Nonverbal Learning Disorder

What Causes Nonverbal Learning Disorder?

The cause of NVLD is not well understood; some scientists believe that it results from atypical structure or function in the parts of the brain associated with visual-spatial processing. Because many of the areas associated with this kind of nonverbal processing are located on the right side of the brain, some researchers believe that the root cause of the condition lies in the brain’s right hemisphere.

Is Nonverbal Learning Disorder Hereditary?

Children with a history of NVLD or other learning disabilities in their families have a greater risk than the general population of having the disorder. Environmental factors could play a role in the prevalence of learning disabilities within families, but studies of identical twins–who are genetically identical to one another–suggest that genetic similarities are at least part of the reason for increased risk in some families.

Researchers have not yet determined which genes or gene variants might contribute to the risk of developing learning disabilities. The process of neurological development that results in learning disorder is complex, however, and, likely, there is not a single genetic cause. Instead, it’s more likely that an interplay of multiple genes and environmental factors is to blame.

How Is Nonverbal Learning Disorder Detected?

NVLD is often mistaken for attention-deficit/hyperactivity disorder (ADHD) because some of NVLD’s learning-related symptoms overlap with those of ADHD. However, children with NVLD often have distinctive traits that set them apart.

Possible signs of NVLD in childhood include:

• Extensive vocabulary at an early age
• Good memory for facts
• Clumsiness
• Poor handwriting
• Difficulty with math
• Problems with spatial processing (e.g., a poor sense of direction)
• Problems following social cues or reading facial expressions

How Is Nonverbal Learning Disorder Diagnosed?

A diagnosis of NVLD can be difficult to obtain because it is not recognized as a distinct disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, if a doctor suspects that NVLD is the cause of a child’s symptoms, they may recommend a psychological or psychiatric assessment by a professional familiar with the disorder to make a diagnosis.

Diagnostic steps may include:

• A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms. The doctor will likely administer a hearing exam to rule out hearing loss as a cause of the communication problems.
• Psychological assessments. If no physical or neurological causes can be found, the doctors may use these assessments to determine if the disorder has a psychological cause. The assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

Although there are currently no formal diagnostic criteria for NVLD, psychiatric professionals have proposed criteria that include:

• Strong verbal performance and weak visual performance on diagnostic tests
• Poor math abilities in conjunction with strong reading abilities
• Poor fine motor control
• Poor visual memory

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Nonverbal Learning Disorder Treated?

There is no standard treatment for NVLD, but behavioral therapies and psychotherapy approaches may be effective for improving symptoms in some people. Commonly used treatments include:

• Occupational therapy
• Cognitive-behavioral therapy
• Parent training

How Does Nonverbal Learning Disorder Progress?

Without treatment, people with NVLD may struggle to create and maintain friendships and other meaningful relationships. Over time, their communication difficulties can lead to social isolation and the potentially serious complications that come along with it, including:

• Being bullied
• Problems with schoolwork
• Impairment of social relationships
• Anxiety or depression

How Is Nonverbal Learning Disorder Prevented?

There is no known way to prevent an NVLD. However, recognizing the disorder early and intervening with treatment may help a child learn strategies to cope with the disorder’s challenges.

Nonverbal Learning Disorder Caregiver Tips

Some of the ways you can help your child cope with NVLD include:

• Educate yourself. The more you know, the better you’ll be able to help your child. That means you should learn as much as possible about NVLD, but it also means you should know about your child’s individual experience with the disorder. You can best support your child when you’re an expert on their disorder.
• Be an advocate for your child. NVLD is not listed as a specific learning disability under the Individuals with Disabilities Education Act (IDEA), so you may face some challenges obtaining services for your child. Only you know what’s best for your child, and it’s up to you to be sure that caregivers, teachers, family members, and everyone else knows how to best support your family.

Many people with NVLD also suffer from other brain-related issues, a condition called co-morbidity. Here are a few of the disorders sometimes associated with NVLD:

• NVLD is sometimes co-morbid with attention-deficit/hyperactivity disorder (ADHD).
• NVLD and autism are sometimes associated.

Nonverbal Learning Disorder Brain Science

Research has suggested that specific differences in brain structure and function may underlie at least some of the symptoms of NVLD. Brain areas associated with the disorder by some studies include:

• Multiple studies have suggested that problems with connectivity between nerve cells called white matter in the brain’s right cerebral hemisphere are common in children with NVLD. At least one study has also concluded that dysfunction in other right-hemisphere cells may also be associated with the disorder.
• Another study found that children with NVLD may have a smaller splenium in their brains. This structure is part of the corpus callosum, a membrane that connects the brain’s left and right hemispheres. The precise function of the splenium is not well understood, but it may be involved in the transfer of visual-spatial information between the two hemispheres.

Scientists don’t yet fully understand how differences in brain function impact social communication. However, some scientists believe that people with social communication difficulties, like those in NVLD, have trouble processing social cues quickly and effectively enough to respond appropriately. They theorize that the problem lies in different brain networks, diverse parts of the brain that work together to process and react to external stimuli. In some people, these networks might not function properly, either internally within a network or in the connections between networks.

The brain networks that might be involved in social communication problems include:

• Salience network. This network includes the insula and the anterior cingulate cortex. One of its functions is thought to be the identification of other people’s mental states, an essential part of pragmatic language comprehension.
• Default mode network (DMN). This network is involved in deciphering social cues.

Studies have found that activity in these parts of the brain is atypical in people with social communication problems when they’re confronted with complex social situations.

Nonverbal Learning Disorder Research

Title: Natural Treatments for the Management of Emotional Dysregulation in Youth With Non-verbal Learning Disability (NVLD) and/or Autism Spectrum Disorders (ASD)

Stage: Recruiting

Principal Investigator: Janet Wozniak, MD

Massachusetts General Hospital

Boston, MA  

This study consists of a 6-week, open-label, randomized clinical trial study to compare the efficacy and tolerability of the natural treatments of omega-3 fatty acids, inositol, and N-acetylcysteine (NAC) in the treatment of mood dysregulation in children and adolescents with non-verbal learning disability (NVLD) or Autism Spectrum Disorder (ASD). Subjects will include youth ages 5-17 years with a non-verbal learning disability (NVLD) or autism spectrum disorder (ASD) and current symptoms of emotional dysregulation.

Title: Neural Basis of Social Cognition Deficits

Stage: Recruiting

Principal Investigator: Aarti Nair, PhD

Loma Linda University

Loma Linda, CA  

Difficulties in reciprocal social interaction are hallmark features of several neuropsychiatric disorders, most notably autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SSD). While recent studies have demonstrated substantial overlap in genetic etiology between ASD and SSD, little is known about common versus unique neural mechanisms that may underlie these downstream social deficits that cross diagnostic boundaries. Thus, a comprehensive imaging study examining social deficits in youth with ASD and adolescent-onset SSD at the neurochemical, connectivity, and functional activation level will be crucial in furthering our understanding of these underlying neural mechanisms. Specifically, the current project aims to examine how targeted social skills interventions may impact the organization of large-scale functional brain networks implicated in social cognition in these disorders, leading to improved outcomes. Thirty adolescents with ASD and 30 with SSD will undergo the Program for the Education and Enrichment of Relational Skills (PEERS), a 16-week parent-assisted social skills intervention that aims to improve friendship quality and social skills of teens with social difficulties. All participants will receive pre- and post-treatment MRI scans, including functional MRI and magnetic resonance spectroscopy, to quantify neural changes resulting from the intervention. All participants will also receive behavioral and social cognition assessments pre- and post-intervention to quantify real-world gains in social behaviors resulting from the intervention. Additionally, 30 typically developing adolescents will be recruited to serve as control participants and undergo two MRI and behavioral assessment sessions 16 weeks apart with no intervention in between. Specific aims include (1) examining inter-group disruptions in connectivity patterns, activation levels, and neurometabolite concentrations in key social brain regions pre-treatment in ASD and SSD groups, (2) examining inter-group changes in connectivity patterns, activation levels, and neurometabolite concentrations in key social brain regions in response to treatment in ASD and SSD groups, and, (3) dimensionally identifying intra-group differences in brain responses and how they relate to real-world treatment outcomes.

Title: Memantine for the Treatment of Social Deficits in Youth With Disorders of Impaired Social Interactions

Stage: Recruiting

Principal Investigator: Gagan Joshi, MD

Massachusetts General Hospital

Boston, MA  

This study is a 12-week randomized-controlled trial of memantine hydrochloride (Namenda) for the treatment of social impairment in youth with Non-Verbal Learning Disorder, High-Functioning Autism Spectrum Disorder, and related conditions. Eligible participants will be males and females ages 8-18.

This study consists of up to 6 visits to Massachusetts General Hospital.