Nonverbal disorders of learning: The reverse of dyslexia

Nonverbal Disorders of Learning: The Reverse of Dyslexia?

Nathlie A. Badian

Holbrook Public Schools Holbrook, Massachusetts

Children's Hospital Medical Center Boston, Massachusetts

Teacher perceptions of the social-behavioral characteristics of 99 boys were examined. Subjects were divided into three groups (Low Nonverbal, High Nonverbal, Equal) on the basis of their scores on two verbal and two performance WISC-R subtests, considered to be good measures of left- and right- brain functioning. The pattern of strengths and weaknesses shown by Low Nonverbal subjects suggested good left-brain functioning, but a right-brain dysfunction. These subjects were good readers, but relatively weak in arithmetic. Behaviors reported significantly more often for the Low Nonverbal subjects were low motivation, poor work habits, inability to work independently or to take age-related responsibility, disorganization, and poor relationships with peers. High Nonverbal subjects, who exhibited signs of a probable left- brain dysfunction, were usually perceived by their teachers as sociable, responsible, and determined to succeed, in spite of their having language disorders and dyslexia. It is argued that the constellation of behaviors displayed by the Low Nonverbal subjects is part of the right-brain dysfunction syndrome. To date, there are limited resources available for helping such children.

Nearly twenty years ago Johnson and Myklebust (1967) devoted a chapter of their book on learning disabilities to "nonverbal disorders of learning." They described children with nonverbal disorders as exhibiting a constellation of problems which could include defective body image, inability to learn motor patterns, poor sense of orientation in time and space, social imperception, and distractibility. Such children

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254 STUDIES, COMPARISONS, AND CASES

are sometimes thought to be emotionally disturbed. They usually have at least average verbal intelligence, but lack the ability to acquire the significance of nonverbal aspects of daily living. Myklebust (1975) later gave detailed case histories of children with nonverbal disorders, illustrating the types of problems such children have in everyday life.

Johnson and Myklebust (1967, p. 272) reported encountering the child with a nonverbal disorder "over and over again" in their experi- ence with children having learning disabilities. Their assumption was that this type of learning disability is principally related to dysfunc- tions of the right cerebral hemisphere. They stressed that disturbances of social perception, in particular, are among the most debilitating of the learning disorders because they impede the acquisition of basic adaptive patterns of behavior. Johnson and Myklebust found that problems in social perception occurred frequently in association with disorders of arithmetic (dyscalculia). They described a group of 14 dyscalculic children, with a mean verbal IQ of 109.7, a performance IQ of 82, and a social quotient of only 77.3. These children excelled in oral reading, spelling, and speaking, but had problems not only in arithmetic, but in visual-motor integration (e.g. learning to dress, feed themselves, ride a bicycle), in social judgment, and in understanding time and distance.

Since Johnson and Myklebust (1967) delineated nonverbal learning disorders, little interest has been shown in them, compared with the volumes devoted to verbal disorders. There is a considerable body of literature showing that children with learning disabilities tend to have difficulties in interpersonal relations and to be less sensitive to social cues than normal children (e.g. Bryan 1977, 1978; Bryan and Bryan 1978; Bryan and Sherman 1980; Bryan, Sherman, and Fisher 1980; Wong and Wong 1980). Bryan and Sherman (1980) suggested that learning-disabled children, although heterogeneous on academic or cognitive tasks, share a social offensiveness. Unfortunately, most studies of the social problems of children with learning disabilities do not differentiate them according to their type of learning problem, but treat them as a homogeneous group. Badian (1983) stressed that delineation of subgroups is as important to research on nonverbal disorders, such as social imperception, as it is to research on the academic learning disabilities, such as dyslexia.

In an investigation of the social behavior of children with dyscalculia, Badian and Ghublikian (1983) demonstrated that good readers who were poor in arithmetic, were rated lower in personal-social behavior by their teachers than children who were poor readers, but average in arithmetic, or than children who were low average in both reading and arithmetic. Significant intergroup differences were con- fined to boys. Characteristics, in which boys poor in arithmetic were

NONVERBAL DISORDERS OF LEARNING THE REVERSE OF DYSLEXIA? 255

deficient, induded attention, organization, social acceptance, and responsibility. Badian and Ghublikian raised the question whether the behavioral and mathematical deficits were both symptoms of the same underlying cerebral dysfunction. Badian (1983) described two boys with social imperception, relatively poor arithmetic skills, and higher verbal than performance IQ. The brain functioning of one of these boys was investigated through brain electrical activity mapping (BEAM) (Duffy and McAnulty 1985), and diminishment of right temporal lobe function was observed.

Rourke and his colleagues have carried out considerable research on two subgroups of children with learning disabilities (Ozols and Rourke 1985; Rourke 1982; Rourke and Finlayson 1978; Rourke and Strang 1983; Strang and Rourke 1983, 1985): (1) Children with poor reading, spelling, and psycholinguistic skills, but with good abilities on visual-spatial tasks, whose performance reflects impairment in abilities believed to be subserved by the left cerebral hemisphere, but a strength on right hemisphere tasks. (2) Children who have problems in visual-spatial and psychomotor skills, and in arithmetic, but who do well on verbal tasks, including word recognition and spelling. The deficits of these children reflect impairment in abilities thought to be subserved by the right cerebral hemisphere, with a strength in left hemisphere functioning.

These two groups of children did not differ in arithmetic, but for the children with a reading disability, arithmetic was a comparative strength, while for those who were good readers, it was a relative weakness (Rourke and Finlayson 1978; Rourke and Strang 1983; Strang and Rourke 1983).

Recently, Rourke and his colleagues have reported on the "social learning disabilities" and "adaptive behavior" of children who have problems with arithmetic (Ozols and Rourke 1985; Rourke 1982; Rourke and Fisk 1981; Strang and Rourke 1985). They use the term "nonverbal perceptual-organizational-output disability (NPOOD)" to refer to the type of child with a strength in rote language-related skills, but with a disability in the processing of nonverbal information and in psychomotor output (Strang and Rourke 1985). Strang and Rourke (1985) describe such children as frequently not well-adjusted from a socioernotional standpoint and state that they are strikingly similar in general characteristics. Their NPOOD children tend to be excessively talkative with a tendency to use jargon and to use speech to manipulate others. They do well in word reading and spelling, but reading comprehension is less good. Possibly because they do not understand nonverbal communications of others, they do not do well in novel social situations. They are likely to have poor posture, to lack facial and body expression, and to be awkward. Because of their poor psycho-


motor skills, they are often dependent on adults much longer than the average child. Rourke (1982) argues that the social and other problems of these children are indicators of deficient right-hemisphere capabilities.

The aim of the present study was to examine teacher perceptions of the social-behavioral characteristics of children, referred because of poor school achievement, who exhibited different psychological test profiles. The subjects were boys only, since earlier studies found no differences in teacher ratings of personal-social behavior among groups of girls (Badian and Ghublikian 1983). It was anticipated that children with a verbal strength and a deficit on visual-spatial tasks (suggesting a relative right-brain dysfunction) would be poorer in arithmetic than in reading, and would, in their teachers' opinions, exhibit more social and behavioral problems than children with a verbal weakness and a visual-spatial strength.

Method Subject Selection

The records of approximately 150 boys aged 7 to 14 years, who were students in the schools of a small suburban town, were examined. The 150 records included all current and recent cases on file, and a sampling of earlier cases. The boys had been referred for either an initial or a follow-up evaluation.

As part of an evaluation teachers are usually asked to write a description of the child, as observed in the regular classroom, and to include information on academic strengths and weaknesses, work habits, attitude toward school, classroom behavior, peer relationships, and anything else relevant. Excluding boys who had not been administered the WISC-R or whose full scale WISC-R IQ was less than 80, there remained 121 boys whose records included a teacher report. The evaluation of these boys also included individual school achievement tests.

In order to obtain groups which varied on tasks in which the left or right cerebral hemisphere is assumed to be strongly involved (Kauf- man 1979), the subjects were divided on the basis of their scores on four WISC-R subtests, as follows:

Group 1--Total scaled scores for Similarities and Vocabulary at least 5 points greater than the total for Picture Completion and Object Assembly (Low Nonverbal Group). Group 2 Total scaled scores for Similarities and Vocabulary at least 5 points less than the total for Picture Completion and Object Assembly (High Nonverbal Group).

NON'VERBAL DZSORDERS OF LEARNING: TnE R~WRSE OF DYSLEXIA? 257

Group 3---Total scaled scores for Similarities and Vocabulary no more than 2 points different from the total of Picture Completion and Object Assembly (Equal Group).

The 22 boys whose difference between the subtest pairs was 3 or 4 points were omitted from the study, leaving 99 subjects: Group 1, N = 36; Group 2, N = 33; Group 3, N = 30. Nearly all the 99 subjects were white and from lower-middle or middle socioeconomic groups. Their mean age was 10 years 5 months, with a range from 7-0 to 14-3. Mean WISC-R full scale IQ was 100.7 (range 81-133). Group characteristics are given in Table I.

Procedures Behavioral Characteristics Teacher reports were scrutinized to de-

termine the number of negative behaviors mentioned. The negative behaviors were classified into nine categories, which are listed below, with the types of behaviors assigned to each category. Because the behaviors assigned to each category were clearly defined prior to group assignment, knowledge of a subject's group placement is un- likely to have had any significant effect on the validity of the data.

1. Motivation: Low motivation, makes little effort, poor attitude toward school, does not participate, uncooperative.

Table I Characteristics of the Low Nonverbal, High Nonverbal, and Equal Groups

Low High Nonverbal Nonverbal Equal

Group 1 Group 2 Group 3

Variable Mean SD Mean SD Mean SD F p

Age (months) 122.8 25.3 122.5 23.7 129.5 22.3 0.85 .429 Sim/Voc* 25.5 4.1 17.6 3.5 20.3 3.7 40.38 <.001 PC/OA** 17.3 4.0 25.3 3.2 20.3 3.9 40.15 <.001 Picture Arrangement 10.9 3.0 12.2 3.0 11.1 2.9 1.96 .146 Verbal IQ 111.8 10.9 93.7 9.9 99.3 9.5 28.75 <.001 Performance IQ 92.1 12.9 108.2 11.6 98.9 12.7 14.28 <.001 Full Scale IQ 102.6 11.8 100.1 10.7 98.9 11.4 0.95 .390 Word Reading 106.4 12.0 93.6 12.6 97.5 8.6 11.75 <.001 Reading Comprehension 99.3 12.2 85.6 11.9 90.2 10.6 12.29 <.001 Arithmetic 94.5 12.3 93.8 12.0 90.2 12.6 1.13 .326 Behavior 3.3 1.5 1.1 1.0 1.8 1.5 24.00 <.001

*Similarities plus Vocabulary **Picture Completion plus Object Assembly


2. Work habits: Poor work habits, slow to get started, dawdles, daydreams, slow to finish work, seldom finishes assignments. 3. Independence: Cannot work independently, immature, will not take age-appropriate responsibilities. 4. Directions: Cannot follow directions, has to be given directions individually or several times or one at a time. 5. Organization: Disorganized, loses things, untidy desk, forgets to bring homework to school, forgets to do long-term assignments. 6. Written work: Messy, untidy or poorly-organized written work, poor handwriting. 7. Appropriate behavior: Makes strange noises, hums, sings, talks excessively without permission, plays with pencils or trinkets, drums fingers. 8. Criticism: Cannot accept criticism, angers or becomes arrogant when criticized, cannot accept teasing. 9. Peer relationships: Poor peer relationships, a loner, not ac- cepted or liked by other children, mean to others, gets along better with adults or younger children than with peers.

Each subject was given a score of 1 or 0 for each of the 9 behavioral characteristics, with a possible total score of 0 to 9. For each characteristic, a score of 0 indicated no teacher reference to a negative behavioral characteristic, and a score of 1 indicated a reference to such a characteristic.

School Achievement The majority of the subjects (68 percent) had been administered the Wide Range Achievement Test (WRAT) as part of their evaluation, and a further 12 percent had been given one or two subtests. The groups did not differ in the proportion administered the WRAT. When the WRAT Reading subtest was not available as a measure of word reading, the word recognition subtest from the Peabody Individual Achievement Test (PLAT) or the Woodcock Read- ing Mastery Tests, administered as part of the evaluation, was the substitute measure. When the WRAT Arithmetic had not been given, the measure of arithmetical computation was the Basic Achievement Skills Individual Screener (BASIS) Mathematics subtest or the Stanford Achievement Test (SAT) Mathematics Computation subtest.

All tests of school achievement were converted to standard scores (mean 100, SD 15) from national percentile ranks.

Data Analysis The data were analyzed primarily by analysis of variance. Variables were age, verbal, performance, and full scale IQ (WISC-R), word reading, reading comprehension, arithmetic, WISC-R Similarities plus Vocabulary (Sim/Voc), Picture Completion plus Ob- ject Assembly (PC/OA), WISC-R Picture Arrangement, and the be-

NONVERBAL DISORDERS OF LEARNIN(~ THE REVERSE OF DYSLEXIA? 259

havioral score (Behavior). Picture Arrangement was the only WISC-R subtest on which groups were compared, other than those used as group criteria. It was included as a variable because Johnson and Myklebust (1967) believed that children with deficits in social perception score low on this subtest. Subjects were classified as poor school achievers if their standard score for any achievement measure was 489.

Differences between the three groups in the frequency of the nine negative behavioral characteristics were compared by means of Chi square.

Results

The three groups (Group 1, Low Nonverbal; Group 2, High Nonverbal; Group 3, Equal) did not differ in age, full scale IQ, Picture Arrangement, or arithmetic. Mean ages of the groups were 10 years 3 months to 10 years 10 months, and mean full scale IQs ranged from 98.9 to 102.6. The groups did differ significantly in verbal and performance IQ (as well as on the Sim/Voc, PC/OA grouping criteria), word reading, reading comprehension, and in Behavior. For detailed results, see Table I.

WISC-R Profile

Group 1 showed a high verbal (111.8) low performance (92.1) pattern. Group 2 showed the reverse pattern (verbal 93.7, performance 108.2), while Group 3 was equal in verbal (99.3) and performance (98.9) IQ. As the grouping criteria were two verbal and two performance subtests, these WISC-R profiles were as expected.

School Achievement

Group 1 was superior to the other groups on both reading measures and showed a word reading > reading comprehension > arithmetic profile. Achievement profiles of the other groups were: Group 2--Word reading = arithmetic > reading comprehension; Group 3--word reading > arithmetic = reading comprehension.

With poor school achievement defined as a standard score <~89, 27 percent of the 99 subjects showed no disability, 24 percent were low in arithmetic only, 27 percent in reading only (word reading and/or reading comprehension), and 21 percent were low in both reading and arithmetic. The distribution of the cases among the three groups is shown in Table II.

Group 1 had the highest number of subjects with no disability (42 percent), and with arithmetic as their only low score (33 percent), and

260 STUDIES, COMPARISONS, .AND CASES

Table II Percentage of Subjects in Each Group with Poor School Achievement.

Group N Low Nonverbal 36 High Nonverbal 33 Equal 30

School Achievement

Low Low Low No Arithmetic Reading Arithmetic

Disability Only Only and Reading

Percent Percent Percent Percent 42 33 14 11 18 12 42 27 20 27 27 27

Total 99 27 24 27 21

the lowest number poor only in reading (14 percent). Group 2 showed the highest number poor only in reading (42 percent), and the lowest number poor only in arithmetic (12 percent). Group 3 subjects were fairly evenly distributed across the achievement categories. The groups did not differ in the number of subjects with no disability (Chi square = 5.813, p < .10).

Behavioral Characteristics

Group 1 received the highest Behavior score, indicating a higher reported frequency of negative behaviors. The t-test for differences among several means showed that, although the Behavior score of Group I was significantly higher than that of either of the other groups (p < .001), Groups 2 and 3 did not differ significantly (p < .10). Group 2 subjects received the lowest mean score on the Behavior rating (i.e. fewest negative behaviors).

The percentage of subjects in each group exhibiting each behavior is given in Figure 1.

The groups differed in Work Habits (Chi square = 8.221, p < .025), Independence (Chi square = 19.912, p < .001), Organization (Chi square = 6.00, p < .05), and Peer Relationships (Chi square = 9.103, p < .025). Each negative behavior was reported more frequently for Group 1. The between-group differences in Motivation nearly reached significance (Chi square = 5.840, p < .10), and Group 1 did differ significantly from Group 2 in Motivation (Chi square = 5.936, p < .025). For Directions, Written Work, and Appropriate Behavior, there was no difference between the groups. No formal analysis was made for Criticism because of the small number of cases involved.

When Behavior scores were examined by achievement categories, a significant difference was found (p < .0165). The 24 percent of subjects who were poor only in arithmetic received the highest Be-

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havior score (mean = 2.9), followed by those with no disability (mean = 2.3), those low in both reading and arithmetic (mean = 1.9), and those poor only in reading (mean = 1.5). Subjects poor only in arithmetic were significantly higher on the Behavior score than those poor in reading only (p < .01), and those poor in both reading and arithmetic (p < .05). Those with no disability did not differ significantly in Behavior from those in any other achievement category.

The four achievement subgroups of Group 1 (i.e. no disability, low in arithmetic only, low in reading only, low in both reading and arithmetic) were similar in their Behavior scores (3.0 to 3.5). In Groups 2 and 3, the highest frequency of negative behaviors was reported for the subgroups low only in arithmetic (Group 2 = 1.75; Group 3 = 3.0).

Discussion

As anticipated, boys who scored lower on two WISC-R nonverbal subtests (Picture Completion and Object Assembly) than on two verbal subtests (Similarities and Vocabulary) were stronger in word reading than in arithmetic, were significantly higher in verbal than in performance IQ, and exhibited more social and behavioral problems than two comparison groups. One comparison group consisted of boys who were lower on verbal than on nonverbal tasks, and the other consisted of boys who performed equally on both types of tasks. The three groups did not differ in chronological age or in full scale IQ. The most striking differences were observed between the Low Nonverbal and High Nonverbal groups, with the Equal group intermediate on most measures, including behavior.

Approximately one-quarter (27 percent) of the boys studied did not demonstrate below-average school achievement on the measures used in this study. Whether or not they met the criteria for low achievement, the Low Nonverbal group subjects were lower in arithmetic than in reading, and exhibited social-behavioral problems. How- ever, their arithmetic scores were as high or higher than those of the other two groups. That is, for the Low Nonverbal group arithmetic was a weakness, but not a serious deficit. In their characteristics, the Low Nonverbal children closely resembled those described by Johnson and Myklebust (1967) as having a "nonverbal disorder of learning" and the "NPOOD" children of Strang and Rourke (1985).

The subjects of this study differed in some respects from those studied by Rourke and his colleagues. Their subjects were clinical referrals and included girls, whereas the subjects of this study were boys referred within one school system. Many of Rourke's studies have been limited to children aged 9 to 14 years (e.g. Rourke and

NONVERBAL DISORDERS OF LEARNING." THE REVERSE OF DYSLEXIA? 263

Finlayson 1978; Strang and Rourke 1983), and group selection criteria were differences in WRAT subtest scores. The subjects of this study were aged 7 to 14 years, and the group criteria were WISC-R subtests considered to be good measures of left- and right-brain functioning (Kaufman 1979).

Boys in this study with poor arithmetic skills but satisfactory reading exhibited more negative behaviors, even when they did not meet the criteria for inclusion in the Low Nonverbal group. This was particularly true of the subgroup of eight boys in the Equal group who had low arithmetic scores. All but two of these boys showed, or had shown, signs of possible right-brain dysfunction. If the selection criteria had included Block Design, rather than Picture Completion, three of them would have been in the Low Nonverbal group. One boy showed the Low Nonverbal profile at age 9, but not at age 13 when retested. Two other boys were low on Block Design (9 percentile) and exhibited other signs of possible right-hemisphere dysfunction: (1) left-sided weakness following a head injury at age 7; (2) a significant deficit on the WISC-R Digits Backward, compared with Digits For- ward, which tends to be associated with right-hemispheric dysfunction (Rudel and Denckla 1974).

Picture Completion and Object Assembly were selected as the two right-brain processing tasks because Kaufman (1979, p. 157) argues strongly that Picture Completion and Object Assembly appear to require "almost exclusively the holistic synthetic right-brain cognitive style." Kaufman believes that Block Design measures integrated functioning because it requires analysis, a left-brain function, in addition to the subsequent holistic synthesis needed to assemble the blocks cor- rectly. Nevertheless, Kaufman quotes Reitan (1974, p. 45), who believed that Block Design was sensitive to posterior right-hemisphere involvement, and especially to right parietal and occipital damage. Lezak (1983, p. 279) reports that Block Design scores tend to be lower in the presence of any kind of brain injury.

As part of their evaluation following referral, the brain functioning of three of the boys of the Low Nonverbal group was examined through brain electrical activity mapping (BEAM) (Duffy and McAnulty 1985). These boys were nine years of age. They were referred for the BEAM because, in spite of fairly good basic skills, they were not succeeding in school. The BEAMs of all three revealed abnormal brain activity bilaterally or in the right hemisphere, including the right temporal lobe. These boys were superior oral readers. Arithmetic was significantly lower, but not a serious deficit, and verbal IQ was significantly higher than performance. Each boy was a source of great irritation to parents and teachers because he exhibited so many of the behavior problems described earlier. One of the boys, Donald,


was a loner who had no close friends and irritated other children around him in school. He was always the last chosen for a team game. In the classroom, he would make strange noises and play with his pencil case when he should have been working. He would work only when the teacher spent time getting him started, and directions had to be given to him individually. Work was seldom finished. Another of the boys, David, was a bright boy with superior verbal intelligence who had no self-motivation. He could do well on teacher-directed tasks, such as a spelling test, but had difficulty beginning a task and moving from one assignment to another. If given a series of inde- pendent tasks, he either did not do them at all or did not complete them. Homework assignments were usually forgotten, left at home, or, if done, were incomplete. When told he had made a mistake, either at home or at school, David became arrogant. In one-to-one situations with an adult, such as testing sessions, these children were friendly and cooperative.

In sharp contrast to children such as Donald and David, teachers often speak glowingly of children of the High Nonverbal group. Mike, for example, who had a severe reading disability and was poor in arithmetic also (although arithmetic was comparatively a strength), was described by his teacher as extremely well-liked, with a marvelous sense of humor. Mike desperately wanted to learn, he listened well, and he remembered what he heard. At times he became upset by his failure in school, but he never gave up and tried his utmost. Another boy, Sean, had a well-documented language disability, but as early as when he was six, his teacher wrote that his effort was superb. He would tend to a task for a long period of time, even if he found it frustrating. His work was slow and labored, but he would stay with the task until it was completed. He got along well with peers and teachers. By age ten he was described as being dependable and responsible. He pushed himself and tried hard to do his best and was very popular with his peers. He was constantly chosen to be on teams with "the best of the bunch."

Rourke et al. (1983) give three case studies of children with right hemisphere dysfunction or documented damage (removal of the right temporal lobe). In each case WISC performance IQ was significantly lower than verbal, and arithmetic was low in relation to reading and spelling. All three demonstrated poorly developed interpersonal skills, with relationships with adults better than peer interactions. Rourke and his colleagues describe the test results of one of these cases as suggestive of moderate chronic dysfunction of the temperoparietal and (possibly) adjacent frontal regions of the right hemisphere. Lezak (1983, p. 62) writes that patients with right hemisphere lesions have a diminished capacity for self-awareness, which tends to reduce their

NONVERBAL DISORDERS OF LEARNING: THE REVERSE OF Eh'SLEXIA? 265

sensitivity to others. As a result, they are more difficult to live with and more likely to be rejected by friends and family than patients with left hemisphere lesions.

In thecurrent study, behaviors reported significantly more often by teachers for children who scored low on tests assumed to be mediated primarily by the right hemisphere were low motivation, poor work habits, inability to work independently or to take age-related responsibility, disorganization, and poor relationships with peers. Inability to accept criticism was a trait observed almost exclusively among the Low Nonverbal group of children.

Although they may have no serious academic weaknesses, Low Nonverbal children are referred for evaluations quite frequently. Younger children tend to be referred because letter reversals slow their acquisition of reading and writing and older children because of problems in arithmetic or written language or because they are under- achieving or failing. Their problems may exacerbate when they reach the higher elementary grades. By that time, teachers are less likely to tolerate the dependency and disorganization so often shown by these children. At this time also, when the peer group becomes so important to children, Low Nonverbal children are at a disadvantage because of their inept social skills and because many of them are clumsy and do not do well in sports or physical education.

Strang and Rourke (1985) report a recent follow-up study of eight adults who exhibit the "NPOOD" syndrome. None of them held a job commensurate with academic qualifications. All exhibited emotional and social difficulties and had a poor understanding of their adaptive limitations. Some were diagnosed as schizophrenic at some point in adult life. Wing (1981) describes several adult and child cases of Asperger's syndrome, many of whom appear very similar in their characteristics to the NPOOD cases of Strang and Rourke (1985) and the children described by Myklebust (Johnson and Myklebust 1967; Myklebust 1975), as having a nonverbal disorder of learning. As is true of the Low Nonverbal subjects of this study, most of the cases of Asperger's syndrome were good readers and verbal, but socially inept, "conspicuously lacking in common sense," clumsy, unable to understand humor, and oversensitive to criticism. According to Wing, Asperger described them as unsatisfactory students because they followed their own interests, regardless of the teacher's instructions and the activities of the rest of the class.

Remediation

The limited evidence available to date that children with a nonverbal disorder and a probable right-brain dysfunction tend to be poorly adjusted in adult life highlights the urgency of finding ways to


help them cope. It appears to be more difficult to help children with a nonverbal disorder effectively than it is to help those with a verbal disorder. For one thing, children with a probable right-brain dysfunction or nonverbal disorder are rarely diagnosed as such, whereas language disorders have long been recognized and specific remedial techniques have been developed for them. Unless children with a nonverbal disorder have a definable learning disability in a school subject, such as mathematics or written English, they may not be eligible for special services. They are likely to be considered lazy, uncooperative, behavior problems, odd or emotionally disturbed, and capable of improving themselves if they will take the trouble.

If, as seems probable, the nonverbal disorder reflects organic right-brain dysfunction, children suffering from it require as much patience and skilled help as those with a verbal learning disability. They are difficult to help, however, because their deficits affect almost every aspect of daily life. School adjustment counselors or therapists may be able to help them if they recognize the problem for what it is. The focus should be on ways of changing specific inappropriate behaviors through the setting of short-term goals with incentives for their successful attainment. Providing aids to daily organization and teaching personal responsibility through role models may also be useful. Teachers and parents must try to be patient and encouraging and provide structure for these children, while training them in independence. A school adjustment counselor might help improve social skills by including the socially inept child in a small group of socially well-adjusted children and teaching him/her how to interact appropri- ately.

Although the basis for some of the problem behaviors may be poor visual-perceptual-motor skills, it is not known whether training in such skills will help to resolve problems in daily living. With young children, training in careful visual observation, in visual-constructive skills, and in interpreting emotions and social situations portrayed in pictures may be of use. Johnson and Myklebust (1967) give examples of techniques to help children with nonverbal disorders. Strang and Rourke (1985) devote part of their chapter to remediation/habilitation for the NPOOD child, with suggestions to parents and teachers. Strang and Rourke state that whereas the primary goal for children in most educational programs is to help them master a particular cur- riculum, the program needed by NPOOD children must focus primarily on the development of life skills. Strang and Rourke stress the urgency of developing life skills by referring to their finding that some NPOOD children have, as adults, developed debilitating forms of psychopathology.

NONVERBAL DISORDERS OF LEARNING: THE REVERSE OF DYSLEXIA ? . 267

Conclusions

The research available to date indicates that there is a type of child with a nonverbal disorder whose pattern of strengths and weaknesses is strongly suggestive of good left-brain functioning, but of right-brain dysfunction. A specific constellation of behaviors is so consistently associated with the high verbal/low nonverbal test profile that it is probable that these behaviors are part of the right-brain dysfunction syndrome. The characteristics of children with this type of disorder are well-described by Strang and Rourke (1985, p. 302-319) and by Thompson (1985). The evidence becomes even more compelling when children with a nonverbal disorder are compared with those with verbal disorders and signs of probable left-brain dysfunction. In spite of their learning disabilities, many children with a language disorder, such as dyslexia, exhibit positive behavior characteristics, such as sociability and determination to succeed, which are the opposite of those described for children with a nonverbal deficit. As the main problems of low nonverbal children are observed in daily living, the term "social learning disability" (Rourke 1982) can be aptly applied to them.

Further research on this type of child is essential. It would be instructive to know what proportion of the subjects in the extensive studies of the social behavior of children with learning disabilities, such as those conducted by Bryan and her colleagues (e.g. Bryan 1977; Bryan 1978; Bryan and Bryan 1978) exhibited the right-brain dysfunction syndrome, with its constellation of problems. A recent review of the literature on the social status of learning-disabled children and adolescents (Dudley-Marling and Edmiaston 1985) concluded that many students with a learning disability are not unpopular with their peers; indeed, some are popular. It is possible that the less popular students may include many who show signs of right-brain dysfunction. As stressed earlier in this paper, an essential requirement for further advances in the study of learning disabilities is that subjects with learning disorders should not be considered to be a homogeneous group and that subgroups be carefully defined and delineated.

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Bryan, T. H. 1978. Social relationships and verbal interactions of learning disabled children. Journal of Learning Disabilities 11:107-115.

Bryan, T. H. and Bryan, J. H. 1978. Social interactions of learning disabled children. Learning Disability Quarterly 1:33-38.

Bryan, ]. H. and Sherman, R. 1980. Immediate impressions of nonverbal ingratiation attempts by learning disabled boys. Learning Disability Quarterly 3:19-28.

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Nonverbal disorders of learning: The reverse of dyslexia

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