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NLDA Presentation November 9 2001
 

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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    NLDA Presentation November 9 2001 NLDA Presentation November 9 2001 Presentation Transcript

    • Diagnosis & Educational Intervention for Nonverbal Learning Disorders (NLD) Nonverbal Learning Disorders Association (NLDA) November 9, 2001 9 AM to 3 PM
    • 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
    • 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
    • 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
    • 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”
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • Neuropsychological deficits
      • Tactile & visual perception
      • Psychomotor coordination
      • Visual attention
      • Nonverbal memory
      • Reasoning
      • Executive function
      • Pragmatic aspects of language
    • Academic deficits
      • Math calculation
      • Math reasoning
      • Reading comprehension
      • Written language
      • Handwriting
    • Social-emotional/adaptation deficits
      • Social perception
      • Perception of nonverbal social cues
      • Social interaction
      • Anxiety
      • Depression
    • 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
    • Distinction Matter of Degree
      • Not seen in typical NLD presentation
        • Severe speech prosody deficits
        • Pronounced deficits with planning & organization
        • Severe tactile-spatial deficits
    • 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
    • Classification Concerns
      • There is no formal provision under federal special education law recognizing the existence of nonverbal learning disability as a handicapping condition.
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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)
    • 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
    • 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
    • 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
    • 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
    • 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”
    • 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)
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • Instructional Methods
      • Social Skills Training : Direct & Explicit Teaching
        • Skillstreaming curriculum (Arnold Goldstein & Ellen McGinnis)
        • Role playing
        • Videotaping
        • Counteract withdrawal
        • Involvement in physical activity
    • 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
    • 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)
    • 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
    • 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)
    • 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.
    • 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.
    • 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.
    • 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/