Nonverbal Learning Nonverbal Learning Disabilities Disabilities - - PowerPoint PPT Presentation

Nonverbal Learning Nonverbal Learning Disabilities Disabilities

• NLD overview

NLD overview

• Examination of an Intervention Used to Improve

Examination of an Intervention Used to Improve Visual Working Memory Visual Working Memory

• Hypothesized Intervention to Improve Social

Hypothesized Intervention to Improve Social Competency Competency

• By Amanda Lee, Jason Parker & Shelley Vainshtein

By Amanda Lee, Jason Parker & Shelley Vainshtein

Overview of NLD Overview of NLD

• General Features

General Features

• Pluralistic population

Pluralistic population

• Etiological uncertainty

Etiological uncertainty

• Relative dearth of research

Relative dearth of research

• Areas of Strength

Areas of Strength

• Above average verbal skills

Above average verbal skills

• Strong rote memory

Strong rote memory

• Become experts on subjects

Become experts on subjects

• Follow the rules (sometimes to a fault)

Follow the rules (sometimes to a fault)

• Correlation with high intelligence and NLD

Correlation with high intelligence and NLD

Overview of NLD (cont Overview of NLD (cont’ ’d) d)

• Areas of Weakness

Areas of Weakness

Visual-spatial recognition/perception skills Attention/focus/processing speed Social skills (e.g. pragmatic language, expressive

language, nonverbal communication, semantics)

Emotional stability (advanced risk for suicide) Executive functioning (e.g. organization, planning,

prioritizing)

Reading comprehension Rigidity (i.e. poor adaptability) Fine and gross motor skills

Overview of NLD (cont Overview of NLD (cont’ ’d) d)

Practical Examples

Locker/desk/nap sack Lost in the hallway and playground Social isolation Copying from the board Written work and phonetic spelling Lots of questions Bullying Linear objects

Overview of NLD (cont Overview of NLD (cont’ ’d) d)

More than Just a Learning Disability

Co-morbidity with behavioural and psychological

pathologies

NLD with: processing speed disorder, ADHD, OCD,

OCPD (perhaps maladaptive perfectionism), Tourette’s syndrome, Anxiety disorders, ODD, clinical depression, substance abuse, bipolar

greater risk for physical injury greater risk for stress related diseases (e.g.

hypertension, stroke, heart attack, depression)

Evidence

• Mammarella, I .C., Cornoldi, C., Pazzaglia, F., Toso, C.,

Mammarella, I .C., Cornoldi, C., Pazzaglia, F., Toso, C., Grimoldi, M., & Vio, C. (2006). Evidence for a double Grimoldi, M., & Vio, C. (2006). Evidence for a double dissociation between spatial dissociation between spatial-

• simultaneous and spatial

simultaneous and spatial-

• sequential working memory in visuospatial (nonverbal)

sequential working memory in visuospatial (nonverbal) learning disabled children. learning disabled children. Brain and Cognition Brain and Cognition, 62, 58 , 62, 58-

• 67.

67.

• Initial study to prove difference between spatial

Initial study to prove difference between spatial-

• simultaneous and

simultaneous and spatial spatial-

• sequential working memory in individuals with NLD

sequential working memory in individuals with NLD

• Discusses the importance of distinguishing between these process

Discusses the importance of distinguishing between these processes es within the visuospatial working memory within the visuospatial working memory

• Distinction between sequential and simultaneous processes may

Distinction between sequential and simultaneous processes may contribute to the further understanding of working memory contribute to the further understanding of working memory

• Further research is necessary

Further research is necessary

Simultaneous Simultaneous-

• Spatial

Spatial Working Memory Working Memory

Mammarella, I .C., Coltri, S., Lucangeli, D., & Cornoldi, C. (200 Mammarella, I .C., Coltri, S., Lucangeli, D., & Cornoldi, C. (2009). 9). I mpairment of simultaneous I mpairment of simultaneous-

• spatial working memory in

spatial working memory in nonverbal (visuospatial) learning disability: A treatment case nonverbal (visuospatial) learning disability: A treatment case study.

• study. Neuropsychological Rehabilitation, 19 (5),

Neuropsychological Rehabilitation, 19 (5), 761 761-

• 780.

780.

• Literature

Literature

• Intact verbal but impaired visuo

Intact verbal but impaired visuo-

• spatial abilities

spatial abilities

• Types of deficits include: visuo

Types of deficits include: visuo-

• spatial

spatial

• rganizational, psychomotor, tactile
• rganizational, psychomotor, tactile-
• perceptual,

perceptual, non non-

• verbal problem solving skills, visuo

verbal problem solving skills, visuo-

• spatial

spatial working memory deficits working memory deficits

Visuo Visuo-

• Spatial Working Memory

Spatial Working Memory

• Working memory for manipulating visual

Working memory for manipulating visual and spatial info and spatial info

• These areas activate different areas of the

These areas activate different areas of the brain and may be separate components brain and may be separate components

Aim Aim

• Test the efficacy of a visuo

Test the efficacy of a visuo-

• spatial

spatial memory treatment for a child with NLD memory treatment for a child with NLD

• Specifically could this child improve on

Specifically could this child improve on visuo visuo-

• spatial working memory (VSWM)

spatial working memory (VSWM) after training in this area after training in this area

Subject Subject

• 11 year old with a diagnosis of NLD

11 year old with a diagnosis of NLD

• Grade six in Italy

Grade six in Italy

• School reported concerns with: recalling

School reported concerns with: recalling the positions of objects, orientation the positions of objects, orientation around the school, and remembering the around the school, and remembering the locations of familiar landmarks locations of familiar landmarks

Assessment Assessment

• Visuo

Visuo-

• spatial Battery (BVS)

spatial Battery (BVS)

• 9 computerized tests

9 computerized tests

• These assessed visual, sequential

These assessed visual, sequential-

• spatial,

spatial, and simultaneous and simultaneous-

• spatial components

spatial components

• Had to indicate whether the slide was the

Had to indicate whether the slide was the same as the one previously presented same as the one previously presented

• Test progress through a hierarchy starting

Test progress through a hierarchy starting with two objects up to eight objects with with two objects up to eight objects with three repetitions at each level three repetitions at each level

Assessment Assessment

• Half the responses at each level were the

Half the responses at each level were the same, the other half were different same, the other half were different

• Presentation of slides was timed

Presentation of slides was timed

• Final score is the sum of the last three

Final score is the sum of the last three correct questions correct questions

• Results were compared to a normative

Results were compared to a normative sample sample

Visual Memory Assessment Visual Memory Assessment

• Nonsense shapes task

Nonsense shapes task

• Little fish recognition task

Little fish recognition task

• Toy balloons recognition task

Toy balloons recognition task

Sequential Sequential-

• Spatial Assessment

Spatial Assessment

• Sequential light

Sequential light-

• bulbs recognition task

bulbs recognition task

• Sequential lines test

Sequential lines test

• Dot matrix sequential test

Dot matrix sequential test

Simultaneous Simultaneous-

• Spatial

Spatial Assessment Assessment

• Simultaneous light

Simultaneous light-

• bulbs recognition task

bulbs recognition task

• Simultaneous lines test

Simultaneous lines test

• Dot Matrix Simultaneous test

Dot Matrix Simultaneous test

Assessment Assessment

• Child scored below the mean on spatial

Child scored below the mean on spatial-

• simultaneous tests

simultaneous tests

• Simultaneous light

Simultaneous light-

• bulb recognition task

bulb recognition task

• Simultaneous lines test

Simultaneous lines test

Treatment Treatment

• Designed to improve child's ability to

Designed to improve child's ability to memorize simultaneous memorize simultaneous-

• spatial material

spatial material

• Conducted over seven sessions within one

Conducted over seven sessions within one month month

• 40 minutes of playing games

40 minutes of playing games

• 10 minutes of discussing strategies with a

10 minutes of discussing strategies with a trainer and providing a metacognitive trainer and providing a metacognitive briefing to the child where strategy briefing to the child where strategy efficacy was discussed efficacy was discussed

Treatment Treatment

• Strategies discussed include:

Strategies discussed include:

• Chunking

Chunking

• Verbalization of stimuli

Verbalization of stimuli

• Mental imagery

Mental imagery

• Three phases of training: memory

Three phases of training: memory recognition, memory recall, and everyday recognition, memory recall, and everyday memory memory

Treatment Treatment

• Memory recognition:

Memory recognition:

• Sessions 1

Sessions 1-

• 3

3

• Session 1

Session 1-

• recognize location of objects after

recognize location of objects after being read a story (point to correct picture in being read a story (point to correct picture in booklet) booklet)

• Session 2

Session 2-

• answer simple questions about

answer simple questions about location of objects from a story location of objects from a story

• Session 3

Session 3-

• answer simple questions about

answer simple questions about location of landmarks from a story location of landmarks from a story

Treatment Treatment

• Memory recall

Memory recall

• Sessions 4

Sessions 4-

• 6

6

• Same as above but the child had to recall

Same as above but the child had to recall rather than recognize rather than recognize

• Everyday memory

Everyday memory

• Session 7

Session 7

• Maps of cities with landmarks were shown

Maps of cities with landmarks were shown

• Child had to recall locations of landmarks

Child had to recall locations of landmarks

Results Results

• Child was retested on BVS battery after

Child was retested on BVS battery after treatment and 6 months later treatment and 6 months later

• He improved significantly but was still

He improved significantly but was still below the mean below the mean

• Results were maintained at follow

Results were maintained at follow-

• up

up

Limitations Limitations

• Small sample size

Small sample size

• Would children in different countries

Would children in different countries respond to intervention respond to intervention

• Are results generalizable to academic

Are results generalizable to academic achievement achievement

Evidence

• Fisher, N.J., & DeLuca, J.W. (1997). Verbal Learning Strategies

Fisher, N.J., & DeLuca, J.W. (1997). Verbal Learning Strategies of

• f

Adolescents and Adults with the Syndrome of Nonverbal Learning Adolescents and Adults with the Syndrome of Nonverbal Learning Disabilities.

• Disabilities. Child Neuropsychology

Child Neuropsychology, 3(3), 192 , 3(3), 192-

• 198.

198.

• Individuals with NLD have highly developed rote verbal skills

Individuals with NLD have highly developed rote verbal skills

• Sample:

Sample:

• 7 individuals with NLD (4 children, 3 adults)

7 individuals with NLD (4 children, 3 adults)

• 7 individuals with VLD (4 children, 3 adults)

7 individuals with VLD (4 children, 3 adults)

• Test:

Test:

• Recalling grocery list A (5 different types of fruit, toys and c

Recalling grocery list A (5 different types of fruit, toys and clothing) lothing)

• Recalling grocery list B (5 different types of fruit, desserts a

Recalling grocery list B (5 different types of fruit, desserts and nd household items) household items)

Evidence

Individuals with NLD performed within average

range for serial but not semantic clustering

Serial clustering: 2 consecutive items in the

same order as they appeared on the shopping list

Semantic clustering:2 consecutive responses

from the same semantic category

These results translate into a an individual with

NLD taking a passive/unorganized approach to verbal learning strategies

Evidence

• Tuller, B., Jantzen, K.J., Olvera, D., Steinberg, F., & Kelso, S.J.A.

(2007). The I nfluence of I nstruction Modality on Brain Activation in Teenagers with Nonverbal Learning Disabilities: Two Case

• Histories. Journal of Learning Disabilities, 40(4), 348-359.
• Sample:

2 teenage participants with NLD 2 typically developing teenage participants – no known learning

disorder

• Tests:

2 identical conditions; differing of mode of instruction (verbal vs.

tactile)

Evidence

Results:

Brain area was affected for those with NLD

but not the controls; based on instructional mode

Individuals with NLD showed more errors with

tactile instruction

Brain patterns suggest that individuals with

NLD may use silent verbalization to help rehearse information that is given to them in a non verbal format

Evidence

• Foss, J.M. (1991). Nonverbal Learning Disabilities and Remedial

I nterventions. Annals of Dyslexia, 41, 128-140. Tutor and student work side by side to teach the

student how to gain meaning from written word, verbal instruction or social situations

Goal:

Learn strategies to be generalized Learn to silently analyze and verbalize situation in

• rder to compute it

Evidence

Elements of Effective intervention: Explicit direct instruction Association of verbal and non verbal

aspects

Use of verbal skills to analyze situations

Hypothesized I ntervention

Social Competence I ntervention Program

SCIP published by Guli, Wilkinson and Semrud-

Clikeman in 2008

Drama based intervention program for youth on the

Autism spectrum, but also relevant for NLD and ADHD

First published initial research back in 2000 Eventually was the basis for doctorate by Guli in 2004 Very well grounded in evidence based research Program was developed and piloted at University of

Texas at Austin

Hypothesized I ntervention (cont (cont’ ’d) d)

SCI P Overview

16 session, divided into 3 segments:

1) I nput – emotional knowledge, facial

expressions vocal cues

2) I ntegration – when cues do not match, point

• f view, understanding interactions

3) Output – becoming fluent in conversation,

dealing with teasing, review

Hypothesized I ntervention (cont (cont’ ’d) d)

Program Limitation

Target population is 8 to 14 years old

Early intervention key, not just academically but

socially

Almost every article we have read in HDAP 1285

underscores the benefits to early intervention

By age 8, a child may already be socially isolated,

typecast and vulnerable to teasing and bullying

Hypothesized I ntervention (cont (cont’ ’d) d)

Hypothesized Program

Remedies to SCIP

Add two new stages to program:

pre-school and K-2

Reduce length and number of sessions Adapt program content to each new stage

Thank You