Unable to Parallel Park or Read a Map? You Might Have Nonverbal Learning Disorder (NVLD)

Doing tasks that require hands and space together

Phillips says examples in this category include things like packing the trunk of a car, folding clothes, following picture-only assembly instructions and finding an item in a visually busy space like the pantry. Margolis adds copying a diagram.

Some people with NVLD report trouble with attention, organization, coordination or nonverbal social information, such as noticing a subtle shift in someone’s expression. Those difficulties are not present in everyone. Researchers continue to disagree about which associated traits belong in the definition.

“We each have our own individual profile of cognitive abilities, and we may see some of the characteristics of NVLD in ourselves without the level of impairment that would constitute a diagnosis,” Phillips says. In other words, although you may have trouble assembling Ikea furniture or folding a fitted sheet, struggling with these tasks doesn’t mean you have the condition. For a difficulty to become clinically significant, it needs to interfere with work, relationships, home life or another important area of functioning.

Why can it go unrecognized for so long?

One reason that the condition often goes undiagnosed is that it’s not in the DSM. “If it’s not there, it sort of doesn’t exist,” Fisher says.

Access is another factor. Because a full neuropsychological evaluation can be expensive, Fisher says, the people most likely to receive an NVLD diagnosis have often been those who could afford the full battery of testing.

Many people simply adapt. They choose work that plays to their verbal strengths, memorize routes, use GPS instead of reading maps or hire someone to assemble the dresser they bought online.

“A person might simply have spent much of their life thinking, I’m terrible with directions or I’ve never been good at diagrams without realizing that those difficulties could be part of a broader developmental pattern or related to other challenges they were experiencing,” Margolis says.

The work-arounds can hold for years. Then life can shift.

“Changes in job responsibilities, retirement, moving to a new home, losing a spouse who previously handled certain tasks or having to navigate unfamiliar medical and financial systems could expose difficulties that had previously been well compensated for,” Margolis says.

As people get older, processing information, staying focused or keeping track of things can take more effort, which may make long-standing work-arounds harder to use, she says.

“But this distinction is crucial: NVLD itself is developmental. It should not suddenly appear at age 60,” Margolis says. If someone who used to navigate easily starts getting lost, that is a different situation.

Someone who has struggled with directions or visual tasks for decades has a different history from someone who used to handle those things easily and now cannot. A new problem does not automatically mean dementia. Vision changes, medications, poor sleep, depression and anxiety can also affect thinking. But a new or worsening problem should be checked by a doctor rather than assumed to be NVLD.

How NVLD Is Diagnosed

In part because NVLD is not an official DSM diagnosis, doctors do not have one agreed-upon set of rules for diagnosing it. Over the years, clinicians have used different definitions and tests, which has made the condition harder to diagnose consistently and harder to study.

What does an adult evaluation involve?

Since there is no single test for NVLD, Fisher says doctors often use a neuropsychological evaluation. That means a series of tests that look at things such as how well a person understands visual information, pays attention, remembers things, uses language and plans tasks. The clinician looks at the overall pattern rather than any one test score.

A newer proposal for diagnosing NVLD relies more on a person’s history and the problems they are having. Margolis says someone would not necessarily need a full battery of cognitive tests, which could make an evaluation easier to get.

Because NVLD starts in childhood, doctors look for signs that the problems were there when the person was young. Old report cards, school testing or memories from brothers, sisters or friends who knew the person when they were young can help. Many older adults will not have those records or anyone to ask, but they can still be evaluated.

“The absence of this information does not make an evaluation impossible; a clinician can gather developmental evidence through an interview by asking very specifically about earlier function and choices a person made over time that may reflect challenges with visual-spatial processing,” Margolis says.

NVLD can overlap with ADHD, autism and anxiety, and a person can have more than one of them. A thorough evaluation determines which conditions are contributing rather than assuming a single diagnosis explains everything, Margolis says.

Is it NVLD or a new cognitive change?

For an older adult, one of the biggest questions is whether the problem has always been there or whether it is new. A newer proposal, which would rename the condition developmental visual-spatial disorder, or DVSD, relies more on a person’s history and the problems they are having now.

“The word I would emphasize is ‘new,’ ” Margolis says. “There should be evidence that the basic pattern has been present for many years, ideally going back to childhood or adolescence. With mild cognitive impairment or dementia, we are concerned about a decline from a person’s previous level of functioning.”

Treatment and What Can Help

There is no medication specifically for NVLD, and there is very little intervention research involving adults, Margolis says. The practical approach is to identify the specific task causing trouble and build support around it. Some suggestions are:

• Turn diagrams and other visual information into written or spoken steps. Margolis says the same material may be easier to process when it is explained aloud or presented in sequence.
• Use GPS or written directions instead of a map. “If you’re not good at reading a map, get the directions in written form,” Phillips says. Fisher also suggests using GPS or writing directions down.
• Reduce visual clutter. Margolis suggests asking for simpler documents and allowing extra time for tasks that require processing complex visual information.
• Label objects and keep them in the same place. That can reduce the need to search through a visually crowded space.
• Break financial and administrative tasks into steps. Margolis also suggests double-checking information presented in charts or tables.
• Hand off assembly jobs. “If construction or assembly tasks are not easy for you, ask someone else to put together the Ikea bookshelf,” Phillips says.
• Be direct about missed social cues. Phillips suggests telling people close to you that you may miss nonverbal signals and asking them to speak plainly or to tell you when you have missed something. She also suggests asking a friend or coworker to “translate” in an awkward social situation.
• Consider help with organization. Phillips says an executive coach, someone who helps people develop organizational strategies, can also be an option.

Occupational therapy may help with specific visual-spatial or motor difficulties. Psychotherapy can address anxiety or other emotional problems when they are present. ADHD, depression or another coexisting condition should be evaluated and treated separately.

Which raises a practical question: If someone already has work-arounds, what can an evaluation add?

“A diagnosis does not change a person’s brain, but it can change how they understand and manage particular difficulties,” Margolis says. “Someone who has spent decades believing, I should be able to do this, so why can’t I? may instead recognize that there is a specific type of information that is unusually difficult for them to process. That allows them to approach the problem strategically rather than simply trying harder at the same task.”

Where to start

Where you start depends on whether the problem is new or something you have dealt with for most of your life.

If you are suddenly getting lost, struggling with familiar tasks or noticing other changes in your thinking, talk to your doctor.

If these difficulties have been with you for years and are interfering with daily life, consider a psychologist or neuropsychologist who works with adults. Margolis suggests you do your research: “I would specifically ask whether the clinician has experience evaluating developmental visual-spatial difficulties.”

Bring whatever history you have. Old school records can help, but so can your own memories of always getting lost, struggling with diagrams or routinely handing certain tasks to someone else.

Phillips says understanding your own pattern can be useful whether or not you ultimately receive a diagnosis.

“In many cases, knowledge of one’s own strengths and weaknesses is the most powerful tool in knowing your own limitations and making decisions about what to take on and what to delegate or get help with,” she says.