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This chapter discusses working from a shared theoretical orientation. This chapter addresses how all of the professionals on the team must be well versed in understanding the underlying psychological issues presented when someone has NVLD. Children with a learning disability such as NVLD are vulnerable to feeling inadequate, not accepted, and sometimes having minimal control over their life. Starting at a young age, the child may begin to form an image, self-narrative, and belief about themself and others that is potentially incorrect, incoherent, and unhealthy. A model theory suited to dealing with these challenges, Weiss’ control mastery theory (CMT), is presented. The CMT approach would address these issues by establishing a safe and accepting environment, fostering the child’s understanding of themself and others and how their mind works, and helping them to experience mastery over pathogenic beliefs and gain control in their life.

In this chapter we offer a step-by-step guide to address the specific challenges the patient is experiencing within the context of the patient’s developmental stage. Starting with designating someone as the case manager, a team will need to be created to treat the co-occurring or secondary psychological issues in each of these areas of concern. We stress the importance of finding a school environment that will maximize the students’ success. Look for a school that is open-minded, flexible, and willing to consider the specific unique needs of the whole child, not just their disability and remediation needs, recognizing, supporting, and enhancing their strengths as well as their challenges. In addition, we address how to create an action plan. After the initial clinical interview and reading of test materials, an action plan will need to be developed which considers the patients age, family’s resources, the child’s passions, and the areas presenting the most challenge. This plan will shift as the child grows and develops and as their workload increases.

In this chapter, we describe HomeWork TherapyTM, a treatment developed in our practice at the Brooklyn Learning Center that combines psychotherapy, cognitive remediation, and tutoring into a single treatment for children with learning disorders. We also describe how it is delivered for individuals with NVLD. We also describe specific strategies that we often use when we are working with students with NVLD. Like all of the treatment approaches described throughout this book, HomeWork Therapy is also delivered in a team approach and collaboration with families, school faculty, tutors, therapists, speech/language pathologists, occupational, and physical therapists is essential to the success of the treatment.

In this chapter we present a new definition for nonverbal learning disability (NVLD) and a research-driven model for NVLD with 11 potential subtypes. We then report on a new name and consensus definition for NVLD generated by a consortium led by Prudence W. Fisher, PhD, Division of Child and Adolescent Psychiatry, Columbia University College of Physicians & Surgeons.

This chapter presents our current understanding of the need for early assessment and intervention. Clinical experience and empirical evidence suggest that an early and accurate diagnosis, coupled with early intervention, yields better outcomes for children with learning disabilities. Since approximately 65–75% of meaning is communicated by nonverbal cues, such as tone of voice, facial expression, posture, and body language, there is potential for significant difficulty in pragmatic communications for the child who cannot decipher or interpret nonverbal behavior. Children with NVLD are at high risk for a multitude of clinical concerns including anxiety or depression, ADHD, and social and academic problems. With your diagnosis and understanding in hand, it is now time to begin treatment. We offer specific intervention guidelines in this chapter.

Many questions remain regarding the etiology, or underlying causes, of NVLD. Genetic factors likely contribute to NVLD through their role in brain development and the formation of circuits that allow people to perform visual–spatial tasks and processes. There is also some evidence that Performance IQ and the Verbal IQ–Performance IQ discrepancy, which defines some patients with NVLD, may be under genetic control. Environmental factors, like exposures to neurotoxicants, may also contribute to the occurrence of NVLD. In Chap. 4, “The Etiology and Pathophysiology of NVLD,” we discuss our most recent understanding of these issues. Lastly, we consider common comorbidities with NVLD and their relevance for treatment considerations.

In this chapter, we offer techniques and interventions to work with our patients to tailor their treatment to their specific needs. As we have noted above, every patient presents differently with different assets and challenges. Therefore, our single best source of information we will have about our patient comes directly from them. Explicitly acknowledging and inviting information about past problems in order to avoid them in the future and giving agency to the patient could be a useful technique to separate yourself from previous bad experiences. In addition to addressing their psychological and academic issues, the importance of attending to environmental factors is introduced.

In this chapter, we consider the timing of interventions. This chapter helps you navigate how to decide which issues to address, in what order, including how to break down and create a plan for each specific problem your patient faces. We explain how the physical aspects of an environment may be important, including how crowded an area might be, size, amount of light, amount of noise, temperature level, or clothing requirements. We discuss the nonverbal aspects of social environments which are likely worth considering, such as the amount of structure the activity provides and how familiar the patient is with how this activity proceeds. The logistical aspects of environments such as amount and complexity of transit time, familiarity of transit route, and flexibility of arrival and departure times from the event are explained. Lastly we address the psychological aspects of dealing with difficult environments, namely, trained or innate social anxiety and psychological perceptions, sometimes bolstered by outside influences, of how the patient “should” feel and behave in different environments.

In this chapter, we present the common composition of a test report. We offer a guide to parents, teachers, and professionals in other fields (occupational therapists, speech-language pathologists, etc.) on the structure of the report, the types of scores presented in the report, and how to interpret and read a test report. We then discuss how a treatment plan can flow from the report. Specific recommendations/strategies for parents and professionals for working with students with NVLD are listed. Lastly, we offer a “how to” for professionals to make a provisional diagnosis of NVLD using prior documentation when new testing is not available.

In this chapter, we discuss your initial contact and the intake process for diagnosis of your student with NVLD. Included are the points to cover in your first session and the forms we use to collect the needed data. If the data is suggestive of a NVLD syndrome (issues in visual–spatial; academic, math/science; social function; and executive function and environmental sensitivities), and testing is not complete, we would then make a referral for (or do) neuropsychological testing to confirm or disconfirm this diagnosis. We outline the specific steps one must take to determine what treatment your student with NVLD will need.

In this chapter we address how to use neuropsychological testing to determine if an individual has NVLD. We describe the specific screening and assessment instruments we utilize and the areas we cover in our Assessment Battery. The neuropsychological capacities covered include intellectual abilities, executive functions and attention, memory–visual and verbal, sensory motor skills, graphomotor–timed and untimed, language–receptive and expressive, and visual processing. The academic areas assessed include various aspects of math, written expression, and reading. We also assess socio-emotional and behavioral functioning, personality, and other aspects of emotional/psychological functioning as needed. We then discuss how one may present the results to the family. Finally we offer suggestions for how to access assessment for families with limited resources.

This secondary analysis of a cross-sectional study estimates the prevalence of the nonverbal learning disability cognitive profile in children and adolescents from studies centered around brain imaging in the US and Canada., Key Points Question What is the prevalence of nonverbal learning disability among children and adolescents in North America? Findings In this secondary analysis of a cross-sectional study of 2596 children and adolescents in North America, the population prevalence of nonverbal learning disability ranged from 3% to 4%. Meaning This study showed that 2.2 million to 2.9 million children and adolescents may have nonverbal learning disability; further studies appear to be needed to develop and test interventions for treatment of this disorder., Importance Nonverbal learning disability (NVLD) is a neurodevelopmental disorder characterized by deficits in visual-spatial processing but not in reading or verbal ability; in addition, problems in math calculation, visual executive functioning, fine-motor skills, and social skills are often present. To our knowledge, there are no population-based estimates of the prevalence of NVLD in community samples. Objective To estimate the prevalence of the NVLD cognitive profile in 3 independent samples of children and adolescents from studies centered around brain imaging in the US and Canada. Design, Setting, and Participants This cross-sectional study used data from 2 samples recruited from the community and overselected for children with psychiatric disorders (Healthy Brain Network [HBN], January 1, 2015, to December 31, 2019, and Nathan Kline Institute–Rockland Sample [NKI], January 1, 2011, to December 31, 2018) and 1 community-ascertained population sample (Saguenay Youth Study [SYS], January 1, 2003, to December 31, 2012) overselected for active maternal smoking during pregnancy. Main Outcomes and Measures Prevalence of NVLD. Criteria for NVLD were based on clinical records of deficits in visual-spatial reasoning and impairment in 2 of 4 domains of function (fine-motor skills, math calculation, visual executive functioning, and social skills). Sample weighting procedures adjusted for demographic differences in sample frequencies compared with underlying target populations. Inflation factor weights accounted for overrepresentation of psychiatric disorders (HBN and NKI samples). Results Across 3 independent samples, the prevalence of NVLD was estimated among 2596 children and adolescents aged 6 to 19 years (mean [SD] age, 12.5 [3.4] years; 1449 male [55.8%]). After sample and inflation weights were applied, the prevalence of NVLD was 2.78% (95% CI, 2.03%-3.52%) in the HBN sample and 3.9% (95% CI, 1.96%-5.78%) in the NKI sample. In the SYS sample, the prevalence of NVLD was 3.10% (95% CI, 1.93%-4.27%) after applying the sample weight. Across samples and estimation strategies, the population prevalence of NVLD was estimated to range from 3% to 4%. When applied to the US population younger than 18 years, 2.2 million to 2.9 million children and adolescents were estimated to have NVLD. Conclusions and Relevance The findings suggest that the prevalence of NVLD in children and adolescents may be 3% to 4%. Given that few youths are diagnosed with NVLD and receive treatment, increased awareness, identification of the underlying neurobiological mechanisms, and development and testing interventions for the disorder are needed.

Capitalizing on Gerstmann’s early work (1940), Johnson and Myklebust (1967) brought thinking about NVLD into the “modern age.” In their book, Learning Disabilities: Educational Principles and Practices they described their version of the syndrome of nonverbal learning disorders. They observed fine motor difficulties, difficulties with math and writing, and difficulties in visual–spatial processing including something they called “social perception.” They suggested that children with these issues had difficulties in the following areas: understanding gesture, nonverbal motor learning, body image, spatial orientation, right–left orientation, and social perception. Additionally, they also noted that children with NVLD also demonstrated distractibility, perseveration, and disinhibition. Later work has also found overlap with ADHD and executive function issues (Landau, Gross-Tsur, Auerbach, Van der Meer, & Shalev, 1999).

This chapter provides an overview of the evolution of what we, today, call a nonverbal learning disorder (or nonverbal learning disability) (NVLD). Although there was increased interest in this disorder in the 1980s and 1990s, researchers and practitioners have not even been able to agree whether nonverbal learning disabilities should be abbreviated as NLD (mostly used on the West Coast) or NVLD (preferred by East Coast clinicians), nor have they arrived at an accepted definition for this condition, although Rourke’s definition is the most frequently noted (Pelletier, Ahmad, & Rourke, 2001). We will use the abbreviation NVLD for the purposes of this book.

Inconsistent findings in previous studies of interpretations have resulted from the confounding of categories of interpretations with accuracy of interpretations. This study adds two new patient process measures (Insight and Referential Activity) to our original study (Fretter, 1984; Silberschatz, Fretter, & Curtis, 1986) and consistently demonstrates that accuracy (as measured by Plan Compatibility) is a significant predictor of three patients' immediate progress in brief dynamic psychotherapy, whereas category (transference versus nontransference) is not. The theoretical concept of transference is translated into the concept of the Plan. Finally, a clinical case taken from the empirical study is presented to illustrate our theoretical point that the power of the Plan lies in its case-specific ability to address multiple aspects of the patient's many transferences whether or not they are directed explicitly toward the therapist.

The National Center for Education Statistics estimates that 20–25% of children will have learning disabilities (1998). “Specific learning disability” (SLD) is the most prevalent eligibility category in special education. SLD is a disorder in one or more of the central nervous system processes involved in perceiving, understanding, and/or using concepts through verbal (spoken or written) language or nonverbal means. The term does not include learning problems that are primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage (Federal guidelines 34 CFR 300.7).

This chapter will cover eligibility for special services including brief overviews of both the Individuals with Disabilities Education Act-2004 and Section 504 of the Rehabilitation Act of 1973. Since our model suggests that students with NVLD often have academic and social impairment, knowing the pertinent laws will help the students and their families get the added support they will need.

Historically, Rourke (1985, 1991) and others (Drummond, Ahmad, & Rourke, 2005; Harnadek & Rourke, 1994; Johnson & Myklebust, 1967; Pennington, 1991) spent a significant amount of time clarifying the differences between what are often referred to as verbal or phonologically based learning disorders and nonverbal learning disorders. More recently, some theorists have suggested that, as with many developmental disorders, NVLD should be considered as a disorder with different subtypes (Davis & Broitman, 2007; Forrest, 2004; Grodzinsky, 2003; Mamen, 2006). This notion fits with our clinical experience. This chapter reviews the most recent developments in the understanding of NVLD as a disorder with multiple subtypes or components.

In this chapter we will discuss the extent of our knowledge, as well as our uncertainty, regarding the causes of NVLD. Unfortunately, as is the case with other learning disabilities (LD: Duane, 1991) and developmental disorders (DD: Ozonoff & Rogers, 2003), the exact cause or causes of nonverbal learning disabilities are not yet clear. We review the current available information from the areas typically addressed when considering causality: genetics, neurobiology, and environment. Finally, the current model of understanding NVLD, which is commonly called the “white matter model” from a neurological perspective, will be presented.