Nonverbal Learning Disorder
Nonverbal learning disorder (NVLD), also known as nonverbal learning disability, is a neurological condition which typically emerges during childhood but can persist through adulthood. It is marked by one or more of a set of cognitive, and sometimes social, difficulties experienced by children of otherwise average or superior intelligence, such as visual-spatial struggles and motor-skill deficits. Some people diagnosed with NVLD also have trouble comprehending nonverbal information such as body language and facial expressions.
NVLD is not widely known or understood, and affects different people in different ways, and so experts believe it may be significantly underdiagnosed, potentially leading to years of struggles for individuals who do not realize they could seek treatment.
In general, NVLD involves problems managing visual-spatial information, such as difficulty drawing, writing, or telling time using analog clocks. Tasks that require motor coordination, such as tying one’s shoes, may also be impaired. NVLD may also include problems with executive function and higher-order information processing, math, and social skills. It is important to note that only one or two skill sets may be compromised in NVLD, and not all. If a child's intellectual abilities are strong in all but one or more of these areas, testing for NVLD may be warranted.
The signs and symptoms of a nonverbal learning disorder are difficult to pinpoint, as many deficits potentially fall under this umbrella term, and most children will not exhibit all of them; in other words, it can look very different in one child than it does in another. The condition is not defined in the Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-V), although some advocates believe it should be. Typically, though, in spite of a large vocabulary and strong language, memory, and verbal skills, a child with NVLD will have difficulty with reading comprehension and more advanced math problems that require spatial visualization or pattern recognition. They may have a poor sense of direction and struggle to manage money. Deficits in fine and gross motor skills can lead to trouble with handwriting, using scissors and other tools, riding a bicycle, or participating in sports; other children may see them as clumsy.
Socially, some children with NVLD have trouble recognizing the nonverbal cues of body language and facial expressions. Social skills that others learn by observation may not come easily, although verbal instruction may help. Some of these social struggles are a byproduct of their deficits: As they may rely on the spoken word for social information, they may ask questions incessantly, or interrupt others, frustrating teachers and peers. They can also be highly literal, and so they may not recognize sarcasm, humor, or other verbal nuances.
Behaviorally, a resistance to change, a lack of so-called “common sense,” fear of new situations, poor “big picture” comprehension, failure to respect personal space, and an inability to consistently recognize when “enough is enough” are all traits associated with a nonverbal learning disorder, and all can make it difficult to meet new people and make friends.
How prevalent is NVLD?
Because it is so often misdiagnosed or undiagnosed, the prevalence of nonverbal learning disorder is unclear. The condition does appear to affect boys and girls equally, and to run in families, suggesting a genetic component.
How is nonverbal learning disorder diagnosed?
After parents or teachers observe symptoms of NVLD — typically, identifying a particular deficit or set of challenges a child cannot muster — the child may be taken to see a neuropsychologist who will gauge their speech and language development, visual-spatial skills, motor development, and IQ to see if he or she fits the pattern of traits commonly seen in those with the condition.
Clinicians sometimes mistake nonverbal learning disorder for specific learning disability, developmental coordination disorder, social phobia, or autism spectrum disorder, which can delay a child getting attention and therapy for their core visual-spatial deficits. NVLD is also sometimes misdiagnosed as ADHD, which can be a concern especially if medication is then prescribed, as it will generally not help the child.
Do children with nonverbal learning disorder face social challenges?
Yes. Unlike other children and adults who take in information and social cues from both verbal and nonverbal communication (body language), those with NVLD tend to be able to consistently rely only on verbal expression. Because of this, they may have unusually large vocabulary and memory; in fact, younger children with NVLD are often seen as precocious. But because some are prone to being so highly talkative, and to placing a greater reliance on what others tell them, they can encounter a range of social struggles and difficulty making friends.
How does NVLD affect adults?
As adults, people with NVLD may struggle to set priorities, maintain long-term relationships, or find professional success. The symptoms may manifest in adults in one or more of these specific ways:
Difficulty reading maps or charts
Tendency to speak more than warranted, which can lead to oversharing personal information
An embrace of routines and discomfort when schedules or assignments are changed
Difficulty planning for and meeting deadlines
Trouble organizing ideas when writing
Struggling to understand when others are joking
Anxiety in social situations, avoidance of new experiences, and a tendency to prefer staying home
Nonverbal learning disorder is thought to be related to a deficit in the right cerebral hemisphere of the brain, where nonverbal processing occurs.
Since children with NVLD tend to be of average or above-average intelligence, some develop systems, including rote memories of past experiences, to guide them toward acceptable behavior in new situations rather than responding organically to specific social cues.
Is nonverbal learning disorder on the autism spectrum?
Some experts argue that in certain cases, NVLD and autism spectrum disorder (ASD) may be the same condition viewed from different perspectives. Behavior attributed to the high-functioning autism once known as Asperger’s Syndrome in particular bears similarities to NVLD but there are important differences. Specifically, while a child with either condition might have both excellent memorization skills and poor social skills, individuals with NVLD have particular difficulty taking in information from the visual environment, as well as trouble with math, which is often taught in a visual context. These processing difficulties are shared by some with ASD but not all. Still, some approaches used to help children with ASD can also help those with NVLD.
There is no single recommended treatment plan for nonverbal learning disorder. As with any learning disorder, however, children are best served by early intervention and support, which often includes occupational therapy. Talk therapy can benefit children experiencing social struggles. Left unaddressed, the condition can lead to lifelong challenges.
How can schools help students with NVLD?
After observation and an initial assessment to determine a child’s specific needs, school-based professionals can put a plan into place for both social and academic accommodations that can create an environment for improvement. These interventions may include extra practice time for developing skills in pattern recognition and organizing thoughts, or counseling to help a child better understand social expectations. NVLD is not covered by the federal Individuals with Disabilities Education Act (IDEA), so children may not always qualify for an Individualized Education Program, but teachers and administrators aware of an individual student's struggles can still work with families to make accommodations and offer extra assistance to help them manage their academic workload.
What can parents do to help children with nonverbal learning disorder?
At-home strategies can be coordinated with a child’s school-based learning and interventions, but parents should also pay close attention to a child’s mental health. Children with NVLD are aware that they struggle in one or more areas, and because this presents challenges to their confidence and self-esteem, they may be at higher risk than other children of having generalized and social anxiety disorders. Therefore, psychotherapy may be beneficial.