Nonverbal learning disorder

For the autism condition where a person never learns to speak, see Nonverbal autism.

Nonverbal learning disability (NVLD) is a proposed category of neurodevelopmental disorder characterized by core deficits in visual-spatial processing and a significant discrepancy between verbal and nonverbal intelligence (where verbal intelligence is higher).^[2] A review of papers found that proposed diagnostic criteria were inconsistent.^[2] Proposed additional diagnostic criteria include intact verbal intelligence, and deficits in the following: visuoconstruction abilities, speech prosody,^[3] fine motor coordination, mathematical reasoning, visuospatial memory and social skills.^[4][5][6][7] NVLD is not recognised by the DSM-5 and is not clinically distinct from learning disorder.^[8]

Nonverbal learning disorder
Other names	Nonverbal learning difficulties
Specialty	Neurology/psychiatry
Frequency	Currently unknown, estimated to be around 3%^[1]

NVLD's symptoms can overlap with symptoms of autism spectrum, bipolar disorder, and ADHD. For this reason, some claim a diagnosis of NVLD is more appropriate in some subset of these cases.^[3][9]

Signs and symptoms

 

Using an analog clock to tell time is difficult for people with symptoms of NVLD.

Considered to be neurologically based,^[10][11] nonverbal learning disorder is characterized by:

• impairments in visuospatial processing
• discrepancy between average to superior verbal abilities and impaired nonverbal abilities such as:
  • visuoconstruction
  • fine motor coordination
  • mathematical reasoning
  • visuospatial memory
  • socioemotional skills^[5]

People with NVLD may have trouble understanding charts, reading maps, assembling jigsaw puzzles, and using an analog clock to tell time. "Clumsiness" is common in people with NVLD, especially children, and it may take a child with NVLD longer than usual to learn how to tie shoelaces or to ride a bicycle.^[9]

At the beginning of their school careers, children with symptoms of NVLD struggle with tasks that require eye–hand coordination, such as coloring and using scissors, but often excel at memorizing verbal content, spelling, and reading once the shapes of the letters are learned. A child with NVLD's Average or Superior verbal skills can be misattributed to attention deficit hyperactivity disorder, defiant behavior, inattention, or lack of effort.^[9] Early researchers in the syndrome of NVLD Johnson and Myklebust characterize how the children appear in a classroom: "An example is the child who fails to learn the meaning of the actions of others [...] We categorize this child as having a deficiency in social perception, meaning that he has an inability which precludes acquiring the significance of basic nonverbal aspects of daily living, though his verbal level of intelligence falls within or above the average."^[12]

In the adolescent years, when schoolwork becomes more abstract and the executive demands for time management, organization, and social interactions increase, students with NVLD begin to struggle. They focus on separate details and struggle to summarize information or to integrate ideas into a coherent whole, and they struggle to apply knowledge to other situations, to infer implicit information, to make predictions, and to organize information logically.^[9]

As adults, tasks such as driving a car or navigating to an unfamiliar location may be difficult. Difficulty with keeping track of responsibilities or managing social interactions may affect job performance.^[9]

People with NVLD may also fit the diagnostic criteria of dyscalculia,^[13][14] dysgraphia,^[15][16][17] or dyspraxia.^[18][19]

Cause

Research suggests that there is an association with an imbalance of neural activity in the right hemisphere of the brain connected to the white matter.^[10]

Diagnosis

Nonverbal learning disability (NVLD) is characterized by core deficits in visualspatial processing and social impairment.^[10] Additional proposed diagnostic criteria include average to superior verbal intelligence and deficits in visuoconstruction abilities, fine motor coordination, mathematical reasoning, visuospatial memory and social skills.^[5]

"While NVLD is not classified into any distinct diagnosis in DSM-5 (American Psychiatric Association, 2013) or ICD-10 (World Health Organization, 1992), it does have a robust research base."^[20][21][22] "The majority of researchers and clinicians agree that the profile of NLD clearly exists [...] but they disagree on the need for a specific clinical category and on the criteria for its identification." (One researcher notes: "just because we cannot reasonably place such children into our present classification scheme does not mean they do not exist."^[23])

Assorted diagnoses have been discussed as sharing symptoms with NVLD. In some cases, especially the form of autism previously called Asperger syndrome, the overlap can be significant; a major clinical difference is that NVLD criteria do not mention the presence or absence of either repetitive behaviors or narrow subject-matter interests,^[9] which is part of the diagnostic criteria for autism.^[24] These overlapping conditions include, among others:

• attention deficit hyperactivity disorder (ADHD)
• autism spectrum, especially high-functioning autism^[25]
• bipolar disorder^[3]
• developmental coordination disorder (dyspraxia)^[25][26]
• dyscalculia^[26]
• social communication disorder^[25]
• right hemisphere brain damage and developmental right hemisphere syndrome^[9][27][28]
• social-emotional processing disorder^[29][30]
• Gerstmann syndrome^[31][32]

There is diagnostic overlap between nonverbal learning disorder and autism spectrum, and some clinicians and researchers consider them to be the same condition.^[9][7] Some claim that some diagnoses of attention deficit hyperactivity disorder would be more appropriately classified as NVLD.^[9]

History

While various nonverbal learning difficulties were recognized since early studies in child neurology,^[33] there is ongoing debate as to whether/or the extent to which existing conceptions of NVLD provide a valid diagnostic framework.^[34][35]

As presented in 1967, "nonverbal disabilities" (p. 44) or "disorders of nonverbal learning" was a category encompassing non-linguistic learning problems.^[12] "Nonverbal learning disabilities" were further discussed by Myklebust in 1975 as representing a subtype of learning "disability" with a range of presentations involving "mainly visual cognitive processing," social imperception, a gap between higher verbal ability and lower nonverbal processing, as well as difficulty with handwriting.^[36] Later neuropsychologist Byron Rourke^[37] sought to develop consistent criteria with a theory and model of brain functioning that would establish NVLD as a distinct syndrome (1989).^[38]

Questions remain about how best to frame the perceptual, cognitive and motor issues associated with NVLD.^{[11][39][40][5]}

See also

• Alexithymia – difficulty with understanding emotions
• Children's Nonverbal Learning Disabilities Scale
• Deficits in attention, motor control and perception

References

1. Margolis, Amy E.; Broitman, Jessica; Davis, John M.; Alexander, Lindsay; Hamilton, Ava; Liao, Zhijie; Banker, Sarah; Thomas, Lauren; Ramphal, Bruce; Salum, Giovanni A.; Merikangas, Kathleen; Goldsmith, Jeff; Paus, Tomas; Keyes, Katherine; Milham, Michael P. (2020). "Estimated Prevalence of Nonverbal Learning Disability Among North American Children and Adolescents". JAMA Network Open. 3 (4): e202551. doi:10.1001/jamanetworkopen.2020.2551. PMC 7148441. PMID 32275324.
2. Fisher, Prudence W.; Reyes-Portillo, Jazmin A.; Riddle, Mark A.; Litwin, Hillary D. (1 February 2022). "Systematic Review: Nonverbal Learning Disability". Journal of the American Academy of Child & Adolescent Psychiatry. 61 (2): 159–186. doi:10.1016/j.jaac.2021.04.003. ISSN 0890-8567. PMID 33892110. S2CID 233382776.
3. "Does your patient have a psychiatric illness or nonverbal learning disorder?" (PDF). Current Psychiatry.
4. Mammarella, Irene C.; Cornoldi, Cesare (2014). "An analysis of the criteria used to diagnose children with Nonverbal Learning Disability (NLD)". Child Neuropsychology. 20 (3): 255–280. doi:10.1080/09297049.2013.796920. hdl:11577/2668053. ISSN 0929-7049. PMID 23705673. S2CID 34107811.
5. Mammarella & Cornoldi 2014, pp. 255–280.
6. Doty, Nathan (2019). "Nonverbal Learning Disability". The Massachusetts General Hospital Guide to Learning Disabilities: Assessing Learning Needs of Children and Adolescents. H. Kent Wilson, Ellen Braaten. Cham, Switzerland: Humana. ISBN 978-3-319-98643-2. OCLC 1080078884.
7. Fine, Jodene Goldenring; Semrud-Clikeman, Margaret; Bledsoe, Jesse C.; Musielak, Kayla A. (March 2013). "A critical review of the literature on NLD as a developmental disorder". Child Neuropsychology. 19 (2): 190–223. doi:10.1080/09297049.2011.648923. ISSN 0929-7049. PMID 22385012. S2CID 12655825.
8. Dupaul, George J.; Gormley, Matthew J.; Laracy, Seth D. (2013). "Comorbidity of LD and ADHD". Journal of Learning Disabilities. 46 (1): 43–51. doi:10.1177/0022219412464351. PMID 23144063. S2CID 206423076.
9. Doty 2019, pp. 103–106.
10. Ramphal, Bruce; Pagliaccio, David; Thomas, Lauren V.; He, Xiaofu; Margolis, Amy E. (15 April 2021). "Contributions of Cerebellar White Matter Microstructure to Social Difficulty in Nonverbal Learning Disability". The Cerebellum. 20 (6) (published December 2021): 931–937, 931. doi:10.1007/s12311-021-01265-4. ISSN 1473-4222. PMC 8530438. PMID 33856654.
11. Fine, Jodene Goldenring; Musielak, Kayla A.; Semrud-Clikeman, Margaret (2014). "Smaller splenium in children with nonverbal learning disability compared to controls, high-functioning autism and ADHD". Child Neuropsychology. 20 (6): 641–61. doi:10.1080/09297049.2013.854763. PMID 24215424. S2CID 15495423.
12. Johnson, Doris J.; Myklebust, Helmer R. (1967). "Nonverbal Disorders of Learning". Learning disabilities: educational principles and practices. New York: Grune & Stratton. p. 272. ISBN 978-0-8089-0219-5.
13. Rourke, B. P.; Conway, J. A. (1997). "Disabilities of Arithmetic and Mathematical Reasoning: Perspectives From Neurology and Neuropsychology". Journal of Learning Disabilities. 30 (1): 34–46. doi:10.1177/002221949703000103. PMID 9009877. S2CID 46413188.
14. Geary, David C. (2010). "Mathematical disabilities: Reflections on cognitive, neuropsychological, and genetic components". Learning and Individual Differences. 20 (2): 130–133. doi:10.1016/j.lindif.2009.10.008. PMC 2821095. PMID 20161681.
15. Tsur, V. G.; Shalev, R. S.; Manor, O.; Amir, N. (1995). "Developmental Right-Hemisphere Syndrome: Clinical Spectrum of the Nonverbal Learning Disability". Journal of Learning Disabilities. 28 (2): 80–6. doi:10.1177/002221949502800202. PMID 7884301. S2CID 46398326.
16. Rourke, Byron P. (1989). "Patterns of Reading, Spelling, and Arithmetic". Nonverbal Learning Disabilities: The Syndrome and the Model. Guilford Press. pp. 20–9. ISBN 978-0-89862-378-9.
17. Szklut, Stacey E.; Philbert, Darby Breath (2013). "Learning Disabilities and Developmental Coordination Disorder". In Umphred, Darcy A.; Lazaro, Rolando T.; Roller, Margaret L.; et al. (eds.). Neurological Rehabilitation (6th ed.). Elsevier. pp. 379–418. ISBN 978-0-323-26649-9.
18. Clayton, MC; Dodd, JL (2005). "Nonverbal neurodevelopmental dysfunctions". Pediatric Annals. 34 (4): 321–7. doi:10.3928/0090-4481-20050401-13. PMID 15871436.
19. Solodow, William; Sandy, Sandra V.; Leventhal, Fern; Beszylko, Scott; Shepherd, Margaret Jo; Cohen, Jonathan; Goldman, Shoshana; Perry, Richard; Chang, Jennifer J.; Nass, Ruth (Fall 2006). "Frequency and Diagnostic Criteria for Nonverbal Learning Disabilities in a General Learning Disability School Cohort". Thalamus. 24 (1): 17–33.
20. Brenchley, Celia; Costello, Shane (2 January 2018). "A model of assessment and intervention for Non-Verbal Learning Disability (NVLD) in the Australian education system: an educational and developmental psychologist perspective". Australian Journal of Learning Difficulties. 23 (1): 67–86. doi:10.1080/19404158.2018.1467936. ISSN 1940-4158. S2CID 150281995.
21. Horn, Nnifer L., PhD, HSPP. "An Overview of Learning Disabilities." http://beaconindiana.com/pdfs/OverviewOfLDs.pdf San Mateo, CA: Schwab Learning, 2002. N. pag. Web.
22. Mammarella & Cornoldi 2014, pp. 255–280, 256.
23. Fine, Jodene Goldenring; Semrud-Clikeman, Margaret; Bledsoe, Jesse C.; Musielak, Kayla A. (March 2013). "A critical review of the literature on NLD as a developmental disorder". Child Neuropsychology. 19 (2): 190–223. doi:10.1080/09297049.2011.648923. ISSN 0929-7049. PMID 22385012. S2CID 12655825.
24. CDC (2 November 2022). "Diagnostic Criteria | Autism Spectrum Disorder (ASD) | NCBDDD | CDC". Centers for Disease Control and Prevention. Retrieved 8 April 2023.
25. Doty 2019, p. 110.
26. Mary Dobbins, M. D.; Theodore Sunder, M. D.; Stephen Soltys, M. D. (1 August 2007). "Nonverbal Learning Disabilities and Sensory Processing Disorders". Psychiatric Times Vol 24 No 9. 24. {{cite journal}}: Cite journal requires |journal= (help)
27. Wilmshurst, Linda (2014). "Sandy Smith: Marching to the Tune of a Different Drummer". Child and Adolescent Psychopathology: A Casebook. Sage. pp. 89–99. ISBN 978-1-4833-2268-1.
28. Riccio, Cynthia A. (2007). "Dyscalculia". In Reynolds, Cecil R.; Fletcher-Janzen, Elaine (eds.). Encyclopedia of Special Education. John Wiley & Sons. pp. 769–70. ISBN 978-0-471-67798-7.
29. Tsatsanis, Katherine (2013). "Right-Hemisphere Syndrome". In Volkmar, Fred R. (ed.). Encyclopedia of Autism Spectrum Disorders. Springer. pp. 2596–600. doi:10.1007/978-1-4419-1698-3_1587. ISBN 978-1-4419-1698-3.
30. Manoach, Dara Sue; Sandson, Thomas A.; Weintraub, Sandra (April 1995). "The Developmental Social-Emotional Processing Disorder Is Associated with Right Hemisphere Abnormalities". Neuropsychiatry, Neuropsychology & Behavioral Neurology. 8 (2): 99–105. INIST 3510330.
31. Semrud-Clikeman, Margaret; Hynd, George W. (1990). "Right hemisphere dysfunction in nonverbal learning disabilities: Social, academic, and adaptive functioning in adults and children". Psychological Bulletin. 107 (2): 196–209. doi:10.1037/0033-2909.107.2.196. PMID 2181523.
32. Forrest, Bonny J. (2011). "Developmental Gerstmann Syndrome". In Kreutzer, Jeffrey S.; DeLuca, John; Caplan, Bruce (eds.). Encyclopedia of Clinical Neuropsychology. Springer. pp. 826–7. doi:10.1007/978-0-387-79948-3_1540. ISBN 978-0-387-79948-3.
33. Gardner-Medwin, David (1990). "John Walton". In Ashwal, Stephen (ed.). The Founders of Child Neurology. Norman. pp. 862–70. ISBN 978-0-930405-26-7.
34. Pollak, Jerrold (July 2011). . Current Psychiatry. 10 (7). Archived from the original on 16 July 2019.
35. Admin, LD I. "DSM-V to Exclude Asperger's, PDD-NOS & NLD in 2013; Wait, What? | Life Development Institute." Life Development Institute. N.p., 2 June 2011. Web. 06 Sept. 2016.http://discoverldi.com/dsm-v-to-exclude-aspergers-pdd-nos-wait-what/
36. Myklebust, Helmer R. (1975). Myklebust, Helmer R. (ed.). "Nonverbal learning disabilities: Assessment and intervention". Progress in Learning Disabilities. 3. Grune and Stratton: 85–. ISSN 0079-6387.
37. Donders, Jacobus (2011). "Obituary for Dr. Byron Rourke". Child Neuropsychology. 17 (5): 417. doi:10.1080/09297049.2011.617105. S2CID 145142840.
38. Rourke, Byron P. (1989). Nonverbal Learning Disabilities: The Syndrome and the Model. Guilford Press. ISBN 978-0-89862-378-9.^{[page needed]}
39. Spreen, Otfried (2011). "Nonverbal learning disabilities: A critical review". Child Neuropsychology. 17 (5): 418–43. doi:10.1080/09297049.2010.546778. PMID 21462003. S2CID 31974898.
40. Davis, John M.; Broitman, Jessica (2011). Nonverbal Learning Disabilities in Children: Bridging the Gap Between Science and Practice. Springer. ISBN 978-1-4419-8213-1.

Further reading

Books

• Thompson, Sue (1997). The Source for Nonverbal Learning Disorders. East Moline, IL: LinguiSystems. ISBN 978-0760601631.
• Palombo, Joseph (2006). Nonverbal Learning Disabilities: A Clinical Perspective. New York: W.W. Norton. ISBN 9780393704785.
• Broitman, Jessica; Davis, John M. (2013). Treating NVLD in Children Professional Collaborations for Positive Outcomes. New York: Springer. ISBN 978-1461461791.

By Authors with NVLD

• Murphy, Michael Brian (2016). NLD from the Inside Out: Talking to Parents, Teachers, and Teens about Growing Up with Nonverbal Learning Disabilities (Third ed.). Jessica Kingsley Publishers.
• Fast, Yvona (2004). Employment for Individuals with Asperger Syndrome or Non-Verbal Learning Disability: Stories and Strategies. with other writers. London & Philadelphia: Jessica Kingsley Publishers. ISBN 9781846420153. OCLC 61493670.
• Flom, Peter (2016). Screwed up Somehow but Not Stupid, Life with a Learning Disability. Peter Flom Consulting. ISBN 9780692611692.

External links

• NVLD Project