Questions and Answers
Question # 7
What is the comorbidity of NLD and Attention Deficit/Hyperactivity Disorder?
Persons with NLD very often exhibit problems in maintaining attention to tactile and visual stimuli. These difficulties are apparent from early childhood. Because of this, children with NLD are frequently classified as having Attention Deficit Disorder (ADD), with or without Hyperactivity. This diagnosis is made in spite of the very obvious attentional deployment assets in the auditory modality that children with NLD exhibit.
It is clearly possible to have NLD and ADD, each arising from different etiologies. That said, however, it is also the case that most children with NLD who are diagnosed with ADD are, in fact, not suffering from both sets of difficulties. The diagnosis of ADD in children with NLD is usually based on inattentiveness to visual and tactile stimuli in the very early school years. Because much of the "teaching" that goes on in the earliest school years is visually mediated and requires "hands on" exercises (two areas wherein children with NLD have enormous difficulties), their inability to do such tasks is often misinterpreted as a primary failure in attention to them. Of course, in the NLD model, such inattention is thought to be a secondary deficit that stems from more basic deficits in primary visual and tactile perception (see NLD Content and Dynamics,
None of this prevents or protects young children with NLD from being prescribed Methylphenidate (Ritalin) or other cortical stimulants for the treatment of their apparent (i.e., inferred) ADD. Indeed, follow-up of children with NLD who are prescribed Ritalin or other forms of stimulant medication almost always leads to the conclusion that the drug has been "effective." That is, the child with NLD who has taken the medication over a period of time tends to be classified as a "positive responder" to it. I would suggest that this conclusion is best characterized as an example of the false attribution of therapeutic efficacy. Because the expected positive result is achieved, it is thought that the pharmaceutical agent employed was responsible for the therapeutically beneficial change. However, this ignores any consideration of the natural (developmental) history of NLD: specifically, that the child with NLD goes through an early period of seeming to be hyperactive, then later is seen as normoactive, and by early adolescence is quite noticeably hypoactive. Similarly, the young (4- to 6-year-old) child with NLD is seen as inattentive, but quite clearly loses this inattentiveness as the source of information delivery in the classroom becomes increasingly of the auditory variety. Conclusion: An examination of the natural history of those children with NLD who do not receive stimulant medication would suggest strongly that the stimulant medication thought to be "effective" in children with NLD who receive it is, in fact, no more therapeutically efficacious than a placebo or M & Ms would be.