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,
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
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.
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
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.