Professional Documents
Culture Documents
Objectives
Handwriting
Mathematics
Distractible
Perseveration
Disinhibition
Byron Rourke
Cognitive/Neuropsychological
Strengths
VIQ>PIQ by 10-15 pts or
more
Good receptive& expressive
language , High in
Similarities
Verbal Recognition,
Repetition, Associations,
Storage, Output
Auditory Perception
Verbal Attention & Rote
Memory
Focus on Details
Simple motor skills intact
Grip strength normal
Finger tapping average
Deficiencies
PIQ<VIQ, Block Design, Object Assembly,
Picture Arrangement& Coding
Bilateral Tactile Perception (more on left )
Finger localization, fingertip number
writing
Tactile Form Recognition & Memory
Bilateral Visual Perception
Visual Memory (particularly as figures
become more complex)
Visual discrimination/Visual figure ground
Visual spatial organizational abilities
Perseveration
Attention
Selective attention
Novel Material
Understanding the big picture
Concept Formation
Nonverbal Problem Solving
(1) Less than two errors on simple tactile perception and suppression vs. finger agnosia, finger
dysgraphesthesia, and astereognosis. Simple composite greater than 1 SD below the mean. Simple
tactile-perceptual skills are superior to complex tactile-perceptual skills.
(2) WRAT /WRAT -R standard score for Reading is at least 8 points greater than Arithmetic. Single
word reading is superior to mechanical arithmetic.
(3) Two of WISC/WISC- R Vocabulary, Similarities, and Information are highest of the Verbal scale.
Straightforward and/or rote verbal skills are superior to those involving more complex processing
(e.g., Comprehension).
(4) Two of WISC/WISC -R subtests Block Design, Object Assembly, and Coding subtests are the
lowest of the Performance scale. Complex visual-spatial-organizational skills and speeded eye-hand
coordination are impaired.
(5) Target Test at least 1 SD below the mean. Memory for visual sequences is impaired.
(6) Grip strength within one standard deviation of the mean or above vs. Grooved Pegboard Test
greater than one standard deviation below the mean. Simple motor skills are superior to those
involving complex eye-hand coordination, esp. under speeded conditions. (7) Tactual Performance
Test Right, Left, and Both hand times become progressively worse vis--vis the norms. Complex
tactile-perceptual and problem-solving skills under novel conditions are impaired.
(8) WISC/WISC -R VIQ > PIQ by at least 10 points. Verbal skills are superior to visual-spatialorganizational skills.
The following criteria are currently under investigation:
7 or 8 of criteria = definite NLD
5 o 6 of criteria = probable NLD
3 or 4 of these criteria - Questionable NLD
1 or 2 of these features: Low Probability of NLD
Drummond, C. R., Ahmad, S. A., & Rourke, B. P. (2005). Rules for the classification of younger children with Nonverbal Learning Disabilities and Basic Phonological
Processing Disabilities. Archives of Clinical Neuropsychology, 20, 171-182.
Academic Assets
Graphomotor (late)/Word Decoding
Spelling/ Verbatim Memory
Socioemotional Assets
Academic Deficit
Graphomotor (Early)/Reading Comprehension
Mechanical Arithmetic/Mathematics
Science
Socioemotional Adaptive Deficits
Adaptation to Novelty/Activity Level
Social Competence/Emotional Stability
4 Subtypes of NLD
3. Visualspatial
Executive
Functionin
g
Significant
Academic
Problems
1. Visual Spatial
Executive functioning
Mild social &
Academic
Difficulties
2 types
Executive novel problem solving - frontal
Posterior visual-spatial holistic problem
solving- right hemisphere
Attention
Executive Functioning
Hypothesis generation
Flexible problem solving;
Self-monitoring;
Behavior regulation;
Integration of emotion with context
Visual Perception;
Scanning-Tracking;
Figure-ground disturbance
Visual-spatial
Constructional
Sensory-Motor Deficits
Tactile-Kinesthetic;
Tactile Defensiveness;
Motor Sequencing,
Strength
Gross motor coordination (skipping, bike riding, jump
roping)
Fine Motor coordination (handwriting, coloring,
cutting, tracing, fastening, fine motor speed &
dexterity)
Complex psychomotor tasks,
Language
Receptive
May
not
understand
social
Nuances
in
conversation
(lack
of
tact)
Problem
s
decodin
g
prosodic
or
vocal
intonation
s
Problems
reading
facial
expressio
ns and
gestures
May
lack
sense
of
humor
Concrete
interpretation
of
metaphors
Expressiv
e
Good
vocabular
y
Lack
of
gestures,
facial
expressions
or
vocal
intonations
Social Deficits
Problems
forming
friendships
Rigid,
rule-bound
Problems
forming
close
personal
attachments
Socially
awkward &
inappropriate
Difficulty
reading
social cues
Disruptive
play
Problems
with
interpersonal
intimacy
Bossy,
aggressive
& defensive
with peers
Problems
with
adaptability
Emotional
At risk for internalizing problems, e.g., anxiety &
depression (Rourke, 1989; Little, 1993)
Depression (Cleaver & Whitman, 1998) Children with
sxs of right hemisphere white matter dysfunction had
arithmetic difficulties and showed significant levels of
depression
Petti et al. (2003) found that children with NLD had a
higher percentage of internalizing diagnoses among
children at psychiatric treatment facilities.
Higher risk for suicidal behavior as compared to other
LDs (Rourke,1989; Bigler,1989; Fletcher, 1989;
Kowalchuk & King,1989) -based on extremely small
Emotional
Co-morbidity- ADHD
Lack of empathy
or compassion
Self critical,
perfectionistic,
lack selfconfidence
Anxious, worried
Increased risk
for depression
& suicide
Problems
modulating
affect
Easily
frustrated, loses
control
Academic
Assets
May initially have trouble
with letter or number
recognition & learning
letter-sound relationships
then become good
readers
May lose place in rdg.
Good spelling skills
Average or above
average in verbal
language skills
Good syntax
Good rote memories
Problems generating
ideas for essays, but
Deficits
Arithmetic (rarely achieve >6th grade level,
even as adults (Rourke, 1995), number
alignment
Word problems (money, msmnt., esp. time
calendar & clock);
Quantitative analysis & size, weight &
distance estimation
Physics , Hypothesis testing
Organization
Spatial representation of abstract nonverbal
concepts (graphs, diagrams)
Written expression early problems with
orthograhic identification of letters spelling,
graphomotor tactile and constructional
deficits that affect legibility & accuracy
Reading comprehension for complex
reading material (e.g., main idea &
inferences),problems understanding
characters/motives
Story Retelling, question response (Worling,
Humphries, & Tannock, 1995)
Handwriting
Assets
Liabilities
Sensory-Motor
Auditory-Verbal
Tactile-Kinesthetic; Tactile
Defensiveness; Motor Sequencing,
Coordination, strength
Attention
Sustained Auditory;
Rote Recall, Verbal
Visual-Spatial
None
Language
Verbal
Comprehension;
phonological;
Expressive,
receptive, and
repetitive
Auditory-Verbal;
Visual Immediate, Working; Delayed,
Learning & Memory Recognition, Visual-Verbal Learning;
for Rote Information Tactile-Kinesthetic Learning and
Memory; Location Memory
Asset
Liability
Executive
Speed &
Efficiency of
Cognitive
Processing
Academic
Achievement
Mechanical Arithmetic;
Science; Writing; Gist
Reading Comprehension
Social-Emotional
Language Pragmatics;
Nonverbal Cues & Behavior;
Social Judgment
F. Strength in rote verbal memory (e.g., reciting the alphabet). Intelligence may be overestimated.
G. Deficits in perception and attention in both the visual and tactile domains.
I. Initial problems in oral-motor praxis, and longstanding, mild difficulties in pronouncing complex,
polysyllabic words.
Problems in arithmetic.
E. Fine motor problems, coloring, cutting,& handwriting in early school years, often improving to normal levels but
only with considerable practice.
F. Deficient social perception, social judgment, and social interaction. Poor perception & comprehension /
interpretation of facial expressions of emotion, and marked deficits in providing non-verbal communication signals.
G. May develop stress, anxiety, obsessional preoccupation, depression, self esteem, attentional problems (Palomobo
& Berenberg, 1999)
H. With advancing years, a tendency to become normoactive and then hypoactive. Problems in "attention" in formal
and informal learning environments tend to disappear as the situational stimulus and response demands become
more verbal in nature.
B.
C.
D.
E.
F.
Etiology
Hydrocephalus
Turners Syndrome
Fragile X
Aspergers Syndrome
leukomalacia
spina bifida
Etiology
Etiology
Filley, 2001
the NLD syndrome remains a theoretical construct,
and there is little documentation of right hemisphere
damage in white (or gray) matter in children with this
disability (p. 262).
the relevance of the NLD syndrome to the behavioral
neurology of white matter must remain conjectural
(p. 204).
careful correlation with neuroradiologic or
neuropathologic data [is necessary] . . . to confirm or
deny that white matter pathology is in fact present (p.
262).
Etiology
Aspergers Syndrome
History
Lorna Wing, MD
British psychiatrist
Coined the term Aspergers syndrome &
proposed formal diagnostic criteria
1979 conducted an epidemiological study in
London
Triad of Impairments:
Impairment of social interaction
Impairment of social communication
Impairment of social imagination, flexible
thinking and imaginative play
Diagnostic Criteria
C.
AS - Social Impairments
May not like
physical contact
Inability to engage
in appropriate play
Extremely
egocentric; selfcentered
Socially awkward
Failure to develop
developmentally
appropriate peer
relationships
Lack of
spontaneously
seeking enjoyment
Difficulty
understanding
other peoples
expressions &
feelings
AS - Motor Impairments
Odd Motor
Mannerisms
Delayed
Acquisition of
Motor Skills
Poor
Manipulative
skills
Impaired
mirror-image
imitation
Poor
Coordination
& Balance
AS - Sensory Impairments
Sensitivity to
Pain and
Temperature
Visual
Sensitivity to
Certain Colors
Sensitivity to
taste and
texture of food
Tactile
Sensitivity
Synaesthesia
A sensation in one sensory system
and as a result experiences a
sensation in another modality
Colored hearing seeing colors
when hearing a sound
AS Language Impairments
Adult like
speech/little
professors
Lack of tact
Poor prosody,
monotone, strange
intonation, rate (too
fast), volume (too loud),
poor fluency.
Difficulty understanding
metaphors/idioms/jokes
Echolalia
Emotional Co-morbidities
Eating Disorders
Depression
ADHD
Substance Use
ODD
Bipolar
Anxiety
(GAD, PTSD, Social
Phobias, Phobias,
OCD, PTSD
Other Co-morbidities
Seizure
Disorders
Tourettes
& Tics
Developmental
Coordination
Disorder
Learning
Disabilities
Hyperlexia
Other Characteristics
Rigidity in rituals
& routines
Above Average
Rote Memory
Executive
Function Deficits
Intense Interest
in circumscribed
subjects
NLD & AS
NLD & AS
NLD vs. AS
Palumbo (2001)- hypothesized that AS & NLD
could be 2 different subtypes of the same
syndrome
Children with Aspergers Syndrome have more
profound social difficulties than children with
developmental NLD (Thompson 1997).
NLD & AS could be on a continuum of severity
ranging from NLD to Aspergers and finally
autism (Roman, 1998)
NLD vs. AS
Children with Aspergers Syndrome typically
have restricted interests, where they
become obsessed with unusual interests
(Stein, Klin, & Miller 2004,
The presence of stereotyped and restricted
patterns of interest and the need to adhere
to routines present in children with AS but
not NLD (Semrud-Clikeman, 2007).
NLD vs. AS
NLD & AS
NLD vs. AS
NLD
Aspergers
diagnosed from
neuropsychological perspective
Psychological test scores
learning disability, discussion of
how children learn
Prevalence
NLD
.1 1%
10% (Ozols & Rourke,
1991
25% (Bender & Golden,
1990
29% (Van der Vluat, 1989)
Higher or equal rates in
females
1:1
Recognized in 4th & 5th
grades
AS
1-10 in 10,000
Higher rates in
Males
Recognized
around 3-4 yrs.
of age
Neuropsychological
NLD
AS
Visual-spatial perception
Nonverbal concept
formation
Attentional problems
Visual Motor
NLD
Psychomotor coordination
problems
Clumsy, poor at sports
Delayed Gross Motor
Milestones
Fine Motor difficulties,
drawing, handwriting
(Frankenberger, 2005)
Avoidance of graphomotor
tasks
Difficulties dressing, problems
with fasteners
Poor organizational skills
May not learn from diagrams,
need verbal explanations (Fast,
2004)
AS
Psychomotor
coordination problems
Clumsy
Fine and Gross Motor
delays (Tantam, 1988; Gillberg,
1990)
Stereotypic motor
mannerisms (Mamen, 2007)
Do not have visual
issues & may be visual
learners (Fast, 2004)
Language
AS
Verbal >performance
Verbal >Performance
Poor prosody
Monologues
NLD
Poor prosody
Lack of appreciation of
incongruities and humor
Literal interpretation
Academics
NLD
Significantl
y
delayed
arithmetic
skills
(Rourke, 1989;
1995; Rourke &
Conway,
1997))
AS
Average
or above
word
reading
Delays
in
reading
compre
hensio
n
Difficulties
in
written
expression
Inconsiste
nt reports
of
arithmetic
performan
ce (some
show good
math skills
(Kuipers, 1962)
Reading
relatively
intact,
may be
voracious
readers
Social
NLD
Social delays
Problems developing
friendships
At risk for peer
rejection
Poor social
perception, judgment
& interaction
Problems in empathy
Automatized
stereotyped ways of
(Little, 2001)
AS
Social delays
Problems developing
friendships
At risk for peer rejection
(Little, 2001)
Withdrawal in NLD
is reactive
Primary in
Aspergers
Emotional
NLD
AS
Emotional problems
(internalizing anxiety &
depression)
( Petti, Voelker, Shore &
Hayman-Abello, 2003
(Klin, 2004)
( Bigler,
1989; Fletcher, 1989; Rourke, Young, & Lennars, 1989)
Anxiety (esp. in
adolescence)
Potential of mood
disorders is high
Lainhart,2005
(Fast, 2004)
Repetitive Behaviors
NLD
Inability to
Adapt to
Change
AS
Inability to adapt to
change/novelty
Ritualistic
Preoccupation with
stereotyped and
established routines
AS & NLD
Klin, Volkmar,
Sparrow, Cicchetti,
& Rourke, 1995
Cederlund &
Gillberg (2004)
Semrud-Clikeman
Model
AS
Preoccupations
Special Interests
Facts
Ritualistic
NLD
Social
Communication
Nonverbal
Communication
Psychomotor
Emotional
Visual Motor
Executive
Functioning
Theory of Mind
Attention
Novelty
Problems
Neuropsychological
Difficulties
Math
Reading
Comprehension
Written Expression &
Organizational
Problems
Assessment
Cognitive Assessment
Thinking &reasoning skills must be at least average
Although IQ does not have to be average (e.g., average WJIII
Thinking ability or Cognitive Efficiency)
There must be an impairment in at least one psychological
process related to learning
Neuropsychological
Assessment
WISC-IV
Woodcock-Johnson Cognitive Battery III (WJCog III) (Woodcock, McGrew, & Mather,2001a)
esp. Analysis & Synthesis & Concept
Formation)
KABC-2(Chow & Skuy, 1999) found that NLD
children showed significantly higher
successive than simultaneous processing
WASI
Possible Assessment
Instruments
Rey-Osterreith Complex Figure (Osterreith,
1944)
Grooved Pegboard (Klove, 1963).
Finger Tapping Test (Reitan & Wolfson, 1985).
Purdue Pegboard
Judgment of Line Orientation (JLO) (Benton,
Sivan, Hamsher, Varney, & Spreen, 2004)(Semrud-Clikeman, yes, not Benton, Varney, &
Hamsher, 1978)
Possible Assessment
Instruments
Possible Assessment
Instruments
ADI-R
The Structured Interview for Diagnostic Assessment of Children (SIDAC) (PuigAntich & Chambers, 1978). (K-SADS)
Behavior Assessment System for Children2 (BASC2) (Reynolds & Kamphaus,
2004).
CBCL
Possible Assessment
Instruments
Selected References
Bloom, E., & Heath, N. (2010). Recognition, expression, and understanding facial expressions of
emotion in
adolescents with nonverbal and general learning disabilities. Journal of Learning
Disabilities, 43, 180
192.
Fisher, N. J., DeLuca, J. W., & Rourke, B. P. (1997). Wisconsin Card Sorting Test and Halstead
Category Test performances of children and adolescents who exhibit the syndrome of
Nonverbal Learning Disabilities. Child Neuropsychology, 3, 61-70.
Foss, J. (1991). Nonverbal learning disabilities and remedial interventions. Annals of Dyslexia,
41, 128-140.
Geary, D.C.(2000). From infancy to adulthood: The development of numeric abilities. European
Child and Adolescent Psychiatry, 9, 11-16.
Ghaziuddin, M. & Mountain-Kimchi, K. (2004). Defining the intellectual profile of Asperger
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Gilberg, C.(1989).Autism and Asperger Syndrome. Cambridge: Cambridge University Press.
Selected References
Hain, & Hale, J. B. (2010).Nonverbal learning disabilities or Aspergers Syndrome? Clarification through
cognitive
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Evaluations: Case Reports for
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Hale, J..B. & Fiorello, C.A.(2004). School neuropsychology. New York: Guilford Press.
Humphries, T., Cardy, J., Worling, D., & Peets, K. (2004). Narrative comprehension and retelling
of children
abilities
Selected References
Montgomery, J. M., Dyke, D. I., & Schwean, V.L. (Autism spectrum disorders: WISC-IV
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Palombo, J. (2001). Learning disorders and disorders of the self in children and adolescents.
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W. W. Norton & Co.
Pelletier, P. M., Ahmad, S. A., & Rourke, B. P. (2001). Classification rules for Basic
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York: Guilford.
Petti, V. L., Voelker, S. L., Shore, D. L., & Hayman-Abello, S. E. (2003). Perception of
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Selected References
Semrud-Clikeman, M., & Glass, K. L. (2008). Comprehension of humor in children with Nonverbal Learning
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Selected References
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