Descriptive Profile of Children with Nonverbal Learning Disabilities

J. Palombo

From their article: "Working with Parents of Children with Nonverbal Learning Disabilities: A Conceptual and Intervention Model," Joseph Palombo and Anne Hatcher Berenberg state: "In previous papers we have detailed the profile of children with NLD (Palombo, 1995; Palombo & Berenberg, In Press). For readers who are unfamiliar with those papers, we summarize some of these children's features. However, we caution readers that these features represent neither a comprehensive picture of the syndrome nor are they meant to indicate that all children have every feature mentioned. Each child may be said to have his or her own topography of deficits and symptoms. There is a considerable range in types, combinations, and severity of deficits and symptoms. Just as some geographic regions may have an abundance of lakes and vegetation, while others may be dry and barren, so too with children with NLD, some may have severe deficits in some areas and be unimpaired in others. Each configuration of deficits will produce its own set of presenting problems."

October 21, 1994

The attached "Descriptive profile of children with Nonverbal Learning Disabilities" provides a compilation of the characteristics of children thought to have this problem. It was culled from an extended review of the literature.

Because our knowledge about these children is incomplete , this Profile should be used with caution. Some children with some of the characteristic in the Profile may not suffer from Nonverbal Learning Disabilities. It is also possible that some children with Nonverbal Learning Disabilities may not fit many of the characteristics described in the Profile.

I would welcome hearing from readers of this Profile, whether it be to have questions answered, or to provide input on any item(s) in the Profile. Please feel free to call the Center at (847) 933-9339. Leave a message stating that you are calling in connection with the Profile. One of the staff members will get in touch with you.

The development profile:

As infants:

• They are passive, fall to engage in exploratory play, and do not respond as expected.

As toddlers:

visual-spatial-motor problems emerge;

• Many cannot use toddler toys or enjoy coloring or drawing. They are unable to put puzzles together (Johnson 1987);
• They appear clumsy and ill coordinated. Caregivers must watch them closely because they bump into furniture, are unsteady on their feet, break toys and endanger themselves;
• They appear to not have a good sense of the relationship of their bodies to their spatial surrounding;

They are slow to learn limits and instructions from their caregivers,

• They appear unable to understand casual relationships;
• Caregivers must intervene and correct them constantly, to which they respond with frustration and anger. Often, their frustration escalates so that temper tantrums emerge that are much more intense than those normally occurring at this age;
• Their self-help skills do not develop comparably to those of children their age. They are slow to learn to feed and dress themselves. They do not master tasks such as hand-washing, or grooming;
• They must be helped and reminded to complete tasks that other children already perform independently.

By the age of three:

• They go through an initial stage when their speech is difficult to understand because of articulation problems. These problems dissipate and their verbal skills emerge as an area of strength. They then become quite adept at verbal communication. This channel becomes reinforced by caregivers who become over reliant on it to relate to the child.;
• They have difficulties interacting with other children in groups.
• They seem not to know how to play with others.
• They cling to their caregivers and find it difficult to separate. If this strategy is unsuccessful then they isolate themselves.

By the time they reach kindergarten or first grade other problems become evident:

• They appear to be quite bright and to have excellent verbal abilities, but their behaviors do not match the expectations for a child this bright and verbal;
• They have major problems is the area of peer relationships. They are unable to form friendships or to sustain being with other children even for brief periods of time without an eruption ensuing.;
• Academically, they start out having difficulty decoding letters and words, but once they discover the rules they become good readers;
• Their writing is quite illegible. Their small motor problems and their visuospatial difficulties make this task particularly difficult;
• Arithmetic difficulties emerge once simple computation is introduced.
• Caregivers notice that this child is different from their other children. But they are hard put to pinpoint what it is about the child they feel to be different:
• They find themselves frustrated in their efforts to understand the child. They seem unable to decode the child’s cues, and find the child to be socially unresponsive;
• They feel placed in the position of constantly having to correct, limit, or punish the child;
• They are puzzled when the child in turn responds with fury at what the child experiences as unfair treatment.
• The family feels controlled by the child in all its activities;
• They often feel guilty, and blame themselves for what they believe to be their failure to parent properly. This frustration may initiate a cycle in which the caregivers feel rejected by the child and in turn distance themselves emotionally from the child;
• Some caregivers are intuitively able to read the child’s messages and soon find themselves being the only ones who can communicate effectively with the child. If that does not occur then the difficulties are compounded by the child’s increasing demands on the caregiver and their inability to cope.
• Some caregivers unwittingly contribute to the confusion because of their own personal difficulties:
• Some caregivers themselves have NVLD;
• The household then appears like that of a family which each member speaks a different language. While a measure of communication occurs there are large areas which are fraught with misunderstandings. The level of frustration, the anger resulting from constant injury, the lack of gratification in having such a difficult child, all contribute to the ensuing chaos.

By the age of seven or eight the full-fledged "syndrome" manifests itself. It is often at this point that children are referred for therapy.

The "clinical presentation" of the latency age child with NVLD

Children with NVLD are generally referred for a variety of problems:

• Boys are often referred because of behavioral problems while girls may be referred because of their social isolation;
• Both boys and girls often present with clinical signs of severe anxiety, depression, attentional problems, obsessional preoccupations, and self-esteem problems;
• They perform poorly in some academic areas, but not in all. They are good readers, but have great difficulty with tasks involving writing or arithmetic.

Diagnostic interviews disclose social emotional distress.

Academic problems:

In the visual-spatial-motor area, areas of primary deficits are:

• Tactile perception, such as finger agnosia;
• Discrimination and recognition of visual details;
• Organization of visual stimuli;
• Tactile and visual memory;
• Complex psychomotor tasks that require the crossmodal integration of visual perception and motor output, such as putting puzzles together, solving mazes;

In the area of verbal language;

• The children are either average or above average in verbal language skills;
• They have good syntax and good pragmatics;
• They have problems with prosody, they tend to speak in monotone, or with a "sing-song" voice;
• They may reverse pronouns at an early age, but these clear up with maturation;
• They have good memories and manifest rote memory verbalizations that makes them look much smarter than they actually are;
• Their concepts lack preciseness. Although they appear sophisticated there is a shallowness to the content of their expressions. A child may use a vocabulary that seems advanced for his or her age, but the communications are not always well connected, and the content appears superficial;
• Their problem with concept formation limits their capacity to reason, analyze and synthesize materials;

In the academic areas, they have:

• Poor handwriting;
• Deficient skills in arithmetic;
• Their reading comprehension is not on a par with their verbal skills, although they are good readers;
• Their reading comprehension drops, as they move to higher grades. Complex material becomes much harder to grasp and concepts are harder to understand;
• The cannot organize a narrative to pick out the main points from supporting details, the relevant from irrelevant;
• They have great difficulty with tasks required by art classes.

In school they also have problems with:

• Attention;
• Exploratory behavior;
• Dealing with novel materials, and adjusting to new solution;
• Reading between the lines, making inference, and understanding the double meaning of expressions;
• Giving a narrative account of en event, they grasp one aspect of the total picture and miss the broader gestalt. Consequently, when they are asked to report on an event they give an account that appears disconnected and devoid of feeling. It is very difficult to reconstruct what happened from their reports;
• Problem solving; and,
• Conforming with expected behavior.

The social-emotional profile.

• The area of affective communication is problematic for children with NVLD.
• In the receptive area:
• They appear unable to decode prosodic or vocal intonations;
• They also have difficulty reading facial expressions. They are unable to decode the emotional message conveyed by people’s faces, and
• They are unable to read bodily gestures.

In the expressive area:

• They do not use vocal intonations. They either speak in a flat monotone or with a "sing-song" voice:
• It is difficult to read their mood from their facial expressions. It is hard to tell whether they are really happy or unhappy.
• They do not sue body gestures in speaking. They seem wooden and constricted;

In the processing area:

• They may have problems in the area of decoding affective states, or in the area of visual processing;
• They respond to affect laden situations with anxiety, withdrawal or sadness;
• They have problems in modulating or regulating certain affects;
• They loose control and have temper tantrum, when frustrated;
• They respond to most feelings with generalized excitement that is unfocused and lacking in content;
• They appear to have no compassion or empathy for others;
• They appear not to have the same feelings about events and people that their peers are capable of having.

Their functioning in social situations is often problematic:

• They interact quite well with adults, but not as well with peers. This may be because adults are more predictable in their responses and can be engaged verbally;
• They respond more nonverbally and are more erratic in their responses to their peers;
• They are unable to decode social cues involved in "reading" other people’s body language, facial expression and vocal intonations;
• They are inept in social situations. Grasping the subtle nuances of a social situation is difficult;
• Their eye contact (gaze) seems unnatural, they seldom make solid eye contact;
• They lack a sense of humor. They do not know when they are being teased;
• They interpret concretely colloquialisms or metaphorical expressions.
• They lack basic social skills:
• Sometimes, they are taken to be rude although they are not consciously being disrespectful;
• They are overly familiar with strangers. They will start a conversation with strangers as though they were old friends. They will ask personal questions too quickly. They do not respect privacy that we presume others to need. They share personal facts too quickly giving intimate details to strangers;
• They do not understand the physical aspects of social boundaries. Their sense of body in space does not allow them to respect the usual social distances, such as the culturally determined conversational distance of physical intimate closeness and distance;
• With peers, their play is disruptive, they appear unable to negotiate social interchanges with other kids.

Psychiatric symptomatology:

At a young age, their frustration with confusing social situations often leads them to be emotionally overwhelmed and fragmented. This frustration lends itself, in younger children, to motor output such as hand flapping, jumping up and down excitedly, or extreme temper tantrums. They are then mistaken for children who suffer from Asperger’s syndrome or mild autism.

• They generally suffer from high levels of anxiety, and severe self-esteem problems;
• They also suffer from depression, obsessive compulsive symptoms, or attentional problems that lead them to a misdiagnoses as ADD.
• In contrast to children with Asperger’s syndrome, they appear to crave social contact, and to be capable of relating to others. They try reaching out to other people. But their attempts are inept and are misread by others who misinterpret their overtures. Their withdrawal is reactive rather than primary.
• Comorbidity with other diagnoses is often present.

Joseph Palombo M.A. is a Clinical Social Worker, Research Coordinator, Founding Dean and Faculty Member, Institute for Clinical Social Work.   This paper was done in conjunction with Rush Neurobehavioral Center, 970 Knox Avenue, Skokie, IL 60076, Phone (847) 933-9339.  Mr. Palombo also has a private practice in Highland Park, IL.

May 30 1994

SELECTED BIBLIOGRAPHY ON NONVERBAL LEARNING DISABILITIES

Updated Bibliography April 20, 1998

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