Questions and Answers
Question # 50
Some investigators maintain that the NLD model posits visual-spatial deficits as the primary cause of psychosocial dysfunction in persons with NLD. Is this the case?
Short answer: No.
Basic Considerations. The following need to be taken into account to
address this question:
(a) Obviously, visual capacity itself does not constitute a cause of
psychosocial dystunction. Otherwise, those with significant visual acuity
deficits would be at significant risk for psychosocial dysfunction.
They are not.
(b) In the NLD Model: Although deficits in visual-spatial-organizational
skills are seen as a primary causal factor in the developmental emergence
of psychosocial dysfunction in persons with NLD, these are characterized as
only one of four sets of deficits that constitute the principal etiological
bases for eventual psychosocial dysfunction.
(c) The other three primary deficits hypothesized to be operative in this
respect are in (1) complex tactile perceptual skills, (2) complex psychomotor
skills, and (3) dealing adaptively with novelty (see
NLD Content and Dynamics,
especially Figure 1, and Question #18).
(d) As yet, there is no firm determination of the relative contributions of these
four primary areas of deficit (and their subsequent ramifications at the Secondary,
Tertiary, and Psycholinguistic levels of the model). That said, I am inclined to
the view that deficiencies in dealing adaptively with novelty are most contributory
(see Question #4; Rourke, 1982; Rourke, van der Vlugt, &
Rourke , 2002).
(e) The magnitude of the difference between rote verbal skills (higher) and
complex visual-spatial organizational skills(lower) is more contributory for classification/diagnostic purposes than are absolute levels of visual-spatial-organizational skills (see Questions #10
and #12). Even when both of these are within normal
limits, a clearly significant difference between them has major implications
vis-a-vis the probability of psychosocial dysfunction, now and in the future (e.g.,
Fuerst, Fisk, & Rourke, 1990). Important within the present context are the
findings that significant risk for psychosocial dysfunction can be predicted in the absence of below-normal/average-for-age visual-spatial skills (e.g.,
Pelletier, Ahmad, & Rourke, 2001; Rourke & Fuerst, 1992).
Clinical considerations. In addition to the classificatory/diagnostic considerations
spread above, the following are some related clinical issues that have a direct
bearing on the relevance of visual-spatial-organizational skills in treatment
planning for persons with NLD:
(a) With advancing age from childhood to adulthood, emerging developmental demands
in many important areas require less dependence on visual-spatial skills and
increasing demands for skills in other areas. For example, psycholinguistic
assets and deficits play an increasingly prominent role in adaptive coping, at
least in our society. Thus, it becomes necessary to examine nonadaptive
functioning in this area. For example, it is often found that older children
and adults with NLD tend to rely increasingly on their over-learned linguistic
assets in situations where other quite different avenues for coping would be more
adaptive. In turn, the frequent and inappropriate use of these linguistic skills
as coping mechanisms tends to increase in frequency to the point where no other
coping mechanisms are deployed, including those dependent upon visual-spatial-organizational skills. A close examination of the verbal
communications of persons with NLD usually reveals that these are deficient
in content (meaning) and pragmatics (function). Such over-use/dependence tends
to alienate others with the possible exception of those who find content-free,
random chatter appealing. The deployment of their limited pscholinguistic assets
at the wrong time or in the wrong place or situation does nothing to foster
adequate coping and adaptation. Under most circumstances, this practice leads
to any number of psychosocial difficulties. Also, avoidance of any practice of
skills directly related to visual-spatial abilities does nothing to develop
whatever potential capacities may be possible in this domain. This can contribute
to significant limitations in psychosocial adaptation.
(b) For persons who exhibit the syndrome of NLD, It should also be borne in
mind that factors other than--and /or in addition to--NLD may contribute to
psychosocial dysfunction in the individual case: That is, there may be genuine
comorbidities (see Questions #7,
#34, and #38 for some examples of these) and/or
particularly adverse environmental (including family) circumstances that contribute
substantially to nonadaptive psychosocial outcomes for those who exhibit the
syndrome of NLD. Deficits in the visual-spatial realm are usually not relevant in
the etiologies of these comorbidities, although they may constitute significant
limitations for adaptation in some socio-cultural mileux.
Bottom line. The probability that deficits in visual-spatial skills are the
primary cause of psychosocial dysfunction for persons with NLD approaches
zero. Although characterized as significant factors in the etiology of such
dysfunction in the NLD neurodevelopmental model, deficits in
visual-spatial-organizational skills are seen as only ONE of the important
interactive elements that play a role in the etiology of psychosocial
disturbance for persons who exhibit Definite or Probable NLD (see Question
#10 for characterizations of these levels of NLD).
It is also the case that (a) the vast majority of persons who have moderate
to severe visual-spatial deficits do not exhibit significant psychosocial
disturbance, and (b) many persons with NLD--including, of course, significant
absolute or relative deficits in visual-spatial-organizational skills--exhibit
reasonably adequate psychosocial skills within some socio-cultural milieux
(see Question #47). A thorough examination of the
NLD model and its supporting literature--with especial attention to the
distinction between correlation and causation-- should disabuse the
disinterested investigator regarding any validity that some accord to the misconception under consideration.
References cited and some related readings
Fuerst, D. R., Fisk, J. L., & Rourke, B. P. (1990). Psychosocial functioning
of learning-disabled children: Relations between WISC Verbal IQ-Performance IQ
discrepancies and personality subtypes. Journal of Consulting and Clinical
Psychology, 58, 657-660.
Fuerst, D. R., & Rourke, B. P. (1995). Psychosocial functioning of children with
learning disabilities at three age levels. Child Neuropsychology, 1,
Harnadek, M. C. S., & Rourke, B. P. (1994). Principal identifying features of the
syndrome of nonverbal learning disabilities in children. Journal of Learning
Disabilities, 27, 144-154.
Pelletier, P. M., Ahmad, S. A., & Rourke, B. P. (2001). Classification rules for
Basic Phonological Processing Disabilities and Nonverbal Learning Disabilities:
Formulation and external validity. Child Neuropsychology, 7, 84-98.
Ralston, M. B., Fuerst, D. R., & Rourke, B. P. (2003). Comparison of the psychosocial
typology of children with below average IQ to that of children with learning
disabilities. Journal of Clinical and Experimental Neuropsychology, 25,
Rourke, B. P. (1982). Central processing deficiencies in children: Toward a
developmental neuropsychological model. Journal of Clinical Neuropsychology,
Rourke, B. P. (2005). Neuropsychology of learning disabilities: Past and future.
Learning Disabilities Quarterly, 28, 111-114.
Rourke, B. P., Ahmad, S. A., Collins, D. W., Hayman-Abello, B. A., Hayman-Abello,
S. E., & Warriner, E. M. (2002). Child-clinical/pediatric neuropsychology: Some
recent advances. Annual Review of Psychology, 53, 309-339.
Rourke, B. P., & Fuerst, D. R. (1992). Psychosocial dimensions of learning disability
subtypes: Neuropsychological studies in the Windsor Laboratory. School Psychology
Review, 21, 360-373.
Rourke, B. P., & Fuerst, D. R. (1996). Psychosocial dimensions of learning disability
subtypes. Assessment, 3, 277-290.
Rourke, B. P., Hayman-Abello, B. A., & Collins, D. W. (2003). Learning disabilities:
A neuropsychological perspective. In R. S. Schiffer, S. M. Rao, & B. S. Fogel (Eds.),
Neuropsychiatry (2nd ed., pp. 630-659). New York: Lippincott, Williams, & Wilkins.
Rourke, B. P., & Tsatsanis, K. D. (1996). Syndrome of Nonverbal Learning Disabilities:
Psycholinguistic assets and deficits. Topics in Language Disorders, 16,
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., Fuerst, D. R., & Rourke, B. P. (1997). Psychosocial dimensions of
learning disabilities: External validation and relationship with age and academic
functioning. Journal of Learning Disabilities, 30, 490-502.
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.