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.