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?

Answer

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, 38-55.

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, 255-273.

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

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, 30-44.

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.