Questions and Answers
Question #19


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Questions and Answers


Questions and Answers

 

Question # 19

But my 23-year-old son, who is said to exhibit NLD, is so bright! How could he possibly have all of the problems associated with NLD?


It is very often the case that parents and other relatives express in this manner the ambiguity that they feel for their adult family member with NLD. The bases for the assertion of "brightness" are fairly clear: The adult in question has done well in school (even up to and including the college level); he is articulate and his fund of words appears virtually endless; he is seemingly knowledgeable about a wide variety of topics; he speaks endlessly and without noticeable effort; his fund of “facts” seems extraordinarily large.

Given these data, why, they ask, is it that he cannot get and hold a job? Why is it that he does not seem to be able to make and keep friends? Why does he seem so out of sorts in social situations? Why does he stumble through simple situations that have the least bit of novelty associated with them? Why does he not apply what he knows in situations that he encounters for the first time? Why does he become anxious and upset at the prospect of anything that smacks of an interpersonal challenge (such as going out on a date with an unfamiliar person)? Why does he appear to be so "dumb" when asked to articulate specific reasons and logical steps involved in an argument? Why does he seem to lack insight into even simple situations?

     Of course, the problem here is that "brightness" defined solely in terms of well-developed and glib prosaic linguistic dimensions is not very adaptive: that is, not very intelligent, in the best sense of that term. Making and maintaining friendships, adapting well to novel situations (social or otherwise), coping with changing circumstances, and learning from experience on the job and elsewhere--all of these dimensions of adaptive life in our society do not require a vast lexicon, endless talk regarding countless facts, or a whole lot of school learning. These dimensions require adequate nonverbal problem-solving skills, the capacity to utilize information of a nonverbal sort, and the self-confidence that comes with repeated successes in adapting to changing circumstances. Unfortunately, the adult with NLD experiences very much difficulty in developing such skills and attributes. Indeed, he usually exhibits outstanding deficits in them. In these senses, he is not "bright". (See Question #27)


Addendum:

Some Background and Theoretical Rationale

As a doctoral student at Fordham U, I took four courses from Anne Anastasi, and had the great honour and pleasure of getting to know her quite well. In several of her lectures, and in many of our private conversations, the issue of the correlations between and among human skills and abilities arose often enough to stick in my mind.

Of course, the findings regarding these issues are there for all to see. The bulk of the data from every comprehensive longitudinal study of human development can be interpreted as suggesting that human abilities, if not skills, are highly correlated. As a group, persons with higher IQs are likely to have better jobs, sounder social relationships, more education, better feelings of self-worth, and the like. That said, of considerable importance is the low correlation of abilities that may occur in the individual case. This absence of the expected high degree of relationship needs to be explained. And this is where the clinical/applied psychologist earns his keep.

When first tackling this problem, I was impressed by how dimensions of early experience, population demographics, individual reinforcement histories, and the like could be “employed” to assist in the explanation of these individual deviations. It wasn’t until much later that I came to the realization that brain impairment would be expected to play a crucial role as well. Indeed, this is one of the important reasons that I became interested in neuropsychology. The rest is history.

Those who study persons with significant brain impairment don’t take very long to realize that low correlations among abilities are the rule rather than the exception. Indeed, some would argue that the lower the correlations (put another way: the higher the “scatter”) among a person’s abilities, the more likely it is that brain impairment is playing a significant role in that person’s attempts at adaptation. Ralph M. Reitan was the earliest investigator in our field to demonstrate these and related matters. And he was most certainly the first to explain in detail the adaptive/clinical significance of such disparities. So too, those of us who concentrate on child-clinical/developmental neuropsychology cannot help but be struck by the often very significant role that early divergences in neuropsychological assets and deficits resulting from perturbations in brain development can have on subsequent development. Of course, this is but one part of a much larger story.

Observations:
(1) It is common for the vast majority of persons to believe and act implicitly on the (non-articulated or not totally conscious) view that human abilities are highly correlated. This may take the form of questions such as the one under consideration.

(2) Concurrent and predictive validity of neuropsychological assessment results are far more likely to be related to patterns of performance (i.e., “scatter”) than to any--even reasonably reliable--levels of performance. [See Q & A #12 for a consideration of this matter. A specific example of how patterns can be misconstrued is contained in Q & A #11.]

(3) Some patterns of performance may eventuate in counterintuitive findings. For example, we have done a lot of work on the concurrent and predictive validity of patterns of neuropsychological assets and deficits as these relate to subtypes of psychosocial functioning among older children with LD. One very reliable conclusion of this research programme: The HIGHER the Wechsler VIQ (especially relative to PIQ), the MORE LIKELY it is that a child with LD will be at risk for the development of clinically significant types and levels of psychosocial disturbance. One might construe this as an example of where "less" (in this case, VIQ) predicts "more" (i.e., better psychosocial adjustment). For reviews of these studies, see: Rourke (2000), Rourke & Fuerst (1991, 1992, 1996).

Final Note. To borrow a phrase from Sigmund Freud, when commenting on the interpretation of dreams and their relationships to the understanding of the “unconscious”: The “Royal Road” to the interpretation of neuropsychologial assessment findings is one that involves an explanation of the dynamics and synergies that play a role in the adaptive implications of patterns of performance among and between neuropsychological assets and deficits. For example, it is clear that high levels of verbal fluency, associations, and output relative to very low levels of nonverbal skills and abilities (as in NLD) are related to MALadaptive psychosocial functioning (questions # 5, #18). This is a notion (involving a theoretical rationale) that is very difficult to get across in any number of clinical/multidisciplinary settings. But, it always pays considerable therapeutic dividends to explain in detail and communicate the implications of this view. Leaving this undone or incompletely understood leads, almost inevitably, to less than ideal outcomes.

References

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., & 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. (1996). Psychosocial dimensions of learning disability subtypes. Assessment, 3, 277-290.

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