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

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. PLAIN LANGUAGE SUMMARY: Inclusion of nonverbal learning disability (NVLD) in the DSM would lead to improved identification of individuals with significant visual-spatial deficits and encourage research. Before a mental health disorder can be included in the DSM, it must be defined in a way that a wide range of clinicians can use. The authors report on a multiyear, iterative process used to formulate a behaviorally defined, clinically oriented DSM-style criteria set for NVLD, which included input from experts on NVLD and child psychiatric diagnoses and from mental health practitioners, resulting in NVLD being reconceptualized as "developmental visual spatial disorder" (DVSD). This criteria set will be included in a proposal to the DSM to include DVSD as a "condition for further study." 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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