Nonverbal learning disorder explained

Synonym:Nonverbal learning difficulties, Nonverbal learning disability
Specialty:Neurology/psychiatry
Frequency:Currently unknown, estimated to be around 3%[1]

Nonverbal learning disorder (NVLD or NLD) 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. Proposed additional diagnostic criteria include intact verbal intelligence, and deficits in the following: visuoconstruction abilities, speech prosody, fine motor coordination, mathematical reasoning, visuospatial memory and social skills.[3] [4] [5] NVLD is not recognised by the DSM-5 and is not clinically distinct from learning disorders.[6]

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.[7]

Signs and symptoms

Considered to be neurologically based,[8] [9] nonverbal learning disorder is characterized by:

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.

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. 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."

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.

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.

People with NVLD may also fit the diagnostic criteria of dyscalculia,[10] [11] dysgraphia,[12] [13] [14] or dyspraxia.[15] [16]

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.[8]

Diagnosis

Nonverbal learning disability (NVLD) is characterized by core deficits in visualspatial processing and social impairment.[8] 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.

"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."[17] [18] "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."[19])

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, which is part of the diagnostic criteria for autism.[20] These overlapping conditions include, among others:

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

History

While various nonverbal learning difficulties were recognized since early studies in child neurology,[28] there is ongoing debate as to whether/or the extent to which existing conceptions of NVLD provide a valid diagnostic framework.[29] [30]

As presented in 1967, "nonverbal disabilities" (p. 44) or "disorders of nonverbal learning" was a category encompassing non-linguistic learning problems.[31] "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.[32] Later neuropsychologist Byron Rourke[33] sought to develop consistent criteria with a theory and model of brain functioning that would establish NVLD as a distinct syndrome (1989).[34]

Questions remain about how best to frame the perceptual, cognitive and motor issues associated with NVLD.[35] [36]

See also

Further reading

Books

By Authors with NVLD

External links

Notes and References

  1. Estimated Prevalence of Nonverbal Learning Disability Among North American Children and Adolescents . 10.1001/jamanetworkopen.2020.2551 . 2020 . 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. . JAMA Network Open . 3 . 4 . e202551 . 32275324 . 7148441 .
  2. Fisher . Prudence W. . Reyes-Portillo . Jazmin A. . Riddle . Mark A. . Litwin . Hillary D. . 2022-02-01 . Systematic Review: Nonverbal Learning Disability . Journal of the American Academy of Child & Adolescent Psychiatry . English . 61 . 2 . 159–186 . 10.1016/j.jaac.2021.04.003 . 0890-8567 . 33892110. 233382776 .
  3. Mammarella. Irene C.. Cornoldi. Cesare. 2014. An analysis of the criteria used to diagnose children with Nonverbal Learning Disability (NLD). Child Neuropsychology. en. 20. 3. 255–280 . 10.1080/09297049.2013.796920. 0929-7049. 23705673. 11577/2668053 . 34107811. free.
  4. Book: Doty, Nathan. The Massachusetts General Hospital Guide to Learning Disabilities: Assessing Learning Needs of Children and Adolescents. 2019. Humana. H. Kent Wilson, Ellen Braaten. 978-3-319-98643-2. Cham, Switzerland. Nonverbal Learning Disability. 1080078884.
  5. 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. en. 19. 2. 190–223. 10.1080/09297049.2011.648923. 0929-7049. 22385012. 12655825.
  6. Dupaul . George J. . Gormley . Matthew J. . Laracy . Seth D. . 2013 . Comorbidity of LD and ADHD . Journal of Learning Disabilities . 46 . 1 . 43–51 . 10.1177/0022219412464351 . 23144063 . 206423076.
  7. Does your patient have a psychiatric illness or nonverbal learning disorder? . Current Psychiatry.
  8. 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 . en . December 2021 . 20 . 6 . 931–937,931 . 10.1007/s12311-021-01265-4 . 1473-4222 . 8530438 . 33856654 .
  9. Fine . Jodene Goldenring . Musielak . Kayla A. . Semrud-Clikeman . Margaret . Smaller splenium in children with nonverbal learning disability compared to controls, high-functioning autism and ADHD . Child Neuropsychology . 20 . 6 . 641–61 . 2014 . 24215424 . 10.1080/09297049.2013.854763 . 15495423 .
  10. Rourke . B. P. . Conway . J. A. . Disabilities of Arithmetic and Mathematical Reasoning: Perspectives From Neurology and Neuropsychology . Journal of Learning Disabilities . 30 . 1 . 34–46 . 1997 . 9009877 . 10.1177/002221949703000103 . 46413188 .
  11. Geary . David C. . Mathematical disabilities: Reflections on cognitive, neuropsychological, and genetic components . Learning and Individual Differences . 20 . 2 . 130–133 . 2010 . 20161681 . 2821095 . 10.1016/j.lindif.2009.10.008 .
  12. Tsur . V. G. . Shalev . R. S. . Manor . O. . Amir . N. . Developmental Right-Hemisphere Syndrome: Clinical Spectrum of the Nonverbal Learning Disability . Journal of Learning Disabilities . 28 . 2 . 80–6 . 1995 . 7884301 . 10.1177/002221949502800202 . 46398326 .
  13. Book: Byron P. . Rourke . 1989 . Patterns of Reading, Spelling, and Arithmetic . 20–9 . https://books.google.com/books?id=W9ttiC0MvP8C&pg=PA20 . Nonverbal Learning Disabilities: The Syndrome and the Model . Guilford Press . 978-0-89862-378-9 .
  14. Book: Stacey E. . Szklut . Darby Breath . Philbert . Learning Disabilities and Developmental Coordination Disorder . 379–418 . https://books.google.com/books?id=lVJPAQAAQBAJ&pg=PA379 . Darcy A. . Umphred . Rolando T. . Lazaro . Margaret L. . Roller . Gordon U. . 3 . Burton . 2013 . Neurological Rehabilitation . 6th . Elsevier . 978-0-323-26649-9 .
  15. Clayton . MC . Dodd . JL . Nonverbal neurodevelopmental dysfunctions . Pediatric Annals . 34 . 4 . 321–7 . 2005 . 15871436 . 10.3928/0090-4481-20050401-13.
  16. William . Solodow . Sandra V. . Sandy . Fern . Leventhal . Scott . Beszylko . Margaret Jo . Shepherd . Jonathan . Cohen . Shoshana . Goldman . Richard . Perry . Jennifer J. . Chang . Ruth . Nass . Fall 2006 . Frequency and Diagnostic Criteria for Nonverbal Learning Disabilities in a General Learning Disability School Cohort . Thalamus . 24 . 1 . 17–33 .
  17. Brenchley. Celia. Costello. Shane. 2018-01-02. 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. en. 23. 1. 67–86. 10.1080/19404158.2018.1467936. 1940-4158. 150281995.
  18. 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.
  19. 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. en. 19. 2. 190–223. 10.1080/09297049.2011.648923. 0929-7049. 22385012. 12655825.
  20. Web site: CDC . 2022-11-02 . Diagnostic Criteria Autism Spectrum Disorder (ASD) NCBDDD CDC . 2023-04-08 . Centers for Disease Control and Prevention . en-us.
  21. Mary Dobbins . M. D. . Theodore Sunder . M. D. . Stephen Soltys . M. D. . 2007-08-01 . Nonverbal Learning Disabilities and Sensory Processing Disorders . Psychiatric Times Vol 24 No 9 . en . 24.
  22. Book: Linda . Wilmshurst . 2014 . Sandy Smith: Marching to the Tune of a Different Drummer . 89–99 . https://books.google.com/books?id=TkcXBAAAQBAJ&pg=PA89 . Child and Adolescent Psychopathology: A Casebook . Sage . 978-1-4833-2268-1 .
  23. Book: Cynthia A. . Riccio . Dyscalculia . 769–70 . https://books.google.com/books?id=wdNpBchvdvQC&pg=PA769 . 2007 . Cecil R. . Reynolds . Elaine . Fletcher-Janzen . Encyclopedia of Special Education . John Wiley & Sons . 978-0-471-67798-7 . limited .
  24. Book: Katherine . Tsatsanis . Right-Hemisphere Syndrome . 2596–600 . 10.1007/978-1-4419-1698-3_1587 . Fred R. . Volkmar . 2013 . Encyclopedia of Autism Spectrum Disorders . Springer . 978-1-4419-1698-3 .
  25. 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 . .
  26. 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. 10.1037/0033-2909.107.2.196. 2181523.
  27. Book: Bonny J. . Forrest . Developmental Gerstmann Syndrome . 826–7 . 10.1007/978-0-387-79948-3_1540 . Jeffrey S. . Kreutzer . John . DeLuca . Bruce . Caplan . 2011 . Encyclopedia of Clinical Neuropsychology . limited . Springer . 978-0-387-79948-3 .
  28. Book: David . Gardner-Medwin . John Walton . 862–70 . Stephen . Ashwal . 1990 . The Founders of Child Neurology . Norman . 978-0-930405-26-7.
  29. July 2011 . Differentiating NLD . Current Psychiatry . 10 . 7 . https://web.archive.org/web/20190716133751/https://www.mdedge.com/psychiatry/article/64369/practice-management/differentiating-nld. 16 July 2019 . Pollak . Jerrold .
  30. 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/
  31. Book: Johnson. Learning disabilities: educational principles and practices. Myklebust. Helmer R.. Grune & Stratton. 1967. 978-0-8089-0219-5. New York. 272. Nonverbal Disorders of Learning. https://archive.org/details/learningdisabili00john.
  32. Helmer R. . Myklebust . 1975 . Nonverbal learning disabilities: Assessment and intervention . 85– . Helmer R. . Myklebust . Progress in Learning Disabilities . Grune and Stratton . 3 . 0079-6387 .
  33. Donders . Jacobus . Obituary for Dr. Byron Rourke . Child Neuropsychology . 17 . 5 . 2011 . 417 . 10.1080/09297049.2011.617105. 145142840 .
  34. Book: Byron P. . Rourke . 1989 . Nonverbal Learning Disabilities: The Syndrome and the Model . Guilford Press . 978-0-89862-378-9 .
  35. Spreen . Otfried . Nonverbal learning disabilities: A critical review . Child Neuropsychology . 17 . 5 . 418–43 . 2011 . 21462003 . 10.1080/09297049.2010.546778 . 31974898 .
  36. Book: John M. . Davis . Jessica . Broitman . 2011 . Nonverbal Learning Disabilities in Children: Bridging the Gap Between Science and Practice . Springer . 978-1-4419-8213-1 .

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