Q My soon to-be-13-year-old daughter was diagnosed with nonverbal learning disorder and ADHD inattentive type, along with developmental coordination disorder and concomitant hypotonia. She had occupational therapy from first to third grade. What type of OT is beneficial for an approaching teenager? And is there any form of treatment to improve laterality between her left and right hemispheres and to improve the way her brain processes information in the prefrontal cortex?
Older kids with nonverbal learning disorders should work with an OT who helps them target the specific skills they need to develop. For example, if your daughter gets overwhelmed learning new things, an OT can teach her how to break complex information into smaller, more manageable parts. They can practice looking at big picture details first and then moving onto smaller ones, for instance. If she has trouble reading maps, the OT can teach her a strategy like starting at the right side and looking at that first quadrant of space and then moving over to the left side and so on. The OT can also help your daughter build habits and routines for other situations that cause her difficulty, like copying information, packing her backpack, or managing school materials. Skilled teachers, learning specialists, and educational therapists can also be helpful with this sort of thing.
OTs should also help older kids learn how to use their strengths to their advantage. Children with NVLD often have strong verbal skills and are good at mastering rote information, and mining these strengths is important. For example, if your daughter has visual-spatial difficulties, the OT can teach her to compensate by first translating the information on the map into spoken language. If she’s looking at a map of Italy, describing it as boot-shaped and noting that it has a soccer ball at the bottom of it and that Rome is in the middle and Venice is at the top can help her understand the geography.
Not all OTs will be qualified to do this kind of work, so you want to make sure that working with older kids on these kinds of targeted interventions is within the scope of their practice and training. Neuropsychologists can also be helpful here. Whereas OTs work with kids to change behaviors and master routines through skills training, neuropsychologists with a background in cognitive remediation can target specific brain functions. There isn’t a package of empirically supported treatments that work to help kids with NVLD, but there are skilled clinicians who work to help kids through good remediation.
There are a few other things that might help as well. Since your daughter has ADHD, taking medication for that would provide the frontal areas of her brain with more dopamine, making her more attentive and better able to organize her efforts in response to tasks. Computerized interventions like CogMed, which aim to enhance working memory, might also be helpful. More studies need to be done on CogMed, but there’s data to suggest that it may improve frontal functional skillsets.
Of course, getting the right accommodations in school is important, too. Your daughter should be getting copies of class notes if she has a hard time listening and taking notes at the same time, or reproducing visual information. Learning to use a laptop for class or using programs like Geometer Sketchpad, which helps kids think about rotating visual images in space, can also be useful. An OT can help recommend good accommodations like this.
As for improving laterality, there is no specific treatment to do that. It’s simply beyond the scope of our knowledge at point. And actually, we don’t know that your daughter is having any trouble with cross-hemisphere communication. There is some data that suggests the right hemisphere processes novel information, which then gets transferred over to the left hemisphere as that information becomes more familiar. So some amount of communication is already happening pretty naturally for your daughter.