In 1989 Dr. Byron Rourke published his groundbreaking book, Nonverbal Learning Disabilities: The Syndrome and the Model. Dr. Rourke’s research focused on individuals who had difficulty with nonverbal (visual-spatial) learning. He proposed the term “Nonverbal Learning Disability” to describe the challenges faced by people who had statistically significant gaps between their verbal and nonverbal IQ scores, with the nonverbal (performance) scores being weaker. These individuals almost always had greater difficulty in learning and applying math concepts than they did with language arts (e.g., reading and spelling). He also observed that, depending upon the magnitude of their verbal/performance split, they typically had other symptoms in common. Parents would describe difficulties with puzzles, handwriting, drawing, social interactions and anxiety. Dr. Rourke’s work has advanced what psychologists and neuropsychologists know about nonverbal learning disabilities.
At that time, Dr. Julie Steck and I were early in our careers and were noticing the patterns described by Dr. Rourke. By the early 1990s, CRG was growing and we were doing more psychoeducational and psychological evaluations of children and adolescents. Thus, we were able to see the pattern clinically and learn from our patients and their families about the impact of nonverbal learning disorders. At the time, I assumed that a clearer definition of this syndrome would evolve. This would lead to clarity about how professionals could diagnosis this condition and how schools could provide targeted special education services to students with this condition. Unfortunately, neither of these developments has occurred. Meanwhile, the set of symptoms we could associate with these processing weaknesses increased with our knowledge and experience. Unfortunately, we also noticed the significantly negative impact this pattern had on our clients’ learning, processing abilities, and life. This was occurring in children, adolescents and adults who clearly had these NLD/NVLD patterns.
Early in the discussion of NLD/NVLD, there were attempts to place individuals with this set of symptoms under the umbrella diagnosis of autism spectrum disorder (ASD). This was due to the fact that many individuals with NLD/NVLD present with social impairments including difficulty reading nonverbal cues, body language, emotional expression, and body space that can also be seen in people with autism. This overlapping of symptoms continues to create some confusion in the field. Clearly, however, they are two distinct entities. Many individuals with ASD have strong nonverbal processing and many individuals with NLD/NVLD have excellent social skills. Further understanding of NLD/NVLD and the underlying processing problems that create this condition will, hopefully, clarify these distinctions over time.
Since we currently lack a universally accepted educational definition and DSM diagnostic criteria, psychologists and neuropsychologists are left to describe the symptomatology (verbal/nonverbal split) their assessments reveal and then educate clients about test results and their implications as best they can. Since educators and clinicians typically have no formal training on this syndrome, their competencies vary tremendously. Thus, many individuals who experience this syndrome do not receive the guidance they need.
What follows are some common symptoms seen in individuals with NLD/NVLD. Do not expect every individual with this syndrome, however, to have an identical pattern of symptoms. NLD/NVLD varies in its presentation depending on the individual much like the symptoms of ASD in people with that diagnosis. Nonverbal learning disorder is a brain-based condition (probably affecting the right CRG Newsletter: Winter Edition February 2019: Volume 9 (1) Page | 2 hemisphere) characterized by weaknesses in nonverbal processing; that is, the ability to think and reason without the use of language. Symptoms include weaknesses in the following:
- visual-spatial reasoning (puzzles, building)
- organization and synthesis of information (big picture thinking)
- visual recall (where is the car, where is the exit)
- spatial motoric integration (drawing, fine-motor skills, clumsy)
- social interpretive skills (reading body language, facial expression)
- understanding math concepts (story/applied problems)
- understanding abstract concepts (slavery during the Civil War, federalism) • organizational skills (how we organize space and time)
- literal interpretations (difficulty with sarcasm or innuendo)
- change (prefers sameness)
Sometimes we see middle schoolers at CRG with a question of whether they have ASD. They may not have some of the classic symptoms (i.e., they have good eye contact and appropriate greeting skills) associated with that disorder. We then learn that their parents have worked extensively to teach them these skills. Similarly, some young people with NLD/NVLD have learned to verbally mediate many of the above tasks. In fact, one of the key ways to help them cope with their weaknesses is to teach them to verbally-sequentially process as much information as possible. Unfortunately, not all tasks or learning environments lend themselves to this type of processing. Tasks requiring visual-spatial reasoning are particularly difficult to verbally mediate. Applied math concepts, for example, draw heavily on spatial reasoning skills. While you can verbally-sequentially talk yourself through an algebra problem, recalling verbal rules as you go, applied geometry is a higher challenge and generally requires spatial thought. But simpler tasks do as well, such as drawing a cube or a three-dimensional drawing, “reading” maps, and parallel parking. In my experience, impaired visual-spatial processing is the key to understanding this disorder. I hope this central diagnostic trait will provide the key to a uniform definition of NLD/NVLD with a DSM and special education classification to follow (see Cardillo et al., 2017; Poletti, 2017).
Students with NLD/NVLD can cope sufficiently well in elementary school, especially if they have strong verbal skills to draw on. Unfortunately, those same students often begin to struggle in middle school and high school if their processing needs are not understood and addressed. Two issues we have learned to assess carefully in the individuals who have this syndrome are attention and anxiety. Not all clients with NLD/NVLD will need treatment for these two areas but many experience significant symptoms related to them. Some individuals will come to CRG with questions related to ADD/ADHD and anxiety only to discover an underlying NLD/NVLD. Of course, the inverse occurs as well.
As mental health providers and psychologists, we strive to accurately diagnosis individuals. We believe that accurate diagnoses are key to the most effective treatment plans. At CRG we believe that a quality assessment is usually the first step to identifying all of the issues that are adversely impacting an individual’s functioning. NLD/NVLD cannot be accurately identified and may go undetected without an IQ test or at least significant visual-spatial measures contrasted with verbal measures. Once we know this about an individual and whether they also need treatment for their level of anxiety and/or attention deficit, we then strive to provide them with a comprehensive treatment plan. The adverse impact of NLD/NVLD will be contingent upon its severity, how early it is diagnosed, and the ability of the individual to compensate for it. It will have a bearing on what classes (math, higher sciences) will be more challenging and what learning strategies the student should use in those classes. The impact of CRG Newsletter: Winter Edition February 2019: Volume 9 (1) Page | 3 NLD/NVLD will also have implications for the individual’s career path. In general, people with NLD/NVLD will do better in fields where they can utilize their verbal sequential processing skills (e.g., sales, law, service industry) and will need to avoid careers requiring visual-spatial processing (e.g., engineering, physics)