Signs of NVLD at Different Ages

Kids with nonverbal learning disorder (NVLD) are often not diagnosed until middle or even high school. But if you know what to look for, there are signs of the disorder at a much earlier age. 

That’s because NVLD is a neurodevelopmental disorder — like autism or ADHD — which means it’s present throughout a child’s development. Early signs that a child has NVLD are often overlooked or misinterpreted as laziness or not paying attention.

While NVLD has been recognized and studied for decades, it’s not an official disorder in the DSM-5, and few parents, educators, or even mental health professionals are familiar with it. It centers around what is called visual-spatial processing, the skills used to interpret visual information. (In fact NVLD itself is in the process of being renamed developmental visual-spatial disorder or DVSD.) But visual-spatial processing affects kids in ways that can be confusing. And areas that are impaired vary so much from one child to another, it isn’t always obvious how they are connected.

Young kids with NVLD also tend to be overlooked because they have typical or even exceptional verbal skills, which they use to compensate for visual-spatial weaknesses.

“A lot of times kids with NVLD have really strong verbal abilities,” notes Amie Wolf, PhD, a neuropsychologist who assesses, treats, and researches NVLD. “Not always, but often it can mask some of their challenges, especially because in earlier grades, so much of the focus is on learning to read, and they do well with that.”

Adults hear age-appropriate — or unusually sophisticated — vocabulary and assume these kids are developing typically. Struggles they are having get mistakenly chalked up to lack of motivation, effort, or attention. It often isn’t until school becomes too challenging for them to keep up that they are evaluated and diagnosed. But earlier identification could enable them to get support that could help them not only academically but emotionally.

Visual-spatial processing is the ability to integrate and mentally manipulate visual information. It is involved in the ability to understand patterns, decipher information shown visually, organize ideas (or a backpack!), navigate a space or a neighborhood, and coordinate movement. While there are eight specific visual-spatial skills that can be affected, kids with NVLD vary widely in how many and which areas are impaired. 

Signs of NVLD change as children grow. For younger children, it affects how they put together a puzzle, draw a picture, build with blocks, or catch a ball. By the time they are in high school it affects their academic, social, and physical functioning more broadly.

Below is a stage-by-stage picture of what NVLD can look like:

In the early years, motor delays are the most frequently noted indication of NVLD. “A gap between their motor development and language development is an early sign,” says Dr. Wolf. “They may be avoiding or not enjoying activities that require a lot of fine motor or visual-spatial ability, like doing puzzles or playing with Legos or Magna-Tiles.”

• Motor skills delays: Clumsiness, awkward use of crayons or scissors, trouble buttoning clothes, difficulty learning to ride a tricycle.
• Less physical exploration than typical children: These children may prefer to point to an object and ask questions about it, or ask for it rather than crawl toward it or climb to reach things.
• Visual-spatial struggles: They may have trouble drawing simple shapes, building with blocks or Legos, or doing puzzles.
• Social signs: They may play better with adults than with peers and have difficulty interpreting facial expressions or body language, potentially due to their visual-spatial deficits.
• Difficulty with new experiences and transitions: They may prefer routine, repeat favorite activities, and get anxious with change.

Once school starts, kids with NVLD may have problems with fine motor skills, visual tracking, and spatial awareness.

“In math they have problems with things like lining up numbers and using space appropriately on the page,” notes Dr. Wolf. “Trouble learning how to tell time, I think, is a sign of NVLD. There are a lot of visual-spatial processes that go into telling time from an analog clock, and a breakdown in any one of those systems could be a good indicator.”

• Fine motor and handwriting: Messy letters, poor spacing, slow writing, and frustration with drawing.
• Visual tracking: These kids might skip lines when they’re reading, tend to lose their place on the page, and struggle to copy from the board. They may tire easily with busy worksheets.
• Early reading: They may be fine with decoding but struggle with comprehension that depends on pictures, inference, or diagrams.
• Math: They may have difficulty lining up numbers, reading signs (+/–/×/÷), understanding place value, and using number lines — tasks that rely on spatial organization. Learning how to tell time on an analog clock may be a problem for them.
• Pragmatic language: They may miss jokes or sarcasm, be very literal in their interpretations, and have trouble reading tone.
• PE and playground: They may have discomfort with group games and seem clumsy or hesitant.
• Transitions: They may be anxious or act out when routines change. They sometimes have difficulty dealing with new or unexpected situations.

Around third and fourth grade, both the workload and the social world expand. The emphasis on reading shifts from “learning to read” to “reading to learn,” putting more pressure on comprehension and inference in texts. Math grows more abstract, and social expectations become more complex.

Problems with coordination and visual-spatial judgment result in a vague but ongoing symptom: clumsiness. “I hear parents describe clumsiness a lot — their kids are bumping into things. They maybe are more accident prone,” says Dr. Wolf. Team sports can be hard to navigate. She recalls one student saying that she has avoided all team sports since she was young. “I tried soccer, and it was horrible for me. I love fishing — that’s all I’ll do.” She also describes students getting lost on their way to her office once they were in the building, even though she had been treating them for months.

• Reading comprehension: These children may struggle to grasp meaning, especially when it depends on context or visuals.
• Writing: They may have strong ideas but difficulty organizing paragraphs. Their written work can be slow and effortful.
• Math: Growing trouble with place value, multi-step problems, fractions, geometry, and graphs.
• Executive functions: Trouble starting tasks, keeping track of materials, estimating time, and monitoring progress without adult prompts.
• Social communication: They may miss nonverbal cues or stand too close or too far from other people. They may want to connect but struggle to “read the room.”

Middle school brings more academic pressure. Rotating schedules, multiple teachers, and complex projects put more pressure on organizational skills. “Middle school is the time you start to see a lot of the problems ramp up because not only are the executive functioning demands increasing, but so are the academic demands,” says Dr. Wolf. “You have to make a lot more connections. The mathematical concepts are more complex, and you have science classes where you have to follow lab procedures. And there’s a lot more like reading graphs and charts, which have increased visual-spatial demands.”

Changing peer dynamics can also challenge social skills. Middle school is where you start to see the emotional fallout of these struggles, Dr. Wolf notes — anxiety and discomfort in group situations. Avoiding groups may look like typical social anxiety, she explains, but actually can be generated by visual-spatial problems. “I’ve had kids reporting to me that they didn’t like attending dances, because they became anxious,” she explained. “But when I broke it down, it wasn’t because they were anxious about people judging them, it was because a room full of people dancing was overwhelming for them.”

• Organization: These children can have difficulty tracking assignments, materials, and due dates across classes. Their lockers and backpacks can become black holes.
• Task management: They may have trouble starting and finishing work independently, switching strategies when stuck, and managing time.
• Reading and writing: They may have difficulty handling longer texts, note-taking from slides, and writing structured essays with evidence.
• Math and science: Geometry, increased reliance on graphs, charts, lab procedures, and multi-step calculations all pose challenges.
• Social stress: Sarcasm, inside jokes, “group signals,” and subtle exclusion are hard to detect. Unstructured times (lunch, between class periods) can feel overwhelming.
• Emotional health: Students who feel constantly behind or misunderstood can develop anxiety or another mental health disorder.

Academic and executive functioning demands continue to ramp up in high school. And the social expectations get even more intense, which can lead to anxiety and social isolation. “I see kids who have trouble keeping up with the social discourse,” says Dr. Wolf. “They might be completely lost in the conversation because it’s moving too quickly or there are inferences that they’re not making.”

High school-age kids may also struggle with navigating independently, whether it’s taking buses or trains to school or learning to drive. “Some kids get lost in their school building, or forget where a classroom is, or go to the wrong floor repeatedly.”

• Advanced literacy: These kids can have difficulty analyzing themes, interpreting figurative language, and synthesizing across sources.
• Writing at scale: They may have trouble with research papers and lab reports — they may know a lot but struggle to decide what matters most, leading to disorganized or overly long drafts.
• STEM demands: They may have challenges with matrices, trigonometry, statistics, geometry proofs, and multistep labs — things that are heavy on spatial reasoning and procedural precision.
• Executive functions: They may have difficulty juggling long-term projects and multiple deadlines, estimating time accurately, breaking down multistep tasks, and advocating for themselves with teachers.
• Daily living skills: They may struggle with route-finding, time management, meeting times, or remembering materials. For some, learning to drive is harder due to weak spatial judgment.
• Social and emotional: Friendship groups, dating, and subtle “read-the-room” skills may stretch their capacity. Anxiety or low mood can intensify without support.

Dr. Wolf notes that children who are diagnosed with NVLD in high school are likely to have lived for a long time feeling misunderstood, because no one really knew what was going on with them. Often they have had a several earlier diagnoses, none of which fully captured what they were experiencing. “That in itself can contribute to psychological distress and invalidation — ‘something’s wrong with me but no one believes me’ — and that can lead to communicating their distress in maladaptive ways like substance use or self-harm.”

If your child is showing signs of visual-spatial challenges such as the ones listed here, it’s a good idea to ask for a comprehensive neuropsychological evaluation. Since not all neuropsychologists who do this kind of testing are aware of NVLD, Dr. Wolf advises bringing up your visual-spatial concerns before the testing, to make sure the provider is familiar with it.

“There is so much overlap in how all these neurodevelopmental disorders present,” she adds, “that a comprehensive psychoeducation or neuropsychological evaluation is important to help tease those things out.”