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    Original Investigation
    Psychiatry
    April 10, 2020

    Estimated Prevalence of Nonverbal Learning Disability Among North American Children and Adolescents

    Author Affiliations
    • 1Division of Child and Adolescent Psychiatry, Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, New York
    • 2International Control Mastery Therapy Center, Berkeley, California
    • 3Department of Educational Psychology, California State University, Hayward
    • 4Center for the Developing Brain, Child Mind Institute, New York, New York
    • 5Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
    • 6Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
    • 7Department of Psychology, University of Toronto, Toronto, Ontario, Canada
    • 8Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
    • 9Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
    • 10Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
    • 11Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
    • 12Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
    • 13Department of Psychology, University of Toronto, Toronto, Ontario, Canada
    • 14Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
    • 15Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
    JAMA Netw Open. 2020;3(4):e202551. doi:10.1001/jamanetworkopen.2020.2551
    Key Points español 中文 (chinese)

    Question  What is the prevalence of nonverbal learning disability among children and adolescents in North America?

    Findings  In this secondary analysis of a cross-sectional study of 2596 children and adolescents in North America, the population prevalence of nonverbal learning disability ranged from 3% to 4%.

    Meaning  This study showed that 2.2 million to 2.9 million children and adolescents may have nonverbal learning disability; further studies appear to be needed to develop and test interventions for treatment of this disorder.

    Abstract

    Importance  Nonverbal learning disability (NVLD) is a neurodevelopmental disorder characterized by deficits in visual-spatial processing but not in reading or verbal ability; in addition, problems in math calculation, visual executive functioning, fine-motor skills, and social skills are often present. To our knowledge, there are no population-based estimates of the prevalence of NVLD in community samples.

    Objective  To estimate the prevalence of the NVLD cognitive profile in 3 independent samples of children and adolescents from studies centered around brain imaging in the US and Canada.

    Design, Setting, and Participants  This cross-sectional study used data from 2 samples recruited from the community and overselected for children with psychiatric disorders (Healthy Brain Network [HBN], January 1, 2015, to December 31, 2019, and Nathan Kline Institute–Rockland Sample [NKI], January 1, 2011, to December 31, 2018) and 1 community-ascertained population sample (Saguenay Youth Study [SYS], January 1, 2003, to December 31, 2012) overselected for active maternal smoking during pregnancy.

    Main Outcomes and Measures  Prevalence of NVLD. Criteria for NVLD were based on clinical records of deficits in visual-spatial reasoning and impairment in 2 of 4 domains of function (fine-motor skills, math calculation, visual executive functioning, and social skills). Sample weighting procedures adjusted for demographic differences in sample frequencies compared with underlying target populations. Inflation factor weights accounted for overrepresentation of psychiatric disorders (HBN and NKI samples).

    Results  Across 3 independent samples, the prevalence of NVLD was estimated among 2596 children and adolescents aged 6 to 19 years (mean [SD] age, 12.5 [3.4] years; 1449 male [55.8%]). After sample and inflation weights were applied, the prevalence of NVLD was 2.78% (95% CI, 2.03%-3.52%) in the HBN sample and 3.9% (95% CI, 1.96%-5.78%) in the NKI sample. In the SYS sample, the prevalence of NVLD was 3.10% (95% CI, 1.93%-4.27%) after applying the sample weight. Across samples and estimation strategies, the population prevalence of NVLD was estimated to range from 3% to 4%. When applied to the US population younger than 18 years, 2.2 million to 2.9 million children and adolescents were estimated to have NVLD.

    Conclusions and Relevance  The findings suggest that the prevalence of NVLD in children and adolescents may be 3% to 4%. Given that few youths are diagnosed with NVLD and receive treatment, increased awareness, identification of the underlying neurobiological mechanisms, and development and testing interventions for the disorder are needed.

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