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 Psychology For You 2005 IWK Community Public Education. Nonverbal Learning Disability : Often Missed or Misunderstood. Dr. Joseph M. Byrne Chief of Psychology IWK Health Centre. Overview. I. Background II. Pattern of Assets & Deficits Casual Observations Clinical Presentation

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nonverbal learning disability often missed or misunderstood

Nonverbal Learning Disability :Often Missed or Misunderstood

Dr. Joseph M. Byrne

Chief of Psychology

IWK Health Centre

overview
Overview
  • I. Background
  • II. Pattern of Assets & Deficits
      • Casual Observations
      • Clinical Presentation
  • III. Developmental Course
  • IV. Treatment Interventions
  • V. Therapeutic Resources
i background
I. Background

Hypothesizes – Rourke (1989)

  • 1. The Right side of the brain is generally more efficient at processing visual information (pictures, graphs, puzzles, maps).
  • 2. Children who had difficulty processing visual information had similarities with adults who had documented lesions on the Right side of the brain.
i background1
I. Background

Hypothesizes – (Rurke, 1989) Con’t

  • 3. White matter damage is the real causal agent
      • Right side of the brain is more dependent on interconnection with Left side and other parts of the brain to do its job.
      • Evidence – Children: hydrocephalus, receiving intra-cranial radiation, experienced severe localized (right) brain injury had more difficulty with visual information
i background2
I. Background
  • NLD syndrome can develop:
    • Significant interference of Right Hemisphere
      • 1. General deterioration of white matter
      • 2. Substantial destruction of Right Hemisphere white matter
      • 3. Substantial interference of neuronal communication (e.g., Callosal Agenesis)
background
Background
  • Definition: Nonverbal Learning Disability (NLD) is a neurodevelopmental disorder, manifesting in a pattern of neuropsychological, psychological, and academic deficits, which may vary in severity and time of onset, predominantly affecting the efficient and accurate processing of nonverbal information.
i background3
I. Background
  • Essential Features
    • Neurodevelopmental
    • Pattern of Assets and Deficits
    • Severity and time of onset may vary
i background4
I. Background
  • NLD NOT specifically listed in DSM-IV
  • Learning Disability – Not Otherwise Specified (LD – NOS)
ii patterns of assets deficits red flags early years
II. Patterns of Assets & Deficits‘Red Flags’ – Early Years
  • Sees ‘Trees for the Forrest’
  • Perfectionist in work
  • Easily upset with minor change in plan
  • Play has to be on their terms
  • Subtraction / Division challenging (reversals)
  • Avoids sports / crafts, puzzles
  • Sees detail others do not – over focus
  • Poor concept of time – lifelong
ii patterns of assets deficits red flags adolescent years
II. Patterns of Assets & Deficits‘Red Flags’ – Adolescent Years
  • Conversation may appear scripted
  • Friends are few; tend to be younger/older
  • Conversations: ‘Off-topic’ / intrusions
  • Literal (personalized) interpretation of events
  • Poor decision making when no ‘right answer’
  • Does not or incorrectly perceive social cues
  • Good oral reading continues, but poor reading comprehension emerges
  • Poor rule application (formula) math/science
  • Poor interpretation of graphs / diagrams
ii pattern of assets deficits red flags adult years
II. Pattern of Assets & Deficits‘Red Flags’ – Adult Years
  • Adulthood potentially more challenging:
    • more choice fewer rules
    • more ‘interpretation’, unique situations
    • More say in setting own agenda
  • Increased social isolation; stand out more
  • Job performance tied to degree of routine
  • Increased awareness of own ‘disorganization’, may become more rigid to increase control
  • May development Psychiatric disorder (s)
ii pattern of assets deficits
II. Pattern of Assets & Deficits
  • Neuropsychological
  • Academic
  • Psychological Adjustment
ii pattern of assets deficits1
II. Pattern of Assets & Deficits
  •  Neuropsychological
  • Academic
  • Psychological Adjustment
ii pattern of assets deficits neuropsychological
II. Pattern of Assets & DeficitsNeuropsychological
  • Language
  • Memory
  • Attention
  • Sensory-Perceptual (touch, manual skills)
  • Cognition (thinking, problem-solving)
pattern of assets deficits neuropsychological language
Assets

Auditory Perception

Phonology

Verbal Expression

Deficits

Verbal Reasoning

Pragmatics

Semantics

Expression

Complex

Comprehension

Complex

Pattern of Assets & DeficitsNeuropsychological - Language
pattern of assets deficits neuropsychological memory
Assets

Verbal Memory

Verbal Associations

Deficits

Visual Memory

Tactile Memory

Procedural Memory

Pattern of Assets & DeficitsNeuropsychological - Memory
pattern of assets deficits neuropsychological attention
Assets

Auditory Attention

Verbal Attention

Deficits

Visual Attention

Tactile Attention

Pattern of Assets & DeficitsNeuropsychological - Attention
pattern of assets deficits neuropsychological sensory motor perceptual
Assets

Simple Motor

Deficits

Tactile Perception

Visual Perception

Complex Psychomotor & Graphomotor

Oral-motor Praxis

Prosody

Pattern of Assets & DeficitsNeuropsychological - Sensory Motor / Perceptual
pattern of assets deficits neuropsychological cognition
Assets

Perception of Detail

Follow established routine

NB Much more than VIQ – PIQ split

Deficits

Concept Formation

Problem Solving

Rule-governed Behavior

Generalization Skills

Sequencing – Organization

Pattern of Assets & DeficitsNeuropsychological - Cognition
ii pattern of assets deficits2
II. Pattern of Assets & Deficits
  • Neuropsychological
  •  Academic
  • Psychological Adjustment
pattern of assets deficits academic
Assets

Word Reading

Spelling

Rote Learning

Graphomotor [late]

Deficits

Reading Comprehension

Math

Calculation

Reasoning

Science

Written Composition

Pattern of Assets & DeficitsAcademic
ii pattern of assets deficits3
II. Pattern of Assets & Deficits
  • Neuropsychological
  • Academic
  •  Psychological Adjustment
pattern of assets deficits psychological adjustment
Assets

Loyalty

Deficits

Perception of:

Social Cues

Pragmatics

Over Interpretation or Personalization of events

Risk for Psychiatric Disorders

Pattern of Assets & DeficitsPsychological Adjustment
iv differential diagnoses
IV. Differential Diagnoses
  • Nonverbal Learning Disability (NLD)
    • ADHD
    • Specific Mathematical Disorder (MD)
      • Dyscalculia
    • Autism Spectrum Disorder (ASD)
    • Remember – can have more than one problem
nld is not only about nonverbal information1
NLD is not ONLY about nonverbal information
  • Sequencing
  • Organization
  • Pattern Perception
  • Rule Generation and Application
  • Sifting : Essential Vs Non-essential
    • ‘Forrest from Trees’
  • So why call it NLD ?
verbal nonverbal
Verbal  Nonverbal

Take the 1st right on inbound Hwy 2, pass the 2nd toll booth, and exit immediately on outbound Hwy 3, and proceed to the 1st traffic light …….

v therapeutic interventions neuropsychological
V. Therapeutic Interventions Neuropsychological

Early years

  • Photo agenda / daily schedule
  • Reduce # of transitions
  • Verbal reminders before transitions
  • Rehearse ‘what to do’ for transition
  • Reduce distractions
  • Increase prediction
v therapeutic interventions neuropsychological1
V. Therapeutic InterventionsNeuropsychological
  • Ask for recall of instruction – OWN words
  • Color-code binders / dividers
  • Time-management sheets (order/ time)
v therapeutic interventions neuropsychological2
V. Therapeutic InterventionsNeuropsychological

Critical Thinking

  • Highlight patterns / sequences
  • Highlight cause-effect
  • Highlight essential features to facilitate generalization
  • Practice ‘categorization tasks’
  • Compare and contrast
v therapeutic interventions academic math
V. Therapeutic InterventionsAcademic - Math
  • ½ inch graph paper
  • Calculator
  • Written cue cards with procedural steps
  • Simple flow chart for procedural steps
  • N.Bley & C. Thornton (2003 – 4th Ed). Teaching mathematics to students with learning disabilities. Pro-Ed Publishers.
v therapeutic interventions academic math1
V. Therapeutic InterventionsAcademic - Math
  • Encourage ‘talk through’ steps
  • Subtraction / Division (reversals) most challenging
  • Teach to segment word-based problems
  • Dyscalculia
    • www.dyscalculia.org
v therapeutic interventions academic reading comprehension
V. Therapeutic InterventionsAcademic – Reading Comprehension
  • Preview unfamiliar vocabulary / questions
  • Offer thematic, preamble summary statement
  • SQ3R Method
    • Survey
    • Question
    • Read
    • Recite
    • Review
      • www.ucc.vt.edu/lynch/TROverview
      • www.resource.net/comprehension
v therapeutic interventions psychological
V. Therapeutic InterventionsPsychological
  • Highlight essential emotional features
    • What do you think the man felt?
    • Was the woman a little angry or a lot?
    • Why do you think the woman felt that way?
    • How are you feeling? Why do you feel that way?
    • Discuss character’s emotions (books, movies)
v therapeutic interventions psychological con t
V. Therapeutic InterventionsPsychological Con’t
  • Highlight essential emotional features
    • Anticipate new / stressful situations
      • Discuss approaches
    • Facilitate social interaction at comfort level
      • Help at the registration desk at school dance
      • Tutor younger kids learning to read
      • Keep the groups verbal checklist for activity
professional resources the disorder
Professional ResourcesThe disorder
  • B.P. Rourke (1995). Syndrome of nonverbal learning disabilities. Guilford Press
  • S. Thompson (1997). The source for nonverbal learning disorders. LinguiSystems Inc. [formerly, “I should’nt have to tell you! A guide to understanding nonverbal learning disorders”
professional resources parental assistance
Professional ResourcesParental Assistance
  • P. B. Tanguay (2001). Nonverbal learning disabilities at home: A parent’s guide. Jessica Kingsley Publishers Ltd.
  • S. Thompson (1997). The source for nonverbal learning disorders. LinguiSystems Inc. [formerly, “I should’nt have to tell you! A guide to understanding nonverbal learning disorders”
professional resources assistance for the educator
Professional ResourcesAssistance for the Educator
  • P. B. Tanguay (2001). Nonverbal learning disabilities at school: Educating students with NLD, Asperger syndrome, and related conditions. Jessica Kingsley Publishers Ltd.
  • S. Thompson (1997). The source for nonverbal learning disorders. LinguiSystems Inc. [formerly, “I should’nt have to tell you! A guide to understanding nonverbal learning disorders”
professional resources assistance for the educator1
Professional ResourcesAssistance for the Educator
  • R. Moyes (2001). Incorporating social goals in the classroom: A guide for teachers and parents of children with high-functioning Autism and Asperger syndrome.
  • S. Nowicki & M. Duke (1992) Helping the child who doesn’t fit in. Peachtree Publishers Ltd.
professional resources assistance for the educator2
Professional ResourcesAssistance for the Educator
  • E. McGinnis & A. Goldstein (1990). Skillstreaming in early childhood: Teaching prosocial skills to the preschool and A. Goldstein kindergarten child. Research Press.
  • E. McGinnis & A. Goldstein (1997). Skillstreaming the elementary school child: New strategies and perspectives for teaching prosocial skills. Research Press.
professional resources assistance for the educator3
Professional ResourcesAssistance for the Educator
  • A. Goldstein & E. McGinnis (1997). Skillstreaming the adolescent: New strategies and perspectives to teaching prosocial skills (revised edition). Research Press Company.
  • Y. Fast (2004). Employment for individuals with Asperger syndrome or Nonverbal Learning Disability: Stories and strategies. Jessica Kingsley Publishers.
website information parent and educator
Website InformationParent and Educator
  • www.nldontheweb.org
  • www.nldline.com
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