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Understanding Nonverbal Learning Disorders (page 3)

By — MAAP Services for Autism and Asperger Syndrome
Updated on Dec 7, 2010

2.   Characteristics of Nonverbal Learning Disability

Myklebust was probably the first person to describe the characteristics of children with problems processing visuo-spatial information. Subsequently, these children have been studied extensively by Byron Rourke and his colleagues, who have described a syndrome they call a nonverbal learning disability (NVLD). Sometimes, there is no known damage to the right hemisphere, but neuropsychological assessment suggests a dysfunction of the right hemisphere. Often, individuals who fit the criteria for a NVLD have some left-sided signs of brain damage (suggesting a right hemisphere impairment). They also tend to have a big discrepancy between their verbal skills, which are often excellent (at least at first appearance) and their visuo-spatial skills, which can be much lower. These children share many characteristics of the adults we described with right brain damage.

For example, they talk a lot but tend to go on about little of importance. They also have difficulty getting the main idea from a story or a movie, and get caught up in the details. As a result, they have difficulty reading for meaning, and thus do more and more poorly in school as they progress through the grades.

Above and beyond their academic difficulties, however, they also have serious problems in their social functioning. As young children, adults describe them as 'not fitting in'. They want to play with other children, but can't seem to figure out how to interact. Their difficulties in understanding nonverbal cues are a real handicap in social situations with other children, where much of the action is taking place on a nonlinguistic level. Often, they revert to maladaptive ways of getting attention, like clowning or acting out, or become withdrawn and depressed. It seems likely that many of these social and behavioral problems are related to a difficulty in comprehending the meaning of emotional information. As discussed above, the cues that most people use to guide their behavior in a social situation, such as facial expressions, or gestures, are not likely to be available to a person with a right hemisphere dysfunction. These problems are not trivial: although we don't know how many individuals with right hemisphere dysfunction learn to compensate and adjust, we do know that many end up seeking help from psychiatrists and psychologists. Many have significant problems in school, frequently getting labeled as lazy, unmotivated, or a behavior problem. Because they speak fluently and seem to have the fundamental skills needed for reading, writing, and other academic tasks, their failure to achieve at grade level is attributed to an 'emotional' problem, rather than a learning disability. Fortunately, as researchers have learned more about this problem, more of these children are being diagnosed correctly and treated appropriately.

Specific characteristics of NVLD:

  1. Social problems: poor peer relations; inappropriate behavior; difficulty understanding social situations; gravitate toward older/younger playmates; withdrawn in social situations; "out of place"; poor sense of territoriality and violations of personal space (touching); acting out as in "class clown" behavior
  2. Emotional problems: poor understanding of emotional signals from others; difficulty interpreting personal emotional experience; inability to learn from past experience including social interaction; risk for depression and isolation; possible disruptions in sense of self and in ego development
  3. Cognitive characteristics: well-developed verbal abilities; visuo-spatial and visuo-motor deficits; poor handwriting; problems with reading for meaning and poor composition skills; difficulty with part-whole relationships and organizing information; problems with pragmatics of language such as context, intention, plausibility; trouble understanding metaphor and humor; serious arithmetic problems (spatial orientation, misreading of visual detail, procedural errors, failure to shift operations); geographical disability such as reading maps and finding one's way around a building or town; poor adjustment to change; overly dependent on verbal rules and regulations; literal, concrete, and problems with abstract thinking and judgment; significant differences in Performance IQ versus Verbal IQ with VIQ being better; problems understanding the passage of time and telling time.
  4. Motor problems: motor impersistence; disorders in reflexes, weakness, muscle tone, gait abnormalities, tremors, incoordination (inability to learn to tie shoes is practically a pathognomonic sign), dysarthria (problems with articulation like slurring speech etc.), nystagmus; left-sided symptoms on neuropsychological testing
  5. Attentional problems: distractibility, difficulty concentrating; difficulty inhibiting input, behavior, etc.; can make them look hyperactive although typically not hyperactive but NVLD can co-occur with ADHD; sometimes lethargy and apathy (also giving up easily)

 3.   Special Strategies for Intervention and Treatment

General Guidelines

  1. Use verbal strengths to compensate whenever possible (e.g. ask for verbal feedback, repeat instructions, describe social situations verbally, devise verbal coping strategies).

     

  2. Use mechanical devices to compensate (calendars, word processors, beeping watches, calculators) for fundamental deficits in cognitive processing. Also outlining; learning to identify priorities; learning to distinguish essential from non-essential details; identifying main ideas; extracting meaning.

     

  3. Encourage kinesthetic sports to remediate motor deficits e.g. swimming, skating, skiing. Work on body image and physical relationships to object, other people, etc.

     

  4. Build a sense of self; self-esteem development; ego structure; learn to use activity, to generate and initiate activities; develop internal control and motivation.

     

  5. Social skills remediation: teach children/adults to understand feelings and to communicate appropriately e.g. conversational turn-taking, listening skills. Can take place either in therapeutic context, educational setting, or home. Also important to organize structured and supervised peer interaction settings e.g. Girl Scouts, swim team, day camp, computer club, etc.

Specific Therapeutic Strategies for NVLD Children

  • The physical environment

    • Avoid extraneous material; keep surroundings simple

     

  • General strategies and dealing with distractibility/impulsivity

    • Make it fun. Begin in non-performance mode. Build rapport.
    • Structure interactions
    • Make expectations clear/explicit verbal instructions
    • Be concrete, not abstract
    • Make consequences clear
    • Reinforce positive behavior
    • Small steps/just manageable differences
    • Keep up a steady stream of pragmatic information.

     

  • Special circumstances to keep in mind

    • Child may have trouble remembering what you say from week to week
    • Child may be unable to describe his/her emotions
    • Child may not be able to interpret your tone of voice or body language
    • Child may have trouble understanding what your main point is
    • Child may interpret what you say very literally>

     

  • Social skills remediation

    • Understanding context e.g. purpose of therapy, other social situations/contexts
    • How to show you're listening
    • Communication: talking, listening, and turn taking
    • Using/understanding tone of voice
    • Appropriate touching/physical distance from others
    • Other social skills

     

  • Focus on emotions

    • Verbalize what child is doing and child's emotions:

      • "I know it's hard for you to tell if I'm friendly. One thing you can tell is that I'm smiling."
      • Acknowledge feelings of confusion and failure
    • Strategies for emotion sessions:

      • Where is emotion in the body? What does your face look like when you have this emotion? What does the tone of voice sound like? When do you feel this way?
    • Generate strategies for dealing with emotions:

      • "Maybe you're nervous. Sometimes the best thing to do when you're nervous is..."
      • Verbally describe the strategy
      • Model strategy yourself
      • Play act with puppets
      • Now you try it
        Note: Parenting Press, Inc. produces a useful series: "Dealing with Feelings." Books in the series include: "I'm Mad," "I'm Frustrated," and "I'm Proud."
      • Act out scenarios:
        (e.g., going to the store; friend takes away your toy). "What should we do?" "What should we do now?" "How do you think I'm feeling now?"
      • Emotion games:

        • Act out an emotional scene either yourself or with puppets
        • Find the parts of the body that have the feeling
        • How do other people look?
        • What made the character angry?

     

  • Build a sense of self

    • Work on self-esteem e.g. identify and reinforce values, strengths, beliefs
    • Develop appropriate body image (e.g. use drawings)
    • Encourage activities that person enjoys and that are rewarding
    • Encourage discrimination between pretend vs. real; identify relevant information and data; help person identify realistic expectations, understand limitations

     

  • Working with families

    • Helping parents understand NVLD
    • Behavioral strategies, e.g. structure time/activities to help learn strategies for internal control and motivation

© 1997, Wendy Heller, Ph.D.

Dr. Heller is an Associate Professor and Director of Clinical Training, The Psychological Services Center, Department of Psychology, University of Illinois at Urbana-Champaign, where she also sits on the faculty at the Beckman Institute for Advanced Science and Technology.

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