Description of information Where to gather information

1. WISC VIQ > PIQ by at least 10 points. Weschler's Intelligence Test Review

testing, usually done by psychologist

2. Highest of verbal scaled scores from WISC or WISC-R include Two of the

following: Vocabulary Similarities Information Review testing, usually done

by psychologist (school or private)

3. Lowest of the Performance scaled scores WISC or WISC-R include two of the

following: Block Design Object Assembly Coding Review testing, usually done

by psychologist (school or private)

4. Target Test is at least 1 SD below the mean- Hitting suspended ball with

finger as in the Peabody Assessment. Tests timing, eye/hand, motor planning

and anticipation Occupational Therapist (OT)

5. WRAT Standard Score for Reading is at least 8 points greater than

Arithmetic. Psychologist, Resource Teacher, Educational Therapist

6. TPT Right, Left, and Both hand scores become progressively worse

vis-à-vis norms - mimicking of hand patterns such as rapidly reversing

repetitive hand movements - and performance worsens with repeated trials

rather than improving. Use Quick Neurological Screening Test, Sensory

Integration and Praxis test, Sensory Profile Occupational Therapist

7. No or very minimal simple tactile imperceptions and suppressions - no

evidence of tactile desensitization per Sims Weinstein Filament Test

Occupational Therapist

8. Very poor finger agnosia - unable to identify letters drawn onto fingers

OT, Educational Therapist, Psychologist

9. Very poor stereognosis - unable to identify objects placed in hand with

vision occluded. Occupational Therapist

10. Normal to superior grip strength- As measured by clinical observation or

the Dynamometer Occupational Therapist

11. Mild to moderate impairment on Grooved Pegboard - Measured with

Standardized Groove Peg Board. Occupational Therapist

12. Evidence of a preponderance of somatosensory or psychomotor errors on

the left side. - child had significant praxis deficits (motor planning,

ideation and execution), pronounced on left side. Occupational Therapist, PE

Teacher, Classroom Teacher reports

13. Normal to superior Speech-Sounds Perception and Auditory Closure versus

somewhat poorer Sentence Memory and Very poor Phonemically Cued Verbal

Fluency. - Articulation and enunciation is good, poor content of speech,

poor use of pragmatics Speech and Language Therapist

*Based on Byron Rourke's Criteria for the diagnosis of NLD

: Areas to Evaluate and treat

(work in progress - All Rights reserved by Rondalyn Whitney, MOT, OTR)

Precocity in rote verbal memory -- can recite commercials verbatim

Poor sensitivity for gaining and maintaining balance - have to be way off

balance before they correct themselves.

Sedentary lifestyle with little exploration of novel things limits cause and

effect learning. They experience the world verbally by questioning adults.

Lack of body movement toward visual targets reduces visual perceptual

experience of object constancy, depth perception, and position in space.

Tend to bump people/objects especially on their left side.

Avoid activities where they have to move rapidly through space which will

overwhelm their balance reactions - tricycles, big wheels, swings, soccer,

baseball, etc.

These are the kids that want the NAME of things, not necessarily their

function

Prepositions having to do with space and time are left out of their language

(can use as diagnostic technique)

Accident prone in the extreme

Easily lost i.e. poor topographical

Gap between verbal and performance IQ scores on the WISC test - 10 or more

points will indicate difficulty, 20 will present problems in school, social,

and self-care, and 30 point or more will need life long emotional support.

A. -personal spatial problems

kinesthetic body and finger awareness is lower than peers

bilateral fine motor sluggish compared to unilateral. Handwriting is a

struggle in early school career

confusion with body = difficulty with self - care

Personal space/ spatial problems

reduced topographical awareness

confusion with games with spatial content

difficulty gaining meaningful information from visual displays i.e. charts,

maps, graphs

irregular eye pursuits makes tracing moving target inaccurate

clumsy, tends to drift to left

difficulty with diagonals especially left downward sloping. Makes manuscript

more difficult than cursive [Manuscript relies on part to whole visual

integration and diagonals. Curves of cursive is harder motorically for kids.

Can test this by asking kid to organize a group of random dots - do they see

it as 6 or 6 individual dots?]

Visual sequential

visual memory is unreliable, cannot "picture" the answer, days of the week,

month etc are harder. Great dependency on left hemisphere strategies so sing

or rhyme to cue self when stuck in a sequence. Always return to "A" when

searching for the next letter in the alphabet.

Phonetic spelling better, "Who needs vowels anyway?"(non-phonetic words have

to be visualized to remember.

10% of people are left-handed, 50% are left eyed so only 40% will have

trouble with mixed dominance.

Math Disability (dyscalculia)

Poor estimation - too concrete

Spatial alignment of math (messy) leads to errors. Mental calculation more

accurate

Difficulty with multiplication tables due to poor visual memory

Difficulty with abstract reasoning

Difficulty expressing how they arrived at their answer (showing their work)

Visual Organizational Disabilities

Searching for target difficult - can't impose spatial organization over

random visual displays

Gestalt (whole) of overall pattern of letter or design will be disrupted.

Difficulty with plane discrimination

Difficulty crossing the midline

Sequence

multi-step directions are often forgotten or incorrectly sequenced because

student didn't visualize the steps given by the teacher

student has trouble following story line because they hold onto bits of it

without seeing the big picture

Failure to get a joke because of complex judgements required for assessing

the incongruous

Failure to tell a joke because can't sequence the events and set up the

punch line

Social Relationships

difficulty recognizing and interpreting facial expressions, postures and

gestures, paralanguage (tone, intensity, and loudness of voice),

interpersonal distance and touch, rhythm and timing

Seem gullible, don't underestimate "bullies"

Low self esteem leads to withdrawal, anxiety and depression

Language

pragmatics of language are low, output low in quality and high quantity -

have to listen to endless recitation

delayed acquisition and use of prepositions (put your name on top of your

paper - viewed as noncompliant)

reading comprehension impaired

great difficulty interpreting non-literal language: analogies, idioms,

expressions.

Oculomotor/Perceptual skills

imbalance of eye leads to disturbance in depth perception (lazy eye)

difficulty with 3rd dimension leads to frustration with legos, etc.

Intervention is to use cognitive cues and problem solve strategies

difficulty with alignment (as in mathematics) or handwriting

problems judging distance (decreased safety judgement)

problems judging edges of groups, people, and objects

difficulty transferring horizontal information (paper) to vertical (charts,

blackboards, environment) resulting in problems with copying, map skills,

and signs

Visual Guided written output

Copying from blackboard (vertical plane) while seated at a desk (horiz

plane) requires plane integration to follow the spatial directions.

Irregular spacing of individual letters in manuscript - again go to cursive

Gets dizzy or disoriented when required to shift gaze from near/far multiple

times

Difficulty copying from a book due to problems in visual system

Neuroanatomical Symptoms:

Poor judgment

Decreased social skills

Decreased holism (see the trees, not the forest)

Praxis (clumsy, dysgraphia, accident prone)

Dyssemia (tone of voice, gestures, facial expressions, body language and

personal space and paralanguage)

Decreased frustration tolerance

Delayed motor development due to increased intellectual pursuits

Delayed motor

Advanced verbal skills

Advanced reading skills

Advanced arithmetic skills and spelling but poor abstract mathematics

Concrete

Naïve (unable to plan/problem solve, anticipate, generalize)

Ability to learn new motor skills is delayed (clapping out rhythms and

skipping, singing and gesturing to songs)

Hypo-responsivity (tactile, proprioceptive, vestibular)

Sensorimotor dysfunction

Behavior symptoms

Looking bad vs incompetent

Difficulty regarding clothing, foods, noises, etc

Stress (frequent upper respiratory problems, OCD, meltdowns)

Behavior seems inconsistent

Unable to organize and prioritize

Unable to find belongings

Low frustration Tolerance

What Is Nonverbal Learning Disorder: In A Nutshell

:

Nonverbal learning disorders (NLD) is a neurological syndrome consisting of

specific assets and deficits. The assets include early speech and vocabulary

development, remarkable rote memory skills, attention to detail, early

reading skills development and excellent spelling skills. In addition, these

individuals have the verbal ability to express themselves eloquently.

Moreover, persons with NLD have strong auditory retention. Three major

categories of deficits and dysfunction also present themselves:

.motoric (lack of coordination, severe balance problems, and

difficulties with graphomotor skills).

.visual-spatial-organizational (lack of image, poor visual recall,

faulty spatial perceptions, and difficulties with spatial relations).

.social (lack of ability to comprehend nonverbal communication,

difficulties adjusting to transitions and novel situations, and deficits

in social judgment and social interaction).

Parents report several forms of therapy have been useful in the treatment of

NLD to include:

Auditory Integration Therapy 4% ;

Cognitive/Behavioral Therapy 7%;

Occupational Therapy 25 %;

Sensory Integration 18% ;

Sensory Motor Therapy 7% ;

Social Skills Group 25% ;

Speech/Language 3 %

Other 7 %

Parents sometimes feel that they need to schedule every hour of the day with

therapy, activity and enrichment. But children with NLD need to have time to

relax and rest. It is important as therapists that we help parents to

understand the importance of participating in therapy in a logical and

sequential manner. Children with NLD have low muscle tone. That means that

they don't have the same amount of muscle strength and endurance as a more

typical child. They need time to rest and recover. Much of the day is filled

with confusing sensory stimuli. They need time to re-organize and time to be

a kid. We can help parents understand that.

These are children that will likely need support throughout their school

years, from cognitive, to organizational skills, to motor skill development

to pragmatics and social skills. It's important to offer parents support in

developing a plan of intervention. It's not helpful to provide lifeskills

intervention that teaches a 13 year old girl to go shopping independently

when she is dependent in showering and dressing. We need to be instrumental

in the treatment of the child, the family, and the educational setting. It's

a tall order but children with NLD have a very positive prognosis with the

right interventions.

In a recent poll on the NLDline. (NLDline.com) parents said that poor social

skills and lack of friends were the two top problems. Map out a plan for

helping with those areas. This may include setting aside two days a week for

play dates for your child and a friend and gain skills for yourself to help

facilitate social development during the play dates. FreeSpirt Press

(www.freespirit.com) publishes several awarding winning books to help

parents gain skills in this area.

Children with NLD tend to have an advanced verbal and auditory memory, they

are precocious readers, and have advanced vocabularies. In fact, they're

often nicknamed "little professors." However, NLD is a problem of language.

The children have the rote language skills but when it comes to functional

use of language in everyday conversation, they have difficulties with tone

of voice, inference, written expression, gestures, facial expressions and

other areas of pragmatic speech. They benefit from rote learning, practicing

that which many would assume to be intuitive such as greetings, eye contact,

proximity, and other social rules of conduct. These children tend to be

vulnerable to bullies and punitive forms of instruction. They're very

literal and while this can be a tremendous strength, it can also become a

deficit. If you tell a child that you want them to pick up their toys later,

that's vague and later never comes. This can be interpreted as defiance when

in fact it is a literal interpretation. However, that same child will only

eat one piece of your See's Candy you got for Christmas because you told

them that was the rule.

They have difficulty with mathematics, especially when they enter 3rd and

4th grade when math skills become more abstract. Unlike children with

Asperger's, they have difficulty understanding patterns and lining up

columns of numbers in math. Following spoken directions is also hard because

of poor visual memory and they cannot picture doing the steps. NLD effects

coordination. These children tend to be clumsy, are prone to falls and in

general, have poor safety awareness. Doctors are not sure what causes NLD.

One child put it this way, " Even though I'm good at reading and

remembering, sometimes it takes me a little longer to answer a question,

because I cannot find the words. Because I'm focusing on what I want to say,

I talk too quickly. It also slows down my writing. On essay tests, I know

the information, but I have a difficult time getting it on paper. Sometimes

even looking at the face of someone who is speaking can be too much. I feel

everyday the way other people feel in a crowded shopping mall just before

Christmas"

Rondalyn Varney Whitney, MOT, OTR has developed a comprehensive program of

therapy, adaptation and other interventions for children with NLD. She has

been a volunteer for the national organization SHARE Support, Inc. and

currently serves as the president. She has lectured on NLD at PHP, area

schools, and even as far as to the Nebraska School System.

This article may be reprinted with author's permission if printed in full

and author acknowledge is included.

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 judgement. 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 judgement, 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.

Environmental Changes:

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

Compensatory

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 rondalyn@aol.com, 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. Chicago in September and at the OTAC Santa Clara Continuing Ed series

in October-enrollment only $35. To enroll for October workshop or for more

information, contact rondalyn at rondalyn@aol.com or call 408 248 3462)

10 STEPS TO EFFECTIVE PARENTING

from Steve Dykster

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.

http://www.eteamz.com/moosic_raiders/

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