Helping Children with NLD
by Rondalyn V. Whitney, MOTI, COTA
Children with Nonverbal Learning Disorders (NLD) have deficits in visual-spatial-organization, social skills (especially social-cognition and social language) and motor skills. Areas to Evaluate and treat are global and at times subtle. Teachers and therapists alike are frequently baffled by a child who can recite an entire story verbatim and orally dictate a novel worthy of publication but is unable to turn in work, find the bathroom or tie their shoes.
Children with nonverbal learning disorders typically have poor sensitivity for gaining and maintaining balance. Due to poor tone and endurance, they have a tendency to develop a sedentary lifestyle with little exploration of novel events. They tend to bump people/objects especially on their left side and have very poor safety judgment. They avoid activities where they have to move rapidly through space which will overwhelm their balance reactions and, thus, miss out on many social interactions and opportunities.
Prepositions having to do with space and time are left out of their language and so they benefit from games that require them to climb OVER, jump AROUND, slither THROUGH, or hop to the RIGHT, place the ketchup BEHIND the soda… Adding the prepositions into movement help them gain a better sense of spatial relations.
They have significant deficits in visual memory, which is unreliable. They cannot "picture" the answer, days of the week, month etc. They tend to over-rely on left hemisphere strategies (rote learning) and will often employ "self-talk" as a way to organize motor and cognitive tasks. They often miss the Gestalt (whole) of overall pattern and, instead concentrate on the details, missing the meaning of text, pictures, social events and conversations.
They have difficulty recognizing and interpreting facial expressions, postures and gestures, paralanguage (tone, intensity, and loudness of voice), interpersonal distance and touch, rhythm and timing. They often seem gullible, or innocent and can be the target of bullies. Despite their precocious vocabulary, NLD is disorder of language impairment. These children have great difficulty interpreting non-literal language: analogies, idioms, expressions.
These primary deficits lead to secondary academic and social deficits to include poor judgment, clumsiness, dysgraphia, declining academic success as they advance to upper grade levels, poor safety awareness (due to poor anticipation of consequences), anxiety, inability to generalize, poor self-esteem and even depression. Suicide is a real concern for these children.
Children in general would rather look bad than incompetent. They may throw themselves on the floor to avoid visually challenging materials or have other ways of "melting down" when they are overwhelmed and unable to understand the confusing messages bombarding them. They frequently suffer from upper respiratory infections (a common response to stress). They are unable to organize and prioritize and the day to day stressors compete for equal attention and produce poor frustration in tolerance.
Traditional behavior modification is seldom successful as these children need to understand what invisible, non-verbal rule they have just broken. Called "perspective taking" by Michelle Garcia Winner (SPL), these children need to learn via rote practice, to interpret the cues from others so that they can take another’s perspective and change their behavior through understanding next time. A simple reward or withholding of recess will not only not benefit the child but can, in fact, escalate the very behavior targeted for extinction. It can be useful in treatment planning to address the needs of the child in three categories: changing the child through movement and sensory integration techniques, change the environment to provide for greater opportunities for success and select areas to provide compensatory mechanisms.
De-stress the environment, minimize activities and expectations
Provide structure environment
Set up and insist on organizational skills AT ALL TIMES
Model your own thinking processes, talk openly about mistakes, develop atmosphere of attempts and errors as accepted methods of learning
Support the teacher with educational opportunities, materials
Realize the child will need extra time from the teacher and provide her/him with adequate support. Never underestimate the severity of the disability!
Changing the neurology/sensory processing
Provide opportunities for putting the "me" back in the picture through proprioceptive, vestibular, deep pressure touch
Develop motor planning skills, strength and endurance
Develop problem solving skills
Take frequent breaks during seated work
Stress anxiety management – build resilience
Allow for use of lap top computer for school work due to written expression deficits
Provide word lists to compensate for word retrieval problems (make a dictionary and thesaurus part of the child’s homework center)
Activities requiring drawing, copying, and lengthy writing require too much effort – provide child with teacher outline or pre-written copies
Use graphic organizers to aid child with organization of thoughts for creative writing, and other longer writing assignments. Use memory enhancing techniques such as mnemonics, rehearsal, chunking, techniques
Start early with a time management system like Premier from Franklin Covey
Insist on a binder each year (just one) with a system for organizing all materials. Give bonus/rewards if you can pick up the binder, shake it, and nothing falls out
Minimize written work – remember, this is a child with high fatigue, poor endurance, and difficulty parallel processing information
Educate teachers to analyze all homework and desk work for visual overload, handwriting levels (do they want to ascertain the math ability or handwriting? Help them to distinguish)
Use tape recorders to tape lectures, directions and other information
Give additional time for assignments
Take test orally when possible
Verbally teach what others intuitively learn
(for a complete list of intervention strategies and a checklist of areas to evaluate and treat, send an email to firstname.lastname@example.org, subject "NLD checklist" and/or visit the website NLDline.com. Rondalyn Whitney, Occupational Therapist specializes in the treatment of children with NLD and Asperger’s. She has presented workshops on NLD all over the country and will be presenting a workshop on NLD at the Palo Alto Unified School District in May,2000. Chicago in September, 2000 and at the OTAC Santa Clara Continuing Ed series in October, 2000—enrollment only $35. To enroll for October workshop or for more information, contact rondalyn at email@example.com or call 408 248 3462)
10 STEPS TO EFFECTIVE PARENTING
from Steve Dykstra
1) Catch your child doing something right! Look for things to praise, in specific and effective ways. The best teachable moment is when you wish to reinforce something that your child has completed and done well.
2) Be honest. Children usually know if you are telling the truth or not.
3) Have integrity. Integrity is when your beliefs, words and feelings are all in agreement. You cannot tell your child not to lie, and then attempt to get a 9 year old in at the "8 or under" price at the amusement park...
4) Be a role model for various interests. Tell your child what you like and ask them what they like to do. Encourage your child to pursue a variety of interests!
5) Always validate your child's feelings. When a child is upset about something you think is nonsense, it is not nonsense to the child.
6) Laugh a lot! It has been said children on average laugh several hundred times a day - adults, four times. Studies show laughing reduces stress considerably!!!
7) Enjoy some spirituality. Children are idealistic, more so than most adults. Let them express their beliefs in higher things in ways they enjoy most, not necessarily your way.
8) Enjoy the sun, water, and earth. Always teach children to appreciate and enjoy nature.
9) Experiment. Children learn and explore every day. Teach them to develop options, and never punish an honest attempt that ends in failure. If you do, the child may never try something new again, which is the essence of learning!
10) Look for evidence of accomplishment. Gardner says there are 8 kinds of intelligence. We should not ask how intelligent a child is, but we should ask how is the child intelligent. You might be surprised... A child might not be great at mathematical things but might be an absolute prodigy in music or athletics.