Oral language impairments in developmental disorders characterized by language strengths: A comparison of Asperger syndrome and nonverbal learning disabilities

Asperger syndrome (AS) and nonverbal learning disabilities (NLD) are developmental disorders in which linguistic ability is reported to be stronger than in disorders from which they must be distinguished for diagnosis. Children and adults with AS and NLD share pragmatic weaknesses, atypical social behaviours, and some cognitive features. To date, potential similarities between these disorders in oral language have not been directly examined in the literature. A review of the available research suggests that adequate structural language is another area of similarity for AS and NLD. However, systematic investigations of phonology, morphology, or syntax were not found; thus, the evidence for largely intact structural language in these disorders is indirect. The review also pointed to a common semantic profile across both disorders, characterized by strong vocabulary breadth in the face of limited depth and organization. These higher-order problems with semantics are proposed to be consistent with theoretical accounts of poor integrative abilities in AS and NLD, and to contribute to the well-documented pragmatic difficulties in these disorders.     

Socialization and nonverbal communication in atypically developing infants and toddlers

Emphasis on early identification of atypical development has increased as evidence supporting the efficacy of intervention has grown. These increases have also directly affected the availability of funding and providers of early intervention services. A majority of research has focused on interventions specific to an individual's primary diagnoses. For example, interventions for those with cerebral palsy (CP) have traditionally focused on physiological symptoms, while intervention for individuals with Autism Spectrum Disorder (ASD) focus on socialization, communication, and restricted interests and repetitive behaviors. However deficits in areas other than those related to their primary diagnoses (e.g., communication, adaptive behaviors, and social skills) are prevalent in atypically developing populations and are significant predictors of quality of life. Therefore, the purpose of the current study was to examine impairments in socialization and nonverbal communication in individuals with Down's syndrome (DS), CP, and those with CP and comorbid ASD. Individuals with comorbid CP and ASD exhibited significantly greater impairments than any diagnostic group alone. However, individuals with CP also exhibited significantly greater impairments than those with DS. The implications of these results are discussed.     

Improved health outcomes in integrative medicine visits may reflect differences in physician and patient behaviors compared to standard medical visits

ObjectiveTo identify differences in patient-physician interactions associated with improvements in GERD symptoms in a randomized controlled trial comparing integrative medicine and primary care/standard visits.MethodsWe analyzed video recordings of 2-minute excerpts (thin slices) from the beginning, middle, and end of 21 study visits (11 standard, 10 integrative medicine).ResultsAccording to blind coders’ analysis of the excerpts, prospective improvement in GERD symptoms was most highly correlated with patients appearing pleased (r = 0.71, p < 0.01) and friendly (r = 0.67, p < 0.01) at the end of the visit, controlling for visit type. The combination of patient and physician smiling at the end of the visit was associated with improvement in GERD symptoms (r² = 0.45, p = 0.004). The physician in the integrative visits was more engaged (p = 0.009), friendly (p = 0.005), relaxed (p = 0.002), smiled longer (p = 0.006), gazed longer (p = 0.02), and gestured more (p = 0.007), compared to standard visits. Patients in integrative visits also smiled longer (p = 0.004).ConclusionThe expanded history-taking questions asked by integrative clinicians may enhance relationship building, modifying patients’ responses and improving patient-centered behaviors from clinicians,ultimately facilitating symptom improvement.Practice ImplicationsAnalysis of nonverbal behaviors may facilitate a better understanding of patient-clinician interactions in integrative medicine visits and yield insights to improve clinical interactions in conventional medicine.     

Agreeable patient meets affiliative physician: How physician behavior affects patient outcomes depends on patient personality

Objective

This study tests whether the personality trait of agreeableness in simulated patients moderates their reactions to the physician's behavior. We predicted that the more agreeable the participants, the more positive the interaction outcomes when they see a high affiliative physician as compared to a low affiliative physician.

Methods

Participants (60 students) watched videotaped excerpts (2 min each) of 4 physicians exhibiting a high affiliative behavior and of 4 physicians exhibiting a low affiliative behavior. Participants reported after each physician their satisfaction, trust, determination to adhere to the treatment recommendations, and their perception of the physician's competence. They also completed the agreeableness scale of the NEO-PI-R personality questionnaire.

Results

The higher the agreeableness scores of the participants, the higher was their trust with the high affiliative physicians as compared to the low affiliative physicians, their perception of the physician's competence, and their determination to adhere to the treatment.

Conclusion

Results confirmed that the more agreeable the simulated patients were, the better they reacted to a physician behavior that was high rather than low in affiliativeness.

Practice implications

These results suggest that the more agreeable patients are, the more important it is that physicians adopt a high affiliative behavior.     

Nonverbal communication of caregivers in Slovenian nursing homes

This study aimed at determining the characteristics of nonverbal communication (NVC) of caregivers in Slovene nursing homes. The cross-sectional study was performed on 267 randomly selected caregivers from 27 randomly selected nursing homes. Facial expressions/head movements, hand gestures/trunk movements, and modes of speaking/paralinguistic signals were observed. The caregivers manifested altogether 11,324 NVC expressions. Those definitely reflecting positive attitude prevailed and accounted for 59.3% of all expressions, whereas those definitely reflecting negative attitude were very rare and accounted for 9.1% of all expressions, at a ratio of 6.5:1 (p < 0.001). Differences were statistically highly significant between genders (men manifested negative attitude expressions significantly more frequently, 11.8%) and professions (social helpers manifested positive attitude expressions significantly less frequently, 56.4%; other professionals manifested negative attitude expressions significantly less frequently, 5.4%) (p < 0.001). The results were similar within groups of NVC expressions. Although our study showed that caregivers in Slovene nursing homes use positive attitude expressions much more frequently than negative there is a reason for concern due to a general decline in positive values and beliefs in Slovene society. Promoting positive attitude NVC among new generations of caregivers in nursing homes need to become one of the most important contents of their life-long learning and training.     

Impairment of simultaneous-spatial working memory in nonverbal (visuospatial) learning disability: A treatment case study

We report the case of B.A., an 11-year-old child with a nonverbal (visuospatial) learning disability (NLD). Detailed psychometric and neuropsychological assessment on visuospatial working memory (VSWM) revealed specific simultaneous-spatial working memory impairment. A treatment targeting simultaneous-spatial working memory was given to B.A. for seven sessions (over one month); this resulted in improvement of simultaneous-spatial working memory, with the benefit that the training was maintained after six months.

Discussion of clinical and theoretical implications is given, taking account of the distinctions that can be made between the different components of visuospatial working memory and different subtypes of NLD, thus allowing the tailoring of specific training to target the impaired VSWM component.     

Nonverbal imitation skills in children with specific language delay

Research in children with language problems has focussed on verbal deficits, and we have less understanding of children's deficits with nonverbal sociocognitive skills which have been proposed to be important for language acquisition. This study was designed to investigate elicited nonverbal imitation in children with specific language delay (SLD). It is argued that difficulties in nonverbal imitation, which do not involve the processing of structural aspects of language, may be indicative of sociocognitive deficits. Participants were German-speaking typically developing children (n = 60) and children with SLD (n = 45) aged 2–3½ years. A novel battery of tasks measured their ability to imitate a range of nonverbal target acts that to a greater or lesser extent involve sociocognitive skills (body movements, instrumental acts on objects, pretend acts). Significant group differences were found for all body movement and pretend act tasks, but not for the instrumental act tasks. The poorer imitative performance of the SLD sample was not explained by motor or nonverbal cognitive skills. Thus, it appeared that the nature of the task affected children's imitation performance. It is argued that the ability to establish a sense of connectedness with the demonstrator was at the core of children's imitation difficulty in the SLD sample.     

On the importance of nonverbal communication in the physician-patient interaction

OBJECTIVE: The goal of this paper is to show that nonverbal aspects in the physician-patient interaction play an important role. Interpersonal judgment relies mostly on nonverbal and appearance cues of the social interaction partner. This is also true for the physician-patient interaction. Moreover, physicians and patients tend to mirror some of their nonverbal behavior and complement each other on other aspects of their nonverbal behavior. Nonverbal cues emitted by the patient can contain important information for the doctor to use for treatment and diagnosis decisions. CONCLUSION: The way the physician behaves nonverbally affects patient outcomes, such as, for instance, patient satisfaction. Affilliative nonverbal behavior (e.g., eye gaze and proximity) of the physician is related to higher patient satisfaction. However, how different physician nonverbal behaviors are related to patient satisfaction also depends on personal attributes of the physician such as gender, for instance. PRACTICE IMPLICATIONS: Physician training could profit from incorporating knowledge about physician and patient nonverbal behavior.     

Culture and nonverbal expressions of empathy in clinical settings: A systematic review

ObjectiveTo conduct a systematic review of studies examining how culture mediates nonverbal expressions of empathy with the aim to improve clinician cross-cultural competency.MethodsWe searched three databases for studies of nonverbal expressions of empathy and communication in cross-cultural clinical settings, yielding 16,143 articles. We examined peer-reviewed, experimental or observational articles. Sixteen studies met inclusion criteria.ResultsNonverbal expressions of empathy varied across cultural groups and impacted the quality of communication and care. Some nonverbal behaviors appeared universally desired and others, culturally specific. Findings revealed the impact of nonverbal communication on patient satisfaction, affective tone, information exchange, visit length, and expression decoding during cross-cultural clinical encounters. Racial discordance, patients’ perception of physician racism, and physician implicit bias are among factors that appear to influence information exchange in clinical encounters.ConclusionCulture-based norms impact expectations for specific nonverbal expressions within patient-clinician dyads. Nonverbal communication plays a significant role in fostering trusting provider-patient relationships, and is critical to high quality care.Practice implicationsMedical education should include training in interpretation of nonverbal behavior to optimize empathic cross-cultural communication and training efforts should accommodate norms of local patient populations. These efforts should reduce implicit biases in providers and perceived prejudice in patients.