NONVERBAL LEARNING DISABILITY

OVERVIEW

Although it is not yet recognized as a formal diagnosis with agreed-upon diagnostic criterial, Nonverbal Learning Disability (NLD) is a syndrome characterized by a pattern of unusual strengths and deficits thought to be due to dysfunction in the right hemisphere of the brain.

Children and teenagers with NLD often have a history of early speech and vocabulary development. They may have outstanding rote memory sills and attention to auditory detail. They also have history of early reading development and advanced or precocious spelling skills.

As gifted as they appear in these aspects of their skills development, however, they tend to have major deficits in other skills and aspects of functioning. For example, while children with NLD can decode text with relative fluency, they may struggle to comprehend what they are reading due to difficulty in organization and higher level reasoning. Similarly, although they may have an excellent retention of material presented orally, they don't always comprehend or "get" the subtleties and nuances of language. Like their peers with autism spectrum disorders (ASD), they tend to be very concrete in their thinking and somewhat inflexible in terms of how they approach tasks or handle transitions. Impaired in problem-solving skills, they fail to apply or generalize previously learned skills to new situations or materials.

The student's discrepant skills development is also manifest in mathematics. Because of their advanced rote memorization skills, they may find it easy to memorize their math facts or equations. When it comes to applying the information, however, they may struggle, and often show poor visual attention to the various algebraic signs. Visual-spatial deficits are also reflected in poor visual recall, faulty space perceptions, and poor sense of directionality. Indeed, poor comprehension of visually presented material is one of the hallmark characteristics of NLD, and there is often (but not always) a significant Verbal IQ - Performance IQ discrepancy on intelligence tests (with VIQ significantly higher than PIQ).

In general, children and teens with NLD may function relatively normally when presented with verbally mediated information, but they do poorly in coping with nonverbal information. This impairment not only affects their academic functioning, but also impairs them socially.

On a motoric level, students with NLD also appear to be clumsy, and many will have balance problems as well as graphomotor or handwriting impairment.

Not all students with NLD will have significant impairment in all of the deficit areas noted above. They may be impaired in only one of these aspects of these functioning.

The "profile" of a children or teenagers with NLD depends on which author or researcher you read, as there are no agreed-upon diagnostic criteria. Thus, Telzrow and Bonar (2002) identify the profile of an NLD student as one who has:

• Stronger verbal than perceptual cognitive skills
• Weak psychomotor and perceptual motor skills
• Deficiency in arithmetic
• Difficulty with novel and complex tasks
• Poor problem-solving skills
• Social and interpersonal deficits
• Psychosocial adjustment problems

Since these characteristics might suggest an autism spectrum disorder to those who are experienced in working with students with Asperger's Disorder or high functioning autism, it is worth noting that some investigators have questioned whether NLD is truly different than autism spectrum disorders (ASD) or whether it may just represent part of the same spectrum.

The NLDA, an organization devoted to nonverbal learning disorders, provides its own perspective on the characteristic features of a child or teenager with NLD: 

• Bilateral tactile-perceptual deficits
• Bilateral psychomotor coordination deficits
• Outstanding deficiencies in visual-spatial-organizational abilities
• Deficits in the areas of nonverbal problem solving, concept formation, hypothesis testing
• Difficulty dealing with negative feedback in novel or complex situations
• Difficulties in dealing with cause-effect relationships
• Difficulties in the appreciation of incongruities
• Well-developed rote verbal capacities and rote verbal memory skills
• Over-reliance on prosaic rote, and consequently inappropriate, behaviors in unfamiliar situations
• Relative deficiencies in mechanical arithmetic as compared to proficiencies in reading (word recognition) and spelling
• Rote and repetitive verbosity
• Content disorders of language
• Poor psycholinguistic pragmatics (cocktail party speech)
• Poor speech prosody
• Reliance on language for social relating, information gathering, and relief from anxiety
• Misspelling almost exclusively of the phonetically accurate variety
• Significant deficits in social perception, social judgment, and social interaction skills
• Marked tendency for social withdrawal and isolation as age increases
• High risk for social-emotional disturbance if no appropriate intervention is undertaken

As should be clear from the preceding discussion, NLD is a syndrome of assets and deficits. The combination and extent of assets and deficits will vary across students. Most students with NLD, however, will exhibit a pattern of relative impairment in social perception, visual-spatial abilities, and mechanical arithmetic, with well developed verbal skills and rote memory.

WHAT TO DO?

In another article on this site, Jean Foss provides some strategies for teachers. In a second article of hers published on the NLDline web site, she has also suggested the following strategies:

• provide verbal mediation for nonverbal experiences, and in conjunction with their interactions with others, whenever appropriate
• teach them to use their own verbal analytic strengths to mediate their own experiences
• anticipate situations in which they might have difficulty, and act as a buffer and support to facilitate the most positive outcomes possible - help them to anticipate the kinds of situations in which they might have difficulty, and to plan in advance some alternative responses they might have to those situations
• teach them to interpret facial expressions, gestures and other nonverbal aspects of communication
• teach them to watch for and interpret indications from others that they are talking too much, or that the communication is ineffective in some other way
• monitor their understanding when communicating, and teach them to self-monitor their understanding and ask clarifying questions
• be particularly careful to ensure their understanding when spatial language is involved
• take care to make cause-effect relationships explicit, whenever possible
• help this learner to anticipate cause and effect relationships in order to avoid difficulties in many areas of life
• teach and practice organizational skills
• control as much as possible the demands for performance to be sure they are manageable and not seemingly overwhelming
• relying on verbal strengths, help this individual practice and internalize the process of making decisions, setting goals, making plans and taking action to achieve those goals, and reflecting and evaluating the results. The outcome of the process must be to credit oneself for one's own efforts and accomplishments
• be confident and hopeful; interventions like those above can effect a positive difference

Other positive interventions, suggested by the NLDA, include:  

• Clearly Stated Expectations
• Computer Use
• Consistent Scheduling
• Facilitated Group Activity
• Foreign Language Waivers
• Good Role Models
• Language based therapy
• Logical Explanations for Change
• Mentoring
• Methods for Coping with Anxiety
• Methods for Coping with Sensory Defensiveness
• Modified Art and Physical Education
• Modified Grading
• Modified Homework Assignments
• Modified Testing (Time, Content)
• Occupational and Physical Therapy
• Organizational Skills Coaching
• Prompted Writing Assignments
• Psychotherapy, Cognitive Therapy
• Second Set of Textbooks at home
• Social Skills Training
• Speech and Language Therapy which addresses social cognition rather than articulation
• Time Management Coaching
• Trained Advocates
• Verbal Brainstorming
• Verbal Explanation of Visual Material

and especially

•   COMPASSION