THE TALKING PLAYHOUSE

A Place for Social Learning, Executive Function | Organizational Skills, Pragmatic Language & Written Expression

 

Labels and acronyms abound in the world of Autism. So let’s get them out on the table now and leave them behind for the real work. The garden variety of related labels for kids on the “Spectrum,” that is Autistic Spectrum Disorder, include PDD-NOS, ADHD, ADD, SPD Hyperlexia, and more. Years ago “Autism” was defined very narrowly for only a severe population. Now with the addition of “…Spectrum Disorder” the term has broaden in order to define and accommodate a wide ‘spectrum’ of functional levels.

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While it is important to know what your child is up against, the controversy continues with regard to the etiology (origin) of Autism. The current consensus is that Autism is of genetic or neuro-physiological origin that may, or may not include subcortical dysfunction. Subcortical dysfunction often presents an unusual response to environmental stimuli, including excessive reaction or and unexpected lack of reaction to sensory input. Sounds such as a vacuum cleaner, playing a radio, may elicit incessant screaming from a child with subcortical dysfunction. Children with subcortical dysfunction may also display fight or flight reactions to everyday sensory stimuli such as bright lights, touching, or simply swinging on a swing.

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A large part of what Social Interactionists and/or Speech/Language Pathologists do is map out, in hierarchical fashion, the social language and social skills most needed in the child’s environment in order to achieve a significant and satisfying experience. What are the most crucial needs in his/her world that will have the most likelihood for success. While every child is unique, some of the areas of difficulty we often see in social deficits are:

Perception & Awareness – Difficulties processing sensory information. These children have difficulty getting the whole picture (gestalt) from the different modalities such as touch, hearing, sight, taste, and smell. They are often ‘blind’ when it comes to reading an emotional situation.

 

Social Interaction Skills – More times than not, we see children who have no interest in social play and will often do “parallel” play; not concerned with interaction with others during playtime. If put in a situation for play, or greetings and other social conventions, these children do not know what to do. They do not inherently have the skills for social engagement. Typical interactions with others such as greetings, eye contact, turn taking, conversation, engagement are missing.

 

Social Pragmatic Language Skills - If a child is higher functioning and does have a desire for play or some social interaction with another, s/he often will not have the social language map to engage, elicit, emote, respond and converse.

Behavioral Intervention – Behavioral issues sometimes stand in the way of more appropriate social behavior. The lack of organizational thinking and communicative skills manifest themselves in frustration and other acting out behaviors. All behavioral intervention at The Talking Playhouse is positive-based reinforcement and redirection training. We do not subscribe to philosophies that require time-outs, or the old traditional negative consequence approaches.

 

WHAT IS NONVERBAL LEARNING DISORDER (NLD)?
(From the  Nonverbal Learning Disorder Association. For more information about the organization visit: www.NLDA.org)

 

NLD is a neurological disorder that originates in the right hemisphere of the brain. Reception of nonverbal or performance-based information governed by this hemisphere is impaired in varying degrees, causing problems with visual-spatial, intuitive, organizational, evaluative, and holistic processing functions.

The syndrome of Nonverbal Learning Disorders (NLD) consists of specific assets and deficits.

 

The assets include:

• Early speech and vocabulary development

• Remarkable rote memory skills

• Attention to detail

• Early development of reading skills and excellent spelling skills

• Eloquent verbal ability

• Strong auditory retention

The three categories of deficits are:

• Motoric: lack of coordination, problems with balance and graphomotor skills

• Visual-spatial-organizational: lack of image, poor visual recall, faulty spatial perception, and difficulty with spatial relations

• Social: inability to comprehend nonverbal communication, difficulty adjusting to transitions and novel situations, and deficits in social judgment

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People with NLD can be affected in varied levels of severity in each of the categories, so that each person with NLD presents a unique clinical, behavioral, and educational picture… their world is filled with confusing sensory stimuli. For some, their physical endurance is challenged by generally low muscle tone. Some need support throughout life with cognitive and organizational skills, motor skill development, pragmatics and social skills.

Children with NLD have advanced verbal and auditory memory. Some are precocious readers with advanced vocabularies. Nevertheless, NLD is a problem of language. People with NLD have rote language skills but when it comes to functional daily use of language, they have difficulties with tone of voice, inference, written expression, facial expression, gestures, and other areas of pragmatic speech.

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People with NLD have difficulty understanding patterns and lining up columns of numbers. Spoken instructions can be troublesome due to difficulty picturing consecutive directions and poor visual memory. NLD can also affect coordination, causing clumsiness, poor balance and a tendency to fall. Many people with NLD have poor safety judgment.

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We are not sure what causes NLD, but we know that the earlier the intervention, the better the prognosis.

 

Diagnostic Criteria

The environment is the most important support for people with NLD. When school and home are positive, safe and predictable, children with NLD can thrive and become independent and productive adults.

• Bilateral tactile-perceptual deficits

• Bilateral psycho-motor coordination deficits

• Outstanding deficiencies in visual-spatial-organizational abilities

• Deficits in the areas of nonverbal problem solving, concept formation, hypothesis testing

• Difficulty dealing with negative feedback in novel or complex situations

• Difficulties in dealing with cause-effect relationships

• Difficulties in the appreciation of incongruities

• Well-developed rote verbal capacities and rote verbal memory skills

• Over-reliance on prosaic rote, and consequently inappropriate, behaviors in unfamiliar situations

• Relative deficiencies in mechanical arithmetic as compared to proficiencies in reading (word recognition) and spelling

• Rote and repetitive verbosity

• Content disorders of language

• Poor psycholinguistic pragmatics (cocktail party speech)

• Poor speech prosody

• Reliance on language for social relating, information gathering, and relief from anxiety

• Misspelling almost exclusively of the phonetically accurate variety

• Significant deficits in social perception, social judgment, and social interaction skills

• Marked tendency for social withdrawal and isolation as age increases

• High risk for social-emotional disturbance if no appropriate intervention is undertaken

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NLD is a syndrome of assets and deficits. In each individual with NLD, the assets and deficits manifest in different combinations and different intensities. Most people with the diagnosis, however, share the basic configuration of relative impairment in social perception, visual-spatial abilities, and mechanical arithmetic, with well developed verbal skills and rote memory.  This information is from the Nonverbal Learning Disorders Association and you can find out more information at NLDA.org.
 

Please see below for references on Sensory Integration Disorder/Dysfunction and stay tuned for more information in our newsletter that will be launching later this year.

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Sensory Integration

Sensory Integration is the physiological process in the brain when organizing, interpretation and integrating multiple sensory input converge. A hallmark of Autism is the lack of sensory integration or sensory processing. The theory of Sensory Integration therapy stems from the fundamental belief that if the sensory information is presented in a predictable, non threatening and graded form, then the child can be exposed objectively to the stimuli without triggering fight or flight reaction. This would furthermore assist the brain of the child to process the enormous amount of sensory stimuli necessary to perform activities of daily living.

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Sensory Integration (SI) is a therapeutic approach for children who have difficulty organizing and interpreting the sensory signals in their environment. Often we see children who are overwhelmed by one or more sensory signals such as movement, touch (tactile), smell, vision, hearing, taste. The difficulties manifest themselves in frustrating behaviors such as aggression, crying, withdrawal, physical self-stimulation (hand flapping, etc.) And, we see the opposite—children who completely withdraw. Children with SI with specific vestibular stimulation concerns (movement sensed via the middle ear) may engage in sensory seeking activities such as constant writhing, jumping, putting things in their mouths.

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The approach to Sensory Integration therapy originated in southern California by Jane Ayers, founder of The Ayers Clinic.

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Our occupational and physical therapists are registered and board certified. Each therapist is specialized in working with children who exhibit sensory integration issues as well as social language concerns. We do a complete “SIPT” Sensory Integration assessment and therapy. Areas of therapeutic intervention include:

Function Areas for Occupational Therapy:

• Proximity & Modulation 
• Visual-Perception
• Gross Motor
• Positioning
• Fine Motor
• Eye-Hand Integration
• Attention Span
• Self-Help
• Balance
• Strength & Endurance

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Please see below for references on Sensory Integration Disorder/Dysfunction and stay tuned for more information in our newsletter that will be launching later this year.