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The
Syndrome of Nonverbal Learning Disabilities
learning disability subtypes
Rourke (1995a) has grouped these into
three major areas:
1-
neuropsychological deficits:
include difficulties with tactile and visual perception, psychomotor
coordination, tactile and visual attention, nonverbal memory, reasoning,
executive functions, and specific aspects of speech and language
These
primary neuropsychological deficits include tactile perception, visual
perception, and motor coordination. In turn, these secondary deficits lead to
tertiary deficits, particularly in nonverbal memory, abstract reasoning,
executive functions, and specific aspects of speech and language.
2-
academic deficits:
Deficits
in math calculations, mathematical reasoning, reading comprehension, specific
aspects of written language, and handwriting
3-
social-emotional/adaptational
deficits :Social deficits include problems with social perception and social
interaction. Children with this disorder are also seen as having substantially
increased risk for internalized forms of psychopathology, primarily anxiety and
depression. There has also been evidence to suggest a greater risk for suicide
Cognitive and Neuropsychological
Performance Issues
Children with NVLD present with a wide
range of visual-spatial, visual motor, sensory, and motor deficits. At the more
basic levels, these deficits involve problems with visual and tactile perception
and discrimination
Such children are often described as
better "auditory learners" than "visual learners
they are likely to have extreme
difficulty with tasks requiring them to find embedded figures (e.g., visual
figure-ground on the TVPS-R) or determine the spatial orientation of lines
These abilities typically measure
within the average to above average range relative to normal peers. These
strengths include simple motor skills, auditory perception, simple auditory
attention, and rote memory for simple verbal material. Language strengths
include adequate receptive language, adequate simple verbal expression, and good
phonetic analysis
Intellectual
functioning
One of the most readily obvious
identifying features of NVLD is a significantly higher verbal IQ score than
Performance IQ score on formal measures of intelligence
Executive functions include such higher
level abilities as abstract reasoning, logical analysis, hypothesis testing, and
cognitive flexibility, or the ability to "shift gears" mentally. The
ability to focus, shift, and distribute attention, organize information into
memory to aid learning and remembering, and otherwise regulate thought processes
are also examples of executive functions.
poor performance on measures of
executive functioning are not always found in children with NVLD.
Significant discrepancies between
verbal and nonverbal memory are also frequently observed
Deficits in executive functions,
including working memory, are hypothesized to be responsible for these
difficulties on more complex verbal memory measures
A good core memory battery for
assessing the presence of nonverbal learning disabilities might include the
Verbal Selective Reminding Test or the California Verbal Learning Test and
selected subtests of the Wide Range Assessment of Memory and Learning,
particularly the Story Memory, Picture Memory, and Design Memory subtests
Children with NVLD usually perform well
on measures of receptive vocabulary and expressive vocabulary
weakness in particular aspects of
speech and language. As with right hemisphere damage individuals (Ryalls,
Joanette, & Feldman, 1987), difficulties with speech prosody and problems
understanding and/or expressing emotional intonation are frequently observed in
the more severe cases of NVLD. Difficulties with prosody often involve monotone
speech with little inflection. Because these children are often hyperverbal in
social contexts, their peers frequently see them as droning on relentlessly over
boring topics. The deficits these children demonstrate in nonverbal aspects of
interaction directly lead to an overreliance on verbalization as a primary means
of social interaction.
As already noted, difficulties with
visual perception, visual processing, and visual-spatial cognitive abilities are
the most prominent features in NVLD
more impairment on tasks demanding a
greater degree of visual processing or involving visual-spatial demands.
Measures such as the Judgment of Line Orientation Test are typically very
difficult for these children
Difficulties with copying block designs
are also typical.
Problems with drawing or copying are
frequently observed. In addition, handwriting may often be poor, at least
initially
Difficulties with tactile
discrimination, haptic discrimination, and fine motor coordination are typical
difficulty with such tasks as finger
localization, fingertip number writing, tactile form recognition, and fine motor
speed and dexterity on measures such as the Grooved Pegboard Test
They are frequently less coordinated
with regard to gross motor activity, particularly when the development of
specific skills is required
Educational and
Academic Performance Issues
perform better on measures of word
recognition and spelling than math. The primary reason for this is that math is
more dependent on spatial and nonverbal concepts than is the case for either
reading or spelling. For example, one cannot understand the concept of fractions
without some mental representation of an object divided into pieces
Social Performance
Issues
Because much of social communication is
nonverbal, involving "body language," facial expressions, and tone of
voice, individuals with NVLD are at a significant disadvantage due to their
impairments in visual processing and visual-spatial perception.
They tend to miss important cues in
social interaction and almost always fail to appreciate nuances in behavior and
the subtle cues they may convey.
These weaknesses lead to significant
deficits in social perception.
Social judgment and social problem
solving are also typically impaired. Some of these impairments are a direct
result of problems with perception
Interpersonal intimacy is frequently
impaired, although problems forming close personal attachments may not be
noticed until late childhood or early adolescence when dating begins
Difficulty maintaining meaningful
friendships may also occur
lack of adaptability, respond poorly to
novel circumstances. The ability to deal with changing circumstances is a
fundamental aspect of social competency.
Emotional Issues
increased risk of emotional disorders
right hemisphere dysfunction (Weintraub
& Mesulam, 1983), appear to be at risk for virtually all types of emotional
disorders ranging from adjustment problems to active psychotic disorders
Difficulties with socialization,
problems maintaining close interpersonal relationships, and the decreased
likelihood of developing intimate relationships significantly contribute to
feelings of low self worth
increased risk for both depression and
suicide attempts relative to the normal population
Developmental Course
Acquisition of simple self-help skills
is often delayed
the poor motor coordination resulting
from their tactile and visual-spatial deficits increases the likelihood they
will be identified as disruptive or destructive
Difficulties with daily living skills
related to eating, dressing, and simple grooming may be noted
motor abilities necessary for dressing
- such as fastening fasteners and learning to tie shoes - are frequently
impaired. The acquisition of early preacademic skills related to coloring,
cutting, and pasting is also typically delayed
demonstrate initial difficulties
acquiring early academic skills. Problems with letter and number recognition,
difficulty with one-to-one correspondence in counting, and problems with copying
letters and numbers are common. Printing and drawing also are frequently poor
With repeated practice, most NVLD
children develop normal proficiency with these types of tasks. Rourke (1995a)
suggested that these children eventually acquire normal or nearly normal
proficiency on these types of tasks regardless of whether or not they receive
early physical intervention such as occupational therapy
difficulty getting math, reading, and
writing "off the ground." It is common for them to have difficulty
acquiring recognition of letters and numbers because of the inherent
visual-spatial aspects involved in early acquisition. With frequent practice,
they become more successful at these tasks and eventually profit from the
development of the necessary symbol systems required for the early development
of reading and math concepts
Difficulties with executive
functioning, problem solving, and memory for more complex and meaningful verbal
and nonverbal material make it difficult for them to maintain their prior levels
of performance
a number of practical deficits emerge,
particularly with regard to mathbased survival skills related to time, money,
and measurement
These children often have difficulty
with the concept of time. This often applies to the calendar as well as the
clock
Learning to tell time is almost always
difficult, particularly on an analog clock.
These children may have difficulties
naming the days of the week or months of the year in order, but typically
succeed after much practice.
Problems with time management and
scheduling may persist into adulthood
Their ability to recognize and
discriminate coins is often slow to develop.
More fundamentally, they have
difficulty acquiring money concepts. These difficulties frequently persist into
adulthood and are manifest as difficulties with budgeting, balancing a
checkbook, making change, and doing comparison shopping.
Difficulties
with measurement concepts are most obvious on tasks requiring estimation
their difficulties with social skills
and higher level cognitive abilities frequently lead to frustration on the job
or difficulty finding employment.
Problems
with planning and organizational skills can further impair their ability to
function well at home and on the job.
