NLD: What is It…Really?
By Patricia S. Lemer, M. Ed. DDR Executive Director
This spring, my friend Evelyn Vuko, of the Washington Post‘s "Teacher Says" column invited me to an online chat on NLD. I learned about NLD when Carol Kranowitz spoke at an NLD conference last year. Then in May I rejected a new book on NLD for the DDR booklist. Three strikes!
What is NLD?
First appearing in the literature in the late sixties, when I was finishing graduate school, non-verbal learning disabilities (NLD or NVLD) are now diagnosed frequently. NLD describes a cluster of deficits in motor, visual- spatial, social and sensory arenas combined with strengths in vocabulary, rote memory, and attention to detail. This syndrome causes sensory overload and profound difficulty with cognition, academics, and relationships. NLD is easily confused with Asperger syndrome and sometimes used synonymously with the dual diagnosis of gifted/ learning disabled. While most psychologists agree on the etiology and treatment of language-based LD, vision-based LD or NLD is poorly understood.
Compensate or Remediate?
Traditional approaches to NLD focus on diagnosis and compensatory techniques, without addressing the motor, sensory and visual deﬁcits. While teaching strategies can be beneﬁcial, ameliorating deﬁcits makes more sense. In How To Develop Your Child‘s IntelligenceHow to Develop Your Child‘s Intelligence, Getman proposes a developmental relationship between the motor and visual systems that offers a structure for remediation in the context of development. At ﬁrst the motor system dominates, then the motor and visual systems work together. Finally, vision dominates.
Children diagnosed with NLD probably had motor and sensory deﬁcits in the ﬁrst year of life. Any skipped step in motor development is a red ﬂag to me. Those with NLD may have never crawled, walked early or late, or adopted idiosyncratic movement patterns. They could also overly favor one hand or lack a dominant side. Individualized sensory-motor activities can bring their motor systems up to age level.
The Motor-Visual Team
Binocular vision and depth perception emerge when the body begins to move through space. In the Motor-Visual stage, movement is primary. Then, as children learn to reach with the eye and the hand at the same time, movement allies with vision. If the two eyes do not work together, the body may show bilateral integration problems. Deﬁcits at this stage often cause motor clumsiness, lack of interest in motor activities, or extreme shyness due to spatial insecurity. A developmental optometric evaluation and intervention are imperative now, to avoid later visual-spatial and social problems.
Vision Directs Motor
Typically, vision takes precedence over movement sometime before kindergarten. This transition from motor-visual to visual-motor is a huge jump. How many times have pre-school teachers watched a child begin to draw a dog and end up with something else? That child‘s hand simply could not produce what the mind told it to. Many older children with NLD are still not using their vision purposefully to direct their movements. To draw a dog a child‘s eyes must direct the motor act, as he visualizes the animal in his mind‘s eye. The emersion of vision as the dominant sense depends upon a reliable store of touch, movement and muscle "memories" acquired during early development.
Children with NLD have early histories of tactile defensiveness, vestibular disturbance and low tone, which preclude having well-integrated touch and movement experiences. To cope, they rely more heavily on what they hear than on what they sense, do or see. Audition and language skills predominate over vision and the more primitive senses early on. As language becomes ever more proficient, the NLD child becomes less able to use vision to focus on and give meaning to what he sees. Avoidance and fear perpetuate the problems. I wrote about these social challenges in "Say Hi to Patty," New Developments 5:2.
What Can We Do?
NLD is REALLY a visual processing disorder that starts early in life with developmental motor, sensory and visual delays. Fortunately, it‘s rarely too late to remediate. DDR is committed to assisting those with NLD in ﬁnding skilled therapists to help close the gaps in their development.
The ﬁrst priority should be a developmental vision exam. Most people with NLD have problems with eye teaming, focusing, tracking and perception. (See "Choosing An Eye Doctor," 3:4.) Physical and occupational therapists, Brain Gym consultants, psychologists and developmental optometrists can all be part of the team working on sensory, motor, visual-spatial and social skills.
I look forward to the time when books and conferences on NLD include experts from the above disciplines. Individuals with NLD deserve more than palliative intervention. They CAN learn how to use their bodies and minds together. As Carla Hannaford aptly states in the subtitle of Smart Moves: Why Learning Is Not All in Your HeadSmart Moves: "Learning is not all in your head!"[Initially published in New Developments: Volume 8, Number 4 - Summer, 2003]