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NLDA Presentation November 9 2001

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2001 presentation to the East Coast NLD Association

2001 presentation to the East Coast NLD Association

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  • 1. Diagnosis & Educational Intervention for Nonverbal Learning Disorders (NLD) Nonverbal Learning Disorders Association (NLDA) November 9, 2001 9 AM to 3 PM
  • 2. Neuropsychological Framework for Diagnosis of Learning Disorders
    • Disorders of the Left-Hemisphere
    • Disorders of the Frontal Lobes
    • Disorders of the Motor Strip
    • Right-Hemispheric Learning Disorders
      • Autism
      • Aspergers
      • NLD
  • 3. Autism: DSM-IV Criteria
    • Marked impairment in use of multiple nonverbal behaviors
    • Failure to develop peer relationships
    • Lack of seeking to share enjoyment & interests
    • Lack of social or emotional reciprocity
    • Qualitative impairments in communication
    • Restricted, repetitive & stereotyped patterns of behavior & interests
  • 4. Aspergers: DSM-IV Criteria
    • Qualitative impairments in social interaction same as defined for Autism
    • Restricted, repetitive & stereotyped patterns of behavior & interests same as defined for Autism
    • No clinically significant delay in language
    • No clinically significant delay in cognitive development
  • 5. NLD: DSM-IV Silent
    • PDD-NOS
      • Impairment of reciprocal social interaction
      • Impaired verbal and non-verbal communication skills
      • Stereotyped behavior, interests & activities
      • Category includes “atypical autism”
  • 6. NLD: DSM-IV Silent
    • LD-NOS
      • Includes problems in reading, math & written expression that significantly interfere with academic achievement
      • NLD encompasses a broad range of skill set difficulties which result in academic and social deficits
  • 7. History of NLD in Research Literature
    • Johnson & Myklebust (1967)
      • Nonverbal disorders of learning. In Learning Disabilities: Educational Principles and Practices . New York: Grune & Stratton.
    • Wechsler Verbal > Performance by 12 points or more
  • 8. Johnson & Myklebust (1967)
    • Academic weaknesses are rooted in deficits in perception & visual imagery
    • Deficits result in confusion in language processing & cognition
    • Confusion manifests in difficulties interpreting spatial, part to whole & causal relationships
  • 9. Johnson & Myklebust (1967)
    • Difficulty forming visual images
    • Focus on details
    • Failure to grasp the complete picture
    • Trouble interpreting non-verbal cues
    • Significant difficulty perceiving & interpreting social situations
    • Awkward & slow development of motor skills
  • 10. Dormant Stage of NLD Research
    • 1970’s Right To Education Laws parse out broad categories of exceptionality
      • 1970’s Mental Retardation significant focus of attention with PARC decision
    • 1980’s Shift to Learning disabilities
      • Diagnosis & placement issues
      • LD subtype research
      • Reading disabilities: The Reading War
  • 11. Awakening Stage of NLD Research
    • 1980’s Frontal lobe dysfunction: ADHD classification systems
    • 1980’s Major inroads in Reading Research
    • 1980’s Increased research attention to disorders of written expression
    • Late 1980’s Return to the Right Hemisphere with work of Byron Rourke
  • 12. Byron Rourke
    • 1985 Neuropsychology of Learning Disabilities . Adaptive behavior of children who exhibit specific arithmetic disabilities and associated neuropsychological abilities. NY: Guilford Press.
    • 1989 Nonverbal Learning Disabilities . NY: Guilford Press
  • 13. Byron Rourke
    • 1995 Syndrome of Nonverbal Learning Disabilities: Neurodevelopmental manifestations . NY: Guilford Press.
    • 3 areas of deficit:
      • Neuropsychological deficits
      • Academic deficits
      • Social-emotional/adaptation deficits
  • 14. Neuropsychological deficits
    • Tactile & visual perception
    • Psychomotor coordination
    • Visual attention
    • Nonverbal memory
    • Reasoning
    • Executive function
    • Pragmatic aspects of language
  • 15. Academic deficits
    • Math calculation
    • Math reasoning
    • Reading comprehension
    • Written language
    • Handwriting
  • 16. Social-emotional/adaptation deficits
    • Social perception
    • Perception of nonverbal social cues
    • Social interaction
    • Anxiety
    • Depression
  • 17. Overlapping Conditions
    • NLD is a discrete & separate diagnostic entity
    • Some symptoms of NLD, however, are similar to those described in other disorders of the right hemisphere.
    • NLD overlaps with Aspergers syndrome and some central processing disorders
  • 18. Distinction Matter of Degree
    • Not seen in typical NLD presentation
      • Severe speech prosody deficits
      • Pronounced deficits with planning & organization
      • Severe tactile-spatial deficits
  • 19. Overlapping Conditions
    • Low functioning children diagnosed with Asperger’s syndrome may be more properly diagnosed as Autistic
    • Higher functioning children diagnosed with Asperger’s, may be more properly diagnosed with NLD
  • 20. Classification Concerns
    • There is no formal provision under federal special education law recognizing the existence of nonverbal learning disability as a handicapping condition.
  • 21. Common Characteristics of NLD
    • Precocious speech & language development
    • Verbosity at a young age
    • Remarkable rote verbal memory
    • Hyperlexia (word calling)
    • Strong spelling from dictation
    Strengths
  • 22. Common Weaknesses of NLD
    • Verbal IQ > Performance IQ (12+ points)
    • Poor writing & writing organization
    • Math disability
    • Poor coordination & balance
    • Poor fine-motor skill
    • Poor visual-spatial and part-to-whole perception
  • 23. Common Weaknesses of NLD
    • Difficulty comprehending novel material
    • Poor pragmatic language skills
    • Poor social interaction
    • Withdrawal tendencies
    • Hyper- to hypo-activity
    • More interest in verbally naming objects than exploring them
  • 24. Brain Basis of NLD
    • Disruption to the right-hemisphere white matter connections
    • Forms basis for intermodal integration
    • Synthesizer part of the brain
      • Visual spatial analysis
      • Non-verbal social cues
      • Complex comprehension
      • Attention to verbal & non-verbal input
    • May be genetic or acquired
  • 25. Risk Factors for NLD
    • 50% NLD children have evidence of an antecedent prenatal or perinatal encephalopathic event
    • 50% genetic predisposition
    • 40% history of prematurity
    • Radiation to the head predisposes
    • Agenesis of the corpus callosum
    • Hydrocephalus
  • 26. Evaluation Clues on Cognitive Measures
    • Good Information & Vocabulary subtest scores
    • Good rote, verbal memory for math facts
    • Elevated Digits forward (rote verbal memory)
    • Depressed scores on Comprehension & Picture Arrangement (Social cognition)
    • Depressed scores on Object Assembly (part-to-whole visual-spatial organization)
  • 27. Evaluation Clues on Achievement Test Measures: Reading
    • Strength in phonetic decoding of nonsense words (oral reading is strong)
    • Weakness in reading comprehension requiring:
      • Prediction of cause & effect
      • Ability to separate relevant from irrelevant detail
      • Inferential thinking
    • No trouble recalling what is read
    • Good memory for read material
  • 28. Evaluation Clues on Achievement Test Measures: Writing
    • Good spelling from dictation
    • Poor spelling in expository writing
    • Poor writing mechanics & organization
    • Will sit & stare at the page; unable to organize and communicate thoughts through writing
    • Poor penmanship
    • Failure to answer the question: Essay exams
  • 29. Evaluation Clues on Achievement Test Measures: Math
    • Often exhibits strength in rote math facts recall
    • Trouble with math word problems; can’t separate relevant from irrelevant
    • Trouble with higher-level math concepts
    • Particular difficulty with geometry
  • 30. Evaluation Clues on Achievement Test Measures: Knowledge
    • Often advanced knowledge of facts in Science
    • Typically poor performances on tests measuring knowledge of content in Social studies
    • Excels in geography bees but does poorly in Social Studies classes
  • 31. Evaluation Clues on Language Tests
    • Strong verbal elaboration and word finding
    • Weak listening comprehension
    • Poor pragmatic language skills
      • Social language
      • Getting the punch line in a joke
      • Literal translations of language
      • See things as “black & white”
  • 32. Evaluation Clues on Visual Perceptual Tests
    • Poor scores on reversal tests (e.g. Jordan Left-Right Reversal Test )
    • Poor scores on Category Test (Reitan)
    • Poor performances on Bender and Developmental Test of Visual-Motor Integration
    • Low scores Trails A & B (Reitan)
  • 33. Sample WISC-3 for NLD Student
    • Information = 17
    • Similarities = 10
    • Arithmetic = 8
    • Vocabulary = 16
    • Comprehension = 5
    • (Digit Span) = ( 9)
    • Verbal IQ = 107
    • VCI = 111 FDI = 93
    • Full Scale IQ = 83
    • Picture Completion = 7
    • Coding = 5
    • Picture Arrangement = 4
    • Block Design = 8
    • Object Assembly = 3
    • (Symbol Search) = (6)
    • Performance IQ = 72
    • POI = 75 PSI = 77
    • Verbal > Performance by 35 points
  • 34. Sample WIAT for NLD Student
    • Basic Reading 125
    • Reading Comprehension 80
    • Math Reasoning 75
    • Numerical Operations 65
    • Spelling 122
    • Written Expression 75
    • Listening Comprehension 85
    • Oral Expression 135
  • 35. Process Assessment: Qualitative
    • Wechsler IQ
      • Watch for V>P split
      • Look at subtest patterns
    • Halstead-Reitan
      • Watch for depressed scores on Category, TPT and Trails tests
    • Bender & VMI
    • Pragmatic language scales
    • Childhood Autism Rating Scales (CARS)
    • WIAT: Deficits
      • Reading comprehension
      • Listening comprehension
    • Woodcock-Johnson
      • Elevations on Word Attack
      • Poor scores on Math & Written expression
    • Social skills
      • Piers-Harris
      • CPQ or MAPI
      • Child Behavior Checklists
  • 36. Educational Course
    • Elementary: May appear gifted due to strengths in rote memory, oral reading, and fact recall; often poor social skills & attention problems; may be hyperactive
    • Middle School: Deficits in complex comprehension, inferential thinking, writing and math become more debilitating; social withdrawal; hypoactivity & low arousal; depression
  • 37. Instructional Methods
    • Reading : SDI’s for early literacy instruction
      • May have initial difficulty learning to read due to misperception of symbol directionality
      • Work on directionality perception
      • Use synthetic, phonetic instruction
  • 38. Instructional Methods
    • Reading : SDI’s for comprehension
      • SQ3R
      • Project READ Reading Comprehension Strand
      • Highlighting techniques
      • Consumable text books
      • Extra time to compensate for difficulties in complex comprehension
      • Accept literal translations of language
      • Teach to look for main idea; key concepts; notes
  • 39. Instructional Methods
    • Math : SDI’s for complex reasoning & calculation
      • Saxon math series
      • Teach using step-wise procedures
      • Rote verbal memory for steps
      • Extend time
      • Shorten assignments
      • Spot tutoring
      • Calculator
  • 40. Instructional Methods
    • Writing : SDI’s for written expression
      • Teach touch typing at an early age
      • Teach rules: capitalization, punctuation, spelling, grammar (step-wise procedures)
      • Teach key word note taking methods
      • Teach step-wise procedures for expository writing
      • Teach word processing after keyboard is mastered
      • Extend time/shorten written assignments
      • Oral tests instead of essay tests
  • 41. Instructional Methods
    • Social Skills Training : Direct & Explicit Teaching
      • Skillstreaming curriculum (Arnold Goldstein & Ellen McGinnis)
      • Role playing
      • Videotaping
      • Counteract withdrawal
      • Involvement in physical activity
  • 42. Instructional Methods
    • Executive functions & higher level reasoning
      • Cannot shift gears; needs help with transitions
      • Perseverative behavior
      • Require direct eye contact
      • Preferential seating away from distractions
      • Avoid visually stimulating environments
      • Keep all possessions in one central place
      • Assist with organization
  • 43. Observed problems: Language
    • No problem learning vocabulary word meanings
    • Problem with pragmatics
      • Cannot understand or express emotional intonation
      • Hyperverbal in social context; drone on relentlessly over boring topics
      • Content of speech is simple & repetitive
      • Restricted range of interests (TV & computers)
  • 44. Instructional Methods
    • Language Therapy
      • Pragmatics
      • Non-verbal language: Gestures, body language
      • Tone of voice
      • Jokes
      • Idioms, slang, play on words
      • Social language: Requires direct & explicit instruction
  • 45. Instructional Methods
    • General Teaching Considerations:
      • Part-to-whole, stepwise approach
      • Redundant, sequential teaching
      • Encourage participation in physical exercise
      • Explain everything verbally: This type of student cannot read “body language”
      • Give practice for repetitive, motor skills
      • Tell student what to listen for when giving directions
      • Counter passivity & withdrawal (blends into woodwork)
  • 46. Recommended Reading: Neurology
    • Rourke, B.P. (ED) (1995). Syndrome of Non-Verbal Learning Disabilities: Neurodevelopmental Manifestations . Guilford Press.
    • Roman, M.A. (1998). The Syndrome of Nonverbal Learning Disabilities: Clinical Description & Applied Aspects. Current Issues in Education , 1 (1).
    • Semrud-Clikeman, M., & Hynd, G.W. (1990). Right hemispheric dysfunction in nonverbal learning disabilities: Social, academic and adaptive functioning in adults & children. Psychological Bulletin , 107, 196-209.
  • 47. Recommended Reading: Teachers
    • Thompson, S. (1997). The Source for Non-Verbal Learning Disorders . LinguiSystems.
    • Foss, J.M. (1991). Nonverbal learning disabilities and remedial interventions. Annals of Dyslexia, 41, 128-140.
  • 48. Recommended Reading: Counselors & Therapists
    • McGinnis, E. & Goldstein, A.P. (1997). Skillstreaming the Elementary School Child: New Strategies & Perspectives for Teaching Prosocial Skills . Research Press.
    • McGinnis, E. & Goldstein, A.P. (1997). Skillstreaming the Adolescent: New Strategies & Perspectives for Teaching Prosocial Skills . Research Press.
  • 49. On-line Resources
    • NLD Line http://www.nldline.com/
    • OASIS http://www.udel.edu/bkirby/asperger/
    • NLD on the Web http://www.nldontheweb.org/
    • Social learning disabilities project at Yale University http://info.med.yale.edu/chldstdy/research.htm
    • ASPEN of America http://www.asperger.org/
    • ASPEN http://www.aspennj.org/

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