Triple diagnoses

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My stepson was diagnosed with PDD-NOS when he was 4. Later he was diagnosed with APD (auditory processing disorder) but I'm not sure how old he was. Then at 12 he was diagnosed with NVLD. He is 13 now. He had a speech delay and didn't speak until he was 4 yrs old which I think eliminates AS although he shares many of the same traits. Also, when he was diagnosed with the NVLD, he was also diagnosed as 'Math Disabled', so I guess it's really 4 diagnoses. He is getting an IEP and the school is taking the diagnoses of NLVD. I am so confused as to all these disorders as there seems to be parts that overlap. When I look at the DSM checklist for HFA, he also fits that. The only hard thing about the diagnoses of NVLD, it seems hardly anyone is familiar with it. Is it common to have all these diagnoses?

People with AS and HFA tend to have symptoms of NVLD. If he didn't talk until he was four, he probably has HFA. I can't see why a doctor wouldn't diagnose it.

Edit: PDD-NOS is a from of autism. It just means that he dosen't fit any one thing...so that's where that diagnoses comes in. Different docters would have different opinions.

I have been dxd with AS, HFA, and PDD-NOS, all by different doctors.

I'm confused about the distinctions as well. PDD seems to be the umbrella, with autism and NLD being specific symptom groups. I'm just not sure, which is why I have an appointment with my son's psychiatrist to so I can find out why he's dx'd NLD and not AS or HFA. there must be something in his history to have made them put him in that particular group, and I want to know what specifically.

one thing I can say is since the correct dx and IEP, he's doing so much better because he's getting appropriate support in school, and it's a nice break to not have school administrators giving me a rough time all the time over his reaction to their stupidity. I do worry about his transition to high school though because he really doesn't fit in with the average teenager and I haven't found out what programs are available in my city as of yet. I kind of doubt he'll thrive.

It's common for young children to be diagnosed with PDD-NOS and then, when they get older, to have a somewhat more exact diagnosis, like AS, HFA or NVLD, made - older children are a bit easier to diagnose (apparently). APD is a common feature in kids (people, actually) with ASD or NVLD.

The Math disability is a totally different kind of disability, although it is common in NVLD. It is also common for people not on the spectrum, and is a basic learning disability, like dyslexia, but for math instead of reading.

It is very common for people to have multiple diagnoses. Sometimes it is troubling, because it could be indicative of poor diagnosis (diagnose everything, so you don't have to be precise, but you also haven't missed anything). In this case, however, it sounds like appropriate diagnoses of separate issues, which may even be different on different axes.

I forgot to mention, at least they figured out the right disorder group for your step-son. my son was initially diagnosed as bipolar and anxiety disorder, and the medication they put him on was all kinds of bad. it took two inpatient stints to sort it out. I can't really fault the professionals handling his case though. everything was so very confused by domestic violence and ongoing emotional abuse, neither my son nor I knew which way was up.

Grace09 APD not sure that that is the same as CAPD which central auditory processing disorder which my wife suffers from but the symptoms AS. She was born without ear drums and until surgery at age 7 could not hear (they built her ear drums). I'm AS myself, she does exhibit many of the same symptoms as myself but there are subtle differences. So hard to tell, she has problems with sorting out sounds in noisy room as do I. AS really is difficult to diagnose because it really can be a number of other comorbid conditions.

Not speaking until age 4 doesn't sound like NVLD.

I am not sure whether it is common, but it is quite possible if you are "atypical" diagnosis-wise, that you end up with multiple diagnoses. Some people with PDD have visual and motor delays (ie. NLD-like) and some have auditory processing deficits. Some do not have them bad enough that they warrant another diagnosis, but some people who have these issues severely, need all the diagnoses.

I found this article, which was actually pretty helpful to me.
http://apt.rcpsych.org/cgi/content/full/7/4/310

overlook the bad data for boy:girl ratio and the part about asperger's resolving in adulthood, and it does give some good information on differential diagnosis and points out some real flaws in the assessment process that undoubtedly persist.

Well my husband said the doctor looked at his son for 5 minutes when he was 4 and said "autism" but he would need further evaluation. They refused to have him evaluated further which is why I think he ended up with PDD-NOS. They both felt the doctor was wrong.

Yes sorry, it's CAPD he has but I was glad for the NVLD diagnosis because I felt I was losing my mind because it didn't explain most of his symptoms. The NVLD fits much better than the CAPD, I mean it explains many of his social troubles.

I just joined WP last week because I wanted to have someone to talk to about these things and MANY of the people here have said the same exact thing. I felt also, it was strange because when you read about kids with NVLD they all seem to share the trait of being 'early talkers' not late. I also heard only a psychiatrist can diagnose AS? but I am not sure. I don't think he is AS, the NVLD fits in ways but he seems to fit HFA best. He won't be diagnosed again unless the school requires it. His parents will never voluntarily have him diagnosed, he had a psycho-educational evaluation a year ago because it was required by the school. And his parents want to send him to the public HS in 2 years and they have accepted the NVLD diagnosis and aren't requiring further testing, but yes, I haven't read anywhere that kids with NLVD have any speech delay.

I agree, HFA seems like the best "fit"--although I am not an expert.

Well when he had the psychoeducational evaluation the psychologist gave him a test which found the gap between the PIQ and the VIQ, hence the diagnosis of NVLD and also found the math disability. I just realized that of course they wouldn't find a diagnosis of HFA because how would the psychologist know about his behaviors? I mean it is really the behaviors that stand out with him, the behaviors for which I so far have not found an answer because they sure don't fit a kid with AS. The things I don't think the psycho-ed would find are he:

obsesses about cars, car keys, GPS systems, cell phones, blenders, vacuum cleaners, fans
has very limited food choices (mostly very plain foods, mostly carbs and he'll eat the same food over and over)
constantly corrects other people
takes things literal
talks too loud
stands too close
can't stand anyone getting too close to him
(His dad says his concept of personal space is that no one else has any)
constantly tripping and bumping into things
poor motor coordination
inability to self motivate, needs constant direction
he acts like an authority on everything even though his facts are often incorrect
if he lose at something he lashes out
walks sometimes on his tiptoes
shows no empathy for other people, none
has a perpetual smile on his face, even if someone has had horrible news
has a sing-song intonation to his voice, voice starts high and goes low then back up again
his meltdowns can be scary
didn't speak until 4
can't take info learned and apply to a similar situation
seems to forget being told something again and again (like to not talk loud)
collects electrical cords, old cell phones, car keys
loves to push things, be it a shopping cart or a stroller but he's careless and will run into people,
it's the 'pushing' part he really loves
loves to play with a blender, this is almost an obsession
remembers all the details he doesn't need to remember, like what someone was wearing last Nov 2007
has very messy writing
interrupts constantly
gravitates towards much younger children or adult, but avoids his peer group

see? these may not have been noticed with a psycho-educational evaluation

I fixed that for you. The fix is in bold.

The only thing on your list that isn’t stereotypical AS is the late speech, but that is debatable. Many experts like Tony Attwood will still diagnose AS with a speech delay. It seems that HFA and AS are so similar anyways that it shouldn’t matter.

It sounds like your stepson is more of an AS or HFA with NVLD than just someone with NVLD. Is your husband going to let you do anything to help though?

As it stands right now, your stepson has figured out that he’s somehow different. He doesn’t know why though. He’s asked your husband and your husband dances around the topic.

There will be no dancing around the topic when he hits mainstream high school though. From what you’ve described, he stands out enough that the kids are going to eat him alive. He needs to know what’s different about himself and have some coping mechanisms before that happens.

Just my 2c. Yours for free.

Last edited by j0sh on 08 Sep 2009, 4:19 pm, edited 1 time in total.