When I think about teaching young adults with NVLD, I sometimes step into a situation that is fraught with past failure, misunderstanding, and frustration on the part of the client and his or her loved ones. We have to work skillfully to set the stage for change and growth, and to help a client’s family understand that their loved one is not hapless, or willfully failing at the goals they have set for themselves. Families of NVLD adults can feel hopeless to understand, and feel discouraged from extending further help to their loved one. It is as if a tough love approach, which I have not seen work for any learning disabled student of mine in 25 years of private practice, is a last ditch effort by frustrated and worried parents to force change upon the NVLD person. Sometimes, this tough love is experienced by the NVLD client as a withdrawal of support just when understanding is most needed.
I had a client who was 30 years old when I met her, and very much wanted to become a medical researcher, but Vera had failed out of her program after one semester at a prestigious and very selective university. She had made it into the program on full scholarship, as her IQ scores and all her GRE standardized testing scores were very high in the verbal domain. What drove her to my office was the sheer volume of material she had to learn and the depth of processing required to learn it well. She was a detail person, but understanding how systems fit together, how data could be construed to make assumptions about disease paths was difficult for her at this level. She had hoped to develop IT systems to help turn databases of co-occuring endocrine system maladies into useful and interpretable research that could be used to predict the probability of co-morbid diseases. She had never experienced difficulties that she could not handle in her undergraduate work at an Ivy League college in the Northeast. The crash in graduate school came as a shock to her and her family. She had never been well organized but could use her verbal abilities and her interest in her studies to pass tests. If one looked at her undergraduate research papers, they were detail oriented and well-written. If you looked at her writing for English class, she’d miss the point of a complex novel quite often, and in fact, found class boring. All that talk about what was going on inside the characters made less sense to her than what the character did. She was content then with finding fictional characters mysterious or inexplicable.
Several years between college and medical school had been spent at home with her parents, working in a laboratory, as she tried to find out what she wanted to do with her life.
Now that she was in graduate school, she discovered that she couldn’t organize her time successfully for all she had to do, and she had reached the limit of what her memory for facts and terms could absorb without a structure to organize material with. Organizing her time, materials, and her basic needs with the demand of classes that relied on her ability to select and construct research experiments was a disaster for her. She was frightened when I met her. This was the first time she had been unable to pass courses, and she was disoriented.
Her social skills were weak enough for her to be somewhat awkward when speaking to those who could most help her at the school, and her social life was marked by the kinds of blunt statements to others that caused her to lose opportunities to make friends easily. She had difficulty approaching faculty that could mentor her, and so was at a loss to understand the culture of her school.
She was an attractive woman, fair of face, and kindly in her interactions with me. She had a psychotherapist and some very old testing that showed a marked disparity between her high verbal skills and her visual perceptual cognition.
Vera had been diagnosed as ADHD, and was using medication to successfully allow her to focus. Yet, meds won’t teach a person how to manage their interactions with teachers and peers, nor will it help you understand how to manage your calendar or begin your assignments if they ask of you something you don’t recognize as a familiar demand.
Her goal was to get back into the Ph.D. program she had failed out of, and the school offered her a choice to take some MIT science courses online in order to demonstrate that she could get good grades, manage her time and handle studying for school. I thought this a good idea, a preview of her basic coursework in science, done at her own pace, and with a transcript of the teacher’s lecture appearing alongside the filmed lecture.
I first called her therapist and wrote her prescribing psychiatrist to talk about my suspicion that NVLD was part of Vera’s profile, and to request new testing to find out if my suspicion was correct. I wanted to relieve her anxiety and that of her parents so that she could learn now to read in a way that helped her to hold a set-shifting perspective between the goal or main idea of anything she had to read, and the details she needed to organize flexibly within that context. She needed to learn to do this in spite of the fact that she had a curious mind that could learn and partly relate many ideas she had read within any topic. Soon we had a date set for her to visit with a neuropsychologist who was very good at teasing out NVLD profiles, since it is true that no two are alike.
Our goals were prioritized. First we would work on developing a better sense of time. Vera could procrastinate and lose track of time. She could over or underestimate how long any reading and writing work might take. Typically she underestimated it, partly because she had become so anxious that she waited till the last minute to work on material that deserved a more careful approach over time.
We kept track of two whole days together, during which I asked her to log what she was doing each hour of the day, from wake to sleep. I showed her two photos of a neat and a messy closet and said that these photos represented the use of time, which is really the use of the mind in the service of any goal. This is really a concise definition of executive function: the ability to make sacrifices and choices in pursuit of a goal. MaryDee Sklar’s excellent workbook for NVLD people, Seeing My Time, proved useful to us.
The next goal was learning to read efficiently, take notes that showed relationship between big ideas and details, and learn the science of review, retrieval practice (self quizzing) and interleaving study of one topic with another. These ideas are beautifully laid out in Ben Carey’s excellent book, How We Learn: The Surprising Truth about When, Where and Why it Happens.
Vera needed reassurance, and with the result of her new evaluation showing that she fit the profile of an NVLD adult, and I discussed the findings with her and with her parents to help them see that Vera had not bombed out on purpose, and that she was not a person who could not succeed in her studies, but that she might need to pursue them with fewer classes each semester until she was better able to handle her responsibilities. Vera needed to be taught to understand and manage herself, and to connect with whatever services there were at school. She’d need to disclose her diagnosis to student services and let them know what she needed. She’d need to display real understanding of her issues as well as a commitment to learn how to handle them.
Her parents were discouraged by the diagnosis and thought it might be better to pull the plug on supporting Vera’s education. They were fatigued by the level of support they had given in the form of tutoring during high school and undergraduate school. They had always thought Vera was ADHD, but during this current crisis, they feared that she was willfully failing. They thought they had infantilized her and were contemplating a tough love approach to the support they had always given her. It was my job to convince them that Vera needed a different kind of support that would help her learn to manage herself, advocate for herself, and learn to “see” better what was so hard to see about the relationship between category and detail in her studies. Luckily, most parents love their children dearly, and once Vera’s could express their frustration to me safely, I could direct them to resources that would help them understand Vera’s struggles better.
She also needed help in this new setting with finding her people, making connections that would be different now that many people she met were married and had commitments after school. There was less social life in her new school and fewer opportunities for her to connect.
Some social support would be needed so that Vera could find the new friends she needed to feel part of her cohort.
I’d love to tell you that this happened in a year, but it took two years of part time study before she was ready to study full time. However, the wonderful thing that Vera discovered in herself was her desire to learn.
Understanding herself better, she took a master’s degree in biology and tech, and though she was disappointed to give up her Ph.D. dream, she found work at an Ivy League school, teaching as an adjunct, and working in the student services department there, counseling students with learning disabilities and making sure they learned how to manage time, an advocate for themselves. She developed a social circle of young friends, became a very successful teacher and is contemplating another run at her Ph.D., this time in writing and special education.
Susan Micari, MS. Ed.
Board Certified Educational Therapist
Susan Micari is a Board Certified Educational Therapist who, together with Dr.Annalisa Perfetto, has started a practice for adults with learning disabilities called EdTherapyNYC. This practice addresses dyslexia, NVLD, ADHD and executive function deficits in adults who are in college, graduate school, and the work force.
Susan has practiced educational therapy with children, teens, and adults for 27 years, and has written for The Educational Therapist, an online journal of The Association of Educational Therapists, and has served on the board of directors for the organization. Her film on learning disabilities appears on youTube and on The Today Show.Share your own story