A Speech Language Pathologist's Approach to NVLD

Breanna Raborn is a speech language pathologist specializing in pediatric private practice. Breanna discusses NVLD, and how speech language pathologists can help improve social communication and understanding of receptive and expressive language. 

Transcript

Lauren Clouser

Welcome to the LDA Podcast, a series by the Learning Disabilities Association of America. Our podcast is dedicated to exploring topics of interest to educators, individuals with learning disabilities, parents and professionals to work towards our goal of creating a more equitable world.

Hi, everyone. Welcome to The LDA Podcast. I'm here today with Breanna Raborn, a speech language pathologist specializing in pediatric private practice. She's going to be here today to talk to us about an SLP's approach to nonverbal learning disabilities and comprehension. Breanna, thank you so much for being here.

Breanna Raborn:

Lauren, thank you so much for having me.

Lauren Clouser:

I'm so excited to be here today and dive more into nonverbal learning disabilities with you and with everyone listening. So, to start us off, could you tell us a bit about your experience and just yourself?

Breanna Raborn:

Yes. So, hi everyone. My name is Breanna Raborn. I am a pediatric speech language pathologist based in Houston, Texas. I currently work in the outpatient private practice setting and I am in my second year of clinical practice. I am currently supporting children from birth to 21 with a wide range of diagnoses, and I'm very passionate about helping kids build their confidence in their everyday interactions, finding their voice, and also feeling successful when communicating with others and collaborating and supporting their families along with that. So that's a little bit about my background.

Lauren Clouser:

Thank you. So I know it's a broad scope of things that you do, but would you be able to give us an overview of what a speech language pathologist can do? What sorts of diagnoses can they work with?

Breanna Raborn:

So speech language pathologists can help identify and treat various communication and swallowing disorders. So we work on things like understanding language and then as well as using language, working on social communication as well as speaking clearly, some more articulation. So we work on that as well. And in addition, we also work on feeding and swallowing difficulties, which I feel like is not mentioned a whole lot.

But for me, I really focus and love focusing on helping my patients with their communication right now and connecting with others. So I'm focusing on a lot of articulation, receptive and expressive language. And so I think that's actually why our conversation today about nonverbal learning disability is so important, because I feel like many of the kids that I'm working with now, or just many of the kids in general who have strong verbal skills, they still struggle with that social side of communication, which is tied into our scope of practice as well. So that's just a little bit about what we do, even though we can keep going on and on and on. But that's basically what all of that encompasses.

Lauren Clouser:

And could you tell us how NVLD ties into that? How can it impact these oral, written and reading comprehension skills?

Breanna Raborn:

So this learning disability can impact our communication in a variety of ways that are not always obvious because these children that we see, they often have really strong vocabulary and verbal skills. And so a lot of the times we see them and we're like, oh, these kids are totally fine as far as their speech and language because they're just so strong in that area. But it can really affect oral written and reading comprehension. 

So their oral language, again, they may be very talkative, but they're going to have difficulty with things like understanding people's tone of voice, reading, social cues, and being able to stay on topic with people that they're communicating with. So their topic maintenance can be a little difficult for them, as well as knowing how to adjust their language, like, depending on the situation that they're in. So that's how it impacts their oral language reading comprehension. 

They usually can decode words really well, but they may struggle to understand the bigger picture as far as, like, okay, we read a story, now let's make some inferences about what happened in the story. Or, okay, can you identify the main idea, what is this story about? Can you tell me more about that? And also, like, understanding the characters perspectives can be really, really, really challenging. So taking that out of the story and really diving into how the characters feel and why. So they struggle with those skills as far as their reading comprehension goes, and then just their written comprehension as well. Or their written language.

They often have difficulty, like, organizing their thoughts, summarizing information, and then putting their ideas together in a structured way. So that's how nonverbal learning disability kind of affects all three of those areas. So overall, I feel like it's less about the mechanics of language, again, because their verbal skills are so high, but it's more about the understanding and organizing and their ability to, like, apply the information in meaningful ways. And so, yeah, that's often why these challenges can be missed. I feel like these kids are missed a lot because their language sounds really strong, but there's a lot more going on under the surface.

Lauren Clouser:

Absolutely. Well, do you have any advice for spotting NVLD?

Breanna Raborn:

Whenever speech therapists are looking at nonverbal learning disability, as far as assessment goes, we can kind of dive into that. So we're looking for their functional communication and discourse. So if a teacher has a student, they can also be looking at these things like their ability to engage in conversation, how is their discourse, how is their inferencing during tasks, multi-step directions is another one that you can look at. Like if you have a student in the classroom and they're really struggling following those multi-step directions, that may be a reason or a red flag to kind of be like, I think we might need to look more into this. And yeah, just considering the discrepancy between their verbal output versus what they're understanding. So I think the multi-step directions as well, so those are just some things to kind of look out for.

Lauren Clouser:

Well, and a lot of these things will also directly tie into their social skills and social ability. Could you talk a little bit more about how that can impact somebody?

Breanna Raborn:

So this can impact their social skills, mainly because our social interaction relies so heavily on nonverbal cues. And so these kids may again have really strong verbal skills, but they're struggling if they're having a conversation with their peers. Reading their facial expressions may be really difficult for them to kind of like lean into, and understanding their tone of voice. If someone's feelings are hurt, if someone's angry, if someone is happy, they have a really difficult time distinguishing the tone of voice and how people are feeling, which can obviously impact the conversation and where it goes or even like their body language.

So if they're speaking to someone and someone's walking away trying to leave the conversation, or if someone is leaning over and maybe yawning, what is that telling you? So they're having a hard time reading those types of things, which again can make conversations and relationships that they're having much more challenging than others. So that's how that's going to affect their social skills.

Lauren Clouser:

Absolutely. What are some strategies that an SLP can use to support individuals with NVLD?

Breanna Raborn:

So there are a lot. Our scope is so big when it comes to this. We can kind of break it down into categories. Since we just talked about social skills, we can talk about social communication first.

So as far as that, we would teach skills like understanding different perspectives. So that kind of ties back into understanding characters' perspectives. We can also talk about our peers

perspectives, people that we're engaging with, understanding how they're feeling and why.

So we can target making inferences because a lot of these kids have a lot of trouble with making inferences and then using language appropriately in their everyday conversation. So we can kind of break that down and help them navigate those challenges

that they may be experiencing. 

As far as their language and literacy, we can target more complex language. So for example, they may be struggling with their abstract language. So figurative language, similes, metaphors, personification, things like that, we can really dive into that. Idioms as well is a big one. So really getting into that, understanding the meanings of those. 

And then also if they're having difficulty with more of their executive functioning in that area, we can help with their planning, their organizing, and their flexible thinking so that they can better understand and express their ideas when that executive functioning is an area of difficulty for them. So those are just some things, some quick things that speech therapists can do to help our kids with this disability.

Lauren Clouser:

Well, I wanted to talk a little bit about your experience too with working with individuals with NVLD. I know you mentioned before that it's very likely under-diagnosed, so I was just curious, have you seen a lot of people with NVLD?

Breanna Raborn:

So again, I'm in my private practice setting, so probably not as many as we would see in the school. In the school setting. I do have one patient that I was seeing whose learning profile was very similar to this one. So he was 8 years old. He had a variety of diagnoses going on.

He had a mixed receptive expressive language disorder. So we're obviously working on that. He did have a diagnosis of autism, adhd, partial trisomy. So he had a lot going on. And from the outside his expressive language skills were pretty adequate.

Like he had strong vocabulary, and was able to conversate pretty well. And so he is one that, you know, would go straight under the radar as far as a referral for speech, because even his expressive language testing was really, really high. But once we kind of did some digging, there were significant difficulties in his understanding of non literal language, inferencing and his pragmatic skills. And so once we kind of dove into that and really started to see some of those deficit areas, that really mirrors our nonverbal learning disability learning profile.

So he was struggling with the same things. And so I worked with him for a while. He was so fun to work with. But some of the things that we were working on in our sessions where we were working on social skills, again, our pragmatic language, we were working on one of the things that he was struggling with was being able to express like sympathy to others,

working to express things like regret. Like if we did something that we regret, how do we express that we're feeling that way to other people? We were working on initiating conversations, which was really hard for him because his verbal skills are really high.

But even having to initiate was a struggle, transitioning between topics was hard for him whenever he would be conversating with others. So being able to like formulate questions to kind of keep the conversation going.

And so we were working a lot with his social skills. Another thing was being able to evaluate his environment and look around, and kind of evaluate what's going on. And basically I would ask him, what should you be doing based on the environment that you're in? So he would struggle with a lot of his pragmatic social skills, which is what we were working on. And then he did have some executive functioning deficit areas. So we would kind of tap into that. So organizing and planning and evaluating his environment also goes into that area as well. And then his non-literal language. So again, like I mentioned earlier, we're having difficulties with similes, metaphors, personification.

So we were working on things like that as well. So he's been my biggest case that I can provide as far as nonverbal learning disability, that profile. So he was really fun to work with. But yeah, that's my experience with that.

Lauren Clouser:

That really goes back to what you were talking about earlier about how there are so many different things that an SLP can help with. So that leads to my next question. What factors can help determine if somebody would benefit by seeing an SLP? I feel like there's a lot of things that you're able to do that people might not already know about.

Breanna Raborn:

Yes, for sure. Our scope is so wide, and so speech therapy can be helpful for kids who have trouble with many things, but specifically trouble being understood. So their articulation. So if they're having a really hard time being understood by others, like unfamiliar listeners or peers, that would be a reason to refer to speech or seek out those services. If our kids are struggling with their speech, speaking or writing clearly, that would be a reason to look into speech as well. Or if they're having difficulty understanding or using language, whether that be spoken language, written language.

And so again, it's also useful if they're having difficulty following directions as well. So understanding, receptively, that language part, can we follow directions? Can we organize our thoughts? And another big thing that we've been talking about this whole time is can they connect with others socially, would be another thing to look at. So if they're struggling with that, that may be another red flag to kind of look at.

And so I encourage everyone that if you notice any of these challenges, I would definitely encourage you to seek out speech therapy services and an evaluation for your kids.

Lauren Clouser:

And I think that's such a great note to end on. Breanna, thank you so much for being on the show and giving us this great overview of NVLD and telling us a little bit more about what an SLP does.

Breanna Raborn:

Thank you so much, Lauren. I appreciate being here. Thank you for having me.

Lauren Clouser:

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