Aptos psychologist: Asperger’s or Non-Verbal Learning Disability? An example of Peter…

written by Cameron Jackson DrCameronJackson@gmail.com

Does Peter — this is a hypothetical clinical case — suffer from NLD or Asperger’s Disorder or PDD-NOS? So some combination? What is the best fit? Many of the facts are true however names and identifying information has been changed to protect privacy.

Remember the children’s verse: “Peter, Peter, pumpkin eater… had a wife and couldn’t keep her… so he put her in a pumpkin shell… there he kept her very well… ”

It certainly was socially inept of Peter to keep his wife locked in a shell….Was that the best that Peter could do?

Non-verbal learning disability (NLD) was much talked about 10 years ago. Maybe because NLD never made it into in the Diagnostic and Statistical Manual (DSM-IV) it’s only known in certain circles.

In some ways NLD is similar to 298.0 Asperger’s Disorder — which is a diagnosis in the DSM-IV.

Many people somewhat approximate the diagnosis that are in the DSM-IV. The issue is to find the best fit.

Let’s see what is the best diagnosis for Peter. A number of facts are changed to protect privacy. Let’s see whether Nonverbal Learning Disability (NLD) or Asperger’s fit as a better fit for this young man.

Peter — not his real name — is in his middle 20’s. He went to private schools in Santa Cruz County and finished at an alternative high school. Both his parents finished college and work professionally. Peter is an only child.

From his father for years he heard, “Just step up to the plate… you can do it… Try harder…” Yes, Peter has low self esteem.

Per comments from his teachers, Peter has always had problems with organization and finishing assignments. Sometimes he failed classes in high school as he did not turn in assignments. He teachers comment on his high language abilities and creativity.

Peter was never identified for special education. In 8th grade the resource teacher sent his parents a letter saying that he did not have a learning disability. As it was simply a letter sent to the home there was no one to one discussion with the school psychologist.

Had there been a school meeting, a psychologist would have noted that there was a huge, larger than 45 standard scored difference, between visual abstract reasoning ability and general academic performance. A 15 point difference is statistically significant and important. So here Peter has a 45 point standard score difference between visual abstract reasoning abilities and general performance and has no learning disability? Of course he has and did. It was not identified however in 8th grade.

Because there was no meeting of psychologist and family in 8th grade Peter’s disabilities were not identified. That Peter has extraordinary high visual abstract reasoning abilities as well as very high verbal reasoning abilities lessens the likelihood that Non-verbal Learning Disability best describes Peter’s difficulties.

Peter has heard for many years, you can do it… just step up to the plate….you’ve got great talent.

Peter is not convinced that he can do it as he flunked out of college. He had to take and pass a particular class. Having flunked it once he went back to the same instructor, the same lectures, the same assignments. How to apply certain skills to improve him portfolio was the task he flunked before. And — as you might guess — he flunked it again. And then he flunked the same class a third time. Clearly there was no academic advisor available to recommend a different strategy to getting a pass in the required class.

Peter started college at age 21. Before going to college he got some tutoring from a Santa Cruz tutoring organization. It is my understanding that this tutoring organization lacks psychologists on staff and does not use diagnosis. So, again, similiar to 8th grade, his family did not have input into Peter’s disabilities based on psychological assessment.

It does not appear that there were any accommodations put in place to assist Peter to succeed in college once he got there. Peter was across the U.S. in a different state. He had never had an IEP and he had never been identified as having developmental learning disabilities.

What is Peter good at doing? He can tell oral stories. He can write stories. He does have difficulty finishing the writing of stories. He does better with the structure of a class to finish a story.

The purpose of diagnosis — after getting the best fit diagnosis — is the suggest appropriate treatment. It looks like NLD is not the best fit diagnosis for Peter.

However, Peter has heard from one parent for many years that he has NLD. Probably based on these discussions, Peter thinks that hi is neurologically defective. One step in treatment is to change the mind set of Peter to view himself as neurologically different not neurologically defective. Web sites such as Wrong Planet.net may assist Peter to view his differences in a positve way.

Per the article included below NLD is due to traumatic brain injury of the right side.

The following was found by Google to nonverbal learning disabiliites and was written around 2000.

Success for Young Adults with NLDBy Kathy Allen

“NLD (Syndrome of Nonverbal Learning Disabilities) is a complex disorder of the brain that causes wide-ranging effects on the day-to day functioning of young adults in work and college.

The most likely cause for this disorder is a congenital or traumatic injury to the right brain. This is the location of the majority of the long, mylenated fibers which are the “highways” of the brain. The right brain takes care of many diverse functions such as planning, organization, social interaction, maintaining mood, and coordination.

Although each individual is affected differently, this disability generally impacts a young adult’s ability to organize schedules, carry through on tasks which require multi-step planning and follow-through, and deal with changes in time and place. Difficulty with subtle nonverbal cues are also common in most NLD students. NLD often causes high anxiety and impairs the fluid use of socially correct language. Double meanings, sarcasm, and polite white lies are all difficult for these young adults.

Many of these students are very bright academically, and it is easy for professionals and teachers to be confused or annoyed by the gap between their high academic skills and their poor organizational abilities. Unlike blindness or other sensory disorders, this disability is invisible. While students with cerebral palsy are routinely provided with note takers or computers,it is very difficult for college students with NLD to receive services. Frequently, these students are told they are irresponsible and should just try harder. But since NLD is a serious condition, the student is only able to achieve success when specific interventions are in place. Without help, students can become crippled by anxiety and shame, frequently dropping out of school and developing severe psychiatric problems. With these interventions, many students succeed in work and school.

The methods used are neither complex nor expensive, but they do require a radical change in perspective. First, professionals must be educated about the disability. This will lead to the understanding that right-brain injuries are real, although invisible, and pose a great challenge to the student. Counselors must be positive and affirming, and let the student know that they are a team who will work together to find strategies and support for the student. Young adults with NLD are so used to school and work authorities who are frustrated with them that even this simple change in perspective can be very powerful. Having an informed, helpful person to aid in the student’s problem-solving is crucial to student success. Given the time constraints that many professionals and teachers face, a question often asked is, “How can I achieve a basic understanding of NLD?”

There are excellent articles available at www.NLDline.com or www.NLDontheweb.org However, a model I use with students may be useful in seeing how the condition impacts day to day living.

(Here I insert the model with the island in the middle with the palm trees, and grass hut, then other concentric circles that get into the area of comfort like words about facts, predictable safe people, routine and structure. Outside of that are the circles with time and spaces that change, unpredictable people, ideas about theoretical people.)

From this model, it can be seen that the student with NLD is most at home in the world of words about unchanging, intellectual facts. Students enjoy and excel at learning the vocabulary and rules about everything from physics to computer games. This ability is a mixed blessing, as our society often defines people with large vocabularies as being very bright and capable in all areas. Instructors and counselors may be surprised and indignant when NLD students do so poorly in organization and time management, forgetting deadlines, appointments, and changes in class time. We know from experience that most students with NLD will do best in classes or jobs that have a heavy emphasis on facts, memorization, and a built-in schedule. Classes in which the bulk of work is done in class are especially successful, such as writing workshops, labs, or practicums which use special equipment. This is because the class itself provides the structure for the student.

Predictable, accepting people are also near the area of comfort, and from this we see that students/workers find it easiest to succeed if they deal mainly with these types of people. Most students with NLD suffer from a great deal of anxiety due in part to the disorder and in part from their inability to read faces and nonverbal language with ease. NLD students should have access to instructors and counselors who will be accepting of the fact that the student may need accommodations.

Just outside the comfort zone are ideas and inferences about facts. We can see that critical thinking may challenge students a little more. Drawing conclusions, solving problems that are written or presented in a different way than they were taught, and some aspects of inferential thinking may be more difficult than one would expect. Symbolism in novels, stories, and poems can be quite difficult for these students.

Moving further outside the zone of competence, we see that issues of time and space will pose challenges for the student affected by NLD. It may take anywhere from a several days to a few years for a student to navigate around the college or large work area. Support staff can help offering an escort to help point out and write down landmarks, a “script” of where to go, while some students with NLD will use a map.

It is equally difficult for our students to cope with time. Time is simply not a concrete fact that can be seen or touched, so it has little reality for these students. Regular appointments for work meetings or office hours are preferable to those which change. Use of an appointment book is very helpful. Ideally, a student will be shown several different ways to keep track of appointments, rather than only one. For important appointments, an e-mail or phone call from a counselor or coach can be a great first step. After a few weeks, the student can call the coach as a check-in that he/she remembered the appointment. It should not be assumed that the student is unmotivated based only on ability to be present at an appointment, as this is a part of the disability.

Far outside the comfort zone, (near the alligators!) we find unpredictable people and those who are ignorant of the impact that NLD has on a student. “Unpredictable people” for NLD students, are those who moods or disposition alter quite a bit from day to day, those who have a very neutral face with little expression, or those who raise their voices at unexpected times. This can be very stressful for the student. If the unpredictable person is accepting of the student, however, most students can eventually learn to cope with this type of person.

The greatest problem for students with NLD are people who are know nothing about NLD and are aggressive or hostile toward the student. Many are sure that the student has just been overprotected and needs to deal with the “real world”. While “tough love” works with some students, it rarely does with the NLD student. They misread “tough love” as meaning the employer or instructor hates them, and they rarely understand such vague concepts as “pull yourself together”, or “grow up”. Instead of making positive changes, they are flooded with anxiety.

It would be best for students to avoid this type of person if possible. If not, the student should go with an anchor person who can help with the situation. Role plays in which the student successfully explains the disability to a sympathetic listener, even by initially giving an information sheet about NLD and answering questions, should be extensively used first. This can be followed by explanations to an sympathetic adult (such as an instructor) in a real life setting. Only then should role plays toward a person with a more negative mindset begin.

NLD students have so often been told, “You ought to know that by now!” that they are very hesitant to seek help. It will help to tell the student that you will not shame her for asking “stupid” questions. After an explanation, have them explain the work assignment back to you. It’s useless to say, “Do you understand?” when a student isn’t sure what he or she might be missing.

Finally, for many students, one of the most difficult things in college or work is to make a hypothesis about the imagined behavior of people not personally known to the student. This struggle is seen in work when young adults deal with the general public, especially with frustrated customers. It’s also seen when students try to respond to questions in literature classes. Tutoring may be helpful here, as are templates for writing. In the same way, a worker should receive clear directions about how to handle people related problems. The more detail offered, the better the results will be.

Key strategies in helping the student will include:

· Understanding NLD

· Using student’s strengths in memory and rules to offset other problems

· Providing extra help in management of time and organization

· Use predictable, accepting people to problem solve solutions.

· Emphasize self-advocacy through scripts and role play

· Offers of help develop systems for student to track appointments

· Understand that the student is hesitant to ask for help.

· Offer tutoring for written assignments, especially novels or stories which involve complex characters and symbolism.

There are many other ways to help, including low and high-tech aids, but they are beyond the scope of this article. Although the focus here has been on the young person’s challenges, NLD young adults also have many wonderful traits such as persistence, reliability, honesty and a desire to succeed. Helping them to use their strengths to compensate for their problems is the key to success.