Non verbal learning disability dsm 5

NVLD: What is it and Why is it Not in the DSM?, by Benjamin Meyer, LCSW | The NVLD Project

There exists some controversy regarding a diagnosis called NVLD (Nonverbal Learning Disorder). It is defined as a set of strengths in verbal memory and vocabulary, accompanied by visual-spatial, fine motor, and social difficulties that include decoding body language and understanding inference and humor. Many with NVLD also face challenges adapting to frequent changes and novel situations and struggle to see the big picture, focusing on the details of a story or essay instead of the main theme. Given that so many people have been classified as having NVLD, why it is not in the DSM. One possible answer was offered by the Colombia psychiatric social work professor, Dr. Prudence Fischer, who acknowledged that there is no agreed upon definition of NVLD, other than that it involves “visual spatial deficits” (Burkhardt, 2019). It is also the case that there is considerable variance within the NVLD population regarding how individual strengths and weaknesses manifest, with some individuals exhibiting strong social skills and others struggling with handwriting, for example. However, there is significant evidence that NVLD does exist as a neurological profile, which I will summarize below, as well as speak to the effort to have it included in the DSM.

NVLD was extensively studied by the neuropsychologist Byron P. Rourke, who compared groups of children with different neurological profiles, and stated that those with NVLD tended to present with “outstanding problems in visual-spatial-organizational, tactile-perceptual, psychomotor and nonverbal problem-solving skills within a context of clear strengths in psycholinguistic skills” (Rourke, Byron & Harnadek, Michael, 1994). Furthermore, in his 1982 model, he classified some children as exhibiting “…what may be referred to as quite deficient right hemisphere capacities within the context of well-developed, modality-specific, routinized, and stereotyped left-hemisphere skills” (Rourke, 1989). In other words, a dysfunction in the right hemisphere of the brain in what is known as “white matter,” which helps to transmit neurological messages, may cause some of the weaknesses in NVLD. However, while neurological deficits do explain some of the skills gap seen in children and adolescents with NVLD, these deficits have not been enough to have NVLD included in the DSM. Perhaps this is partly due to the fact that as a neurological condition, it cannot be easily classified under the usual rubric of a psychiatric, intellectual, developmental, or personality disorder.

In addition, NVLD is easily misrecognized as other disorders, such as Autism Spectrum Disorder, which also includes social difficulties. However, there are some core differences between NVLD and ASD, including the fact the former does not include deficits in verbal expression, and involves motor difficulties and challenges reading body language rather than stereotyped or repetitive movements (Linell-Olson, 2019). Some children and families with NVLD complain that the services they have received have been geared towards those on the spectrum and therefore did not effectively address their unique needs. Therefore, part of the effort to have NVLD included in the DSM-5 is to help individuals with it to access appropriate care, both in terms of providers’ awareness and insurance reimbursement.

Many children and adolescents with NVLD face a variety of comorbid mental health diagnoses, such as anxiety and ADHD, and receive psychotherapy and coaching for these conditions. However, while they may benefit from Cognitive Behavioral Therapy (CBT) and other forms of psychotherapy, interventions that focus on the mental health ramifications of their NVLD are also important. The NVLD Project, which is an advocacy and awareness organization, collaborated with the Mary McDowell Friends School to modify instruction and group work to meet the needs of students with NVLD (Chau, 2016). However, there also mental health interventions that can help children and adolescents with this condition, such as using mindfulness to cope with anxiety during transitions and building social skills for making friends and managing bullying. Including NVLD in the DSM may help more children and adolescents to receive therapy that is responsive to their needs.

To learn more about current research efforts funded by The NVLD Project, click here. The findings of these studies may help to further demonstrate what makes NVLD a distinct diagnosis, supporting the claim that it should be included in the DSM. While there is still much that is not fully known about this diagnosis, it is clear that is presents a distinct set of strengths and weaknesses which affect many children and adolescents. The more educational and mental health professionals are educated about it, the better served this population will be.

I am a bilingual psychotherapist and executive functioning coach who specializes in working with young adults with NVLD, and I was inspired by my personal experience to help those I work with to transition to the professional and social demands of adult life. I believe that each person is unique, and that we are more than just our labels and diagnosis. I am a Project Social Ambassador for The NVLD Project.

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NVLD: To Be or Not to Be Real NVLD - Children's Resource Group

by Sandra Burkhardt, Ph. D., ABPP

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.

Understanding Non-Verbal Learning Disabilities by Erica Patino, M.A.

DSM-V to Exclude Asperger’s, PDD-NOS & NLD in 2013; Wait, What? by ldiadmin, posted Jun 2, 2011.

AS and NLD: Descriptions, Differences and Similarities by Yvonne Fast (a woman with NLD)

A special thanks to Dr. Fisher for her time and expertise in assisting me with preparing this article.

What is non-verbal learning disorder and how to help a child?

Many people think that the term "learning disorder" only covers problems with verbal skills, like reading or writing. But what if your child has good verbal skills and a large vocabulary but doesn't understand when someone is being sarcastic? What if he reads at an advanced level but can't identify key parts of the story?
These are the classic signs of Nonverbal Learning Disorder (NVLD / NLD). Nonverbal learning disorder (NVLD) affects skills such as abstract thinking and organization. NRA affects your child's learning ability, but creates even more problems when it comes to communication.
Learn more about NRA and how to help your child. nine0004

What is Nonverbal Learning Disorder?

Learning and attention disorders create difficulties in communication. The NRA affects a child's social skills, but not their speaking or writing skills.

Children with non-verbal learning disorder tend to talk a lot, but they don't always manage to do it in acceptable ways. They often miss important information, don't understand sign language, so it's hard for them to make friends, and there can often be misunderstandings with teachers, parents, and other adults. nine0007

In contrast to children with learning disorders related to speech and writing (dyslexia, dysgraphia), children with NVL have difficulty understanding non-verbal communication. This includes body language, intonation, and facial expressions.

When a classmate says something sarcastic, a child with non-verbal learning disorder may take it literally. He may laugh at something serious because the speaker is smiling. Due to the fact that the child does not understand the non-verbal subtext to words, it is difficult for him to make friends. nine0007

To better understand what NLR is, it is necessary to learn more about learning disorders based on speech developmental problems. Children with these problems have difficulty reading, writing, and speaking. Their speech and language skills are weak and they have difficulty with accuracy and processing speed.

Some children with NDE have good language skills but have difficulty analyzing information and understanding hidden meanings. They may not have problems with written or spoken language, but they take information literally without understanding the subtext. nine0007

The exact cause of NRO is not yet clear, but researchers believe that this is due to a lack of coordination in different brain processes located in the left and right areas of the brain.

Despite growing awareness of this disorder, non-verbal learning disorder is controversial in medical circles. It does not appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the most recent update of the manual used by therapists to diagnose learning disorders. nine0007

Non-verbal learning disorder may cause learning difficulties, but this does not mean that a child with NVD is not bright. Like most children with learning disabilities, children with LLD usually have average or above average intelligence.

It is also important to know that non-verbal learning disorder is not the same as Asperger's syndrome or autism, although they can also affect social skills and social interaction.

How common is non-verbal learning disorder?

It is difficult to know exactly how many children an NRA has. This is because there is no clear definition of what this category of learning disorder includes. Studies show that the NRA may have 1% of children in the United States. This applies equally to boys and girls. Apparently, NRO is not inherited, as, for example, problems with concentration and dyslexia. nine0007

Non-verbal learning disorder often occurs in people with Asperger's syndrome. In fact, studies show that up to 80% of children with Asperger's have symptoms associated with NRO. People with ADHD may also experience symptoms of NRO, although there are no statistical data on this yet.

What causes NRA?

Experts don't know the exact cause of NRA symptoms. But they are exploring a number of theories related to differences in important brain processes and functions in the left and right sides of the brain. nine0007

There is no consensus among experts as to whether nonverbal learning disorder exists and what are the underlying causes of NLD symptoms. For example, some experts believe that problems may be caused by damage or developmental features of the part of the brain that coordinates the work of the two hemispheres. Others believe that the problems may be related to the frontal lobe of the brain, which is responsible for executive function skills such as working memory, organization and planning. nine0007

Help your child overcome learning difficulties quickly and permanently!

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What are the symptoms of NRA?

The main symptoms of non-verbal learning disorder include poor social skills, but NVE can manifest itself in other ways. For example, children with NDE may have difficulty with math, reading comprehension, writing, and/or physical coordination. Here are some of the symptoms you may find in your child with NRO:

  • Remembers information but does not know why it is important;

  • Communicates in socially unacceptable ways;

  • Pays attention to details but does not see the big picture;

  • Has difficulty reading;

  • Has difficulty with mathematics, especially with problems;

  • Physically awkward and clumsy;

  • Poor handwriting;

  • Takes information literally;

  • Does not understand intonation, body language, facial expressions;

  • Poor social skills;

  • violates the personal boundaries of others - may stand too close to the interlocutor;

  • Pays no attention to other people's reactions;

  • Changes subject abruptly;

  • Too dependent on parents;

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    Afraid to be in an unusual situation;

  • Has difficulty adjusting to change.

Children with ADHD are often misunderstood because of their behavior. Peers and adults may find them strange or immature. Not knowing that the child has NRO, the teacher may think that he is inattentive or cocky.

Symptoms may change with age.

Young children with non-verbal learning disorder may appear bright and precocious because they have good verbal skills. They, like little professors, ask adults a lot of questions and spew out the information received like a fountain. nine0153

Despite their good memory, they may find it difficult to interpret and draw conclusions from what they read.

As children get older, the symptoms of NRO may become more obvious and cause more problems. Children understand that they perceive social situations differently than their peers, but do not know what to do with it. Some develop anxiety that can lead to compulsive behavior, such as touching a doorknob a certain number of times before opening the door. nine0007

The sooner you know about your child's problems, the sooner you can find treatments and strategies to improve social skills and relieve anxiety.

What skills are affected by non-verbal learning disorder?

NLL does not affect all children in the same way, but for most children NLL affects the following skills:

  • Conceptual Skills: Difficulties with problem solving, understanding big concepts and cause and effect relationships. nine0007

  • Motor skills: problems with coordination and movement. This includes gross motor skills (such as running), fine motor skills (such as writing), and balance (such as cycling).

  • Visual-spatial skills: problems with visual images, visual processing and spatial relationships. The child may remember what he heard, but not what he saw.

  • Social skills: Difficulty sharing information in a socially acceptable way. The child may not understand sarcasm or facial expressions, may interrupt the interlocutor in the middle of a conversation. nine0007

  • Abstract and critical thinking: problem with reading comprehension and understanding the "big picture". A child may be good at remembering details but not understanding the larger concepts behind them. You may also have trouble organizing your thoughts.

How to recognize NRA?

Since there is no universally accepted test for HRO, the diagnostic process involves several steps:

Step 1: Get a medical examination. Your child's doctor probably isn't an expert on learning disorders, but you can talk to them about your concerns and find out if a medical condition might be causing your child's symptoms. Your doctor can help you find a specialist, such as a neurologist, for further evaluation. nine0007

Step 2: Get a referral to a mental health professional. Once the medical causes are corrected, your child's doctor will likely refer you to a mental health professional such as a neurologist. The specialist will talk to you and your child about your concerns. He will then administer various tests to assess your child's ability in the following areas:

  • Speech and language: Development of speech in young children; verbal skills, understanding of abstract ideas and context in older children. nine0007

  • Visuospatial Organization: The ability to draw a parallel between visual information and abstract concepts, such as reading a map or telling time by a clock.

  • Motor skills: Fine motor skills such as drawing and writing and gross motor skills such as the ability to throw and catch objects.

The specialist will look at your child's performance in these skills and ask you about the symptoms you have noticed in your child. nine0007

Step 3: Analyze the received information. After collecting all the information, the specialist will look for the strengths and weaknesses that are characteristic of children with ADHD. This will help determine if your child has a disability.

General strengths:

  • The level of intelligence is average or above average;

  • Good verbal skills;

  • Early speech development;

  • nine0002 Good memory and ability to repeat what was said;

  • Learns better what he heard than what he saw.

General weaknesses:

  • Social skills;

  • Balance, coordination, handwriting;

  • Understanding cause and effect;

  • Visualization of information;

  • Activity level (higher at a young age, decreases with age). nine0007

What disorders are associated with NRO?

Nonverbal learning disorder is the disorder most closely associated with problems with social skills. However, there are several other disorders that prevent children from making friends. These disorders are not related, but they may occur together with NMR:

  • ADHD: Children with ADHD may initially be misdiagnosed with ADHD. Both deviations have similar symptoms, such as excessive talkativeness, poor coordination and the habit of interrupting the interlocutor. But ADHD is not a learning disorder. This is a brain disorder that makes it difficult for children to concentrate, think about consequences, and control impulses. nine0007

  • Speech development disorders: these are problems with speech (expressive speech development disorder) and language understanding (receptive speech development disorder). Children with these disabilities find it difficult to understand and use sign language, follow directions, and carry on a conversation. NRO may also resemble some of the symptoms of social communication disorder.

  • Asperger's Syndrome: This is a developmental disorder that affects a child's ability to socialize and communicate with others. This is a mild form of autism. Many of the symptoms of Asperger's Syndrome and NRO overlap, and researchers suggest that about 80% of children with Asperger's Syndrome also have NRO. But these are two separate disorders. nine0007

"We have the potential to help children who are lagging behind reach the norm and even exceed it!"

Watch part of Dr. Michael Merzenich's TED talk in 2004 where he talks about techniques based on brain plasticity to correct the workings in a child's brain to increase their ability to recognize speech, speak, read and learn successfully.

How can professionals help with NRA? nine0009

There are a number of treatments and educational strategies that can help your child manage the symptoms of NRO. These include:

  • Social skills training groups where children are taught how to behave in social situations, such as how to greet a friend, join a conversation, and recognize and respond to teasing.

  • Parental support from a psychologist is needed to help parents learn how to cooperate with teachers and help children improve their social skills. nine0007

  • Occupational therapy helps reduce fear of the unknown, improve coordination and improve fine motor skills.

  • Cognitive therapy helps to cope with anxiety and other types of mental disorders.

  • Talk to teachers about how to help your child do well in school.

What can you do at home?

Parenting a child with ADHD can be challenging, but there are many things you can do at home to help your child cope with symptoms and learn social skills. You can also try some of the behavior experts' strategies. These steps can help you make positive changes in your child's life and in your family life:

  • Think about how you speak. Remember that children with NRA are not good at understanding sarcasm and intonation, and they are likely to take what you say literally. For example, if you say, “If I see that thing in your hands again…,” he may continue to play with the prohibited item, turning away so that you cannot see him. Give clear instructions such as, "Please don't touch this thing."

  • Help with transitions. Children with NRO tend to dislike change because it is difficult for them to understand it. They may not have the abstract thinking skills needed to imagine what's next. You can prepare your child for routine changes by using logical explanations. Instead of saying, “We're going to have dinner with grandma soon,” try, “We're going to have lunch at grandma's house tonight because it's her birthday. We leave in an hour." nine0007

  • Watch your child. A child with NRO may be shocked by sudden external stimuli such as noise, smells, sounds, and temperature. Try to avoid situations that may trigger shock reactions in your child.

  • Arrange meetings with friends. Help your child find friends with similar interests, whether it's a love of comics or cooking. Invite friends over for a social experience in a familiar setting. Think about what the children will do, offer them games so that they do not sit idle. It is also best to invite guests at times of the day when the child is usually well-behaved. nine0007

Study neurological Fast ForWord online method. It is also called "Brain Fitness". By studying Fast ForWord at home, your child will train the brain areas responsible for key executive functions, reading, speech skills, concentration skills, develop memory and other important cognitive skills necessary for successful learning and socialization. Thanks to these activities, more than 3 million children in the world have left special education.
classes! nine0377

What can make learning easier?

There are many ways to support your child with NRO:

  • Take notes. Monitor the child's behaviors and symptoms, when and where they occur. Your observations will be valuable information for professionals who can help your child.

  • Tell your child's doctor about your findings to discuss possible next steps. This may include a referral to a psychologist who can conduct a comprehensive assessment and develop a treatment plan. nine0007

  • Talk to your child's teacher to find out what problems your child is having at school. Ask what methods of assistance have been used and which ones are most effective. Discuss with teachers if the child needs special education.

  • Contact other parents. Discuss your observations with parents who have experienced similar problems, perhaps they can share their successful experience with you.

  • nine0141

    Non-verbal learning disorder can cause both social and academic problems for your child and there is no proven cure. But there are many approaches, treatments, and strategies that can help your child develop social skills and overcome adversity. By learning as much as possible, you can better help your child.


    Sign up for trial online classes using the Fast ForWord method, don't put off helping your child! nine0377

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    Non-verbal learning disorder

    Non-verbal learning disability ( NVLD ) is a neurodevelopmental disorder characterized by a major deficit in visuospatial processing in the presence of intact verbal abilities. nine0440 [2] Additional diagnostic criteria include moderate to excellent verbal intelligence and deficits in visual design, fine motor skills, mathematical reasoning, visuospatial memory, and social skills. [3] [4] [5] [6] In clinical settings, some diagnoses of attention deficit hyperactivity disorder are more properly classified as NVLD. [7]

    The symptoms of NVLD are very similar to both autism spectrum disorders (ASD), specifically high-functioning autism, and ADHD, with which it has an exceptionally high rate of comorbidities. nine0440 [8] [9] [10] For this reason, it is often the case that NVLD is overlooked in patients in favor of ADHD or ASD alone. [11]

    People with NVLD may have trouble understanding charts, reading maps, doing puzzles, and using analog clocks to tell time. "Clumsiness" is not uncommon for people with NVLD, especially in children, and a child with NVLD may take longer than usual to learn to tie their shoelaces or ride a bike. nine0440 [7]

    Early in their school career, children with NVLD symptoms struggle with eye-hand coordination tasks such as coloring and using scissors, but often excel at verbal memory, spelling, and reading after learning letter shapes . . A child with average to excellent NVLD verbal skills can be misdiagnosed as Attention Deficit Hyperactivity Disorder, defiant behavior, inattention, or lack of effort. nine0440 [7] Early NVLD researchers Johnson and Micklebust characterize how children appear in the classroom: “An example would be a child who fails to internalize the meaning of the actions of others… We categorize this child as a social perception deficit child, which means that he has a disability that prevents him from acquiring meaning in the basic non-verbal aspects of everyday life, although his verbal level of intelligence is within or above average. nine0440 [14]

    During adolescence, as school work becomes more abstract and executive demands for time management, organization, and social interaction increase, students with NVLD begin to struggle.

    Learn more