Longer term, our goal is to demonstrate that NVLD is a valid and distinct diagnosis. To help accomplish this, The NVLD Project is conducting evidenced-based research with several renowned institutions and experts, including Columbia University and Children’s Hospital of Los Angeles. This includes epidemiologic, neuroimaging and MRI studies. Our research examines NVLD symptoms in groups of children in order to see how NVLD presents itself and how its symptoms differ from symptoms of other disorders. We are currently imaging the brains of children with NVLD, hoping to pinpoint the neurobiological basis of the disability.
Our research initiatives also include a distinct effort to secure inclusion of Non-Verbal Learning Disability into the DSM (Diagnostic and Statistical Manual of Mental Disorders).
Future DSM Inclusion for Non-Verbal Learning Disability
The NVLD Project is funding a project at Columbia University Medical Center’s (CUMC) Department of Child and Adolescent Psychiatry (PI: Prudence Fisher, Ph.D.) to prepare a proposal to include NVLD in the DSM.
On May 11-12, 2017, The NVLD Project sponsored a consensus working meeting at Columbia with the goal of arriving at a proposed standard definition of NVLD, in DSM format, that would be acceptable to the field, based upon currently available research data. The consensus meeting brought global leaders in the field for the first time to agree on a standard definition for NVLD. Prior to the conference, many experts in the field held varied opinions on the precise diagnosis of NVLD.
Participants at the two day conference included CUMC faculty, experts from other academic institutions, and educators from the New York area. Additionally, seven NVLD global experts, Drs. Jessica Broitman, Joseph Casey, Jack M. Davis, Jodene Goldenring Fine, Irene Mammarella, M. Douglas Ris, Margaret Semrud-Clikeman, and members of the NVLD Project’s Board of Directors and Advisory Board were in attendance.
The attendees discussed changing the name to “Spatial Processing Disorder (Non Verbal Learning Disability) ” to reflect the fact that spatial processing difficulty is what differentiates NVLD from other DSM disorders, and to disconnect it from the term ‘non-verbal,’ which is confusing to those unfamiliar with the disorder as those with the disability are not verbally impaired.
Getting NVLD into the DSM is a multi-step process involving expert review and public comment. NVLD experts at Columbia are currently conducting a systematic review of the scientific literature to provide supporting evidence for its inclusion in the DSM. This work is being led by Dr. Fisher, with the support of the NVLD Project. Getting NVLD in the DSM is critically important for several reasons.
A DSM diagnosis is often required to report diagnostic data to interested third parties (including governmental agencies, private insurers, education systems and programs) for purposes of reimbursement and for determining eligibility for and financing of services. Without its inclusion, access to psychological treatment and educational interventions and accommodations might be blocked.
DSM inclusion also would provide a common language for mental professionals and others serving NVLD children and is often used as an educational tool or required text in many training programs and graduate schools to train professionals on how to recognize common disorders and problems. Inclusion of NVLD in the DSM, giving it a “diagnostic home” would help in better recognition of children who have this condition and how they differ from children who have more specific academic problems.
Lastly, inclusion of NVLD in DSM would serve a heuristic purpose by stimulating research in this area as it would require a clear definition of what NVLD is. In order to research a condition – its’ risk factors, causes, and outcomes, it is important to clearly define what it is (and what it is not). Thus research on interventions, how to best define it and differentiating it as a unique condition would be stimulated.
Epidemiologic research studies illnesses in general populations rather than in treatment clinics. In order to define and understand the behaviors associated with NVLD, we are collaborating with epidemiologists at Columbia University, the University of Southern California and Children’s Hospital Los Angeles and other institutions around the world. We are identifying what components of the NVLD diagnosis come together naturally in the general population, rather than only in patients identified in treatment clinics. This will help us understand what the symptoms and signs of NVLD really are.
Our research has and will continue to help us better understand how the brains of children with NVLD differ from those of other children.
Diffusion Tensor Imaging
Bradley S. Peterson, MD, is one of only a handful of leading academic psychiatrists in the nation using advanced brain imaging technology to conduct comprehensive research into the causes and origins of developmental disorders, including non-verbal learning disability. While clinicians acknowledge NVLD, it has not yet been validated as a diagnosis. Dr. Peterson and his team of researchers at CHLA are conducting work to validate NVLD by demonstrating that it has biological underpinnings, one of the most powerful methods of scientific validation. This will ultimately help children receive a definitive and timely diagnosis, early intervention and targeted ongoing treatment.
Dr. Peterson is working to validate NVLD by demonstrating that the discrepancies between verbal IQ and performance IQ scores—the core measurable feature of NVLD—have biological root causes in the brain. His latest research attempts to show this using diffusion tensor imaging (DTI).
“We have very strong findings that relate the DTI measures and white matter in the brain to the measure of NVLD that we are using, which is the verbal IQ and performance IQ split,” says Dr. Peterson. “The findings are very convincing and very exciting.”
Philanthropy, generously provided by The NVLD Project and the Laura Lemle Family Foundation, is funding this work and will help to replicate the findings from this study using a second, independent DTI data set. This strategy has proven successful for Dr. Peterson in the past; he used the same method in earlier research, which related brain structure to discrepancies between verbal IQ and performance IQ scores and was published in the Journal of Neuroscience. This is just one important step among many on the path his laboratory is pursuing to validate NVLD as a distinct diagnosis.
A Neuroimaging Study of Children with NVLD
We are conducting a neuroimaging study of children who have been diagnosed with NVLD at Columbia University Medical Center. Neuroimaging research gives us information about the structure, function, and connectivity of the brain’s circuits. Disruption of these circuits can lead to developmental disabilities and neuropsychiatric illness. Our research program aims to understand the disturbances in brain circuits that lead to NVLD.
Our current study is aimed at determining whether the brains of children with NVLD, relative to healthy children, have the same features that we are identifying in our samples drawn from the general population. Identifying similar features in their brains would help validate NVLD as a distinct diagnosis, suggesting that it is neurobiologically at one extreme along a continuum of verbal/perceptual reasoning differences found in the general population.