Report of a Work Group on Nonverbal Learning Disability: Consensus Criteria for Developmental Visual-Spatial Disorder: Reconceptualizing Nonverbal Learning Disability for DSM Consideration - 07/03/25

Doi : 10.1016/j.jaac.2025.01.007

Prudence W. Fisher, PhD ^a,^b,^⁎ , Hillary D. Litwin, PhD ^b,^c, Mark A. Riddle, MD ^d, Amy E. Margolis, PhD ^e,^f,^g
^a Columbia University Vagelos College of Physicians and Surgeons, New York, New York
^b New York State Psychiatric Institute, New York, New York
^c Columbia University Irving Medical Center, New York, New York
^d The Johns Hopkins University School of Medicine, Baltimore, Maryland
^e College of Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio
^f Clinical and Translational Science Institute, The Ohio State University, Columbus, Ohio
^g Child Mind Institute, New York, New York

^∗Correspondence to Prudence W. Fisher, PhD, Child and Adolescent Psychiatry, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 78, New York, NY 10032Child and Adolescent PsychiatryNew York State Psychiatric Institute/Columbia UniversityUnit 781051 Riverside DriveNew YorkNY10032

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Abstract

Objective

Although extant research points to nonverbal learning disability (NVLD) as a distinct disorder, it is not included in the diagnostic nomenclatures, and there is heterogeneity in how it is defined. A working group was formed to gain consensus on a standard DSM-type definition for NVLD, a necessary first step for proposing its inclusion in future DSM editions, and the disorder was renamed to better reflect the core deficit—visual-spatial problems.

Method

An iterative process was used to reach consensus on a DSM-style criteria set that reconceptualizes NVLD as developmental visual-spatial disorder (DVSD). This process, similar to that used during the DSM-5 revision, included working with an advisory group of NVLD experts and obtaining feedback from experts in youth psychiatric diagnosis and child and adolescent mental health practitioners. Data on stakeholder acceptance of the new name were collected from adults who self-identify as having NVLD and parents of youth with NVLD.

Results

During the iterative process, the criteria set shifted from syndromic, multi-area, and quantitative to single focused and more clinically oriented, conceptualizing individuals with the disorder as having persistent deficits in a single area—processing or integrating visual and spatial information. This fills a gap in the DSM system, which includes diagnoses underpinned by problems in other cognitive domains. Data indicate stakeholder acceptance of the name.

Conclusion

A standard definition for NVLD, reconceptualized as DVSD and included in DSM, will lead to improved identification of youth with clinically significant visual-spatial deficits and associated functional impairment and improve research in the area.

Diversity & Inclusion Statement

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

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Key words : nonverbal learning disability, NVLD, visual-spatial deficits

Plan

Method

Phase 1: Initial Development of Consensus Criteria Set (2017)

Phase 2: Revision of Consensus Criteria Draft 1 (June 2017 to October 2018)

Phase 3: Revision of Consensus Criteria for DSM submission (November 2018 to May 2022)

Phase 4: Post DSM Submission Work on Consensus Criteria Set (August 2022 to January 2024)

Discussion

CRediT authorship contribution statement

	This work was supported by a gift to the Department of Psychiatry, Columbia University, from The NVLD Project (nvld.org/).
	The New York State Psychiatric Institute Institutional Review Board approved the survey studies.
	Earlier drafts of the consensus criteria were presented at a workshop at the American Academy of Child and Adolescent Psychiatry (AACAP) 65th Annual Meeting; Seattle, Washington; October 22-27, 2018; and at a workshop at the AACAP 70th Annual Meeting; New York, New York; October 23-28, 2023.
	Data Sharing: Data collected for the study will not be made available to others.
	The authors wish to acknowledge the contributions of Michael First, MD, of Columbia University, for his guidance on DSM conventions, formulations, and processes; the NVLD Expert Advisory Committee (Jessica Broitman, PhD, of the San Francisco Psychotherapy Research Group; Joseph Casey, PhD, of University of Windsor; John M. [Jack] Davis, PhD, of California State University, East Bay; Jodene Goldenring Fine, PhD, of Michigan State University; M. Douglas Ris, PhD, ABPP-CN, of Baylor College of Medicine; Irene C. Mammarella, PhD, of the University of Padua; and Margaret Semrud-Clikeman, PhD, ABPDN, of University of Minnesota); the NVLD Scientific Council (Geraldine Dawson, PhD, of Duke University; Stephen P. Hinshaw, PhD, of University of California, Berkeley and University of California San Francisco; James T. McCracken, MD, of University of California, Los Angeles, and, now, University of California San Francisco; Peter Szatmari, MD, of University of Toronto and, now, Centre for Addiction and Mental Health and Hospital for Sick Children; Benedetto Vitiello, MD, of University and Turin and Johns Hopkins School of Public Health; and Agnes H. Whitaker, MD, of Columbia University); Jazmin A. Reyes-Portillo, PhD, of Columbia University and, now, Montclair State University, for her review of extant definitions for NVLD, support, and assistance in early stages of the iterative process; Amie Wolf, PhD, of Brooklyn Learning Center for working with us on the DSM proposal and chapter; and Aditi Purushothaman, an undergraduate student at Washington University, who assisted in software development and testing for referenced surveys.
	Disclosure: Prudence W. Fisher receives funding support from The NVLD Project for additional work focused on NVLD/developmental visual-spatial disorder (DVSD). Unrelated to NVLD/DVSD, she has received funding from TeleSage, Inc (under a Small Business Innovation Research grant to TeleSage, Inc from the US Centers for Disease Control and Prevention); donor support for the Man O’ War Project, which focuses on equine-assisted psychotherapy (including the Earle I. Mack Foundation, Mary and Daniel Loughran Foundation, and Elsa and Peter Soderberg Foundation); and a training contract from Sapir Academic College. She also receives support as a co-investigator on a research project funded by the National Institutes of Health (NIH). She receives royalties from the Research Foundation for Mental Hygiene as a co-author of the Columbia-Suicide Severity Rating Scale (C-SSRS) and will receive royalties from Springer Nature for a book about equine-assisted psychotherapy beginning in 2025. Hillary D. Litwin has received funding from the Rita G. Rudel Foundation to study DVSD in a clinical population of minoritized youth with neurodevelopmental and other psychiatric disorders. Mark A. Riddle has received grant funding from the NIH; royalties from the American Academy of Pediatrics; consultation fees as a member of the Data Management Committee for the Best Pharmaceuticals for Children Act administered by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and a fee from The NVLD Project as Chair of the Scientific Advisory Council. Amy E. Margolis receives an unrestricted gift from The NVLD Project to further her work on understanding the etiology, pathophysiology, and treatment of NVLD/DVSD. Unrelated to NVLD/DVSD, she has received donor support from the Promise Project, the Translational Therapeutics Pilot award from Columbia University, and support from multiple grants as principal and co-investigator on research projects funded by the NIH. She receives royalties from Springer Nature for books about NVLD and learning disorders. None of this funding presents a conflict for her work in this area. She is a faculty member at The Ohio State University and a consultant for Child Mind Institute.