Frequently Asked Questions
What is Nonverbal Learning Disorder Syndrome?
by Emily S. Fudge

(This article appeared in the Hydrocephalus Association Newsletter, Spring, 1997. The information contained in this article is adapted from a paper by Rochelle Harris, PhD, David H. Bennett, PhD, Brian Belden, PhD, Lynne Covitz, PhD and Vicki Little, PhD, of the Section of Developmental Medicine and Psychology, Children's Mercy Hospital, Kansas City, MO)

It is not uncommon for children with hydrocephalus to have learning disabilities. Nonverbal Learning Disorder Syndrome (NVLD) is a specific type of learning disability that affects children's academic progress as well as their social and emotional development. This specific type of learning disability has been identified in some children with hydrocephalus.

NVLD encompasses a combination of learning, academic, social and emotional issues. Most children with learning disabilities do not have significant problems with normal social and emotional development. Some children may have the academic difficulties associated with NVLD but do quite well socially and emotionally. A valid diagnosis of NVLD includes a combination of learning, academic, social and emotional issues as described in this article. Additionally, because the pattern of academic strengths and weaknesses may not show up early in life, and difficulties with social relations are not always apparent in the very young, it is often difficult to make a diagnosis of NVLD until a child is in middle-to-late elementary school.

Academic Characteristics

Children with NVLD have difficulty with mechanical arithmetic, particularly more complex math involving many columns (such as long division). They have problems keeping columns straight, often mixing up which column to put a number in when they carry over in addition. They can have difficulty with word problems or math reasoning, being unable to read a math problem and know what operation to perform. Higher math skills that rely on spatial abilities or seeing the relation between concepts (such as in geometry or algebra) are especially difficult for them to acquire.

Children with NVLD often do quite well with word recognition, oral reading and spelling. While they might be slower in learning to recognize their letters, once they master early reading skills they show good phonetic skills (word pronunciation). However, reading comprehension is weak, especially for more abstract or novel subject matter. The child with NVLD may be able to read a paragraph quite fluently but then be unable to extract the main point or answer conceptual questions about what has just been read.

Language abilities are also unique in children with NVLD. Some may show an initial delay in early expressive speech but then rapidly show gains, progressing to become very talkative or even excessively verbal. This speech pattern (verbosity) has been termed "cocktail party speech" because although a great deal may be said, the content may have little substance or value. Compared to their peers, children with NVLD tend to rely more heavily on language to engage and relate to people, to gather information and to relieve anxiety. For instance, when young, instead of picking up and manipulating an object that is new to them, they may instead question an adult about what it is, how it works, etc.

Children with NVLD may develop a great deal of skill in talking their way out of challenging tasks or facing novel situations that provoke anxiety. Their rote verbal capacities and rote verbal memory skills may be a personal strength but they show poor language pragmatics or the functional use of language.

Nonverbal tasks may be quite difficult for children with NVLD. On tasks that require fine motor coordination these children often show early delay. Early paper/pencil tasks can be extremely frustrating for them and later handwriting may show poor quality. On formal tasks of cognitive functioning they do much better on verbal than nonverbal tasks. Tasks that require interpreting or pulling together visual information can be hard, especially if it is not possible to explain the task verbally with step-by-step instruction. Additionally, verbal tasks that entail more complex problem solving or the integration of information from various sources are quite hard for children with NVLD. Children struggle with common academic tasks such as answering questions at the end of a chapter or performing on tests where the questions are worded differently from the study material.

Humor or sarcasm can be hard for children with the NVLD to appreciate. They often cannot understand jokes, or they interpret them in such a concrete way that the humor is lost. Sarcasm, expressed by the mismatch between a spoken message and the facial expression or tone of voice, requires integration of information from different sensory modalities. Children with NVLD may interpret the message quite literally, missing altogether the information needed to recognize that it is sarcasm.

Social or Adaptive Characteristics

Novel situations can be particularly troublesome as they require generating responses that cannot be anticipated or practiced beforehand. Children with NVLD often rely on rote or practiced behaviors that may not be appropriate for the context. For example, if they learn the right way to introduce themselves to an unfamiliar adult (by shaking hands and saying "pleased to meet you") they may attempt the same response in a group of children where it might be viewed as odd or 'nerdy'. When peers do give them subtle feedback, such as raised eyebrows, they miss the information completely and therefore cannot modify their behavior next time. Peers may pull away or nonverbally signal the end of a conversation and children with NVLD may pursue the interaction, talking even as the peer turns his back. Children with NVLD want
friends, just like everyone else, and they may intensify their efforts to reach out, despite repeated rejection. The recognition that they are being rejected may not come until they are older; their hurt and confusion grows because they are unable to understand the increasingly complex social rules of adolescence.

Causes of Nonverbal Learning Disorder Syndrome

Although no cause for this disorder has been definitely identified, it is known that deficits in the functioning of the right hemisphere of the brain play a significant role. The brain is divided into two hemispheres, the right and left, which typically complement each other in functioning but are suited for different types of processing. The right hemisphere can integrate
information from several sensory modalities at once (can interpret visual and spoken information at once, thereby clarifying how a facial expression can change the meaning of a verbal message) and is best for processing novel information. The left hemisphere processes information presented in a step-by-step fashion and is best at using information once it is well practiced or rote. Spoken language is processed by the left hemisphere, visual or nonverbal information is processed by the right hemisphere, and the right hemisphere also becomes involved in understanding anything novel or contradictory between the verbal and nonverbal messages.

Deficits in the functioning of the right hemisphere, observed in children with NVLD, could emerge through various avenues. If there is any early interruption in the development of the central nervous system, the right hemisphere is more likely to be compromised than the left. Direct damage to the right hemisphere through trauma, tumors and/or seizures can cause compromise in right hemisphere functioning. Sometimes there is no known reason for observed weakness in right hemisphere functioning.

Interventions

1.Children with NVLD do best with instruction that is verbal and descriptive in nature. Instead of showing them how to perform a math operation, for instance, they should be verbally instructed in a step-by-step manner.

2.Assess reading comprehension carefully because good oral reading can hide the extent of weak comprehension. Teach strategies to aide comprehension such as learning to identify the topic sentence and highlighting important information for later study or review. Tell them what specific facts they will need to know for a test rather than asking them to determine, on their own, what important information within a text or lecture they should focus on.

3.Because language concepts can be weak, children with NVLD need to understand terms such as same versus different, part-to-whole relationships, how to classify or categorize objects and the difference between cause and effect. In expressive language instruction they should focus on staying on the topic, listening without interruption, and recognizing when someone has signaled the end of a conversation.

4.Spatial concepts are difficult for children with NVLD so they may need to learn verbal self-instruction for analyzing and reproducing designs. Certain tasks such as map reading or learning the location of all the capital cities should be avoided altogether. If telling time on a clock face is very challenging, teach telling time with a digital clock instead.

5.Written work can be extremely frustrating due to the combination of mechanical problems related to fine motor delays and poor visual spatial skills. Decrease the quantity of writing expected and instead allow verbal expression of information. Also, teach early keyboard skills.

6.Involve the school counselor or social worker to foster social development at school. Friendship groups that involve a small number of selected peers are one intervention. Teachers can help identify which classmates would be most responsive and supportive of your child. Specific, concrete instruction such as teaching the child how and when to initiate peer interactions, how to wait one's turn or the appropriate moment to speak, how to make consistent eye contact and pleasant facial expressions can be very beneficial.

7.Create a supportive home environment in which your child feels secure and successful. Minimize demands that highlight your child's weaknesses by being very clear and specific about what you expect. Observe your child carefully in novel or complex situations to gain an appreciation of strengths and weaknesses and set your expectations accordingly.

Remember that watching you do something is not the best way for your child to learn. Instead, instruct them in an step-by-step manner. Reminder lists of even basic tasks such as daily hygiene and simple chores are very helpful. It is all right to point out to them what they may not yet have recognized about themselves, i.e., "You do much better when you know what's going to happen than when you get unexpected surprises." Constructive suggestions rather than criticism work best.

And, as you've heard countless times before,  you are the best advocate for your child. Collaborate with your child's school about proper interventions and work hard to develop and maintain a positive relationship with school personnel so that you can share what has worked for your child in the past and brainstorm with them about other interventions that might be helpful.

Nonverbal Learning Disorder Syndrome is not a widely recognized diagnosis and school personnel may be genuinely unsure about how best to serve your child. A comprehensive and thorough neuropsychological assessment by an experienced clinician, with regular follow-ups, is critical to insure that appropriate strategies are put in place to assist your child in realizing his or her potential.

Links of interest:
LD OnLine
LD OnLine Early Warning Signs of Learning Disabilities
Asperger Nonverbal Learning Disorders
National Center for Learning Disabilities (NCLD)
THE GRAM Nonverbal Learning Disorders Revisited in 1997

*Credit* Info was taken from opengroup