Is it Nonverbal Learning Disorder or ADHD?

Nonverbal learning disorder (NLD) might be the most overlooked — and under diagnosed — learning disability, in part because its symptoms look so much like ADHD. Poor social and fine-motor skills, inattention, trouble organizing thoughts — learn if these might be signs of NLD in your child.

Nonverbal learning disorder is a constellation of brain-based difficulties. Once considered rare, NLD is now thought to be as prevalent as dyslexia. Strongly genetic in origin, NLD affects girls as frequently as boys and is characterized by poor visual, spatial, and organizational skills, poor motor performance, and difficulty recognizing and processing nonverbal cues — body language, facial expression, and the nuances of conversation.

Most children with NLD have large vocabularies, outstanding memory and auditory retention, and average to superior intelligence. Kids with NLD are often misdiagnosed with ADHD.

Almost every child diagnosed with NLD was first diagnosed with ADHD, says the late Marcia Rubinstien, the founder of the Nonverbal Learning Disability Association. “Pediatricians ought to be able to recognize NLD and refer children for an evaluation, but teachers and medical professionals are more aware of language-based learning disabilities. That’s why every parent of a child with NLD has to become a full time advocate for their child.”

Despite their facility with language, kids with NLD often have poor reading comprehension. A child with NLD may miss the forest and the trees because of his intense focus on the leaves. After reading a book about the Civil War, for instance, the child might be able to name and describe each battlefield — yet fail to recognize that the conflict was about slavery and federalism.

Young children with NLD are often good at compensating for their limitations. But once those kids hit puberty, they often experience severe anxiety. In adulthood, mood disorders — combined with trouble picking up social cues and setting priorities — make it hard for people with NLD to hold on to jobs and relationships. The earlier the correct diagnosis is made and appropriate interventions begin, the better the outlook for a person with NLD.

Far more than other children, kids with NLD rely mostly on language to learn about their world. Yet because they have trouble with abstract concepts, their language comprehension and speech lack nuance.

When an exasperated mom says, “Don’t let me see you playing with that toy any more,” her child with NLD might continue to play with it, but turn away — so his mom cannot see him. No wonder kids with NLD are often considered smart alecks.

Because they’re literal-minded, children with NLD tend to be naïve and virtually incapable of deception. These traits are often endearing, but they can cause heartbreak when a child reaches adolescence. For example, a teenage girl who cannot comprehend lying may not hesitate to befriend a stranger who offers her a ride home.

NLD varies from child to child, and is not defined as a separate entity in the DSM. For diagnosis, a child must undergo neuropsychological testing, speech and language assessment, and educational and occupational therapy evaluations.

As measured by the Wechsler Intelligence Scale for Children, kids with NLD usually demonstrate a verbal I.Q. that’s 20 or more points higher than their performance I.Q. (Verbal I.Q. is a measure of a child’s language ability. Performance I.Q. measures how well he makes use of what he knows.) Another test, the Brown ADHD Scales, can help differentiate NLD from ADHD.

One reason doctors have trouble diagnosing NLD is because it shares similar symptoms with ADHD such as…

• Poor social skills

• Academic difficulties

• Inattentivness

• Overfocusing on certain tasks

• Excessive talking

• Speaking without thinking about it first

Given the complexities of NLD, children do best when they get help from a team of professionals, including a neuropsychologist, occupational therapist, education specialist, and a speech and language therapist.

Importantly, NLD usually does not respond to medication. But children with NLD often do well with various other kinds of intervention:

• Social skills groups can help teach kids how to greet a friend, how to greet a stranger, and how to recognize and respond to teasing.

• Occupational therapy builds a child’s tolerance for tactile experiences, improves balance, and enhances fine motor skills.

• Typing instruction software, like Jump Start Typing, can help kids compensate for poor handwriting.

• Recorded books are key for kids who learn by listening. Recording classroom lectures may also be helpful.

• Using a daily planner can help students improve organizational skills.

Sound daunting? Helping a child with NLD is like learning a new language. Once you learn it, you can give your child the tools they need to thrive.