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Questions and Answers
Question # 18
What are the neurodevelopmental dynamics and probable psychosocial outcomes (difficulties) for persons with NLD?
The psychosocial difficulties of persons with NLD appear to result from interactions among and between their neuropsychological assets and deficits. The following are some examples of such interactions:
(1) The NLD person's deficits in social judgment would appear to result from more basic problems in reasoning, concept-formation, and the like that also lie at the root of their difficulties in mechanical arithmetic and scientific reasoning (Fisher, DeLuca, & Rourke, 1997; Strang & Rourke, 1983, 1985).
(2) Deficits in visual-spatial-organizational skills appear to account for their problems in identifying and recognizing faces, expressions of emotion, and other subtle nonverbal identifiers of important dimensions of human communication.
(3) Lack of prosody, in conjunction with a high volume of verbal output, tend to encourage negative feedback from those who find themselves forced to listen to the seemingly endless recitation of dull, drab, colourless statements that the person with NLD seems impelled to deliver. In a word, the types of speech and language characteristics exhibited by such persons tend to alienate them from others, thus increasing the probability that persons with NLD will experience psychosocial/adaptational difficulties (Rourke & Tsatsanis, 1996).
(4) The tactile-perceptual and psychomotor prowess required for smooth affectional encounters, in conjunction with the NLD person's typically inappropriate judgments regarding nonverbal cues, render positive intimate encounters all but impossible (Casey & Rourke, 2002).
(5) Adaptability to novel interpersonal situations is the hallmark of socially appropriate individuals. A combination of aversion for novelty, failure sometimes even to appreciate that an event is in fact novel, poor problem-solving and hypothesis-testing skills--all of these conspire to render spontaneous, smooth adaptation to the constantly changing milieux of social groups and the interactions nascent therein all but impossible for individuals with NLD.
Inter-reIationships That Usually Transpire in the NLD Syndrome
(1) Psychomotor Clumsiness and Problems in Tactile Sensitivity. The importance of psychomotor coordination and basic sensory-perceptual competencies (such as tactile sensitivity) are characteristically undervalued in most psychosocial treatments of adult competencies. This is, of course, due primarily to the overwhelming emphasis and rather obvious importance that is accorded linguistic proficiencies in connection with adult competency/adaptation. Although not for a moment denying the importance of linguistic competence for mature adaptation, it must also be pointed out that adult interactions, especially of the intimate variety, are largely functions of smooth, coordinated, integrated sensorimotor functioning and spontaneous adaptive alterations to meet sometimes rapidly changing social circumstances. These processes involve not only sensorimotor integrity but also a number of other "nonverbal" dimensions that have been discussed above in connection with the NLD syndrome. Persons who are incapable of deploying such behaviours are seldom, if ever, "popular" with their peers. Indeed, they are often viewed as social misfits. The serious clinical ramifications of this state of affairs would be expected to include an increase in the probability of social withdrawal, social isolation, and depression.
(2) Visual-Spatial-Organizational Deficits. Standing too close or too far away from other persons whilst engaged in various forms of social interaction; failure to appreciate subtle--and, sometimes, even obvious--visual details in configurations, with consequent misinterpretation of them; extreme difficulties in appreciating others' nonverbal "body language"; poor appreciation of visualspatial relationships when locomoting, driving a car, engaging in gestures of affection--all of these are examples of the predictable ramifications of deficits in visual-spatial-organizational skills. In addition to encouraging social ostracism for the person with NLD (with unfortunate consequences such as an increase in the likelihood of withdrawal, isolation, and depression), it should also be clear that these disabilities render such persons at risk for personal injury--at the hands of others or through their own misperception and mismanagement of physical dangers. Their tendency to "rush in where angels fear to tread" is not a reflection of their courage, but rather of their failure to appreciate the dangers inherent in situations and the consequences of their actions within them.
(3) Difficulties in Dealing with Novelty. The person with NLD is expected to have particular difficulty in adapting to situations that require systematic orientation to, and analysis of, novel stimulus material. This is especially the case when there exist no overlearned descriptive systems and/or patterns of adaptation for coping with them. Instead of orienting successfully to such novel situations, planning and executing adequate coping strategies, and dealing flexibly with changing patterns of interaction within them, it is quite probable for the person with NLD to attempt to apply previously overlearned strategies to such situations in a stereotyped, rigid fashion. It goes without saying that such inflexible approaches are likely to meet with considerable resistance from others involved in the interaction. This sort of predicament becomes even worse when, as is very likely to be the case, the person with NLD attempts to deal with such situations in a verbal fashion although some other mode of interaction (e.g., touching, psychomotor expression, appropriate gesturing) is called for. As the inevitable social rebuffs that the person experiences are multiplied many times over, it is reasonable to expect that he/she will become prone to withdraw from such contacts after even brief encounters with them. Indeed, he/she may eventually become seriously isolated and avoid social encounters almost entirely. Thus, we see another manifestation of the NLD syndrome that would be expected, under a wide variety of circumstances, to lead directly to marked isolation and withdrawal from social intercourse, with consequent increases in the likelihood of depression.
(4) Problems in lntermodal Integration. Included among the difficulties that arise from limitations in the capacities of the person with NLD for intermodal integration are the following: problems in the assessment of another's emotional state through the integration of information gleaned from his/her facial expressions, tone of voice, posture, psychomotor patterns, and so on; limitations in the assessment of social cause-and-effect relationships because of a failure to integrate data from a number of sources such as is often necessary in order to generate reasonable hypotheses regarding the chain of events in social intercourse; failure to appreciate humour because of the complex intermodal judgments required for assessing the juxtaposition of the incongruous; imputing of unreasonable, trite, and/or over-simplified causes for the behaviour of others, and imparting such assignations in situations that would lead to embarrassment for the person so described.
These are but a few of the consequences that accrue for the person with NLD because of the difficulties that he/she experiences in integrating information from a variety of sources. Such unfortunate outcomes, of course, are much worse when he/she is anxious and confused (as becomes increasingly common) in novel or otherwise complex situations. It should be clear that such experiences, common as they are for the person with NLD, encourage withdrawal and eventual isolation from social intercourse--with consequences vis-a-vis depression that are identical to those proposed above.
It should also be clear that this state of affairs would increase greatly the probability that those individuals so afflicted will feel that others do not wish to be with them; that their behavioural expressions are seen as silly and the object of ridicule; that they are impotent in the face of what are for them challenging circumstances (but with which others seemingly deal without difficulty). Thus, it should come as no surprise that depression and suicide attempts are greater than average in individuals who exhibit this syndrome (Bigler, 1989; Fletcher, 1989; Rourke, Young, & Leenaars, 1989).
Summary & Related Considerations
The pattern of psychosocial disturbance exhibited by persons with NLD is considered to arise directly from the interactions among their primary, secondary, tertiary, and linguistic neuropsychological assets and deficits. For example, their deficits in social judgment and interaction appear to result from more basic problems in reasoning, concept-formation, and intermodal integration-- problems that also lie at the root of their difficulties in mechanical arithmetic (Rourke, 1993; Strang & Rourke, 1983). Adaptability to novel interpersonal situations is the hallmark of socially appropriate individuals. A combination of aversion for novelty, failure sometimes even to appreciate that an event is in fact novel, poor problem-solving and hypothesis-testing skills--all of these conspire to render spontaneous, smooth adaptation to the constantly changing milieux of social groups and the interactions nascent therein all but impossible for the child or adult with NLD. Deficits in visual-perceptual organizational skills are thought to give rise to their problems in deciphering the meaning of various facial expressions, gestures, and other forms of paralinguistic information important for effective human communication.
Included among the adaptive difficulties that arise from limitations in the capacities of the person with NLD for intermodal integration are the following: problems in the assessment of another's emotional state through the integration of information gleaned from his/her facial expressions, tone of voice, posture, psychomotor patterns, and so on; limitations in the assessment of social cause-and-effect relationships because of a failure to integrate data from a number of sources such as is often necessary to generate reasonable hypotheses regarding the chain of events in social intercourse; failure to appreciate humor because of the complex intermodal judgments required for assessing the juxtaposition of the incongruous; imputing of unreasonable, trite, or oversimplified causes for the behaviour of others, and imparting such imputations in situations that would lead to embarrassment for the person so described. Clumsiness and poor psychomotor skills (e.g., eye-hand coordination), coupled with the aforementioned difficulties, make it likely that such individuals will be regarded as social misfits. As a result, they are often ridiculed and ostracized. Because of these experiences, it is expected that there will be an increased likelihood of social withdrawal, isolation, and depression on the part of the person with the NLD syndrome. Thus, it should come as no surprise that depression and suicide attempts are greater than average in individuals who exhibit this syndrome. Additional information and discussions of the psychosocial dimensions of NLD are contained in Rourke, van der Vlugt, & Rourke, 2002).
Issues related to psychosocial subtypes more generally and the differences evident in early presentations and long-term psychosocial outcomes for children who exhibit LD and other subtpes of LD can be found in the References/Bibliography section. Two of the more important conclusions of this work are as follows: (1) children who exhibit NLD appear very much at risk for the worsening of their psychosocial status (especially the development of significant degrees of internalized psychopathology) with advancing years; (2) children who exhibit Basic Phonological Processing Disabilities (BPPD) appear to be at only slightly higher risk for psychosocial disturbance than do their normal learning peers, and there is no reliable evidence that children with BPPD are at greater risk for psychosocial disturbance with advancing years.
Addendum (December, 2010)
There are a number of Q & As that deal with specific disorders and issues that are relevant within the context of the relationships between NLD and dimensions of psychosocial functioning. Some of these are as follows (Q & A number in brackets):
Attention Deficit Disorder (# 7)
Bigler, E. D. (1989). On the neuropsychology of suicide. Journal of Learning Disabilities, 22, 180-185.
Casey, J. E., & Rourke, B. P., (2002). Somatosensory perception in children. In S. J. Segalowitz & I. Rapin (Eds.), Handbook of neuropsychology, Vol. 8: Child neuropsychology (2nd ed., pp. 385-403). Amsterdam: Elsevier.
Casey, J. E., Rourke, B. P., & Picard, E. M. (1991). Syndrome of nonverbal learning disabilities: Age differences in neuropsychological, academic, and socioemotional functioning. Development and Psychopathology, 3, 331-347.
Del Dotto, J. E., Fisk, J. L., McFadden, G. T., & Rourke, B. P. (1991). Developmental analysis of children/adolescents with nonverbal learning disabilities: Long-term impact on personality adjustment and patterns of adaptive functioning. In B. P. Rourke (Ed.), Neuropsychological validation of learning disability subtypes (pp. 293-308). New York: Guilford Press.
DeLuca, J. W., Rourke, B. P., & Del Dotto, J. E. (1991). Subtypes of arithmetic-disabled children: Cognitive and personality dimensions. In B. P. Rourke (Ed.), Neuropsychological validation of learning disability subtypes (pp. 180-219). New York: Guilford Press.
Fisher, N. J., DeLuca, J. W., & Rourke, B. P. (1997). Wisconsin Card Sorting Test and Halstead Category Test performances of children and adolescents who exhibit the syndrome of Nonverbal Learning Disabilities. Child Neuropsychology, 3, 61-70.
Fletcher, J. M. (1989). Nonverbal learning disabilities and suicide: Classification leads to prevention. Journal of Learning Disabilities, 22, 176 & 179.
Fuerst, D., Fisk, J. L., & Rourke, B. P. (1989). Psychosocial functioning of learning-disabled children: Replicability of statistically derived subtypes. Journal of Consulting and Clinical Psychology, 57, 275-280.
Fuerst, D. R., & Rourke, B. P. (1991). Validation of psychosocial subtypes of children with learning disabilities. In B. P. Rourke (Ed.), Neuropsychological validation of learning disability subtypes (pp. 160-179). New York: Guilford Press.
Fuerst, D. R., & Rourke, B. P. (1995). Psychosocial functioning of children with learning disabilities at three age levels. Child Neuropsychology, 1, 38-55.
Galway, T. M. & Metsala, J. L. (2011). Social cognition and its relation to psychosocial adjustment in children with nonverbal learning disabilities. Journal of Learning Disabilities, 44, 33-49.
Greenham, S. L. (1999). Learning disabilities and psychosocial adjustment: A critical review. Child Neuropsychology, 5, 171-196.
Heath, N. L. (2001). Exploring the relationship between learning disabilities and depression: Methodological, pubertal status, gender, and subtyping issues. Thalamus, 19, 2-10.
Little, S. S. (1993). Nonverbal learning disabilities and socioemotional functioning: A review of recent literature. Journal of Learning Disabilities, 26, 653-665.
Pelletier, P. M., Ahmad, S. A., & Rourke, B. P. (2001). Classification rules for Basic Phonological Processing Disabilities and Nonverbal Learning Disabilities: Formulation and external validity. Child Neuropsychology, 7, 84-98.
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, 23-36.
Ralston, M. B., Fuerst, D. R., & Rourke, B. P. (2003). Comparison of the psychosocial typology of children with below average IQ to that of children with learning disabilities. Journal of Clinical and Experimental Neuropsychology, 25, 255-273.
Rourke, B. P. (1988). Socio-emotional disturbances of learning-disabled children. Journal of Consulting and Clinical Psychology, 56, 801-810.
Rourke, B. P. (1993). Arithmetic disabilities, specific and otherwise: A neuropsychological perspective. Journal of Learning Disabilities, 26, 214-226.
Rourke, B. P. (2000). Neuropsychological and psychosocial subtyping: A review of investigations within the University of Windsor laboratory. Canadian Psychology, 41, 34-50.
Rourke, B. P., & Conway, J. A. (1997). Disabilities of arithmetic and mathematical reasoning: Perspectives from neurology and neuropsychology. Journal of Learning Disabilities, 30, 34-46.
Rourke, B. P., & Del Dotto, J. E. (2001). Learning disabilities: A neuropsychological perspective. In C. E. Walker & M. C. Roberts (Eds.), Handbook of clinical child psychology (3rd ed., pp. 576-602). New York: John Wiley & Sons.
Rourke, B. P., & Fisk, J. L. (1992). Adult presentations of learning disabilities. In R. F. White (Ed.), Clinical syndromes in adult neuropsychology: The practitioner's handbook. (pp. 451-473 ) Amsterdam: Elsevier.
Rourke, B.P., & Fuerst, D. R. (1991). Learning disabilities and psychosocial functioning: A neuropsychological perspective. New York: Guilford Press.
Rourke, B. P., & Fuerst, D. R. (1992). Psychosocial dimensions of learning disability subtypes: Neuropsychological studies in the Windsor Laboratory. School Psychology Review, 21, 360-373.
Rourke, B. P., & Fuerst, D. R. (1995). Cognitive processing, academic achievement, and psychosocial functioning: A neuropsychological perspective. In D. Cicchetti & D. Cohen (Eds.), Developmental psychopathology (Vol. 1, pp. 391-423). New York: Wiley.
Rourke, B. P., & Fuerst, D. R. (1996). Psychosocial dimensions of learning disability subtypes. Assessment, 3, 277-290.
Rourke, B. P., Hayman-Abello, B. A., & Collins, D. W. (2003). Learning disabilities: A neuropsychological perspective. In R. S. Schiffer, S. M. Rao, & B. S. Fogel (Eds.), Neuropsychiatry (2nd ed., pp. 630-659). New York: Lippincott, Williams, & Wilkins.
Rourke, B. P., & Tsatsanis, K. D. (1996). Syndrome of Nonverbal Learning Disabilities: Psycholinguistic assets and deficits. Topics in Language Disorders, 16, 30-44.
Rourke, B. P., van der Vlugt, H., & Rourke, S. B. (2002). Practice of child-clinical neuropsychology: An introduction. Lisse, The Netherlands: Swets & Zeitlinger.
Rourke, B.P., Young, G.C., & Leenaars, A. (1989). A childhood learning disability that predisposes those afflicted to adolescent and adult depression and suicide risk. Journal of Learning Disabilities, 21, 169-175.
Rourke, B. P., Young, G. C., Strang, J. D., & Russell, D. L. (1986). Adult outcomes of childhood central processing deficiencies. In I. Grant & K. M. Adams (Eds.), Neuropsychological assessment of neuropsychiatric disorders (pp. 244-267). New York: Oxford University Press.
Strang, J. D., & Rourke, B. P. (1983). Concept-formation/non-verbal reasoning abilities of children who exhibit specific academic problems with arithmetic. Journal of Clinical Child Psychology, 12, 33-39.
Strang, J. D., & Rourke, B. P. (1985). Adaptive behaviour of children who exhibit specific arithmetic disabilities and associated neuropsychological abilities and deficits. In B. P. Rourke (Ed.), Neuropsychology of learning disabilities: Essentials of subtype analysis (pp. 303-328). New York: Guilford Press.
Tsatsanis, K. D., Fuerst, D. R., & Rourke, B. P. (1997). Psychosocial dimensions of learning disabilities: External validation and relationship with age and academic functioning. Journal of Learning Disabilities, 30, 490-502.
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