I’ve just posted a response to a question re nld in which I outlined a “subtypes” theory of a psychologist who specializes in nld (and I’m using lower case because I like des’s response in that thread-I just want to add letters that reflect the subtypes!)
Having deduced that my son reflects the attentional type of nld, with attentional difficulties that are secondary to the nld syndrome (and which tend to be evident more at school than at home), I am wondering who has had experience with using Ritalin for attentional difficulties that are either accompanied by nlds, or are secondary to them?
What if any changes did you note?
According to my local expert, some members of this population are helped by this medication. For ex. written output and quality increases—reinforcing the idea that attentional problems are primary when they may not be. (Underlying difficulties with perceptual organization/processing speed are not resolved by medication, however.)
Russell Barkley (whose lengthy interview re ADD/ADHD can be accessed through an entry on this board) puts the number of this group that are helped at only around 20%.
We are seeing an ADD paediatrician specialist next week (at the suggestion of the psychoed. consultant who did testing), and I will be curious to see how knowledgeable he is about nlds.
Thank you in advance for your responses/comments.
JanL
Book that subtypes nld
It is called Nonverbal Learning Disabilities and Their Clinical Subtypes: Assessment, Diagnosis and Management: A handbook for Parents and Professionals by Maggie Mamen, a clinical psychologist in Ottawa, Ontario, Canada, who specializes in this syndrome.
It is published privately by her consulting group, however, so you won’t find it on Amazon. It can be ordered on-line from a parenting bookstore in Toronto, but I’m not sure of the store’s name. (It’s likely something obvious such as The Parents’ Bookstore.) Googling with parenting + bookstore + Toronto would get you to it.
It is a small but useful book, and I intend to order my own copy after I return my loaner.
JanL
attention v. visual perception problems
Here’s what my author, Maggie Mamen, has to say about distinguishing the 2:”…visual-motor and visual-perceptual tasks are often poorly performed because of very poor attention to visual detail…Thus, A-NLD children have a lower score on the index measuring Perceptual Organization, or even Processing Speed, than they do on the Freedom from Distractibility index that is usually significantly affected in children with attentional disorders. ”
Teachers often see minor mistakes in writing and math as attentional rather than visual-perceptual, but the visual-perceptual problem is key. Getting kids to verbalize as they work helps.
Re: Medication and nld (inattentive)
Being effective forf 20% of kids doesn’t mean much — what matters is if your kiddo is one of the 20% or not. My guess is that if you could rule out visual-perceptual issues that percentage would go up since the kiddos left over would be the ones more likely to have more “pure” attentional issues.
And the “Freedom from distractibility” cluster of scores is *not* truly diagnostic — just a flag of sorts.
Re: Medication and nld (inattentive)
I’m in a little bit different situation than you are. My son has been diagnosed with anxiety, inattentive ADHD, APD, and NLD - in that order.
So we started him on the psychostimulant meds and saw great improvement in his focus and attention. I did see some increase in his anxiety, but hoped that would decrease as he began to be able to attend his world more thoroughly (didn’t happen).
Then we had him tested for APD, both pre-meds and post-meds. There was some improvement with his auditory processing - but it was more attentional issues, such as remembering the word he was to repeat was “cold” and not “hot.” He still tested in the “clinically significant” range for APD while on the psychostimulant meds.
The NLD diagnosis came several months later - and he has all the parts of NLD except a problem with math concepts. He has the anxiety, poor social skills, poor fine and gross motor skills, visual processing difficulties, he’s clumsy, etc. etc.
We finally put him on anti-anxiety meds in conjunction with the psychostimulant meds - and that was the right mix of medications for him. So, we started with a Ritalin type drug prior to the NLD diagnosis, and did see a lot of improvement with it.
But, as Friendshiplady says - all kids react differently to different meds. Watch your child, and make your own decisions. One thing I learned throughout this process is to trust my own instincts above every professionals’ advice. In the end, my gut reactions regarding disorders/syndromes, needs, therapies, and remediation, have been entirely accurate for my son - no matter how many professionals have told me differently. :-)
Good luck,
Lil
Re: Medication and nld (inattentive)
Hi Jan,
I don’t know if this helps or not but I am an adult with NLD/ADHD. Yes, I think the ADHD part is legit as I have always had difficulty paying attention in all walks of life.
Recently, I was put on Wellbutrin along with the Adderall I have been taking. I have been on alot of antidepressants but I think this is the winning combination. For me, the organization does improve tremendously if I am on the right combination combination of meds. I am still making the same output errors when typing but can’t have everything:))
About the ritalin you mentioned - when I was given a test dose before being tested for ADHD, it was like my brain become clear all of a sudden. I know everyone says that almost anybody improves their focus on Ritalin but this was like nothing I have ever experienced in my life.
Sorry, I probably haven’t answered your question as I may be a different profile from your son. Lil is right though, definitely trust your instincts. I had gut feeling it was time to move away from SSRIs and it looks like I have been proven right.
PT
Re: Medication and nld (inattentive)
Thank you for your reply. I agree the advice of trusting instincts is a good one.
One point of confusion: I have heard contradictory views from various experts on ADD, for example, that Ritalin does nothing for those who don’t need it, to the view you expressed that it can sharpen focus for anyone. I wonder, since the basis for ADD is neurobiological, whether it would have just about the effect of a good cup of coffee for those without ADD and a much more noticeable impact for those with.
I had also heard that the ithe positive impact of the medication was in itself diagnostic.
I need to learn more about this class of medications.
Jan
Re: Medication and nld (inattentive)
[quote=”Jan L”]Thank you for your reply. I agree the advice of trusting instincts is a good one.
One point of confusion: I have heard contradictory views from various experts on ADD, for example, that Ritalin does nothing for those who don’t need it, to the view you expressed that it can sharpen focus for anyone. I wonder, since the basis for ADD is neurobiological, whether it would have just about the effect of a good cup of coffee for those without ADD and a much more noticeable impact for those with.
I had also heard that the ithe positive impact of the medication was in itself diagnostic.
Hi Jan,
I have heard the same conflicting information. Like you, have also heard that the positive impact of medication is diagnostic. Although if I remember correctly, Edward Hallowell in the Distraction Book said it was not.
No wonder we all have gray hairs:)) Good luck in your med research
Vivian
Adderall
Thank you for your response. We visited the paediatrician today (an ADD specialist), and he prescribed a low dose of Adderall, claiming that a trial is diagnostic. He also said that with ADD Inattentive or NVLD with inattentiveness it helps in more than 20% of cases.
We are going to try it and not tell the school (easy to do since he will take one timed release capsule in the am).
Thanks again.
JanL
My experience as a parent and in the schools, is that different kids respond differently to medications. So what works for one may not work for another. Also, age and grade can make a big difference.
ritalin was useless for my ds in 1st grade. He started taking Adderall XR in 9th, and because there is so much more writing and so many more organizational demands, he finds it helpful.
Other kids (especially elementary) respond well to the SSRI’s and newer antidepressants because their inattention is related to anxiety and or depression.
With NLD kids, you need to be careful not to confuse visual attention with attention. I’ve heard from more than one teacher that my son doesn’t pay attention. Other teachers tell me that he looks like he isn’t paying attention, but when they ask him questions it is clear that he is listening.
I’m curious. What book did you read that talks about 4 kinds of NLD?
Leah