Question
My 4-year-old was diagnosed with Aspergers a month ago. I went for a second opinion, and that doctor doesn’t think she has Aspergers – he thinks it is NVLD. So I was reading about them and I understand that they are very similar (except that with AS, they have obsessions). My daughter does not have anything she is obsessed with, but she does need structure and routine throughout the day to regulate herself. My daughter also has Sensory Integration Disorder, which from what I understand can coexist with AS. I don’t know if I should get a 3rd opinion or just keep the Aspergers diagnosis so she can get services in school. The doctor that says he thinks it is NVLD said that Aspergers usually isn’t diagnosed until age 5 or 6, which I don’t think is true. I am just looking for your input.
Answer
There is often confusion between Aspergers (high functioning autism) and Nonverbal Learning Disabilities (NLD). In fact, sometimes these two terms are mistakenly used interchangeably. There are some basic differences though.
NLD is not included with Aspergers and Autism under the DSM-IV’s umbrella term of Pervasive Developmental Disorders. Both Aspergers and NLD children may show similar social and attentional difficulties, strong verbal skills and a confusing display of strengths and weaknesses. There are a few key items that help in a differential diagnosis though:
- if the child is helped rather than hindered by your verbal explanations, then look to NLD
- if the child’s skill at deriving meaning from what he sees is a strength, then it’s more likely he has Aspergers
The Aspergers profile of neuro-psychological assets and deficits is very similar to the NLD profile. Both have neuro-developmental abnormalities involving functions of the right cerebral hemisphere. In both disorders, there is no delay in cognitive development and speech. In fact, early verbal ability is one of the hallmarks of NLD; children with NLD are often extremely verbal and early readers.
Aspergers has been conceptualized as a "Non-Verbal Learning Disability". A comparison of NLD and Aspergers children revealed 20 out of 21 similarities, including a verbal over spatial discrepancy. Aspergers may be an extreme form of NLD.
Both Aspergers and NLD children seek out social interaction, but are often rejected by their peers. A related problem shared by both disorders is the inability to perceive or understand nonverbal cues (i.e., they are oblivious to nuances of facial expressions, body language, tone of voice, gestures, and appropriate spatial distance). Children without Aspergers or NLD use eye contact appropriately and understand that you can tell how someone feels by looking at their face. These cues are "invisible" to those with Aspergers and NLD.
The most significant problem for both Aspergers and NLD children is in the area of social relationships, whether at home or school:
- exclusion and rejection become part of life
- living with this social disability and constant rejection often leads to uncertainty, confusion, insecurity, depression, and anxiety, which they may try to relieve by creating routines and rituals
- they are often accused of rudeness, laziness, lack of caring, or a poor attitude
- they are often misunderstood
- they can't "connect" socially
- wanting to make friends and fit in, but unable to, they may respond by withdrawing, acting out with emotional outbursts, or refusing to cooperate
Aspergers and NLD diverge in the affective area. Aspergers children do not feel the same range of emotions as children with NLD. 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, and have difficulty with initiating or experiencing normal social relationships. Conversely, children with NLD have normal emotions, but are inept in expressing them - and in recognizing them in others - to the extent that they are expressed non-verbally.
Children with Aspergers generally have greater social problems. Their highly restricted interests present an additional obstacle to their social functioning. These restricted interests seem to be idiosyncratic to Aspergers children (“restricted interests” is not mentioned in the literature about NLD). This is the main difference between the two disorders, as they are most frequently defined clinically. The Aspergers child’s odd behaviors (e.g., rocking, flapping) can also contribute to his social problems (behaviors that are not present in NLD). In contrast, the NLD child’s social ineptness is mainly due to his inability to read nonverbal communication (e.g., facial expressions and gestures).
Literature on Aspergers doesn't mention problems with visual spatial issues, which are a major problem area for children with NLD. In fact, many “Aspies” respond well to visuals and diagrams, and are visual learners. Many find work as engineers or architects. In contrast, Children with NLD don't respond to physical demonstrations and may not understand diagrams. They can't learn by watching, and need everything explained in words. Thus, these children tend to become wordsmiths (e.g., teachers and writers) while “Aspies” often excel in math and find work in computer fields.
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COMMENTS:
• Anonymous said… Aspergers is no longer diagnosed. She should be diagnosed with Autism Spectrum Level I. NVLD is not diagnosable via the DSM 5. Autism is diagnosed young which is important because she will likely need individual therapy, occupational therapy, and a social thinking group.
• Anonymous said… Don't forget that Aspergers in girls also presents quite differently in part to Aspergers in boys. I feel strongly that any assistance DNS therapy is personalised on the child's individual needs based on the further assessments so take whichever diagnosis will allow you to access the help you need, it won't affect the outcomes
• Anonymous said… Each child doesn't have to hit every single box to be diagnosed-for my son I do not notice any flapping or rocking-- He is an Aspie but I have also noticed the older he gets the less sensory issues he has- they are so mild now- mostly hands in early am- ot says from no pressure on them all night so am is pretty brutal- he describes them as way to soft- but rest of day very mild if at all- hoodie now just when he is in strange place- it used to be hoodie all the time everywhere even when he was at home watching tv- so the demonstration of penguin 🐧 saying every one ☝ on spectrum is different is so so true! And I'm realizing he is mastering issues within his self so well! Also as far as interest he does have only one at a time just like friends - only one at a time- but that's his interest - and it seems more like an interest to me v/s obsession--when he was smaller it seemed more like an obsession- strange how things start balancing more as they get older- I'm sure his ot and phyc therapy is doing great things as well!
• Anonymous said… I had many many doctors/therapists fail to give the correct diagnosis for my daughter with Aspergers -they diagnosed her with generalized anxiety which was correct but it stems from aspergers - she also has sensory issues - I knew that she was on the spectrum but no one else believed it to be true - so go with your gut - truly Mom's know their child best - I wish I did so that I got my child the correct therapy when she was younger -
• Anonymous said… My daughter has a Aspergers diagnosis. At age 4 she did not obsess over anything, but at age 10 she shows plenty of obsessive behaviors. Things can change over time I guess, so I wouldn't rule out Aspergers based on that behavior not presenting at 4, it may show up as she matures.
• Anonymous said… My Son has NVLD and my daughter has Aspergers, they are similar but different. This was interesting to read and realize the differences they do have.
• Anonymous said… My son was diagnosed with Asperger's at 6 & 1/2. I'm not sure what you do if you feel like the diagnosis doesn't quite fit because with our son it's definitely exactly who he is. I can say the extra help to get him through his school day has made a world of difference. The school classifies him as High Functioning Autistic. He almost failed first grade and in third grade,last year, he made honor roll every marking period.. Teacher's knowing your child has a disability instead of thinking he/she is just a disruptive child makes a world of difference in how they are treated and your child's comfort level in school. Right now I think it's a matter of which diagnosis will get you the services you need at the school. If there is a way to make sure the teacher's will work with you to help her work on transitioning through her school day and with her sensory issues then maybe you could even wait on submitting a diagnosis to the school until Kindergarten or 1st grade when there days have a lot more school work and sitting still during the day. It may make it more clear to everyone what her most pressing issues will be moving forward and what diagnosis is most accurate.
• Anonymous said… My son was diagnosed with NVLD at 10 and it didn't seem to fit from the first moment. I'm still trying to figure out where to go from there. My hunch as he was mildly on the sprctrum. I wish I understood NLVD well enough to know my next steps better.
• Anonymous said… They dont have to be obsessed with something, sometimes it could be that they like things a curtin way "obsession stands for a broad range of things. Most doctors totally miss understand aspergers and only look for specific things instead of just different quirks about the child and getting the sensory side of things right. There is no list every person is different so therefore there should not be one set list. Apsergers would have to be one of the most complex things to understand on the planet and thats comming from a mother who has aspergers and 3 of her children and each one of us carries different symptoms and tics and quirks. :) ive come to realize a good 90% of the world actually have it in some way
• Anonymous said… We were told my daughter has aspergers too at the age of 5, she is 7 now and does get help from school. When I look at the criteria for Aspergers alone, it's nothing like her. But then when I look at HFA highly functioning autism or highly sensitive aspergers it's her to a tea!! She is also on the waiting list for autism and adhd too. The thing is with these Is that the spectrum is so huge it is difficult to say exactly what boxes she ticks. The main point is, that is will be able to get some form of help and hopefully it will help your daughter overcome some of her issues. Good luck xx
• Anonymous said… Yes, our daughter was diagnosed at 4 with NLD. (Non-verbal). We felt that there was more to it than that. Someone else in this thread said that you don't have to check every box to have AS, and I agree. We are looking into AS now because it seems to fit better. We lived in OK when she was diagnosed and now live in UT. Here it seems no one recognizes NLD as a diagnoses. They tend to think it's something diagnosticians use when they have nowhere else to turn and aren't certain on the results. You may also look into PDD-NOS. it's also on the spectrum, but is a little different than Aspergers. I also feel 4 is a young age to diagnose definitively, and it may change over time, but if you have an AS diagnosis I would run with it. It's not the name that matters, it's the symptoms. If you can get better help with one diagnoses than another, I'd say take it! Our babies need the most help they can get. If you want to talk more, I'd love to visit. Just PM me. We all need friends, including me!
Post your comment below…
• Anonymous said… Aspergers is no longer diagnosed. She should be diagnosed with Autism Spectrum Level I. NVLD is not diagnosable via the DSM 5. Autism is diagnosed young which is important because she will likely need individual therapy, occupational therapy, and a social thinking group.
• Anonymous said… Don't forget that Aspergers in girls also presents quite differently in part to Aspergers in boys. I feel strongly that any assistance DNS therapy is personalised on the child's individual needs based on the further assessments so take whichever diagnosis will allow you to access the help you need, it won't affect the outcomes
• Anonymous said… Each child doesn't have to hit every single box to be diagnosed-for my son I do not notice any flapping or rocking-- He is an Aspie but I have also noticed the older he gets the less sensory issues he has- they are so mild now- mostly hands in early am- ot says from no pressure on them all night so am is pretty brutal- he describes them as way to soft- but rest of day very mild if at all- hoodie now just when he is in strange place- it used to be hoodie all the time everywhere even when he was at home watching tv- so the demonstration of penguin 🐧 saying every one ☝ on spectrum is different is so so true! And I'm realizing he is mastering issues within his self so well! Also as far as interest he does have only one at a time just like friends - only one at a time- but that's his interest - and it seems more like an interest to me v/s obsession--when he was smaller it seemed more like an obsession- strange how things start balancing more as they get older- I'm sure his ot and phyc therapy is doing great things as well!
• Anonymous said… I had many many doctors/therapists fail to give the correct diagnosis for my daughter with Aspergers -they diagnosed her with generalized anxiety which was correct but it stems from aspergers - she also has sensory issues - I knew that she was on the spectrum but no one else believed it to be true - so go with your gut - truly Mom's know their child best - I wish I did so that I got my child the correct therapy when she was younger -
• Anonymous said… My daughter has a Aspergers diagnosis. At age 4 she did not obsess over anything, but at age 10 she shows plenty of obsessive behaviors. Things can change over time I guess, so I wouldn't rule out Aspergers based on that behavior not presenting at 4, it may show up as she matures.
• Anonymous said… My Son has NVLD and my daughter has Aspergers, they are similar but different. This was interesting to read and realize the differences they do have.
• Anonymous said… My son was diagnosed with Asperger's at 6 & 1/2. I'm not sure what you do if you feel like the diagnosis doesn't quite fit because with our son it's definitely exactly who he is. I can say the extra help to get him through his school day has made a world of difference. The school classifies him as High Functioning Autistic. He almost failed first grade and in third grade,last year, he made honor roll every marking period.. Teacher's knowing your child has a disability instead of thinking he/she is just a disruptive child makes a world of difference in how they are treated and your child's comfort level in school. Right now I think it's a matter of which diagnosis will get you the services you need at the school. If there is a way to make sure the teacher's will work with you to help her work on transitioning through her school day and with her sensory issues then maybe you could even wait on submitting a diagnosis to the school until Kindergarten or 1st grade when there days have a lot more school work and sitting still during the day. It may make it more clear to everyone what her most pressing issues will be moving forward and what diagnosis is most accurate.
• Anonymous said… My son was diagnosed with NVLD at 10 and it didn't seem to fit from the first moment. I'm still trying to figure out where to go from there. My hunch as he was mildly on the sprctrum. I wish I understood NLVD well enough to know my next steps better.
• Anonymous said… They dont have to be obsessed with something, sometimes it could be that they like things a curtin way "obsession stands for a broad range of things. Most doctors totally miss understand aspergers and only look for specific things instead of just different quirks about the child and getting the sensory side of things right. There is no list every person is different so therefore there should not be one set list. Apsergers would have to be one of the most complex things to understand on the planet and thats comming from a mother who has aspergers and 3 of her children and each one of us carries different symptoms and tics and quirks. :) ive come to realize a good 90% of the world actually have it in some way
• Anonymous said… We were told my daughter has aspergers too at the age of 5, she is 7 now and does get help from school. When I look at the criteria for Aspergers alone, it's nothing like her. But then when I look at HFA highly functioning autism or highly sensitive aspergers it's her to a tea!! She is also on the waiting list for autism and adhd too. The thing is with these Is that the spectrum is so huge it is difficult to say exactly what boxes she ticks. The main point is, that is will be able to get some form of help and hopefully it will help your daughter overcome some of her issues. Good luck xx
• Anonymous said… Yes, our daughter was diagnosed at 4 with NLD. (Non-verbal). We felt that there was more to it than that. Someone else in this thread said that you don't have to check every box to have AS, and I agree. We are looking into AS now because it seems to fit better. We lived in OK when she was diagnosed and now live in UT. Here it seems no one recognizes NLD as a diagnoses. They tend to think it's something diagnosticians use when they have nowhere else to turn and aren't certain on the results. You may also look into PDD-NOS. it's also on the spectrum, but is a little different than Aspergers. I also feel 4 is a young age to diagnose definitively, and it may change over time, but if you have an AS diagnosis I would run with it. It's not the name that matters, it's the symptoms. If you can get better help with one diagnoses than another, I'd say take it! Our babies need the most help they can get. If you want to talk more, I'd love to visit. Just PM me. We all need friends, including me!
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