Nonverbal learning disabilities: A critical review

This article presents a critical review of the term and concept of nonverbal learning disability (NLD). After a brief historical introduction, the article focuses on the apparent rarity of NLD; the hypothesis of the frequent co-occurrence of emotional disorder, depression, and suicide in NLD; the white matter hypothesis as an explanation of the origin of NLD; and the question of NLD as part of a variety of other disorders. It is argued that NLD presents a broad hypothesis, but that there is little evidence to support its use in clinical practice.     

Visual Perception and Memory Impairments in Children at Risk of Nonverbal Learning Disabilities

Visuospatial working memory (VSWM) and visual perception were examined in two groups aged 11–13, one with children displaying symptoms of nonverbal learning disability (NLD) (n = 18) and the other a control group without learning disabilities (n = 18). The two groups were matched for general verbal abilities, age, gender, and socioeconomic level. The children were presented with VSWM tests involving visual and spatial-simultaneous processes, and also with a classical visual illusion, a classical ambiguous figure, as well as visual perception tests specifically devised for the present study. Results revealed that performance of children at risk of NLD was worse than controls in some VSWM and in visual perception tests without memory involvement; these latter required comparisons of visual stimuli and locations in space with distractors. Moreover, the two groups differed in perceiving the classical ambiguous figure. Findings are discussed in the light of both theoretical and clinical implications.     

Spatial and emotional aspects of language inferencing in nonverbal learning disabilities.

Although subtle linguistic deficits have been postulated for children identified with nonverbal learning disabilities (NLD), there is little empirical evidence to support this contention. Two experimental language inferencing measures that have been demonstrated to be problematic for individuals with right hemisphere brain damage (RHBD) and one norm-referenced inferencing task were examined in three groups of children aged 9-13: (1) children with NLD (n = 14), (2) children with verbal impairments (VI) (n = 14), and (3) children without learning disabilities who served as controls (n = 19). The NLD and VI groups did not differ from one another on any of the three measures, indicating a generalized language inferencing deficit in the NLD group. Relative to the control group, however, the NLD group experienced specific difficulties with spatial and emotional inferencing. The implications for right hemisphere involvement in the NLD profile are examined in relation to the effects of working memory on inferential abilities.     

Nonverbal learning disabilities: The syndrome and a case study

Presents the syndrome of nonverbal learning disabilities (NLD) and the model developed to encompass its complex manifestations. Included are the history of the development of the syndrome, the types of children in whom its principal features are manifest, the hypothesized neurological bases of the syndrome, and a test of its developmental dimensions. A case study with assessment results and treatment implications illustrates the clinical dimensions of the syndrome. General developmental and treatment implications of the NLD syndrome and the NLD model are also included.     

Neuropsychological, learning and psychosocial profile of primary school aged children with the velo-cardio-facial syndrome (22q11 deletion): evidence for a nonverbal learning disability?

In this exploratory study, the neuropsychological and learning profile of nine primary school age children with velo-cardio-facial syndrome (VCFS) was studied by systematic neuropsychological testing. In five out of nine children, the following profile was found: a VIQ-PIQ discrepancy (in favor of the VIQ), significantly better scores (.05 level) for reading (decoding) and spelling compared to arithmetic, deficient tactile-perceptual skills (difficulties mainly on the left side of the body), weak but not deficient visual-perceptual abilities, deficient visual-spatial skills, extremely poor psychomotor skills (gross motor skills more deficient than fine motor skills), problems with processing of new and complex material, poor visual attention, good auditory memory and relatively good language skills. These findings correspond to the pattern of neuropsychological assets and deficits that has been described for the syndrome of nonverbal learning disabilities (NLD) (Rourke, 1987, 1988, 1989, 1995). The psychosocial profile of all nine children with VCFS also correspond to that of children with NLD. Further studies on the relationship between cognitive function, behavior, psychiatric disorder and abnormalities in brain anatomy in young people with VCFS will be needed. In clinical practice, it is worthwhile exploring in greater depth the neuropsychological functions of children with VCFS to rule out NLD, since they may benefit from specific remediation following the learning principles of the NLD-treatment.     

Working Memory Interference Control Deficit in Children Referred by Teachers for ADHD Symptoms

In this exploratory study, the neuropsychological and learning profile of nine primary school age children with velo-cardio-facial syndrome (VCFS) was studied by systematic neuropsychological testing. In five out of nine children, the following profile was found: a VIQ-PIQ discrepancy (in favor of the VIQ), significantly better scores (.05 level) for reading (decoding) and spelling compared to arithmetic, deficient tactile-perceptual skills (difficulties mainly on the left side of the body), weak but not deficient visual-perceptual abilities, deficient visual-spatial skills, extremely poor psychomotor skills (gross motor skills more deficient than fine motor skills), problems with processing of new and complex material, poor visual attention, good auditory memory and relatively good language skills. These findings correspond to the pattern of neuropsychological assets and deficits that has been described for the syndrome of nonverbal learning disabilities (NLD) (Rourke, 1987, 1988, 1989, 1995). The psychosocial profile of all nine children with VCFS also correspond to that of children with NLD. Further studies on the relationship between cognitive function, behavior, psychiatric disorder and abnormalities in brain anatomy in young people with VCFS will be needed. In clinical practice, it is worthwhile exploring in greater depth the neuropsychological functions of children with VCFS to rule out NLD, since they may benefit from specific remediation following the learning principles of the NLD-treatment.     

Social functioning using direct and indirect measures with children with High Functioning Autism,nonverbal learning disability,and typically developing children

Social perception is an important underlying foundation for emotional development and overall adaptation. The majority of studies with children with High Functioning Autism (HFA) or nonverbal learning disabilities (NLD) evaluating social functioning have used measures of parent and/or teacher ratings. The present study utilized parent and teacher ratings of behavior as well as executive functioning in addition to direct measures of social perception. Three groups participated in this study (control [n = 38] HFA [n = 36], NLD [n = 31]). Results indicated that the HFA group experienced the most difficulty understanding emotional cues on the direct measure while both the HFA and NLD groups experienced difficulty with nonverbal cues. Significant difficulties were reported on the parent rating scale for sadness and social withdrawal for both clinical groups. Executive functioning was found to be particularly problematic for the clinical groups. The direct social perception measure was highly correlated with the measures of executive functioning and reflects the contribution that executive functions have on social functioning. These findings suggest that the clinical presentation on behavior rating scales may be very similar for children with HFA and NLD. Moreover, it appears that measures of executive functioning are sensitive to the clinical difficulties these groups experience. The findings also suggest there is a commonality in these disorders that warrants further investigation.     

Periventricular leukomalacia (PVL): an identical twin case study illustration of white matter dysfunction and nonverbal learning disability (NLD).

This paper discusses the implications of Periventricular Leukomalacia (PVL) lesions for the development of Nonverbal Learning Disabilities (NLD) as illustrated through an identical twin case study. PVL lesions were identified in an 8-year-old child, but were not detected in his identical twin brother who served as a matched comparison. While the nonclinical twin displayed a largely unremarkable neuropsychological profile, the clinical twin evidenced a distinct pattern of social, intellectual, academic, and neuropsychological test results often identified among children with PVL and those with the NLD syndrome. The clinical and theoretical implications for this case study are discussed.     

Periventricular Leukomalacia (PVL): An Identical Twin Case Study Illustration of White Matter Dysfunction and Nonverbal Learning Disability (NLD)*

This paper discusses the implications of Periventricular Leukomalacia (PVL) lesions for the development of Nonverbal Learning Disabilities (NLD) as illustrated through an identical twin case study. PVL lesions were identified in an 8-year-old child, but were not detected in his identical twin brother who served as a matched comparison. While the nonclinical twin displayed a largely unremarkable neuropsychological profile, the clinical twin evidenced a distinct pattern of social, intellectual, academic, and neuropsychological test results often identified among children with PVL and those with the NLD syndrome. The clinical and theoretical implications for this case study are discussed.     

Commentary on Paper by Terry Marks-Tarlow

This discussion of the paper merging and emerging: A nonlinear portrait of intersubjectivity during psychotherapy focuses on how the original paper demonstrates the usefulness of the concepts of nonlinear dynamics systems theory (NLD) to clinical psychoanalysis. Diagnosis conceptualize in NLD terms successfully resists the pressure to reduce complex situations to overly simple few word phrases. The phenomena of transference and repetition are redescribed as resulting from an iterative process that is evident in complex adaptive systems. The model of psychoanalysis in terms of coupled oscillators is demonstrated to be clinically useful as is the concept of emergence which overcomes some of the less useful aspects of the reductionist program. The idea of studying boundaries per se, as opposed to their function of separating individuals, arises naturally from the study of fractals and promises to clarify the oversimplified discussions of these matters in the psychoanalytic literature. The original author has successfully demonstrated how useful NLD conceptualizations can be to the clinical psychoanalyst.     

Classification rules for basic phonological processing disabilities and nonverbal learning disabilities: formulation and external validity.

Rules for the classification of two subtypes of learning disabilities (LD), namely, Basic Phonological Processing Disabilities (BPPD) and Nonverbal Learning Disabilities (NLD), are reported. These rules (refined as a result of application to two separate samples of children with LD) were used to select children from an entirely new sample who could be classified as having "definite" or "probable" BPPD or NLD. As a first step in the external validation of these rules, the patterns of psychosocial functioning exhibited by these two subtypes of LD were determined. As predicted, the vast majority of the BPPD subtype exhibited a pattern most consistent with normal or relatively normal psychosocial adjustment, and no appreciable increase in the incidence of significant psychosocial disturbance with advancing years. Also, as predicted, an increasing incidence of internalized psychosocial dysfunction (a form of significant psychosocial disturbance) was evident in the NLD subtype with advancing years. It is clear that children classified as having BPPD or NLD using these rules exhibit quite different, and predicted, relative patterns of psychosocial functioning. Thus, in this sense, the rules have concurrent validity. Finally, sets of rules/criteria for classification are presented that reflect their actual incidence in the two subtypes of LD generated for use in the validation phase of this investigation. These rules would appear to be useful for clinical purposes. It is also clear that they should be subjected to further validation studies in a broader age range for clinical and research purposes.     

Verbal Learning Strategies of Adolescents and Adults with the Syndrome of Nonverbal Learning Disabilities

Abstract

Although many psychometric studies of individuals with the syndrome of nonverbal learning disabilities (NLD) have been conducted, one relatively neglected area has been the study of their performance on explicit verbal memory measures. We examined the performance of adolescents and adults with NLD on the California Verbal Learning Test, a measure allowing analysis of self-initiated learning strategies, and compared their performance to age- and Full Scale IQ-matched verbal learning-disabled (VLD) controls. Mean performance of the NLD sample on the semantic clustering index fell one standard deviation below the normative mean, whereas their serial clustering score was within normal limits. Additionally, the serial clustering score for our NLD sample was significantly greater than their semantic clustering score, suggesting that these individuals are more likely to spontaneously employ serial verbal learning strategies as opposed to those that are semantically driven. This difference in serial versus semantic clustering scores was not seen in our VLD controls, who performed equally well, and within normal limits, on both indices.     

Classification Rules for Basic Phonological Processing Disabilities and Nonverbal Learning Disabilities: Formulation and External Validity*

Rules for the classification of two subtypes of learning disabilities (LD), namely, Basic Phonological Processing Disabilities (BPPD) and Nonverbal Learning Disabilities (NLD), are reported. These rules (refined as a result of application to two separate samples of children with LD) were used to select children from an entirely new sample who could be classified as having ‘definite’ or ‘probable’ BPPD or NLD. As a first step in the external validation of these rules, the patterns of psychosocial functioning exhibited by these two subtypes of LD were determined. As predicted, the vast majority of the BPPD subtype exhibited a pattern most consistent with normal or relatively normal psychosocial adjustment, and no appreciable increase in the incidence of significant psychosocial disturbance with advancing years. Also, as predicted, an increasing incidence of internalized psychosocial dysfunction (a form of significant psychosocial disturbance) was evident in the NLD subtype with advancing years. It is clear that children classified as having BPPD or NLD using these rules exhibit quite different, and predicted, relative patterns of psychosocial functioning. Thus, in this sense, the rules have concurrent validity. Finally, sets of rules/criteria for classification are presented that reflect their actual incidence in the two subtypes of LD generated for use in the validation phase of this investigation. These rules would appear to be useful for clinical purposes. It is also clear that they should be subjected to further validation studies in a broader age range for clinical and research purposes.     

Emotion knowledge,emotion regulation,and psychosocial adjustment in children with nonverbal learning disabilities

Nonverbal learning disability is a childhood disorder with basic neuropsychological deficits in visuospatial processing and psychomotor coordination, and secondary impairments in academic and social-emotional functioning. This study examines emotion recognition, understanding, and regulation in a clinic-referred group of young children with nonverbal learning disabilities (NLD). These processes have been shown to be related to social competence and psychological adjustment in typically developing (TD) children. Psychosocial adjustment and social skills are also examined for this young group, and for a clinic-referred group of older children with NLD. The young children with NLD scored lower than the TD comparison group on tasks assessing recognition of happy and sad facial expressions and tasks assessing understanding of how emotions work. Children with NLD were also rated as having less adaptive regulation of their emotions. For both young and older children with NLD, internalizing and externalizing problem scales were rated higher than for the TD comparison groups, and the means of the internalizing, attention, and social problem scales were found to fall within clinically concerning ranges. Measures of attention and nonverbal intelligence did not account for the relationship between NLD and Social Problems. Social skills and NLD membership share mostly overlapping variance in accounting for internalizing problems across the sample. The results are discussed within a framework wherein social cognitive deficits, including emotion processes, have a negative impact on social competence, leading to clinically concerning levels of depression and withdrawal in this population.     

非言语学习不良的研究现状和展望

非言语学习不良日益成为学习不良研究的新热点,非言语学习不良的概念界定、筛查和诊断标准以及非言语学习不良的神经心理、认知、社会性和教育干预等领域取得了大量的研究成果。但是,非言语学习不良研究中还存在许多需要解决的问题,如：界定标准不统一;对非言语学习不良的系统研究有待完善;缺乏有效的干预模式及实证研究等。这些问题都需要进一步的研究、探讨     

Narrative comprehension and retelling abilities of children with nonverbal learning disabilities

Nonverbal learning disabilities (NLD) are characterized by weaknesses in narrative discourse. Thirty-three children (M ag e= 11.7 years), 15 girls and 18 boys, listened to stories to evaluate their narrative comprehension and retelling abilities. Children with NLD (n = 11) performed as poorly as children with verbal impairment (n = 10) on all narrative measures. Compared to typical controls (n = 12), the NLD group was poorer in comprehending inferences, but not facts. They included less of the original content than controls in their story retells, and there were strong trends suggesting fewer utterances and less variety in their vocabulary usage. Results are discussed regarding their implications for understanding the neuropsychological profile of NLD.     

Asperger syndrome: How does it relate to non‐verbal learning disability?

The syndrome of non‐verbal learning disabilities (NLD) is associated with prominent non‐verbal deficits such as reduced perceptual and spatial abilities, against a background of relatively intact verbal abilities. Asperger syndrome is one of the several developmental disorders for which Byron Rourke has claimed that almost all the signs and symptoms of NLD are present. This study investigated the claim utilizing a battery of neuropsychological tests that were found to be sensitive to NLD in the original learning disordered populations used to describe the syndrome. Children aged between 8 and 14 were recruited to form two groups: (1) children with Asperger syndrome (N=14) and (2) normal healthy schoolchildren (N=20). By contrast to the main principle outlined in the NLD model, children with Asperger syndrome did not display a relative difficulty with spatial‐ or problem‐solving tasks; indeed, they displayed significantly higher performance on some non‐verbal tasks in comparison with verbal tasks. It was only in relation to their high levels of psychosocial and interpersonal difficulties, which are also predicted on the basis of their psychiatric diagnosis, that the children with Asperger syndrome were clearly consistent with the NLD model in this study. These results raise questions about the relevance of the syndrome of NLD for children with Asperger syndrome.     

Case illustration of a boy with nonverbal learning disorder and Asperger's features: neuropsychological and personality assessment

I present a case study of a latency-age boy referred for assessment of a nonverbal learning disability/disorder (NLD) who also had features of Asperger's syndrome (AS). I review NLD terminology, presumed brain-behavior relationship, neuropsychological profile, and diagnosis/classification issues. I discuss the challenge of differentiating NLD from AS in relation to the client's pattern of visual-spatial, communication, social-emotional, and behavioral NLD correlates. I integrate neuropsychological and personality assessment data with interviews, observations, prior testing, and input from teacher and therapist in formulating a diagnostic impression. I discuss Rorschach (Exner, 2003) and neuropsychological consultations in relation to subtle language and interpersonal features of the client's communication style. I provide parent feedback at 18 and 24 months posttesting. I discuss implications relative to a model of school neuropsychological assessment that includes the Rorschach test.     

Smaller splenium in children with nonverbal learning disability compared to controls,high-functioning autism and ADHD

The current study investigated morphological differences in the corpus callosum in children ages 8 to 18 years old with nonverbal learning disability (NLD; n = 19), high-functioning autism (HFA; n = 23), predominantly inattentive ADHD (ADHD:PI; n = 23), and combined type ADHD (ADHD:C; n = 25), as well as those demonstrating typical development (n = 57). Midsagittal area of the corpus callosum and five midsagittal anterior-to-posterior corpus callosum segments were examined using magnetic resonance imaging. Controlling for midsagittal brain area and age, no group differences were found for total corpus callosum area. This finding indicates that higher functioning children on the autistic spectrum do not have smaller corpus callosi as has been found in previous research with heterogeneous samples. Following segmentation of the corpus callosum, the NLD group was observed to have significantly smaller splenia compared to all other groups. Smaller splenia in the NLD group was associated with lower WASI PIQ scores but not WASI VIQ scores. Children with HFA were observed to have larger midbody areas than children with NLD and neurotypically developing children. Children with HFA and NLD demonstrated behavioral symptoms of inattention and hyperactivity similar to the ADHD groups indicating that corpus callosum differences seen in the NLD and HFA groups are not related to these behaviors.