In this issue of the CRG Newsletter, we have attempted to provide an overview of the condition known as Nonverbal Learning Disorder (referred to in this article as NLD), the process of evaluation used in identifying and differentiating NLD from other conditions, and to discuss the diagnostic dilemmas of NLD. This article will focus on recognizing symptoms of NLD in the educational setting and addressing students’ needs in the classroom or at home.
It may be helpful to first identify the children who are most at risk for NLD. While not all children who have NLD have known neurological conditions, those who have had a difficult course during their mother’s pregnancy, labor or delivery are at higher risk of learning disorders in general. Individuals with medical diagnoses including cerebral palsy, spina bifida, and seizure disorders are at higher risk for NLD. In addition, some forms of treatment of childhood cancer can negatively impact visual-spatial processing.
As parents and caregivers watch a young child develop, they usually focus on their motor skills development in the first year of life. That is when we watch an infant begin to reach for objects, sit, crawl, and take their first steps. Assuming that these developmental milestones are met within a timely manner, the focus of development then turns to marveling at the unfolding of language. Concerns are raised if a child does not develop single words by 18 months to 2 years and is not using phrases and sentences by age 3. Children with NLD usually meet or exceed the expected language milestones. They are very verbal – often to the detriment of the development of other skills. Adults are less likely to be paying attention to the child’s visual-spatial abilities and play skills. These are the areas in which children with NLD fall behind their agemates.
Individuals with NLD show differences in their developmental course from a young age. The typical developmental course of those with NLD is outlined below:
The early signs of NLD prior to kindergarten or 1st grade are sometimes seen as positive traits and include:
- early language development
- strong rote learning and verbal memory
- frequent questioning
- comfort with conversation, especially with adults
- may have slower motor development or be somewhat uncoordinated
- may have separation anxiety in new situations
- dislike for spatial-organizational tasks and avoidance of fine motor activities
In early elementary school, the symptoms of NLD are mixed – some seeming to be strengths and the emergence of some weaknesses. This mixed pattern often causes disagreement between home and school regarding the child’s abilities. In the classroom, a teacher is often able to see the weaknesses more clearly as they are comparing a child to a classroom of other children of the same age. However, teachers do not always understand the inconsistencies in performance. The presentation of a child in elementary school typically includes the following:
- perceived as bright due to verbal skills
- acquires reading skills easily
- friendships present some difficulties and the child typically does better with one or two peers
- conscientious regarding schoolwork
- tends to work slowly
- handwriting is sloppy, slow and/or arduous
- problems copying work from board
- anxious in new situations
- lack of “common sense” at times
- in trouble for talking, not completing work, inattentiveness
- may begin to fall behind in math
- signs of anxiety may emerge
By middle school, the indications of NLD are becoming more apparent but are typically not understood. The pattern often includes:
- student may be perceived as underachieving and unmotivated or over-achieving
- begins to struggle with math and physical sciences
- despite their strong verbal skills and good reading skills, reading comprehension may begin to drop and organization of written work may be problematic
- grades drop dramatically
- poor study habits
- disorganization problems with work and spatial orientation
- peer problems may emerge along with a preference for small groups
- anxiety and/or attention problems are becoming more apparent
If the NLD is not identified as the individual enters high school and young adulthood, the problems in all areas are magnified and may include:
- increased academic difficulties
- problems or anxiety about learning to drive
- increased dependence upon others
- shrinkage of peer group
- increased anxiety and depression
- more difficulty in math and physical sciences
- more difficulty with abstract reasoning than with recall of information
- problems with self-concept
The following are considered “life support” strategies that can be used at home and in school:
- Never assume the individual with NLD understands. Watch for confirmation that they understand or have them reword or explain concept in their own words.
- Explain new information or concepts using concrete verbal terms and visual input (i.e., pictures, YouTube videos, movies of books).
- Allow time for and encourage frequent questions.
- Minimize the time element required for processing of and responding to information. For example, those with NLD often need more time to interpret maps, charts and graphs as they need to convert the visual-spatial aspects of this information to verbal information and then process and determine a response. Or, the individual may have enough anxiety that they feel a need to re-read or clarify information before answering a question.
- Decrease the amount of work or number of activities to be completed.
- Assist with daily organization of time, schedule and materials.
Students with NLD will benefit from the following instructional strategies:
- Provide step-by-step verbal instructions, especially in math.
- Teach the student how to think in pictures as they read. This will require slowing down the reading process to allow them to describe what they “see” as they read.
- Use visual organizers and specific instructions for writing assignments.
Appropriate accommodations include:
- Decrease the visual clutter in the classroom and on assignments. Too much visual information (pictures, drawings, graphs) is overwhelming.
- Use clear visual supports for learning such as a visual schedule, a list of class rules, or a number line.
- Provide a digital clock in the classroom as individuals with NLD (especially younger students) are not adept at using an analog clock.
- Provide an alternative to handwriting by use of a scribe and eventually a computer/tablet.
- Provide extended time on tests to allow for slower processing.
- Limit copying from a board or textbook.
- Provide a copy of class notes to supplement their own notes.
- If the student benefits from “talking to themselves” as they work, allow them to use a quiet place that won’t distract others.
- Provide preferential seating near the point of instruction and away from distractions so that their work and attention may be monitored.
- Approach the student discreetly to see if they have questions (they are not likely to ask in front of others).
- Provide very specific instructions so that the student and family may refer to these.
- Provide a verbal explanation of visual representations (charts, graphs, timelines).
- Allow the student to preview what they will be reading or learning through watching the movie before reading the book, watching a movie about the time period or location of a novel or subject.
Dr. Sheldon Horowitz with the National Center for Learning Disabilities provides an excellent overview of NLD in this YouTube video. He also has a follow-up video entitled Asperger’s Syndrome vs. Nonverbal LD: The Same or Different?