My Eyes are on Backwards

1. My Eyes are on Backwards An Assessment of a Nonverbal Learning Disability

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. 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

20. 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 Cornoldi et al., 1999; & Little, 2001

21. 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 Fisher & Deluca, 1997; Palombo, 1996; & Petti, et al., 2003

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. 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

24. 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 Palombo, 1996

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

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

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/nonverbal • 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 WorkJournal, 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.