Diseases & Conditions


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Nonverbal learning disabilities (NLD)


A form of LEARNING DISABILITY that primarily affects social functioning in areas such as interpersonal skills, social perception, and interaction. Also called “right-hemisphere learning disorders,” this problem often goes unrecognized for a large part of a child’s schooling. Since abnormalities of the right hemisphere interfere with understanding and adaptive learning, experts believe that nonverbal learning disabilities are more debilitating than verbal disabilities. Experts suspect that nonverbal learning disabilities are caused by a problem in the right hemisphere of the brain, either from brain injury or damage before birth. The damage primarily affects visual-spatial perception, processing, and reasoning. Children with nonverbal learning disabilities (NLD) often are very good verbally and may develop reading and speaking skills earlier than their peers; consequently, their nonverbal learning difficulties may be overlooked. Both parents and teachers will often suspect that something is wrong early on, but they cannot quite figure out what it is. Nonverbal learning disorders remain predominantly misunderstood and largely unrecognized. Although NLD syndrome was discovered in the early 1970s, even today education professionals are largely unfamiliar with nonverbal learning disorders. Typically, parents are assured that everything is fine and that their child is “just a perfectionist,” or is immature, bored, or a bit clumsy. Rarely are a parent’s or teacher’s concerns accepted until the child reaches a point in school where he is no longer able to function. These children are often labeled “behavior problems” or “emotionally disturbed” because of their frequent inappropriate and unexpected conduct, despite the fact that NLD has a neurological rather than an emotional origin. It is especially important to identify children with nonverbal learning disorders because overestimates of the child’s abilities and unrealistic demands made by parents and teachers can lead to ongoing emotional problems. Unfortunately, there are few resources available for the child with NLD syndrome through schools or private agencies, and it is hard to find a professional who understands nonverbal learning disabilities. Nonverbal learning disorders are much less common than language-based learning disorders (affecting only between .1 percent and 1 percent of the general population). Unlike language-based learning disabilities, the NLD syndrome affects girls as often as boys. Although there are not many people with NLD, experts suspect that as school assessment procedures improve, a higher proportion of children will be identified with NLD. Symptoms Children with NLD may have trouble perceiving and understanding the subtle visual cues important to nonverbal communication that form the basis of social interaction and interpersonal relations. They may misread overt signals of impatience, annoyance, or the desire to end an interaction and consequently may respond in ways that are perceived by others as inappropriate. A child with NLD syndrome may have trouble adapting to new situations or accurately reading nonverbal signals and cues. Although these students make progress in school, they have trouble “producing” in situations where speed and adaptability are required. There are three categories of dysfunction: . • lack of coordination, severe balance problems, or difficulties with fine motor skills . . • poor visual recall, faulty spatial perceptions, or problems with spatial relations . . • lack of ability to comprehend nonverbal communication, trouble adjusting to new situations, or significant problems with social judgment and social interaction . Children with nonverbal learning disorders commonly appear awkward and uncoordinated in both fine and gross motor skills. They may have had extreme difficulty learning to ride a bike or to kick a soccer ball. Fine motor skills, such as cutting with scissors or tying shoelaces, seem to be impossible for them. Young children with NLD are less likely to explore their environment because they cannot rely on their own perceptions. These children do not learn much from experience or repetition and cannot generalize information. In the early years, children may appear confused much of the time despite a high intelligence and high scores on receptive and expressive language measures. Closer observation will reveal a social ineptness due to misinterpretations of body language and tone of voice. These children do not perceive subtle cues in their environment, such as the idea of personal space, the facial expressions of others, or nonverbal displays of pleasure or displeasure. These are all social skills that are normally grasped intuitively through observation, not directly taught. Instead, these children cope by relying on language as their principal means of social relating, information gathering, and relief from anxiety and often develop an exceptional memory for rote material. Since the nonverbal processing areas of the brain are not giving automatic feedback, they rely solely on memory of past experiences, each of which they labeled verbally to guide them in future situations. This, of course, is less effective and less reliable than being able to sense and interpret another person’s social cues. Normal conversational “give and take” seem impossible for these children. It is hard for these children to change from one activity to another or to move from one place to another. A child with NLD needs to concentrate merely to get through a room. Owing to the inability to handle such information processing demands, these children will instinctively avoid any kind of novelty. Problems with NLD grow more apparent and more profound during the latter stages of childhood development and into adolescence, as pressures on social interaction increase and the requirements for appropriate social performance become more subtle and complex. Cause Non-language-based learning disorders are believed to be inherited, but a specific genetic problem has not yet been discovered. Nonverbal learning disabilities involve the performance processes that originate in the right cerebral hemisphere of the brain, which specializes in nonverbal processing. Brain scans of children with NLD often reveal mild abnormalities of the right cerebral hemisphere. Current evidence suggests that a contributing cause of the NLD syndrome involves early damage of the right cerebral hemisphere or white matter disease that forces the left hemisphere system to function on its own. A number of children suffering from NLD have at some time early in their development: . • sustained a moderate to severe head injury . . • received repeated radiation treatments on or near their heads over a prolonged period of time . . • had congenital absence of the corpus callosum . . • been treated for hydrocephalus . . • had brain tissue removed from the right hemisphere . Prognosis How well these children progress seems to depend on early identification and accommodation. Typically, children with this condition are regularly punished for circumstances they cannot help without ever really understanding why, and they are often left with little hope that the situation will ever improve. As a result, these children tend to have serious forms of depression, withdrawal, anxiety, and in some cases, suicide. Diagnosis Whereas language-based disabilities are usually obvious to parents and educators, nonverbal learning disorders routinely go unrecognized. Many of the early symptoms of nonverbal learning disabilities (the language-based accomplishments) make parents and teachers proud. This child may speak like an adult at two or three years of age, and during early childhood, he is usually considered “gifted” by his parents and teachers. Sometimes the NLD child has a history of rote reading at a very young age. This child is generally an eager, enthusiastic learner who quickly memorizes rote material. Extraordinary early speech and vocabulary development are not often suspected to be a coping strategy used by a child with problems in the righthemisphere brain system and limited access to nonverbal processing abilities. The NLD child is also likely to acquire an unusual aptitude for spelling, but few adults will consider this to be a reflection of the overdependence on auditory perceptions. Likewise, remarkable rote memory skills, attention to detail, and a natural facility for decoding, encoding, and early reading development are not generally cause for alarm. Yet these are some of the important early indicators that a child is having trouble relating to and functioning in the nonverbal world. Dysfunctions associated with NLD are less apparent at the age of seven to eight years than at 10 to 14 years, and they become progressively more apparent and more debilitating with each year. During late elementary school, the child will begin to not complete or turn in written assignments. The child produces limited written output and the process is always slow and laborious. By the time the problem is revealed, the child may have already shut down in response to impossible academic pressures and performance demands. Treatment Parents and the school should not underestimate the gravity of this disability. The main problem in the painstaking approach to teaching the child is the caregiver’s faulty impression that the child is much more adept than he is. Everyone tends to overestimate the intelligence of NLD adolescents. The child should be shielded from teasing, persecution, and other sources of anxiety. Independence should be introduced gradually, in controlled, nonthreatening situations. The more completely the strengths and weaknesses of the child are understood, the better prepared the care providers will be to promote the child’s independence. These children should never be left to their own devices in new activities or situations that lack sufficient structure. Goals and expectations must be attainable. Occupational therapy is a good idea for the younger child. Use of a computer word processor can help, since the spatial and fine motor skills needed for typing are not as complicated as those involved in handwriting. Tasks requiring folding, cutting with scissors, or arranging material (maps, graphs, mobiles) will require considerable help. Timed assignments will need to be modified or eliminated. Adults need to check often that the child understands, and that information is presented clearly. All expectations need to be direct and explicit, and the student’s schedule needs to be as predictable as possible. He should be prepared in advance for changes in routine, such as: assemblies, field trips, minimum days, vacation days, finals, and so on. This type of child needs to be assigned to one case manager at school who will oversee progress and can make sure all of the school staff are making the necessary accommodations and modifications. Inservice training and orientation for all school staff that promotes tolerance and acceptance is a vital part of the overall plan for success, as everyone must be familiar with and supportive of the child’s academic and social needs. This child needs to be in a learning environment that provides daily, nonthreatening contact with nondisabled peers—not a “special” or alternative program in order to boost social development. This child will benefit from cooperative learning situations when grouped with good role models. Transitions will always be difficult for this child, so he will need time during the school day to collect his thoughts before “switching gears.” Teachers will need to present strategies for conversation skills, how and when to change the subject, tone and expression of voice, and nonverbal body language (facial expressions, correct social distance). Isolation, deprivation, and punishment are not effective methods to change the behavior of a child who is already trying his best to conform, but who misinterprets nonverbal cues.