My Eyes are on Backwards An Assessment of a Nonverbal Learning Disability By: Megan Arnold

Elliot Smith 5 year old boy Diagnosed with a Communication Disorder. He was diagnosed with Developmental Delay. He is enrolled in a general education classroom.

Elliot’s Strengths (IEP) Very curious Exceptional reader Great memory Loves music and singing Enjoys structure and organization Happy personality Cognitive skills

Elliot’s Weaknesses (IEP) Transitions Social skills Expressive language Problems with abstract concepts Communication skills Sharing Taking turns

Observation Three problematic settings: Centers/Stations Transitions Circle time Similarities between settings: Involve waiting Lack structure and consistency

Centers/Stations Behaviors: Singing/Humming Bossing around other children Yelling Behaviors are aimed at: Emotional stimulation Activity/sensory stimulation Relatedness Self-determination Emotional stimulation may be related to gaining relatedness or gaining a connection with others. Usually a teacher or adult in the room reprimands Elliot.

Centers/Stations Continued.. At the end of the observation, Elliot’s caseworker was coming to class daily to: Helps Elliot to initiate contact with peers Remind Elliot of appropriate behaviors Behaviors directed toward emotional stimulation have reduced, but behaviors aimed at activity sensory stimulation have remained constant (i.e. singing and humming) Elliot made a friend in his group

Payoffs of Centers/Stations

Transitions Problematic because children are supposed to learn through observation. Elliot need specific instruction. He does not understand subtle cues and body language.

Transitions continued.. Elliot’s behaviors are typically aimed at: Cognitive stimulation Activity/Sensory stimulation Competence Self-determination Behaviors: Running Singing/humming Ordering other students around

Payoffs for Transitions

Circle Time Allows Elliot to feel close to other children without having to say anything to them. Elliot’s behaviors are aimed at: Activity/sensory stimulation Gain competence Gain social/kinesthetic stimulation

Circle time Behaviors: Standing up Humming Calling out answers Touching other people As behaviors aimed at seeking competence decrease (due to a teacher reprimand) behaviors aimed at seeking sensory/activity stimulation increase.

Payoffs for Circle time

Other Behaviors Inappropriate responses: “My eyes are on backwards.” “I’m busy.” “You will help me.” Problems sorting by shapes and not color Library book

After observation conclusions Problems Social judgment Transitions New situations Inability to understand nonverbal communication Confusion due to lack of specific instructions

Ruling out ADHD-H Elliot’s behaviors are typically aimed at seeking stimulation: Activity/sensory stimulation Activity/sensory stimulation behaviors increase when other behaviors decrease due to a teacher reprimand: Cognitive stimulation Competence

Ruling out ADHD-H

Elliot’s behaviors may be reduced by changing the consequences and antecedents: Giving Elliot a job Checklists Praise aimed toward competency

Cornoldi et al., 1999; & Little, 2001 Nonverbal Learning Disability (NVLD) Neuropsychological deficit Affects 1 out of every 10 children with learning disabilities Higher scores on tests of verbal memory vs. nonverbal memory Discrepancy between verbal IQ and performance IQ scores

Fisher & Deluca, 1997; Palombo, 1996; & Petti, et al., 2003 Characteristics on NVLD Well developed rote memory Exceptional skills in reading Impairment in visual and spatial abilities Problems with context cues and nonverbal cues High verbal intelligence and low visuospatial intelligence

Problems associated with NVLD Adapting Interpreting complex social situations Rely on rote memory May look awkward Use inappropriate behaviors and language to convey meaning Social distance Developing friendships

Palombo, 1996 Developmental Profile Preschool: Problems with speech and articulation Communication Disorder Delayed development Developmental Delay Problems with decoding words and letters Exceptional readers once they learn the rules

Palombo, 1996 Developmental Profile Kindergarten Appear smart Do not meet expectations set based on verbal abilities Unable to make friends Illegible writing Problems with fine motor skills

NVLD in comic form

Behaviors that support diagnosis: “My eyes are on backwards” Excellent reader Problems communicating needs, wants, and emotions Inappropriate way to gain relatedness Lack of understanding of context Creating own meanings

Payoffs that support diagnosis Need for activity sensory/stimulation Need for competence Need for social/kinesthetic stimulation Need for emotional stimulation

Palombo, 1996; Petti et al., 2003; Sheeringa, 2001 Comorbidity Internalizing Disorders: Depression Anxiety Develop based on feelings of: Incompetence Worthlessness Lack of understanding

Palombo, 1996; & Sheeringa, 2001 Misdiagnosis ADHD Asperger’s Syndrome Developmental Delay Narcissistic Personality Disorder Borderline Personality Disorder

Intervention/Replacement Behaviors Aimed at allowing Elliot to feel: Competent Cognitive stimulation Related Sensory/activity stimulation

Interventions Continued.. Teach Elliot to make friends Peer buddy Student helper Mutual benefits Lack of self-esteem should be addressed: Make instructions explicit!

What Should a Teacher Know? Elliot needs explicit verbal instructions “Be more careful”-too ambiguous Structure transitions Make checklist Make use of Elliot’s exceptional rote memory and verbal skills Read the titles of books

Resources for teachers l l

Just remember: A boy with NVLD said, "It's not common sense if it is not common to me."

References Cornoldi, C., Rigoni, F., Tressoldi, P. E., & Vio, C. (1999). Imagery deficits in nonverbal learning disabilities. Journal of Learning Disabilities, 32, Fisher, N. J., & DeLuca, J. W. (1997). Verbal learning strategies of adolescents and adults with the syndrome of nonverbal learning disabilities. Child Neuropsychology, 3, Little, L. (1998). Severe childhood sexual abuse and nonverbal learning disability. American Journal of Psychotherapy, 52, Palombo, J. (1996). The diagnosis and treatment of children with nonverbal learning disabilities. Child & Adolescent Social Work Journal, 13, Petti, V. L., Voelker, S. L., Shore, D. L., & Hayman-Abello, S. E. (2003). Perception of nonverbal emotion cues by children with nonverbal learning disabilities. Journal of Developmental and Physical Disabilities, 15, Scheeringa, M. S. (2001). The differential diagnosis of impaired reciprocal social interaction in children: A review of disorders. Child Psychiatry and Human Development, 32,