NLD vs Asperger’s syndrome

The Diagnostic and Statistical Manual of Mental Disorders IV published by the American Psychiatric Association has grown with each publication since its inception as more and more disorders were identified. As increasingly distinctive points have been identified for various disorders, the criteria for diagnostic definition and treatment have evolved. Asperger’s syndrome is a good example of one such disorder that wasn’t even discovered till 1944 and has already been eliminated in 2013.

Asperger’s syndrome was discovered by a paediatrician called Hans Asperger in 1944 who studied clumsy children in his practice and noticed their lack of non-verbal communication and limited spectrum of empathising compared to other children. Although, it became a formalised diagnosis only in 1990s it has been eliminated from the DSM-5 2013 edition and replaced by Autism spectrum disorder of a severe degree. Non verbal learning disorder, in contrast, is a disorder characterised by significant difficulty in complex verbal skills, lower motor skills and social skills, all visible on an IQ test.

The exact cause of Asperger’s syndrome is not known but possibility of genes being involved is not discarded. Yet, no genetic cause has been identified nor have imaging techniques of the brain given a clue to where the disorder might originate. The cause of NLD also remains elusive to the medical fraternity yet.

The symptoms are all functional, since no pathologist can attribute it to the dysfunctioning of any particular organ. There is severe difficulty in social interaction like sharing objects with others, sharing emotions with others combined with a lack of eye contact, gestures, facial expressions and appropriate body postures. Repetitive behaviours are common and a military-like strict adherence to routine to the degree of inflexibility. The characteristic feature of Asperger’s syndrome is the pursuit of a single or very narrow field of interest without any particular reason. Stereotyping and restricted repetitive behaviours like flapping of hands, tics etc. characterise Asperger’s syndrome. Language and speech do not have much developmental delay but usage is atypical and idiosyncratic.

NLD is characterised by difficulty in mathematics and arithmetical calculations, walking, running, drawing and writing. On the other hand they often have very strong verbal skills and can literally talk themselves through situations that involve skills that they might be weak at. People with NLD often have severe anxiety with an intense fear of failure often leading them to stagnate and end up in frustration. Clumsiness in everyday actions can lead to severe criticism at school and workplace often leading to depression. There might be unusually good audio-visual skills and rote memory.

Diagnosis for Asperger’s syndrome is by the criteria in DSM-V. Diagnosis is not yet formalised in the DSM-5 although the agreed-upon criteria for diagnosis has been declared.

There is no single treatment for Asperger’s and absolutely no cure. Therapies for abnormalities of speech and interaction are available to improve daily social communication and needs multi-disciplinary approach. Treatment for NLD too is symptom-specific. Drugs might be used to treat the anxiety, depression. Motor disabilities might be improved upon by physiotherapy and occupational therapy.

Take home pointers:

Asperger’s syndrome is no longer a separate diagnosis but a disorder on the autism spectrum of a severe degree, as stated in the DSM-5. NLD doesn’t yet feature as a formalised diagnosis.
Symptoms of both are similar. Asperger’s syndrome has many verbal difficulties while NLD has verbiage as a skill set.
Diagnosis for both is purely clinical. No tests are available for either.
Treatment is multi-disciplinary for both with speech therapy, occupational therapy and physiotherapy all being utilised on an individual need basis.

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