Impact on Social Functioning; And Interpersonal Skills
Maggie Mamen, Ph.D., C.Psych
In our complex social world, it is vital that we become competent at recognizing important cues from the environment that trigger appropriate behavioral responses. Many of these cues are contained in the language that we speak, and we are attuned to listening to what someone says in order to judge what is expected of us in interpersonal situations. It has long been accepted, however, that communication skills are substantially non-verbal, and therefore it is critical that we learn not only to listen to the words, but also to be attuned to the wealth of non-verbal data that provide vital information to shape and direct social responses. It is therefore not surprising that disruptions in the ability to process this non-verbal information can have profound effects on an individual's ability to function appropriately in a social environment.
Non-verbal learning disabilities (NVLD) effect most non-linguistic aspects of communication, for example:
- Interpretation of visual social cues, such as body language, gestures, facial expressions.
- Understanding of tone of voice, mood, emotional cues
- Comprehension of information not immediately contained in words, such as nuances, humor, sarcasm, metaphor, imagery
- The pragmatics of language, particularly social language; knowing what another party knows or needs to know, what to say when, when and how to initiate and maintain conversations, when and how to terminate communication, and so on.
In addition, deficits are frequently found in the following, more general, areas of functioning:
- General organizational abilities: most specifically, in the ability to break down a complex task into its component parts and to work through the steps in order to complete the task;
- Difficulties with part-whole relationships
- Mastery of nonverbal mathematical concepts such as time, space, quantity, visual array
- Ability to grasp and manipulate spatial relationships in one-, two- and three- dimensions
- Understanding of the position of self in space, orientation, directionality
- Visual pattern recognition and memory
- Visual-motor integration and fine motor control
The overwhelming impacts of deficits in these areas on the life of tile NVLD individual is consistently underestimated. Adding to the problem is the fact that many NVLD children have such strong, sometimes superior or very superior, verbal abilities, that they are frequently an enigma to those who live with and teach them. Verbal strength may be used both as a defense and as a weapon, and NVLD children are sometimes viewed as "mouthy," overly verbose, or even verbally aggressive. Since expressive vocabulary is seen as a reliable predictor of "intelligence," NVLD individuals arc frequently expected to perform as uniformly competently as they appear to be from their perceived verbal abilities. Frustration is a very common, natural result of the discrepancy between expectation and reality, on the part of both the NVLD individual and those around him.
While several potential subtypes of NVLD arc being suggested, this article focuses on the group of individuals who, rather than being deferred for academic difficultics (in mathematics, written expression, organizational skills, and related areas), present primarily with social skills problems and difficulties with interpersonal interactions. These may manifest as problems making; or keeping friends, inappropriate social behaviors (e.g.., "weird" behavior in the classroom, unsuitable conversation, etc.), lack of understanding of personal space, boundary and privacy issues, difficulty maintaining social conversation (e.g., use of adult jargon with other children, inability to take turns in conversation, etc.), "loner" personality, fixation on certain topics or interests out of the normal range for their age group, and so on. Unless their behaviors are disruptive in the classroom, they arc more commonly referred by concerned parents than by their teachers, although teachers also worry about their social difficulties.
These children are frequently being diagnosed with Asperger's Syndrome (particularly if they are not showing any obvious history of early language difficulties), emotional disturbance, social maladjustment, oppositional defiant disorder, or other such primarily descriptive diagnoses. It is felt to be very important to examine these children's cognitive profiles very carefully in order to distinguish NVLD children from those who are more autistic-like, or those whose social problems stem from environmental factors, such as inappropriate or inconsistent parenting, chaotic family background, deprivation, or other related social or behavioral factors.
Examination of the.cognitive profiles of' these children suggests that they do not only have difficulty "reading" social cues, or nonverbal communication, from their visual environment, especially others' body language and/or tone of voice, but that they often do not have a strong cache of "internalized "rules" by which to monitor, plan and execute interpersonal interactions. In other words, they do not appear to have learned how to behave in social situations either by being told what to do, or by observation of others' behavior. On the other hand, they may score relatively well on tests of social knowledge, but do not appear to be able to access these skills when required in real-life situations.
The inability to process and interpret visual cues from the environment is frequently a handicap in social interactions, albeit in sometimes quite subtle ways. NVLD children may well be able to "talk the talk" but not always "walk the walk" in interpersonal situations. There may, in addition, be some gender-related issues at work when it comes to mediating factors in the area of social deficits. NVLD girls, in particular, appear to benefit from the female propensity for verbally-focused interactions as the social focus, since their relative strengths in linguistic competence can sustain girls' social-rules-based play. Boys with NVLD, however, may well suffer from difficulties in more activity-oriented social situations, particularly when team play is involved in terms of having to "read" a play in soccer or hockey, for example, or in other situations where gut instincts are important. Extraverted NVLD children, regardless of gender, may often be successful in the initial stages of making friends, but have considerable difficulty sustaining relationships beyond the introductory level.
One of the major factors that seems to differentiate Asperger's children from NVLD youngsters is the ability to acquire social knowledge. Children with NVLD appear to benefit appreciably from social skills remediation, either in a one-on-one, pragmatic-language-based program, or in small group settings with opportunities for role play, and re-testing on measures of social comprehension often indicates significant gains.
Asperger's children, on the other hand, do not appear to learn as quickly, if at all, since the motivation to interact is quite often lacking, even in a one-to-one situation, and they tend not to show improvement on psychometric measures from pre- to post-testing. In addition, Asperger's children tend to show many more autistic-like behaviors, including some stereotypic behaviors, preservation, self-absorption, fixation on certain objects or themes, and so on. Our clinical observations, experience and practice suggest that it is worthwhile objects or themes, and so on.
Our clinical observations, experience and practice suggest that it is worthwhile to premeditate the social skills deficits of NVLD children, primarily by helping them to translate social problems into words, thus enabling various rules that govern the more predictable social situations. Care does need to be taken to ensure that the words are not dissociated from the actions. In other words, in situ problem-solving is quite critical in order to avoid a situation where the child is quite able to "parrot" what to do, but is still unable to self-trigger from nonverbal cues that enable him to behave appropriately in a real social context. It is also sometimes necessary to teach them physical play skills that other children acquire automatically, such as catching, throwing, jumping, balancing, turn-taking, joining in a group or team game, and so on.
The following are some general "rules of thumb" for remediation:
- Labeling feelings and emotions, yours and theirs, even if they appear obvious to others. "I am getting cross with you." "You are upset that your brother took your book."
- Modeling self-talk while carrying out everyday activities in order to encourage task completion, error detection and memory for routines, and providing a means to show children that even adults constantly self-correct and redirect.
- Connecting the verbal with the nonverbal whenever possible, making an effort to catch the child in the act. It is far more effective to label a feeling or describe an action when the child is still in the midst of the situation and feeling the feeling, rather than attempting to re-create it at a later date.
- Avoiding over-verbalizing. This may result in a widening discrepancy between verbal and nonverbal abilities, even further disrupting the balance that is required in a variety of social situations.
- Providing an overall context in which a particular "bit" of learning is relevant. There is a danger in teaching individual skills out of context, in that they may well get to be very competent in that specific skill (for example, using appropriate special language) but may not use the skill outside the situation in which it was taught.
- Emphasizing the importance of patterning activities. Music, art and movement are vital in assisting children to understand and to recognize patterns in the apparent chaos of their nonverbal world, and provide social-learning opportunities.
- Labeling undesired behavior, along with providing a directive as to what is expected. Examples would be: "Jennifer, you are out of your seat. Please go back and sit down." "Robbie, your voice is getting loud and rude. Please use your polite voice. when you talk."
- Teaching socially-appropriate behaviors, however basic they may seem to others, keeping it simple and ensuring that the child actually performs the behavior. "Please look at me when you arc speaking," "When someone says `hello', I want you to look at the person and say `hello' back," "It is Richard's turn now," etc. Remember that modeling is the most powerful teaching tool.
- Teaching child language. Children's play has a jargon of its own that adults do not normally teach, but rather that children pick up from each other. Other children do not always realize that they need to repeat or reword things, and a child who does not have appropriate child-language may be fell out or actively rejected. While, parents, siblings and teachers may be able to help, sonic sessions with a speech-language pathologist may be beneficial and/or language-oriented social skills group training may well be appropriate at some point.
In general, it is vital to understand that nonverbal learning disabilities can indeed be understood in terms of basic cognitive functioning and patterns, and that they can be rennediated. Appropriate programming goals can be set and achieved, along with behavioral management techniques designed to maximize compliance and social learning. This has been found to result in a renewed sense of optimism on the parts of teachers, parents and students alike.
Reprinted from the LDAO newsletter, Communique, Vol. 29, No. 2, Summer, 2000