Nonverbal Learning Disability (NLD) Flashcards
1
Q
What is NLD
A
- Right hemisphere disorder
- Receptive difficulty which results in functional problems in all areas that require visual-spatial reasoning.
- According to NLD website, this includes:
— “intuitive, organizational, evaluative, and holistic processing functions”
- Disorder not recognized by DSM
2
Q
Neurological Damage
A
- According to LD Online, children with NLD:
- Hx of moderate-to-severe head injury (TBI)
- Prolonged radiation treatment near head
- born without corpus callosum
- Hydrocephalic- spinabifida
- Removal of right hemisphere brain tissue
3
Q
Three Major Deficits w/ NLD
A
- Motoric: lack of coordination, problems with balance and graphomotor (writing) skills
- Visual-spatial-organizational: lack of image, poor visual recall, faulty spatial perception, and difficulty with spatial relations
- Social: inability to comprehend nonverbal communication, difficulty adjusting to transitions and novel situations, and deficits in social judgment
- Have reading comprehension issues
4
Q
Assets
A
- Early speech and vocabulary development
- Remarkable rote memory skills
- Attention to detail
- Early development of reading skills and excellent spelling skills
- Eloquent verbal ability (empty speech)
- Strong auditory retention
- A lot of social cognitive issues
5
Q
Diagnostic Criteria
A
- Bilateral tactile-perceptual deficits
- Bilateral psycho-motor coordination deficits
- Outstanding deficiencies in visual-spatial-organizational abilities
- Deficits in the areas of nonverbal problem solving, concept formation, hypothesis testing
- Difficulty dealing with negative feedback in novel or complex situations
6
Q
Diagnostic Criteria 1
A
- Difficulties in dealing with cause-effect relationships
- Difficulties in the appreciation of incongruities
- Well-developed rote verbal capacities and rote verbal memory skills
- Over-reliance on prosaic rote, and consequently inappropriate, behaviors in unfamiliar situations
- Look really good verbally
7
Q
Diagnostic Criteria 2
A
- Relative deficiencies in mechanical arithmetic as compared to proficiencies in reading (word recognition) and spelling
- Rote and repetitive verbosity
- Content disorders of language
- Poor psycholinguistic pragmatics (cocktail party speech)
- Poor speech prosody (robotic)
- Reliance on language for social relating, information gathering, and relief from anxiety
- Misspelling almost exclusively of the phonetically accurate variety
8
Q
Diagnostic Criteria 3
A
- Significant deficits in social perception, social judgment, and social interaction skills
- Marked tendency for social withdrawal and isolation as age increases
- High risk for social-emotional disturbance if no appropriate intervention is undertaken
- In a research study by Keller, Tillery & McFadden, 61% of subjects (small group, about 18) had APD, mostly TFM (tolerance fading memory, what happens in noise)
9
Q
NLD Summary 1
A
- Subtype of learning disability, according to Byron Rourke (University of Windsor), in contrast to the basic type, which is Basic Phonological Processing Disorder
— Impaired speech/language, and significant difficulty with reading & writing, generally normal performance IQ
— Nonverbal problem solving essentially normal
- In this profile, Nonverbal IQ > verbal IQ; fit definition of dyslexia
10
Q
NLD Summary 2
A
- Rourke also ID’ed 2nd profile of LD:
- Verbal IQ essentially normal but nonverbal IQ not within normal limits
- Nonverbal problem solving is impaired
- Also affected: visual, spatial, organization, tactile and complex psychomotor
— Poor ability to label emotion from facial expression
- Reading and spelling are average or above, but math is significantly impaired
- May talk excessively
- Good memorization of verbal material
11
Q
NLD & Language
A
- Language performance is deceptive
- Lack social competency
- Comprehension is not complete
- Poor ability to use context
12
Q
Cause of NDL
A
- Rourke suggests damage to white matter in right hemisphere
- Others suggest working memory deficit or executive function disorder
- No evidence to definitively differentiate NLD from Asperger’s
- Also possible aspect of : Turner syndrome; velocardial facial syndrome
13
Q
Form-Content-Use in NLD
A
- Form appears intact, but all through anecdotal info
- Content is difficult—individuals with NLD use sophisticated vocabulary, but may be inappropriate
- “unilateral triangle” (p. 2)
- Figurative language is poorly developed at least for comprehension (may appear okay in production, but superficial)
14
Q
Use
A
- Primary deficit of NLD
- Discourse is disorganized
- Other descriptors (from Rourke, reported in Volden, p. 3): tangential, repetitive (use of phrases like “by the way”)
- Exaggerated
- Poor ability to read and produce body language
15
Q
Other Parameters of NLD
A
- Little physical activity
- Good readers (decoders) with poor comprehension
- Science is a difficult subject for individuals with NLD
- Math is difficult because they have problems with mechanics of it (e.g., keeping digit in appropriate place value); also may not be able to switch to a new operation
16
Q
Testing for NLD
A
- Volden suggests that Test of Pragmatics is not effective
- Suggests Children’s Communication Checklist by Dorothy Bishop
— 70 items across 9 areas
— Completed by caregivers or professionals
— Agree/disagree with statements regarding communication
17
Q
Children’s Communication Checklist by Bishop
A
- 70-item checklist (parents, caregivers, or service providers)
- nine dimensions of communication (5 pragmatic)
— inappropriate initiations
— difficulties with coherence
— stereotyped conversation
— difficulties in using conversational context
— difficulties in establishing conversational rapport
- “Talks repetitively about things that no one is interested in”
- “It is sometimes hard to make sense of what he is saying because it seems illogical or disconnected.”
18
Q
Maltreatment
A
- Abuse, neglect and alcohol exposure cause “lifelong impairments” of “language, social communication, social cognition, and executive functioning”
(Coggins, Friet & Morgan, 1998; Streissguth, 1997; Timler, Olswang & Coggins, 2005 in Hyter, 2007, p. 94)
- 12.4 per 1000 children nationally (Hyter, 2007)
- Complex trauma: “repeated exposure to traumatic events within the ‘care giving system’ and the effects of that exposure on developmental outcomes” (Cook, Blaustein, Spinazzola & van der Kolk, 2003, p. 3 in Hyter, 2007 p. 93)
- Trauma- children that are starving, parents use drugs or alcohol, and abuse
- Can cause an increase of cortisol, which affects brain tissue
19
Q
Alcohol
A
- Fetal alcohol effect (FAE)
- Fetal alcohol syndrome (FAS)
- Alchohol-related neurodevelopmental disorders (ARND)
- Also causes problems in maturation of auditory system
—- OM and/or sensorineural hearing loss
- 6 per 1,000 live births, or 2,000-12,000 per year
20
Q
Impact on Brain Development
A
- Brain growth/development
— 34% of 573 children had static encephalopathy
- personality, social conduct, relationships
— 50% had neurobehavioral issues
- language, social communication/ language, cognition (Memory, impulse control, attention, executive functioning
— 34% mild-moderately impaired
— 40% mod-severe impaired
21
Q
Trauma 1
A
- May affect ability to regulate sensory experience
— Both increased and decreased need for sensory input may occur
— EEAC list members often describe kids who “crash” into people, furniture, walls, seeking sensory input
22
Q
Trauma 2
A
- Rage, Oppositional defiant disorder
- Catastrophic reaction to mild stressors
- Henry, Sloane & Black-Pond (2007) report findings by Kernic et al.(2002):
- 7x more likely than child not experiencing trauma to be referred for speech-language services
23
Q
Multiple brain structures affected by FAS and trauma
A
- Amygdala
- Hippocampus
- Corpus callosum
- Thalamus
- Striatum
- Anterior cingulate gyrus
- Hypothalmic-pituitary-adrenal axis
- Multiple neurotransmitters
24
Q
Physical Characteristics of FAS
A
- Microcephaly
- Short palpebral fissures
- Flat midface
- Indistinct philtrum
- Thin upper lip
- Epicanthal folds
- Low nasal bridge
- Minor ear anomalies
- Short nose
- Micrognathia
25
Communication Manifestations 1
- Disorders of speech production associated with the syndrome include deficits in fluency (language- not stuttering), lack of intonation, voice dysfunctions, slurred speech, and poor articulation (29).
- Language acquisition and comprehension are influenced by both hearing and cognitive functions. Verbal learning and memory deficits have been found in children with F.A.S. (29).
26
Communication Manifestations 2
- Expressive and receptive language delays are present in 86% of patients with F.A.S. (30).
- The act of involuntarily imitating words and phrases spoken by others has been observed in some children with F.A.S. (29).
- Families will often report drug or alcohol use when they are in a rehab program
27
4 Hearing disorders resulting from prenatal exposure to alcohol
- At least four types of hearing disorders result from prenatal alcohol exposure:
(a) delayed maturation of the auditory system
(b) sensorineural hearing loss
(c) intermittent conductive hearing loss secondary to recurrent serous otitis media
(d) central hearing loss (31) (possibly code for APD)
28
Cognitive deficits and FAS
Cognitive deficits and behavioral anomalies such as ADHD become more apparent in school-aged children with F.A.S. and persist into adolescence and adulthood (24).
29
Rogers-Adkinson- Child abuse and neglect
- Children of abuse & neglect most often part of child welfare system in US
- show problems in mid-elementary to adolescence with language processing, receptive-expressive language
--- Understanding sarcasm
--- Understanding indirect requests as a direction
--- Interpreting body language
--- Sometimes poverty
--- Could be poverty and alcohol
- e. g. poor understanding of cues such as rolling eyes, crossed arms (Harpur, 2001)
- Poor recognition of how much personal info to share and when
- Receptive and expressive issues
- No filter
30
SLP Goals for FAS
- Vocabulary of “feeling” words
- Understanding of different roles & expectations in different settings
--- Appropriateness of former words & behaviors in new settings
--- School vs. home
- Interaction with judicial system re: child and family especially in relation to goals
