“I shouldn’t have to tell you this!” Peter’s* exasperated mother felt like a “broken record,” once again admonishing Peter for yet another instance in which he had misinterpreted commands, directions, rules, or social cues, or had seemingly disregarded the “personal space” of others, or had blundered into trouble because he naively failed to understand that he was being misled by a taunting peer.
“He’s a bright child who doesn’t apply himself.” “He’ll be fine once he learns to better organize himself.” These were the dismissive responses from school personnel to the concerned parents of Bill,* a fifth-grader who had exhibited strong verbal skills and exceptional rote memory from a young age, but who was now resisting schoolwork and failing to complete his assignments. The well-meaning but poorly informed educators who passed off Bill’s problems failed to notice the immense difficulty he experienced with handwriting and mathematics, with copying material from the board, or with lining up columns on his math papers.
“Poorly motivated.” “Intentionally misbehaving.” These were descriptions of Lisa,* whose marks by the sixth grade had dropped from A’s and B’s to D’s and F’s. Lisa’s lateness to class (due to getting lost finding her way around the school campus), her failure to complete assignments (due to being overwhelmed by the organizational demands of written assignments), and her physical clumsiness (such as frequently knocking over objects or falling out of her seat due to motoric dyscoordination) were regarded as expressions of defiance and accordingly punished by teachers and by Lisa’s parents.
Peter, Bill, and Lisa exhibit some of the hallmark problems of children with nonverbal learning disabilities (NLD), which are difficulties associated with deficits or weaknesses in areas of the right hemisphere of the brain. These are the areas that support so-called “nonverbal” processing, including visual-spatial and social perception as well as intuitive, organizational, evaluative, and holistic thinking.
Problems in social comprehension, such as Peter’s, often lead to exasperation on the part of parents and teachers, to teasing and bullying by peers, and to confusion and self-hatred in the afflicted child. Visual-spatial-organizational problems, such as Bill’s and Lisa’s, are easily written off to sloppiness, laziness, or lack of motivation. Motoric dyscoordination, such as Lisa’s, may be seen as carelessness or defiance. In all such cases, children in whom these problems remain undiagnosed and misunderstood are at high risk for deterioration, depression, and even suicidality.
As with other areas of psychiatric and psychological difficulty (see, for example, this writer’s article on ADHD), correct diagnosis is crucial in guiding intervention for children and adolescents with NLD. For example, behavioral techniques such as ignoring unwanted behaviors, which may be extremely useful for many children, will be unhelpful with an NLD child, who needs repeated and patient explanation of expectations without which he or she may be literally unable to “learn from his/her own mistakes.” Assessment should begin with a thorough neuropsychological evaluation supplemented, if indicated, with consultations from specialists in allied fields including psychiatry, neurology, and occupational therapy.
Individuals who wish further information on nonverbal learning disabilities may wish to avail themselves of resources such as the book The Source for Nonverbal Learning Disorders by Sue Thompson, available from LinguiSystems, Inc. (www.linguisystems.com), from which the three examples cited in this article (*) were adapted. Organizations with websites about the disorder include the National Center for Learning Disabilities (www.ncld.org) and “NLD on the Web!” (www.nldontheweb.org). As always, such sources should never take the place of appropriate professional consultation.
Dr. Stone, a clinical psychologist, is an Assistant Professor of Psychology in Clinical Psychiatry at Weill Medical College of Cornell University, and Director of the Dialectical Behavior Therapy Program for Self-Injuring Adolescents at the Westchester Division of New York-Presbyterian Hospital in White Plains, New York. He resides in Pawling with his wife, Susan, and their family.
