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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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Psychology for you 2005 iwk community public education

Psychology For You2005 IWK Community Public Education


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


    Ii pattern of assets deficits neuropsychological language
    II. 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


    Ii pattern of assets deficits neuropsychological memory
    II. 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


    Ii pattern of assets deficits neuropsychological attention
    II. 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


    Ii pattern of assets deficits neuropsychological sensory motor perceptual
    II. 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 deficits neuropsychological cognition
    II. 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


    Ii pattern of assets deficits psychological adjustment
    II. Pattern of Assets & DeficitsPsychological Adjustment


    Iii developmental course relative functional impairments
    III. Developmental CourseRelative Functional Impairments


    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


    Differential diagnosis nld versus adhd
    Differential DiagnosisNLD Versus ADHD



    Differential diagnosis nld versus md con t
    Differential DiagnosisNLD Versus MD Con’t


    Differential diagnosis nld versus asd
    Differential DiagnosisNLD Versus ASD


    Differential diagnosis nld versus asd con t
    Differential DiagnosisNLD Versus ASD Con’t



    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 ?


    Conceptual framework functional impairments
    Conceptual FrameworkFunctional Impairments


    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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