Questions and Answers
Question #49


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Question # 49

Some have suggested that your views regarding the probable developmental course of psychosocial functioning for persons with NLD (Question 18) are too ďnegative". Any comments?


Answer

I am aware of this. Indeed, some even maintain that these views are "grim" and "discouraging". It is also said that I concentrate too much on the deficits of persons with NLD, and not enough on their assets. Still others go so far as to maintain that it is well to ignore any neuropsychological deficits exhibited by any individual, and to focus exclusively on that personís assets. A corollary of this view is that persons donít exhibit Learning DISABILITIES; rather, they exhibit Learning DIFFERENCES.

Instead of engaging in an argument that is largely semantic (and, hence, moot), let me offer the following metaphor: Imagine that a person finds himself on one side of a minefield, and wishes to cross it safely in order to get to the other side. Obviously, he will need to have the foresight and means available to follow a safe path across this field.

Within the present context, letís say that this person is a youngster with NLD who wishes to reach "the other side" (i.e., adaptive maturity) of this metaphorical "minefield" relatively unscathed. To do so, he will need to have a flexible plan and the means necessary. In this case, he and his caregivers will need to know about the potential difficulties he faces: The vicissitudes of psychosocial development within his particular sociocultural-environmental milieu. And, he will need to have or acquire the means necessary to deal constructively/adaptively with these.

With this quest in mind, let me state my purpose for delineating both the assets and the deficits of persons with NLD and their implications for the neurodevelopmental dynamics of psychosocial adaptation. Continuing the metaphor, my purpose is to point out the "mines" that are present in the developmental "field" so that caregivers and the person with NLD himself can learn to avoid them by following a path that capitalizes on the use of his assets and minimizes exposure to his deficits. This usually involves a prospective view of probable course, as well as a "mine-detector" that would be useful along the way. It is understood that his "path" must be individualized and monitored frequently so that adaptive changes in it can be effected.

The purpose of a comprehensive neuropsychological assessment (Question 37) is to provide the wherewithal to construct a probable neurodevelopmental trajectory and to determine the sorts of "detectors" that will enhance the likelihood of traversing this psychosocial minefield in an adaptive manner. This leads to a treatment plan. Of course, modifications to this plan will probably be necessary over time, as developmental demands change in a substantive manner.

Hiding your head in the sand (i.e., ignoring the deficits and their likely interactions with assets in persons who exhibit NLD) is counterproductive. You donít send a three-year-old across a real minefield (or a very busy street) unassisted, just because he has the psychomotor skills necessary to traverse this space. Such actions are as imprudent as thinking that you can teach a child to swim by carrying him to the end of the dock and throwing him into the lake. Common sense suggests otherwise, and embracing foolhardy caregiver practices such as these constitutes child abuse, pure and simple.

It is almost always better to know than not to know. This is certainly the case regarding persons with NLD. An example of this is the preparations (plan) for situations that are likely to induce "panic attacks" (Question 33). Adaptive management for persons with NLD requires that they and/or their caregivers be aware of the pitfalls/challenges that they may face. And that they learn the adaptive behaviours to employ when these arise. Such learnings are possible, but only for those who choose to keep their heads out of the sand Ö and who recognize minefields (metaphorical or otherwise) when they encounter them (e.g., Question 47).

Note: The knowledgeable student of the content and dynamics of NLD will recognize that the considerations spread above also apply, mutatis mutandis, to cognitive and academic development, as well as to vocational opportunities and conditions (e.g., Question 40). Their forensic implications are fairly straightforward (Question 45).


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