Here are the second, five ideas about helping your child with NLD at home. I have included some examples of my own, with the hope that some of you who are parents with an NLD child send me some more examples.
Whatever strategy you find helpful for your child will lose its efficacy if it does not become a part of the child’s sense of himself and what he can do. That means practice. The strategy must become almost automatic, like a habit. Previewing or rehearsing new activities or places, can become a habit. Reviewing the calendar to remind you of the events of the coming day can become a habit. Discussing “what the story is about”, the “forest” rather than the trees, can become a habit. Taking regulatory breaks can become a habit, and slowing down can become a habit.
Example: Susan’s mother was so stressed when she got home from work that the last thing she wanted to do was engage in a series of what seemed like chores, with Susan. She just wanted to relax and enjoy her time with her. However, she found that if she made a list of the things to do with Susan – go through her back pack, go over the calendar, talk about the theme of the story – and followed the list every night, it actually didn’t take much time and she and Susan had a better time together. The more she did her list, the less bothersome it became. She found that after a while she began to rely on the security of the structure as much as Susan did. She found that Susan could sit at the table better if she jumped on the trampoline or took a walk before supper. She began to look forward to what she would find in Susan’s backpack. She felt reassured by reminding herself of the upcoming events on the calendar. She even found ways of talking about the theme of the story that made it more fun for both of them, for example, whether this was a story of a child (or animal) who did something he was not supposed to do and got into trouble, or a story of a child who used her imagination to have an adventure. Susan’s mother kept having to remind herself to slow down, but even that made her feel calmer after a while.
Here is another idea for the child with this cognitive profile, which almost always includes disorganization and “executive function disorder”. Start early in the child’s life building a routine for organizing the child’s room and the extensions of his room (back pack, lunch box). It is often hard for busy families to do this, but if parents think of it as a powerful learning experience for their child and not just keeping the house neat, sometimes it helps them keep it up. It is best to keep up whatever organizational schema you create religiously. Some important features of any plan should be a clean and orderly workspace (child’s desk or table) with only the essentials on it, a routine of going through the backpack (parent and child together) every afternoon after school and every morning before school, and a regular place to keep coat, gloves, hat, and boots. Parents should not hesitate to work together with the child to keep this order in the child’s life. Requiring the child to do it alone only invites struggles, which are to be avoided at almost any cost.
8. Network with teachers, babysitters, parents, peers:
Your child’s teachers, babysitters, other parents, and peers are valuable resources. Talking with them can help fill in the gaps of your child’s life that he cannot do himself. Babysitters will have an important perspective on your child that can complement your experience. Frequent discussions with the teacher can help you keep track of comings and goings in the classroom that may have an impact on your child without his being aware of it. Now, many schools have activities and schedule changes on a website, but in the past notes from the school would get left in the cubby or dropped in the playground. Other parents will have information about the complexities of school social life that your child may completely miss. Other children in the class will also pick up information that may go unnoticed by your child. Sometimes parents of a child with NLD have so many painful experiences – such as hearing about their child’s disruptive, noncompliant, or atypical behavior – that they withdraw from these essential connections. In these cases, it takes a great deal of energy to stay involved with the community. Identifying a couple of trustworthy people you can talk to without fear of being shamed or hurt can make it possible to avoid isolation.
Jason’s mother had received so many telephone calls from the school complaining about Jason’s behavior or notifying her that he had missed the deadline for some important event that she shuddered every time the phone rang. She began to avoid the gaze of the other parents in the hallways and rush to get Jason out of the school and into the car as soon as possible. One day after a particularly painful telephone call, she forced herself to make an appointment to meet with Jason’s school team. She found that they were more sympathetic to her than she had imagined and that they really liked Jason, even though he was difficult. She made a plan with them to check in with the assistant teacher, with whom she felt the most comfortable, every Monday and Friday afternoon. The teacher’s friendly greeting made her feel welcome and as if she belonged in the school.
9. Process afterwards:
Talking about an event after it happens is as important as previewing it before it happens. When you do this you are helping your child make sense of a situation that he may be completely unable to understand. This is particularly important when your child has an upsetting experience. However, it also can be very helpful when things go well; in that case talking about it afterwards can maximize the possibility of the positive experience happening well again.
Matt’s younger brother begged him to “not tell” the secret joke he wanted to play on their babysitter, but as soon as his babysitter came in the door, Matt rushed up to her and told her the joke. His brother broke into tears and his mother was furious. Couldn’t he let his brother have that one satisfaction, or did he have to grab the attention every time? She tried to talk about it with Matt, but he got angry and ran out of the room. That evening, when they were sitting down to read a story, she told Matt that before they read the story she was going to talk to him about what happened that afternoon. (Note that she did not ask him if she could talk to him about it; she told him that she was going to do it. Often parents cede their authority to their children in a way that is not helpful to them nor to the child.) Matt looked unhappy, but he wanted the story, and he listened. His mother explained that his brother had been so excited about showing the babysitter the joke, and that though she knew how hard it was for Matt to share that kind of attention with his brother, he should not have spoiled his brother’s fun. Matt quietly agreed. Then they talked about what they could do the next time his brother wanted attention and Matt felt jealous. His mother knew that this situation would happen again, but she also knew that with practice Matt would get better at restraining himself, and even more important, that he would get better at imagining how his brother would feel if he stole his thunder.
10. Play dates:
Play dates are not only enjoyable; they are valuable learning experiences. However, play dates can be particularly challenging for the NLD child and her parents. They take more work and planning than with typical children. The most important goal is to make the play date fun for your child and her playmate. That means that you tailor the experience to minimize the challenges and maximize the probability of success. If your child is more comfortable at home, you have the play date at your house. If your child gets territorial about his possessions, you have the play date on the playground. If your child takes a while to warm up and get going, you try to make the play date longer. If your child can’t hold it together for more than a couple of hours, you make the play date shorter. Don’t try to invite more than one other child at a time; your child will have a hard enough time with one playmate. Don’t expect to be able to chat with the other parent while your children play; you may be called into action suddenly to negotiate a conflict.
I am looking forward to your comments. In the next posting I will begin a summary of our infant parent mental health course weekend in March.
April 23, 2012
Here is a very helpful comment offered by my friend and valued colleague, Dr. Anne Berenberg:
I think it would be helpfu to say more about understanding what is usually involve in an NLVD, with a stress on the difficulties reading and interpreting nonverbal cues such as facial expression, tone of voice, body language; the difficulties in giving off appropriate cues so that others can “read” the child; and the difficulty in interpreting his own emotions before they becoming overwhelming. Then there’s the difficulty in processing and integrating novel information, so that every new situation is hard–the child kind of starts over each time. The child is overly reliant on learned “rules,” tends to be rigid, and has trouble adapting to slight changes flexibly. In addition, the nonverbal concepts of spatial relationships and of time are difficult for many children with NLVD. Understanding how pervasively these deficits affect every day life is a first but very challenging step for parents in understanding how to help their children. Often, walking through the child’s day, thinking about how her particular deficits would make everyday tasks difficult, confusing, and therefore exhausting, is an eye-opener. The mother you quoted tried doing that with one incident in her child’s day, which was great. In order to do that, she had to first have some idea of the difficulties her child faces in dealing with her world–the ways in which her child is likely to misperceive and misinterpret cues that other children pick up without coaching.
I find that many parents don’t have a good frame of reference for seeing the world through their child’s eyes and it really helps to walk them through the meaning of “nonverbal” cues and the trouble these kids have in reading them in others and in giving them off to others. Also there is the fact that these children can’t read their own internal affective cues until their reactions become so strong that they have an overly strong emotional response to something others would see as minor. It helps parents to underscore the problem these kids have with anything new–it helps parents to understand why the children tend to be rigid and rule bound. That’s the basis for a number of your recommendations, and again can be really important as an opening framework for parents to understand their children. You’re weaving a narrative for the parent or caregiver of a child who is doing the very best he can to operate in a world which is much more challenging for him than it is for others, but for which parents are helping to provide roadmaps and signposts.