Best Caught Early
Despite their facility with language, kids with NLD often have poor reading comprehension. A child with NLD may miss the forest and the trees because of his intense focus on the leaves. After reading a book about the Civil War, for instance, the child might be able to name and describe each battlefield - yet fail to recognize that the conflict was about slavery and federalism.
Young children with NLD are often good at compensating for their limitations. But once they hit puberty, NLDers often experience severe anxiety. In adulthood, mood disorders - combined with trouble picking up social cues and setting priorities - make it hard for people with NLD to hold on to jobs and relationships. The earlier the correct diagnosis is made and appropriate interventions begin, the better the outlook for a person with NLD.
No Conception of Deception
Far more than other children, kids with NLD rely mostly on language to learn about their world. Yet because they have trouble with abstract concepts, their language comprehension and speech lack nuance.
When an exasperated mom says, "Don't let me see you playing with that toy any more," her child with NLD might continue to play with it, but turn away - so his mom cannot see him. No wonder NLD kids are often considered smart alecks.
Because they're literal-minded, children with NLD tend to be naïve and virtually incapable of deception. These traits are often endearing, but they can cause heartbreak when a child reaches adolescence. For example, a teenage girl who cannot comprehend lying may not hesitate to befriend a stranger who offers her a ride home.
At first glance, children with NLD seem to behave like those with ADD, but the appropriate interventions are not the same. A child with NLD may have trouble sitting still and may bump into people. But this isn't due to hyperactivity - it's due to his poor balance and coordination, and trouble with visuospatial relationships.
Some children have both ADHD and NLD. "You can miss NLD in children with ADHD if you don't have a thorough neuropsych evaluation," cautions Ruth Nass, M.D., professor of pediatric neurology at New York University School of Medicine in New York City.
Making the Diagnosis
NLD varies from child to child, and is not defined as a separate entity in the Diagnostic and Statistical Manual. For diagnosis, a child must undergo neuropsychological testing, speech and language assessment, and educational and occupational therapy evaluations.
As measured by the Wechsler Intelligence Scale for Children, kids with NLD usually demonstrate a verbal I.Q. that's 20 or more points higher than their performance I.Q. (Verbal I.Q. is a measure of a child's language ability. Performance I.Q. measures how well he makes use of what he knows.) Another test, the Brown ADHD Scales, can help differentiate NLD from ADHD.
ADHD and NLD: Overlapping Signs
One reason doctors have trouble diagnosing NLD is because it shares similar symptoms with ADHD such as…
- Poor social skills
- Academic difficulties
- Overfocusing on certain tasks
- Excessive talking
- Speaking without thinking about it first