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Questions and Answers
Question # 47
Is psychosocial dysfunction one of the defining characteristics of NLD?
Short answer: No.
Persons with NLD are at risk for the development of psychosocial
dysfunction. Although most persons with NLD come to exhibit significant
degrees of psychosocial dysfunction and psychopathology, many do not.
The following should be borne in mind:
| (1) |
In the NLD/White Matter model, psychosocial
dysfunction is characterized as a dependent--not an independent/antecedent--
variable/dimension (see NLD Content and
Dynamics and Question #3 and
#18). |
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| (2) |
Many persons with NLD exhibit no or relatively
mild forms of psychopathology. In most of these instances, it is found that the
family, school, and community environments are conducive to the kind of structure
and predictability that persons with NLD require. Significant difficulties in
dealing with novelty constitute a primary causative factor in the NLD/White Matter
neurodevelopmental model (see Questions #4,
#33, #34, and #38). Thus, it should
come as no surprise that supportive and highly structured social environments (such
as the monastic life and other vocations that include rather predictable routines
and few adaptive psychosocial demands) would be ideal for the person with NLD.
In a word, the less novel the performance requirements, the less likely the
development/emergence of psychopathology, and the more likely that adaptive behaviour
will be encouraged/enhanced (see Question #40). |
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| (3) |
Related to (2), the incidence and severity of
psychosocial dysfunction for persons with NLD increases with increasing age. This is
probably because of the unfolding developmental demands for dealing with increasing
complexity and novelty in social, educational, and vocational pursuits with advancing
age. One important implication of this is that the use of psychosocial dysfunction
as a defining characteristic of persons with NLD at all ages would exclude many younger
persons with NLD from studies of the NLD syndrome (see Question
#3). The increasing incidence of Depression with advancing age is one example of
this (see Question #38). Another example of the faulty
application of inclusion/exclusion criteria: Use of a Verbal IQ-Performance IQ
discrepancy of 10 or more points (favouring Verbal IQ) as a criterion for selecting
youngsters with NLD for study would exclude some 30% of 7- and 8-year-old children
with NLD. Use of this criterion for the selection of 9- to 15-year olds with NLD
would be expected to exclude some 73% from study (see Question
#10 and #11). |
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| (4) |
Attention Deficit Disorder is another example
of the manifestations of psychosocial dysfunction in youngsters with NLD that are
expected to change over time. In this case, the apparent “disorder” declines with
advancing age, with or without pharmacological or other forms of intervention (see
Question #7). These “changes” in “symptoms” of supposed
ADD are real enough, but their support for changes in diagnosis are illusory: The
“attentional deficit” exhibited by younger children with NLD is modality-specific:
that is, it applies only to material presented through the tactile and visual
modalities, not the auditory modality. When the somatosensory and visual modalities
become less important avenues for information delivery and the auditory modality
becomes far more important in the academic sphere, the apparent ADD of youngsters
with NLD “disappears” (see Question #26) |
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Bottom Line. The reliable and valid classification of youngsters with NLD
does not include psychosocial dysfunction (see Question #10).
That said, it is clear that the neurodevelopmental dynamics of NLD put youngsters at
risk for the development of psychopathology. This “at risk” status is not shared
by youngsters who exhibit BPPD (see Question #1,
#3 and #18).
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Related issue. There is some evidence of “over-diagnosis” of NLD (see Question
#17). One reason for this appears to be clinical reasoning
based upon this non-sequiter: All apples (NLD) are fruit (psychosocially disturbed),
therefore all fruit are apples.
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Clinical Implications.
(1)Although the emergence of psychosocial difficulties in persons with
NLD is fairly predictable, there can be wide variability in the individual
manifestations of this neurodevelopmental pattern. This has very important
implications regarding treatment planning for persons who exhibit the syndrome
of NLD (see Question #31). This is especially the
case for the fluid/nuanced choice and orchestration of effective skill-learning
programmes (see Question #16 and
#21).
(2) Contrary to the widely held notion that
it is the “overprotectiveness” of parents of persons with NLD that causes
psychosocial dysfunction in their children (see Question
#20), it is family structures that are chaotic and/or given to laissez-faire
notions of parenting that are quite antithetical to the psychosocial needs of
youngsters with NLD.
References. The principal investigative sources
relevant to these issues are spread in the References section of Question
#18 and some of the Questions cited above.
Tsatsanis, K. D., & Rourke, B. P. (2008). Syndrome of Nonverbal
Learning Disabilities in adults. In Wolf, L. E., Schreiber, H.E., & Wasserstein,
J (Eds.), Adult learning disorders: Contemporary issues. (pp. 159-190).
New York: Psychology Press.
Addendum/Caveat
Culturally Patterned Defect. This notion, explored by
E. Fromm and others, is relevant within this context. The “defect” reflects the
inability of persons to adapt to a set of novel social/economic/political
circumstances to which they are unaccustomed. It implies that they cannot adapt
because previous learnings and current capacities for countenancing change are
inadequate for coping within the new environment. In a sense, it refers to the
very simple notion of “a fish out of water” – i.e., lacking the wherewithal to
cope with a very different set of demands (in the case of the fish, of the
extra-aquarial variety). So long as the fish stays submerged and the person
with NLD stays in his supportive environment, everything is fine. The “defect”
is seen only when these environmental supports are absent, and especially when
they are removed in a sudden manner. What is expected of the person with NLD
in such circumstances are any number of negative psychosocial reactions (e.g.,
panic attacks; see Question #33).
In fine, the “defect” is present but not evident in the
supportive environment (e.g., the monastery or protective family), and is seen
only when a very novel set of environmental demands obtains. In this sense,
psychosocial deficiencies may well be nascent in the person with NLD, but do
not emerge unless novel circumstances and new coping demands become necessary
(see Question #4). In view of this, psychosocial
difficulties may very well be part of the personality profile of the person
with NLD, but these will probably not become evident unless and until
environmental demands change and support systems are withdrawn.
Thus, making psychosocial dysfunction one of the “defining
characteristics” of NLD may rule out many persons (especially the young) from
consideration and study. Because they are still in an environment that
essentially masks (through compensatory supports) their “defect.” And, as
the defect is not evident, they may not receive the sort of intervention that
will be of assistance to them in their futures outside of their supportive
environments.
Finally, there is a tendency in our society to adopt without
question the following precept: “If it ain’t broke, don’t fix it.” Unfortunately
for persons with NLD, much might be “broke” (e.g., neuropsychological assets and
deficits crucial for psychosocial development) but will not be deemed as in need
of any sort of “fix.” And, much that appears to be “broke” (e.g., single-word
reading) may need no “fix” at all (see Questions #26,
#28, #31, and
#38).
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