
However the line is ultimately drawn in differentiating Asperger’s and NLD, both require services addressing the full range of their needs and a much more complete understanding of their ways of thinking and processing their experiences. Further understanding of the relationship between NLD and Aspergers would help define and hopefully encourage a broader range of services to both.