Both attention deficit hyperactivity disorder (ADHD) and a nonverbal learning disability (NVLD) are life long neurobiological challenges. ADHD was first formally recognized as a disorder by the American Psychiatric Association (APA) in the 1960’s. Today, ADHD is one of the most commonly diagnosed and perhaps over diagnosed childhood and adolescent disorders. In contrast, NVLD has yet to be formally recognized and is generally overlooked, underdiagnosed, and misunderstood. Moreover, NVLD is frequently mistaken for ADHD.
Risks of Misidentifying NVLD and ADHD
One of the key dangers of misidentifying mental health disorders is the distress it can cause the individual and their family. A lack of proper identification can result in unrealistic demands, expectations and overestimations of the individual’s ability. Subsequent self esteem and self confidence issues, social and emotional concerns, as well as academic struggles and frustrations can give rise to a lifetime of challenges.
Wrongful pharmaceutical treatment is another risk that improper identification can cause. Although ADHD can and does commonly coexist with NVLD, ADHD intervention and pharmacological treatment is usually ineffective for the management of NVLD symptoms. Increasing the dosage of the ADHD medication or changing the medication will have little or no impact on the challenges that NVLD presents and can lead to adverse effects.
Part of the reason for the confusion is because these two conditions share many of the same symptomatology, even though the underlying foundation of the symptoms differ. Since ADHD symptoms are more commonly recognized and understood, it is not surprising that at first glance individuals with NVLD can be misidentified as having ADHD.
Some of the shared observable symptoms include:
- Excessive talking
- Interrupting people/Impulsivity
- Poor interpersonal skills
- Difficulty with peers
- Difficulty with problem solving
- Poor organization skills
- Poor time management skills
- Inattentive, forgetful and easily distracted
- Requires extra time to complete tasks
- Does not follow through or complete tasks
- Trouble with transitions
- Inflexible and rigid
- Extreme behavioral issues/emotional dysregulation
- Argumentative and oppositional
- Academic performance inconsistent
So what can be done to ensure an accurate diagnosis of NVLD?
The first step is to consult with a neuropsychologist who has expertise in ADHD, NVLD and other learning disabilities and who can differentiate between possible disorders. A detailed history of the individual’s development, socio emotional well-being, and academic performances must be taken. Just as important, specific information regarding the individual’s fine and gross motor abilities, interpersonal and visual spatial skills should also be collected.
The neuropsychological battery of tests must consist of a cognitive evaluation (such as Wechsler Intelligence Tests), academic testing and visual spatial/perceptual measures. Individuals with NVLD typically score significantly higher on verbal measures as compared to nonverbal measures and delays in reading accuracy, reading comprehension, written expression and/or mathematics are characteristic and usually become apparent in the upper elementary grade levels. Finally, it is important to understand that an ADHD diagnosis should never be made solely on information gathered from subjective measures of attention (such as rating scales), as this can give rise to a false positive ADHD diagnosis (for the reasons mentioned above), but must also include data from other tests, including objective measures of attention (such as the Test of Everyday Attention).