 Psychology For You 2005 IWK Community Public Education

1.  Psychology For You2005 IWK Community Public Education

2. Nonverbal Learning Disability :Often Missed or Misunderstood Dr. Joseph M. Byrne Chief of Psychology IWK Health Centre

3. Overview • I. Background • II. Pattern of Assets & Deficits • Casual Observations • Clinical Presentation • III. Developmental Course • IV. Treatment Interventions • V. Therapeutic Resources

4. I. Background Hypothesizes – Rourke (1989) • 1. The Right side of the brain is generally more efficient at processing visual information (pictures, graphs, puzzles, maps). • 2. Children who had difficulty processing visual information had similarities with adults who had documented lesions on the Right side of the brain.

5. I. Background Hypothesizes – (Rurke, 1989) Con’t • 3. White matter damage is the real causal agent • Right side of the brain is more dependent on interconnection with Left side and other parts of the brain to do its job. • Evidence – Children: hydrocephalus, receiving intra-cranial radiation, experienced severe localized (right) brain injury had more difficulty with visual information

6. I. Background • NLD syndrome can develop: • Significant interference of Right Hemisphere • 1. General deterioration of white matter • 2. Substantial destruction of Right Hemisphere white matter • 3. Substantial interference of neuronal communication (e.g., Callosal Agenesis)

7. Background • Definition: Nonverbal Learning Disability (NLD) is a neurodevelopmental disorder, manifesting in a pattern of neuropsychological, psychological, and academic deficits, which may vary in severity and time of onset, predominantly affecting the efficient and accurate processing of nonverbal information.

8. I. Background • Essential Features • Neurodevelopmental • Pattern of Assets and Deficits • Severity and time of onset may vary

9. I. Background • NLD NOT specifically listed in DSM-IV • Learning Disability – Not Otherwise Specified (LD – NOS)

10. II. Patterns of Assets & Deficits‘Red Flags’ – Early Years • Sees ‘Trees for the Forrest’ • Perfectionist in work • Easily upset with minor change in plan • Play has to be on their terms • Subtraction / Division challenging (reversals) • Avoids sports / crafts, puzzles • Sees detail others do not – over focus • Poor concept of time – lifelong

11. II. Patterns of Assets & Deficits‘Red Flags’ – Adolescent Years • Conversation may appear scripted • Friends are few; tend to be younger/older • Conversations: ‘Off-topic’ / intrusions • Literal (personalized) interpretation of events • Poor decision making when no ‘right answer’ • Does not or incorrectly perceive social cues • Good oral reading continues, but poor reading comprehension emerges • Poor rule application (formula) math/science • Poor interpretation of graphs / diagrams

12. II. Pattern of Assets & Deficits‘Red Flags’ – Adult Years • Adulthood potentially more challenging: • more choice fewer rules • more ‘interpretation’, unique situations • More say in setting own agenda • Increased social isolation; stand out more • Job performance tied to degree of routine • Increased awareness of own ‘disorganization’, may become more rigid to increase control • May development Psychiatric disorder (s)

13. II. Pattern of Assets & Deficits • Neuropsychological • Academic • Psychological Adjustment

14. II. Pattern of Assets & Deficits •  Neuropsychological • Academic • Psychological Adjustment

15. II. Pattern of Assets & DeficitsNeuropsychological • Language • Memory • Attention • Sensory-Perceptual (touch, manual skills) • Cognition (thinking, problem-solving)

16. Assets Auditory Perception Phonology Verbal Expression Deficits Verbal Reasoning Pragmatics Semantics Expression Complex Comprehension Complex Pattern of Assets & DeficitsNeuropsychological - Language

17. II. Pattern of Assets & DeficitsNeuropsychological - Language

18. Assets Verbal Memory Verbal Associations Deficits Visual Memory Tactile Memory Procedural Memory Pattern of Assets & DeficitsNeuropsychological - Memory

19. II. Pattern of Assets & DeficitsNeuropsychological - Memory

20. Assets Auditory Attention Verbal Attention Deficits Visual Attention Tactile Attention Pattern of Assets & DeficitsNeuropsychological - Attention

21. II. Pattern of Assets & DeficitsNeuropsychological - Attention

22. Assets Simple Motor Deficits Tactile Perception Visual Perception Complex Psychomotor & Graphomotor Oral-motor Praxis Prosody Pattern of Assets & DeficitsNeuropsychological - Sensory Motor / Perceptual

23. II. Pattern of Assets & DeficitsNeuropsychological -Sensory Motor / Perceptual

24. Assets Perception of Detail Follow established routine NB Much more than VIQ – PIQ split Deficits Concept Formation Problem Solving Rule-governed Behavior Generalization Skills Sequencing – Organization Pattern of Assets & DeficitsNeuropsychological - Cognition

25. II. Pattern of Assets & DeficitsNeuropsychological - Cognition

26. II. Pattern of Assets & Deficits • Neuropsychological •  Academic • Psychological Adjustment

27. Assets Word Reading Spelling Rote Learning Graphomotor [late] Deficits Reading Comprehension Math Calculation Reasoning Science Written Composition Pattern of Assets & DeficitsAcademic

28. II. Pattern of Assets & DeficitsAcademic

29. II. Pattern of Assets & Deficits • Neuropsychological • Academic •  Psychological Adjustment

30. Assets Loyalty Deficits Perception of: Social Cues Pragmatics Over Interpretation or Personalization of events Risk for Psychiatric Disorders Pattern of Assets & DeficitsPsychological Adjustment

31. II. Pattern of Assets & DeficitsPsychological Adjustment

32. III. Developmental CourseRelative Functional Impairments

33. IV. Differential Diagnoses • Nonverbal Learning Disability (NLD) • ADHD • Specific Mathematical Disorder (MD) • Dyscalculia • Autism Spectrum Disorder (ASD) • Remember – can have more than one problem

34. Differential DiagnosisNLD Versus ADHD

35. Differential DiagnosisNLD Versus MD

36. Differential DiagnosisNLD Versus MD Con’t

37. Differential DiagnosisNLD Versus ASD

38. Differential DiagnosisNLD Versus ASD Con’t

39. NLD is not ONLY about nonverbal information

40. NLD is not ONLY about nonverbal information • Sequencing • Organization • Pattern Perception • Rule Generation and Application • Sifting : Essential Vs Non-essential • ‘Forrest from Trees’ • So why call it NLD ?

41. Conceptual FrameworkFunctional Impairments

42. Verbal  Nonverbal Take the 1st right on inbound Hwy 2, pass the 2nd toll booth, and exit immediately on outbound Hwy 3, and proceed to the 1st traffic light …….

43. V. Therapeutic Interventions

44. V. Therapeutic Interventions Neuropsychological Early years • Photo agenda / daily schedule • Reduce # of transitions • Verbal reminders before transitions • Rehearse ‘what to do’ for transition • Reduce distractions • Increase prediction

45. V. Therapeutic InterventionsNeuropsychological • Ask for recall of instruction – OWN words • Color-code binders / dividers • Time-management sheets (order/ time)

46. V. Therapeutic InterventionsNeuropsychological Critical Thinking • Highlight patterns / sequences • Highlight cause-effect • Highlight essential features to facilitate generalization • Practice ‘categorization tasks’ • Compare and contrast

47. V. Therapeutic InterventionsAcademic - Math • ½ inch graph paper • Calculator • Written cue cards with procedural steps • Simple flow chart for procedural steps • N.Bley & C. Thornton (2003 – 4th Ed). Teaching mathematics to students with learning disabilities. Pro-Ed Publishers.

48. V. Therapeutic InterventionsAcademic - Math • Encourage ‘talk through’ steps • Subtraction / Division (reversals) most challenging • Teach to segment word-based problems • Dyscalculia • www.dyscalculia.org

49. V. Therapeutic InterventionsAcademic – Reading Comprehension • Preview unfamiliar vocabulary / questions • Offer thematic, preamble summary statement • SQ3R Method • Survey • Question • Read • Recite • Review • www.ucc.vt.edu/lynch/TROverview • www.resource.net/comprehension

50. V. Therapeutic InterventionsPsychological • Highlight essential emotional features • What do you think the man felt? • Was the woman a little angry or a lot? • Why do you think the woman felt that way? • How are you feeling? Why do you feel that way? • Discuss character’s emotions (books, movies)