Download Responding to Students with Nonverbal Learning

Responding to
Students with
Nonverbal Learning
Disabilities
Cathy F. Telzrow
Aimée M. Bonar
Would you know whether a student of
yours has the syndrome of nonverbal
learning disability (NLD)? If you were
included on a planning committee for
this student’s individualized education
program (IEP), what would you recommend or plan? Recognizing NLD and
providing responsive educational programming for affected students are critical if we are to ameliorate the poten-
tially devastating course of this disorder
(Fletcher, 1989; see box, “What Is
NLD?”).
This article provides an overview of
the NLD syndrome to assist educators in
identifying this frequently overlooked
condition and to describe educational
strategies, or interventions, for the special
challenges experienced by students with
this disability.
What Is NLD?
TEACHING Exceptional Children, Vol. 34, No. 6, pp. 8-13. Copyright 2002 CEC.
Over the past 15 years, researchers and clinicians have described a profile of characteristics that comprise the syndrome of nonverbal learning disability (NLD).
Although initially identified in 1975 as a neurologically based disorder with specific clinical and educational markers (Myklebust, 1975), many educators are
unfamiliar with NLD for the following reasons:
• Few textbooks used in teacher preparation programs mention this disorder,
resulting in limited exposure to its characteristics and implications for student
adjustment.
• Much of the literature concerning this disorder has appeared in medical and
psychological publications rather than in sources typically accessed by educators.
• The NLD profile may result from a variety of neurological and developmental
conditions, including moderate to severe head injuries, untreated hydrocephalus, and Asperger syndrome (Rourke, 1988), and these diagnoses may
obscure the symptom complex that is characteristic of NLD.
• The disorder is poorly understood because the pervasive cognitive and interpersonal features associated with NLD are quite disparate from those observed
in the majority of students with learning disabilities, whose difficulties tend to
be restricted to the areas of reading and spelling (Palombo & Berenberg, 1999;
Rourke & Tsatsanis, 2000).
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An NLD Profile
Distinctive patterns of strengths and
weaknesses in neuropsychological, academic, and social-emotional functioning
characterize people with NLD (GrossTsur, Shalev, Manor, & Amir, 1995;
Rourke, 1988, 1989; Rourke & Tsatsanis,
2000). One of the hallmark characteristics is stronger verbal than nonverbal
cognitive abilities, as evidenced by higher Verbal than Performance IQ scores.
This pattern of cognitive strengths and
weaknesses extends to attention and
memory skills, and students with NLD
perform better on such tasks when information is presented verbally rather than
through visual or tactile modes (Fisher &
DeLuca, 1997; Landau, Gross-Tsur,
Auerbach, Van der Meere, & Shalev,
1999; see Table 1).
Students with NLD also demonstrate
weak psychomotor and perceptual motor
skills that persist across time (Rourke,
1988). They tend to be physically awkward and have particular difficulty
acquiring gross motor skills that are necessary for age-appropriate self-care and
play tasks, such as dressing, skipping,
jumping rope, or riding a bicycle (Casey
& Strang, 1994). In addition, students
with NLD perform significantly below
average on standardized motor and visual motor tests (Gross-Tsur et al., 1995)
Table 1. Characteristics and Indicators of the NLD Syndrome
Primary Characteristics of NLD
Possible Indicators of the NLD Syndrome
Stronger verbal than perceptual cognitive skills
Higher Verbal IQ than Performance IQ scores
Stronger on verbal than visual attention and memory tasks
Weak psychomotor and perceptual motor skills
Physically awkward: slow to skip, ride bike, jump rope
Difficulty with tracing, cutting, and coloring
Sloppy handwriting
Deficiency in arithmetic
Better reading and spelling than arithmetic performance
Problems with number alignment and directionality
Confusion of mathematical symbols and problem-solving sequences
Difficulty with novel and complex tasks
Rote memory performance superior to tasks requiring integration and
synthesis
Reliance on automatic verbal responses in novel situations
Poor problem-solving skills
May be inflexible, unable to consider alternative actions
Difficulty with changes in routine
Social and interpersonal deficits
Misinterprets social cues: may be too impulsive, too familiar
Tendency to be teased or bullied; prone to social withdrawal
Pedantic, “little professor” style of communication
Unusual prosody, such as mechanical, “robot-like” speech
Difficulty understanding jokes or sarcasm
Limited self-awareness; unrealistic in vocational choices
Psychosocial adjustment problems
Evidence of inattention and hyperactivity during preschool and primary grades
Higher prevalence of anxiety and depression during adolescence
Increased risk of suicide during adolescence and young adulthood
Note: The NLD (nonverbal learning disability) syndrome may be indicated when there is a pattern of characteristics and indicators present.
and struggle with skills such as tracing,
cutting, coloring, and handwriting. Their
performance in these areas contrasts
sharply with their early reading and
spelling skills, which are frequently
above average.
This pattern of uneven skill development in kindergarten and first grade signals a characteristic profile of academic
strengths and weaknesses in NLD.
Students with this disorder tend to excel
on reading/decoding and spelling tasks,
but struggle with mechanical arithmetic,
as indicated by difficulty solving arithmetic problems and confusion of mathematical symbols and procedures (GrossTsur et al., 1995; Rourke, 1988). In addition, people with NLD have difficulty on
tasks that are novel and complex, such as
higher-order academic skills and many
social situations. Consequently, they commonly have adequate to good mastery of
early rote skills, followed by difficulty
with making inferences and synthesizing
and integrating content in the middle
grades and beyond. Furthermore, these
cognitive deficits appear to be exacerbated in unfamiliar settings and situations.
The difficulties that students with
NLD demonstrate in responding to novel,
unpredictable tasks affect their ability to
change cognitive set and consider alternative possibilities, which results in
impaired problem-solving skills. As a
result, these individuals do not respond
well to changes in well-rehearsed routines and may function inappropriately
during school transitions or unstructured
recreational activities.
Students with NLD demonstrate an
unusual pattern of social and interpersonal weaknesses, many of which are
directly linked to underlying cognitive
and neuropsychological deficits (Voeller,
1995). Such students tend to have poor
social judgment, which may be evidenced by impulsive behavior, inappropriate affect, or the tendency to invade
others’ personal space. Although the
name of this disorder—nonverbal learning disability—suggests that verbal skills
are intact in students with NLD, in fact,
subtle language deficits are present.
Specifically, social pragmatic skills are
typically impaired, meaning that students
with NLD do not use communication effectively within a social context. Their speech
One of the hallmark
characteristics of students with
NLD is stronger verbal than
nonverbal cognitive abilities.
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may have unusual prosody or rhythm,
resulting in poorly inflected, “robot-like”
speech. In addition, their conversational
skills are often pedantic, and they may misperceive nonverbal nuances in communication that are necessary for understanding
jokes or sarcasm.
As a result of such social and interpersonal deficits, students with NLD may
be victimized, teased, or bullied by other
children (Casey & Strang, 1994). They
may gravitate toward adults, who are
likely to engage in verbal rather than
physical activities and who may have
more tolerance for their “little professor”
communication style. Over time, students with NLD frequently experience
social withdrawal and isolation.
Finally, distinctive psychosocial adjustment problems have been associated with
the NLD syndrome, and these may
change over time. Young children with
NLD (i.e., preschool and primary children) frequently have inattentive, hyperactive, and impulsive behavior patterns,
which may lead to a diagnosis of attention
deficit/hyperactivity disorder (ADHD;
Gross-Tsur et al., 1995; Voeller, 1995). As
students with NLD become older, such
behaviors may be replaced by a pattern of
internalizing adjustment problems, characterized by pervasive anxiety and a high
incidence of depression (Cleaver &
Whitman, 1998; Palombo & Berenberg,
1999). Of particular concern is evidence
that students with NLD may be at
increased risk for suicide during their adolescent and young adult years (Bigler,
1989; Rourke, Young, & Leenaars, 1989).
Interventions for NLD
Many of the characteristics of NLD—
weak psychomotor and perceptual
motor skills; arithmetic disabilities;
weaknesses in synthesizing and inte-
Distinctive psychosocial
adjustment problems have been
associated with the NLD
syndrome, and these may change
over time.
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grating information; poor problem-solving skills; social and interpersonal skill
deficits; and internalizing adjustment
problems, such as anxiety and depression—have significant educational
implications. Figure 1 shows many
interventions that educators, parents,
and clinicians might use with students
with this disability. We derived this list
of recommended strategies and
approaches from the clinical and educational literature. We hope that they may
serve as guides as professionals—and
parents—design appropriate services for
students with this challenging disorder.
We have shown three types of intervention for each skill area listed: remedial, compensatory, and instructional or
therapeutic.
• Remedial interventions are designed
to exercise deficient skills directly. For
example, Rourke (1988) indicated
Intensive training and practice in
handwriting for students with
NLD could result in marked
improvement over time.
that intensive training and practice in
handwriting for students with NLD
could result in marked improvement
over time.
• Compensatory approaches employ
assistive technology or other techniques to assist students with NLD in
circumventing areas of deficit in their
achievement of academic objectives.
Concerns about sloppy handwriting,
for example, are minimized when
students can use a word processor;
and a calculator can help students
keep pace with their classmates
despite weaknesses in mechanical
arithmetic.
• Instructional or therapeutic interventions use specialized methods to
teach the student foundational skills
or strategies to enhance performance
in deficient areas. Examples include
problem-solving instruction, socialskills training to develop personal and
As students with NLD become
older, they may have pervasive
anxiety and depression—and they
may be at increased risk for
suicide during their adolescent
and young adult years.
interpersonal skills, and cognitive
behavioral interventions to address
depressive symptoms.
You should select an approach
according to the individual student characteristics, including age (e.g., remedial
interventions are more frequently found
to be effective in younger than older children), the severity of deficits, the degree
of functional impairment, and evidence
of preserved abilities (Rourke, 1989).
Final Thoughts
The identification of the NLD syndrome
is complicated by several factors, as follows:
• Multiple etiologies may produce the
characteristic profile of strengths and
weaknesses.
• The disorder may masquerade as one
of its primary deficits, such as an
arithmetic disability or depression.
• There are age-related expressions of
the disorder that change over time.
Well-informed educators can help
overcome these challenges to timely
identification of students with this syndrome and may find effective approaches to enhance student performance.
References
Bigler, E. D. (1989). On the neuropsychology
of suicide. Journal of Learning Disabilities, 22, 180-185.
Casey, J. E., & Strang, J. D. (1994). The neuropsychology of nonverbal learning disabilities: A practical guide for the clinical
practitioner. In L. F. Koziol & C. E. Stout
(Eds.), The neuropsychology of mental
disorders: A practical guide (pp. 187-201).
Springfield, IL: Charles C. Thomas.
Cleaver, R. L., & Whitman, R. D. (1998).
Right hemisphere, white-matter learning
disabilities associated with depression in
an adolescent and young adult psychiatric
population. The Journal of Nervous and
Mental Disease, 186, 561-565.
Figure 1. Interventions for Students with NLD
Interventions for psychomotor and perceptual motor deficits
Remedial interventions
• Specific training/practice in handwriting accuracy and speed
• Direct instruction in functional perceptual skills, such as reading facial expressions, understanding gestural communication, and reading maps and graphs
Compensatory interventions
• Extended time for completion of written tasks
• Handwriting aids, such as word processor or scribe
• Reliance on multiple choice over essay tests when examining content knowledge
• Organizing worksheets with a limited number of clear, well-spaced prompts
• Teacher-prepared lecture guides to minimize need for note-taking
• Use of oral or written directions and explanations instead of visual maps and schemas
Instructional/therapeutic interventions
• Adapted physical education with emphasis on developing functional recreational activities
• Early and sustained training and practice in keyboarding skills
• Occupational therapy to enhance perceptual and psychomotor deficits
Interventions for arithmetic deficits
Remedial interventions
• Direct instruction in computation using verbal mediation to rehearse sequential steps
• Compensatory interventions
• Graph paper to assist in column alignment when completing arithmetic problems
• Use of calculator or matrix of arithmetic facts
• Instructional/therapeutic interventions
• Verbal rhymes and memory aids to teach math facts
• Color-coded arithmetic worksheets to cue left-right directionality
• Interventions to improve synthesis and integration
• Direct instruction in organizational schemas and checking strategies
• Preteaching/reteaching to illustrate and reinforce relationships and distinctions among concepts
Compensatory interventions
• Commercially or teacher-prepared chapter summaries and study guides
• Rehearsal strategies that rely on verbal mnemonic devices
Instructional/therapeutic interventions
• Strategy training in specific skill areas, such as written expression (e.g., De La Paz, 1999; Sexton, Harris, & Graham, 1998)
• Graphic organizers, especially those with sequential/linear components
Interventions for problem-solving skills
Remedial interventions
• Direct instruction and rehearsal of appropriate responses in various situations
Compensatory interventions
• Reference list of rote “rules” to direct behavior
Instructional/therapeutic interventions
• Problem-solving instruction and practice, such as through the PATHS (Greenberg, Kusch‚ Cook, & Quamma, 1995) or I
Can Problem Solve (Shure, 1992) curricula
Continued on page 12.
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Figure 1. Interventions for Students with NLD (continued)
Interventions for social and interpersonal skills
Remedial interventions
• Direct instruction in social pragmatic skills, such as making appropriate eye contact, greeting others, and requesting assistance
• Teaching strategies for making and keeping friends
Compensatory interventions
• Vocational guidance toward careers that minimize interpersonal skill requirements
• Choosing structured, adult-directed, individual or single-peer social activities over unstructured or large group events
Instructional/therapeutic interventions
• Social skills training using published curricula (DuPaul & Eckert, 1994); for best results: target critical skills, match training
to individual behavioral deficits/excesses, train in naturalistic settings, and use functional approach to generalization
(Gresham, 1998)
• Interpersonal rules, social stories, and social scripting (Swaggart et al., 1995)
• Pragmatic language therapy to address skills related to topic maintenance, verbal self-monitoring, and appropriate social
communication
Interventions for psychosocial adjustment problems
Remedial interventions
• Self-monitoring to reduce symptoms of inattention and impulsive behavior
Compensatory interventions
• Investigation of other features of NLD syndrome in preschool/primary age children who display symptoms of ADHD
• Relaxation skills to compensate for pervasive anxiety
• Increasing access to pleasant events to address depressive symptoms (Lewinsohn, Clarke, Rohde, Hops, & Seeley, 1996)
Instructional/therapeutic interventions
• Educator/parent awareness training concerning risk for depression and suicide
• Student insight counseling about NLD features, interventions, and prognoses
• Cognitive behavioral interventions to enhance positive self-schema and reduce cognitive distortions (Lewinsohn et al., 1996)
Note: NLD = nonverbal learning disability.
De La Paz, S. (1999). Self-regulated strategy
instruction in regular education settings:
Improving outcomes for students with and
without learning disabilities. Learning
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DuPaul, G. J., & Eckert, T. L. (1994). The
effects of social skills curricula: Now you
see them, now you don’t. School
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Gresham, F. M. (1998). Social skills training:
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Gross-Tsur, V., Shalev, R. S., Manor, O., &
Amir, N. (1995). Developmental right-
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hemisphere syndrome: Clinical spectrum of
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Landau, Y. E., Gross-Tsur, V., Auerbach, J.
G., Van der Meere, J., & Shalev, R. S.
(1999). Attention-deficit hyperactivity
disorder and developmental right-hemisphere syndrome: Congruence and incongruence of cognitive and behavioral
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Neurology, 14, 299-303.
Lewinsohn, P. M., Clarke, G. N., Rohde, P.,
Hops, H., & Seeley, J. R. (1996). A course
in coping: A cognitive-behavioral approach to the treatment of adolescent
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Cathy F. Telzrow, Coordinator and Professor,
Graduate Program of School Psychology; and
Aimée M. Bonar, Doctoral Student in School
Psychology, Department of Educational
Foundations and Special Services, Kent State
University, Ohio.
Address correspondence to Cathy F. Telzrow,
405 White Hall, Kent State University, Kent,
OH 44242 (e-mail: [email protected]).
TEACHING Exceptional Children, Vol. 34,
No. 6, pp. 8-13.
Copyright 2002 CEC.
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