Nonverbal Learning Disorders

Parents and teachers alike are aware of the important role that language plays in learning and social interaction. A young child who speaks clearly and with a well-developed vocabulary is typically seen as more able than a child who has difficulty in these areas. Yet, more than 65% of all of our day-to-day communication is conveyed through nonverbal means such as gestures, facial expressions and other visual signs/symbols. An individual who has difficulty perceiving or understanding such nonverbal information is clearly at a disadvantage. Over the past decade, increasing attention has been paid to understanding the nature of such difficulties and their effects on academic achievement and social success. The result of the research has been the identification of a syndrome known as the Nonverbal Learning Disorder (NLD).

Unlike language-based learning disorders such as reading disabilities (commonly called dyslexia), NLD often goes unrecognized, particularly during the early school years. Many young children with NLD speak early and soon amass a large, seemingly sophisticated, vocabulary. They are often eager learners who quickly memorize rote information. They may appear to remember everything that they hear, down to the smallest of details. Such verbal precocity may impress teachers and caregivers.

On the other hand, parents and other adults close to the child may suspect that something is not right, but may not be able to quite put a finger on it. Particular difficulties may be apparent in three areas: motor skills, visual-spatial organization and social perception.

Children with NLD are often lacking in motor (muscle) coordination and have considerable difficulty learning to ride a bike or kick a soccer ball. Deficits in body in space awareness may result in frequently bumping into objects or people or having trouble with activities requiring balance. Quite often, children with NLD exhibit poor fine motor skills, making a task such as learning to tie shoes quite difficult, and resulting in very poor handwriting.

Weaknesses in visual-spatial organization may show up as poor memory for visual information, such as remembering locations of objects and places. The child with NLD may have difficulty with puzzles or construction toys and may shun these in favor of less "hands-on" activities such as reading or watching television.

Perhaps most evident to the parent of a child with NLD is the childís difficulty relating to other children. The child with NLD has trouble understanding nonverbal communication, such as facial expressions, tone of voice and body language, and is somewhat unable to engage in the usual give and take of conversation. He may not perceive subtle social cues that indicate when something has "gone far enough," may not acknowledge and respect anotherís personal space and may have difficulty distinguishing criticism from good-natured kidding. These are social skills that are normally acquired through observation and, for most children, do not need to be taught explicitly.

As a child with NLD progresses through the elementary school years, weaknesses in some academic areas become increasingly apparent. Though some children with NLD have difficulty in the very early stages of learning to read, once they master the code, they often become skilled, even enthusiastic readers. The young child with NLD may demonstrate an unusual ability to decode new words and may be able to read books that are quite above his or her age or grade level. As the child with NLD moves through the elementary school grades, however, his ability to understand what he reads may begin to lag behind. Children with NLD often have difficulty placing events in the proper sequence, understanding cause and effect relationships and interpreting subtle or ambiguous language. As a result, reading or organizing lengthy or complex material may be extremely challenging. School assignments such as book reports can thus prove quite frustrating.

Difficulty with mathematics may also become more apparent over time. Although good rote memory skills may make learning basic math facts relatively easy, children with NLD often have difficulty with directionality, aligning numbers in columns, carrying tasks through to completion, understanding spatial relationships, and attending to visual details such as mathematical signs. Difficulties with speed and organization also begin to interfere with performance on math tasks.

Identifying Nonverbal Learning Disorders

Unfortunately, Nonverbal Learning Disorders frequently go unrecognized by teachers and other professionals for much of a childís early schooling. Often, initial consultations with a school psychologist or health care providers will serve to minimize or dismiss a parentís concern. Parents may be told that their child is "a little immature," "just a perfectionist," "bored" or " a bit clumsy." Alternatively, the child with NLD may be labeled as having a "behavior problem," or "attention deficit disorder" because he may be distractible and disorganized, or as "emotionally disturbed" because of her frequently inappropriate conduct. A childís verbal strengths may lead parents and teachers to overestimate his abilities across areas and result in unrealistic expectations. In turn, this can result in ongoing educational and behavior problems.

Even when NLD is correctly diagnosed, it may be difficult to obtain the accommodations and modifications that a child needs in order to achieve to his potential in the classroom. He may be achieving at or above the expected grade level on most tasks that are measured in the early school years, although the deficits in motor, visual-spatial, and social skills may be quite obvious. Many schools continue to rely on a "formula" for determining the presence of specific learning disabilities. This formula requires a "significant discrepancy" between a childís intelligence and his achievement in academic areas. Because many children with NLD perform at or above grade level in these academic areas early on, parents may be told that their child does not qualify for special education services. However, a thorough evaluation of the childís intellectual strengths and weaknesses typically reveals a significant difference between his verbal and nonverbal abilities. It is the discrepancy between these two types of intellectual abilities that is important, not whether the scores are above or below average or even whether the child is doing grade-level work. It is not unusual for a child with NLD to have a verbal IQ in the superior range and a performance IQ in the average range.

What should parents/teachers do?

If a parent, teacher or other concerned adult suspects that a child may have NLD, a thorough evaluation of the childís intellectual, academic and emotional/behavioral strengths and weaknesses is warranted. Such an evaluation should be conducted by a psychologist or neuropsychologist who is familiar with NLD, is skilled in the appropriate testing procedures and is able to consult with parents and school officials concerning any needed educational accommodations or other intervention.

Specific strategies for parents and teachers:

The childís relative weakness in visual memory suggests that he may experience difficulty attending to and remembering information that is presented visually. Care should be taken to ensure that he is attending fully before such information is presented. Use verbal strengths to compensate. Children with NLD tend to be highly verbal. Provide verbal instructions and ask the child to repeat them back to you. This helps to reinforce the information and ensure that the child has understood. In school and at home, emphasis should be placed on language. Procedures introduced should be written in prose and visual information should be given a verbal label. Language is the primary means through which NLD children learn.

Children with NLD often have difficulty anticipating the consequences of their actions and may be punished without fully understanding the reason. Similarly, they may have trouble generalizing from one situation to the next and thus may repeat the same problematic behavior even after being reprimanded previously. Expectations for behavior should be clearly and briefly stated and the consequences for misbehavior should be clearly understood and consistently applied. Praise and positive reinforcement for appropriate behavior are likely to be much more effective than punishment or negative consequences.

Parents and teachers should be aware that nonverbal learning disabilities are often associated with difficulties in social perception. Children with NLD may benefit from group psychotherapy designed specifically for children with these difficulties. This allows immediate feedback and opportunities for rehearsal of social skills. In addition, parents may benefit from supportive instruction in strategies for dealing with the challenges of raising a child with NLD.

Parents can also provide direct instruction in social skills, teaching the child how to understand facial expressions, body language and other nonverbal cues, such as tone of voice. Talking through new or unfamiliar social situations beforehand will help to reduce anxiety and ease transitions by letting the child know what to expect.

The child with NLD can usually be accommodated in a fully mainstreamed classroom setting as long as his unique academic and social needs are being met. A detailed and comprehensive Individualized Education Program (IEP) should be put together by a team that includes the parents as well as regular and special education teachers and the school psychologist or social worker. Some children with NLD also benefit from other special education services, such as occupational therapy to improve fine motor skills. Formal assessment of the childís academic and behavioral strengths and weaknesses should be re-evaluated on a regular basis in order to assist in educational planning. With proper identification and the coordinated efforts of concerned parents and professionals, the child with NLD can expect to enjoy a successful and rewarding academic and social experience.

Elizabeth Hart, Ph.D. is a Clinical Child Psychologist, an Assistant Clinical Professor of Psychiatry at Yale School of Medicine and the mother of two young daughters.


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