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Questions and Answers
Questions and Answers
Question # 29
Are children with NLD more prone to physical injury than are most other children?
Short answer: Yes. There are several inter-related reasons for this, as follows.
Children with NLD tend not to anticipate the consequences of their actions. They often approach dangerous situations with little or no concern for their potentially damaging consequences. They also tend to fall in with age-mates and others who manipulate them and place them in harm's way. Their failure to anticipate consequences and their gullibility would be expected to pose a persistent threat to their physical (and psychological) well-being.
Their marked difficulties in appreciating cues of a visual nature, paralinguistic information, and humour/sarcasm/irony in concert with their failure to benefit fully from experience, will often single them out for abuse within any number of situations. Imagine for a moment a situation in a family of several children, one of whom exhibits NLD, when a drunken father comes careening through the front door of the home after a night on the town. The "normal" children recognize the cues inherent in such a situation, and realize full well that their father usually becomes physically abusive when he is in this state. Thus, they run for cover, or at least get out of his way. The child with NLD, on the other hand, may greet and approach the father, thus placing him/herself very much in danger of physical injury and psychological harm.
The gullibility of children with NLD is a consequence of their failure to draw veridical conclusions about events that are transpiring in their social and physical environments. Although they can learn specific stimulus-response contingencies through repeated practice (e.g., they will probably learn to avoid an abusive father after several pairings of his presence with violence), they tend not to generalize such learning to other, similar situations. An equally probable occurrence is that they will over-generalize many such stimulus-response contingencies because they fail to see that a new situation does, in fact, contain elements that would negate completely the usefulness or appropriateness of a particular response. All of these problems increase the probability of harm and injury.
Children who exhibit the NLD syndrome (and, hence, may be suffering from significant impairment of right hemisphere systems) are prone to "rush in where angels fear to tread," including out from between parked cars and into roadways filled with speeding vehicles. Similarly, they are more likely to fall from swings, slides, bicycles, and so on than are children who are developing their psychomotor, somatosensory, and visual-spatial-organizational skills at a normal rate. As development proceeds and more advanced levels of dimensions such as concept-formation, trouble-shooting, and insight into cause-and-effect relationships (another set of deficits of the NLD syndrome) emerge as normal developmental demands, it is likely that the older child and adolescent will remain at risk for harm and injury.
Clinical Implications. These important developmental implications of the NLD syndrome should be anticipated and must be taken into consideration in treatment planning. Efforts to enhance skill developments in these areas should be important elements of any treatment programme. For considerations of such skill developments in the area of psychosocial functioning see Questions 21 and 22.
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