Tag Archives: Nonverbal Learning Disabilities

A Message for the Holidays: Finding a Way to Say I Love You

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A mother I know has a 12-yo daughter who goes to school away from home. This girl, whom I will call “Mona”, can sometimes seem unresponsive to her parents. For example, when her parents come to pick her up at school, she may at first appear to ignore them instead of running to greet them with the enthusiasm the other girls show their parents. Mona also struggles in school and requires academic support. Her development has been atypical; neuropsychological testing suggests that using language to make sense of her world is a particular challenge. Even making sense of her bodily sensations may escape her so that she neglects to put on her coat when it is cold outside. It also seems that picking up cues about others’ feelings and from her own emotional state is difficult for her. This does not mean that Mona is without feelings or insensitive. She in fact feels things deeply and can be very sensitive to others. It is just that it sometimes takes her more time or more energy to achieve a state of responsiveness. She needs to “put it together” instead of it smoothly coming into place the way it does for people with typical development. Because her internal world is often confused or poorly integrated, she can be hard to “read”. She is not an easy child to parent.

One time, on the way to pick Mona up at school, her mother was reflecting on some of the frustration and disappointment she and Mona’s father felt in their relationship with her. She decided that she would have to search for a better way of expressing her love for her daughter, one that Mona could “hear” better than conventional ways. She was particularly conscious of Mona’s embarrassment at expressing feelings for her parents in front of the other girls. When they met, she said, “You know, Mona. I was thinking on the way here that I always say, “I love you, I love you,” but that doesn’t really capture the depth of the feeling I have for you. We have to think up our own words for it.” The next day, a thought occurred to her. She spoke to Mona again. She said, “I thought of it, Mona. ‘I glove you’. Mona’s mother was thinking of surrounding her daughter with her love, the way a glove surrounds her hand. It may also be that she was thinking of her wish to protect her daughter from the cold in a way that Mona herself sometimes seemed unable to do. Finally and perhaps most important, in her suggestion that they “think up our own words for it”, her mother was showing Mona that together they could be creative in the ways they communicate their feelings to each other. They did not have to restrict themselves to conventional language. The next day when they said goodbye to each other, her mother held up her hand. Mona smiled and raised her hand.

Mona’s birthday is close to Christmas. This year her mother wanted to make something special for her. Instead of typical Christmas decorations on their tree, her mother decorated it with different colored gloves. While the tree is very attractive, it also has special meaning for Mona and her mother. It is a way to say, “I love you” without words. It captures new possibilities for mutual understanding and for ways of growing their relationship. Maybe it is a way of saying “Happy New Year” for next year and for the future. As I always say, parenting is a creative enterprise.

Ten Ways to Help Your Child with Nonverbal Learning Disabilities at Home

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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.

6. Practice

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. 

7. Organize:

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.

Example

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.

Example:

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.

 

 

 

 

 

Ten Ways to Help Your Child with Nonverbal Learning Disabilities at Home

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Two days in a row last week parents asked me about non-verbal learning disabilities.  One child had been given that diagnosis and the other had been given a diagnosis of Asperger’s Syndrome. I told them both that people in different academic centers used one or the other of these diagnoses to describe the same general population of children, at least according to my experience. When pressed to give a diagnosis, I tend to use a more inclusive one of autistic spectrum disorder that has three criteria only – (1) Difficulties with speech. (2) Difficulties with social engagement. (3) Behavioral sterotypies (rigid, repetitive behaviors such as flapping, rubbing, sniffing.) I also told both sets of parents that categorical diagnoses are useful for obtaining services and sometimes for planning interventions, but otherwise tell you little about an individual child. I generally refer to children like theirs as “quirky” or as having “regulatory problems” that can interfere with their learning and growing.  The parents asked me what I would recommend that they do to help their children at home. 

An important source of ideas about helping parents with NLD children is my friend and colleague, Dr. Anne Berenberg. Over the years, in our many conversations in Massachusetts, Illinois, and Michigan, Anne has taught me a great deal about the challenges faced by these parents. She co-authored a chapter in a recent book: Palombo, J., & Berenberg, A.H. (1999). Working with parents of children with nonverbal learning disabilities: A conceptual and intervention model. In Understanding, Diagnosing, and Treating AD/HD in children and Adolescents: An Integrative Approach. Ed. J.A. Incorvaia, B.S. Mark-Goldstein, & D. Tessmer. Northvale, New Jersey: Jason Aronson.

Through my own clinical experience, through my study of development, and through consultations and conversations with colleagues like Anne, I have developed a set of recommendations for what parents of NLD children can do at home to help them grow. In keeping with my two earlier postings – “Ten Ways to Help Your Child Behave” (of which I have only written five to date!), http://www.supportingchildcaregivers.com/?sort=&search=behavior, and “Ten Ways to Handle Sexual Abuse Disclosure”, http://www.supportingchildcaregivers.com/?sort=&search=sexual+abuse,  I will write “Ten Ways to Help Your Child with NLD at Home”.  When reading these suggestions, it is always important to remember that your child is unique. Although he or she may seem to “fit” a certain cluster of behaviors or problems, how he or she developed these problems, what these problems mean to the child and to the family, and what will help, is highly variable and depends on the individual child and family.

1. Imagine your child’s mind:

Probably the most important thing you can do to help your child at home is to get better and better at “imagining your child’s mind”. A wonderful parent of a child on the spectrum sent me the following email (the names have been changed for confidentiality purposes): 

“I want to share a story from this morning regarding Jane. Jane woke up and told us that Jack (her second grade teacher) sings songs that all the kids disliked. I asked her how did she know that the kids all disliked Jack’s songs. She replied because they all moaned and groaned and said, “Stop! Stop!” I thought that is may be a case of Jane being very literal in her interpretation of what she saw. So, I told her a story about how her cousins get squeezed by their dad, her uncle, and they shriek, “Stop!” when in fact they really love what’s going on. I also said that sometimes, kids say the opposite of what they really mean (kind of like sarcasm, which is a concept I introduced a while ago). For example, some older kids say that they don’t like their parents to hug and kiss them and act upset when their parents kiss them. In reality, they really actually love it and they’d be sad if the parents stopped hugging and kissing them. She paused for a bit to consider this and then she said she didn’t like Jack’s songs. I then said to her that it’s OK for her to not like Jack’s song. She can just go away from it.

The mother was emailing this to me and to others on Jane’s “team”, including her teachers. She added, “I would love to get your respective perspectives on this. If you agree that Jane is being literal in interpreting what she sees and is generalizing her own feelings, this might be a great opportunity to help her understand that there may be alternative meanings to what she is observing.” 

What I liked so much about this email was that the mother “imagined Jane’s mind” enough to not take her complaint about Jack at face value, to first inquire more to find out what Jane’s observations had been to allow her to draw that conclusion, and then to imagine how Jane might have misinterpreted the other children’s behavior. If Jane had been distressed by Jack’s singing, she might have misperceived her own distress reflected in the other children’s joyful protests. I also liked the fact that Jane’s mother did not criticize her for “not liking” her teacher’s song, but instead legitimized Jane’s feelings, while at the same time pointing out that she could behave in an adaptive way (“go away from it”, instead of making a fuss).

2. Slow down:

The second suggestion I would give to parents of all children who are struggling would be to slow down. Slowing down gives you a chance to think. Slowing down gives you a chance to manage your emotions and your stress level better. There are many ways to slow down.

One is to give more time for transitions. A big transition is getting up and out in the morning. It is always hard for families to manage this transition, but when the family has a child with this kind of regulatory difficulty, it is many times harder. Giving yourself more time for this transition usually requires a combination of getting up earlier and organizing things ahead of time. Both are huge challenges, but if you can turn these habits into rituals, it will save time in the long run. 

Another way of slowing down is talking more slowly. Talking slowly means speaking with a slower pace and leaving more pauses. Pauses are important because they chunk your communication into pieces that your child will more easily apprehend, and the pauses also invite him to let you know if he has had enough of the conversation.

One more way of slowing down is to take more time to accomplish tasks. Whenever you can, think of the tasks as an opportunity to spend good time together and to help your child learn. If you are helping your child put away his toys, approach this job in an unhurried fashion. Talk about what you are doing as you arrange toys on the shelf. Do not ask many questions, but make comments. Remember that questions place a demand on the child, but comments can facilitate understanding.

3. Take a break:

What I mean by take a break is more than just stopping what you are doing. I mean, take a break to restore regulation, to organize the body and the nervous system. I have learned about these “regulatory breaks” from two main sources – from my occupational therapist colleagues, such as Debbie Bausch, and from an important child psychiatrist colleague, Dr. Bruce Perry, (http://www.childtrauma.org/index.php/articles/cta-neurosequential-model). Most regulatory breaks involve repetitive rhythmic activity, such as walking, clapping, or drumming. Doing these activities with someone else enhances their regulatory effectiveness because the coordination of rhythms between two partners (that occurs out of awareness) is highly organizing. This is true with human-centered animals also. Walking a dog is more regulating than walking alone, although one of my dogs can suddenly lurch to the side when he finds an interesting smell on the path so that it sometimes can be dysregulating to walk him! Also, horse back riding can be highly organizing for the same reason – even more so, because the human rider is coordinating rhythms with a living creature with whom she is in physical contact.  Often children with NLD need to take regulatory breaks during the school day. They may take a walk to the principal’s office carrying a heavy load, which can be regulating to the body. Or, they may jump on a trampoline, or run in the playground, if these activities are regulating to that particular child. If the child likes to run, it is better to avoid random running. Instead, one can construct a simple obstacle course that indicates a route for the child to take, or a route designated by objects the child must tag, before returning “home”. Sometimes the child may request to take a break, but many children need these breaks built into their school day. If the child is able to anticipate a break, he may be able to stay organized and engaged better.

4. Tell a story:

A useful technique I use is one I learned from my friend and colleague, Dr. Gil Kliman, (http://www.childrenspsychological.org/content/view/36/46/). Gil’s technique includes building a “reflective network” by talking about the child and his experience of the world with others in the presence of the child. When you do this you are not declaring what is in the child’s head. Instead, you are relating events and what you can tell about the child’s subjective experience of them. For example, when Mom comes home, then Dad might say, “Oh, Mom, George and I had such an interesting afternoon. First we went to the library, but there were too many children in the library making noise, and George didn’t like the noise, so we left. Then we walked along the stone sidewalk and looked at the spring flowers coming up in the park. George got a pebble in his shoe, and it hurt his foot, so we sat down on a bench and took off his shoe and shook the pebble out and saved it, and here it is!” This story (perhaps most appropriate for a preschooler) is probably just too long for some children, and not long enough for others, but the idea is to provide the child with a snapshot of his daily experience in language that he might not be able to put together in coherent form himself, and link this experience to his expressed emotion. As I mentioned above, I find it is easier for a child to think when you do not ask him a question; a question is an implicit demand, and often it stresses the child. Don’t worry about getting the story right; the child will correct you if it isn’t, or if he doesn’t he understands that the story you are telling is only a guess.  It is often best to direct your gaze at the other adult when you speak so as to not stress the child unnecessarily (direct eye contact can be highly stressful for these children). Later, Mom may set the table with George and say to Dad, “Dad, George and I set the table, and George asked me why there were spoons, and I said, because we are having soup tonight. I can understand why he asked me that because we hardly ever have big spoons like that at supper!”  You can see how these simple stories can help weave together events of the day into a coherent story that puts together what happened with how the child felt about it, the outside world with the child’s inside world. It is an exercise in integration.

Creating a narrative incorporates the first idea also, in that while you are telling the child about his experience you are practicing imagining his mind. As you search for words to describe his time at the library, you are creating something that includes part of his subjective experience and part of yours, because you don’t really know what he was thinking or feeling, you can only imagine.

Another suggestion I make to the parents of my little patients is to read to them, and when you read them stories, stop periodically to ask the child to tell you what is going on in the story. That is because children with this kind of learning disability often have a hard time “finding the forest for the trees” and get lost in the details of the story. Therefore, they can use help learning how to find “the forest”, or the main theme of the story. This can be tricky, because if it is too hard for your child, or if you get too anxious or sad if they don’t get it right, this process can backfire and make the child dislike reading or fear your disapproval. But if you back off when your child starts to resist, it can build their skills.

5. Prepare:

A hallmark of children with NLD is a lack of flexibility. This has nothing to do with actual intelligence, but only means that the child with NLD is challenged by novelty and unpredictability. Therefore, it is important to help him or her prepare for the new or unexpected. That means rehearsals – walking through a new school before the school year starts, looking through the picture book that will be read in afternoon meeting ahead of time, making a calendar with pictures or words representing the events of the days and week ahead, and planning small visits with an important new person such as a babysitter before being left alone with her. In school, it is necessary for the child to be introduced to a new subject matter or a new academic technique slowly, and to be given frequent reviews. 

The second set of five ideas for the parents of children with NLD will appear in the next posting. I would like to offer you illustrations of how these ideas can or cannot work, but the very best examples are real ones, so I am inviting my blog readers to send me comments that I can incorporate into my next posting. 

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