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Question #4


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Questions and Answers

 

Question # 4

Why is there so much emphasis in the NLD syndrome upon novelty and reactions to changing circumstances?


The NLD syndrome and model are based upon deductions from a particular model of brain-behavior relationships (Goldberg & Costa, 1981). In this model, special emphasis is placed upon the role of right hemisphere systems in dealing with novelty and the intermodal integration of information that is necessary for dealing with such events/material. This view also maintains that systems within the left cerebral hemisphere are particularly adept at dealing with the automatized, stereotypic application of overlearned codes (e.g., natural language), but have little or no capacity to deal with the generating or application of such codes for dealing with unfamiliar or novel events.

Our extensions and applications of this model (e.g., Rourke, 1982, 1987, 1988, 1989, 1995; Rourke & Tsatsanis, 2000; Tsatsanis & Rourke, 1995; Rourke, van der Vlugt, & Rourke, 2002) have emphasized the deficits in right hemispheral systems (or access to them) that appear to characterize persons with NLD. Also, we have attempted to relate these characterizations to the assimilation-accommodation theory of Jean Piaget (e.g., 1954) which emphasizes the salience of adaptation to novelty as a balance between these basic cognitive dimensions. The relevance for NLD in all of this may be seen best in two examples, as follows.

Persons with NLD often fail to appreciate humour. Note that humour was defined by Aristotle more than two millennia ago as the juxtaposition of the incongruous. Thus, a failure to appreciate or deal adequately with incongruity would prevent a person from judging and reacting to an event as humourous. The failure to appreciate or deal with incongruity is, essentially, a cognitive (concept-formation) deficit. It is this deficit that is an earmark of persons with NLD.

Another dimension of congruity/incongruity that we have observed for some time is well illustrated by older children and adolescents with NLD who experience a considerable difficulty in dealing with incongruities between pictures and words. We demonstrate this by presenting pictures that illustrate particular emotions (e.g., happiness) in conjunction with words that are either congruent (i.e., happy) or incongruent (e.g., sad). Even when the person with NLD is instructed to look only at the picture and indicate the emotion being expressed in the picture, the common response to any incongruity between the picture and the word is a longer reaction time, confusion, and some form of response that may constitute an amalgam of the picture and the word (e.g., "pretty good"). No such reactions or responses are evident when the picture and the word are congruous.

In both of these examples, the point to bear in mind is that the person with NLD experiences considerable difficulty in dealing with novel circumstances, whether it be an oxymoron (e.g., jumbo shrimp) or a mismatch between pictures and words. Driven by their penchant for ascribing salience to words (either spoken or written), and their tendency to interpret words concretely rather than figuratively, it makes sense to ascribe their deficit to a failure in intermodal integration. Having no previously overlearned code to deal with such situations, their interaction and capacity to deal with them are predictably nonadadaptive.

To complicate matters, persons with NLD often exaggerate the "newness" of a situation. Because they tend not to "catalogue" previous experiences into meaningful schemata (categories of understanding) due to deficiencies in concept-formation (a prerequisite for categorization), what may seem to the average observer to be a small and insignificant variation from a previously encountered situation may, unfortunately, strike persons with NLD as radically different from anything previously experienced. Thus, what most would consider a trivial variation of overlearned experiences may be construed as completely novel to the person with NLD. A moment's reflection will reveal that the repetition of such "newness" throughout the course of a day may lead to much confusion, anxiety, and even panic attacks.


References

Goldberg, E., & Costa, L. D. (1981). Hemisphere differences in the acquisition and use of descriptive systems. Brain and Language, 14, 144-173.

Piaget, J. (1954). The construction of reality in the child. New York: Basic Books.

Rourke, B. P. (1982). Central processing deficiencies in children: Toward a developmental neuropsychological model. Journal of Clinical Neuropsychology, 4, 1-18.

Rourke, B. P. (1987). Syndrome of nonverbal learning disabilities: The final common pathway of white-matter disease/dysfunction? The Clinical Neuropsychologist, 1, 209-234.

Rourke, B. P. (1988). The syndrome of nonverbal learning disabilities: Developmental manifestations in neurological disease, disorder, and dysfunction. The Clinical Neuropsychologist, 2, 293-330.

Rourke, B. P. (1989). Nonverbal learning disabilities: The syndrome and the model. New York: Guilford Press.

Rourke, B. P. (1995).  Introduction and overview: The NLD/white matter model.  In B. P. Rourke (Ed.), Syndrome of nonverbal learning disabilities: Neurodevelopmental manifestations (pp. 1-26).  New York: Guilford Press.

Rourke, B. P., & Tsatsanis, K. D. (2000). Syndrome of Nonverbal Learning Disabilities and Asperger syndrome. In A. Klin,F. Volkmar, & S. S. Sparrow (Eds.), Asperger syndrome (pp. 231-253). 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.

Tsatsanis, K. D., & Rourke, B. P. (1995). Conclusions and future directions. In B. P. Rourke (Ed.), Syndrome of nonverbal learning disabilities: Neurodevelopmental manifestations (pp. 476-496). New York : Guilford Press.


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