Deficits of Nonverbal Communication in Children With Language
Transcript of Deficits of Nonverbal Communication in Children With Language
DEFICITS OF NONVERBAL
COMMUNICATION Diana Ignatova
Sofia University “St. Climent Ohridski”
DefinitionA Nonverbal Learning Disability (NVLD) is a developmental brain based disorder that impairs a child’s capacity to perceive, express, and understand nonverbal (nonlinguistic) signs.
The disorder is generally expressed as a pattern of impaired functioning in the nonverbal domains, with higher functioning in the
verbal domain.
Definition- The neuropsychological deficits associated with this disorder constrain children’s capacity to function in the academic, social, emotional, or vocational domain and lead to a heterogeneous set of neurobehavioural symptoms.
- The brain dysfunctions affect children’s behaviors their social interactions, their feelings about themselves and others, and their emerging personality patterns – all of which may manifest as symptomatic behaviours.
Discovery Johnson & Myklebust (1967) coined the term
nonverbal learning disability. The term referred to a residual group of children
who did not have verbal language problems but did have a range of symptoms that interfered with their school functioning.
Initially used the term “disorders of social imperception”, referring to: “a child’s lack of ability to understand his social environment, especially in terms of his own behaviour.”
Concluded that these children have a hard time understanding the meanings of other people’s social cues.
Gender Ratio
Reports have changed over time:- 1960’s – 5:1 (Rourke , 1989)- 1970’s – 2,8 :1 (Rourke & Strang, 1978)- 1989 – 1:1 (Rourke , 1989)
Changes thought to be due
to different evaluation criteria
Behavioural Perspective
Primary Assets
Simple Motor Skills – Simple repetitive motor skills are generally intact, especially at older age levels (middle childhood and beyond).
Auditory Perception – After a very early developmental period when such skills appear to be lagging, auditory – perceptual capacities become very well developed.
Rote Material – Repetition of auditory stimulus, is well appreciated.
Simple motor acts, including some aspects of speech and well practiced skills such as handwriting, eventually develop to average or above – average levels.
Secondary Assets
Attentional skills – deployment of selective and sustained attention for simple, repetitive verbal material (especially that delivered trough the auditory modality) becomes very well developed.
(Rourke, 2008)
Tertiary Assets Memory – Rote verbal memory and memory for material
that is easily coded becomes extremely well developed. Verbal Assets: Speech and Language
- Following an early developmental period when linguistic skills appear to be lagging, a number of such skills emerge and develop in a rapid fashion. These include good phonemic hearing, segmentation, blending, and repetition.
- Very well-developed receptive language skills and rote verbal capacities are evident, as are a large store of rote verbal material and verbal associations, and a very high volume of speech output. All of these characteristics tend to become more prominent with advancing years.
Academic Assets
Following initial problems with the visual-motor aspects of writing and much practice with a writing instrument, grapho-motor skills (for words) may reach good to excellent levels.
Following initial problems with the development of the visual-spatial feature analysis skills necessary for reading, good to excellent single-word reading skills also develop to above – average levels.
Misspellings are not specific. They are similar to the type seen most often in normal spellers.
Verbatim memory for oral and written verbal material can be outstanding in the middle to late elementary school years and thereafter.
Primary deficits Tactile Perception – Bilateral tactile-perceptual deficits are
evident, often more marked on the left side of the body. Deficits in simple tactile perception and suppression may become less prominent with advancing years, but problems in dealing with complex tactile input tend to persist.
Visual perception – There is impaired discrimination and recognition of visual detail and visual relationships, and there are outstanding deficiencies in visual-spatial-organization skills. Simple visual discrimination, /especially for material that is verbalisable/ usually reach normal levels with advancing years. Complex visual-spatial-organizational skills, especially when required within a novel framework, tend to worsen relative to age-based norms. (Rourke, 2008)
Primary deficits Complex psychomotor skills – Bilateral psychomotor
coordination deficiencies are prominent; these are often more marked on the left side of the body. These deficits, except for well-practiced skills such as handwriting, tend to increase in severity with age, especially when they are required within a novel framework.
Novel material – As long as stimulus configurations remain novel, they are dealt very poorly and inappropriately. Difficulties in age-appropriate accommodation to, and a marked tendency toward over-assimilation of novel events increase with the advancing years. There is an over-reliance on prosaic, rote ( inappropriate) behaviour in novel situations. The capacity to deal with novel experiences often remains poor and may even worsen with age. (Rourke, 2008)
Secondary deficits
Attention – Attention to tactile and visual input is poor. Relative deficiencies in visual attention tend to increase over the course of development, except for material that is programmatic and over-learned (e.g., printed text). Deployment of selective and sustained attention is much better for simple, repetitive verbal material (especially that delivered though the auditory modality) than for complex, novel nonverbal modality (especially that delivered through the visual or tactile modalities).
The disparity between attentional deployment capacities for these two sets of materials (simple, repetitive verbal material and novel nonverbal modality) tends to increase with age.
(Rourke, 2008)
Secondary deficits
Exploratory behaviour
During early phases of development, there is little physical exploration of any kind. This is the case even for objects that are immediately within reach and could be explored through visual or tactile means. A tendency toward sedentary and physically limited modes of functioning tends to increase with age.
(Rourke, 2008)
Tertiary Deficits Memory – Memory for tactile and visual stimuli is poor.
Relative deficiencies in these areas tend to increase over the course of development, except for material that is programmatic and over-learned (e.g., spoken natural language). Memory for non-verbal material, whether presented through the auditory, visual, or tactile modalities, is poor if such material is not easily coded in a verbal fashion.
Relatively poor memory differences between good to excellent memory for rote material and impaired memory for complex material and/or that which is not easily coded in a verbal fashion tend to increase with age.
(Rourke, 2008)
Tertiary Deficits
Deficits in concept-formation, problem-solving, strategy-generation, and hypothesis-testing/appreciation of informational feedback. Marked deficits in all of these areas are apparent, especially when the concept to be formed, the problem to be solved, and/or the problem –solving milieu is novel or complex. Also evident are significant difficulties in dealing with cause-and-effect relationships and marked deficiencies in appreciation of contrasts (e. g., age-appropriate sensitivity to humor).
Most noticeable when formal operational thought becomes a developmental demand (i.e., in late childhood and early adolescence), relative deficits in these areas tend to increase markedly with advancing years, as is evident in the often widening gap between performance on rote (over-learned) and novel tasks.
Linguistic Deficits
Speech and Language – Mildly deficient oral-motor praxis i.e. purposeful oral-motor movements), little or no speech prosody, and much verbosity of a repetitive, simple, rote nature are characteristic.
Content disorders of language , characterized by very poor psycholinguistic content and pragmatics (e.g., “cocktail party speech”) and reliance upon language as a principal means for social relating, information gathering, and relief from anxiety.
“Memory” for complex verbal material is usually very poor , probably as a result of poor initial comprehension of such material.
All of these characteristics, except oral-motor praxis, tend to become more prominent with advancing the years.
Academic Deficits
Grapho-motor – In the early school years, there is much difficulty with printing and cursive script; with considerable practice, handwriting often becomes quite good. However, some avoid practice and remain deficient in such skills.
Reading Comprehension
Reading Comprehension is much poorer than single-word reading (i.e., decoding). Relative deficits in reading comprehension, especially for novel material, tend to increase with advancing years.
(Rourke, 2008)
Academic Deficits
Mechanical Arithmetic and Mathematics
There are outstanding relative deficiencies in mechanical
arithmetic as compared to proficiencies in reading (word-recognition ) and spelling.
With advancing years, the gap between good to excellent
single-word reading and spelling and deficient mechanical
arithmetic performance widens.
Mathematical reasoning, as opposed to programmatic arithmetic calculation, remains poorly developed.
(Rourke, 2008)
Academic Deficits
Science Persistent difficulties in academic subjects involving
problem-solving and complex concept-formation (e.g.,
physics) are prominent.
Problems in dealing with scientific concepts and theories
become apparent by early adolescence.
The gap between deficiencies in this type of complex
academic endeavor and other, more rote, programmatic
academic pursuits widens with age.
(Rourke, 2008)
Psychosocial /Adaptational Deficits Adaptation in novel situation - There is extreme
difficulty in adapting to (i.e., countenancing, organizing, analyzing, and synthesizing) novel and otherwise complex situations.
An over-reliance on prosaic, rote (or inappropriate) behaviors in such situations is common. These characteristics tend to become more prominent and problematic with advancing years.
Social Competence – Significant deficits are apparent in social perception, and social interaction skills; these deficits become more prominent and problematic as age increases. There is a marked tendency toward social withdrawal and even social isolation with advancing years.
Psychosocial /Adaptational Deficits
Psychosocial Disturbance – Often characterized during early childhood. Such children are very much at risk for the development of internalized forms of psychopathology. Indications of excessive anxiety, depression, and associated internalized forms of psychosocial disturbance tend to increase with advancing years.
Activity Level – Children who exhibit the syndrome are frequently perceived as hyperactive during early childhood. With advancing years, they tend to characterized as normo-active and eventually hypoactive.
The Neuropsychological Perspective
History and Models
Early Studies Generaly pursued a hypothesis of right hemisphere
dysfunction. Focused on brain – damaged individuals who
displayed symptoms similar to NLD. Major validity questions:
- No uniformity among samples- No precise way to indentify type or location of brain
lesion
(Palombo, 2006)
Early Studies
Applied various labels :- Disorders of social perception (Johnson & Mykelbust,
1967)- Non-verbal Learning disability (Rourke, 1989; Johnson,
1987)- Social–Emotional learning disability (Denckla, 1983;
Voeller, 1986)- Right parietal lobe syndrome/developmental learning
disability of the right hemisphere (Weintraub & Mesulam, 1982)
- Right hemisphere deficit syndrome (Semrud – Clikeman & Hynd, 1990)
Rourke and Finlayson (1978)
GROUP 1 (RELATIVE ARITHMETIC WEAKNESS)
NVLD
GROUP 2
Performed worse on visuo-spatial skills measures.
Performed better on rote verbal and auditory processing measures.
Performed worse on rote verbal and auditory processing measures
Performed better on visuo – spatial skills measures.
Rourke & Finalson (1978)
Concluded that the arithmetic deficit group
(Group 1) represented a distinct population with a unique profile of neurological assets and deficits.
Suggested that the difference between Group 1 and Group 2 had to do with brain hemispheres
These Group 1 difficulties were due to dysfunction in the right cerebral hemisphere
The other group’s difficulties were related to left hemisphere skills.
Rourke (1987)
Found the NLD neuropsychological profile in children with other neurological conditions such as hydrocephalus, moderate to severe head injury, congenital absence of the corpus callosum, and post-radiation survival of childhood cancer.
The common feature of this group is not right hemisphere dysfunction, but white matter damage or dyfunction.
Rourke’s White Matter Model
NLD occurs when there is a problem with:
- The white matter in the brain- In the right brain hemisphere
Adverse conditions in early childhood are more likely to affect right hemisphere processing abilities because:
- The right hemisphere contains a greater proportion of white matter to grey matter then does the left hemisphere
- The right hemisphere is dominant in infancy
(Rourke, 1987; Rourke et al., 2002)
Hemispheric Specialization/Hemispheric Lateralization
Because many NLD symptoms appear to be the products of right hemisphere dysfunctions, that doesn’t necessarily mean that the left hemisphere and sub-cortical regions do not also contribute to those problems.
(Palombo, 2006)
Specializations of the Right Brain
Complex and Nonlinguistic Perceptual Tasks - Auditory abilities to recognize pitch and melody.
- Visual Discrimination such as the ability to recognize
faces, identify complex geometric shapes
- Visual-Spatial abilities necessary for depth perception,
spatial location, mental rotation, visual perspective
taking
-Visual-Motor abilities such as tracing mazes and block
design
-Spatial memory to recall complex spatial relationships
- Time perception
Many of these abilities are essential to successful social
communication
Specialization of the Right Brain
Paralinguistic Aspects of Communication
Decoding: the ability to read social signs such as
facial expressions and vocal intonation
Encoding: the ability to form mental representations
of social signs and store them in memory
Processing: understanding what the signs
communicate within the context in which they occur
Expression: retrieving the sign from memory
and producing it through some motor output
Specialization of the Right Brain
Emotional Perception
- Processing the perception of affect states
- Coordinating the expression of emotional tone
through paralinguistic communication
- Identifying the emotion behind other’s prosody and facial expressions
- Modulating affects involved in the development of social skills
Developmental Profile
NLD Through the Lifespan
(from Thomson, 1997)
Infant and Toddler Years
- Doesn’t explore the world motorically- Speech and Language develop early- Wants a verbal label for everything- No strong evidence of non-motor
developmental delay- Difficulties in early attempts to walk- Does not automatically assume a position
of balance when set down after being held- Clings to objects and people for balance- Constantly bumps into things
Preschool Years
- Exceptional rote verbatim memory skills
- Extremely verbose, talking “like an adult”
- Early reading skills, strong letter and
number recognition and spelling skills
- Understands statements and reading
very literally, views things as black and white
-Poor gross motor development and
motor planning skills
Middle School Years (11-14)
- Often excluded, teased, and persecuted at school
- Often are misunderstood by both teachers and peers
- Have difficulty meeting age-appropriate behaviour; /these difficulties may be attributed to
“emotional” issues/
- Have problems with work and study habits;
/these problems may be attributed to
“motivational” issues/
- Have visual-spatial-organizational difficulties,
difficulty using a locker,
finding the way around school or home is often lost or too tardy
High School Years (15-18)
- Peer Tolerance usually increases;
- One or two close friendships may develop or continue
- If an Individual Educational Program has been put
into place to accommodate the student, academic
achievement, which typically drops in middle school,
makes an encouraging comeback; if no IEP, this student
is at risk for dropping out of school
- Children still think in concrete and literal terms
- Slow to interact with the opposite sex
High School Years
- Early job experience and performance problems
are common
- Difficulty learning to drive
- Socially immature; may be seen as “weird”
by classmates
- Have low self-esteem; are prone to
depression, withdrawal, anxiety, and suicide
Child filters context through his/her unique neuropsychological
profile
Children with NLD :-Have difficulty with reciprocal exchanges
-Are socially immature
-Are argumentative and socially disruptive
-Have difficulty maintaining friendships
-Are often rejected by their peers
Clinical Data suggests that:
These children typically desire friends and relationships
with others. They are not capable of
deception and imaginary play.
A case study Alex, age 11, complained bitterly to his therapist that
kids continually teased him. When asked what they
said, he reported that they accused him of being cruel
and sadistic to his beloved cat. They said that
he enjoyed hurting the pet or that he had set fire to
his cat’s tail, none of which was true. His response
was to protest loudly that he was not that kind of
person and would never do such things to his pet.
However, his reaction only inflamed the other kids,
inciting them to escalate their teasing.
Why are these children so
often helpless to defend
themselves against taunting?
Where is the deficit?
Alex couldn’t get beyond the literal meaning of what his peers said; he
couldn’t see through their remarks to discern their motives Once these
motives were pointed out to him, he was able to take what the other kids said as
a “joke” and respond with his own brand of humor.
Differential Diagnosis
Is NLD really different from Aspergers?
NLD/Asperger Syndrome (AS)
NLD and AS are very similar in behaviors,
Neuropsychological profiles, and commorbid conditions.
“The process of differentiating the characteristics of
AS, and NLD, and a pragmatic language disorder, is arguable and may be the most challenging diagnostic task in developmental-behavioral pediatrics.
There is a lack of agreement of core definitions of
both disorders.
I. The following chart helps differentiate NLD children from children with AS or Pervasive
Developmental Disorder
Nonverbal Learning Disability
Asperger’s Syndrome
Pervasive Developmental
Disorder
Early Speech and Vocabulary
No Language Delay Speech develops, then forms plateau
Poor pragmatics and prosody
Poor pragmatics and prosody
Absence of pragmatic and prosody skills
Normal to superior I.Q.VI.Q.>NVI.Q.; verbal can be notably developed
Normal to superior I.Q. VIQ>NVIQ
Normal I.Q., then fails to maintain commensurate with peers
The following chart helps differentiate NLD children from children with AS or Pervasive
Developmental Disorder
Nonverbal Learning Disability
Asperger’s Syndrome
Pervasive Developmental
Disorder
Significant gross, fine and visual-motor problems; dysphagia
Clumsiness; gross motor is generally with normal line; fine motor is poor;
Coordination develops normally and generally remains with normal line;
Lacking Verbal Communication skills (receptive and expressive); poor social skills
Perserverating behaviors; restrictive areas of interest; hyper-focus on details
Restrictive; repetitive; stereotypical patterns of behavior
The following chart helps differentiate NLD children from children with Attention-
Deficit/Hyperactivity DisorderNonverbal Learning Disability Attention-Deficit/Hyperactivity
Disorder
Difficulty with spatial relationships and perceptions; frequently bumps into objects; may have difficulty with maintaining balance in seat.
Often fidgets or squirms; difficulty remaining still or seated when sustained visual attention is required.
Slow motor performance on non-verbal tasks with hyper-vigilance to details
Easily distracted and impulsive; poor planning and follow-through with details.
Talkative; reliant on verbal mediation; may not be aware of manipulation or deception.
Talks excessively; impatient and often loses things; may be manipulative and deceptive.
Poor social skills; frequent avoidance of novel situations.
Seeks out novelty with enthusiasm; risk-taking behaviors.
Comorbidity with depressive or anxious symptoms.
Comorbidity with oppositional and deviant behaviors.
Interventions
Psychomotor and Perceptual Motor Deficits
Remedial Interventions
Specific Training/practice in handwriting
accuracy and speed
Direct instruction in functional perceptual skills
such as:
- Reading facial expressions
- Understanding gestures
- Reading maps and graphs
Psychomotor and Perceptual Motor Deficits
Compensatory Interventions- Extended time for completing written work;
Using of keyboards for written work,
- Providing multiple choice rather than essay questions
when testing content knowledge
- Organizing worksheets with a limited number of
well-spaced prompts
- Providing teacher-prepared lecture guides
to minimize need for note-taking
- Use of oral or written directions and explanations
instead of visual maps and schemes.
Psychomotor and Perceptual Motor Deficits
Instructional/Therapeutic Interventions
- Adapted physical education with emphasis
on developing functional recreational activities.
- Early and sustained training and practice in
keyboard skills.
- Occupational therapy to enhance perceptual
and psychomotor deficits.
Arithmetic Deficits
Remedial Interventions:
- Direct instruction in computation using
verbal mediation to rehearse sequential steps
- Color-coded arithmetic worksheets to cue
left- right directionality
- Direct instruction in organizational schemes
and checking strategies
- Pre-teaching/re-teaching to reinforce and
distinct relationships among concepts.
Arithmetic Deficits
Compensatory Interventions
- Graph paper to assist in column alignment when
completing arithmetic problems
- Use of a calculator or matrix of arithmetic facts
- Chapter summaries or study guides
- Rehearsal strategies that rely on verbal mnemonic
devices
Instructional/Therapeutic Interventions
- Strategy training in specific skill areas, such as written
expression
- Graphic organizers, especially with sequential/linear
components
Problem-Solving Skills
- Remedial Interventions
- Direct Instruction and rehearsal of appropriate
responses in various situations
-Compensatory Interventions
-Reference List of rote “rules” to direct behavior
- Instructional/Therapeutic Interventions
Interpersonal Skills
Remedial Interventions
- Direct instruction in social pragmatic skills, such as
making eye contact, greeting others, and requesting
assistance.
- Teaching strategies for making and keeping friends.
Compensatory Interventions
- Vocational guidance toward careers that minimize
interpersonal skill requirements.
- Choosing structured, adult-directed, individual or
single-peer social activities over unstructured or large
group events.
Social and Interpersonal Skills
- Instructional/Therapeutic Interventions
- Social Skills Training using published curricula
- For best results: target critical skills, match training to
individual behavioral deficits/excesses, train in
naturalistic settings and use practical oriented approach to
generalization.
- Teaching of interpersonal rules, training of social stories
- Pragmatic Language Therapy to address skills related to
topic maintenance, verbal self-monitoring, and appropriate
social communication.
Psychosocial Adjustment Problems
Remedial Interventions
- Self-monitoring to reduce symptoms of inattention and
impulsive behavior.
Compensatory Interventions
- Investigation of the features of NLD syndrome in
preschool/primary age children who display ADHD
- Relaxation skills to compensate for pervasive anxiety.
- Increasing access to pleasant events to address depressive
symptoms
Psychosocial Adjustment Problems
Instructional/Therapeutic Intervention
- Educator/parent awareness training concerning risk
for depression and suicide.
- Student/parent counseling about NLD features,
interventions, and prognosis.
Cognitive/behavioral interventions to enhance
positive self-schema and reduce
cognitive distortions.
A General List of Recommendations for Children
with NLD- Provide extra time for in-class tests and assignments
- Provide extra assistance with understanding material (break it down, assist with highlighting, note general area and page numbers to assist with referencing, alphabet grid on desk to use as a quick reference for writing).
- Provide enough time for the student to respond, in order to compensate for the slow processing speed, both verbally and in writing.
- It is not uncommon for children to want to say something socially, or raise their hands to give an answer, but forget what they were going to say once it’s their turn.
A General List of Recommendations for Children with NLD
- Provide help with note taking to compensate for thedecrease in mental processing speed and organizational skills.-Modifying of the homework- Keep requirements for written output to a minimum. - Try not to let motor deficits block learning and academic success.- Preview material and use supplemental aids, such asoutlines, study guides, and highlighting, to allow thechild to benefit from instruction.
A General List of Recommendations for Children with NLD
- Specifically teach study skill techniques.
- Use organizational techniques for keeping track of
material. A daily system of monitoring organization must be in place on a daily basis.
- Use verbal strengths to help with organization, problem-solving, and learning (such as self-talking).
- Encourage learning and using cognitive enhancement techniques.
- Provide a structured, predictable environment.
- Specifically discuss and prepare the child for transition and changes. It is often helpful to write out changes in the schedule so the child can refer to this when there is a question. This aids independence (because the child can refer to the schedule on his or her own) and also saves the
teacher or parent from repeating the plan again and again.
A General List of Recommendations for Children with NLD
Accommodations for testing:- Minimize visual confusion on tests and answer
sheets. (e.g. remove decorative graphics and non-relevant visuals).- Use verbal testing as needed- Modify or eliminate timed tests.- Eliminate or break down abstract essay questions to a concrete
level with extraneous information eliminated.- Provide encouragement to participate in structured extracurricular
peer groups.- Verbally teach the child things that other students learn intuitively
or from observing.- Provide verbal interpretation of visual cues to help the child
understand social situations. Movies can offer good practice for this.
References
1. Lerner, J., (2000). Learning Disabilities:Theories,Diagnosis, and teaching strategies. Boston: HoughtonMifflin.
2. Palombo, J., (2006). Nonverbal Learning Disabilities: AClinical Perspective. NY: W.W. Norton & Company.
3. Rourke, B., (1989). Nonverbal Learning Disabilities: TheSyndrome and the model. N.Y: Guilford Press.
4. Shapiro, J. R. & Applegate, J. S., (2000). CognitiveNeuroscience neurobiology and affect regulation:
Implicationsfor clinical social work. Clinical Social Work Journal, 28, 9-21.
References
5. Stein, M. T., Klin, A., Miller, D., Goulden, K., & Coolman, R. (2004). When Asperger’s Syndrome and a Nonverbal Learning Disability look alike. Journal of Developmental & Behavioral Pediatrics, 25 (3), 190-195.
6. Telzrow, C. & Bonar, A. (2002). Responding to students with nonverbal learning disabilities. Teaching Exceptional Children, 34 (6) pp 8-13.
7. Thomson, S., (1997). The source for nonverbal learning disorders. East Moline, IL: Lingui Systems
NVLD Links
1. http:// www. nldline.com
2. http:// www. nldontheweb.org
3. http:// www. Udel.edu/bkirby/asperger
4. http:// www. Nimh.nih.gov/anxiety
5. http:// Idonline.org