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NonVerbal Learning Disability: Evidence for a discrete clinical entity in a community sample. Margolis, A. 1 , Pao, L. 1 , Herbstman, J.B. 2 , Rauh, V. 2 , & Peterson, B.S. 3 1 The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, Columbia University 2 The Mailman School of Public Health, Columbia University 3 The Division of Child and Adolescent Psychiatry, Keck School of Medicine, University of Southern California Hypothesis: Larger VIQ>PIQ discrepancy scores will associate with increased levels of difficulty with attention, executive function, anxiety, and social difficulty, symptoms purported to be consistent with NonVerbal Learning Disability. NonVerbal Learning Disability (NVLD), a debilitating condition deriving from deficits in spatial perception, accompanied by poor executive functions, inattention, anxiety, and social deficits, was first described in 1967 by Johnson and Mykelbust 1 . Whether the condition is a valid and discrete clinical entity remains an open question 2 .A discrepancy between verbal and spatial ability, often operationalized by a Verbal greater than Performance IQ (VIQ>PIQ) discrepancy is the hallmark feature of NVLD 3 . Our strategy for demonstrating the validity of the condition has been to examine the neural 4,5 and behavioral correlates of the VIQ>PIQ discrepancy in an epidemiologic sample, free of ascertainment bias inherent in case-control studies. Study Population: We studied the behavioral correlates of the VIQ>PIQ discrepancy in a community sample of 433 children (8-14 years) participating in a prospective longitudinal cohort study (Columbia Children’s Center for Environmental Health). In healthy, high IQ children, larger VIQ>PIQ discrepancies correlated with greater impairment in cognitive control, attention, anxiety and social difficulties, the core symptoms of NVLD. These data provide evidence that NVLD as described in clinical practice and case-control studies may be a valid clinical entity. 1.Johnson, D. J., & Myklebust, H. (1967). Learning disabilities: Educational principles and remedial approaches. New York, NY: Grune & Stratton. 2. Fine JG, Semrud-Clikeman M, Bledsoe JC, Musielak KA. A critical review of the literature on NLD as a developmentaldisorder. Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence. 2013;19(2):190-223. 3. Grodzinsky GM, Forbes PW, Bernstein JH. A practice- based approach to group identification in nonverbal learning disorders. Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence. 2010;16(5):433-460. 4. Margolis A, Bansal R, Hao X, et al. Using IQ Discrepancy Scores To Examine the Neural Correlates of Specific Cognitive Abilities. The Journal of neuroscience : the official journal of the Society for Neuroscience. Aug 28 2013;33(35):14135-14145. 5. Margolis A, Pao, L., Tau, G. Zhao, G., Wang, Z., Peterson, B.S., Marsh, R. Associations of IQ Discrepancies with Brain Activation During Conflict Resolution Paper presented at: Society of Biological Psychiatry; May 14-16, 2015; Toronto Canada. Acknowledgements: R01DA027100, RS015579 Lemle Family Foundation, NVLD Project. Measures: VIQ-PIQ Discrepancy Scores were calculated based on each participant’s Verbal Comprehension Index and Perceptual Reasoning Index Score obtained from the WISC- IV. To create the VIQ-on-PIQ score, we regressed VCI onto PRI with an intercept of zero and saved the residual. These scores were normally distributed. NEPSY Inhibition assesses the ability to inhibit automatic responses in favor of novel responses. The child looks at a series of black and white shapes or arrows and names either the shape or direction or an alternate response, depending on the color of the shape or arrow. NEPSY Auditory Attention assesses selective auditory attention and the ability to sustain it (vigilance). The child listens to a series of words and touches the appropriate circle when he or she hears a target word. RCMAS Oversensitivity assesses obsessive concerns about a variety of things, most of which are typically vague and ill-defined, as well as fears about being hurt or emotionally isolated, as measured through an 11-item self report subscale of the RCMAS. CBCL Social Problems assesses a child’s behavior with respect to seeming dependent, lonely, not getting along with others, being teased, not being liked by peers, and getting along better with younger children, as measured through 11-item parent report form. -13 -11 -9 -7 -5 -3 -1 1 3 -40 -30 -20 -10 0 10 20 30 40 NEPSY Auditory Attention VIQonPIQ (FSIQ<110) -13 -11 -9 -7 -5 -3 -1 1 3 -40 -30 -20 -10 0 10 20 30 40 NEPSY Auditory Attention VIQonPIQ (FSIQ≥110) -10 -8 -6 -4 -2 0 2 4 6 8 10 -40 -30 -20 -10 0 10 20 30 40 NEPSY Inhibition VIQonPIQ (FSIQ<110) -10 -8 -6 -4 -2 0 2 4 6 8 10 -40 -30 -20 -10 0 10 20 30 40 NEPSY Inhibition VIQonPIQ (FSIQ≥110) -10 -8 -6 -4 -2 0 2 4 6 8 10 -40 -30 -20 -10 0 10 20 30 40 RCMAS Oversensitivity VIQonPIQ (FSIQ<110) -10 -8 -6 -4 -2 0 2 4 6 8 10 -40 -30 -20 -10 0 10 20 30 40 RCMAS Oversensitivity VIQonPIQ (FSIQ≥110) -6 -4 -2 0 2 4 6 8 10 -40 -30 -20 -10 0 10 20 30 40 CBCL Social Skills VIQonPIQ (FSIQ<110) -6 -4 -2 0 2 4 6 8 10 -40 -30 -20 -10 0 10 20 30 40 CBCL Social Skills VIQonPIQ (FSIQ≥110) FIGURES 1-4: We detected significant FSIQ by domain interactions. Among children with Full-Scale IQ (FSIQ) greater than 110, we detected an inverse relationship between the magnitude of the VIQ>PIQ discrepancy and performance on: • attention (NEPSY-Auditory Attention, p <.047), Figure 1 • Inhibitory control (NEPSY-Inhibition, p <.049), Figure 2. and a positive relationship between the magnitude of the VIQ>PIQ discrepancy and levels of: • anxiety (RCMAS, p <.005), Figure 3. • social problems (CBCL; p<.09) Figure 4 Overall, a larger VIQ>PIQ discrepancy was associated with greater functional impairment. In lower FSIQ children, the relationship was either not significant, or was significant in the opposite direction. BACKGROUND METHODS CONCLUSION REFERENCES Statistical Analyses: General linear modeling was used to assess the behavioral correlates of the VIQ-PIQ discrepancy score, controlling for age at test, sex, and ethnicity when significant. RESULTS Figure 1. Attention Figure 2. Inhibitory Control Figure 3. Anxiety Figure 4. Social Problems

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Page 1: NonVerbal Learning Disability: Evidence for a discrete

NonVerbal LearningDisability:Evidenceforadiscreteclinicalentityinacommunitysample.

Margolis,A.1,Pao,L. 1,Herbstman,J.B. 2,Rauh,V. 2,&Peterson,B.S.31TheDivisionofChildandAdolescentPsychiatryintheDepartmentofPsychiatry,ColumbiaUniversity

2TheMailmanSchoolofPublicHealth,ColumbiaUniversity3TheDivisionofChildandAdolescentPsychiatry,KeckSchoolofMedicine,UniversityofSouthernCalifornia

Hypothesis:LargerVIQ>PIQdiscrepancyscoreswillassociatewithincreasedlevelsofdifficultywithattention,executivefunction,anxiety,andsocialdifficulty,symptomspurportedtobeconsistentwithNonVerbal LearningDisability.

NonVerbal LearningDisability(NVLD),adebilitatingconditionderivingfromdeficitsinspatialperception,accompaniedbypoorexecutivefunctions,inattention,anxiety,andsocialdeficits,wasfirstdescribedin1967byJohnsonandMykelbust1.Whethertheconditionisavalidanddiscreteclinicalentityremainsanopenquestion2.Adiscrepancybetweenverbalandspatialability,oftenoperationalizedbyaVerbalgreaterthanPerformanceIQ(VIQ>PIQ)discrepancyisthehallmarkfeatureofNVLD3.Ourstrategyfordemonstratingthevalidityoftheconditionhasbeentoexaminetheneural4,5 andbehavioralcorrelatesoftheVIQ>PIQdiscrepancyinanepidemiologicsample,freeofascertainmentbiasinherentincase-controlstudies.

StudyPopulation:WestudiedthebehavioralcorrelatesoftheVIQ>PIQdiscrepancyinacommunitysampleof433children(8-14years)participatinginaprospectivelongitudinalcohortstudy(ColumbiaChildren’sCenterforEnvironmentalHealth).

Inhealthy,highIQchildren,largerVIQ>PIQdiscrepanciescorrelatedwithgreaterimpairmentincognitivecontrol,attention,anxietyandsocialdifficulties,thecoresymptomsofNVLD.ThesedataprovideevidencethatNVLDasdescribedinclinicalpracticeandcase-controlstudiesmaybeavalidclinicalentity.

1.Johnson,D.J.,&Myklebust,H.(1967).Learningdisabilities:Educationalprinciplesandremedialapproaches.NewYork,NY:Grune &Stratton.2.FineJG,Semrud-ClikemanM,BledsoeJC,Musielak KA.AcriticalreviewoftheliteratureonNLDasadevelopmentaldisorder.Childneuropsychology :ajournalonnormalandabnormaldevelopmentinchildhoodandadolescence.2013;19(2):190-223.3.GrodzinskyGM,ForbesPW,BernsteinJH.Apractice-basedapproachtogroupidentificationinnonverballearningdisorders.Childneuropsychology :ajournalonnormalandabnormaldevelopmentinchildhoodandadolescence.2010;16(5):433-460.4. MargolisA,Bansal R,Hao X,etal.UsingIQDiscrepancyScoresToExaminetheNeuralCorrelatesofSpecificCognitiveAbilities.TheJournalofneuroscience:theofficialjournaloftheSocietyforNeuroscience.Aug282013;33(35):14135-14145.5. MargolisA,Pao,L.,Tau,G.Zhao,G.,Wang,Z.,Peterson,B.S.,Marsh,R.AssociationsofIQDiscrepancieswithBrainActivationDuringConflictResolutionPaperpresentedat:SocietyofBiologicalPsychiatry;May14-16,2015;TorontoCanada.Acknowledgements:R01DA027100, RS015579 Lemle FamilyFoundation,NVLDProject.

Measures:VIQ-PIQDiscrepancyScoreswerecalculatedbasedoneachparticipant’sVerbalComprehensionIndexandPerceptualReasoningIndexScoreobtainedfromtheWISC-IV.TocreatetheVIQ-on-PIQscore,weregressedVCIontoPRIwithaninterceptofzeroandsavedtheresidual.Thesescoreswerenormallydistributed.NEPSYInhibitionassessestheabilitytoinhibitautomaticresponsesinfavorofnovelresponses.Thechildlooksataseriesofblackandwhiteshapesorarrowsandnameseithertheshapeordirectionoranalternateresponse,dependingonthecoloroftheshapeorarrow.NEPSYAuditoryAttentionassessesselectiveauditoryattentionandtheabilitytosustainit(vigilance). Thechildlistenstoaseriesofwordsandtouchestheappropriatecirclewhenheorshehearsatargetword.RCMASOversensitivityassesses obsessiveconcernsaboutavarietyofthings,mostofwhicharetypicallyvagueandill-defined,aswellasfearsaboutbeinghurtoremotionallyisolated,asmeasuredthroughan11-itemselfreportsubscaleoftheRCMAS.CBCLSocialProblemsassessesachild’sbehaviorwithrespecttoseemingdependent,lonely,notgettingalongwithothers,beingteased,notbeinglikedbypeers,andgettingalongbetterwithyoungerchildren,asmeasuredthrough11-itemparentreportform.

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FIGURES1-4:WedetectedsignificantFSIQbydomaininteractions.AmongchildrenwithFull-ScaleIQ(FSIQ)greaterthan110,wedetectedaninverserelationshipbetweenthemagnitudeoftheVIQ>PIQdiscrepancyandperformanceon:• attention(NEPSY-AuditoryAttention,p

<.047),Figure1• Inhibitorycontrol(NEPSY-Inhibition,p<.049),

Figure2.andapositiverelationshipbetween themagnitudeoftheVIQ>PIQdiscrepancyandlevelsof:• anxiety(RCMAS,p<.005),Figure3.• socialproblems(CBCL;p<.09)Figure4Overall,alargerVIQ>PIQdiscrepancywasassociatedwithgreaterfunctionalimpairment.InlowerFSIQchildren,therelationshipwaseithernotsignificant,orwassignificantintheoppositedirection.

BACKGROUND

METHODS

CONCLUSION

REFERENCES

StatisticalAnalyses:GenerallinearmodelingwasusedtoassessthebehavioralcorrelatesoftheVIQ-PIQdiscrepancyscore,controllingforageattest,sex,andethnicitywhensignificant.

RESULTS

Figure1.Attention

Figure2.InhibitoryControl

Figure3.Anxiety

Figure4.SocialProblems

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