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

-10.00%

-5.00%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

Gain self-determination

Gain emotionalstimulation

Avoid boredom

Gain competence

Gain activity/sensorystimulation

Gain relatedness

Avoid failure

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

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Gain activity/sensorystimulation

Gain self-determination

Gain cognitivestimulation

Gain competence

Gain relatedness

Gain emotionalstimulation

Gain social/kinestheticstimulation

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

-10.00%

-5.00%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

Gain competence

Gain social/kinestheticstimulation

Avoid failure

Gain sensory/activitystimulation

Gain relatedness

Gain tangible stimulation

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

-10.00%

-5.00%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

Get competence

Get relatedness

Get self-determination

Get emotional stimulation

Get activity/sensory stimulation

Get tangible stimulation

Get novelty

Get cognitive stimulation

Avoid failure

Avoid boredom

Get social/kinesthetic stimulation

Avoid task

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

http://www.nldline.com/ http://www.ldonline.org/indepth/nonverba

l http://www.nlda.org/ http://www.nldontheweb.org/

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 nonverballearning disabilities. Journal of Learning Disabilities, 32, 48-57.

Fisher, N. J., & DeLuca, J. W. (1997). Verbal learning strategies of adolescents and adults withthe syndrome of nonverbal learning disabilities. Child Neuropsychology, 3, 192-198.

Little, L. (1998). Severe childhood sexual abuse and nonverbal learning disability. AmericanJournal 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 inchildren: A review of disorders. Child Psychiatry and Human Development, 32, 71-87.