Learning Disorders and Disorders of the Self in Children and Adolescents
Nonverbal Learning Disabilities
Guide to Psychoanalytic Developmental Theories

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Learning Disorders and Disorders of the Self in Children and Adolescents

Foreword by Bertram Cohler
Preface (Acknowledgments & Permissions)
Chapter 1. Introduction: Theoretical and Historical Setting

Section I: Developmental Considerations
Chapter 2. Learning Disorders and the Sense of Self
Chapter 3. Learning Disorders and the Self-Narrative
Chapter 4. Learning Disorders and Disorders of the Sense of Self
Chapter 5. Learning Disorders and Incoherent Self-Narratives
Chapter 6. Learning Disorders in Adolescence

Section II: Diagnostic Considerations
Chapter 7. Dyslexia
Chapter 8. AD/HD
Chapter 9. Executive Function Disorders
Chapter 10. Nonverbal Learning Disabilities
Chapter 11. Asperger's Disorders

Section III: Treatment Considerations
Chapter 12. Deciding When to Treat
Chapter 13. The Therapeutic Process
Chapter 14. Working with Parents
Chapter 15. Summary and Conclusion

The relationship between learning disorders and the development of the self is complex. However, clinicians who work with children with learning disorders must have a way to think about this relationship if they are truly to be of help. This book presents a theoretically integrated conceptual framework, based on psychoanalytic self psychology, to understand and treat children and adolescents whose development has been derailed by learning disorders. It addresses the concerns of two audiences: psychotherapists who treat children and adolescents with learning disorders, and professionals, such as neuropsychologists, clinical and school psychologists, and learning-disability specialists, who are involved in the assessment and remediation of children's learning disorders.

Taking as his starting point the principle that all psychopathology must be understood from a developmental perspective, Palombo conceptualizes disorders of the self as occurring at the intersection between the context within which the child is raised and the neuropsychological strengths and weaknesses he or she brings to that context. The desire for a cohesive sense of self and coherent self-narrative is a central motive organizing the child's development. When a child has a learning disorder and the relationship between the child's context and neuropsychological deficits is out of balance, the effects are seen in school performance, relationships, sense of self, and self-narrative.

To illustrate his conceptualization, Palombo uses five common learning disorders: dyslexia, attention deficit disorder, executive dysfunction disorder, nonverbal learning disability, and Asperger's disorder. The probable effects of each disorder on development of the self are described, along with extensive case illustrations The author then discusses treatment issues, including how and when to recommend psychotherapy, how to think about the treatment process, and how to work with the parents of a child with a learning disorder.

It is inevitable that child therapists will see children and adolescents with learning disorders and that learning-disability specialists will encounter children whose self and relationships have been shaped by neurological deficits. With this interdisciplinary book in hand, these professionals will be able to understand and treat children with these complex disorders.

“This is a landmark book for mental health professionals. educators, and parents who work to improve the lives of children and adolescents with learning disorders. Joseph Palombo provides us with a new understanding of the complex interplay between a child's developing sense of self and the challenges presented by a variety of learning disorders. In this masterly work, the author articulates psychotherapeutic strategies for working with children who suffer from poor self-cohesion and the inevitable breakdown of the learning process. This is not a book you will read through only once; you will reach for it again and again as a necessary resource to help each child and adolescent that you serve.”

UCLA Department of Psychiatry
Author of Nobody's Perfect: Living and Growing with Children Who Have Special Needs

“If I were a parent of a child with a learning disorder, or a therapist with a patient similarly afflicted, I would breathe a sigh of relief at finding Palombo's book. The relief is the discovery of someone who knows what the problem is all about. It is all there in this book, and we are all lucky to have it available in this way.”

Cynthia Oudejans Harris
Professor Department of Psychiatry,
Rush Medical College Training and Supervising Analyst,
Chicago Institute for Psychoanalysis

“The culmination of many years of research and clinical practice with clients suffering from neuropsychological deficits, this important volume offers a balanced, integrative approach to the assessment and treatment of children and adolescents with learning disorders. Palombo's book is illustrated with exquisitely crafted clinical cases, and offers the reader a unique approach to understanding and working with this clinical population. Perhaps the book's meet impressive accomplishment lies in its ability to emphasize the role of each child's narrativity, while furnishing a sound clinical framework guided by the insights of psychoanalytic self psychology, and anchored in the learning disabilities literature.”

Professor, Wayne State University School of Social Work
Author of Of Mice and Metaphors Therapeutic Storytelling with Children
Founding editor of Psychoanalytic Social Work

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Nonverbal Learning Disabilities

by Joseph Palombo New York, WW Norton & Co,. 2001, 322 pp., $32.00.

Clinical Definition of NLD; The Social Features of NLD; Assumptions and Conceptual Framework; The Three Domains and Their Perspectives; Psychotherapy of Children with NLD

Part I: The Syndrome: The Neurobehavioral Perspective

Chapter 1. Clinical Presentation

Chapter 2. Neurobehavioral Profile of NLD
Presenting Problems; Neuropsychological Profile; Social-Emotional Profile; Psychiatric; Symptomatology

Chapter 3. Neurobehavioral Theories of the Social Features of NLD
History of the NLD Concept; A Right Hemisphere Disorder; Contributions from Neurology; Rourke’s neuropsychological contribution; The Dissociability of Visual-Spatial Processing and Social Cognition; Critique of Theory of Right Hemisphere Dysfunction; Conclusion

Part II: The Interplay with Context: The Social Perspective

Chapter 4. Impaired Social Functioning
Social Cognition and NLD; Clinical Presentation: The Social Profile; Reciprocal Social Interaction; Theory of Mind; Conclusion

Chapter 5. Impaired Social Communication
Clinical Presentation: NLD and Nonverbal Signs; The Semiotics of Nonverbal Communication; Dyssemia; Verbal Language Problems and NLD; Relevance Theory and Theory of Mind; Conclusion

Chapter 6. Impaired Emotional Functioning
The Universal Language of Emotions; NLD and Affects, Emotions, and Feelings; The Contribution of Affective Neuroscience; Conclusion

Chapter 7. The Social Features of NLD Subtypes
Patterns of Social Impairments in Four NLD Subtypes; NLD Subtype I; NLD Subtype II; NLD Subtype III; NLD Subtype IV; Conclusion

Part III: Sense of the Self: An Intrapersonal Perspective

Chapter 8. Mindsharing, Aloneness, and Attachment
Mindsharing; Aloneness and Loneliness; Attachment in Children with NLD; Conclusion

Chapter 9. Self-Cohesion and Narrative Coherence
Self-Cohesion; Self-narratives; Central Coherence; Self-Cohesion and Narrative Coherence; Conclusion

Chapter 10. Disorders of the Self in NLD
Etiology and Psychodynamics; NLD and the Loss of Self-Cohesion; NLD and Incoherent Self-Narratives; Expansion of the Definition of the Social Features of NLDs; Comorbidity and NLD; Conclusion

Chapter 11. NLD and Asperger’s Disorder
Asperger’s Disorder; Neuropsychological Features of NLD and Asperger’s Disorder; Social Features of NLD and Asperger’s Disorder; Intrapersonal Features of NLD and Asperger’s Disorder; NLD Contrasted with DSM-IV Criteria for Asperger’s Disorder; NLD and Social-Emotional Learning Disabilities; Neurobiology of Social Cognition; Conclusion

Part IV: Treatment

Chapter 12. Restoring Self-Cohesion and Narrative Coherence
Individual Therapy with a Child with an NLD; The Therapeutic Process; Transference Motifs; Countertransference Motifs; Case Illustration; Conclusion

Chapter 13. Attending to caregivers
Working with caregivers; Educational Focus; Interventions ; “What is in Store for My Child?”

Chapter 14. Conclusion: The Challenges Ahead

Appendix 1: Summary of NLD Social-Emotional Symptoms

Appendix 2: Helpful Resources

This volume focuses on an important and understudied topic - psychotherapeutic interventions for children with learning disorders. Although a large literature exists on the diagnosis of these conditions and on educational and behavioral interventions, relatively few books have addressed the implications of these disorders for the child’s long-term mental health. The attempt to bridge the gaps between neuropsychologists, learning disabilities specialists, and clinical psychotherapists is clearly needed,

The author adopts a self-psychology perspective on diagnosis and treatment and uses a well-integrated conceptual framework to approach these conditions. Within this perspective Palombo strongly emphasizes developmental factors as the child copes with his or her pattern of strengths and weaknesses in building a more coherent and cohesive self-narrative. Several different patterns of learning difficulties are discussed. including attentional problems, dyslexia, nonverbal learning disability, problems with executive functioning, and Asperger’s disorder. The pattern of strengths and weaknesses associated with these problems and their implications for the child's development and for psychotherapy are also discussed.

The book includes a helpful series of case examples that illustrate the author’s approach in helping the child develop a personal narrative to foster a greater sense of integration and self-cohesion. These examples illustrate the author’s approach and highlight critical issues in dealing with children who have learning problems.

“The book is well organized around three major considerations - developmental, diagnostic, and treatment considerations. The chapter on deciding when to treat is particularly well done, as is the chapter on working with parents. This book will be of great interest to psychiatrists, psychologists, social workers, and other mental health professionals who work with children who have learning disabilities.”

New Haven, Conn.
American Journal of Psychiatry 160:1 January 2003

A nonverbal learning disability (TLD) is a developmental disorder that impairs a person's capacity to perceive, express, and understand nonverbal (nonlinguistic) signs. The dysfunctions affect behaviors, social interactions, perceptions and feelings regarding oneself and others, and emerging personality patterns. NLD constrains an individual's capacity to function in a wide variety of domains, including the academic, social, emotional, and vocational. Parents and clinicians often have difficulty understanding and helping children and adolescents who are cherished but whose functioning is hampered by the condition.

Based on current neurobehavioral research, this book brings together perspectives drawn from the three major domains of knowledge about NLD-neurobehavioral, social, and intrapersonal. From the neurobehavioral perspective, Palombo provides a research-based phenomenological description of the NLD child's symptoms. From the social perspective, he presents the child's social context and how that contributes (in positive and negative ways) to the child's skills and deficits. From the intrapersonal perspective, he introduces the concept of mindsharing as basic to under- stand the development of the sense of self in children with NLD.

Readers are introduced to NLD as it presents in the clinic with a review of the etiology and symptomatology of the syndrome reflected in a case study. The author then goes on to describe the neurobehavioral profile of NLD (including its psychological and social dimensions) and to review the different theories that have been offered to account for the social features of NLD. These chapters root Palombo's clinical perspective in neurology and the latest research findings that bear on the treatment of NLD.

The social perspective and intrapersonal aspect of NLD are considered next. In Part II, Palombo describes the impact of the syndrome on social functioning, social communication, and emotional functioning. In each case, the impairment is addressed not only in terms of how it presents to the clinician but in terms of its neurobiological basis and current theories connecting the biological basis to social manifestations. At the close of Part II, readers find a clear articulation of the four NLD subtypes and how each is a specific variation of three key elements-neurolinguistic perceptual deficits; other neuropsychological deficits; and social cognition impairments. In Part III, the intrapersonal area is considered on the basis of the concept of mindsharing-i.e., the ability of one person to both know and feel what another person is experiencing. Because they lack a capacity for mindsharing, children and adolescents affected by the syndrome often fail not only a social and emotional connection with others but also experience a lack of cohesion in their own sense of self Not surprisingly, there is a relationship between NLD and Asperger's Disorder and Palombo's differential diagnostic work sheds light on both impairments.

Finally, Palombo presents a therapeutic approach to working with youth with NLD. Drawing together the various clinical insights from earlier in the book, these last chapters synthesize the material and highlight the most important aspects so as to best guide the treatment of children and adolescents. This last part of the book contains a chapter on attending to the needs of caregivers of youth with the syndrome as well as a chapter with reflections on the prospective challenges the effort to better understand and effectively treat NLD.

Addressed to clinicians, psychiatrists, psychologists, clinical social workers, and other psychotherapists, this book is a fund of knowledge and clinical wisdom for working with youth with NLD. It offers an overarching paradigm relevant to all professionals and parents alike as they care for affected children and adolescents.

“Comprehensive, insightful, and practical, Joe Palombo's new book, Nonverbal Learning Disabilities, will enable mental health professionals and educators to better understand the inner life of children with learning challenges. Remarkable in its clinical scope and depth, it provides thoughtful descriptions of the different ways in which these learning challenges affect children and their faniilies-ranng from daily learning and social interactions to the deepest feelings and sense of self"

Coauthor of the First Idea: How Symbols, Language and Intelligence Evolved froin Our Primate Ancestors to Modern Humans (With Stuart Shanker) and Clinical Professor of Psychiatry and Pediatrics,
George Washington University Medical School.

“Nonverbal Learning Disabilities is a well-integrated explo ration of a fascinating and complex topic. A. serious scholar and compassionate therapist, Palombo combines his considerable clinical experience with research from neuroscience and psychopathology to expand our understanding of learning disabilities and provide us with practical intervention strategies. Palombo rewards readers with a deep understanding of nonverbal learning disabilities and clear insight into many relevant areas of research. This book educates, elucidates, and inspires further exploration.”

Professor of Psychology, Pepperdline University, and author of The Neuroscience of Psychotherapy

“This is a book for anyone who is interested in learning about the true nature of nonverbal learning disability, Joseph Palombo is one of the early pioneers in the study and treatment of children with this disorder. He knows and understands them as only an involved clinician can, and this expertise shows in his clear descriptions of what NLD is and how it interferes with children's attempts to make satisfactory lives for themselves. I believe that this book will become the standard in the field for those seeking to understand this debilitating disorder."

Charles Howard Candler Professor of Psychology, Emory University, and coauthor of Helping the Child Who Doesn't Fit In and Teaching Your Child the Language of Social Success

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Guide to Psychoanalytic Developmental Theories


Section I: Drive Theory

Chapter 1. Sigmund Freud (1856–1939)

Section II: Ego Psychological Theories

Chapter 2. Heinz Hartmann (1894–1970)
Chapter 3. Anna Freud (1895–1982)
Chapter 4. Rene Spitz (1887–1974)
Chapter 5. Peter Blos (1904–1997)
Chapter 6. Stanley I. Greenspan (1941– )

Section III: Object Relations Theories

Chapter 7. Melanie Klein (1882–1960)
Chapter 8. Donald Winnicott (1896–1971)
Chapter 9. Margaret Mahler (1897–1985)
Chapter 10. Otto Kernberg (1928– )

Section IV: Life Cycle Theory

Chapter 11. Erik Erikson (1902–1994)

Section V: Interpersonal Theory

Chapter 12. Harry Stack Sullivan (1892–1949)

Section VI: Theories of the Self

Chapter 13. Daniel Stern (1934– )
Chapter 14. Heinz Kohut (1913–1981)

Section VII: Attachment Theories

Part 1: Traditional Attachment Theories

Chapter 15. John Bowlby (1907–1990)
Chapter 16. Mary Ainsworth (1913–1999)

Part 2: Neuropsychological Attachment theories: The return to psychoanalysis

Chapter 17. Allan Schore (1943– )
Chapter 18. Peter Fonagy (1952– )
Chapter 19. Conclusion

Appendix A Stages or Phases of Development
Appendix B Comparative Chart of Psychoanalytic Developmental Theories
Appendix C Who Analyzed who

About the Authors:

Joseph Palombo, M.A., is a Clinical Social Worker who is the Founding Dean & Faculty Member of the Institute for Clinical Social Work; a Faculty Member of the Child & Adolescent Psychoanalytic Therapy Program, Chicago Institute for Psychoanalysis, a Staff Member of the Rush Neurobehavioral Center, Rush-Presbyterian-St. Luke's Medical Center; and in Private Practice. He was the co-chair of the Child & Adolescent Mental Disorders section of the task force of the Psychodynamic Diagnostic Manual. His publications include numerous papers and two books titled Learning disorders and disorders of the self in children and adolescents, and Nonverbal Learning Disabilities: A clinical perspective, published by W. W. Norton.

Harold Bendicsen, LCSW, BCD, is a Clinical Social Worker who maintains a private practice in Elmhurst, Illinois. He holds a certificate in Child and Adolescent Psychoanalytic Psychotherapy from the Chicago Institute for Psychoanalysis. He has held clinical, supervisory and administrative positions in child welfare agencies, residential treatment centers and social service agencies. He is Adjunct Professor at Loyola University Chicago School of Social Work and a member of the faculty of the Child and Adolescent Psychoanalytic Psychotherapy Training Program at the Chicago Institute for Psychoanalysis.

Barry J. Koch Ph.D., LCSW is an Assistant Professor and Field Coordinator for Newman University's Master of Social Work program in Colorado Springs, where he teaches courses in advanced clinical practice, HBSE, social policy, and psychopathology. He received his BSW from the University of Cincinnati in 1982, his MSW from the University of Kentucky in 1987, and his Ph.D. in Chicago from the Institute for Clinical Social Work in 2004. Dr. Koch draws from 23 years of clinical practice experience, treating a wide variety of mental health issues from a psychodynamic perspective, including 15 years as the director of a clinical training facility near the campus of Miami University in Oxford, Ohio. He left his clinical practice for full time academic pursuits in 2005.

As the foundational theory of modern psychological practice, psychoanalysis and its attendant assumptions, predominated well through most of the twentieth century. The influence of psychoanalytic theories of development was profound and still resonates in the thinking and practice of today’s mental health professionals. Guide to Psychoanalytic Developmental Theories provides a succinct and reliable overview of what these theories are and where they came from. Ably combining theory, history, and biography it summarizes the theories of Freud and his successors against the broader evolution of analytic developmental theory itself, giving readers a deeper understanding of this history, and of their own theoretical stance and choices of interventions. Along the way, the authors discuss criteria for evaluating developmental theories, trace persistent methodological concerns, and shed intriguing light on what was considered normative child and adolescent behavior in earlier eras.

Each major paradigm is represented by its most prominent figures such as Freud’s drive theory, Erikson’ s life cycle theory, Bowlby’s attachment theory, and Fonagy’s neuropsychological attachment theory. For each, the Guide provides:

  • biographical information
  • a conceptual framework
  • contributions to theory
  • a clinical illustration or salient excerpt from their work

The Guide to Psychoanalytic Developmental Theories offers a foundational perspective for the graduate student in clinical or school psychology, counseling, or social work. Seasoned psychiatrists, analysts, and other clinical practitioners also may find it valuable to revisit these formative moments in the history of the field.

Endorsements of Guide to Psychoanalytic Developmental Theories:

“Readers will find that Palombo, Bendicsen and Koch’s Guide to Psychoanalytic Developmental Theories theorists. Beginning with Freud’s foundational drive theory, the authors proceed to examine a range of psychoanalytic theories, including ego psychological, object relational, life cycle, interpersonal, self, and attachment. Chapters are well organized and they include not only the authors’ concise summaries of each theorist’s unique contribution, but in most instances, a clinical illustration derived from the theorist’s own published work. For interested readers, primary references highlighting the theorist’s original contributions, as well as a general bibliography are included at the conclusion of each chapter. This work, with its lucid descriptions of important developmental themes and careful attention to the unique features of each developmental theory, will prove a valuable resource not only for graduate students in the mental health professions, but also for postgraduate professionals.”

Distinguished Professor, Wayne State University, Detroit, MI.

“The Guide is a respectful and loving homage to a century of great minds struggling to understand the complex problem of psychological development. It is a treasure trove of knowledge, which enlivens the human and theoretical history of psychoanalysis, making it accessible to a new generation of clinicians. Designed for the serious student, the Guide provides the commonalities and complexities of a spectrum of developmental theories. The thoughtfulness and attention to detail of the authors serve as a wonderful example to students that not everything can be grasped in sound bites and that careful and detailed scholarship can bring great rewards. The inclusion of attachment theory and their modern expressions in the work of Schore and Fonagy distinguish this book from others, adding the brain to the mind, and bringing us up to the present day.”

Professor of Psychology, Pepperdine University, California.

“This book is an invaluable resource for students, seasoned clinicians, and teachers of psychoanalytic ideas. The authors have assembled clear and succinct summaries of the prevailing developmental theories in psychoanalysis today. The inclusion of brief biographies of the theoreticians allows readers to understand the genesis of their ideas and to have an overview of some of the sociology of psychoanalytic theory. As a basic text, mental health practitioners can use this excellent work to compare and contrast different theoretical perspectives as well as to complement their psychoanalytic education. This work is an imperative addition to personal and reference libraries. Congratulations to the authors!”

M.D. Director, Chicago Institute for Psychoanalysis

“Palombo, Bendicsen, and Koch are to be congratulated for their systematic, straightforward, and lucid presentation of the major concepts of key psychoanalytic developmental theories from Freud’s time to the present. Scholarly but accessible to readers who are not familiar with its content, this volume is enhanced by rich biographical profiles of each theorist, illustrative case examples, and the inclusion of a framework and questions that can be used to analyze and compare the different paradigms. This book is a valuable resource for teaching and should appeal to all those who are interested in learning about this vast body of knowledge.”

Professor Emerita and Director of Post Masters Program in Advanced Clinical Practice New York University Silver School of Social Work.

“A major success is achieved by these authors, who conceptualize the array of complex notions/frameworks associated with major psychoanalytic developmental theories in a clear, concise, and comprehensive manner. Following a historical time line beginning with Sigmund Freud, the book chronicles the evolutionary processes related to the development of modern psychoanalytic thought. This book is important resource for new and sophisticated students of this invaluable tradition.”

Dean and Professor, Loyola University Chicago, School of Social Work