Nonverbal Learning Disabilities
by
Shana R. Erenberg, PhD
CHICAGO, ILLINOIS, USA
Disorganized, lazy, unmotivated, scattered - these are but a few of the erroneous labels applied to children with nonverbal learning disabilities (NLD). Most teachers, psychologists, and other special education professionals recognize and understand verbal learning disabilities that impact oral language, reading, and writing. In contrast, nonverbal learning disabilities, which can affect fine and gross motor coordination, visual spatial perception, social skills, and executive functioning frequently go unrecognized, and are often misunderstood.
Characteristics of Individuals with Non-verbal Learning Disabilities
Individuals with NLD have difficulty organizing and interpreting visual spatial information. Their lockers, desks and bedrooms are usually a mess. They have difficulty looking for and finding things that they need. Children with NLD seem to lose everything. The school supplies, assignment notebooks, and folders purchased before school are gone by the second week of September. Homework assignments may rarely make it home. Conversely, assignments may be completed at home but are lost before they are ever turned in to the teacher. Schoolbooks disappear in the quagmire of the desk, locker, or classroom. Students with NLD have difficulty keeping papers in an organizational system. Papers are stuffed into desks and lockers. Books, assignments, and materials are jammed into haphazardly into backpacks. Often these symptoms present in contrast to strong verbal and reading skills, leading teachers and parents to assume that the child's behaviors are deliberate. Students with NLD are presumed to be irresponsible and immature, when, in actuality, their lack of organization is a direct result of their disability.
Children with nonverbal learning disabilities have difficulty with visual spatial orientation. They may have right - left directionality confusion, making it difficult to know where to start on a specific page. In the religious school setting, right-left orientation problems can impact on the child's ability to process Hebrew reading and writing. Visual memory skills may be weak due to difficulties with forming visual images. The child may perceive visual details, but cannot form the gestalt of a visual image. As such, spatial referencing is affected. The child may know where a classroom is located, but cannot describe its location relative to other rooms in the school. As a result, the student with NLD can easily get lost in both new and familiar settings. He may frequently come into class a few minutes late, further adding to a sense of disorganization and carelessness.
Individuals with NLD may also have considerable difficulty understanding social situations. They cannot accurately perceive the nonverbal cues that make up more than half of all communication. Individuals with NLD have difficulty reading social cues and interpreting facial expressions, often causing them to react inappropriately. They misinterpret body language and vocal intonations, and interpret social situations in concrete, absolute terms. Children with NLD may be hypersensitive to perceived slights by other students. They are naively trusting and as such, easily hurt. They may have difficulty with social conventions, such as how close to stand to someone when having a conversation, and how to take turns when speaking. Since individuals with NLD tend to rely on stronger verbal skills, they may talk incessantly as they attempt to mediate the environment. Peers, as well as teachers, may find this behavior frustrating and annoying, further complicating social issues. Due to their awkward social skills and unpredictable reactions, children with NLD are often mislabeled as having emotional or behavioral disorders. Research indicates that children with nonverbal learning disabilities with problems in social perception are at a greater risk for depression, anxiety, and suicide.
Executive functioning is also impaired in individuals with nonverbal learning disabilities. These students have considerable difficulty with organization. They may not be able to break an assignment down into component parts, and complete each portion by a given deadline. It is not uncommon for the student with NLD to announce that he/she has a major book report due the following day, and has not yet even read the book. It is not that this child is a procrastinator; rather, he/she may not have accurately perceived and understood the timeline for the assignment. Executive functioning impacts on study skills and learning strategies. Students with NLD may lack an effective repertoire of metacognitive learning strategies with which to approach academic and social tasks. Study habits are often poor; students with NLD may have no idea how to study efficiently.
Executive functioning also impacts on the child's ability to direct, sustain, and shift attention. As such, symptoms of NLD are easily confused with Attention Deficit Hyperactivity Disorder. Individuals with impaired executive functioning have difficulty with abstract reasoning, logical analysis, and hypothesis testing. Cognitive flexibility may be weak, making it difficult for the child to shift from one thought, task, or activity to the next. Students with weaknesses in executive functioning appear to be lazy, forgetful, and unmotivated. They are typically late, disorganized, and messy. They may be chronically distracted, and cannot communicate in a logical sequence. Homework is often not completed, and assignments and books are frequently lost. In class these students may have trouble getting started with and completing assignments - particularly written work. It may be difficult for them to find their materials and manage time effectively. In addition to these weaknesses, the child may manifest anosognosia, an inability to reflect on the nature and seriousness of one's problems.
Gross motor skills are often impaired in individuals with nonverbal learning disabilities. Children with NLD may appear clumsy and awkward. They may have problems with balance, trip frequently, and bump into things. Individuals with NLD may be hesitant to explore the environment motorically, impacting on important stages of development. They may have extreme difficulty learning to ride a bicycle, hit or kick a ball, or climb playground equipment. Children with NLD often appear spacey, lost or confused. Due to problems with balance and physical instability, children with NLD may prefer to eat or do school work on the floor where they can more readily maintain equilibrium.
Fine motor skills may also be affected. The child may exhibit uneven dominance, with more pronounced difficulties on the left side of the body. He/she may have trouble crossing the midline of the body for gross and fine motor tasks. Individuals with NLD may have difficulty with cutting and coloring. Handwriting is labored, difficult, and often illegible. In extreme cases, the child may have dysgraphia, a severe graphomotor disability resulting in an inability to write. Pencil grasp is often awkward, and the child may have difficulty exerting the correct amount of pressure on the pencil. Writing becomes a frustrating, disagreeable task to the individual with NLD. As such, the child may attempt to avoid written assignments and may have difficulty with assignment completion and productivity.
Diagnostic Indicators
Nonverbal learning disabilities are thought to be a right hemispheric learning disorder. The problems are often misunderstood and go unrecognized for a large part of a child's schooling due to a lack of understanding of the nature of NLD. These children are often labeled "behavior problems" or "emotionally disturbed" because of their frequent inappropriate and unexpected conduct, but NLD is known to have a neurological rather than a deliberate and/or an emotional origin.
Brain scans of individuals with NLD often confirm mild abnormalities of the right cerebral hemisphere. Developmental histories have revealed that a number of the children suffering from nonverbal learning disorders who have come to clinical attention have at some time early in their development: (1) sustained a moderate to severe head injury, (2) received repeated radiation treatments on or near their heads over a prolonged period of time, (3) congenital absence of the corpus callosum, (4) been treated for hydrocephalus, or (5) actually had brain tissue removed from their right hemisphere (Thompson, 1996).
Nonverbal learning disorders appear less frequently than language-based learning disorders. Research suggests that 10% - 15% of the general population has learning disabilities, of which only 1 to 10% of those individuals have NLD. Increased awareness of the disorder and improved diagnostic evaluations, however, may lead to a rise in the incidence figures. Nonverbal learning disabilities affect males and females equally.
Diagnostic indicators include: significantly higher verbal than performance IQ scores; weaknesses in executive functions and higher level reasoning skills; and discrepancies between verbal and nonverbal memory abilities. In addition, discrepancies between auditory and visual attention spans are common. The student will exhibit deficits in visual perception and visual spatial skills. Difficulty with speech prosody, use and interpretation of emotional language may be noted. The student may demonstrate an over-reliance on verbalization as a social strategy.
The student with NLD will likely have problems with drawing, copying, and handwriting. They may have difficulty with tactile and haptic perception, finger localization, fingertip number writing, and tactile form recognition. Repetitive, basic motor movements may be within the average range; however, deficits in motor speed and dexterity are typical. In addition, the student with NLD may have weak gross motor skills and are often less athletically capable than their peers.
Diagnostic indicators can also be seen in social situations. Individuals with NLD can have difficulty interpreting facial cues and body language. Miscues in social situations include missed nuances and subtle cues. They have difficulty understanding affective intonation. Social judgment may be impaired due in part to difficulty with reasoning and generalization
The deficits that are characteristic of NLD often occur in the presence of advanced verbal skills, adding to the confusion regarding accurate diagnosis. According to Thompson (1996):
"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. The child with NLD is also likely to acquire an unusual aptitude for producing "phonetically accurate" reproductions of words."
Thompson suggests that the early speech and vocabulary development are a coping strategy for the child who has a deficient right-hemisphere system and limited access to nonverbal processing abilities. The advanced oral language and reading skills often mask deficiencies in visual processing.
Remediation
When a child has been diagnosed with a nonverbal learning disability, it is important for teachers and professionals to recognize that this disorder is neurological in nature and not a willful decision on the part of the child. The student with NLD can and should often be accommodated in an inclusive setting, provided that the teachers and professionals have an understanding of the disability. A comprehensive and detailed Individualized Education Program (IEP) put together by a team of informed experts will aid in a successful outcome (Thompson, 1996).
Remediation must provide structure and organization that the student understands and can manage. The focus of intervention should emphasize the management of time, space, materials and work. Effective remedial methods include direct verbal training in planning, organizing, studying, written expression, social cognition, and interpersonal communication.
The following tips will be helpful in teaching and accommodating the student with NLD:
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Provide individualized visual schedules that are reviewed orally with the child several times per day.
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Include written directions with oral instructions. Check frequently for understanding.
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Reduce the number of problems or questions on a sheet
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Reduce visual distractions as much as possible
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Use structured assignment notebooks or PDA's
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Reduce the amount of writing, copying, and other fine motor activities. Use alternatives to writing such as tape recording stories or using preprinted stickers for answers on multiple-choice tests.
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Allow additional time to complete written and motor tasks.
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Minimize the number of folders needed - consolidate work into one specific, consistent system. The student must understand how the system works. With older students, allow them to have a say in the design of the organizational system. This will permit the child to have buy-in and ownership of the system.
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Use a visual calendar at home and at school to keep track of long term assignments, due dates, chores, and activities.
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Teach explicit organization strategies.
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Use a timer if necessary to provide additional structure.
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Allow extra time to get places and provide verbal cues to navigate through space. Continually assess understanding of spatial and directional concepts.
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Plan and structure transition times. Give the child a few minutes warning before shifting activities (five more minutes of play time and then we will return to our desks).
In addition:
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Do not force independence on this child if you sense she is not yet ready for something.
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Provide compensatory strategies to deal more effectively with novel situations.
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Assume a protective and helpful role with the child.
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Avoid power struggles, punishment, and threatening as the child does not understand rigid displays of authority and anger.
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Be proactive and positive in your behavior management.
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Provide a learning environment that provides daily, non-threatening contact with non-disabled peers.
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Use structured cooperative learning groups to foster appropriate social interactions.
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