Nonverbal Learning Disability
Nonverbal Learning Disorder (NVLD) is a specific learning disability affecting both children and adults in their academic progress as well as their social and emotional development. Rourke (1985, 1989) describes NVLD as a cluster of neuropsychological, academic, and social-emotional characteristics reflecting primary deficiencies in non-verbal reasoning. Several significant issues are encompassed by NVLD including learning, academic, social and emotional. Generally, children with learning disabilities do not have considerable problems with normal social and emotional development. Academic difficulties, on one hand, may affect children with NVLD but not significantly on social and emotional areas. The combination of learning, academic, social and emotional issues is a valid identification of NVLD. Moreover, NVLD can be identified not until the child is in middle-to-late elementary school since pattern of academic strengths and weaknesses along with social relations difficulties are not always apparent in early childhood.
Compared to language-based learning disabilities (e.g. dyslexia), nonverbal learning disabilities as less well-known. As a matter of fact, most NVLD often go undiagnosed for the reason that reading ability tends to be considered as the chief indicator of academic well-being by most school systems. Rourke (1985, 1989) differentiated this subgroup of learning disabilities from others that are more frequently known and better understood through years of research. Nonverbal learning disabilities present an exceptional challenge to both parents and teachers because it has a prominent effect on social interaction and academic performance.
Significance of the Study
Learning disorders are common among elementary school children. Studies from Weinberg, Harper, and Brumback (1995) showed that as many as 10 percent of school-aged children have problems with educational achievement or school behavior. Additionally, Levine (1995) showed that as many as 15-30 percent of children may suffer school failures due to learning disorders that usually result from subtle problems with neurological development or mild brain dysfunctions.
Only a few nursing professionals are familiar with nonverbal learning disability and their manifestations notwithstanding the prevalence of learning disorders in children. Johnson (1995) provided reason for this tendency asserting that it is because 80 percent of all children with learning disabilities have verbal learning disabilities that affect their ability to read, speak, or listen but not their nonverbal learning.
Characterizing Nonverbal Learning Disability
Also termed as right-hemisphere dysfunction, nonverbal learning disability affects one of every ten children with a learning disability (Rourke 1995; Torgeson 1993). There are five specific divisions that characterized children with NVLD. These five divisions include problems in the areas of academic performance, social competencies, visual spatial abilities, motor coordination, and emotional functioning.
Most young children with NVLD have the tendency to stray from home or groups and easily get lost. Oftentimes, they spill things at mealtime and have trouble dressing themselves because of motor coordination problems. Problems with spatial skills come out in a weak understanding of nonverbal information such as pictures and cartoons, and tasks like puzzles.
Because of their auditory strengths, children with NVLD are able to use words in an adult fashion and learn to read before school age. These children often try to gain information about the world around them through asking endless questions of adults rather than by exploring on their own. They however have visual perception inaccuracy, physical awkwardness, and difficulty in integrating information in space. Accordingly, time make it harder for children with NVLD to make sense of the physical world. On the other hand, this compensation can intensify the problem since the less the child engages in physical exploration, the less he/she learns about relationships between objects in space (Brace 1998).
Academic Impact to Students with NVLD
Although students with NVLD usually appear to possess above-average cognitive skills due to their verbal strengths, they frequently show academic difficulties by the time they reach secondary levels.
In areas of mechanical arithmetic, children with NVLD usually find trouble solving more complex math involving many columns (e.g. long division). According to Rourke (1995), academic achievement in mechanical arithmetic beyond a fifth-grade level is rare. Specifically, they find it difficult in keeping columns straight, oftentimes in doubt which column to put a number in when they carry over in addition (Fudge 1997). Furthermore, they also have trouble analyzing word problems and math reasoning and unable to read math problem and in doubt as to what operation to perform. In particular, children with NVLD find it more difficult on higher math skills like geometry and algebra that mainly rely on spatial abilities and recognition of the relation between concepts.
On the better end, children with NVLD are generally good with word recognition, oral and spelling. Moreover, they also show good phonetic skills like word pronunciation despite sometimes slower learning in recognizing their own letters. On the other hand, they have weak reading comprehension on more abstract and novel subject matter in particular. While children with NVLD might be able to fluently read a paragraph, they nevertheless unable to extract the main point or even answer conceptual questions on what has just been read.
Due to spatial and coordination problems, the students in the early grades find difficulty in printing and writing, learning math, telling time, reading and coloring maps and keeping one’s place on the page. By the time they are in the secondary school, students with NLD experience problems in subject areas other than math since this level involves more complex verbal language based on nonverbal processes like spatial relationships, logical ordering, and sequencing. Logical ordering and sequencing are two skills that are necessary for writing essays. Students often find difficulties in specific activities that require good spatial awareness like the sense of time, written material arrangement, making change, and typing and sewing.
Distinct to most children with NLD is their inattentiveness and poor organization of things. This is for the reason that they find it difficult to integrate and interpret incoming information. They have the tendency to pay attention to each and every incoming detail rather than combining them to form into more meaningful wholes. Quickly, this effort will lead to information overload resulting into students often coping through adhering to familiar habits and routines that help them structure their world. Nevertheless, this means of coping by students with NLD occasionally appears as misbehavior.
As they reach later secondary and post-secondary education, students with NLD will be having problems of integrating information they hear with the act of writing since information at this level is frequently presented in lecture form. Integrating verbal information into writing is distinctively difficult for students with NLD due to their awkward and slow writing skills. Whereas some students with NLD may attend equally to individual information as they appear, they find setbacks and difficulty in separating important from unimportant details.
Social and Emotional Impact of NLD
The social skills of both children and adults with NLD prove to be the biggest area of concern. One particular result of having difficulty in processing nonverbal and spatial details is the misinterpretation or even missing subtle social cues such as facial expressions, gestures and tones of voice.
Students with NLD are affected in all areas (reading, social, sports activities) leading into social isolation. For this reason, children sometimes tend to alleviate through interacting only with adults since adults are less concerned about physical awkwardness and violations of social conventions. On the other hand, as children with NLD are highly verbal, parents and teachers alike tend to attribute their academic and social failure to laziness or poor character consequently resulting into emotional problems like depression and anxiety expressed in physical ways like phobias, stomach problems and headaches.
Harnadek and Rourke (1994) observed the extreme difficulty in coping with novel and complex situations and an over-reliance on rote, commonplace behaviors on children with NVLD. They found that child with NVLD may find it very difficult in venturing new things like playing a game that they haven’t played before. These children consider new experiences as anxiety-provoking that exploring new things or activities they haven’t used to before may be difficult.
Despite speaking well and being verbal, children with NVLD are of a rote nature with poor linguistic or language use. They frequently interrupt improperly in entering into a conversation. They have little rhythm in speech or variation in tone and inflection. Gregg and Jackson (1989) assert that long, windy monologues are common to children with NVLD.
Children with NVLD present considerable discrepancies in social insight, social judgment, and social relations skills, and marked deficiencies in the appreciation of uneasiness and age-appropriate humor. According to Hoy, Gregg, King, and Moreland (1993), nonverbal cues provide multiple affective and cognitive functions that significantly affect communication. Children with NVLD often have difficulty with relationships in view of the fact that they have difficulty noting and understanding facial expressions, tone of voice, and body language. The poor interpretation of social cues, according to Thompson (1997), makes children and adults with NVLD vulnerable to ridicule, rejection, and victimization.
Another distinct characteristic of NVLD is having difficulties with visual organizational abilities and visual memory. Because children with NVLD have difficulty forming visual images, they don’t revisualize as a strategy for learning (Thompson 1997). They disregard and fail to grasp the whole information and focus only on the details of what they see. What is more is that these children have very poor visual memory unable to remember what they have read or seen. Coming out as a result of visual-spatial problems, Gross-Tsur, Shalev, Manor, and Amir (1995) contend that many children with NVLD meet the clinical criteria for another disorder called Attention Deficit Disorder (ADD).
As a result of poor ability to sense the position and movement of the body, children with NVLD demonstrate unpleasant and fine motor awkwardness. Harnadek and Rourke (1994) found these children to have problems with their reflexes, gait abnormalities, tremors, and lack of coordination. For example, child or adult with NVLD may mess things up, bump into things and fall. Heller (1997) specifically considers the inability to learn how to tie shoelaces as a pathognomonic (indicating specific disease) sign. A faulty sense of balance is also a distinct characteristic of NVLD affecting the child’s ability to perform activities that requires good balance (e.g. bike, skate). To an extent, standing on one foot may not be even possible to children with NVLD.
At the same time as children with NVLD has difficulty in social relations, so is their processing of emotional information. They find it very difficult in interpreting emotional experiences of both others and themselves. They have high risk for depression, isolation, and self-esteem problems because of their inability to learn from past experience, including social interactions (Voeller, 1995).
Furthermore, they have the tendency to misinterpret even a mild criticism from a parent as a major rejection and cry dejectedly for hours. They also exhibit quick changes in their emotional intensity. At one time the child may get very excited but then unexpectedly become overwhelmed and cry. This change in emotional intensity and complexity of feelings may result into feelings of panic and severe distress. They are easily devastated by feelings and described as easily frustrated and chronically inflexible (Greene 1998).
Brief Comparison with Asperger’s Disorder (AD)
It is inevitable to compare Nonverbal Learning Disability with Asperger’s Disorder for a simple reason that the symptoms of each diagnosis describe the same group of children from different perspectives. The child may be diagnosed as having NVLD if taken from a neuropsychological perspective but if taken from either psychiatric or behavioral perspective, children with NVLD might be diagnosed with AD.
As an empirical support for the close similarity between AD and NVLD, studies by the Yale Child-Study Group suggest that up to 80 percent of children who meet the criteria for AD also have NVLD. It is most likely that children with more severe forms of NVLD also have AD regardless of the fact that there are no studies on overlap in the other direction. While children with both AD and NVLD are socially awkward and pay much attention to detail and parts disregarding main themes, these two groups differ in their range of severity. Children with more severe social disability and behavioral rigidity are diagnosed by professionals as having AD with some symptoms overlapping with high functioning autism. There are certain degrees of severity within AD but not to the extent that is appropriate and acceptable in diagnosing NVLD. These certain degrees can range from extreme autistic behavior to cases where the social difficulties are very subtle and the academic or cognitive difficulties are more prominent (Dinklage 2001).
Identifying Nonverbal Learning Disabilities
Despite the study of Thompson (1997) on children with NVLD, only very few contemporary professionals outside the field of neurology and neuropsychology understand and recognized NVLD. The research of Rourke (1995) covers up the current unavailability of medical or psychiatric diagnosis of NVLD through clarifying and refining the diagnosis. There has been a continued research aiming at describing and explaining NVLD characteristics and the range of its associated disorders. By far, several authors view NVLD as part of a spectrum of disorders characterized by major difficulties in social interaction. Several studies (Rourke 1995) have found similar syndrome in NVLD that has been identified in children with Asperger’s syndrome, hyperlexia, Williams syndrome, and traumatic brain injury.
The dysmyelination of the white matter fibers located primarily in the right hemisphere of the brain is thought to be the cause of NVLD. Such fibers, according to Rourke (1995), may be damaged by a variety of neurological diseases, adverse biological events, and certain environmental conditions, before or after birth. Scientifically, this white matter holds nerve fibers that connect the left and right brain hemispheres as well as the posterior and frontal areas of the brain. Rourke (1995) hypothesized that there must be a destruction or dysfunction of the white matter that is required for intermodal integration for NVLD to occur.
Children or patients sustaining right-hemisphere damage may respond indifferently to events that are emotionally disturbing and seem impaired in the comprehension or production of affective signals and higher-order cognition related to emotions. Voeller (1995) describes children with NVLD to be likely impulsive, exhibit poor social judgment, and lack the ability of understanding or integrating complex information and stimuli. Depending on the severity of the symptoms (i.e. less severe or less well defined), children with NVLD can have similar indications as with the preceding two sentences.
While much have been discussed on the characteristics of NVLD, identifying children with NVLD is particularly important. Thompson (1997) reminds that if the child with NVLD is not identified, unrealistic demands and overestimations of the child’s ability are common. In addition, lack of knowledge of the NVLD syndrome may result into ongoing emotional problems in the child and the development of a negative feedback loop. The failure to identify children with NVLD also leads to inappropriate interventions that may result into reactive symptoms of distress. Reactive symptoms of distress includes the child’s inability to finish homework assignments thus being called unmotivated and given detention. Their problem with homework assignments can be attributed to the children’s poor organizational abilities, difficulty in problem solving, or the length of time to write. Unfortunately, the child often cannot articulate this problem and consequently becomes distressed by the criticism.
Parents and teachers both play a significant role in assisting children and students with NVLD in their problems in academic, social, emotional, and all other aspects that these children have setbacks. Teachers, in particular, can greatly help academically through using the student’s strengths in rote learning in helping them develop habits and routines in organizing themselves and their work as well. Parents, too, play a special role in helping their children with NVLD in developing their social relations and social skills through talking about social rules and appropriate responses to social expressions and tones of voice.
In addition, NVLD syndrome can be effectively assessed medically with an experienced clinician along with regular follow-ups. This is very crucial in insuring that appropriate strategies are put in place in order to assist children in realizing their potential.
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