Educate me: what is the difference between MERLD and HFA?

[Anonymous]

TIA.

[Anonymous]

This is contraversial. I have been told by a professional that they are often the same thing, but most parents find MERLD easier to swallow.

I have been told my kid has MERLD and is too blah blah blah to be on the spectrum. I have read enough and consulted with enough professionals to know my kid has MERLD AND is on the spectrum, but is very high functioning and have been told he may fall off the spectrum which sounds silly to me. He will always have a spectrum learning style in my opinion though now not sure he even qualifies for MERLD anymore.

Have met parents who say the child has MERLD and definitely does NOT have autism as he repeatedly plays with the door in the waiting room and then the light switch and then does a bunch of other things my kid did that clued us into ASD. That is fine with me. I keep my mouth shut because it's none of my business. As long as kids get the services they need I don't give a hoot what label makes people comfortable as long as it helps them get some insurance reimbursement and the best help.

Now there may well be plenty of MERLD kids with absolutely no spectrummy stuff whatsoever and I am no expert, but I personally have not met a kid with MERLD who didn't have some of the major spectrum red flags and I have met quite a few MERLD kiddos between OT, St and PT waiting rooms, social skills groups, my child's school, etc.

[Anonymous]

I had never heard of MERLD -- I guess this is a new thing since my DS with an ASD was younger -- so I googled it and all I can say is that they do try hard to keep coming up with ways to avoid diagnosing kids with ASDs. Schizo-affective personality disorder, sensory integration disorder, NVLD, and now MERLD. Heaven forbid any of these kids are actually diagnosed with an ASD.

My DS used to play with doors and light switches just like the child you describe and he definitely has an ASD.

The problem here is that ASDs are seen as the third rail -- no way does my child have THAT -- so everyone runs around developing other ways to describe what is exactly the same thing. This just perpetuates the sense of shame around ASDs. Jeez.

[Anonymous]

I agree that it doesnt matter the label as long as you are getting the right treatment -- but isnt it possible to have a language disorder without having an ASD? MERLD stands for mixed expressive receptive language disorder -- isnt it possible ot have a real disorder in say, expressive language and that's it? Why the scoffing and sniffing and dismissing of this dx?

[Anonymous]

You can definitely be MERLD without being ASD.

[Anonymous]

Anonymous wrote:I agree that it doesnt matter the label as long as you are getting the right treatment -- but isnt it possible to have a language disorder without having an ASD? MERLD stands for mixed expressive receptive language disorder -- isnt it possible ot have a real disorder in say, expressive language and that's it? Why the scoffing and sniffing and dismissing of this dx?

Of course its possible but every single child I read about googling the disorder has red flags for ASDs. Is MERLD in the DSM?

[Anonymous]

Anonymous wrote:I had never heard of MERLD -- I guess this is a new thing since my DS with an ASD was younger -- so I googled it and all I can say is that they do try hard to keep coming up with ways to avoid diagnosing kids with ASDs. Schizo-affective personality disorder, sensory integration disorder, NVLD, and now MERLD. Heaven forbid any of these kids are actually diagnosed with an ASD.

My DS used to play with doors and light switches just like the child you describe and he definitely has an ASD.

The problem here is that ASDs are seen as the third rail -- no way does my child have THAT -- so everyone runs around developing other ways to describe what is exactly the same thing. This just perpetuates the sense of shame around ASDs. Jeez.

MERLD is an old diagnosis. It's been around forever. It's not something that was recently developed. The researchers started exploring the differences between developmental language disorders and autism in the early 70's. There continues to be some debate about whether developmental language disorders are entirely separate from ASDs or part of the spectrum. Many researchers now think that language disorders are part of the broad autism phenotype (ie on the spectrum) but are not autism. It's a condition that is related to autism, as are many other conditions, but it's not autism per se.

ASD has a triad of deficits impairments in social interaction; impairments in communication; and restricted interests and repetitive behavior. Kids with MERLD don't have the triad of disorders seen in ASD. They have impaired social communication because they have impaired receptive language and impaired expressive language. Kids with MERLD don't show the repetitive behavior. They don't show impairments in social interaction, except as it is language based. When you improve the receptive/expressive language, the kid shows marked improvements in social communication and social interaction.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I agree that it doesnt matter the label as long as you are getting the right treatment -- but isnt it possible to have a language disorder without having an ASD? MERLD stands for mixed expressive receptive language disorder -- isnt it possible ot have a real disorder in say, expressive language and that's it? Why the scoffing and sniffing and dismissing of this dx?

Of course its possible but every single child I read about googling the disorder has red flags for ASDs. Is MERLD in the DSM?

MERLD is in the DSM. One of the criterion for a MERLD diagnosis is that ASD was ruled out. If a parent tells that their child has MERLD, that means the person doing the diagnosis looked at ASD and ruled it out.

It is absolutely possible to just have an expressive language disorder or a receptive language disorder or a mixed expressive receptive language disorder. About 5% of kindergartners have one of them.

[Anonymous]

Anonymous wrote:The problem here is that ASDs are seen as the third rail -- no way does my child have THAT -- so everyone runs around developing other ways to describe what is exactly the same thing. This just perpetuates the sense of shame around ASDs. Jeez.

MERLD is an old diagnosis. It's been around forever. It's not something that was recently developed. The researchers started exploring the differences between developmental language disorders and autism in the early 70's. There continues to be some debate about whether developmental language disorders are entirely separate from ASDs or part of the spectrum. Many researchers now think that language disorders are part of the broad autism phenotype (ie on the spectrum) but are not autism. It's a condition that is related to autism, as are many other conditions, but it's not autism per se.

ASD has a triad of deficits impairments in social interaction; impairments in communication; and restricted interests and repetitive behavior. Kids with MERLD don't have the triad of disorders seen in ASD. They have impaired social communication because they have impaired receptive language and impaired expressive language. Kids with MERLD don't show the repetitive behavior. They don't show impairments in social interaction, except as it is language based. When you improve the receptive/expressive language, the kid shows marked improvements in social communication and social interaction.

I'm one of those who's DS was diagnosed with MERLD and ASD was definitively ruled out. In no way am I trying to run from an ASD diagnoses nor do I fear one. MERLD is not the same thing as ASD or the ASD researchers at NIH would not definitively ruled it out. If it were the same thing, our well respected developmental pediatrician would have diagnosed him has having ASD rather than MERLD.

I can understand why some casual observers might think my DS has ASD because of the widespread coverage of ASD symptoms but I find it annoying that I have to defend his diagnosis to people on the SN forum. Those 'red flags' referenced by some aren't exclusive to ASD, they're also indicative of other disorders which is why diagnosis by a specialist is critical. My DS's social issues are language based and improve as his communication improves. He does not have any repetitive behaviors. Combine his diagnosis of MERLD with apraxia of speech and you have a child with significant communication challenges and, therefore, significantly different socially from his peers. That doesn't mean he's got ASD. I have an older DS with ADHD (primarily inattentive). He, too has some social issues because of expressive/receptive speech delays and anxiety. Red flags, for sure, but not just for ASD. It, too, was definitively ruled out by the NIH researchers and the developmental pediatrician. Those 'red flags' are indicative of developmental disorders, not ASD exclusively.

[Anonymous]

The problem here is that ASDs are seen as the third rail -- no way does my child have THAT -- so everyone runs around developing other ways to describe what is exactly the same thing. This just perpetuates the sense of shame around ASDs. Jeez.

MERLD is an old diagnosis. It's been around forever. It's not something that was recently developed. The researchers started exploring the differences between developmental language disorders and autism in the early 70's. There continues to be some debate about whether developmental language disorders are entirely separate from ASDs or part of the spectrum. Many researchers now think that language disorders are part of the broad autism phenotype (ie on the spectrum) but are not autism. It's a condition that is related to autism, as are many other conditions, but it's not autism per se.

ASD has a triad of deficits impairments in social interaction; impairments in communication; and restricted interests and repetitive behavior. Kids with MERLD don't have the triad of disorders seen in ASD. They have impaired social communication because they have impaired receptive language and impaired expressive language. Kids with MERLD don't show the repetitive behavior. They don't show impairments in social interaction, except as it is language based. When you improve the receptive/expressive language, the kid shows marked improvements in social communication and social interaction.

I'm one of those who's DS was diagnosed with MERLD and ASD was definitively ruled out. In no way am I trying to run from an ASD diagnoses nor do I fear one. MERLD is not the same thing as ASD or the ASD researchers at NIH would not definitively ruled it out. If it were the same thing, our well respected developmental pediatrician would have diagnosed him has having ASD rather than MERLD.

I can understand why some casual observers might think my DS has ASD because of the widespread coverage of ASD symptoms but I find it annoying that I have to defend his diagnosis to people on the SN forum. Those 'red flags' referenced by some aren't exclusive to ASD, they're also indicative of other disorders which is why diagnosis by a specialist is critical. My DS's social issues are language based and improve as his communication improves. He does not have any repetitive behaviors. Combine his diagnosis of MERLD with apraxia of speech and you have a child with significant communication challenges and, therefore, significantly different socially from his peers. That doesn't mean he's got ASD. I have an older DS with ADHD (primarily inattentive). He, too has some social issues because of expressive/receptive speech delays and anxiety. Red flags, for sure, but not just for ASD. It, too, was definitively ruled out by the NIH researchers and the developmental pediatrician. Those 'red flags' are indicative of developmental disorders, not ASD exclusively.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I agree that it doesnt matter the label as long as you are getting the right treatment -- but isnt it possible to have a language disorder without having an ASD? MERLD stands for mixed expressive receptive language disorder -- isnt it possible ot have a real disorder in say, expressive language and that's it? Why the scoffing and sniffing and dismissing of this dx?

Of course its possible but every single child I read about googling the disorder has red flags for ASDs. Is MERLD in the DSM?

MERLD is in the DSM. One of the criterion for a MERLD diagnosis is that ASD was ruled out. If a parent tells that their child has MERLD, that means the person doing the diagnosis looked at ASD and ruled it out.

It is absolutely possible to just have an expressive language disorder or a receptive language disorder or a mixed expressive receptive language disorder. About 5% of kindergartners have one of them.

I cannot imagine that newer version of the DSM say to rule out ASD first when most kids with ASD have both receptive and expressive impairment to some degree, but the DSM has many things I don't agree with so perhaps this is still in there.

I have noticed whenever this topic comes up people get very upset. It reminds me of all the discussion about ASD and OCD and ADHD, etc where what some clinicians call ADHD plus OCD plus semantic pragmatic disorder, another clinician calls it ASD and Greenspan (may he rest in peace) may have called the same thing a regulation disorder that was misdiagnosed as ASD. What I find over and over is that ASD seems to be the diagnosis so many people can't tolerate. Yes, perhaps there are plenty of kids with just MERLD, but there are also parents who shop around until they get the diagnosis they can swallow and in the end as long as the kid is getting good help it does not matter. Nobody has said people on this forum who have kids with MERLD all have kids with true ASD, but even the mention of ASD gets some people in a big ol tizzy. If someone suggested a few kids with MERLD were purple googly eyed bunny rabbits you might just laugh at how silly and unfitting that is, but if there is even a hint that some kids may have ASD without officially having that diagnosis people get defensive. We haven't met your kid so there is no need to defend. All I know is every clinician we hae seen has called my son's presentation different names and autism has been ruled out many times, but ASD describes all the other labels put on him (ADHD, MERLD, SID) best.

[Anonymous]

@20:21- I'm the parent of a kid that was recently diagnosed with autism at 3 yrs. It took a long time to get that diagnosis, but not because I was in denial as you imply. It was because the many well regarded specialists who saw my child were unwilling to call it ASD until DC got older since DC was lacking some of the more obvious ASD deficits. Please respect that the diagnosis is not always obvious and clear cut, and you may do as much disservice rushing to misdiagnose and treat a kid with ASD who may have another unrelated disorder like MERLD.

[Anonymous]

MERLD is not "un-related." Many kids with ASD have both a mixed and expressive language disorder. This does not mean all kids with MERLD have ASD, but "unrelated" IMO is not the right term. Many times I suspect it's not that a dianosis is not always obvious and clear cut, I think it's more that clinicians do not agree with eachother. I know I and many of my peers have heard different things from different "experts."

[Anonymous]

For the exact definition --- and note No. 3, where it clearly says a Pervasive Developmental Disorder (Autistic Disorder, PDD-NOS, Retts, Asperger and Childhood Disintegrative Disorder) must be ruled out.

http://www.dsm5.org/ProposedRevisions/P ... px?rid=90#

Mixed Receptive-Expressive Language Disorder (DSM-IV 315.32)

A. The scores obtained from a battery of standardized individually administered measures of both receptive and expressive language development are substantially below those obtained from standardized measures of nonverbal intellectual capacity. Symptoms include those for Expressive Language Disorder as well as difficulty understanding words, sentences, or specific types of words, such as spatial terms.

B. The difficulties with receptive and expressive language significantly interfere with academic or occupational achievement or with social communication.

C. Criteria are not met for a Pervasive Developmental Disorder.

D. If Mental Retardation, a speech-motor or sensory deficit, or environmental deprivation is present, the language difficulties are in excess of those usually associated with these problems.

Coding note: If a speech-motor or sensory deficit or a neurological condition is present, code the condition on Axis III.

[Anonymous]

And to add to the above:

The DSM-IV also says about MERLD "Associated Features and Disorders" that "deficits in various areas of sensory information processing are common." Also, "difficulty in producing motor sequences smoothly and quickly is also characteristic."

It also mentions that memory impairments may be present. Other associated disorders are ADHD, Developmental Coordination Disorder and Enuresis. MERLD may be accompanied by abnormal EEG and abnormal findings on neuroimaging.