Nonverbal Learning Disabilities Research Articles

Applicability of the Nonverbal Learning Disability Paradigm for Children With 22q11.2 Deletion Syndrome

Chromosome 22qll.2 deletion syndrome (22qllDS) is the most common microdeletion in humans. Nonverbal learning disability (NLD) has been used to describe the strengths and deficits of children with 22q11DS, but the applicability of the label for this population has seldom been systematically evaluated. The goal of the current study was to address how well the NLD diagnosis characterizes children and adolescents with 22q11DS. A total of 74 children and adolescents with 22q11DS were given neurocognitive, socioemotional, and academic assessments to measure aspects of NLD. Of the cohort, 20% met at least 7 of 9 assessed criteria for NLD; 25% showed verbal skills exceeding their nonverbal skills as assessed by an IQ test; and 24% showed the good rote verbal capacity commonly associated with NLD. Hypothesizing that if the entire cohort did not show consistent NLD characteristics, the descriptor might be more accurate for a distinct subgroup, the authors used latent class analysis to divide participants into three subgroups. However, the lines along which the groups broke out were more related to general functioning level than to NLD criteria. All three groups showed a heightened risk for psychiatric illness, highlighting the importance of careful mental health monitoring for all children with 22qllDS.

A critical review of the literature on NLD as a developmental disorder

The extant research on nonverbal learning disability (NLD) was analyzed in this review. Studies were defined for use in the review as those that appeared in a peer-reviewed journal and included participants characterized as having NLD. Each study also needed to provide a statistical analysis of dependent variables. An a priori system was used to evaluate the quality of the research. Of the 88 publications found, 32 met criteria for inclusion in the review, with 6 meeting full criteria as strong studies. The diagnostic criteria used and the research findings are briefly discussed, as are proposed guidelines for future research.

A Model to Guide the Conceptualization, Assessment, and Diagnosis of Nonverbal Learning Disorder

Although many learning disability types are formally recognized in major classification systems such as DSM-IV-TR and ICD-10, Nonverbal Learning Disorder (NLD) is not despite over 40 years of literature addressing its theoretical and neuropsychological foundation, its major features, and the methods by which to assess and diagnose it. Currently, there is no general agreement regarding the defining features of NLD and their relationship to daily functioning. Presented here is a description of NLD in the context of a model aimed at providing a standard language and framework for describing health and health-related states: the International Classification of Functioning, Disability and Health (ICF). It is proposed that the ICF model can guide clinical thinking, professional practice—including assessment, diagnosis, and treatment—and research with respect to NLD, eventually leading to the inclusion of NLD in formal classification systems.

Intuitive geometry and visuospatial working memory in children showing symptoms of nonverbal learning disabilities

Visuospatial working memory (VSWM) and intuitive geometry were examined in two groups aged 11–13, one with children displaying symptoms of nonverbal learning disability (NLD; n = 16), and the other, a control group without learning disabilities (n = 16). The two groups were matched for general verbal abilities, age, gender, and socioeconomic level. The children were presented with simple storage and complex-span tasks involving VSWM and with the intuitive geometry task devised by Dehaene, Izard, Pica, and Spelke (2006). Results revealed that the two groups differed in the intuitive geometry task. Differences were particularly evident in Euclidean geometry and in geometrical transformations. Moreover, the performance of NLD children was worse than controls to a larger extent in complex-span than in simple storage tasks, and VSWM differences were able to account for group differences in geometry. Finally, a discriminant function analysis confirmed the crucial role of complex-span tasks involving VSWM in distinguishing between the two groups. Results are discussed with reference to the relationship between VSWM and mathematics difficulties in nonverbal learning disabilities.

Enhancing Empathy and Theory of Mind

Social cognitive skills such as empathy and theory of mind are crucial for everyday interactions, cooperation, and cultural learning, and deficits in these skills have been implicated in pathologies such as autism spectrum disorder, sociopathy, and nonverbal learning disorders. Little research has examined how these skills develop after early childhood and how they may be trained. We tested the hypothesis that experience in acting, an activity in which one must step into the shoes of others, leads to growth in both empathy and theory of mind. In two studies, we followed children (elementary school aged) and adolescents (high school freshmen) receiving 1 year of either acting or other arts training (visual arts, music) and assessed empathy and theory of mind before and after training. In both studies, those receiving acting (but not other arts) training showed significant gains in empathy scores; in Study 2, adolescents receiving acting training also showed significant gains on a naturalistic measure of theory of mind, the Empathic Accuracy Paradigm. These findings demonstrate plasticity in empathy and theory of mind long past the watershed age of 3 to 4 years and suggest that both capacities are enhanced by role-playing.

Transient nonverbal learning disorder in a child suffering from Familial Hemiplegic Migraine

To study the link between nonverbal learning disorder and right cerebral hemisphere dysfunction due to migraine attack in a case of Familial Hemiplegic Migraine. Familial Hemiplegic Migraine can cause neuropsychological deficits besides the motor ones. The nonverbal learning disorder is thought to be caused by a right hemisphere dysfunction. We describe a child with Familial Hemiplegic Migraine type 2 who showed a transient neuropsychological impairment featuring a nonverbal learning disorder during and after a Hemiplegic migraine attack. Clinical and neuropsychological data showed a nonverbal learning disorder. A mutation in the ATP1A2 gene on chromosome 1q23 was found. Symptoms of nonverbal learning disorder outlasted the left hemiparesis. Two months later he showed a full recovery. Neurophysiological and neuroradiological evaluations were congruent with clinical course and with right hemisphere involvement. The link between nonverbal learning disorder and right cerebral hemisphere dysfunction due to migraine attack is confirmed. Familial Hemiplegic Migraine can cause transient complex neuropsychological syndromes that can be overlooked if not appropriately investigated.

Mental Representation of Spatial Information in Children with Non-Verbal and Reading Disabilities: Two Case Studies

Non-verbal learning disability (NLD) is a specific difficulty related to the processing of visuo-spatial material. The aim of the present study is to elucidate the profile of NLD as regards ability to process and comprehend spatial descriptions, through the analysis of individual cases. Our study examined one child with NLD (M.N.), plus a second child (G.B.) with reading disability (RD) for comparison. The two children had similar reading comprehension ability. They listened to two spatial descriptions, in both survey (i.e., bird's-eye view) and route (i.e., person's point of view) perspective, plus one non-spatial description. They then answered questions about the descriptions and relocated landmarks from the spatial descriptions on a map. Performance of the child with NLD was poor in spatial descriptions but good in the non-spatial description. In particular, task performance was poorer after survey description learning. Instead, G.B. performed well in both non-spatial and spatial (i.e., survey and route) descriptions. The NLD child was shown to be specifically impaired in ability to mentally represent spatial information in survey perspective.

Imaginative Representations of Two - and Three-Dimensional Matrices in Children with Nonverbal Learning Disabilities

Children with non-verbal learning disabilities (NLD) are characterized by high verbal and poor non-verbal intelligence, poor cognitive abilities, school difficulties, and—sometimes—depressive symptoms. NLD children lack visuospatial working memory, but it is not clear whether they encounter difficulties in mental imagery tasks. In the present study, NLD adolescents without depressive symptoms, depressed adolescents without NLD symptoms, and a control group were administered a mental imagery task requiring them to imagine to move along the cells of a 2-D (5 × 5) or 3-D (3 × 3 × 3) matrix. Results showed that NLD adolescents had difficulty at performing the imagery task when a 3-D pattern was involved. It is suggested that 3-D mental imagery tasks tap visuospatial processes which are weak in NLD individuals. In addition, their poor cognitive performance cannot be attributed to a depressive state, as the depressed group had a performance similar to that of controls.

Cerebrotendinous Xanthomatosis: A Treatable Disease With Juvenile Cataracts as a Presenting Sign

Cerebrotendinous Xanthomatosis (CTX) is an autosomal recessive disorder of bile acid synthesis1. At least 50 different causative mutations have been identified in the CYP27A1 gene encoding for a sterol 27-hydroxylase important in bile acid synthesis2. Sterol 27-hydroxylase deficiency leads to 5α-cholestanol accumulation in the blood and tissues of affected patients1, including brain, often leading to severe neurological dysfunction that can incapacitate patients by the 4th–5th decade of life1. CTX generally presents clinically in the 2nd–3rd decade; childhood signs and symptoms can include chronic diarrhea, juvenile cataracts, school failure1,3, and potentially xanthomas1. Eighty-five percent of CTX patients develop cataracts of multiple types2, reported to occur as young as age 5–6 years1, with cataracts and chronic diarrhea commonly presenting before neurologic disease3. For this reason, and since diarrhea is non-specific, the clinician may not consider a diagnosis of CTX when cataracts are identified. Treatment for CTX is available in the form of chenodeoxycholic acid (CDCA)1,4. The FDA recently reapproved CDCA (Manchester Pharmaceuticals, Inc). As treatment of CTX from the preclinical stage prevents the onset of disease complications4, the value of early diagnosis for this disorder cannot be overstated. We describe two cases of CTX affected children enrolled in an IRB approved study at OHSU with bilateral cataracts as presenting signs of disease. Case 1 A 9 year old female was referred to an ophthalmologist for decreased vision over several months. Past ocular history was unremarkable; full ocular exam 2 years prior was normal. Family history was unremarkable. Past medical history was significant for diarrhea and nonverbal learning disorder. On examination uncorrected distance visual acuity was 20/80 and uncorrected near acuity was 20/50 in each eye. Manifest refraction was 0.75+0.50X90 in each eye, with corrected distance acuity of 20/60 in the right and 20/80 in the left. Complete dilated exam was remarkable for the presence of cataract in each eye and described as a diffuse nuclear haze on slit lamp examination, with mild posterior capsular opacification (figure 1). Retroillumination highlighted posterior capsular findings (figure 2). Sequential bilateral cataract surgery with intraocular lens placement resulted in a corrected visual acuity of 20/20 in each eye. A metabolic workup indicated plasma 5α-cholestanol was markedly elevated at 3.7 mg/dl (normal < 0.2 mg/dl1), suggestive of CTX. Urine testing confirmed CTX with elevated bile alcohol glucuronides present (30.1 μg/ml). CDCA treatment was initiated and diarrhea resolved within one month, with accompanying weight gain. Plasma cholestanol dropped to 0.5 mg/dl within 7 months and after 6 years of treatment is currently stable at <0.2 mg/dl. No further clinical symptoms of CTX have developed. Figure 1 Diffuse nuclear haze and posterior sub capsular capsule opacification in right (A) and left (B) eye. Figure 2 Posterior sub capsular opacification in right (A) and left (B) eye. Case 2 An 11 year old male was referred to an ophthalmologist for cataract evaluation. High myopia was noted by a previous ophthalmologist at age 4. Family history was significant for high myopia and detached retina in mother and grandmother. Medical history included diarrhea from infancy, delayed language, autism, and seizures. Examination was limited by cooperation; however uncorrected distance visual acuity was at least 20/400 with both eyes open. Dilated examination revealed a refraction of −9.00 +1.00X090 in the right eye, and −9.50+1.25X090 in the left and was remarkable for bilateral cataracts. The lens opacities appeared visually significant with cortical flecks and distorted retinoscopic reflexes. Sequential bilateral cataract surgery was conducted with intraocular lens placement. The corrected visual acuity was 20/30+1 in the right and 20/40 in the left eye. Approximately 5 years later the patient was screened for a cholesterol disorder. Plasma 5α-cholestanol was elevated at 3.1–4.2 mg/dl, consistent with CTX. Elevated bile alcohol glucuronides in urine confirmed CTX. Diarrhea resolved within one month of initiating treatment. Plasma 5α-cholestanol dropped to 0.6 mg/dl within 6–8 months. After 8 months of treatment, the patient remains intellectually impaired, and continues to require an augmentative communication device. Although he still types single words to express wishes and needs, his spoken vocabulary has expanded modestly. His behavioral difficulties (making loud noises/head banging) also appear to be subsiding.

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.

Updates on Attention-Deficit/Hyperactivity Disorder and Learning Disorders

The relationship of attention-deficit/hyperactivity disorder (ADHD) to learning disorders was reviewed and included reading disability, mathematics learning disability, and nonverbal learning disability. Genetic, neuroimaging, and neuropsychological functioning were examined for each disorder, along with a discussion of any existing literature when ADHD co-occurred with the disorder. All the disorders were found to frequently co-occur with ADHD. A review of the underlying neuroanatomic and neurofunctional data found specific structures that frequently co-occur in these disorders with others that are specific to the individual diagnosis. Aberrations in structure and/or function were found for the caudate, corpus callosum, and cerebellum, making these structures sensitive for the disorder but not specific. Suggestions for future research, particularly in relation to intervention, are provided.

Comprehension of Different Metaphoric Tasks between Children with Nonverbal Learning Disabilities and Typical Language

Comprehension of Different Metaphoric Tasks between Children with Nonverbal Learning Disabilities and Typical Language

Nonverbal and verbal learning: A comparative study of children and adolescents with 22q11 deletion syndrome, non-syndromal Nonverbal Learning Disorder and memory disorder

The 22q11 deletion syndrome (DS) is a common genetic disorder, and a Nonverbal Learning Disorder (NLD) is considered as a predominant part of the phenotype. The focus of our study was to investigate the role of learning in this NLD characteristic. We compared results of children and adolescents with 22q11 DS; with non-syndromal NLD and with memory disorders on multi-trial verbal and nonverbal learning tests. Better verbal and worse nonverbal IQs were significantly discrepant for the 22q11 DS sample and for the NLD sample; the memory sample had a FS-IQ in the normal range with lower verbal IQ. General IQ was lowest for the 22q11 DS group. Similar differences in normal verbal and worse nonverbal learning resulted for the 22q11 sample and NLD-sample, while memory sample showed low performances on both tasks. Error analysis in the visual learning task indicated that lacking integration of visual-spatial information affected impaired visual memory performances in 22q11 DS and NLD. Our results reflected a common neurological basis with visual-spatial and visual memory deficits in NLD and in the 22q11 DS sample. To further investigate the issue of cross modal novelty learning deficits we recommend the use of abstract verbal learning material.

Presence of Cysts on Magnetic Resonance Images (MRIs) in Children With Asperger Disorder and Nonverbal Learning Disabilities

The main purpose of this study was to report the existence of previously unidentified brain cysts or lesions in children with nonverbal learning disabilities, Asperger syndrome, or controls. The authors compared the incidence of cysts or lesions on magnetic resonance images (MRIs) in 28 children with nonverbal learning disability, 26 children with Asperger syndrome, and 24 typical controls for abnormalities. In this study, the authors found 25% of children previously diagnosed with nonverbal learning disability to have unsuspected brain abnormalities generally including cysts or lesions in the occipital region, compared with approximately 4% in the Asperger syndrome or control group. The cysts/lesions were found mainly in the occipital lobe, an area responsible for visual/spatial reasoning. It is appropriate to speculate that there might be a connection between anomalous brain development and skill differences among these groups.

The effect of miniature learning on concentration of learning disability children

The aim of the present study was to explore the effect of study of miniature on concentration of Iranian children with nonverbal learning disability (NLD). A sample of 20 children (8-10 years) was randomly assigned to experimental and control groups. The experimental group took part in twelve sessions of miniature with 45-60min, while the control group was put on a waiting list. Both groups received the Toulouse-Pieron test three times (pre- test, mid-test, and past-test). The results of ANCOVA based on repeated measure indicated Analyses of variance revealed that Persian miniature had a significant effect on concentration. Results were discussed in terms of miniature as a possible therapeutic method in rising concentration for learning disability children.

Nonverbal Learning Disability explained: the link to shunted hydrocephalus

Accessible summary Children with a Nonverbal Learning Disability (NLD) resulting from shunted hydrocephalus and spina bifida face many difficulties not experienced by those with a language learning disability. As they grow older and more autonomy is expected, friendships became harder to sustain and daily life can be full of fear if the nonverbal learning disability is not identified and managed. This paper explains the theorised cause of nonverbal learning disability – damage to right hemisphere white matter or myelin. Damage is believed to cause problems with planning, organisation, time management, problem‐solving, decision‐making and friendships, and the mismatch with articulate speech and a good vocabulary causes a functional profile that is difficult for educationists or nonmedical readers to understand. By linking the medical condition to the learning disability, this paper aims to reduce misunderstanding and false accusations of laziness. Implications and the Way Forward provide early guidelines to families, educators and others. The ‘final common pathway’ that links shunted hydrocephalus to nonverbal learning disability is explained in comprehensible language. SummaryA nonverbal learning disability is believed to be caused by damage, disorder or destruction of neuronal white matter in the brain’s right hemisphere and may be seen in persons experiencing a wide range of neurological diseases such as hydrocephalus and other types of brain injury (Harnadek &amp; Rourke 1994). This article probes the relationship between shunted hydrocephalus and nonverbal learning disability. Description of hydrocephalus and intelligence associated with hydrocephalus concludes with explication of the ‘final common pathway’ that links residual damage caused by the hydrocephalic condition to a nonverbal learning disability (Rourke &amp; Del Dotto 1994, p. 37). The paper seeks to assist teachers, teacher aides, psychologists, guidance officers, support workers, parents and disability service providers whose role is to understand and advocate for individuals with shunted hydrocephalus and spina bifida.

Perceptual organization, phonological awareness, and reading comprehension in adults with and without learning disabilities

It is not clear from research whether, or to what extent, reading comprehension is impaired in adults who have learning disabilities (LD). The influence of perceptual organization (PO) and phonological awareness (PA) on reading comprehension was investigated. PO and PA are cognitive functions that have been examined in previous research for their roles in nonverbal LD and phonological dyslexia, respectively. Nonverbal tests of PO and non-reading tests of PA were administered to a sample of adults with postsecondary education. Approximately two thirds of the sample had previously been diagnosed as having LD. In a multiple regression analysis, tests of PO and PA were used to predict scores for tests of reading comprehension and mechanics. Despite the nonverbal nature of the perceptual organizational test stimuli, PO strongly predicted reading comprehension. Tests of PA predicted decoding and reading speed. Results were interpreted as supporting the hypothesis that integrative processes usually characterized as nonverbal were nonetheless used by readers with and without disabilities to understand text. The study's findings have implications for understanding the reading of adults with learning disabilities, and the nature of reading comprehension in general.

A Practice-Based Approach to Group Identification in Nonverbal Learning Disorders

Evidence-based practice, the rigorous conduct of clinical analysis and intervention, includes practice-based evidence. Here, practice data were the source of three “clinical portraits” used for exploratory analysis of an array of cognitive and social problems in 30 children whose neurobehavioral profiles fulfilled psychometric criteria for a nonverbal learning disability (NLD). Qualitative analysis of the children's academic and adjustment difficulties revealed patterns of dissociable deficits. These findings argue for at least three groups within the NLD construct. Identifying such subgroups is of practical importance: More precise characterization of neuropsychological competencies leads to improved interventions and better outcomes.

Neuropsychological Differences Among Children With Asperger Syndrome, Nonverbal Learning Disabilities, Attention Deficit Disorder, and Controls

Confusion is present as to possible diagnostic differences between Asperger syndrome (AS) and Nonverbal learning disabilities (NLD) and the relation of these disorders to attentional difficulties. Three-hundred and forty-five children participated in this study in 5 groups; NLD, AS, attention deficit hyperactivity disorder (ADHD): Combined type, ADHD: Inattentive type, and controls. The NLD group showed particular difficulty on visual-spatial, visual-motor, and fluid reasoning measures compared to the other groups. There was also a significant verbal-performance IQ split in this group related to difficulty in social functioning. This study extends the findings from previous studies and extends these findings to differences between AS and NLD groups.

La psychopathologie de l’enfant dyspraxique

The term “dyspraxia” was coined by Julian de Ajuriaguerra and Mira Stambak in 1964. This clinical term was treated very differently according to which explanatory model was adopted. Nowadays, it is used to refer to developmental coordination disorder in view of its neuro-developmental origin. In any case, the actual clinical situations vary and are often complex. In our opinion, it is first necessary to examine the differential diagnosis: apraxia in children caused by lesions, dysgraphia, simply delayed motor development, non-verbal learning disability syndrome, hemispheric specialisation deficits, pervasive developmental disorders (autisms, Asperger syndrome, atypical autism and other pervasive developmental disorders), mixed specific developmental disorders, multiple developmental disorder, and children with high potential. Next we focus on co-morbidity. Firstly, we look at psychopathological disorders associated with dyspraxia: autism and pervasive developmental disorders, dyscalculia/math disability, dyslexia/reading difficulties, dysphasia accompanied by verbal dyspraxia, intelligence deficiency, anxiety disorders, and attention-deficit hyperactivity disorder (ADHD). Secondly, we examine psychopathological disorders associated with dyspraxia. Children with developmental coordination disorder are less inclined to participate in collective games. As a result, there is a greater risk of them becoming lonely and isolated. They have higher child behaviour checklist (CBCL) scores in the somatic problems scale as well as for anxiety, depression and social withdrawal. They have low self-perception in sports as well as at school, which is related to their physical appearance and their self-esteem, attention deficit and externalized behaviour. These children are often at risk of academic failure and they suffer from oppositional defiant disorder and functional disorders. And finally, we believe that it is important to touch on the impact of these disorders on the family.