Questions and Answers
Question #48


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Questions and Answers

 

Question # 48

Are persons with NLD more prone to the development of Schizophrenia than are members of the general population?


Answer (in collaboration with Dr. Saadia Ahmad and Dr. Brian Burke):

There appears to be a slightly higher than expected incidence of the diagnosis of Schizophrenia in persons with NLD. There are many facets, nuances, and clarifications that need to be made vis-à-vis this generalization. Some of these are as follows:

(1) Comorbidity. It is possible to have measles and a broken leg. It is possible for a person to have NLD and Schizophrenia, with no shared etiological features.

(2) Age of onset. Schizophrenia typically appears in late adolescence. Indications of significant psychosocial disturbance in persons with NLD are usually evident in middle to late childhood.

(3) Rapidity of onset. The onset of Schizophrenia is typically rather sudden, with few if any “warning signs.” Persons with NLD appear to “grow into” their serious psychosocial difficulties.

(4) Response to antipsychotic medications. The symptoms of schizophrenia typically recede, even disappear, with properly titrated antipsychotic medications. Such medications have no positive effects on the psychosocial disturbances of persons with NLD.

(5) Response to cognitive-behavioural interventions. Persons with NLD typically respond in a very positive manner to systematic cognitive-behavioural interventions designed to enhance skill-learning. Persons with Schizophrenia show little or no positive response to such interventions until they receive appropriate levels of antipsychotic medications.

(6) Paleological reasoning. This is a frequent symptom evident in persons with Schizophrenia. The concept-formation and reasoning of persons with NLD, although quite deficient, is free of this feature.

(7) Primary deficits of NLD. Persons with NLD exhibit their primary deficits in tactile and visual-spatial perception, in psychomotor coordination, and in their nonadaptive responses to novelty (see NLD Content and Dynamics). There is no reliable evidence that these deficits are prominent in persons with Schizophrenia.

(8) Schizo-Affective Disorder, etc. and Diagnostic Overshadowing. Over many years of clinical practice, my colleagues and I have assessed many persons who carry a diagnosis or Schizo-Affective Disorder, Schizophrenia NOS, atypical Schizophrenia, and/or Schizophrenia (Disorganized Type), and who exhibited the syndrome of NLD. Indeed, a perusal of the developmental histories of these individuals most often revealed a course that is typical of persons with NLD, not Schizophrenia. We have found that a treatment programme designed for persons with NLD is a better option for them than that usually offered in a typical psychosis pathway.

For those persons who exhibit the syndrome of NLD and some variety of Schizophrenia, it is important to insure that both disorders receive sufficient attention. At most significant risk for inadequate/incomplete treatment are those whose NLD is effectively “masked” by this comorbid condition. [This is an example of “diagnostic overshadowing.”] Of course, there is a significant probability that what is diagnosed as Schizophrenia is much more adequately designated as NLD. This is virtually always the case when the person is described by experienced clinicians as exhibiting “schizoid” behaviours.

(9) Neurological Disease and the Syndrome of NLD. The too-facile diagnosis of Schizophrenia in persons with those types of neurological disease, disorder, and dysfunction whose behavioural phenotypes include the syndrome of NLD (see NLD and Neurological Disease) is fraught with problems. In such instances, for example, the administration of psychoactive medications usually helpful for persons with Schizophrenia may be counterproductive. In addition, the “masking” of NLD by the combination of neurological and “schizoid” features/symptoms may divert care-givers from considering forms of treatment emphasizing skill-learning that are crucial for persons with NLD.

Bottom Line. Persons with NLD are clearly at significant risk for being diagnosed with Schizophrenia. Whether persons with NLD are more likely to suffer from Schizophrenia than are members of the general population is in doubt. That said, it is clear that persons with NLD require treatment specifically designed for persons with NLD, regardless of any other valid or improperly diagnosed comorbidities.


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