NVLD shares some symptoms with autism and Asperger's, but it's a different disorder, according to experts.

By Claire Gillespie
September 17, 2020
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It’s not uncommon for learning disorders to go undiagnosed until adulthood, and Chris Rock can attest to that. In a recent interview with The Hollywood Reporter, the comedian got serious to talk about his ongoing therapy sessions—seven hours a week, with two therapists—which began earlier this year. After a friend suggested he might have Asperger’s Syndrome (a form of autism that affects the way a person communicates), Rock underwent nine hours of cognitive testing and was diagnosed with non-verbal learning disorder (NVLD). Here's everything you need to know about NVLD, including how to know if you might have it.

What is NVLD, exactly? 

NVLD isn’t defined as a distinct disorder in the Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-V), and how it presents varies from person to person. Generally, it’s characterized by verbal strengths as well as visual-spatial, motor, and social skills difficulties. “All I understand are the words,” Rock said. 

Unlike learning disorders involving language, such as dyslexia, NVLD causes problems with other kinds of learning, including concepts and relationships. “In my opinion, it is more useful to think of the problem for someone with NVLD as the imbalance in thinking skills where they over-attend to detail and often miss the gestalt or big picture, rather than solely visual-spatial problems,” David Dinklage, PhD, the founder of Dinklage Associates, a neuropsychological assessment and consultation service for children and adults based in Arlington, Massachusetts, tells Health.  

While NVLD is often diagnosed later than dyslexia, attention deficit disorder (ADD) and autism spectrum disorder (ASD), Dinklage says the typical time is “late elementary school or middle school.” If it hadn’t been for his friend’s comment about Asperger’s, Rock, 55, might never have been diagnosed. “I think it is often undiagnosed and the child is viewed as just an oddball, or quirky and clumsy,” Dinklage says. “The ubiquity of video game playing—especially with boys—can help hide the social problems. I think that the missed cases are often never diagnosed.” 

What are the signs of NVLD?

Poor coordination, messy handwriting, taking things too literally, trouble reading social cues, lack of common sense, as well as difficulty with word problems in math and reading comprehension, may be signs of NVLD, says Florida-based board-certified psychiatrist Sean Paul, MD. 

However, these signs are often mild and written off as just someone's personality—or even as other learning disabilities. “Because people with NVLD usually have great vocabulary and memory skills, it often leads to the rationalization of the symptoms as less noteworthy,” Dr. Paul tells Health

In social situations, it can result in taking things too literally or adopting an “all or nothing” approach. “All of those things are really great for writing jokes—they’re just not great for one-on-one relationships," Rock told The Hollywood Reporter

How many people have NVLD?  

It's not exactly known. “We don't know how common it is,” Dinklage says. “In my practice, it is much less common than ADD and dyslexia.” Research published in the journal Psychiatry in April 2020 analyzed a cross-sectional study of 2596 children and adolescents in North America. Researchers estimated that 2.2 million to 2.9 million children and adolescents have NVLD. That amounts to 3% to 4% of under-18s. 

What challenges do people with NVLD face? 

Social life can be particularly difficult for people with NVLD. “They often have a hard time making and keeping friends, likely because of having trouble with reading nonverbal cues like facial expression and body language,” Dr. Paul says. “They are also often awkward physically and have poor coordination.”

Other challenges include inferential comprehension, spatial aspects of math, and managing transitions and new situations, Dinklage says. Things tend to get easier when a routine in a predictable setting is established, but, as Dinklage points out, “social interactions rarely go by routines and rely heavily on ‘bigger picture’ processing.” 

Those with NVLD are at much higher risk for developing anxiety problems, Dinklage adds. “Their detail-oriented processing is similar to the way people with severe anxiety process details over and over, missing the bigger picture.” 

How is NVLD treated? 

If NVLD is diagnosed in childhood, group social skills training is “hard but necessary,” Dinklage says. In addition, it’s important for the child to have regular supervised/mediated play time with one other child. “These kids get out of practice because the initiation of interactions is so hard, so parents have to make sure that doesn’t happen," he says. 

A bigger picture approach should be at the center of all behavioral and educational treatment strategies, including keeping children in supervised shared interest groups, developing routines to handle situations that often come up, and active reading strategies. “Using cubes or other physical objects to make math concepts more concrete is helpful,” Dinklage says. “Fine motor planning and handwriting are often extremely difficult, so using a keyboard for all writing is essential.” 

For adults who are diagnosed with NVLD, Dr. Paul says social skills training can still be effective, although it’s harder for adults than kids. Therapy is also important, he adds. “Many people with NVLD have depression or anxiety from years of social difficulty and sometimes even social isolation.”

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