Smart Kids With LD

By Marcia Eckerd, Ph.D.

There’s a lot of confusion about Nonverbal Learning Disabilities (NLD); some people are skeptical of NLD as a diagnosis. But for me, it’s a pragmatic question: Is an NLD diagnosis helpful in understanding a constellation of problems a child might have, predicting areas of weakness and strength, both academically and behaviorally, and devising useful strategies for learning and intervention? In my experience, the answer is yes.

The evaluation for NLD involves comprehensive neuropsychological testing in addition to a thorough history, and is best done by a psychologist familiar with the syndrome.

Often children with NLD have been tested before and have been found to have visual-spatial/organizational weaknesses, but no one has put together the whole picture.

Mining Historical Clues

Because children with NLD are highly verbal and have strong rote memory, NLD often isn’t noticed until they are older. These children tend to do well in elementary school, and in many cases are seen as gifted. However, historical clues are there if you look.

Most children with NLD have early problems with fine motor skills, balance (walking, riding a bike) and activities such as tying shoes. They may be clumsy and bump into things because of poor spatial awareness. They are not the early stars of T-ball or ballet. They often talk a lot because they rely on verbal skills to connect with others. They have problems integrating and responding to the everyday experience of being bombarded by nonverbal stimuli, so they may become inflexible and dependent on routine as a way of coping.

Parents report social problems that are longstanding. These children miss nonverbal cues that make up 70-90% of emotional communication. Their behavior runs the gamut from being awkward, not knowing how to join with peers, and having trouble interpreting facial expressions or friendly teasing, to being significantly impaired, socially isolated, and socially inappropriate.

An evaluator also looks for typical academic problems with math, recognizing main ideas, written expression, and higher-order language skills such as inferential language.

These symptoms of NLD can vary from mild to severe. In addition, children can have co-existing problems, such as ADHD, mood disorders or anxiety.

Evaluation Test Components

Testing can confirm the existence of visual-spatial deficits and their impact, and identify co-existing problems. The components of a comprehensive battery should include:

• Behavioral assessment: The Behavior Assessment Scale for Children (BASC-2) is a rating scale generally used to identify problems such as anxiety, social skills, and adaptability.
• IQ testing: Wechsler Intelligence Test for Children (WISC-IV): There is often (but not always) a significant difference between a strong Verbal Comprehension Index Score and a weak Perceptual Reasoning (PR) Index Score.
• Achievement testing: The Wechsler Individual Achievement Test (WIAT-III) is often used. One looks for typical academic challenges in math and writing, and for older children, with reading comprehension and inferential language.
• Memory testing: Often the Children’s Memory Scale (CMS) or the Wide Range Assessment of Memory and Learning (WRAML-2) are used. These tests can show impairment in visual and spatial memory.
• Test of Visual-Motor Integration (VMI): This shows the ability to integrate drawing with visualizing the shape of a figure and its location in space.
• Rey Complex Figure: This isn’t always given, but it shows the child’s ability to organize “big picture thinking.”
• Fine motor skill testing, such as the Purdue Pegboard; there are others as well.
• Laterality and Sequencing: Children often are confused in differentiating right and left, and can have difficulties with visual sequencing.
• Executive Function Testing: The Behavior Rating Inventory of Executive Function (BRIEF) assesses behavioral and executive functions in everyday life, which is actually the critical issue. Children can do well in a highly structured situation (such as testing) and fall apart when expected to function independently. Subtests of the Delis Kaplan Executive Function System (DK-EFS) look at a child’s abilities to conceptualize and use “big picture thinking” in problem solving. Subtests of the Woodcock Johnson Tests of Cognitive Abilities (WJ-III) also address some executive functions.
• Drawings: Often human figure drawings are very immature.
• Emotional measures: In schools, the BASC2 is often used; in private testing, both projective tests and rating scales are used. It is vital to understand the child as a whole person.

More evaluation components might be added to explore attention or social problem solving.

Once a correct diagnosis has been made, parents and school staff need to become well versed in the underlying processing issues in NLD to respond helpfully to the child and provide the academic and environmental supports needed in school and at home.

The author is an evaluator, consultant, and therapist who specializes in working with children with NLD.