Learning Disorders

Learning disorders (LD) refer to patterns of cognitive strengths and weaknesses in individuals that may create a risk for difficulties in learning specific skills. For example, an individual with weak verbal ability may not be efficient at remembering words, resulting in a reading problem, even though the same individual may have strong visual-spatial skills, which result in good performance in math or science. Conversely, an individual with high verbal ability may be good at reading, history, and so on, but if the same individual is weak in visual-spatial ability, he or she may have difficulties with math or map reading. Thus, LD occurs when a specific cognitive weakness creates a specific deficit in an academic learning area. Although LD was originally related to academic learning, it has now also been associated with nonschool learning (e.g., driving, sports) and social learning problems.

There are two primary reasons LD has become increasingly important to the field of counseling psychology. One relates to the secondary effects of having an LD, such as the emotional frustration of a child who can’t keep up in school, and the other relates to the primary late effects of LD, such as an adolescent experiencing difficulty in college or an adult with a language problem experiencing communication problems with a spouse. Children with LD often experience frustration due to school learning problems, which may create low self-esteem, emotional difficulty, and behavior problems, which in turn may create family and parenting difficulties. It is important for counseling psychologists to understand LD in order to be able to assist parents, the child, and the family in dealing with the consequences of LD in family interactions. Another reason counseling psychologists need to have knowledge of LD is that many vocational, social, emotional, or marital problems are related to the problems in living experienced by the adolescent or adult with an LD. For example, a husband, who may have had a language-based LD in school, may have received reading assistance and no longer has a reading disability, but may still lack efficiency in the use of language. The wife may perceive that this husband ignores her because he does not communicate with her.

Counseling psychology, as a profession, has been a strong advocate for understanding and sensitivity to individual differences as well as to group differences such as gender, ethnicity, culture, and socioeconomic level. Greater knowledge of learning disorders will allow counseling psychologists to understand cognitive differences of individuals with LD and how counseling strategies may be altered in order to take into account the individual’s cognitive strengths and weaknesses. It is also important for the counseling psychologist to understand LD subtypes, because many children and adults with LD deny their disorder and need counseling in order to gain better self-awareness, so they can learn to manage and compensate for their LD.

As an example, individuals with a memory deficit LD (MemLD) may not compensate by using note reminders and a calendar if they do not have insight into their LD. Their forgetfulness will create negativism from friends, teachers, parents, and colleagues. A counseling strategy that uses cognitive strengths to overcome the memory deficit may be very helpful to this individual. Individuals with language deficit LD (LangLD) may have a tendency to become frustrated or angry when they do not understand others and do not have insight into their LD. A counseling strategy that capitalizes on this individual’s strong visual-spatial skills may help this individual process information visually through pictures and maps rather than through weaker language skills. Individuals with non-verbal learning disorders (NLD) have deficits in visual-spatial skills, and hence do not often read the nonverbal cues in human interaction such as facial expression, body language, and postures denoting certain moods. Therefore, the individual with NLD may appear insensitive or naive to others. A counseling strategy that helps this individual to learn how to verbally interpret nonverbal social communication cues may improve the social adaptability of the client with NLD.

This entry addresses three primary types of LD (MemLD, LangLD, NLD) and provides information regarding the primary social, behavioral, and emotional characteristics of each subtype as well as the cognitive patterns found through neuropsychological assessment. It also addresses the counseling implications for each subtype at elementary age, adolescence, and college age.

Learning Disorder Subtypes

Memory Deficit Type (MemLD)

This subtype may involve weaknesses in understanding meaningful information within context (sentences, stories), more isolated information (numbers, specific words), or verbally mediated recall even when stimulus and response are nonverbal. This deficit may be more apparent in serial-order memory tasks than in memory span tasks per se, although weaknesses in both are possible.

Assessment of memory deficits typically includes tasks that measure sequential recall (involving both visual and verbal tasks), memory for increasingly longer and more complex verbal information (sentences), and nonsequential (rote) memory across multiple trials.

The most common problem for individuals with MemLD involves short-term automatic memory weaknesses for isolated (less meaningful) information. This is often apparent in digit span recall tasks. Individuals may perform better on sentence memory tasks if they possess intact associative language skills because of the semantic-associative links embedded within this more meaningful information. Typical daily problems might involve recalling the names of people with whom they are less familiar, phone numbers and addresses, and lengthy directions or instructions that have been verbalized to them. Early academic difficulties often involve learning the names of letters and numbers as well as letter-sound associations. Difficulty with the rapid retrieval of common, well-rehearsed information is also a common problem.

Language Deficit Type (LangLD)

This subtype can involve mixed receptive and expressive weaknesses that may vary in severity. Evaluation has to be sufficiently comprehensive not only to demonstrate receptive weaknesses but also to determine whether adequate nonverbal skills exist in order to differentiate this disorder from mental retardation and pervasive developmental disorder. LangLD individuals often have difficulty understanding and following directions and expressing themselves in both verbal and written work. These symptoms can lead to being mislabeled as attention deficit hyperactivity disorder (ADHD) due to perceived “inattention” and “off-task” behavior.

LangLD individuals with associative weaknesses often show deficits on all associative language tests regardless of whether test items are presented visually or verbally. A few LangLD individuals with intact short-term memory skills may perform well on naming or memory tests. Most perform poorly on labeling and retrieval (memory) tests and show low scores on verbal IQ subtests and on broader indices of verbal intelligence and memory. The most common problems for individuals with less severe LangLD involve school learning (particularly language-based subjects such as reading, language arts, and written expression skills). With stronger nonverbal abilities, math is often a relative strength. Problems associated with memorizing multiplication tables and basic math facts, as well as with comprehending word problems, can also be experienced. For individuals with LangLD who exhibit more severe language deficits, in addition to more pronounced school learning difficulty, significant behavioral and emotional problems are often encountered. These symptoms likely reflect deficits in communication skills and in verbal mediation, which can impair ability to exert self-control or to self-monitor behaviors. This inability to learn and understand how to interact with others can lead to social isolation or significant social interaction difficulties.

Nonverbal Learning Disorders (NLD)

The NLD subtype often involves deficits in visual-spatial reasoning, organizational skills, time management, motor skills, and social interaction skills secondary to social perception. Deficits are manifested in school performance difficulties resulting from lost or late assignments, poor handwriting and composition weaknesses, social acceptance issues, and difficulty understanding math concepts.

Assessment of nonverbal deficits typically involves tasks that include spatial-perceptual reasoning, perceptual-motor and fine motor skills, visual processing speed, and nonverbal (associative) categorizing skills. An appropriate evaluation should also include assessment of verbal intellectual abilities, from which a developmental discrepancy can often be seen. However, recent findings have demonstrated that symptoms of NLD can be present in the absence of a discrepancy between verbal and nonverbal IQ scores.

This subtype is often misunderstood and misdiagnosed by teachers, parents, and well-intentioned professionals. The nature of this misunderstanding arises from the assumption that individuals with capable reading ability, good communication skills, and strong language learning skills do not have a “learning” disorder. Therefore, their apparent school performance difficulties must be volitional and must be related to motivation and effort.

As a consequence, individuals with NLD are often labeled as underachievers. These individuals’ weaknesses in discerning subtle nonverbal social cues (facial expression, body language, and posturing) often cause social interaction difficulties that can result in being ostracized by peers. In a desire to be better liked or more accepted, the socially naive NLD individuals are at increased risk for social exploitation and social isolation. Although NLD was relatively unknown twenty years ago, the considerable work by Byron Rourke and others has created improved understanding and acceptance of this disorder.

Social, Behavioral, and Emotional Aspects

The relationship of cognitive strengths and weaknesses to social-emotional behaviors is a growing field of study. Recent research has shown that there are neurocognitive patterns that place individuals at risk for specific social-emotional disorders dependent upon the interaction of the neurocognitive pattern with environmental conditions.

Memory Learning Disorder (MemLD)

The short-term memory problem of individuals with MemLD can create confusing perceptions by others such as parents, peers, teachers, or spouses. Individuals with MemLD typically have good long-term memory and associative language skills. Therefore, others perceive them as adequate or even bright in verbal language skills. So when they forget simple information, others may assume they were not listening, they did not care what the other person was saying, or they may have attention deficit disorder.

Young children with MemLD will often have symptoms that may help to identify them. They may show difficulty remembering the names of common objects, have difficulty remembering numbers and letters, and may forget even simple directions. Parents often interpret these symptoms as willful neglect or attention deficits. Children who otherwise appear cognitively alert but show these symptoms often have an undiagnosed memory disorder. There is research to show this is a relatively common condition in males and often runs in families. Although specific genetic studies have not isolated specific genes, population genetic studies have shown the male familial incidence.

Memory problems during adolescence are often attributed to bad attitude and lack of caring. When school problems first arise in adolescents, many assume this is due to willful neglect of homework. When adolescents do not follow directions of parents, it is often assumed this is due to rebellion. However, it is important to first rule out a short-term memory deficit before making these assumptions. Often the adolescent with MemLD has been able to “get by” in school due to good language skills; however, as the amount of content to be studied increases in junior high or high school, there is a greater load on memory, and difficulties arise. Also, many adolescents would rather appear to have a motivational problem than be identified as having a learning problem. Research has shown that most attention deficits are identified prior to adolescence, so if an adolescent suddenly shows signs of attention deficit disorder, the counseling psychologist should be alert for a possible memory deficit.

College students who have never shown previous difficulty in learning and then begin to struggle academically often have a memory deficit. Individuals with MemLD usually learn to read, especially if they have received strong early phonics instruction. However, they usually read at a slower rate than average as they attempt to comprehend and remember what they have read. The increased reading demands in college often expose this slow reading rate and the student is not able to keep up. Also, the memory deficit will make it difficult for the college student to listen and remember multiple lectures throughout the day. As they try to take notes, they cannot remember what the instructor is saying. These symptoms should alert the counselor to the possibility of a memory-based learning disorder.

Language Learning Disorder (LangLD)

There is some disagreement in the literature regarding how to classify the various types of language disorders. Some consider the memory disorder discussed in the previous section as a form of an expressive or verbal language disorder. In this section, the discussion will be limited to an associative language disorder that is referred to by some as a receptive language disorder or a comprehension language disorder. There is considerable evidence that children with language disorder are at risk for behavioral and emotional disorders.

The primary problem for the individual with an associative language disorder is a deficiency in efficient verbal mediation skills necessary for verbal abstract reasoning and the self-verbal guidance needed for self-control and maintenance of attention and behavior. This may result in comprehension deficits in academic learning, inability to form the verbal abstraction necessary to develop complex interpersonal relationships, and difficulty in governing externalization of thoughts, feelings, and behavior.

Young children with a language disorder may experience chronic school failure, social rejection, and low self-esteem. They may not have the verbal flexibility to engage in social or teasing banter often seen in young children, and, therefore, they may be ostracized from playgroups. They do not have the verbal fluency to rapidly answer a question in class, so the teacher may cease to call on them. They often perform poorly on tests that tax their verbal comprehension ability. The response to this constellation of problems is social withdrawal, dislike of school, and sometimes acting out behavior due to frustration. These children are often seen as having a primary behavior disorder and are punished, or they are seen as having ADHD and are medicated.

During adolescence, youth with LangLD often begin to become so frustrated due to school failure and lack of positive peer groups they are at risk for bullying or joining unsavory peer groups. Because they do not have efficient verbal abstract reasoning skills, they are vulnerable to the influence of others and are often set up by other behavior-disordered peers to be the scapegoat for group problem behaviors. As academic functioning becomes more abstract, they may drop out of school or attend alternative school for behavior disorders. There is a critical period for language development change with early language therapy success, but not at this age. At this point, recognition of the LangLD can at least lead to functional educational intervention, vocational rehabilitation training, and counseling strategies, which all rely more on visual and active interventions rather than verbal strategies.

Individuals with LangLD rarely succeed academically at a level that will be found in traditional universities. However, they may be attending junior college, vocational schools, or colleges for students with LD.

Nonverbal Learning Disorders (NLD)

The primary characteristic of the individual with (NLD) is difficulty processing visual-spatial information despite good verbal reasoning and verbal memory functions. The cognitive aspects of this problem lead to difficulty with schoolwork involving written work, worksheets, map reading, note taking, and other visual integration tasks. Difficulty in visual abstract reasoning also may result in problems with conceptual elements of time management and organization. A further problem for many individuals with NLD relates to social interaction skills. Individuals with NLD often have difficulty interpreting the nonverbal aspects of human interaction. They have difficulty with reading body language, facial expression, and tone of voice, for example, anger versus joy.

The younger child with NLD usually shows both school and social difficulties. Due to delay in development of visual-spatial and visual-motor skills, they may have school difficulty such as messy worksheets and handwriting problems. The primary academic difficulty is usually in math because of the visual-spatial aspects of mathematical thinking. However, because individuals with NLD usually have good verbal skills, they are often successful in most academic areas. One difficulty often encountered is that teachers and parents may think that these children are not trying on written work or in math because they do so well in other subjects. It is important for the counselor to recognize that the combined symptoms of math problems, messy schoolwork, and social perception concerns may indicate a NLD.

Adolescents with NLD often show organizational difficulties characterized by unfinished or lost school-work, decline in scores on long standardized tests, and math difficulties. Also adolescents with NLD may begin to become involved with problem peer groups as an attempt to find social interaction, because they are often ostracized from mainstream peer groups. As some adolescents with NLD begin to act out due to social frustration, they are often misdiagnosed as having ADHD or behavior disorders. However, careful examination of the etiology of these behaviors often reveals a frustrated, lonely adolescent who lacks the social skills necessary for positive social interaction.

College students with NLD are at particular risk for emotional difficulties. They have often been successful academically, so they may not have experienced particular problems if they have been protected from social difficulty by parents and family. However, when they leave home, there is increased pressure to develop independent social functioning, and their social perception concerns may impair their ability to have positive peer groups or social interactions. This may lead to serious feelings of social isolation, and due to their good verbal abstract reasoning skills, they are also at risk for the loneliness of existential self-questioning. College counselors need to recognize the symptoms of NLD in the students they encounter, because there are academic modifications that can be made and therapeutic approaches to address the self-insight needed to overcome NLD.

Counselor Implications

When working with individuals with LD, counseling psychologists may need to use techniques that fit with the individual’s cognitive strengths and focus on certain types of behaviors that relate to the LD. As with any intervention, these techniques will be different for different age groups.

Elementary Age

Counseling psychologists will often be working with parents as much as children in this age group. Strategies that are concrete and do not involve abstract thinking are often needed when working with elementary age children.

Memory Learning Disorder (MemLD)

Teaching elementary age children specific memory strategies, such as mnemonic devices, acronyms, and verbal cumulative rehearsal, can be helpful. In addition, instructing parents on adding external memory devices, such as using lists and bulletin boards, may be a good strategy.

Language Learning Disorder (LangLD)

Children with LangLD may have a difficult time expressing themselves verbally, so behavioral techniques or strategies that allow them to express themselves through play, pictures, or music may be helpful.

Nonverbal Learning Disorder (NLD)

Social skills training is often needed with elementary age children with NLD. This training should be very explicit and outline specific steps in social interaction and nonverbal communication. Modeling and role-playing is often beneficial. Elementary age children with NLD often do not intuitively pick up social skills, so explicit instruction is helpful.

Adolescent Age

In adolescence, more individual work with the adolescent and less involvement with the parent begins to take place, and new strategies may be needed. At this age, helping to determine what impact (if any) the LD is having in the adolescent’s life may be a focus of counseling. In addition, addressing some of the specific social, behavioral, and emotional aspects of the adolescent’s LD may be necessary.

Memory Learning Disorder (MemLD)

As with elementary age children, teaching specific memory strategies would continue to be helpful, with the adolescents beginning to use external memory devices themselves. At this age, individuals can learn more abstract memory strategies, such as using associations and stories during counseling.

Language Learning Disorder (LangLD)

Incorporating visual and active strategies can be helpful for adolescents with LangLD. Helping them recognize the impact of the LangLD in their social relationships and everyday life and teaching coping strategies may be a focus of counseling. It may also be helpful to involve parents in counseling, so that they may also learn how to better communicate with their adolescent.

Nonverbal Learning Disorder (NLD)

Social skills training will likely continue to be a key component in counseling for adolescents with NLD. As with elementary age students, teaching these skills explicitly is ideal. Adolescents may also need help with general organization strategies.

College Age

College age individuals are working on transition-ing to being independent and responsible for everyday life. They will likely participate in counseling by themselves and have minimal parental support.

Memory Learning Disorder (MemLD)

Teaching memory strategies will continue to be important at this age, again focusing on external memory devices. If students have good associative skills, teaching them how to make associations and use stories can be a useful strategy.

Language Learning Disorder (LangLD)

As with other age groups, college age individuals with LangLD would benefit from using visual and active techniques in counseling. Traditional talking strategies may be difficult and cause frustration for individuals with LangLD. A focus of counseling should include how their LD has an impact on relationships with significant others and strategies to improve all types of communication, both verbal and nonverbal.

Nonverbal Learning Disorder (NLD)

Again, social interaction difficulties are prominent with college age individuals with NLD. In addition to social skills training, counseling may need to focus more on relationships rather than just skills. Counseling psychologists may also need to help the college age individual with NLD explore the impact NLD has on his or her daily life, including academic and social areas.

References:

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