Thought this might be helpful. CHILDRENâS NONVERBAL LEARNING DISABILITIES SCALE David B. Goldstein, Ph.D. Parents: Please answer all of the following questions. NAME OF CHILD: ________________________________________________ DATE OF BIRTH: __________ AGE: ____________ SEX________ GRADE: ________________ SCHOOL: _______________________ HANDEDNESS: RIGHT ______ LEFT _______ BOTH ______ This Questionnaire has been completed by: Mother____ Father____ Other (Please Describe your relationship)__________________________ 1. Motor Skills a. My child has problems with balance (e.g. never learned to ride a bike). Never/Rarely____ Sometimes____ Often/Always____ I donât know____ b. My child displays impaired fine motor skills (e.g. significant difficulties learning to tie shoes). Never/Rarely____ Sometimes____ Often/Always____ I donât know____ c. My child has problems writing or extremely slow writing. Never/Rarely____ Sometimes____ Often/Always____ I donât know____ d. My child seems unusually clumsy. Never/Rarely____ Sometimes____ Often/Always____ I donât know____ 2. Visual-Spatial Skills a. My child has difficulty remembering and organizing visual or spatial information (e.g. has difficulty lining up numbers to do a math problem or lining up words neatly on a page). Never/Rarely____ Sometimes____ Often/Always____ I donât know____ b. My child appears disoriented, lost, or confused when entering a new situation. Never/Rarely____ Sometimes____ Often/Always____ I donât know____ c. My child is slow to become familiar with new physical locations (e.g. continues to appear lost or disoriented after repeated exposures to the same location). Never/Rarely____ Sometimes____ Often/Always____ I donât know____ d. My child has difficulty remembering the faces of people he or she has met. Never/Rarely____ Sometimes____ Often/Always____ I donât know____ e. My child has an auditory memory like a tape recorder. Yes____ No____ I donât know____ f. My child loses his or her way and needs help finding his or her way around. Never/Rarely____ Sometimes____ Often/Always____ I donât know____ g. My child has unusually strong verbal skills (e.g. an impressive vocabulary or early speech). Yes____ No____ I donât know____ 3. Interpersonal Skills a. My child often does not get the humor in a joke because he or she interprets everything so literally. Never/Rarely____ Sometimes____ Often/Always____ I donât know____ b. When interacting with others my child has difficulty reading the other personâs non-verbal cues, such as tone of voice or facial expression. Never/Rarely____ Sometimes____ Often/Always____ I donât know____ c. My child interprets what I say very literally (for example, if I tell my child âto pick themselves up by his or her bootstrapsâ, they appear confused). Never/Rarely____ Sometimes____ Often/Always____ I donât know____ d. My child has difficulty transferring what he or she learns in one social situation to similar social situations. For e.g. my child appears confused when confronted with slight changes in a frequently encountered social situation. Never/Rarely____ Sometimes____ Often/Always____ I donât know____ Guidelines for Scoring the Childrenâs Nonverbal Learning Disabilities Scale The syndrome of NonVerbal Learning Disorder (NVLD) includes a number of specific symptoms. Rourke (1995) has organized these into three primary areas: neuropsychological deficits, academic deficits, and social-emotional/adaptational deficits. Neuropsychological deficits include difficulties with tactile and visual perception, psychomotor coordination, tactile and visual attention, nonverbal memory, reasoning, executive functions, and specific aspects of speech and language. Deficits in mathematical reasoning, math calculations, reading comprehension, specific aspects of written language, and handwriting are primary academic concerns. Deficits in social expertise include problems with social cognition and perception as well as difficulties in social interaction. - Some of the symptoms identified with Nonverbal Learning Disabilities are similar to those described for other disorders. Individuals with right hemisphere dysfunction, Asperger's syndrome, and sensori-motor deficiencies each possess a number of characteristics that overlap with those of a Nonverbal Learning Disability. An evaluation by a Neuropsychologist can often assist in differential diagnosis. - Section H is a checklist of characteristics that may be indicative of a Nonverbal Learning Disability. A referral for a more detailed evaluation by a pediatric neuropsychologist to rule in or rule out a Nonverbal learning disability requires that the parent report symptoms in all three spheres noted in the DSRI; deficiencies in motor-skills, visual-spatial skills, and interpersonal skills. A referral to a neuropsychologist or for a more in-depth evaluation of a Nonverbal Learning Disability could be considered if the parent reports deficits âSometimesâ or âOftenâ on over half the items examining motor skills (at least 3 of the 4 items), visual-spatial skills (at least 4 of the 7 items), and interpersonal skills (at least 3 or the 4 items). References Rourke, B.P. âNeuropsychological Assessment of Children with Learning Disabilities: Measurement Issues.â In G. Reid Lyons (ed.), Frames of Reference for the Assessment of Learning Disabilities: New Views on Measurement Issues. Baltimore, Md., Paul H. Brooks, Publisher, 1994.