Nonsteroidal antiinflammatory drugs NSAIDs

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A type of painkiller and fever reducer that reduces inflammation in the body. Examples of nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (such as Motrin or Advil) and naproxen (Aleve). Ibuprofen is available without prescription to treat fever in children over a year old. Nonaspirin NSAIDs are given to children to lower fever and treat pain instead of aspirin, which has been associated with the development of reye's syndrome.

nonverbal learning disabilities (NLD) A form of learning disability that primarily affects social functioning in areas such as interpersonal skills, social perception, and interaction. Also called "right-hemisphere learning disorders," this prob lem often goes unrecognized for a large part of a child's schooling. Since abnormalities of the right hemisphere interfere with understanding and adaptive learning, experts believe that nonverbal learning disabilities are more debilitating than verbal disabilities.

Experts suspect that nonverbal learning disabilities are caused by a problem in the right hemisphere of the brain, either from brain injury or damage before birth. The damage primarily affects visual-spatial perception, processing, and reasoning. Children with nonverbal learning disabilities (NLD) often are very good verbally and may develop reading and speaking skills earlier than their peers; consequently, their nonverbal learning difficulties may be overlooked. Both parents and teachers will often suspect that something is wrong early on, but they cannot quite figure out what it is.

Nonverbal learning disorders remain predominantly misunderstood and largely unrecognized. Although NLD syndrome was discovered in the early 1970s, even today education professionals are largely unfamiliar with nonverbal learning disorders. Typically, parents are assured that everything is fine and that their child is "just a perfectionist," or is immature, bored, or a bit clumsy. Rarely are a parent's or teacher's concerns accepted until the child reaches a point in school where he is no longer able to function. These children are often labeled "behavior problems" or "emotionally disturbed" because of their frequent inappropriate and unexpected conduct, despite the fact that NLD has a neurological rather than an emotional origin.

It is especially important to identify children with nonverbal learning disorders because overestimates of the child's abilities and unrealistic demands made by parents and teachers can lead to ongoing emotional problems. Unfortunately, there are few resources available for the child with NLD syndrome through schools or private agencies, and it is hard to find a professional who understands nonverbal learning disabilities.

Nonverbal learning disorders are much less common than language-based learning disorders (affecting only between .1 percent and 1 percent of the general population). Unlike language-based learning disabilities, the NLD syndrome affects girls as often as boys. Although there are not many peo ple with NLD, experts suspect that as school assessment procedures improve, a higher proportion of children will be identified with NLD.

Symptoms

Children with NLD may have trouble perceiving and understanding the subtle visual cues important to nonverbal communication that form the basis of social interaction and interpersonal relations. They may misread overt signals of impatience, annoyance, or the desire to end an interaction and consequently may respond in ways that are perceived by others as inappropriate. A child with NLD syndrome may have trouble adapting to new situations or accurately reading nonverbal signals and cues. Although these students make progress in school, they have trouble "producing" in situations where speed and adaptability are required.

There are three categories of dysfunction:

• lack of coordination, severe balance problems, or difficulties with fine motor skills

• poor visual recall, faulty spatial perceptions, or problems with spatial relations

• lack of ability to comprehend nonverbal communication, trouble adjusting to new situations, or significant problems with social judgment and social interaction

Children with nonverbal learning disorders commonly appear awkward and uncoordinated in both fine and gross motor skills. They may have had extreme difficulty learning to ride a bike or to kick a soccer ball. Fine motor skills, such as cutting with scissors or tying shoelaces, seem to be impossible for them. Young children with NLD are less likely to explore their environment because they cannot rely on their own perceptions. These children do not learn much from experience or repetition and cannot generalize information.

In the early years, children may appear confused much of the time despite a high intelligence and high scores on receptive and expressive language measures. Closer observation will reveal a social ineptness due to misinterpretations of body language and tone of voice. These children do not perceive subtle cues in their environment, such as the idea of personal space, the facial expressions of others, or nonverbal displays of pleasure or displeasure. These are all social skills that are normally grasped intuitively through observation, not directly taught.

Instead, these children cope by relying on language as their principal means of social relating, information gathering, and relief from anxiety and often develop an exceptional memory for rote material. since the nonverbal processing areas of the brain are not giving automatic feedback, they rely solely on memory of past experiences, each of which they labeled verbally to guide them in future situations. This, of course, is less effective and less reliable than being able to sense and interpret another person's social cues. Normal conversational "give and take" seem impossible for these children.

It is hard for these children to change from one activity to another or to move from one place to another. A child with NLD needs to concentrate merely to get through a room. owing to the inability to handle such information processing demands, these children will instinctively avoid any kind of novelty.

Problems with NLD grow more apparent and more profound during the latter stages of childhood development and into adolescence, as pressures on social interaction increase and the requirements for appropriate social performance become more subtle and complex.

Cause

Non-language-based learning disorders are believed to be inherited, but a specific genetic problem has not yet been discovered. Nonverbal learning disabilities involve the performance processes that originate in the right cerebral hemisphere of the brain, which specializes in nonverbal processing. Brain scans of children with NLD often reveal mild abnormalities of the right cerebral hemisphere. Current evidence suggests that a contributing cause of the NLD syndrome involves early damage of the right cerebral hemisphere or white matter disease that forces the left hemisphere system to function on its own. A number of children suffering from NLD have at some time early in their development:

• sustained a moderate to severe head injury

• received repeated radiation treatments on or near their heads over a prolonged period of time

• had congenital absence of the corpus callosum

• been treated for hydrocephalus

• had brain tissue removed from the right hemisphere

Prognosis

How well these children progress seems to depend on early identification and accommodation. Typically, children with this condition are regularly punished for circumstances they cannot help without ever really understanding why, and they are often left with little hope that the situation will ever improve. As a result, these children tend to have serious forms of depression, withdrawal, anxiety, and in some cases, suicide.

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