This article focuses on the confusing status of Non-verbal Learning Disability (NVLD) relative to formal clinical and educational labels. Is NVLD simply a learning disability? Is it more than a learning disability? Prudence Fisher, Ph.D. is a Research Scientist and Associate Professor at Columbia University in New York. In a recent phone interview, she shared some insights regarding NVLD and how it is diagnosed now and might be diagnosed in the future. Even the acronym for the condition is inconsistent, with some authors using NLD and others using NVLD. This article will use NVLD as the term preferred by Dr. Fisher.
Dr. Fisher reported that there is no agreed upon definition of NVLD. However, one common problem included in most descriptions of NVLD involves “visual spatial” deficits. Neuropsychological evaluation is often needed to document the presence and severity of visuospatial deficits.
Currently NVLD is a condition that has no true diagnostic home.
- The International Statistical Classification of Diseases and Related Health Problems – 10th edition – Clinical Modification (ICD-10-CM) is the diagnostic guide of the World Health Organization.
- The ICD-10-CM code used for identification of NVLD (F.81.9) encompasses learning challenges impacting academic skills and discrepancies between intellectual ability and rate or efficiency of new learning.
- ICD-10-CM also provides for the diagnosis of “visuospatial deficits” (842), described as cognitive deficits in visuospatial function.
- The Individuals with Disabilities Education Act (IDEA) does not specifically include NVLD as a special education category.
- Many students with NVLD may become eligible for educational accommodations due to the coexistence of NVLD with Specific Learning Disability, such as math, and/or Other Health Impairment related to a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD).
- The Americans with Disabilities Act (ADA) does not specify NVLD as a condition associated with disability.
The Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5)
The American Psychiatric Association’s DSM-5 does not include NVLD as a formal diagnostic category.
Past editions of DSM might have diagnosed a person with an NVLD profile with
- Asperger’s Disorder (AS)
- Pervasive Developmental Disorder (PDD-NOS)
- Learning Disability when academic challenges were evident
- Attention Deficit Hyperactivity Disorder (ADHD), which often co-exists with NVLD Thus, these diagnoses established eligibility for educational services and clinical treatment.
The current DSM-5 removed both Asperger’s Disorder and PDD-NOS as diagnostic categories, replacing them with Autism Spectrum Disorder. (A level of severity of symptoms can be assigned by a clinician.) In light of this change, NVLD might currently be diagnosed as high functioning ASD or a learning disability with or without ADHD.
Diagnostic confusions regarding NVLD exist, in part, because professionals in education, psychiatry, psychology and neuroscience do not agree about this condition.
- Some professionals do not acknowledge NVLD as a condition, preferring to see the performance deficits in a person with good language abilities as motivational, organizational or attentional deficits.
- Some see the NVLD deficits as better addressed by existing DSM disorders such as LD, ASD, ADHD, anxiety and/or developmental coordination disorder.
- Finally, other professionals view NVLD as a unique diagnostic category that deserves its own prominence.
These differences in expert opinions have influenced decisions related to inclusion of NVLD as a formal DSM diagnostic category.
Concerned parents, teachers, clinicians and persons with NVLD are often left wondering what condition is actually being identified and treated. It would be a major positive step forward to gain a consensus on
(a) the signs and symptoms of NVLD,
(b) interventions, treatments and accommodations that are helpful to those with NVLD, and
(c) evidence needed to include NVLD in a future edition of the DSM, as warranted.
Protections under IDEA and ADA and data from around the globe would be more accurately studied if future versions of the ICD circulated a defined NVLD label.
The NVLD Project
The NVLD Project, a 501(c)(3) nonprofit organization, is an important resource for persons interested in NVLD. The project website provides information about conferences and research with a focus on the challenges and benefits of defining NVLD.
Dr. Fisher reported that the site is scheduled to have an on-line survey available soon in order to research the life experiences of persons with NVLD.
References and Resources
Examining Non-Verbal Learning Disorder by Prudence W. Fisher, Ph.D. and Amy Margolis, Ph.D.; Psychology Today, Posted Aug 28, 2017. https://www.psychologytoday.com/us/blog/beyond-disability/201708/new-diagnosis-the-dsm
Understanding Non-Verbal Learning Disabilities by Erica Patino, M.A. https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/nonverballearning-disabilities/understanding-nonverbal-learning-disabilities
DSM-V to Exclude Asperger’s, PDD-NOS & NLD in 2013; Wait, What? by ldiadmin, posted Jun 2, 2011. https://discoverldi.com/dsm-v-to-exclude-aspergers-pdd-nos-wait-what/
AS and NLD: Descriptions, Differences and Similarities by Yvonne Fast (a woman with NLD) http://www.nldline.com/yvonna.htm
A special thanks to Dr. Fisher for her time and expertise in assisting me with preparing this article.