Should Asperger's and Nonverbal learning disability be separate diagnoses?
I was diagnosed with Asperger’s syndrome when I was in tenth grade, and my parents assured me it was the most fitting diagnosis. After being mistakenly diagnosed as schizophrenic when I was hospitalized after failing eighth grade for major depression, this diagnosis seemed appropriate because I’d never heard of it before, and none of the other diagnoses I had been saddled with seemed to fit.. I read Tony Atwood’s first book on Asperger’s syndrome and felt like it was describing me. From then on, I knew that Asperger’s syndrome was what I had.
But was it? There is another disability, a lesser known diagnosis that perhaps fit me better than Asperger’s: Nonverbal learning disability. Little is known about this disorder, and some suggest that it is the same or just another expression of Asperger’s and shouldn’t be categorized separately. In this piece, I will explore the similarities and differences between the two syndromes, how it may apply to me, and most importantly, whether the two disabilities should be regarded as distinct and separate diagnoses.
Both aspies and people with NVLD (Nonverbal learning disability) have trouble recognizing non-verbal cues and body language. Both have trouble with eye contact, recognizing people’s facial expressions and emotions, and making friends. Because both can’t read facial expressions, they have poor social judgment and may have odd conversation habits that may appear rude to the “average” person. They both may change conversation topics in a way that appears self-centered and rude, and may appear oblivious to the odd way they socialize. They may have relationships with children much older or younger than them, where they may not be seen quite as odd.
Both also have trouble with motor coordination, which causes them to be bad at sports, and thus, often get made fun of. Both also often have “sloppy” handwriting. Basically, in the area of socializing, Aspies and NVLDer’s have mostly the same symptoms.
According to nldontheweb.com, up to 80% of the people who meet the diagnostic criteria for Asperger’s syndrome also have nonverbal learning disability. The differences between the two syndromes aren’t very clearly defined. It also doesn’t help that NVLD hasn’t ever even been included in the DSM (Diagnostic statistical manual), so it’s hard to make explicit what exactly separates Asperger’s from NVLD. But there do seem to be some differences.
NVLD is called a learning disability for a reason. Although people with Asperger’s often have academic difficulties, people with NVLD have very specific academic difficulties ( as well as strengths). They typically have deficits in visual/spatial skills, especially as it relates to mathematics. They have extreme difficulty with mathematics, particularly higher level mathematics like algebra. Detection of these difficulties in elementary school is very difficult because they often have superb spelling and grammar skills, and their mathematical difficulties may not truly arise until middle school. Simple multiplication and division may be easy, but becomes more advanced and difficult for the child as grade levels advance. Because of the emphasis on good grammar and reading skills in our society, their learning difficulties may not be recognized until later in schooling, and even then, some teachers may dismiss them as troublemakers or slackers who are unwilling to learn, and dismiss any possibility of a learning disability. People with dyslexia are more quickly identified and accommodated in our society because their deficits are more easily recognized early in childhood than those with NVLD. But NVLD can be just as severe.
They have bad organizational skills and attention deficits as well, and because they tend to be particularly good at spelling and grammar, the possibility of a learning disability is written off by teachers and faculty, in favor of a false and insulting narrative that the child is unwilling to learn and/or is a troublemaker. It doesn’t help that NVLD isn’t recognized in the DSM, so teachers cannot recognize these difficulties for what they are and instead misjudge the child.
Despite having good grammatical skills, those with NVLD may also have poor reading comprehension skills. They may be able to read a paragraph aloud perfectly, but have trouble explaining what they just read or getting the main “jist’ of it. Some have suggested that NVLD’er’s have poor writing skills, but I question this suggestion, partly because it seems a little counterintuitive; if their strengths lie in grammar and spelling, why would they necessarily be bad writers? (more on this later).
On the contrary, although perhaps most of Aspies have academic difficulties in one area or another, it is not necessarily confined to mathematics or spatial skills. In fact, they may be quite strong in those areas, and their deficits may lie in reading or writing. Since Asperger’s syndrome is often stereotyped as “geek” syndrome, it is not surprising that some stereotype aspies as being brilliant at math and science, even though they may not necessarily be true.
In addition, although people with asperger’s are far more likely to be male than female, the gender ratio for NVLD appears to be evenly split between boys and girls, about 50-50. And some research suggests that people with NVLD are less likely to have a “special interest” that they obsess about to the exclusion of other activities. Also, some say that NVLDer’s don’t “stim,” meaning they don’t do the repetitive motor mannerisms like hand flapping or finger twitching that is so common among Aspies. Some suggest that NVLD is merely the female expression of Asperger’s syndrome.
Like I said in the beginning, I was diagnosed with Asperger’s syndrome, but NVLD may have been more fitting for me. However, I do meet most of the diagnostic symptoms of Asperger’s syndrome. I have poor eye contact, I have trouble recognizing social cues, I’ve always had a supremely hard time at making friends, I have obsessive interests, I do “stimming,” and my conversations and interests are one-sided, meaning I lack “social and emotion reciprocity,” and may appear self-centered. In these areas, perhaps Asperger’s was the appropriate diagnosis for me.
However, early in life, my strengths were always spelling, grammar and writing, which was one of the reasons I chose to major in English when I went to college. My main problem subject area has always been math, and I needed a tutor in college for every math class I ever took, even for pre-algebra. I’m also somewhat bad in the physical sciences, and generally struggle with non-verbal subjects. My strengths have always lied in humanities-related subjects.
Starting in middle school, my learning deficits really began to show. I had an extremely hard time paying attention, my organizational skills were terrible, and I of course struggled in math and science. I failed eighth grade as a result of these difficulties, and I had to have a tutor in every class afterwards in order to properly get my work done and graduate from high school.
Many teachers in middle school thought I was a slacker who just didn’t want to learn, and didn’t take into account the fact that I had genuine learning difficulties. Other students made fun of me, and of course, I was bullied quite bad like most people with either Asperger’s or NVLD.
So what was I? Aspie or NVLD’er? Although my specific academic difficulties might warrant a diagnosis of NVLD, I also have had obsessive special interests throughout my life, which some suggest people with NVLD typically don’t have. I also “stimmed,” and still do today. In addition, people with NVLD are said to be bad writers, and this is not true in my case. In fact, the main reason I majored in English in college was because I knew I was a good writer. On the other hand, although I like to read, I sometimes struggle with it because I have genuine reading comprehension issues at times. I may read a sentence three to four times and still not get it. I read quite frequently in my spare time, but because my comprehension issues make me a painfully slow reader at times, some people may wonder why I bother with it at all.
My conclusion is that it doesn’t much matter whether you are diagnosed with NVLD or Asperger‘s, as long as your problems are addressed and accommodated by people who understand that you have a disability. Labels are just labels, and people are complex creatures who may have the symptoms of some aspects of a disorder, but not other aspects, where they could genuinely meet the criteria for two different disorders, or even neither. People with Asperger‘s, for example, can have genuine problems with math or science (despite the stereotypes), without necessarily having to change their diagnosis to NVLD. I’m not suggesting that NVLD is not recognized as a specific diagnosis. In fact, I would like the new DSM to recognize it, if for no other reason than to make explicit a very specific type of learning disability that is usually ignored in our reading-and-writing-centered society. But the purported differences between the two disorders are slim and can be easily applied in either diagnostic area. This is why more research needs to be done on NVLD so we can find out if there is indeed anything particularly specific that warrants strictly separating the two conditions into different categories.