Quick Guide to Nonverbal Learning Disorder (NVLD)

Nonverbal learning disorder (NVLD) is a neurodevelopmental condition that involves difficulty processing visual-spatial information — the skills that are used, for example, to interpret pictorial information and understand objects in space.

Problems with visual-spatial skills are the primary challenge children with NVLD face. Visual-spatial skills capture a person’s ability to integrate and understand visual information, and challenges in these areas may impact any task that requires a student to use these skills (i.e., solving math problems, copying information on a page, playing team sports, crossing the street).

Below are categories of visual-spatial skills:

• Visual-spatial construction. This could include things like putting together puzzles or models, building with blocks or LEGOS, drawing or copying shapes. It could also mean difficulties putting clothes or shoes on correctly or making a bed. And it could include problems with forming mental images when hearing or reading a book.
• Three-dimensional thinking. This involves things like imagining how something looks when rotated or visualizing how things will fit in a defined space, like packing a bookbag or suitcase. It could include problems with math that requires thinking about three dimensional shapes (e.g., cones, cubes, spheres) or volume, and problems with mental route finding.
• Visual-spatial memory. This involves things like remembering layouts of a school, a neighborhood, a local store, a friend’s home. It could include difficulty remembering where they left possessions like a bookbag or bike.
• Visual-spatial estimation and/or reasoning. This could include problems with estimating length, size (whether one object is bigger than another), area, quantity, or distance, or how fast something is moving (such as knowing when it is safe to cross the street). It could also involve challenges with efficiently using space on a piece of paper or filling out a worksheet.
• Interpreting information presented pictorially. This can involve trouble making sense of figures, diagrams, graphs, or pie charts; grasping how pictures in a storybook relate to the story; following instructions that use figures without text; using a map; and telling time from an analog clock.
• Visual-spatial scanning, tracking, and/or searching. This category includes having trouble physically maneuvering in situations in which people or things are moving in different directions (like playing a team sport). It could also lead to difficulty keeping one’s place when reading dense blocks of text; tracing shapes, coloring within the lines, or cutting along a straight line.
• Self-orientation. This includes standing too close or too far away from people in conversations, bumping into people or things in tight spaces, and having a poor sense of direction. It also includes problems orienting to or finding one’s way around big stores or open spaces.
• Noticing physical attributes of people, objects, or physical surroundings. This involves such things as not noticing if a picture or painting is askew, noteworthy physical features of a person (e.g, a raised eyebrow), when shoes or socks are mismatched, stains; trouble detecting differences in an object or scene.

Alongside problems with visual-spatial processing, individuals with NVLD may have age-appropriate or even superior verbal skills, including reading and learning vocabulary, but they may have difficulty with reading comprehension. They may also have problems with social functioning, possibly due to difficulty understanding things like personal space and social patterns. They may struggle with math that relies on spatial information such as geometry or borrowing/carrying numbers. They may have trouble with fine motor skills, such as using utensils or learning to tie their shoes. They may have executive functioning problems, including things like visual sequencing. They also may experience symptoms of anxiety or attention deficit hyperactivity disorder, although these may not reach a diagnostic threshold.

All kids with NVLD have deficits in visual-spatial skills, but they vary in the specific skills they have trouble with — some may have deficits in a few areas, others may have difficulty in all areas. Psychologists and mental health professionals can use clinical interviews and/or psychometric assessments to figure out what specific visual-spatial skills each child is struggling with, as well as what kinds of associated challenges a child may be experiencing. In order to have NVLD, a student must have problems with visual-spatial skills AND challenges in other areas due to their visual-spatial deficits.

The age at which the disorder might be identified can also vary from person to person. For example, kids with impairment in academics (in particular with math, expository writing, or reading comprehension) may be identified in third or fourth grade. Those who do not have impairment in academic functioning but who do have impairment in social and/or executive functioning may not be identified until high school and beyond. Moreover, good verbal skills may further delay recognition of the NVLD, as their challenges may be misattributed to other things, such as attention problems or poor motivation).

NVLD is not yet recognized in the diagnostic and statistical manual of mental disorders (DSM-5), the guide to mental health and learning disorders. Our expert, Dr. Amy Margolis, has led a team with her partners at Columbia University to redefine NVLD as developmental visual-spatial disorder (DVSD) to more clearly signal the primary problems these children have with visual-spatial processing. They are working now on follow-up studies to show that the criteria can be reliably used by clinicians in order to be included in the DSM-5.

Specific treatments for the visual-spatial deficits in NVLD are not yet fully understood. Using verbal strategies to understand visual-spatial materials is often very helpful. Psychologists and mental health professional can use the results of a child’s assessment to develop supports for the child. Treatment often involves an entire team of professionals who separately target each area in which a child is struggling. Academic tutoring aimed at helping students learn to break problems into smaller steps may also be helpful. Therapy aimed at understanding social interactions can help improve social challenges. It is important that the treatment team is aware of the child’s visual-spatial deficits and modifies the treatment accordingly. For example, a lot of anxiety interventions rely of worksheets that require visual-spatial memory and understanding of visual-spatial information. These tools need to be modified for children with NVLD to include a greater number of verbal descriptors and fewer items on the page to reduce to visual-scanning burdens.

Parents can help at home by practicing the strategies a child is learning at school or afterschool. When someone with NVLD runs into a problem, thinking aloud and talking through the problem-solving steps may be helpful. Seeing what problem-solving looks like in action may help children with NVLD tackle the problems they face.