Nonverbal Learning Disabilities and Social Functioning by Stephen Rothenberg, Psy.D. Dyslexia is a well-known term that describes an impaired ability to read. Less known is another "reading disability" which can be at least as disabling. Nonverbal learning disabilities (NVLD) are often associated with difficulty reading and responding to social information, particularly nonverbal cues or "body language." Verbal language alone will often not convey all the information needed to understand a given social situation. Approximately 65 percent of the communication in an average conversation is believed to be nonverbal. This means that the child with nonverbal learning problems has to rely on approximately 35 percent of the communication in order to discern what is being communicated and how to respond. Earliest nonverbal information comes from a child's learning to process visual information from a parent's face. The child begins to associate various internal feeling states with the configuration of the face of the parent. When happy inside (feeling) matches happy outside (parent's smile) this feeling interaction becomes associated in the infant's social/emotional system. A template begins when nonverbal signals and their associated feeling states are internalized as patterns of relating. There is also a congruence of affects that is an organizing force in the young child's life. When moods and signals match, this results in a congruence of feeling and a sense of well being in the child. Children who have difficulty processing visual spatial information will have difficulty internalizing these visual templates. Consequently, they may not have the same congruence of feeling. The resultant development and social/emotional organization will then be delayed. If these missed cues continue through early childhood, they will affect the child's peer relationships. When the child becomes more interactive with others (around 4 to 5 years old) he/she may misread cues about when to join in, when to stay back, what someone might be feeling (difficulty with development of empathy) and how to respond to others. For example: Johnny sees Jimmy playing with a toy. As he gets closer he doesn't notice that Jimmy begins to turn his body away. Johnny continues to move closer and reaches for the toy. Jimmy, interpreting this as a threat, hits Johnny. Johnny, experiencing this as an unprovoked attack, hits him back. In this case, missing the nonverbal cues led to an inappropriate approach on Jimmy's part. Johnny reacted to this as if Jimmy was ignoring his feelings and reacted aggressively. Jimmy is left confused about why he received such an angry response, not knowing what to expect from his interpersonal interactions. As the world of social relationships becomes more complex, the child with NVLD may become more confused and often more withdrawn. Not only do they have difficulty discerning the nonverbal social cues, they also struggle with organizing all of the information into a meaningful whole. Since they feel incompetent within the social arena, they will stay away from that area of incompetence, thereby depriving themselves of further practice. Children with NVLD will struggle with picture puzzles and how the pieces fit together. Social information is more abstract and quickly changing than pulling together puzzles. If a child has great difficulty arranging the static pieces of a puzzle, imagine how difficult it is to assemble all of the quick paced and changing "pieces" of social information. Lacking the ability to form this information into meaningful patterns, the child's sense of self and other is concrete and fragmented. Stanley Greenspan, MD (1) hypothesizes that "visual spatial processing is related more to the perception of the intensity of affect than its meaning." He feels that children with NVLD may be able to discern the meaning of social communications but miss the emotional strength of these communications. These children struggle with managing the intensity of their own feelings and with judging the intensity of the feelings of others. They can be easily overwhelmed by their feelings and then, in turn, easily overwhelm others. They are "sensitive" and overreactive children as they lack self-organization and the ability to self soothe. They are a challenge for parents, teachers, and others who are often confused as to how to respond, resulting in the child feeling more alone and confused. Because of their reactivity, they are frequent targets of teasing by bullies. So, with all this information in mind (and probably feeling overwhelmed ourselves), how can we help? Dr. Stanley Greenspan writes "the optimal environment balances a sense of empathy (the difficult test of feeling the distress of the out of control child when he is excessively excited) with the firm and consistent setting of limits." We, as parents, teachers, and others helping children with NVLD need to be calm in the face of the storm of the child's intensity. We need to provide the organizing and calming forces when the child is unable to provide them for himself. When emotions are running high and we are coping with our own stress, this is no easy task. The optimal environment for a child with NVLD to learn social skills involves minimal stimulation. Just as limiting the amount of written material on a page helps the child to focus, limiting the amount of visual (and other) stimulation helps the child to focus and be focused on social cues. Some children will become overloaded by too much facial information. Someone who is very expressive may overwhelm the child with a nonverbal learning disability, as it is too much to process all at once. Therefore, when communicating with children with nonverbal learning problems it is helpful to do so in a quiet, straightforward manner without too many facial gestures or feelings all at once. It is also important to "check in" verbally to ascertain whether the child has interpreted the meaning of the communication and gesture appropriately. It is important to overuse the verbal channel in order to aid the development of the visual channel as well as self-organization in general. Talking and playing through various situations will help a child develop visual-verbal associations and increase the complexity of their feeling vocabulary. Most children start out with the three basic feelings: happy, mad, sad. Children with NVLD will tend to stay with the three basic feelings longer than other children. We need to help them to learn to verbalize gradations of feelings, e.g. "a little happy," "very sad." Processing social interactions with the child, breaking them down into understandable parts, can help the child with nonverbal learning problems. Watching television sitcoms can be very instructive. Asking a child what is happening in their favorite television show while watching it with them can be helpful in discovering where the child misinterprets social communication. I am often surprised by the interpretations I get when I ask. It can be even more fun when you turn the sound off on the television set, relying only on the nonverbal cues available. This allows the child and adults to learn about nonverbal communication in a playful manner. For older children, this could even be practical at the local mall. "People watching" provides a wonderful opportunity to guess about what others might be feeling or talking about. After a child has been involved in a peer interaction, adults can sit down with him and break down the components of communication such as asking "what do you think he was feeling then?" and "what about his body language told you that he was feeling that way?" Social skills group psychotherapy, focusing on pragmatic social skills, is often quite helpful for the child with nonverbal learning problems. The group affords the child and therapist an opportunity to work on misperceptions and learn appropriate social behavior in the "here and now." The therapist helps the children use the interactions that arise with the group to learn about how they come across to others and to interpret correctly how others come across to them. In group therapy, we often like to play "Name That Feeling." In the game, children take turns at acting out a feeling. It gives the child a chance to practice portraying the appropriate nonverbal gestures, and the children who are guessing a chance to hone their interpretive skills. Children with NVLD will often have trouble with proxemics. They may not know how close or far away to stand from others. Whenever possible, a concrete rule can be very helpful. In this case we usually use the "arm's length" rule: in regular conversations we should always stand about an arm's length from the other person. They respond well to the structure of rote, concrete rules as they make the confusing social world feel a little more under control. I know one boy whom I see who spends a lot of time watching other children. He looks and tries to find patterns that will make it all make a little more sense. The social world does not have to be a confusing and frustrating place. Children with nonverbal learning problems need to be taught how to understand and respond to a complex array of social communication. We need to help them to see patterns and to see that there is some sense to be made of all of this. With firm and understanding teaching, the children can learn to better interpret the world of social communication. (1) Greenspan, S. I. (1996) Developmentally Based Psychotherapy. Madison, CT: International Universities Press. ~~~~~~~~~~ © 1998, Learning Disabilities Association of Massachusetts. All rights reserved. This article originally appeared in two parts, in the October and November, 1998, issues of the Gazette, the Journal of the Learning Disabilities Association of Massachusetts (LDAM). The article is posted on NLD on the Web! with the express permission of the Editor, Teresa Allissa Citro, and the author. Reproduction of this material in any form other than for individual educational purposes, without the express written permission of the LDAM, is prohibited. About the author - Stephen Rothenberg, PsyD, is a graduate of the Massachusetts School of Professional Psychology. He completed a postdoctoral practicum in Child Neuropsychology at Massachusetts Mental Health Center. Dr. Rothenberg specializes in learning and attentional disorders, and relationship difficulties. He has 22 years of psychotherapy experience.