Nonverbal learning disorder (NLD) might be the most overlooked — and underdiagnosed — learning disability. NLD is a brain-based condition characterized by the following:
• poor visual, spatial, and organizational skills
• poor motor performance
• difficulty recognizing and processing nonverbal cues — body language, facial expression, and the nuances of conversation
Once considered highly rare, NLD may be as prevalent as dyslexia — though the high incidence of missed diagnoses makes it difficult to estimate its true impact. We do know that NLD affects girls just as frequently as it does boys, and tends to run in families, like most other learning disabilities.
Most children with NLD have large vocabularies, outstanding memory and auditory retention, and average-to-superior intelligence. They’re also often misdiagnosed with ADHD, due to symptoms that resemble impulsivity or inattention.
"Virtually every child I've seen with NLD was first diagnosed with ADHD," said the late Marcia Rubinstien, an education specialist in West Hartford, Connecticut, and founder of the Nonverbal Learning Disability Association. "Pediatricians ought to be able to recognize NLD and refer children for an evaluation, but teachers and medical professionals are more aware of language-based learning disabilities.”
Young children with NLD are usually good at hiding or compensating for their challenges — and often charm adults with their precocious conversation skills. But once puberty hits, NLD can cause serious trouble — teenagers with the condition often develop extreme anxiety over their inability to connect with their peers; trouble setting priorities or picking up social cues may cause an adult with NLD to lose jobs or jeopardize relationships. This is why accurate diagnosis is critical. It’s also complicated because NLD can look a lot like other disorders, particularly ADHD or autism, but interventions that work for those conditions will not always help someone with NLD.
Symptoms of Nonverbal Learning Disorder
NLD varies from person to person, and is not defined as a separate condition in the Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-V). However, commonly reported symptoms include the following:
- Trouble recognizing nonverbal cues (facial expressions, body language)
- Early speech and language acquisition (talks “like an adult” from a young age)
- Poor coordination; seen as “clumsy” or always “getting in the way”
- Poor fine motor skills (difficulty using scissors, tying shoes, etc.)
- Always asking questions, to the point of being repetitive or interrupting the regular flow of conversation
- Needs to verbally “label” information in order to understand it; difficulty comprehending unsaid or spatial information
- Extremely “literal;” struggles with sarcasm, innuendo, or other linguistic nuances
- “Naïve” or overly trusting
- Difficulty coping with change
- Trouble following multi-step directions
- Difficulty making generalizations or seeing the “big picture”
- Overall challenges often masked by highly advanced verbal skills
Another telltale sign: Despite their verbal proficiency, those with NLD — particularly children — often exhibit poor reading comprehension. “A child with NLD may miss the forest and the trees because of his intense focus on the leaves,” says Priscilla Scherer, R.N. “After reading a book about the Civil War, for instance, the child might be able to name and describe each battlefield — yet fail to recognize that the conflict was about slavery and federalism.”
Diagnosing Nonverbal Learning Disorder
Overlapping symptoms — underdeveloped social skills, impulsive behavior, or trouble focusing on certain tasks — mean that NLD is often mistaken for ADHD, especially in children. But the appropriate interventions for the two conditions are not the same, and treatment for ADHD is useless for someone with NLD.
A mental health professional specializing in the condition, ideally a neuropsychologist, is the best person to evaluate and diagnose signs of NLD in you or your child. He or she will evaluate a patient’s speech and language development, verbal IQ, performance IQ, visual-spatial skills, and motor development. A patient’s score on any one of these individual tests doesn’t matter much, in and of itself; rather, the specialist will be looking to see whether the patient’s overall strengths and weaknesses match the most common patterns seen in patients with NLD.
Treatment Options for Nonverbal Learning Disorder
Unlike other learning disabilities, NLD isn’t covered under IDEA. So, even with a formal diagnosis, your child may not qualify for an IEP or 504 Plan from her school unless she has another diagnosis or disability. This doesn’t mean your child is ineligible for extra help, however. Useful formal or informal accommodations include social skills groups, occupational therapy, and time-management strategies.
Adults who grew up without an NLD diagnosis may feel unsure about effective treatment strategies, or whether treatment will even help. But occupational therapy and social skills training are available for adults, too, and simple workplace accommodations can help to compensate for common challenges. Something as simple as asking a colleague to take notes for you at a staff meeting may help someone who struggles to listen and write at the same time.
More Nonverbal Learning Disorder Resources