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

2. 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.

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

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

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

6. 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.

7. 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

8. Payoffs of Centers/Stations

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

10. 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

11. Payoffs for Transitions

12. 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

13. 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.

14. Payoffs for Circle time

15. 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

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

17. 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

18. Ruling out ADHD-H

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

20. 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

21. 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

22. 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

23. 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

24. 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

25. NVLD in comic form

26. 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

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

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

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

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

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

32. 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

33. Resources for teachers http://www.nldline.com/ http://www.ldonline.org/indepth/nonverba l http://www.ldonline.org/indepth/nonverba l http://www.nlda.org/ http://www.nldontheweb.org/

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

35. References Cornoldi, C., Rigoni, F., Tressoldi, P. E., & Vio, C. (1999). Imagery deficits in nonverbal learning disabilities. Journal of Learning Disabilities, 32, 48-57. Fisher, N. J., & DeLuca, J. W. (1997). Verbal learning strategies of adolescents and adults with the syndrome of nonverbal learning disabilities. Child Neuropsychology, 3, 192-198. Little, L. (1998). Severe childhood sexual abuse and nonverbal learning disability. American Journal of Psychotherapy, 52, 367-380. Palombo, J. (1996). The diagnosis and treatment of children with nonverbal learning disabilities. Child & Adolescent Social Work Journal, 13, 311-332. 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, 23-35. Scheeringa, M. S. (2001). The differential diagnosis of impaired reciprocal social interaction in children: A review of disorders. Child Psychiatry and Human Development, 32, 71-87.