Nonverbal Learning Disorder is one of the common neurological consequences of FASD.  LD Online.org is a great resource for anyone impacted by FASD. 

Nonverbal Learning Disorders

By: Sue Thompson, M.A., C.E. (1996)

An introduction

There is no question that most scholastic accomplishments are measured and defined through language-based communication. Yet, it has been found that more than 65% of all communication is actually conveyed nonverbally. We are all familiar with "non-verbal communication," but few professionals have been specifically trained to look for deficits in this area. Although intelligence measures are designed to evaluate both the verbal and nonverbal aspects of intelligence, educators tend to ignore evidence of nonverbal deficiencies in students. Or worse, they brand students with nonverbal learning disabilities as "problem" children.

We are all aware of the important role language plays in human learning. The competence of an individual, in our present-day society, is most often judged by their verbal proficiencies. A person who speaks eloquently and has a well-developed vocabulary tends to be accorded more credibility than an individual who makes constant grammatical errors and demonstrates a limited vocabulary. A student who has innate difficulties reading, spelling, and/or expressing herself stands out in most classroom situations. And likewise, a student who is a top reader, achieves excellent spelling scores, and expresses herself articulately usually does not prompt her teacher to consider a learning disorder. But, this is often exactly the presentation a child with nonverbal learning disabilities (NLD) syndrome manifests in the early elementary grades.

Nonverbal learning disorders (also called "right-hemisphere learning disorders") often go unrecognized and unaided by teachers and other professionals for a large part of a child's schooling. Overall, there has been an inadequate awareness of the underlying causes for the difficulties these students encounter in school. There are currently few resources available for the child with NLD syndrome through schools or private agencies. It is still difficult to find a professional who understands nonverbal learning disabilities. These children are often labeled "behavior problems" or "emotionally disturbed" because of their frequent inappropriate and unexpected conduct, but NLD is known to have a neurological rather than a deliberate and/or an emotional origin.

The NLD syndrome reveals itself in impaired abilities to organize the visual-spatial field, adapt to new or novel situations, and/or accurately read nonverbal signals and cues. It appears to be the reverse syndrome of dyslexia. Although academic progress is made, such a student will have difficulty "producing" in situations where speed and adaptability are required. Whereas language-based learning disorders have been shown to be genetic in origin, heredity has not, as yet, been linked to NLD. It is known that nonverbal learning disabilities involve the performance processes (generally thought of neurologically as originating in the right cerebral hemisphere of the brain, which specializes in nonverbal processing).

Brain scans of individuals with NLD often confirm mild abnormalities of the right cerebral hemisphere. Developmental histories have revealed that a number of the children suffering from nonverbal learning disorders who have come to clinical attention have at some time early in their development: (1) sustained a moderate to severe head injury, (2) received repeated radiation treatments on or near their heads over a prolonged period of time, (3) congenital absence of the corpus callosum, (4) been treated for hydrocephalus, or (5) actually had brain tissue removed from their right hemisphere.

All of these neurological insults involve significant destruction of white matter (long myelinated fibers in the brain) connections in the right hemisphere, which are important for intermodal integration. Hence, current evidence and theories suggest that early damage (disease, disorder, or dysfunction) of the right cerebral hemisphere and/or diffuse white matter disease, which leaves the left hemisphere (unimodal) system to function on its own, is the contributing cause of the NLD syndrome (definitely not dysfunctional home lives). Clinically, this learning disorder classification resembles an adult patient with a severe head injury to the right cerebral hemisphere, both symptomatically and behaviorally.

Nonverbal learning disorders appear much less frequently than language-based learning disorders. Whereas it is approximated that about 10% of the general population could be found to have identifiable learning disabilities, it is thought that only 1 to 10% of those individuals would be found to have NLD (or between 1.0 to 0.1% of the general population). Unlike language-based learning disabilities, the NLD syndrome affects females as often as males (approximately 1:1 sex ratio) and incidence of left-handedness is uncommon.

Even though NLD is, by definition, a "low incidence disability," there are indications that, as school assessment/intervention procedures improve, a higher proportion of children will be identified with the NLD syndrome. The low rate of occurrence (as low as 1 out of 1,000), is no excuse for the lack of identification and services victims of this devastating impairment currently receive. The symptoms are distinct and display themselves early in a child's development.

The discovery of the NLD syndrome began in the early 1970s, with research involving groups of children with learning disabilities identified by discrepancies between their verbal and performance IQs. It is unfortunate that 25 years later, even professionals in the field of education are largely uninformed about and/or unfamiliar with nonverbal learning disorders as these disabilities can be much more devastating to a child than language-based learning disorders in the long run.

Since diminished access to and/or disordered functioning of the right-hemisphere systems impedes all understanding and adaptive learning, it is fair to say (as Helmer R. Myklebust did in 1975) that nonverbal learning disabilities "are more debilitating than verbal disabilities." The specific central processing abilities and deficits that characterize this syndrome are now well defined. Still, nonverbal learning disorders remain predominantly misunderstood and largely go unrecognized.

A child's earliest mode of communication should be nonverbal. Both parents and teachers will often suspect that "something is amiss" early on, but they can't quite "put a finger on it." Three categories of dysfunction present themselves: (1) motoric (lack of coordination, severe balance problems and/or difficulties with fine graphomotor skills), (2) visual-spatial-organizational (lack of image, poor visual recall, faulty spatial perceptions, and/or difficulties with spatial relations), and (3) social (lack of ability to comprehend nonverbal communication, difficulties adjusting to transitions and novel situations, and/or significant deficits in social judgment and social interaction).

Early consultation with a school psychologist or family physician typically only serves to dismiss or minimize a teacher's or parent's worries about this child. More often than not, parents are assured that everything is fine; perhaps their child is "just a perfectionist" or "immature" or "bored with the way things are normally done" or "a bit clumsy." Rarely are a parent's or teacher's concerns given any credence until the child reaches a point in school where he is no longer able to function given the limitations of his disability and/or, in some cases, the child suffers a "nervous breakdown" (or worse).

The child with nonverbal learning disorders commonly appears awkward and is, in fact, inadequately coordinated in both fine and gross motor skills. She may have had extreme difficulty learning to ride a bike or to kick a soccer ball. Fine motor skills, such as cutting with scissors or tying shoe laces, seem to be impossible for this child to master. She "talks her way through" even simple motor activities. A young child with NLD is less likely to explore her environment motorically because she cannot rely upon her kinesthetic processing and spatial perceptions. This child learns little from experience or repetition and is unable to generalize information.

In the early years, such a child may appear "confused" much of the time (he is confused) despite a high intelligence and high scores on receptive and expressive language measures. Closer observation will reveal a social ineptness brought about by misinterpretations of body language and/or tone of voice. This child is unable to "look and learn." He does not perceive subtle cues in his environment such as: when something has gone far enough; the idea of personal "space"; the facial expressions of others; or when another person is registering pleasure (or displeasure) in a nonverbal mode.

These are all social "skills" that are normally grasped intuitively through observation, not directly taught. If a child is constantly admonished with the words, "I shouldn't have to tell you this!," this should alert everyone that something is awry because you do have to tell them (everything). The child's verbal processing may be proficient, but it can be impossible for her to receive and comprehend nonverbal information. Such a child will cope by relying upon language as her principal means of social relating, information gathering, and relief from anxiety. As a result, she is constantly being told, "You talk too much!"

The child with NLD often develops an exceptional memory for rote material; a coping skill he has had to hone in order to survive. Since the nonverbal processing area of his brain is not giving him the needed automatic feedback, he relies solely upon his memory of past experiences, each of which he has labeled verbally, to guide him in future situations. This, of course, is less effective and less reliable than being able to sense and interpret another person's social cues (because of the vast array of differences in human nature).

Cumbersome monologues are another trait of a child with nonverbal learning disabilities. Normal conversational "give and take" seems to elude her. Teachers complain of a child who "talks incessantly" and parents resolve, "She just doesn't seem to know when to be quiet!" Owing to visual-spatial disturbances, it is difficult for this child to change from one activity to another and/or to move from one place to another. A child with NLD uses all of her concentration and attention to merely get through a room. Imagine the frustration produced when attempting to function in a complicated and/or new social situation. Owing to her inability to "handle" such informational processing demands, she will instinctively avoid any kind of novelty.

The importance of identifying and servicing children with nonverbal learning disorders is especially acute. Overestimates of the child's abilities and unrealistic demands made by parents and teachers can lead to ongoing emotional problems. A favorable prognosis seems to depend upon early identification and accommodation. The child with NLD is particularly inclined toward seriously debilitating forms of internalizing psychopathology, such as depression, withdrawal, anxiety, and in some cases, suicide.

Dr. Byron P. Rourke of the University of Windsor and his associates have found that nonverbal learning disabilities "predispose those afflicted to adolescent and adult depression and suicide risk." The child with NLD is regularly punished and picked on for circumstances he cannot help, without ever really understanding why, and he is in turn often left with little hope that his situation will ever improve. After amassing years of embarrassing and misconceived unintentional social blunders, it is not too difficult to comprehend how a person with nonverbal learning disorders could come to the conclusion that his environment is not structured to accommodate him.

To learn to identify, remediate and understand challenges associated with this disorder, visit www.ldonline.org/article/Nonverbal_Learning_Disorders for the rest of this article.