Nonverbal Learning Disabilities: A Clinical Perspective

by Joseph Palombo

Overview

The effects of nonverbal learning disabilities on a child's social and emotional development.

A nonverbal learning disability (NLD) is a developmental disorder that impairs a person's capacity to perceive, express, and understand nonverbal (nonlinguistic) signs. The dysfunctions affect behaviors, social interactions, perceptions and feelings regarding oneself and others, and emerging personality patterns. NLD constrains an individual's capacity to function in a wide variety of domains, including the academic, social, emotional, and vocational. Parents and clinicians often have difficulty understanding and helping children and adolescents who are simultaneously cherished and whose functioning is hampered by the condition.

Based on current neurobehavioral research, this book brings together perspectives drawn from the three major domains of knowledge about NLD—neurobehavioral, social, and intrapersonal. From the neurobehavioral perspective, Palombo provides a research-based phenomenological description of the NLD child's symptoms. From the social perspective, he presents the child's social context and how that contributes (in positive and negative ways) to the child's skills and deficits. From the intrapersonal perspective, he introduces the concept of mindsharing as basic to understand the development of the sense of self in children with NLD.

In Part I, readers are introduced to NLD as it presents in the clinic with a review of the etiology and symptomatology of the syndrome reflected in a case study. The author then goes on to describe the neurobehavioral profile of NLD (including its psychological and social dimensions). In Part II the social perspective and intrapersonal aspect of NLD are considered. Palombo describes the impact of the syndrome on social functioning, social communication, and emotional functioning. At the close of this part, readers find a clear articulation of the four NLD subtypes.

The intrapersonal area is addressed in Part III where Palombo presents the concept of mindsharing—i.e., the ability of one person to both know and feel what another person is experiencing. Because they lack a capacity for mindsharing, children and adolescents affected by the syndrome often fail not only a social and emotional connection with others but also experience a lack of cohesion in their own sense of self. Finally, in Part IV, Palombo presents a therapeutic approach to working with youth with NLD. Drawing together the various clinical insights from earlier in the book, these last chapters synthesize the material and highlight the most important aspects so as to best guide the treatment of children and adolescents.

Addressed to clinicians, psychiatrists, psychologists, clinical social workers, and other psychotherapists, this book is a fund of knowledge and clinical wisdom for working with youth with NLD. It offers an overarching paradigm relevant to all professionals and parents alike as they care for effected children and adolescents.

Product Details

ISBN-13:	9780393704785
Publisher:	Norton, W. W. & Company, Inc.
Publication date:	03/17/2006
Series:	Norton Professional Bks.
Edition description:	New Edition
Pages:	342
Product dimensions:	6.10(w) x 9.30(h) x 1.00(d)

About the Author

Joseph Palombo is founding dean and faculty member of the Institute for Clinical Social Work, Chicago, faculty member of the Child and Adolescent Psychoanalytic Therapy Program, Chicago Institute for Psychoanalysis, and research coordinator, Rush Neurobehavioral Center, Rush Children's Hospital, Department of Pediatrics, Rush-Presbyterian-St. Luke's Medical Center, Chicago. Recipient of the Annual Reiss-Davis Chair, awarded to a mental health professional that has made an outstanding contribution to the field of Child and Adolescent Mental Health.

Table of Contents

	Preface	xiii
	Acknowledgments	xvii
	Introduction	1
	Clinical Definition of NLD	1
	The Social Features of NLD	2
	Assumptions and Conceptual Framework	5
	The Three Domains and Their Perspectives	7
	Psychoanalysis and Neuroscience	13
	Psychotherapy of Children with NLD	13
Part I	The Syndrome: A Neurobehavioral Perspective
1	Clinical Presentation	17
	Early History	18
	Diagnostic Interviews: Sessions One through Three	19
	The Clinician's Impressions	21
	Author's Discussion	22
2	Neurobehavioral Profile of NLD	25
	Presenting Problems	26
	Neuropsychological Profile	29
	Social-Emotional Profile	35
	Psychiatric Symptomatology	36
	Conclusion	36
3	Neurobehavioral Theories of the Social Features of NLD	38
	History of the NLD Concept	39
	A Right Hemisphere Disorder	42
	Contributions from Neurology	48
	Rourke's Neuropsychological Contributions	49
	The Dissociability of Visual-Spatial Processing and Social Cognition	58
	Other Neuropsychological Deficits	61
	Critique of the Theory of Right Hemisphere Dysfunction	61
	Conclusion	63
Part II	The Interplay with the Context: A Social Perspective
4	Impaired Social Functioning	67
	Social Cognition and NLD	68
	Clinical Presentation: The Social Profile	69
	Reciprocal Social Interaction	73
	Theory of Mind	74
	Conclusion	81
5	Impaired Social Communication	83
	Clinical Presentation: NLD and Nonverbal Signs	84
	The Semiotics of Nonverbal Communication	90
	Dyssemia	97
	Verbal Language Problems and NLD	98
	Relevance Theory and Theory of Mind	104
	Conclusion	106
6	Impaired Emotional Functioning	108
	The Universal Language of Emotions	110
	NLD and Affects, Emotions, and Feelings	111
	The Contributions of Affective Neuroscience	117
	Greenspan's Contribution	121
	Conclusion	123
7	The Social Features of NLD Subtypes	125
	Patterns of Social Impairments in Four NLD Subtypes	128
	NLD Subtype I	128
	NLD Subtype II	131
	NLD Subtype III	134
	NLD Subtype IV	139
	Conclusion	142
Part III	The Sense of Self: An Intrapersonal Perspective
8	Mindsharing, Aloneness, and Attachment	147
	Mindsharing	149
	Aloneness and Loneliness	156
	Attachment in Children with NLD	160
	Conclusion	164
9	Self-Cohesion and Narrative Coherence	166
	Self-Cohesion	167
	Self-Narratives	172
	Central Coherence	175
	Self-Cohesion and Narrative Coherence	176
	Conclusion	180
10	Disorders of the Self in NLD	181
	Etiology and Psychodynamics	182
	NLD and the Loss of Self-Cohesion	184
	NLD and Incoherent Self-Narratives	190
	Case Illustration	192
	Expansion of the Definition of the Social Features of NLD	202
	Comorbidity and NLD	203
	Conclusion	203
11	NLD and Asperger's Disorder	205
	Asperger's Disorder	207
	Neuropsychological Features of NLD and Asperger's Disorder	208
	Social Features of NLD and Asperger's Disorder	209
	Intrapersonal Features of NLD and Asperger's Disorder	211
	NLD Contrasted with DSM-IV Criteria for Asperger's Disorder	211
	NLD and Social-Emotional Learning Disabilities	215
	Neurobiology of Social Cognition	217
	Conclusion	218
Part IV	Treatment
12	Restoring Self-Cohesion and Narrative Coherence	221
	Individual Psychotherapy with a Child with an NLD	222
	The Therapeutic Process	224
	Transference Motifs	228
	Countertransference Motifs	234
	Case Illustration	235
	Conclusion	247
13	Attending to Caregivers	248
	Working with Caregivers	250
	Educational Focus	251
	Interventions	255
	"What Is in Store for My Child?"	276
14	Conclusion: The Challenges Ahead	278
Appendix 1	Summary of NLD Social-Emotional Symptoms	287
Appendix 2	Helpful Resources	291
	References	293
	Index	311

Editorial Reviews

"[A] major contribution to the understanding of not only children with nonverbal learning disabilities, but also those with ADHD or Asperger’s disorder and other children who lack social skills. The author has made the effort to integrate neuroscience and behavioral science. The results show all professionals and parents how to help these children with special needs."

Journal of Clinical Psychiatry

"Nonverbal Learning Disabilities is a well-integrated exploration of a fascinating and complex topic. A serious scholar and compassionate therapist, Palombo combines his considerable clinical experience with research from neuroscience and psychopathology to expand our understanding of learning disabilities and provide us with practical intervention strategies. Palombo rewards readers with a deep understanding of Nonverbal Learning Disabilities and clear insight into many relevant areas of research. This book educates, elucidates, and inspires further exploration."

Louis Cozolino