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NLD and Asperger's Disorder

Joe Palombo

Nonverbal Learning Disabilities, Chapter 11, pages 205-218

NLD and SELD

As we have seen, Denckla (1983; 1991) advocated for a separate category called "social-emotional learning disability" (SELD) that is distinct from NLD. I could find no statement in her published work regarding her position on the issue of the relationship between NLD and Asperger's disorder or autistic spectrum disorders.

In an early paper, Voeller (1991) stated that "the core deficit linking AD [autistic disorder], AS [Asperger syndrome], and SELD is impaired social competence. The distinction is based on severity and associated features" (p. 739). A few years later Voeller (1997) noted that "the social deficits seen in SELD can be dissociated from the neuropsychological and academic deficits seen in nonverbal learning disability A child can have nonverbal learning disability without the array of social deficits and the child with SELD can be quite competent in math and lack the visuoperceptual deficits that characterize nonverbal learning disability" (p. 796). Voeller is proposing two distinct disorders, one of which involves deficits in visual-spatial processing and the other in the ability to process social-emotional information and to make correct inferences about the meaning of social cues. She too suggests that the difficulties in the latter disorder may be related to primary deficits in theory-of-mind functioning. In addition, those children have pragmatic language problems and difficulties judging what is relevant or irrelevant in a given social situation. Finally, at the emotional level, children with SELD can have difficulty with the identification and processing of affects in some instances. Although she suggests that the symptoms of children with SELD can be "mapped onto" the symptoms of children with Asperger’s disorder, she stops short of saying that the two are identical. I believe that this is due, in part, to her belief that Asperger's disorder is a psychiatric disorder, found in DSM-IV whereas SELD is a neurobehavioral entity suggested by neurologists and neuropsychologists. The labels are the creations of different disciplines.

In the absence of data from children diagnosed as having SELD, with no Visual-perceptual, visual-spatial, or visual memory problems, we may only speculate as to their social-emotional profile. The hazard of introducing a new label for a disorder is that unless it is followed by research that justifies its introduction, it remains a pure academic exercise. With some justification, Denckla (2000) states:

Little progress has been made since 1993 in the clinical field of socio-emotional learning disabilities .... The clinician, therefore, is limited to recognition of the existence of a type of learning disability, an NVLD [nonverbal learning disability, that is characterized better by what is spared-well-developed linguistic elements, rote verbal memory, basic reading (i.e., decoding) and spelling skills-than by what is deficient. (p. 314)

In a personal communication with Lipton, (February 14, 2005), she suggested that a useful alternative is the creation of a category called social-emotional learning disorders (with the same acronym, SELD). She substitutes the term disorders for disabilities because of the problems associated with considering these disorders as "learning disabilities" rather than is neurobehavioral disorders. Such a category focuses on the child’s social-emotional functioning. According to Lipton, the criteria used in an evaluation of a child's functioning would include (1) the extent of the child's social interests (desire for age-appropriate, reciprocal peer relationships), (2) the capacity for the comprehension of social-emotional communications, and (3) the ability to give expression to social-emotional behaviors required for effective peer relationships. The children who would be assessed through this algorithm would include all the children (with normal intellectual capacity) who are thought to have developmental brain-based difficulties with sociability and as well as those who fall within the autistic spectrum and children currently diagnosed with NLDs. The rationale for the category is that the symptoms of these children reflect core brain-based deficits in social-emotional cognition.

An advantage of this strategy would be the elimination of the variety of labels currently in use, which only confuses the diagnostic picture. The disadvantage is that, as a dimensional approach to disorders, it would not permit lines of demarcation to be drawn between different disorders. It would assume that the brain mechanisms of such diverse entities as autism and NLD are similar, unless we could specify the brain region in which the impairment that gives rise to the symptoms exists.

In the absence of supporting data, except that of children and adults with right-hemisphere dysfunctions, the differentiation between NLD and SELD leaves open the question as to the differences between the two disorders. If we were to exclude the group of children with visual and visual-spatial deficits from the group diagnosed with NLDs, would tile residual group of children be diagnosed with Asperger’s disorder or with an autistic spectrum disorder? In their 1997 paper Klin and Volkmar lump together SELD and other right-hemisphere disorders, indicating that eventually the right-hemisphere dysfunction may serve to differentiate among these disorders.