Picture this as something to think about…

1. Picture this as something to think about… This is a shape right…? …Pretty straightforward, yes? (hint: it is not an optical illusion or a trick of some sort) What do you see…? Describe it, go ahead… We all see basically the same thing, right…?

2. NLD A Pervasive Life Disability

3. The Flow of Life is Rarely Smooth • NLD is a pervasive, neurological disability which is caused by damage to the brain’s circuitry, resulting in significant deficits. • These deficits affect all learning: academic, social, emotional, psychomotor, visual, spatial, and cognitive. • There is often confusion and danger on all fronts, life’s many mysterious requirements high cause for anxiety. • Quite typically, persons living with NLD also live with an anxiety disorder, resulting in heightened awareness of all things mysterious,(65-70% of communication) which presents more uncertainty to create additional anxiety, and so live a vicious cycle, having no hope of resolution.

4. How is NLD Determined and Classified? • Determination of a Learning Disability as NLD/NVLD occurs when testing shows a significant discrepancy between verbal and performance ability scores. General consensus identifies serious to severe learning impact begins with a discrepancy score greater than 10 points. • Classifying for Special Education services under the category of Other Health Impaired(OHI), defined for students with neurologic and physical impairments as well as health problems, including: • Cerebral Palsy • Muscular Sclerosis • AD/HD • Epilepsy • Severe asthma • Cystic Fibrosis

5. BACKGROUND Historically, NLD has resisted early identification primarily due to a precocious nature of the strengths commonly characteristic of children with NLD- evident at a very young age. Often these children: • Develop speech early • Have large/excellent speaking vocabulary • Are early readers(frequently self taught) • Remarkable rote memory skills display an eager, enthusiastic learner, appearing competent beyond their years • Are verbally adept(seeming like little adults at 2-3 years) • Superficially, such early evident strengths present these children as gifted learners. (in pre-school and early elementary years) • The truth of NLD is simply that it is not primarily a disability that impacts learning with affect on how that happens, although it seriously does, but NLD is a disorder that pervades all aspects of life and life skills, in a profound way.

6. REALITY CHECK… “Although this child hears the language being spoken around her, she may have difficulty understanding it. Figurative speech, idioms, sarcasm, and any non-literal language patterns are like a foreign language to her. Imagine the confusion you would experience if the people around you suddenly began speaking in a language you didn’t know. This experience would become even more frustrating if you thought you recognized some of their words, but the words didn’t seem to mean what you thought they meant. You would probably feel very uncomfortable, wondering why they were laughing at you or pointing at you. What did you do wrong? Why can’t you understand them? This type of bewilderment is felt by the child with NLD throughout the day, every day of her life.” -Sue Thompson, The Source for Nonverbal Learning Disorders

7. NLD On a Spectrum of Disorders

8. Neuropsychological Deficits Tactile and Visual PSYCHOMOTOR AND SPATIAL • Tactile perception and attention- she does not have the ability to identify something by touch alone or to “attend” to teaching strategies which require touch. • Visual perception and attention- she does not have the ability to accurately scan the visual field or environment and process what is seen or “attend” to teaching strategies that use the visual modality. • Psychomotor coordination- her ability to have her body do what she wants it to, when she wants it to, and how she wants it to is impaired. • Spatial orientation- she is unaware of where she is in space and her physical proximity to other objects.

9. Neuropsychological Deficits SOCIAL AND EMOTIONAL COGNITIVE • Pragmatics- her functional and practical use of language is impaired (no intuitive interpretation) • Social Skills-her ability to interact appropriately, based on established social norms, is deficient. • Adaptability-she is seriously limited in her ability to adjust to a new situation or change in circumstance. • Emotional stability-because of her significant deficit, her emotional well-being is inconsistent • Generalizing information- she is unable to apply prior learned knowledge to a similar situation (similar situations are brand new each time they occur-response is not transferred to a similar scenario, but remains new and needing the interpretation and application process all over again) • Mental flexibility- her ability to assimilate and process new information or ideas that may influence the way a person thinks about a topic or situation is impaired. • Executive function and organization- she does not have the innate ability to organize, prioritize, and plan either her thoughts or her work.

10. A General Vignette of Common Tendencies Because life has always been challenging, never expects it to be anything but difficult… • Naïve • Trusting • Determined(so resolute that often viewed as stubborn) • Literal(in interpretation/application) and concrete • Loyal • Atypically honest • Self effacing to the extreme • Struggles endlessly with time management • Weak organizational skills • directionally challenged • Asks lots of questions(verbal is how processing happens) • Exceptionally forgiving • Exceptional memory for rote material • Often appears “confused” • Lack of ability to interpret non-verbal cues often leads to a “flat affect”-doesn’t “read” faces, so can’t respond with a corresponding/appropriate facial expression • Unaware of personal space boundaries • Difficulties with visual-spatial awareness makes for awkward/clumsy and accident prone orientation • Eloquent speaker • Easily bullied/manipulated • Auditory Processing is a strength • strong auditory retention • Excellent Vocabulary • Master at spelling

11. PROFILE NLD/NVLD, also called, “right –hemisphere learning disorders” involve the performance process (generally thought of as originating in the right cerebral hemisphere of the brain, which specializes in nonverbal processing) where it is thought that neurologically, the significance is that white matter connections to the right hemisphere, which are important for intermodal integration are abnormal. This leaves the left hemisphere, or unimodal system, to function on its own. This neurological insult involves significant destruction of white matter (long mylenated fibers in the brain). Clinically, this learning disorder classification resembles an adult patient with a severe head injury to the right cerebral hemisphere. NLD is considered a low-incidence disability, appearing much less frequently than language based learning disorders. It is approximated that 10% of the general population could be found to have identifiable learning disabilities. It is thought that only 1 to 10% (or 1.0 to 0.1 %) of the general population would be found to have a nonverbal learning disability.

12. What Does all This Mean? Imagine a child who through superficial observation and visual measure appears typical. Yet, that child navigates life with a disability so severe and pervasive that in heart-wrenching seriousness she comments- “I wish I had a disability that could be seen, like cerebral palsy or blindness, so that it would define me right up front; people could see it then, and therefore see me…life would be easier that way”. *That child’s best friend from K up through 12th grade happened to be a child with cerebral palsy, so you see, she knew as best anyone could, how difficult and challenging every moment of her friends life was and is-yet still she wished for it, rather than the equally difficult and challenging circumstances that no less drastically but invisibly control hers.

13. Sue Thompson… • The discovery of the NLD syndrome began in the early 1970s, with research involving groups of children with learning disabilities identified by discrepancies between their verbal and performance IQs. It is unfortunate that 25 years later, even professionals in the field of education are largely uninformed about and/or unfamiliar with nonverbal learning disorders as these disabilities can be much more devastating to a child than language-based learning disorders in the long run. • Since diminished access to and/or disordered functioning of the right-hemisphere systems impedes all understanding and adaptive learning, it is fair to say (as Helmer R. Myklebust did in 1975) that nonverbal learning disabilities "are more debilitating than verbal disabilities." The specific central processing abilities and deficits that characterize this syndrome are now well defined. Still, nonverbal learning disorders remain predominantly misunderstood and largely go unrecognized.

14. Sue Thompson cont… Identifying Nonverbal Learning Disorders • Whereas language-based disabilities are usually readily apparent to parents and educators, nonverbal learning disorders routinely go unrecognized. Many of the early symptoms of nonverbal learning disabilities instill pride, rather than alarm, in parents and teachers who ordinarily applaud language-based accomplishments. This child is extremely verbose and may "speak like an adult" at two or three years of age. During early childhood, he is usually considered "gifted" by his parents and teachers. Sometimes the child with NLD has a history of hyperlexia (rote reading at a very young age). This child is generally an eager, enthusiastic learner who quickly memorizes rote material, only serving to reinforce the notion of his precocity. In the early years these children are often serious ,very well behaved , and noted for a diminutive ,quiet manner-extremely easy to please, and why not, unable to get a “reading “on expectations, they have no idea what it is they should act like, so they don’t act like much at all. • Extraordinary early speech and vocabulary development are not often suspected to be a coping strategy being employed by a child who has a very deficient right-hemisphere system and limited access to her nonverbal processing abilities. The child with NLD is also likely to acquire an unusual aptitude for producing "phonetically accurate" reproductions of words (spelling), but few adults will consider this to be a reflection of her over-dependence upon auditory perceptions (as opposed to visual or tactile). Likewise, remarkable rote memory skills, attention to detail, and a natural facility for decoding, encoding, and early reading development do not generally cause red flags to go up. Yet, these are some of the important early indicators that a child is having difficulty relating to and functioning in her world nonverbally, and a warning that she has developed an excessive reliance upon her verbal strengths. • Dr. Rourke and his associates have found that the dysfunctions associated with NLD are "less apparent at the age of 7 to 8 years . . . than at 10 to 14 years," and that they become "progressively more apparent (and more debilitating) as adulthood approaches." Although this child has a history of poor coordination and was probably slow to acquire motor skills, typically initial academic concerns will generate from the fact that he is not completing and/or turning in written assignments during his late elementary school years. This child produces limited written output and the process is always slow and laborious for him. • When the skills for organizing and developing written work don't advance at the expected rate for this student, finally the red flags go up. However, by this time, the child may have already "shut down" or become locked into an oppositional struggle, as a coping mechanism to deal with the academic pressures and performance demands which have been placed upon him by unsuspecting parents and teachers and which he is unable to meet. • The three broad aspects of development NLD presents deviations and abnormalities are (1) motoric, (2) visual-spatial-organizational, and (3) social. in which If a child has right hemispheric dysfunction, deficits in these areas should be quite evident to an observer during the child's early years, despite his valiant efforts to compensate for them. The more novel the psychomotor, visual-spatial, and/or social situation, the more evident his impairments will be. Following are some of the early adjustment problems to be aware of in each category.

15. WHAT ARE THE IMPLICATIONS FOR SCHOOLS AND EDUCATORS? Since the publication of Sue Thompson’s book, The Source for Nonverbal Learning Disorders in 1997, (initially self-published in 1996 entitled-IShouldn’t Have To Tell You That!) as the first definitive work(in laypersons terms) on NLD, there is a slowly increasing body of information available regarding this disability. The fact is however, that there are few educators who are trained to teach, or train others to teach, students with NLD. To date, “The Source” remains a comprehensive and frequently cited “bible” -as body of knowledge for families and educators determined to understand the intricacies of this debilitating and pervasive disorder. The educational success, even life success has thus far primarily depended upon recognition and advocacy initiated by families and those few dedicated professionals who seek to help these fragile souls make their way through a largely undecipherable universe.

16. CAMS: Compensations, Accommodations, Modifications, and Strategies learning models for successful navigation Compensations Accommodations • Extra time and verbal cues to navigate through space • Never underestimate the gravity of this disability • Don’t force independence and take care to avoid comparison to others • Avoid power struggles, criticism, punishment, and threatening(people with NLD are already absolutely their own worst enemy) • All people owe it to persons with NLD to always assume the best; to always take a positive rather than negative approach. • (CAMS do not constitute lower or differential standards. The student with NLD is intellectually capable. By providing CAMS this child is given chance to profit from and demonstrate her level of intelligence.) • Teach Parts to Whole… • School/life’s writing assignments which merely require copying text need to be modified or omitted, due to the visual-spatial nature of such an exercise • Test answer sheet layouts and arrangement of visual-spatial math assignments need to be simplified • Paper and pencil tasks kept to a minimum because of finger dexterity and visual-spatial problems • The global confusions which underlie nonverbal learning disorders also result in limiting the student’s ability to produce the quantity of written work normally expected of grade level peers • Tasks requiring folding, cutting with scissors, or arranging material in a visual-spatial manner(maps, graphs, mobiles, etc.) will require considerable assistance in an accommodating manner, or they should be eliminated entirely. • Any timed assignments will need to be modified or eliminated • People need to check often for understanding and present information in plain and clear verbal terms (i.e. “spell out” everything) • All expectations need to be direct and explicit • As predictable a schedule as possible • At school- assign one case manager1 • Deliberately teach HOW to read context text • Where possible increase to maximum the “white space” surrounding text • Teach this student to recognize their learning strengths and needs so they can educate you

17. CAMS: Compensations, Accommodations, Modifications, and Strategies learning models for successful navigation Modifications Strategies • NLD child needs to be in learning environment that provides daily, non-threatening contact with non-disabled peers(i.e. not a “special” or “alternative” program) to further social development. • Will benefit from cooperative learning situations-provided being grouped with good role models. • Transitions will always be difficult for this child-allow additional time to collect thoughts, before expecting her to switch gears. • Placement must be in an environment having well established routine because child will not decipher nonverbal cues. • Adaptation of special presentation procedures for those subjects requiring visual-spatial-organizational and or nonverbal problem-solving skills. All repetitive-rote homework must be eliminated. Assist with division of long term projects, and provide frequent feedback. • Allow sufficient time AND physical assistance to visually ensure child has everything they need to do what is expected of them- prior to sending home or off to work independently • Do tell this child everything and encourage to give you verbal feedback.(expect rote learning to come before applied learning-be explicit-you need to tell her, what, where, when, why & how-she cannot look and learn)(cannot visualize task in mind-needs verbal sequence) • Verbally teach(don’t expect child to observe)cognitive strategies for skills of conversational pragmatics and nonverbal body language. • Help develop own abstract language skills by always commenting on what was meant by particular phrase or statement. • Observe and expand the coping techniques that child has already acquired on her own. • Group this child with good role models so that she can label and learn appropriate social interaction. • Adult role models should talk their way through decision-making situations in child’s presence, in order to provide her an oral view of someone else’s internal speech process. • Do not put additional or different expectations on this child before she has become comfortable with previous expectations. • Isolation, deprivation, and punishment, are never effective methods to change the behavior of a child who is already always trying her absolute best to conform (but consistently misinterpreting all kinds of nonverbal cues despite heroic effort) • Provide maps of school with verbal review

18. OVERWHELMED Most of us respond and navigate a constant barrage of decisions, replies, questions, conversations, innuendo, suggestions, demands ,and tasks(etc.)- often juggling several simultaneously, all with little conscious regard of our interpretations as being a complicated endeavor, or for the remarkable speed with which it integrates to transpire, for we have no need nor cause to notice the process. Quite the contrary for people with NLD, who finding it all a mysterious muddle are caught in a maze of no end- struggling to make sense of it all without the 65+% piece of the picture that is nonverbal- yet essential to recognize for accurate interpretation. This invaluable portion of important information that has a tremendous impact on comprehension that most of us take for granted, is unavailable information to those with NLD. The right brain processing that so easily allows us to assess and sort all the nonverbal input is just not accessible. With a little imagination, perhaps you can glimpse what life must be like with less than half the information you have available to assist your process of response…in nonverbal help, that is always there for you.

19. WHAT HELPS… • Education: for child, for family, for schools • Advocacy- initially on part of child-ultimately to empower this child with understanding of their disability and the ways in which they can disclose to receive the support they should have, through building self-advocacy skills • Positive attitude and uncritical patience- this child NEVER intends any harm with their responses, which are often received/viewed as less than socially adept • Modeling of Usually Internal Self-Talk as way of explanation for all child cannot intuit from/in social interactions/expectations • Verbal explanation of EVERYTHING!!!!! • Medication- to increase the serotonin level normally present in the brain but insufficient in those with NLD, resulting in an extremely high ratio of anxiety disorders that typically present as partner to NLD-NLD is rarely seen as just NLD • Encouragement and vigilant advocacy to build and maintain open communication between child and those who care-these children are at high risk for depression, manipulation, abuse, and suicide • Music- encouragement to play an instrument- this helps forge/facilitate left-right brain connection • Appreciative reinforcement of all that is generous, good, kind, worthy, honest, loyal and hard working etc. in this child- traits that are highly exploitable • Awareness- if you can possibly put yourself in the shoes of a person with NLD, even for a moment to touch the honor and respect that they deserve-for in the effort required to do ANYTHING takes notably longer than is typical, and always will…

20. Imagine with me for a moment, if you will… I cannot begin to understand, really, what life lives like with NLD, or any disability for that matter, would that I could, for what a wealth of information I would possess to provide the very best strategies imaginable for coping… As a teacher invested in Special Education and the excellent teaching practice it’s strengths afford all learners, I venture to say that we would all do well to try and visualize what learners with disabilities experience… As far as living life with NLD, as near as I can imagine, it may be something like living forever as a brand new ELL student, as a person with NLD who by virtue of inability to interpret a language foreign to them, are denied access to that huge portion of nonverbal communication which we unconsciously intuit and largely master by pre-school age *…do what you must and you shall live a just life; go beyond that- to do what you can, and live as a champion…for those that struggle so heroically not to need you…*

21. Picture this as something to think about… This is a shape right…? …Pretty straightforward, yes? (hint: it is not an optical illusion or a trick of some sort) What do you see…? Describe it, go ahead… We all see basically the same thing, right…? I lied, not that it’s a trick, it isn’t, but we do not, as you by now I hope suspect, all see this shape the same way…a person with NLD typically does not see this shape as a box with an x in it and a line off to the top right, no not at all, in fact they don’t see the x at all until they are verbally told it is there- what they DO see is an image of eleven parts(see them?), not a whole shape at all…they are only able , with verbal instruction to connect the parts into a whole they can then describe as you and I see it at first glance. Initially, they would follow each line as a single entity to copy or recreate this as their own drawing…the same is true for a line as directions-no whole picture, just pieces.

22. What can teachers REALLY do? Perhaps the most important thing, apart from BELIEVING that indeed, ALL CHILDREN CAN LEARN, is to REALLY think about the ways in which you communicate…and… • scaffold what you teach…TEACH PARTS TO WHOLE… • Verbally connect/describe/explain-everything • Transition warnings • Organizational support • Extra time when needed • Good teaching is always about good modeling, never is it more critical than with NLD students • Nurture…these students are among the most articulate ,avid , and dedicated learners you will meet and want more than anything to please you and do well- typically, they are students all teachers hope to have in their classes for they will do their very best always to meet your expectations

23. Bibliography • Tanguay, P. B. (2002). NLD and Hyperplexia. Retrieved April 28, 2009, from NLD on the web. • Tanguay, P. B. (2002). Nonverbal Learning Disabilities at School; Educating Children with NLD, Asperger Syndrome, and Related Conditions. London and Philadelphia: Jessica Kingsley Publishers. • Thompson, S. (n.d.). nonverbal learning disabilities revisited in 1998. Retrieved April 28, 2009 • Thompson, S. (1997). The Source for Nonverbal Learning Disorders. East Moline,IL: LinguiSystems, Inc. • Tom E. C. Smith, E. A. (2008). Teaching Students wth Special Needs in Inclusive Settings(fifth edition). Boston, MA: Pearson Education, Inc.