Non-verbal learning disorder (NLD) is a complex and chronic problem. In addition to any strategies that 'treat' the current difficulties, successful treatment and management includes long term goals to build development and prevent problems,
Adam (see non-verbal learning disorder) has been diagnosed with NLD. His parents understand this is caused by neurological differences, and cannot be 'cured' or overcome with therapies and medications.
We move to the discussion about what can be done. The first step is for the parents to choose goals both for the next 6 months (short-term), and also for the next 10 years (long-term). This is what they wrote down:
Of this list, Adam's parents identified the maths, handwriting and anxiety as the priority issues.
Clearly these can only be general. Adam's parent's goals were:
These are things Adam's parents were afraid may happen in 10 years time, and would like to prevent. They tend to be the reverse of the goals.
The short term goals reflect what is most important at the time. For Adam's parents, the most important issues were to 'get on top' of his developing anxiety and worsening self esteem. It was not clear whether this came more from his academic problems, or more from his social difficulties. For that reason they wanted to explore both areas.
There was no easy solutions within the school. In Queensland, NLD is not recognised as a 'low incidence' category for extra funding and assistance (ascertainment) even though the symmetrical opposite problem (language disorder) is. Adam's needs had to be met within existing school resources. The following are some of the decisions we made.
Children who are verbally clever can often learn how to do step-by-step maths without fully understanding the underlying meaning of what they are doing. For this reason we decided to try and find the level of Adam's true understanding, where his skills were solid. To do this the parents hired a tutor for one afternoon a week. The tutor was a gentle, retired schoolteacher who could identify where Adam's skills were solid. During the next 6 months they consolidated his abilities to build a solid foundation.
The other strategy with maths was that the tutor talked with Adam's school teacher. As a result, the teacher modified the maths curriculum to his current true level. The school understood that from this point onwards, Adam was likely to need a modified maths curriculum where he progressed at his own, slow rate, doing different work from his peers.
We organised a visit with a paediatric occupational therapist (OT) to explore the question of how much Adam's handwriting problem was due to problems of finger (fine motor) control, and how much was due to spatial layout and organisation. The OT found quite significant problems - Adam couldn't write letters automatically - he had to think about each letter as he wrote it. It also meant his fingers would physically fatigue early as his grip was tense. The OT gave some suggestions about pencil grip.
With this information the next step was liaison with the school. By clearly identifying his writing (letter formation problems) they changed their expectations. Specifically they gave him exercises to practice his letters (to try and make these more automatic), and reduced the requirements for written work. For longer pieces of writing at home he was allowed to dictate to his mother who would type the work up for him. At school they managed to get a teachers aide to help him brainstorm ideas before writing them down. Finally they allowed him to use a keyboard, and began the slow process of learning to touch type.
The end result of these changes was that Adam did not feel that he was expected to produce work that was way beyond his abilities.
Although he was relieved to have work he could achieve, Adam did not want to be different. He objected to the modified work. With his teacher and parents they discussed this. The process of accepting that he had difficulties has not been easy for Adam, but he did understand that he could not achieve what the other children could do easily. The early solution to this problem was to include Adam in the discussions of what work he should get in the class and for homework.
These changes had the effect of reducing Adam's anxiety and childish behaviour in the classroom. The remaining social problems were in the playground. Here there was no easy answer. The problem was that other children were maturing, and leaving Adam behind. From our discussions Adam's parents realised that Adam did not have the skills to successfully manage the playground as a social equal, and it was not possible to force the other children to like and include him.
We explored three specific strategies. The first was to make sure he was not getting bullied. In the end, Adam's teacher had to explain to the other children about differences, and specifically that Adam could not help his problems with schoolwork and socially inappropriate behaviour. This reduced the teasing and allowed the other children to be more tolerant. They did not, however, go so far as to include him in their social groups.
The second strategy was to find a safe activity for lunchtime - and Adam ended up in the library. This was built upon to give him some responsibilities in the library.
The final strategy was to find something in the school where Adam could build social friendships in a structured activity that allowed his strengths to shine. For Adam this turned out to be Drama. He was quite musical, could sing in tune and was an excellent actor. He was given a responsible role in the school play, and through this process was able to establish some friendships so that at lunchtime he would either be in the library, involved with the drama, or with those friends he made at drama. The solution was not perfect - he tended to irritate the other children by 'showing off', and being childish in other ways, but with some gentle help from the teaching staff the students accepted him as part of the production.
Interestingly, drama did the most to make him lose his egocentricity (a little) and be more aware of others. At home Adam's parents understood that Adam could talk like an 11 year old (he was aged 9), but understood the world more like a 6 year old. In other words he could only see his point of view, and could not easily see the perspective of others. As a result he could not take appropriate responsibility for his behaviour. They then learned not to get involved with discussions - this was his battleground.
Instead, they began to talk to him at his social developmental age. They made rules, and would only discuss these rules if Adam showed the maturity necessary to accept responsibility. When he did not, they would say things like "If you are going to behave like a 6 year old, we will treat you as one. That means rules and punishments. We won't discuss this unless you are prepared to accept responsibility like any other 9 year old".
This was hard work, because Adam continued to get frustrated, wanting his own way, and wanting to discuss it all the time. But they stuck to their chosen strategy and gradually he began to understand that he could not always get his own way. During the 6 month period, however, he did not change to the extent where he learned to see the other (particularly his parent) point of view and take this into consideration himself
It became clear that a contributing factor to Adam's problems academically and socially was his poor attention and impulsivity. We discussed the possible use of stimulant medication, but the parents decided to hold off. They accepted that if the problems did not improve with the current strategies (or were getting worse) they may have to try this.
Adam's tutor also addressed the issue of organisation. By talking different issues through with Adam (getting ready for school, knowing what to take to school, knowing what was going to happen through the day) they broke each issue up into step-by-step tasks. Then they cut out small pictures from magazines to represent each task, and made for each a visual chart so that Adam could focus on one step at a time by following the sequence of pictures.
This strategy was used over and over, for all situations where organisation was a problem. Later, instead of pictures Adam learned to write lists of steps, and to use a diary. It was not a perfect solution (he regularly forgot to use the lists and lost his diary) but at least he had a strategy for getting through complex situations.
Again, part of the solution was explaining to the teacher that he became lost easily with complex tasks, and the teacher changing her expectations of Adam.
All these measures were enough to manage Adam's anxiety by the time we met again in 6 months time to review the goals. Particularly when drama was underway, his parents said the 'old' Adam was back with his enthusiasm and constant conversation. He had a few friends and was keen to go to school. He was particularly lucky as his teacher had been very understanding and supportive.
We discussed that this may not last for ever. Even with the best support and adaptation it is common for children with NLD to become problematically anxious. In this case, Adam's parents understood that it may be necessary to use medication in order to treat the underlying emotions of anxiety.
The major benefit of identifying long term goals is that you can start doing things now to improve chances of achieving these many years into the future. In this way they are like a superannuation - you start contributing now for something you hope to achieve many years into the future.
To achieve long term goals, several strategies make a clear difference:
The main early interpretation of these long term goals was to permit, and even encourage Adam's parents to take things slowly. By understanding that the journey was a marathon and not a sprint, they could take the time to learn and understand, and prepare for the future. These are some of the specific strategies and goals we set to begin now, and work towards the long term goals (as well as preventing the long term fears).
These points above summarise a process that has continued for over a year. Adam's parents are still apprehensive about the future, particularly because of Adam's poor social skills, fears and potential for a substantial anxiety problems - particularly if he doesn't like himself.
More generally, there are several key points to managing a child with NLD.
Specific recommendations for the classroom can be found at http://www.nldline.com/sue_educ.htm The site (nldline) is dedicated to non-verbal learning disorders, but tends to portray the more extreme clinical problems and may not be applicable to children with reasonable intelligence whose problems are more subtle.
These ideas can only be suggestions. They cannot come close to meeting the needs of every child with their individual differences and needs. This requires the regular assistance of somebody who understands, and with whom you can regularly discuss your child at an individual level.
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This article is published with the permission of the author. Please email: http://www.childdreams.com.au/disorder/nld.html