There are many other disorders that can affect a child’s ability to learn, but are less common, misunderstood, or not acknowledged by academic or medical professionals. Unfortunately, when such issues go unidentified and thus, untreated, the child suffers severe frustration, anxiety, and often ridicule or mistreatment in school. Hopefully, the following information awakens awareness and curiosity to further research and understand the difficulties your child may be facing.
Traumatic Brain Injury
A traumatic brain injury (TBI) is caused by a forceful bump, blow, or jolt to the head or body, or from an object that pierces the skull and enters the brain. However, not all blows or jolts to the head result in a TBI.
Some types of TBI can cause temporary or short-term problems with how the person thinks, understands, moves, communicates, and acts, which may also look like ADHD symptoms. Some injuries are considered primary, meaning the damage is immediate; others are secondary and may occur gradually over the course of hours, days, or weeks later. Although there are two main types of head injuries, non-penetrating & penetrating, our focus is on non-penetrating since these are the ones that may go undetected in children and cause learning difficulties. These injuries are also known as closed head injury or blunt TBI and are caused by an external force strong enough to move the brain within the skull. With early diagnosis and ongoing therapeutic intervention, the severity of these symptoms may decrease.
“Symptoms can vary greatly depending on the extent and location of the brain injury. Impairments in one or more areas (such as cognitive functioning, physical abilities, communication, or social/behavioral disruption) are common” (Brain Injury Association of America, https://www.biausa.org/ ).
Causes typically include falls, motor vehicle crashes, sports injuries, blast injury, or being struck by an object.
In children, the signs to look for are:
- changes in interest
- inability to give attention to tasks
- changes in sleep patterns, moods, and eating
- dizziness, balance, vomiting
- inappropriate behaviors, especially if not seen before
- brief loss of consciousness
- fatigue or restlessness
These symptoms may look similar to ADHD or a behavior problem, but call for a much different response. If your child has experienced a blow to the head (fell off trampoline or bicycle, had a four-wheeler wreck, received a hard baseball hit in the head or other hard hits to the head) a medical examination is required to diagnose TBI.
- National Institute of Neurological Disorders & Stroke, www.ninds.nih.gov , TBI
- America Speech Language Hearing Association (ASHA), Signs and Symptoms
Tourette Syndrome is one of several types of Tic Disorders. Tics are defined as involuntary, repetitive movements and vocalizations.
- In Individuals with Disabilities Education Act (2004), Tourette syndrome is included under the category of Other Health Impairment which is defined as having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment. If a child is identified and diagnosed as having Tourette syndrome, the school paperwork will have him listed as Other Health Impairment. https://sites.ed.gov/idea/regs/b/a/300.8.
There are three different types of Tic Disorders which are neurological conditions that begin in childhood:
- Tourette Syndrome (TS),
- Persistent (Chronic) Motor or Vocal Tic Disorder, and
- Provisional Tic Disorder.
It depends on the types of tics present (motor, vocal/phonic, or both) and the length of time that the tics have been present, as to which tic is diagnosed. Diagnosis must be determined by a medical professional.
- eye blinking
- facial grimacing
- head bobbing, jerking
- neck movements, stretching
- arm jerking
- shoulder shrugging
- combination of the above
- throat clearing
- blurting out a phrase out of context
- swearing, ethnic slurs or socially unacceptable words (this only occurs in 10-15% of the cases)
I have noticed that many children exhibit some of these behaviors at some point in their early development, so it is not uncommon to have a child that clears her throat excessively or blinks her eyes continuously. The key is how long it last. Anxiety can produce tics in children that may be situational and will cease when the situation changes, but if it persists for over a year, then it is uncontrollable. Observe and take notes to determine if your child needs a medical examination.
- Tourette Association of America, https://tourette.org/about-tourette/overview/
- Center for Disease Control, Treatments for Tourette
Speech/language disorders is a separate category of IDEA and is not placed under learning disabilities. However, many children with learning disabilities are also diagnosed with and eligible for speech/language services.
IDEA (2004), https://sites.ed.gov/idea/regs/b/a/300.8
1. Speech is how we say sounds and words. A child with speech disorders may have trouble with:
- Stuttering=repeats sounds or pause when speaking
- Voice=speaks with a raspy or hoarse voice
- Articulation=doesn’t say sounds correctly
2. Language is the words we use to share ideas and get what we want. A child with a language disorder may have problems with understanding language, talking, reading, and writing. Most children can pronounce sounds correctly by age four. However, children with persistent ear infections will be delayed in pronounce sounds correctly because they hear them muffled.
Receptive language (understanding the spoken word) difficulties are:
- Understanding what people mean when they use gestures, like shrugging or nodding
- Following directions
- Answering questions
- Pointing to objects and pictures
- Knowing how to take turns when talking with others
Expressive language (speaking & expressing one’s ideas) difficulties are:
- Asking questions
- Naming objects
- Using gestures
- Putting words together into sentences
- Learning songs and rhymes
- Using correct pronouns, like “he” or “they”
- Knowing how to start a conversation and keep it going
- Changing how they talk to different people and in different places. For example, you speak differently to an adult than a young child. You can talk louder outside than inside.
TIP: Language Deficits Produce Behavior Problems
When a child has a language deficit and cannot communicate his needs (hunger, pain, desires, thoughts), his options are limited in gaining the attention for others to understand what he is trying to communicate. Therefore, burst of anger, crying, throwing objects, self-injurious behavior, or hurting others become forms of communication. Rather than continual punishment, it is wise to teach this child other forms of communication until language is achieved. Sign language, assistive technology like iPads, and picture communication systems provide a few communication alternatives.
- Receptive and expressive language problems should be identified as early as pre-school.
- Speech-language pathologists (SLPs), can help identify these problems and provide the appropriate therapy.
American Speech-Language-Hearing Association, https://www.asha.org/default.aspx
Non-Verbal Learning Disability
Non-verbal learning disability (NVLD or NLD) is not recognized in the Diagnostic Statistical Manual (DSM-V, 2013), or Individuals with Disabilities Act (IDEA, 2004) and is sometimes controversial among medical and educational professionals. As a result, children in public schools do not receive special education support services under this diagnosis, but may qualify for services under other diagnoses such as ADHD or Autism. Since education professionals focus primarily on language-based learning disabilities, NVLD often goes unidentified since these children have such strong verbal abilities.
According to NVLD Project, the key traits of NLVD are:
- strong verbal abilities (well-developed vocabulary, remembers minute details to stories, learns lists of facts easily);
- deficits in nonverbal communication (reading facial expressions & body language); and
- visual-spatial abilities (difficulty completing puzzles, following spatial directions, building with blocks).
The Non-Verbal Learning Disabilities Project, a nonprofit organization dedicated to current research, best practices, and support for NVLD, seeks inclusion in DSM as a recognized disorder and defines NVLD, setting the standard for identification and diagnosis. NVLD Project
- Large vocabulary with strong verbal skills
- Attention to detail, but misses the big picture
- Strong decoding skills, but poor reading comprehension
- Poor fine motor skills (using scissors, tying shoelaces, pencil grip)
- Sometimes weak gross motor skills (throwing a ball, riding a bike, etc.)
- Lack of spatial awareness (bumping into people and things, unable to following directions when traveling, appears clumsy)
- Difficulty with organization, planning, and activities that require multitasking
- Difficulty staying focused
- Great auditory learner, but trouble recalling visual information
- Struggles with peer relationships and forming friendships
- Difficulty reading social cues such as body in space and judging body placement in relation to others, often stands too close to someone
- Difficulty interpreting social interactions and working in groups
- Fears new situations and has trouble understanding them
- Struggles with interpreting nonverbal communication (facial expressions, posture, tone of voice, etc.)
- Doesn’t understand idioms, humor, sarcasm, the tone of an author; is a concrete thinker
- Struggles with organizing essays; handwriting is laborious and messy
- Trouble understanding charts and diagrams, like maps and graphs
- Difficulty with abstract math skills (understanding fractions, geometric shapes and word problems)
- A child with NLVD is often considered by others as ‘spacey’ or a ‘smart aleck’ because of their concrete interpretation of language, thus has difficulty maintaining relationships as demonstrated in this child’s
- NLVD Project https://nvld.org/non-verbal-learning-disability/
- University of Michigan, Michigan Medicine
When having your child evaluated, a diagnostician will look for a discrepancy (significant difference) between perceptual reasoning (formerly Performance IQ) and verbal comprehension (formerly Verbal IQ), as measured by intelligence tests. Students suspected of having NVLD should also be assessed in five areas although they may not exhibit weaknesses in all 5 areas: visual and spatial awareness, higher-order comprehension, social communication, math concepts, and executive functions. Look for a neuropsychologist or education psychologist familiar with an array of childhood learning disabilities to conduct the evaluation.
- ADDitude offers a twelve question self-test screener to determine if your child is struggling with traits of NVLD and may need a professional evaluation.
NVLD is often mistaken as ADHD, since there are overlapping traits and ADHD is a more commonly known condition. However, the two are not the same. Kids with NVLD are struggling to interpret and understand the world around them, whereas those with ADHD are learning to adapt to the structure of the world they live in. Approximately 93% of our communication is nonverbal such as body language, facial expressions, and tone of voice, yet those with NVLD must use their strong verbal skills, the other 7%, to navigate socially. As a result, ADHD medical treatments such as Ritalin, Focalin, and Adderall do not work for these children. Furthermore, NVLD is not the same as Autism (formerly Asperger’s) although some symptoms overlap. It is important to find a diagnostician that is knowledgeable and understands NLVD when seeking an evaluation for your child.
ADDitude, NLVD is not ADHD
Spatial Perception Problems
- Reducing novelty in a situation by reminding students of strategies they used to handle similar problems or similar circumstances.
- Providing specific verbal instruction for anything that requires understanding a part/whole relationship.
- Reducing amount of visual stimulus on a page.
- Providing feedback about why difficulties arise, in a positive manner.
- Use frequent eye contact to check if student is listening.
- Repeating a predetermined ‘alerting’ word that instructions are coming next.
- Offer movement breaks & objects to fidget with while studying.
- Situate seating with limited visual distractions.
- Use explicit instruction (with repetition) when teaching a motor skill.
- Provide handwriting instruction such as Handwriting Without Tears.
- Provide keyboarding instruction such as Type to Learn.
- Employ an Occupational Therapist.
Executive Function Problems
- Provide samples/models of how to solve new problems.
- Develop steps to take when approaching an unfamiliar problem.
- Practice learning material in many different ways such as: labeling it, drawing it, answering essay questions about it, and completing short answer questions.
- Graphic organizers (concept maps, flow charts, outlines, etc.).
- When necessary, allow students to type written assignments or even use voice. recognition software such as Talk to Type instead of handwriting.
For Associated Math Problems
- Use language to describe every step explicitly creating a script to follow.
- Always show sample problems on top of worksheet (or a test).
- Use consistent spatial arrangement of items in math problems; use graph paper.
Source: NVLD Project, Interventions
- Keep the environment predictable and familiar by providing structure and routine.
- Prepare your child for changes, giving logical explanations.
- Be logical, organized, clear, concise and concrete. Avoid jargon, double meanings, sarcasm, nicknames, and teasing; state your expectations clearly.
- Be very specific about cause and effect relationships.
- Have your child use the computer for schoolwork.
- Help your child learn organizational and time management skills.
- Make use of your child’s verbal skills to help with social interactions and non-verbal experiences; for example, giving a verbal explanation of visual material.
- Teach your child about non-verbal communication (facial expressions, gestures, etc.). Help him learn how to tell from others’ reactions whether they are communicating well.
- Locate a small-group social skills training program.
- Encourage your child to develop interests that will build her self-esteem and help her relate to other kids.
- Talk to your child in private after you have gone with him to a group activity. Discuss how to improve interactions with other children. For example, you might point out that other kids don’t feel comfortable when your child stands so close to them. Help him practice the social skills you explain through role-playing.
- Find your child a playmate with something in common and set up play dates to gain some social skills experience in a small, controlled, less-threatening way.
NVLD Project provides video of experts discussing and explaining NLVD; lists of interventions for teaching a child with NLVD; plus other videos, books and toolkits to assists with academic and social success. https://nvld.org/
ADDitude, What is NVLD
Understood, About NVLD
Smart Kids with Learning Disabilities provides plenty of Articles to increase awareness, understanding and how to teach and work with students with NVLD.