Nonverbal Learning Disorder

Image courtesy of tumblr.com.

While growing up, a child learns about his environment with the use of his senses (sight, touch, smell, hearing, sensation) and communication. And while he learns via direct communication (speaking and listening), much more is learned through interpretation of more subtle mode of communication, which is called nonverbal communication. This nonverbal communication includes body language (use of facial expression, hand movements), gestures (hand movement, symbolism), eye contact etc. For most children, they easily learn these things so thus facilitating more learning. However some children especially those belonging in the neurodiversity group do not comprehend nonverbal modes of communication, which is frustrating as it will leave them clueless and naive on navigating the world and also hamper their learning as well. This is what we call nonverbal learning disorder.

What is nonverbal learning disorder?

Nonverbal learning disorder (NLD or NVLD or right-hemisphere learning disorders) is a brain-based condition that affects skills like abstract thinking and spatial relationships.[1] It is characterized by a child having strong verbal skills and a big vocabulary, but doesn’t understand when somebody is being sarcastic.[1] Also, children with NLD can read at an advanced level but can’t tell you the most important parts of the story.[1] Children with NVLD tend to talk a lot, but they don’t always share in a socially appropriate way. Or they might not relay the most important information. They often miss social cues, so making and keeping friends is a big challenge. There can also be misunderstandings with teachers, parents and other adults.[1][2]

Children with NLD are literal in thinking and are onion skinned (emotionally hypersensitive), which makes them subject for teasing and bullying. When a classmate says something in a teasing voice, a child with NVLD may think it’s serious. He may also laugh at something serious if the speaker is smiling a little. Not getting the subtle, unspoken messages people send out makes it hard to form friendships and fit in with other kids.[1][3]

People with this disorder may not perceive nonverbal cues such as facial expression or tone of voice.[4][5] Challenges with mathematics and handwriting are typical.[4][6] Because of this, NLD is often comorbid or mistaken with other neurodiversity conditions like dysgraphia, dyspraxia, dyscalculia, Asperger’s syndrome, Gertsmann syndrome, or hyperlexia.

NLD is said to be the opposite of dyslexia. NLD is not a disorder that makes people nonverbal or mute. It’s a disorder of not absorbing or comprehending nonverbal communication in particular, making people with it “naive” or “stupid.”

What causes NLD?

NLD has no known exact cause yet. However, there are multiple factors associated with the development of NLD. Brain injury or trauma and environments can hamper brain development can contribute to NLD. Brain scans of individuals with NLD often confirm mild abnormalities of the right cerebral hemisphere.[7] It has been proposed is the result of white-matter problems in the brain. White matter is the ‘wiring’ of the brain, carrying information from one place to another. If this is not working properly, it interferes most with brain processes that require a lot of communication from many parts of the brain at the same time, according to Canadian professor Byron Rourke.[8]

Hmm… sounds complicated? First we’ll identify the main function of the bran (particularly the cerebrum).

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.[9]

This is the normal function of the brain. While the left hemisphere is involved with “logic” including verbal, literal, step-by-step communication, the right hemisphere is involved with the nonverbal parts of communication like body language, figures of speech, intuition, and the like. Activities like good handwriting, dancing, playing sports, and good use of common sense involve the use of the right hemisphere of the brain. How are these orchestrated perfectly? It’s in the bundles of brain areas called the white matter (electric cord like brain components that carry nerve impulses to the brain itself to command to do an action)

Image courtesy of ucmas.ca. The brain’s two hemispheres: left and right with different functions. Any injury to either side results in disastrous living and learning. In NLD, the right hemisphere is said to be broken.

Image courtesy of nonverballearningdisability.weebly.com. Another illustration of left and right hemisphere functions.

Now, Professor Rourke proposed a theory about NLD. According to him, the white matter in the right hemisphere of the cerebrum results in NLD, hence called  “white matter, right hemisphere deficit.” Rourke suggests that bundles of fibers connect various parts of the brain and that if these fibers are blocked or have not developed normally at one or several places, communication between or among the parts is impaired. These impairments may be profound or quite mild, so that different students show different characteristics.[9]

The NLD syndrome reveals itself in impaired abilities to organize the visual-spatial field, adapt to new or novel situations, and/or accurately read nonverbal signals and cues. It appears to be the reverse syndrome of dyslexia.[9]

Brain scans of individuals with NLD often confirm mild abnormalities of the right cerebral hemisphere. Developmental histories have revealed that a number of the children suffering from nonverbal learning disorders who have come to clinical attention have at some time early in their development: (1) sustained a moderate to severe head injury, (2) received repeated radiation treatments on or near their heads over a prolonged period of time, (3) congenital absence of the corpus callosum, (4) been treated for hydrocephalus, or (5) actually had brain tissue removed from their right hemisphere.[9]

What are the symptoms of NLD?

Nonverbal learning disorder has a wide range of symptoms. Kids with NLD have trouble understanding the “big picture.” They may also have problems with reading comprehension, math, and implied meaning. Because social interaction relies heavily on the exchange of nonverbal cues, children with NLD are often socially awkward. They may be adept with language and verbal reasoning, making their disabilities less obvious to detect. NLD often does not surface until middle or high school.[10]

NLD has the following symptoms[10]:

  • Talks a lot, but says very little
  • Sees the trees, not the forest
  • Focuses on details; misses the main idea
  • Does not see the big picture
  • Does not read facial expressions, gestures, or other nonverbal cues
  • Misses subtleties and nuances
  • Is socially awkward
  • Has few friends-especially among same-age peers
  • Processes information in a linear, sequential manner, missing multiple dimensions
  • Confuses abstract concepts yet can recall sequences
  • Shuts down when faced with pressure to perform
  • Has poor handwriting

Despite the name of this disorder, those who have NLD are far from nonverbal. In fact, verbal skills are their greatest assets-what they often lack is the ability to moderate or modulate these skills. Children with NLD have difficulty understanding cause-and-effect relationships and anticipating the consequences of their actions. They are often overly literal in their interpretation of social cues, missing the nuances others intuitively understand. The same problem often plagues their reading, especially as they move up in school. Comprehension often falls off as they have trouble inferring, interpreting, and reading between the lines of complex assignments.[10]

What the??? Children with NLD are verbose but are totally clueless in intuition???

This is a paradox. Often, NLD children are very bright, have excellent rote memory, and are usually at the top of the class but they cannot sustain this as they advance into middle and high school. This is because they are unable to comprehend nonverbal cues around them. Remember that communication and learning is 70% nonverbal?

Image courtesy of drselz.com. Components of communication. Note that the bulk is of nonverbal origin (body language, gestures, facial expression).

Deficits[10]:

  • Weak visual-spatial abilities
  • Weak visual discrimination abilities
  • Poor organizational skills
  • Difficulty with inference and abstract reasoning
  • Inflexible adherence to logic
  • Problems with mathematical reasoning
  • Difficulty reading nonverbal cues
  • Impaired fine motor skills

With these deficits, a student with NLD can struggle with mathematics, logic, dances, sports, reading and literature classes, home economics, and most of all, socialization with peers and teachers. This can be very bad as the student can have a hard time at school and with people. The most difficult part of having NLD is that a person having it cannot control his or her emotions and decisions, hence becoming oversensitive and immature for their age. This can profoundly affect a person’s sense of self worth as he or she will perceive his or herself as failure without knowing why.

To illustrate NLD symptoms in children, an excerpt from LearningRX illustrates NLD in children[11]:

Frequent nonverbal learning disability symptoms surface at various stages of the developmental process. Signs that appear in preschool include: delay in understanding or using spoken language; difficulty understanding simple instructions; lengthy pauses before naming objects and colors; limited awareness or interest in books; difficulty coloring or drawing; problems with motor coordination; short attention span (won’t sit through one storybook). Symptoms in school-age children may consist of: difficulty understanding and following instructions; trouble remembering what someone just told them; failing to master reading, spelling, writing, and math skills and therefore failing schoolwork; difficulty telling the difference between “right” and “left;” problems identifying words or a tendency to reverse letters, numbers or words; lacking motor coordination when walking, playing sports, holding a pencil or trying to tie a shoelace; frequently losing or misplacing homework, schoolbooks or other items; unable to understand the concept of time (confused by the difference between “yesterday,” “today,” and “tomorrow.”

There are many other signs that show indications of nonverbal learning disability symptoms. Conditions affecting concentration may include anxiety, depression, stressful events and emotional trauma. Difficulty in mastering certain academic skills can also stem purely from a neurological basis. Neurological conditions that can affect your child’s ability to learn are visual processing disorder, auditory processing disorder, attention-deficit/hyperactivity disorder, pervasive developmental disorders (Autism and Asperger’s syndrome) and Sensory Integration Dysfunction.[11]

Too bad. This can be very traumatic for an NLD child. Now, what happens when the become adults?

As child with NLD turns into a teenager and adult, life can be a slippery slope. A young adult with NLD cannot fit in everything – whether at school, social circles, vocation, every aspect of life because he can’t read nonverbal communication – and the worse is that people around him can never understand his struggles – because an NLD teen is talkative. People just see him as either awkward or stupid.

Now, when he reaches adulthood, he has struggles with employment, relationships, and mental issues as well.

Professor Rourke gave four consequences of nonverbal learning disorders in adults. Here they are[12]:

1) People forsake their chosen career for less demanding jobs.

2) Though these jobs are less demanding they still require psychomotor coordination and other abilities they don’t have.

3) “NLD individuals experience a virtual inability to reflect on the nature and seriousness of their problems…and outstanding difficulties in generating adequate solutions for those problems that they do appreciate;”

4) “NLD individuals experience marked deficiencies in the appreciation of subtle and even fairly obvious non-verbal aspects of communication with consequent social disdain and even rejection.”

NLD adults are at a high risk for depression and suicide as well as social isolation because of NLD’s complicated symptoms.

How is NLD diagnosed?

Like all neurodiverse conditions, NLD is easier managed when detected early in childhood. Though NLD is not included both in the DSM and the ICD-10, there is no single test in diagnosing NLD. Instead, it involves steps for it to be identified[1]:

Getting a medical exam – other medical conditions must be ruled out first – traumatic brain injury, hearing defect, muscle development weakness or chromosomal defects –  before determining NLD in a child. Unfortunately, a lot of children with NLD are misdiagnosed with another neurodiverse condition or any , making NLD one of the most elusive developmental/learning disabilities to note.

Referral to a mental health professional – if the above diagnoses are ruled out, a referral to a developmental pediatrician is sought. Here various tests are made to see if there is a developmental lag in a child.

The mental health professional will use a variety of tests to evaluate your child’s abilities in these areas[1]:

  • Speech and language: Speech development in younger kids; and verbal skills, understanding of abstract ideas and use of context in older kids
  • Visual-spatial organization: The ability to connect visual information with abstract concepts, such as telling time and reading a map
  • Motor skills: Fine motor skills like drawing and writing, and gross motor skills like throwing and catching objects

After gathering all the information, the specialist will look for a pattern of strengths and weaknesses that are common in kids with NVLD. This will help determine if your child has the condition.[1][13]

But how diagnosis of NLD is applied to the adult? The same diagnostic assessment is also applied for adults with suspected NLD.

Image courtesy of scielo.br. Overlap of nonverbal disorder as part of pervasive developmental disorders. This makes diagnoses of NLD very hard.

How is NLD managed?

Management of NLD involves a lot of strategies to ensure coping of a person having it. Because NLD paralyzes 2/3 of learning behavior, intensive strategies are used for NLD.

Management strategies of NLD applies in the classroom, at home, and with social circles.

Effective educational interventions begin by addressing organizational difficulties, working with part-whole relationships, and working toward integrating verbal and nonverbal processes. Interventions use verbal strength to analyze and mediate information (e.g., by describing a scene or situation to oneself), and self-talk to provide direction for completing tasks (e.g., by sequencing the steps to a task and saying each step to oneself). Effective interventions include modifying academic and social environments and direct skills instruction. Direct instruction must include a clear explanation of the contexts in which the skill can be applied.[14]

Modifications that contribute to a supportive academic environment for the person with NLD include[14]

  • Ensuring that all the student’s teachers know that the student has NLD and understand its implications.
  • Establishing performance expectations based on observation and knowledge of what the student is able to complete or produce, given the nature of the tasks and the time available.
  • Providing structure and directions about priorities for completing multiple tasks.
  • Arranging with other teachers to stagger the demands for products (papers, projects, tests, etc.), so that they are not all due at the same time.

Socialization for kids with NLD involve strategies also. Modifications that facilitate socialization include the following[14]:

  • Being sensitive to situations that have high potential for the student to behave inappropriately and intervening to avoid behavior that might lead to criticism, teasing, or social ostracism.
  • Engaging the student in a collaboration in which the teacher or parent signals when the student is making a social error and the student agrees to immediately stop the behavior.
  • Arranging structured social activities for young children (through elementary school); coaching the child in how to participate; and signaling the child discreetly if he behaves in a manner that turns others away.

The bottom line here is direct instruction. NLD children have little to no intuition so they are totally clueless about the nonverbal environment, making them appear innocent and gullible, easily taken advantage of by bullies. That’s why direct, verbal, linear communication in all academic and social arenas must be applied to make life easier for the NLD child.

Aside from these, also focus on the NLD child’s strengths.

Common Strengths[1]

  • Average to above average intelligence
  • High verbal scores
  • Early language development
  • Strong ability to remember and repeat spoken information
  • Learns better by hearing information than by seeing it

NLD children are usually average to smart, making them one of the brightest students in the classroom. Also, they have early language development, meaning they can communicate easier than someone with language disorders or autism spectrum disorders.

They also have excellent memories, thereby making any rote learning possible.

Though they have right hemisphere deficit, their left hemisphere are usually good to excellent, meaning they can have very good analytical skills, making them excellent in sciences (except those involved with heavy maths like physics), history and social studies.

Making coping strategies for weaknesses and focusing on strengths make an NLD child cope better to navigate the world.

Also, managing mental disorders like depression, anxiety, and OCD must be addressed to repair the lost or  broken self esteem a child or adult with NLD has.

What about NLD management in adults?

Unfortunately there are no official management strategies for adults with NLD. Maybe the same strategies are used for adults with NLD just like management for students with NLD. Plus, an adult can choose easier career choices that don’t involve nonverbal communication or complicated job descriptions like a nurse or salesperson. She can choose more analytical repetitive jobs like typist or factory assembly worker. As for relationships, she can join nonverbal learning disorder support groups, thereby increasing chances of having more friendships and lovelife too (birds of the same feather are the same birds flock together).

Reference:

  1. https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/nonverbal-learning-disabilities/understanding-nonverbal-learning-disabilities
  2. Horowitz, Sheldon H. “Nonverbal Learning Disabilities: A Primer.” NCLD.org. National Center for Learning Disabilities. Web. http://www.ncld.org/types-learning-disabilities/adhd-related-issues/autism-spectrum-disorders/nonverbal-learning-disabilities
  3. “Non-Verbal Learning Disability (NLD or NVLD): Your Child.” Med.umich.edu. University of Michigan Health System. Web.http://www.med.umich.edu/yourchild/topics/nld.htm
  4. https://en.wikipedia.org/wiki/Nonverbal_learning_disorder
  5. Non Verbal Learning Disabilities:Impact on Social Functioning; And Interpersonal Skills Maggie Mamen, Ph.D., C.Psych NLDline.com http://www.nldline.com/new_page_52.htm
  6. Nonverbal Learning Disability:The Math and Handwriting Problem by Gayle Zieman, Ph.D.
  7. http://www.ldonline.org/article/6114/
  8. http://www.nldline.com/childdream.htm
  9. http://nonverballearningdisability.weebly.com/causes-of-nld.html
  10. http://www.smartkidswithld.org/first-steps/what-are-learning-disabilities/signs-symptoms-of-nld-2/
  11. http://www.learningrx.com/nonverbal-learning-disability-symptoms-faq.htm
  12. https://www.psychologytoday.com/blog/odd-girl-in/201105/boulevard-broken-dreams-refound-the-intersection-n
  13. Hubbard, Anastasia, and Brenda S. Myles. “Nonverbal Learning Disabilities.” GreatSchools.org. GreatSchools. Web. http://www.greatschools.org/special-education/LD-ADHD/907-nonverbal-learning-disabilities.gs
  14. http://www.schoolbehavior.com/disorders/aspergers-nld/nonverbal-learning-disability-how-to-recognize-it-and-minimize-its-effects/
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3 thoughts on “Nonverbal Learning Disorder

  1. Pingback: Why I Wrote This Blog? | Aegyo Kawaii's Neurodiversity Blog

  2. I have always resented the notion we inherently don’t understand context and the “big picture”. It sounds like, they may seem smart because they read lot of books but it turns out they’re actually just parrots. When I talk about stuff like politics or philosophy I tend to have opinions that are outside the norm but outside the norm doesn’t mean wrong.

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    • Yes! That’s right. Usually, what people say about the big picture, they mean the opinion of the majority. Anything that deviates from the norm is different. But, you’re right also. Different opinions from majority doesn’t necessarily mean different or missing the big picture at all.

      Like

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