non-verbal learning disorder boy

Some children seem to have strong preferences for language based toys and activities beginning at a very young age. They love stories and to talk to adults, but they may shy away from jigsaw puzzles, legos, and blocks. They may also seem clumsy and have trouble learning to use scissors, tie their shoes, and ride a bike. Nonetheless, learning to read is a breeze. And before you know it, they are off and running in elementary school. And then in 3rd grade, these children may start to stumble: Invitations to birthday parties are not forthcoming, teachers are wondering why they don’t understand the main idea of the story, and going to school becomes more daunting and anxiety provoking. But no one thinks these children have a learning disability because they often learn to read with ease and it isn’t until writing or math becomes more prominent in the curriculum that their difficulties are detected. Then because these children are so verbal, their difficulties are attributed to a lack of interest rather than a learning problem. In fact, many children with this profile continue into middle or high school before their problems receive attention—and this is too late. We think many of these children have what has been termed Non-Verbal Learning Disorder (NVLD).

 

NVLD needs to be recognized

Making sure that people who work with children know how to identify NVLD is of the utmost importance for these children. These children are often overlooked because they are highly verbal and tend to like to talk to adults, but are isolated with peers, or are diagnosed with other often co-occurring problems, for example, ADHD, Generalized Anxiety Disorder, Developmental Coordination Disorder, and Specific Learning Disorder in Math. In fact, many of these children receive all of these diagnoses, rather than simply NVLD, which would better capture their difficulties and be more parsimonious. These children need an accurate diagnosis so that they can receive appropriate support in school as well as appropriate psychological and psychiatric treatment.

 

What’s in a name?

This identifiable profile of problems was first called Non-Verbal Learning Disability in the mid-1960s.1 It was so named to distinguish it from the verbal learning disabilities, such as dyslexia, which had received a good deal of attention at that time. In contrast, this group of children with visual-spatial as opposed to language/verbal problems had not received much attention nor been recognized as needing special help in school. Unfortunately, this name, Non-Verbal Learning Disability, suggests that these children are non-verbal (i.e. mute) when, in fact, they are usually more advanced in language than any other area. In addition, the name is not descriptive of the essential feature of the disorder—a deficit in visual-spatial processing.

 

Recognizing NVLD in school

At schools, many professionals who are trained to work with children (school psychologists, guidance counselors, special education teachers) don’t know how to recognize Spatial Processing Disorder (SPD). Recently, two excellent books discuss the kinds of problems these children experience in school and offer suggestions on how to help.2,3 In addition, webinars discuss how to help these children in the classroom.

 

Defining NVLD

Many professionals do not know how to identify NVLD because it is not currently recognized in the DSM-5. Nonetheless, there are more than 40 published papers that define the disorder and investigate the academic and social problems these children experience. One article summarizes much of the prior work and suggests key areas of deficit that are part of the disorder.4 There are a number of different definitions discussed in the literature, which have subtle differences, but the key feature is the spatial deficit. In addition, children often have social difficulties or some other impairment in academic functioning. A working group was convened at Columbia University Medical Center in May 2017 to discuss and define NVLD (see below).

 

What makes NVLD unique is the spatial deficit

Although Language Disorder has long been recognized in the DSM and in schools, and thus been the focus of research, until now, NVLD has not. Through research funded by The NVLD Project in the Division of Child and Adolescent Psychiatry at Columbia University Medical Center (P.I. Amy Margolis, Ph.D), we have begun to uncover the neurobiological underpinnings of discrepancies between spatial and verbal abilities. We have shown that in typically developing individuals there are structural and functional changes in the brain that are associated with the discrepancy between verbal and spatial ability increases.5,6 We and others are currently investigating brain structure and function in individuals with NVLD.7

 

The consensus conference

The NVLD Project is also funding research in the Division of Child and Adolescent Psychiatry at Columbia University Medical Center (P.I. Prudence Fisher, Ph.D) which focuses on preparing a proposal to include NVLD in future editions of the DSM 5. The process of applying for inclusion in the DSM 5 requires a standard definition for the diagnosis of NVLD that clinicians can understand and apply reliably to the individuals they see. Thus, The NVLD Project sponsored a working conference at Columbia University Medical Center on May 11th and 12th of this year with the purpose of arriving at a consensus diagnosis for NVLD. Participants included seven recognized global experts on NVLD diagnosis: Drs. Jessica Broitman, Joseph Casey, Jack M. Davis, Jodene Goldenring Fine, Irene Mammarella, M. Douglas Ris, Margaret Semrud-Clikeman; Columbia Psychiatry faculty and faculty from other academic institutions in New York with expertise in the DSM, Autism, learning disorders, ADHD, NVLD and child development; educators from schools which serve NVLD students; and members of The NVLD Project’s Board of Directors and Advisory Board.

During the meeting, attendees discussed available research data to support the proposal to DSM 5 and strategies for obtaining additional data. In addition, attendees discussed and approved changing the name of the disorder to “Spatial Processing Disorder” (Non-verbal Learning Disability) to reflect the fact that spatial processing difficulty is the hallmark feature of NVLD and what differentiates it from other overlapping DSM disorders. Further, this name change will disconnect it from the term “non-verbal”, which can create confusion since those with NVLD are not verbally impaired. Participants also discussed and generated a working definition for NVLD. The proceedings of the conference are being prepared for publication.


References
1. Johnson &  Myklebust, 1967). Learning disabilities: Educational principles and practices. New York: Grune & Stratton.).
2. Cornoldi, C., Mammarella, I. C., & Fine, J. G. (2016). Nonverbal Learning Disabilities. New York, NY: Guilford Press, xiv + 202 pp. doi:10.1080/07317107.2016.1268010
3. Davis, J. M. & Broitman, J. (2011) Nonverbal Learning Disabilities in Children: Bridging the Gap Between Science and Practice. New York, NY: Springer-Verlag. doi:10.1007/978-1-4419-8213-1
4. Fine, J. G., Semrud-Clikeman, M., Bledsoe, J. C., & Musielak, K. A. (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
5. Margolis, A., Bansal, R., Hao, X., Algermissen, M., Erickson, C., Klahr, K. W., …Peterson, B. S. (2013). Using IQ Discrepancy Scores To Examine the Neural Correlates of Specific Cognitive Abilities. Journal of Neuroscience, 33(35), 14135-14145. doi:33/35/14135 [pii]10.1523/JNEUROSCI.0775-13.2013
6. Margolis, A. E., Davis, K. S., Pao, L. S., Lewis, A., Yang, X., Tau, G., . . . Marsh, R. (2017). Verbal-spatial IQ discrepancies impact brain activation associated with the resolution of cognitive conflict in children and adolescents. Dev Sci. doi:10.1111/desc.12550
7. Semrud-Clikeman, M., Fine, J. G., Bledsoe, J., & Zhu, D. C. (2013). Magnetic resonance imaging volumetric findings in children with Asperger syndrome, nonverbal learning disability, or healthy controls. Journal of Clinical and Experimental Neuropsychology, 35(5), 540-550. doi:10.1080/13803395.2013.795528
Amy Margolis, PhD
Dr. Margolis is a pediatric neuropsychologist with 20 years of clinical experience. Dr. Margolis is funded by the NVLD Project to study the neural correlates of intelligence and how discrepancies between abilities arise in individuals and may contribute to learning disabilities such as Non-Verbal Learning Disability. Dr. Margolis is also funded by the National Institute of Environmental Health Science to study the effects of prenatal exposure to neurotoxicants such as second-hand smoke and air pollution on neurodevelopment.

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