Do comorbid symptoms discriminate between autism spectrum disorder, ADHD and nonverbal learning disability?
Pragmatic language testing gives clear, measurable clues for telling ASD, ADHD and NLD apart.
01Research in Context
What this study did
Mammarella et al. (2022) asked whether pragmatic language problems can tell ASD, ADHD and nonverbal learning disability apart. They tested a mixed group of school-age kids with each label plus typically-developing peers.
Using a quasi-experimental design, they compared scores on pragmatic language measures across the four groups.
What they found
Pragmatic language problems successfully flagged children with ASD, ADHD or NLD from typical peers. The same problems also cleanly separated ASD from NLD.
The finding gives clinicians a practical tool for sorting overlapping diagnoses.
How this fits with other research
Earlier work leaned on IQ scatter. Koyama et al. (2006) and Cramm et al. (2009) showed WISC-III verbal vs block-design gaps could separate PDD-NOS from ADHD. C et al. swap the IQ lens for pragmatic language and still achieve clean group splits, updating the toolkit.
Matson et al. (2009) found only social-communication DSM items helped tell high-functioning ASD from ADHD. C et al. echo that social-communication domain matters, but they measure it with pragmatic tests instead of checklist items, extending the idea into NLD territory.
Ng et al. (2019) warned that objective tests and parent ratings sometimes disagree. C et al. sidestep that tension by using direct pragmatic language tasks, showing objective measures can still discriminate when chosen carefully.
Why it matters
If you struggle to decide whether a chatty but off-topic child has ASD, ADHD or NLD, add a brief pragmatic language test. A low score points toward ASD or ADHD; average pragmatics plus visual-spatial weakness tilts toward NLD. The tool is quick, cheap and evidence-based.
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02At a glance
03Original abstract
Characterizing the functioning of individuals with neurodevelopmental disorders is crucial to their diagnosis. Research has found that children with different neurodevelopmental disorders, including autism spectrum disorders (ASD), attention deficit and hyperactivity disorder (ADHD), and nonverbal learning disability (NLD), may have comorbid symptoms of anxiety and depression, and problems with pragmatic language. The main aim of the present study was to identify any differences in the above-mentioned comorbid symptoms associated with these clinical profiles. A second aim was to establish how well signs of pragmatic language difficulties could discriminate between the three clinical profiles, in terms of their diagnostic power. For this purpose, 107 participants from 8 to 16 years old with a diagnosis of ASD, ADHD or NLD were compared with a group of typically-developing children. Self-reports on symptoms of anxiety and depression, and parents' reports on social and communication problems were analyzed. Our findings confirmed that symptoms of anxiety and depression, and problems with pragmatic language are associated with different neurodevelopmental disorders, but not in the same way. In terms of diagnostic power, we found that pragmatic language difficulties clearly discriminated children with ASD, ADHD or NLD from typically-developing children. Importantly, pragmatic language difficulties also discriminated adequately between ASD and NLD. Our findings are discussed in terms of the value of considering comorbid symptoms to obtain a more accurate diagnosis of neurodevelopmental disorders.
Research in developmental disabilities, 2022 · doi:10.1016/j.ridd.2022.104242