Questions and Answers
Question #31


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Questions and Answers


Questions and Answers

 

Question # 31

Are the academic and psychosocial dimensions of all persons with NLD exactly the same?
Is it necessary or desirable to formulate individual treatment plans for persons with NLD based solely on their NLD manifestations?


These questions are best dealt with in concert:

Every clinician aims to treat clients on an individualized basis. However, there is something to be gained from taking into consideration the neuropsychological assets and deficits of NLD as expressed in (say) an individual child as well as the psychosocial problems and difficulties that would be expected to arise from them over the course of development. Indeed, the NLD subtype should provide some unique input in the formulation of an individual treatment plan over the life-span (Del Dotto, Fisk, McFadden, & Rourke, 1991). These issues have been outlined before (Rourke, 1985, p. 12), and are spread here as a general statement of this rather complex problem of relating subtypal and unique features in an individual with learning disabilities:

   The classification of children into "homogeneous" subtypes does not imply that the children so classified are identical. Indeed, it would appear quite likely that children classified (into subtypes) ... would exhibit, together with their similarities, fairly substantial individual differences. That is, although they may be quite similar to one another with respect to their pattern of adaptive abilities and deficits (and, by implication, with respect to their central processing characteristics), any number of differences in early or current environmental circumstances, reinforcement patterns, and so on would be expected to have a differential impact on the psychosocial functioning of the children. It is for this reason that predictions (prognoses) and treatments must be framed and designed as individual amalgams reflecting common (subtypal) and unique (historical) characteristics.

   In this connection, it should be borne in mind that the common (subtypal) variance is itself a reflection of a certain level of uniqueness or individuality, insofar as it differentiates each child within a particular subtype from those in other subtypes and from those who are not classified. In addition, the idiographic formulation of the treatment plan should take into consideration the final level of individualization that is afforded by an examination and understanding of a child's unique socio-historical milieu and characteristics. It is in this (combined) sense that we view the identification of more general clusters of learning-disabled children who share common dimensions or factors as a complementary form of individualization that (we hope) contributes to the formulation and execution of appropriate individual education/therapeutic plans (Fisk & Rourke, 1983; Rourke, Bakker, Fisk, & Strang, 1983).

The interested reader may wish to consult Rourke, van der Vlugt, and Rourke (2002) for the specifics of a programme of intervention for children with NLD that we have found helpful.
Modifications in this programme to fit individual needs are, of course, required. Examples of such modifications are spread throughout this work. For other publications dealing with interventions for persons with NLD see Question 16.

References

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.

Fisk, J. L., & Rourke, B. P. (1983). Neuropsychological subtyping of learning disabled children: History, methods, implications. Journal of Learning Disabilities, 16, 529-531.

Rourke, B. P. (1985). Overview of learning disability subtypes. In B. P. Rourke (Ed.), Neuropsychology of learning disabilities: Essentials of subtype analysis (pp. 3-14). New York: Guilford Press.

Rourke, B. P., Bakker, D. J., Fisk, J. L., & Strang, J. D. (1983). Child neuropsychology: An introduction to theory, research, and clinical practice. New York: Guilford Press.

Rourke, B. P., van der Vlugt, H., & Rourke, S. B. (2002). Practice of child-clinical neuropsychology: An introduction. Lisse, The Netherlands: Swets & Zeitlinger.


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