Imagine being the proud parents of a child whose acumen for spoken language is so strong that, in early pre-school days, friends and family are simply impressed with his/her cute expressive verbal abilities. But, something doesn’t seem right. Even though this child can verbally express with a parrot-like ability, he/she is sedentary, lacking in early sensory and motor exploration. In kindergarten and early elementary school the child begins to stand out more with problems in fine motor skills, coloring, scissor cutting and pencil grip. Handwriting is almost illegible and additional academic problems emerge especially in understanding of math concepts. Phonetic reading may be adequate at first, but warning signs of a reading disability begin to emerge as the child has poor sight word skills. Even though highly verbal, the child has significant trouble with reading facial expressions and body language. As time goes on, further frustration and difficulty with attention look like ADHD behaviors. The child stands out with social difficulty and significant emotional fallout takes a toll. While some of this may sound like the characteristics of high functioning Autism, Aspergers or a form of ADHD, in fact it is neither. The profile described in this child are but a sample of the characteristics of a condition known as Nonverbal Learning Disability (NVLD).
Neuropsychology has identified those with Nonverbal Learning Disability (NVLD) as having significant strengths in early speech and vocabulary, remarkable rote memory and strong auditory retention with good attention to detail , good early reading ability and spelling skills BUT, deficits in visual processing, especially visual-spatial abilities, visualization (executive function, planning and programing), motor, social and sensory abilities. These deficits largely affects the individual with NVLD in math, gross motor, fine motor, handwriting legibility, planning, problem solving, and communication skills based on nonverbal cues such as facial expression or body language. The cumulative result of these deficits often leads to social and emotional problems. The prevalence is difficult to state as there is controversy regarding the specific diagnosis, but estimates are approximately 10-15% of all those with a specific learning disability.
But the above is only an overview to a notably complex condition. An excellent resource to understand the history, diagnostic subtypes, overlap with other conditions, screening for and the diagnostic evaluation of NVLD (and much more) is the textbook by John M. Davis and Jessica Broitman entitled, Nonverbal Learning Disabilities in Children – Bridging the Gap Between Science and Practice.
On January 27, 2017, our office team of doctors and vision therapists presented to the Annual Michigan Vision Therapy Study Group Meeting in Davison, Michigan entitled: The Importance of Vision Development in NVLD. Presented were techniques for a comprehensive model of vision therapy targeted to remediate the visual-spatial processing, executive and visual motor deficits in those with NVLD. One of the primary goals of this presentation was to demonstrate how Developmental Optometry has a vital role in remediating the cause of the ‘disability’ in NVLD. Developmental optometry has the expertise in diagnosing the complex visual dysfunctions associated with NVLD and the therapeutic modalities to help treat those diagnosed with this condition to gain better visual function in these areas that can translate to significant improvements for the NVLD patient in math, handwriting, reading fluency, comprehension, learning in the classroom and foster accelerated development of social skills and confidence. It is important to note that those with NVLD have a multifactorial condition and therefore the best approach in treatment often involves a multidisciplinary collaborative approach with occupational therapy, developmental optometry and educational therapy. But first this process typically begins with the comprehensive evaluation, diagnosis and recommendations by the neuropsychologist.
Click here to obtain a pdf copy of our lecture
To help bring about better public and professional awareness, Columbia University has partnered with the NVLD Project and created this video.
To learn more check out the NVLD Project Website.
Dan L. Fortenbacher, O.D., FCOVD
Thank you for sharing. This is an excellent presentation!
So how does this possibly relate Vision development for those with Cortical Visual Impairment? What is the same and what is different?
Thank you for your question, Lynda. In the patient with Cerebral Cortical Impairment we usually (but not always) find a loss of visual acuity, especially in the young child. In those with NVLD we do not find reduced visual acuity and their diagnosis is not typically identified until they are in early elementary school or older. Rather they have delays in visual processing and integration, especially visual spatial skills and visually directed fine and gross motor abilities. While NVLD is a neuropsychology diagnosis, there can be overlap in reference to the visual components of both. To see more information about Cortical Visual Impairment(CVI), here is a link to past VisionHelp Blog posts that describe CVI: https://visionhelp.wordpress.com/?s=cortical+visual+impairment&submit=Search