The Paradox of NVLD: A Speech Therapist’s Perspective (Part I), by Amy B.

By March 12, 2019Experts Blog

It can be difficult to suppress a grin when a few pairs of wary teenage eyes peer into the window of “The Language Production Studio.” As the high school students prepare to step onto the invisible but palpable social communication stage, I can sometimes see reflections of my past adolescent self from so long ago in their fleeting eye gaze, flat affect, anxious mannerisms, and manifestations of difficulty with transitions. The expectations have been clearly defined and some of them could recite the “conversational script” flawlessly, but the ostensibly simple role of initiating a greeting and a few conversational turns with the speech-language therapist may prove to be daunting when the spotlight shifts from the rules and the acquisition of knowledge of the skill to a spontaneous demonstration of it.

Like many of these students with social communication challenges, I didn’t see the point in socializing and frankly thought that it was a waste of time, superfluous, or just plain stupid. The verbal and nonverbal demands of conversation can be particularly demanding for individuals with deficits in social reciprocity and nonverbal communication. The intricate acts of monitoring the conversational partner’s level of interest and understanding his/her perspective, shifting and terminating topics, maintaining eye gaze/contact, varying gestures and facial expressions, and modulating intonation and volume may create the impression of acting rather than of a meaningful interpersonal interaction. It may seem paradoxical that many of these students perform exceptionally well in academics and yet cannot carry on a conversation with a peer or “know what to say” when encountering a novel situation. As a speech-language pathologist who grew up with a severe nonverbal learning disability, I must confess that I am well-versed with this paradox. In fact, I occasionally feel more like an actress on their same stage than as their therapist and “director” of social communication.

When I was fifteen, I wasn’t even in high school. Despite the attainment of a 4.0 in middle school, I had succumbed to a maelstrom of depression, anxiety, and obsessive-compulsive behaviors. I had become very violent towards my parents at home, frequently engaged in self-mutilating behaviors (i.e., scratching my arms, legs, and face, pounding my head with my fist), and was intermittently contemplating suicide. I couldn’t connect with anyone except for an apocryphal, quirky detective by the name of Adrian Monk in a new television series (which ended up being a saving grace). I had withdrawn from both a Catholic high school after less than a single semester of enrollment (and had relinquished a full-tuition scholarship for at least that year). I was provided with individualized attention and support and even had a desk in the guidance counselor’s office, but I couldn’t keep pace with the social-emotional or written demands of a high school environment and began to experience a cascade of mental health problems. My parents contacted the local high school, and I was eventually placed in the Hospital Homebound program. However, I only remained with the initial instructor for a few months and then withdrew. I was very conscientious and driven, obsessed with achievement, experimenting with robust vocabulary words and synonyms, and memorizing world capitals. I was very faithful (although I didn’t always get the big picture) and had surmounted quite a few obstacles, including an intense battle with anorexia nervosa as a 44-lb. nine-year-old (for which I was admitted to a behavioral hospital for twenty-eight days ). Yet, I found myself studying for the GED prior to my 16th birthday.

Throughout the course of middle school, I was very anxious and inquisitive (to the point of annoyance) and felt compelled to comprehend everything. My arm frequently shot up in the air to pose and answer the teachers’ questions. However, it often felt as if I was missing something and just couldn’t see the forest through the trees (or explain the meaning of this or many other idioms that I hadn’t memorized). To the understandable frustration of some of my teachers and classmates, I would convey confusion and embark upon jejune emotional outbursts. I enjoyed learning (or forced myself to do so) and eagerly shared factual information, but encountered significant difficulty in answering questions that required “reflection” or expressing emotions. I typically memorized vocabulary words and notes before attempting to process and make sense of it. Speaking with a British accent, I endeavored to use robust vocabulary terms or unconventional descriptions (i.e., “mass of dead cells” when referring to “hair”) when conversing with classmates and was sometimes perceived as condescending or arrogant. In reality, I felt as if I was doing something wrong if I didn’t attempt to speak like the Queen of England and would frequently find myself embroiled in obsessive-compulsive behaviors. I took everything seriously and did not comprehend jokes or things that were not associated with a goal. Needless to say, I didn’t have any close friends, despised the concept of parties or social gatherings and grew increasingly distant from my classmates as my eighth grade year progressed. However, I could rattle off a list of synonyms for “friend” and “party” with impressive alacrity and aplomb.

Very unorganized and frequently lost in thought, I devoted an unduly amount of time to homework assignments. Writing was a very slow and excruciating process; I would often get lost in words and did not seem to be capable of formulating sentences that consisted of fewer than five lines. I couldn’t tie my shoe laces, preferred to eat with my fingers, couldn’t create hairstyles, and had to practice handwriting diligently for years before it improved. I was clumsy, but discovered that I enjoyed running (and eventually relied on it as a coping technique). There were significant inconsistencies, and my solicitous and endearing parents sacrificed significant time, energy, and money to obtain the professional help. In spite of practically “growing up” in the offices of many therapists, psychologists, and psychiatrists, receiving several diagnoses at different times, and being prescribed probably over twenty-five different types of medication, no one seemed to be able to assemble all of the pieces of the exploding puzzle. While my classmates were taking piano and dance lessons, I was learning about the peril of irrational thoughts and developing coping strategies to confront the reality.

Finally, at the age of sixteen, the tide gradually began to change. I was diagnosed with a severe form of NVLD after several months of outpatient therapy at Shand’s hospital. At that time, there was approximately a 47-point discrepancy between verbal and performance IQ (the latter of which approximated the borderline range). This was instrumental in explaining why my level of functioning was so compromised.

If it were not for divine intervention, extraordinary parents and three younger brothers, a strong extended family, and some phenomenal key players, I would not have been able to return to high school. My teen years could have taken a very different path that could have culminated in juvenile detention, prolonged residence at a psychiatric facility, or suicide. I would not have graduated with a 4.0 unweighted/4.45 weighted GPA, and I would not have attained a bachelor’s degree in communication sciences and disorders with a 4.0 or a Master’s degree while working full-time in my field.

I have been remarkably blessed to have a network of unwavering support and compassion, including teachers, a second hospital homebound instructor, and the phenomenal neuropsychologist (whom I despised at first) of Shand’s hospital.

Inspired by the robust support that I have received over the years, I endeavor to pour out the same level of skill, time, dedication, and kindness to my students, clients, and patients. It is paramount that they know that they have value, potential, and purpose on this stage of life regardless of their challenges or the ways in which they must compensate for deficits. Aspects of our lives may resonate with paradoxes, but we can find and embrace the beauty that emerges from the ashes of adversity and empower others to do the same.

Amy B.

Hi! As a speech-language pathologist, I am committed to empower others to reach their communication potential. I assist with the high school youth ministry of my parish and volunteer with handling reptiles in a science center and own a blue-tongued skink named “Professor Lexicon.” (-:  I have a fiery passion for words, religious liberty, and the sanctity of life.

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