Because children with Nonverbal Learning Disabilities 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.
Many 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 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.
Despite their strong verbal skills, these children can have difficulty with the subtleties of social communication and understanding, and with language that isn’t concrete. They don’t “get” many aspects of social communication (pragmatic language) and have trouble with language that is inferred or ambiguous. They may “miss” jokes or sarcasm, and have trouble with reading comprehension when themes or ideas aren’t clearly stated.
NLD children tend to be detail-focused; they see every tree but can miss the forest. This is a problem when they have to differentiate between main and salient ideas in reading, writing and studying. Teachers and parents don’t get it when bright, verbal children miss main ideas and don’t know how to respond to open ended questions, fiction, or higher level tasks such as “describe the theme” of a book.
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.
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 is a rating scale generally used to identify problems such as anxiety, social skills, and adaptability.
- IQ testing: Wechsler Intelligence Test for Children (WISC-V): 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 pragmatic language, such as the Social Development Test for Pragmatics, which gets at inferred language. Also, for inferred and ambiguous language, The Test of Language Competence-Expanded can be a little easy for bright kids. I like the PAL (Process Assessment of the Learner) for elementary grades through 4; it has a note taking task to see if the child picks up main ideas. The 20 Questions Test of the DKEFS gets at abstract vs. concrete thinking, and other tests have subtests that are used.
- 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.