A VISUAL-PROCESSING DEFICIT IS THE INABILITY TO INTERPRET, ORGANIZE, ANALYSE OR SYNTHESIZE A VISUAL MESSAGE IN THE ABSENCE OF A VISUAL IMPAIRMENT.
In our schooling system that is very much language oriented it is much more frequent that children with language differences will be recognized. Those who are proficient with language generally do well in our system and are well rewarded with success. And likewise, a student who is a top reader, achieves excellent spelling scores, and expresses herself articulately usually does not prompt her teacher to consider a learning disorder. This is often exactly the presentation a child with nonverbal learning difficulties manifests in the early elementary grades.
The NLD syndrome reveals itself in impaired abilities to organize the visual-spatial field, adapt to new or novel situations, and/or accurately read nonverbal signals and cues. It appears to be the reverse syndrome of dyslexia. Although academic progress is made, such a student will have difficulty "producing" in situations where speed and adaptability are required.
Etiology: Whereas language-based learning disorders have been shown to be genetic in origin, heredity has not, as yet been linked to NLD. It is known that nonverbal learning disabilities involve the performance processes (generally thought of neurologically as originating in the right cerebral hemisphere of the brain, which specializes in nonverbal processing). Brian scans of individuals with NLD often confirm mild abnormalities of the right cerebral hemisphere. Developmental histories have revealed that a number of the children suffering from nonverbal learning disorders who have come to clinical attention have sat some time early in their development: (1) sustained a moderate to severe head injury, (2) received repeated radiation treatments on or near their heads over a prolonged period of time, (3) congenital absence of the corpus callosum, (4) been treated for hydrocephalus, or (5) actually had brain tissue removed from their right hemisphere.
Incidence: Such disorders appear much less frequently than language-based learning problems. Whereas it is approximated that about 10% of the general population could be found to have identifiable learning disabilities, it is thought that only 1 to 10 % of those individuals would be found to have visual-spatial problems. It affect females as often as males and incidence of left-handedness is uncommon. The characteristics are distinct and are apparent early in a child's development.
Identification: Early consultation with a school psychologist or family physician typically only serves to dismiss or minimize a teacher's or parent's worries about this child. More often than not, parents are assured that everything is fine; perhaps their child is 'just a perfectionist" or "immature" or "bored with the way things are normally done" or "a bit clumsy." Rarely are a parent's or teacher's concerns given any credence until the child reaches a point in school where he/she is no longer able to function given the limitations of the disability or in some cases, the child suffers a "nervous breakdown".
Whereas language-based disabilities are usually readily apparent to parents and educators, nonverbal learning disorders routinely go unrecognized. Many of the early symptoms instill pride, rather than alarm, in parents and teachers who ordinarily applaud language-based accomplishments. This child is extremely verbose and may "speak like an adult" at two or three years of age. During early childhood, he is usually considered gifted by his parents and teachers. The student is usually eager, enthusiastic learner who quickly memorizes rote material, only serving to reinforce the notion of precocity.
Dr. Rourke has found that the characteristics of nonverbal disability are more apparent as the child grows older "less apparent at the age of 7 to 8 years… than at 10 to 14 years," and that they become progressively more apparent as adulthood approaches and much more debilitating.
The following list of characteristics describe children with this difficulty
- The student demonstrates a lack of coordination, severe balance problems and/or difficulties with fine graphomotor skills.
- Appears awkward and is inadequately coordinated in both fine and gross motor skills.
- May have extreme difficulty learning to ride a bike or kick a soccer ball.
- Fine motor skills such as using scissors or tying shoe laces are difficult.
- Produces limited written output and the process is always slow and laborious for them.
- Talks their way through, even simple motor activities.
- Learns little from experience or repetition and is unable to generalize information.
- Despite high IQ scores and high receptive and expressive language measures, the child may appear confused much of the time.
- If you have to say "I shouldn't have to tell you this" or "I've shown you this before", the child may have a visual -spatial difficulty.
- Talks too much. Needs to use language as her principal means of social relating, information gathering, and relief from anxiety.
- Avoids novelty. Needs all their attention and energy to get through a room.
- Visual-spatial organizational - lack of image, poor visual recall, faulty spatial perceptions, and/or difficulties with spatial relations.
- Social - lack of ability to comprehend nonverbal communication, difficulties adjusting to transitions and novel situations, and/or significant deficits.
- The student is restless during videos or visual presentations.
- The student has difficulty copying from the board, test paper, calculator or textbook to the student's own paper.
- The student's written copy may show missing figures or words, reversals, inversions, additions, deletions, or transpositions in letters or numbers.
- The student does not remember what he or she has read silently.
- The student rubs his or her eyes or complains that his or her eyes are bothering him or her. The eyes may be bothered because of the intensity needed to decipher the visual material.
- The student's reading level is below average.
- The student's oral reading comprehension is better than his or her silent reading comprehension. In math, the student is inattentive to function signs (plus, minus, multiply, divide), omits steps in a formula, or confuses visually similar formulas.
- The student is a poor written speller, but is an adequate oral speller.
- The student does not observe visual changes or stimuli that other children notice (e.g. bulletin board displays, posted notices in obvious places).
- The student's directionality is weak, and the student gets lost in unknown places, often copies numbers reversed, inverted or transposed from the original.
- The student's reading level is below average.
- The student's work shows persistent spelling errors.
- This child will have difficulty with internal and external organization and coordination. Tardiness is something he may struggle with and this should not be treated as misbehavior. Help this child by allowing him extra time to get places and by giving him verbal cues to navigate through space. Continually assess his understanding of spatial and directional concepts.
- Frequent criticisms of remedial intervention programs with this particular type of child is that the remedial authorities are unaware of the extent and significance of the child's deficits and emphasized that the principal impediment to engaging in this rather slow and painstaking approach to teaching the child with a visual-spatial difference is the caregiver's faulty impression that the child is much more adept and adaptable than is actually the case. Dr. Rourke also warns that "observers tend to overvalue the intelligence of NLD adolescents . . . and this is the principal reason for an unwillingness to adopt an approach to formal educational intervention that would increase the youngster's probability of success."
- Often inappropriate expectations are placed on the child. Expectations should be applied with flexibility, taking into consideration the fact that he/she has different needs and abilities than her peer group. ( progress is almost always further impeded by the virtual inability to reflect on the nature and seriousness of his/her own problems).
- Do not force independence on this child if you sense she is not yet ready for something (trust your instincts and be careful not to compare her with other children of the same age. It is detrimental to isolate the student, but don't make the mistake of thinking she can be left to her own resources when faced with new and/or complex situations. Give her verbal compensatory strategies to deal more effectively with novel situations. The world can be very scary for someone who is misreading 65% of all communication and she/he will naturally be reluctant to try new things. The social skill development of this child has been delayed by misconceptions which my have caused serious issues of insecurity to evolve.
- The myth of the overprotective mother needs to be dismissed; parents and professionals must both assume a protective and helpful role with the child with NLD. Care and discretion need to be taken to shield the child from teasing, persecution, and other sources of anxiety. Independence should be introduce gradually, in controlled, non-threatening situations.
- Never leave these children to their own devices in new activities or situations which lack sufficient structure. Avoid power struggles, punishment, and threatening. This child does not understand rigid displays of authority and anger. The goals and expectations assigned to him must be attainable and worthwhile. Taking away privileges will not cure a child of a neurological disability.
- Always assume the best - take a positive rather than a negative approach. Most behavior represents the child's own attempt at compensation. Supply appropriate more acceptable replacement behavior through a detailed verbal explanation. At least 90% of your interactions with this child must be positive in nature if you are to make gains!
- Active verbalization and/or sub-vocalization are the best memory approaches for this child.
- Test answer sheet layouts and the arrangement of visual-spatial math assignments need to be simplified (no credit should be lost for a correct answer placed in the wrong column or space). Whenever possible, use of graph paper is recommended to keep columns aligned in written math assignments or consumable math texts should be provided for this student.
- Paper and pencil tasks need to be kept to a minimum because of finger dexterity and visual-spatial problems. Occupational therapy is a consideration for the younger child. Verbally mediated practices to improve handwriting may result in improvements in control and fluency, but the process will remain laborious. Use of a computer word processor is highly recommended for all written school assignments, as the spatial and fine motor skills needed for typing are not as complicated as those involved in handwriting.
- The global confusions which underlie nonverbal learning disorders also result in limiting the student's ability to produce the quantity of written work normally expected of her grade-level peers. This child requires continuous assistance with organizing information and communicating in s=writing. Adjustments must be made in teacher expectations for volume of written products. Additional time will be needed for all written assignments.
- Tasks requiring folding, cutting with scissors, and/arranging material in a visual-spatial manner (maps, graphs, mobiles, etc.) will require considerable assistance, provided in an accommodating manner or they should be eliminated entirely.
- Any timed assignments will need to be modified or eliminated. Processing of all information is performed at a much slower rate when you are compensating for any type of cerebral dysfunction. Time constraints often prove to be counterproductive, as this student is easily overwhelmed by the unrealistic expectations of his teachers.
- Adults need to check often for understanding and present information in plain and clear verbal terms (spell out everything). A "parts-to-whole" verbal teaching approach should be utilized. This child will need to ask a lot of questions, as this is her primary means of gathering information.
- All expectations need to be direct and explicit. Don't require this child to "read between the lines" to glean you intentions. Avoid sarcasm, figurative speech, idioms, slang, etc., unless you plan to explain your usage. Write out exact expectations for any situation where the child may seriously misperceive complex directions and/or proper social cues. Feedback given to the student should always be constructive and encouraging or there will be no benefits derived.
- This student's schedule needs to be as predictable as possible. He/she should be prepared in advance for changes in routine, such as assemblies, field trips, minimum days, vacation days, finals, etc.
- This child needs to be assigned to one case manager at school who will oversee her progress and can assure that all of the school staff are implementing the necessary accommodations and modifications. In-service training and orientation for all school staff that promotes tolerance and acceptance is a vital part of the overall plan for success, as everyone must be familiar with, and supportive of, the child's academic and social needs.
- Cooperative learning situations when grouped with good role models will be a benefit.
- Watch for transition times in the day. This child will have trouble switching gears.
- Special presentation procedures need to be adapted for those subjects requiring visual-spatial-organizational and/or nonverbal problem-solving skills.
- Highlight or underline important phrases in the student's assigned reading.
- Assign fewer questions, but retain the level of difficulty given to an assignment.
- Have the student consistently use a word processor for written work.
- Reduce distracting visual stimuli in the classroom.
- Allow for extra time for written tasks.
- Provide copied notes.
- Allow the use of a calculator for math-related activities.
- Have the student use a sliding mask, finger, or ruler when reading.
- Use a scribe when necessary to record answers.
- Be aware of the difficulty associated with visual tasks such as matching.
- Provide a scribe for testing.
- Give extra time.
- Provide a model or example if possible.
- Provide oral testing.
- Be aware of the visual difficulty of particular test questions.
January 29, 2002