Modified Approaches to Treating Anxiety for Children With Visual-Spatial Problems: A Strengths-Based Perspective

Anxiety disorders are common and impairing¹ and affect as many as 30% of youth with² and without³ neurodevelopmental disorders. Nonverbal learning disability (NVLD) is an understudied neurodevelopmental disorder with an estimated prevalence of 3% in North American children and adolescents.⁴ Although definitions of NVLD vary, all include a core deficit of difficulty with visual-spatial processing. Importantly, anxiety is also a common psychiatric comorbidity for youth with NVLD, affecting roughly one-third of these youth.^4,5 In youth with neurodevelopmental disorders, treatment is often sought or received for comorbid conditions (eg, anxiety, attention-deficit/hyperactivity disorder) or associated impairments, rather than for the symptoms or core deficits of the neurodevelopmental disorder itself.⁶ Considerable work has examined the adaptation of anxiety disorder treatments for children with attention-deficit/hyperactivity disorder⁷ and autism.⁸ Comparatively little work has explored treatment approaches for children with NVLD. Given the overlap of anxiety symptoms and visual-spatial problems in NVLD,^9,10 herein we consider how these cognitive problems might interfere with patients' abilities to engage with common treatment approaches.