Identifying Additional Learning Needs in the Early Years

Christine Macintyre

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317672135
• Edition: 2
• Topic: Education
• Subtopic: Education General

I know there is something wrong, but what?

How do I know if outside help for this child is needed?

How do I tell parents that their child could have a learning difficulty?

These are questions that most nursery workers will have to face during their careers, and questions which this new edition of Identifying Additional Learning Needs sets out to answer. Based on the experiences of real children and typical situations in early years settings, this book will be an invaluable companion for early years practitioners who care for and educate young children with additional learning needs.

Attention Deficit Disorder, dyspraxia, dyslexia and autism are some of the difficulties explained in depth, with detailed suggestions to help support children with these special needs. Chapters in this fully revised new edition:

• explore the process of early identification;
• show how to make inclusion a reality in the nursery;
• tackle the complex issue of dealing with parents;
• discuss techniques for skilled and informed observation and assessment.
• Include developmental charts to allow a child's progress to be monitored and celebrated.

Each chapter has an explanation section supported by a set of practical strategies to support both the child and the practitioner. Throughout this lively and informative book, Christine Macintyre uses case studies to highlight the importance of listening to young children and shows how making time for listening is vital to providing exactly the right level of help and support.

Chapter 1

Supporting children through providing early interventions

One of the most significant and worrying concerns for parents, practitioners and the children themselves arises when the youngsters do not settle in the early years setting or progress as they should, when they do not keep up with their peers and gradually lose their self-confidence, their willingness to try and their motivation to succeed. Yet with the correct support in terms of attitudes and interventions or programmes specifically designed to match each profile of success and difficulties, every child can be helped. It can be difficult to determine the best content of each intervention and parents must appreciate that some time is needed to make detailed observations, assess the children’s responses and evaluate the efficacy of the intervention itself. However, if this doesn’t happen, if there is a wait and see philosophy, then particularly when the children become aware of their limitations, they may become withdrawn or morose or react to changing environments or challenging situations in an inappropriate and upsetting way. The support or intervention activity can often be shared in groups so that individual children do not even realise they are having special attention. Parents and practitioners have to understand that no intervention will harm any child; they will all benefit from extra practice in a positive, fun activity. Practitioners will offer extension ideas to children who readily cope with basic interventions. So whether an intervention is short lived or long lasting, it should be welcomed. Listen to two parents who have experienced interventions.

First, Anne explained:

My Reuben is only four so I was taken aback when the nursery staff said they were concerned because they could not understand what he was saying and they could see him sidelining, i.e. becoming more reluctant to communicate with the staff and the other children. I was really upset, what could I do? I could make out what he said, although on reflection I realised he didn’t say a great deal. He has older brothers – perhaps they do too much for him and he doesn’t need to speak? As a first intervention, the staff advised me to get him to speak on a telephone to his grandparents. I told Reuben that they were a bit deaf so he had to speak clearly as they would have the television on. In this way they were ‘to blame’, not him!

I also had to think of situations where he had to make choices and respond clearly, e.g. ‘Would you like water or juice?’ and wait for the answer rather than just handing him a drink. We also blew bubbles and chewed toast to strengthen the muscles in his mouth. We even tried a mouth organ. At the same time, and with our permission, the setting contacted a speech and language therapist so I knew that this problem was something that wasn’t going to go away on its own. The therapist gave us word games and explained how to begin slowly with different sounds and how to build up sentences. She also said not to ask him to repeat words but to listen and find which words were problematic. Then we introduced some games e.g. I Spy, that gave him time to think then call out one word answers. It was quite taxing for the family to be aware and also to be creative but as Reuben’s confidence grew his articulation improved. What a relief!

Then Donald, Liam’s dad, told his tale.

When we were asked if Liam would go on a movement programme each day before school, I was really unsure because I didn’t want everyone thinking he was different from the other children. I knew he was a bit clumsy, he always had skinned knees, but I thought that was just natural for a six-year-old boy. I wasn’t worried because none of us are sporty but I didn’t realise that writing and reading were all tied up with movement skills. I was asked if he’d crawled as a baby and when I said he’d only bum shuffled, they were obviously concerned. The movement programme broke down the crawling action and very gradually Liam was able to imprint the cross-lateral pattern in his brain. Then all sorts of crawling activities were introduced, e.g. crawling up stairs, even over each other’s backs, then climbing on the frame. We could see Liam become more confident and we put photographs in an album to show his progress. That was a good move!

It turned out that the school handled the explanations about the programme so sensitively we were reassured. Liam was told he’d been chosen to participate, that it was a privilege to be in the motor group and when he found he could do some of the activities and was praised for trying the others, he really enjoyed it and we could see the benefits. I think it was important that the group was mixed ability so there was no stigma – in fact some of the very able children were anxious to join in. It was a positive experience all round. Liam was on the brief daily programme for two years and made strides. It was so good!

Only two difficulties have been described here but practitioners have compiled a useful list of pointers that concern them. They worry about children who:

• can’t cope with the daily routine – appear overwhelmed and anxious;

• show inappropriate behaviour – for example, continual distress or unprovoked aggression;

• refuse to speak, or shout out needlessly;

• don’t understand what is said and give strange replies;

• can’t hold eye contact;

• are hypersensitive to noise and light, seen when they hold hands over their ears or squeeze their eyes closed;

• are overly dependent on routine and are upset by any suggestion of change;

• can’t crawl using the cross-lateral pattern;

• have poor balance and ungainly movements;

• can’t be still – are constantly fidgeting and squirming;

• are overly protective of their personal space;

• won’t share or take turns;

• have rigid routines (e.g. lining up bricks every day) and do not develop these into imaginative games;

• can’t bear to be touched but will annoy others by invading their space and touching them;

• have boor body and spatial awareness (they trip up over thin air and break toys).

Such a list can be overwhelming. One way to simplify observations and yet provide more detail is to record observations using a framework divided into the four key aspects of development (see p. 24 for details).

By adopting this strategy, the lists of difficulties can be turned around and expressed as ‘aims’ and these can move from general statement to personal plans gleaned from observations of what each child needs. These observations should be named and dated so that progress is monitored. This done, the recordings can be passed to other members of staff so that interventions can be ongoing rather than repetitive.

Let’s find out how many children are affected.

The statistics are frightening. ‘An 80 per cent increase in the total numbers of children presenting with special needs in the last ten years’ has been claimed by paediatricians and researchers in hospitals. The autistic spectrum disorders are perhaps the most upsetting and bewildering. Moore (2012), who has two sons with autism, and Baio (2008) quote ratios for autistic spectrum disorders as changing from 1:1000 children to 1:100 to 1:88 within the last twenty years. The National Autistic Society explains that there are 106,000 children registered in the UK (61,750 in the state educational system). Teachers and other early years professionals also suspect that many borderline cases for a range of difficulties are slipping through the net and going without support because there is neither the expert help nor the finances available. In some areas, parents have to pay for access to a psychologist to make the diagnosis in the first place. Many families cannot afford to do so and even when they can, the waiting list is long. This is hugely traumatic when parents are struggling to cope and when they have been told that the earlier that intervention can happen, the more effective it is likely to be.

But why should this increase occur? Are there really so many more children or is society just much more aware of differences and difficulties?

A genetic component in most conditions is hypothesised. Professor Simon Baron-Cohen (1995), a key researcher into autism, claims that too much testosterone flooding into the foetus is causal. He suggests that older-generation adults in the wider family can have traits of autism rather than the full condition and these can be passed on in the gene pool. Parents at diagnosis are asked about unusual traits/habits in family members on both sides for more than one generation back. Parents can be mesmerised by this request and sometimes it is only after a child’s diagnosis that parents reflect and wonder if a relative who showed strange habits was perhaps a missed diagnosis. This kind of information adds to the research that seeks to understand why autistic spectrum disorders should occur. But the cause is still being debated and for many parents it is a devastating mystery. These investigations have shown that ‘poor parenting skills’ are definitely not to blame. In the past, some parents, already devastated by their child’s condition, were told this was the case even when they had other happy healthy children.

There is also the important finding that autistic traits can be discovered in high-achieving children with prodigious memories and specific talents. Depending on the severity of the communication/understanding language difficulty (which will always be present), the children may be described as having Asperger’s syndrome. This finding has certainly added to the statistics. New research is coming up with new ideas/hypotheses too. Reichenberg (2013) studied the familial effects within 36,000 Swedish families, 6000 with autism, and found, ‘We know that older paternal age is a risk factor for autism but now we find that older grandparental age is a factor too.’ However, they do say that that risk is small.

Recent research into the identification of a ‘faulty gene’ by scientists involved in the £1.8 billion human genome project is ‘striving to unravel the web of genes that are implicated in autism’. This shows that our genetic make up is much more complex than was thought with ‘thousands of genes just contributing a tiny part to each condition’. This may explain why two children diagnosed with the same condition can have seemingly disparate symptoms, causing confusion to parents and practitioners alike.

Inheritance is also ‘blamed’ in less severe but still distressing and disabling conditions such as dyslexia (primarily difficulties with reading and spelling), dyspraxia (primarily difficulties with movement control and organisation of daily events), dysgraphia (difficulties with pencil control and writing) and ADD/ADHD (primarily lack of inhibition and lack of concentration/focus that leads to poor memorising and achievement in school). These four are specific learning difficulties, that is, not related to intelligence per se but nonetheless causing a range of distressing problems when children try to cope with the usual curriculum, more so in a traditional classroom. These affect between 5 and 15 per cent of the school population so there is a significant need for specialist support. Parents are more informed today too and many recognise the importance of early intervention so whenever they have suspicions that something is amiss, they put pressure on the setting to act. This puts a huge responsibility onto the shoulders of early years staff.

The vast increase in numbers means that requests for experts to make a formal diagnosis of conditions far exceeds the numbers of psychologists or speech and language therapists/physiotherapists who are available to do the job. Practitioners hope that such specialists will be able to take the responsibility of making a firm diagnosis and offer programmes of support. In the absence of this, they have to read about the conditions and devise programmes of activities themselves. And as the variety of children’s difficulties appears to be ever widening, the problem for practitioners increases. In an ideal world, they would have expert endorsement and guidance before planning interventions, but they are also very conscious that delay can exacerbate the problems the children have. So they feel pressurised into taking decisions, although whenever possible they try to extend the curriculum or modify the environment rather than make too many personal changes. Naturally this leads to them having qualms and questions – for example, ‘What if I miss spotting symptoms?’ ‘What if I get it wrong?’ ‘What if the parents don’t agree?’ And, concerning practice in the setting, ‘How can I provide specific help to each child while looking after all the others, for they need attention too?’

In 2013 there are also 9 per cent more children in the ‘Looked after Children’ group (Harker 2012) in England alone. While this does not mean that these children will have a special needs condition, they will have had an environmental and emotional trauma of some kind – for example, their parental bonding may have been disrupted and that might affect their capacity to cope with new people and different social demands. While many of these children adapt well and overcome early difficulties, it goes without saying that they need time and support to help offset the issues that led to them being in care in the first place. Difficulties in adapting to new social and educational demands and resistance to participating because of fear of trusting adults could be mistaken for special needs conditions.

Given that there are no absolutely definitive tests to confidently differentiate between those who have and those who do not have a condition and that indicators can belong to more than one, it is not surprising that practitioners find daily assessments challenging and sometimes overwhelming.

So the question of causation, that is, ‘Why should these difficulties be present?’, is super-complex with many disputed findings and debates about ‘cures’ so that hopes are raised and sadly often dashed. Restricting the children’s diets – for example, cutting out casein and gluten or dairy products – helps some children, while having sound therapy to reduce hypersensitive hearing can give a positive result too. Having a dietary supplement such as E-Que (mainly for dyspraxia) has also been trialled, with claims that some children become calmer and more coordinated. But not all children benefit and the effects can take time to appear. This can be so dispiriting for those awaiting support. It also takes so long to make sure that the side effects of any new drug are known and that instructions are clear to ensure it is used correctly. Not all parents wish to go down this route. Specialist clinics offer non-invasive programmes – for example, the INPP Clinic in Chester where children have a special programme to ‘retrace the earlier movements they may have missed’ and this ‘gives their brain a second chance’ (Goddard 2005). But although some children derive great benefits, this is expensive and the daily input of exercises can be a hard discipline to follow.

However, new techniques give hope that even the more severe problems will be eased. In the United States, Professor Naviaux and his team are trialling a drug they believe can restore communication in autism but they emphasise that it will be some years before it is available for general use. Their explanation gives us a peephole into their challenges. They write: ‘When cells are exposed to classical forms of dangers such as a virus or a toxic environmental substance, a defence mechanism in the brain is activated. This reduces the communication between neighbouring cells. And when the cells stop talking to each other, the children stop talking too’ (Naviaux 2013).

No one could expect practitioners to be involved in such developments, but are there everyday lifestyle changes that have made life difficult for children and could be more easily resolved?

What can these be?

First, there are changes in the children’s lifestyles that practitioners find reflected in their behaviour. Many are dismayed by the length of time some youngsters are kept ‘safe’ in their buggies, denied the opportunity to practise their early motor skills. Unable to make action choices, they are denied the chance to gain some early independence because, strapped in, the children are unable to decide where to go, what to do and how to do it. Nor can they pick up objects and feel the different textures, run and skip on the grass or clamber on walls. They cannot practise balanced and coordinated movements such as crawling using the cross-lateral pattern (now with a confirmed link to writing and reading abilities), or learn to interact with others or explore their environment. No wonder not achieving their motor milestones at the correct time is the result. This also explains why so many children can’t join in games at play.

Children who lack experience in moving, stumble and bump into things and appear inept beyond the time when they should have acquired a steady, purposeful gait that can be adapted to cope with changing paths and places. They may also have poor muscle tone caused by their inactivity and this hampers willingness to try new activities. This could be confused with dyspraxia – and it may be – yet lack of opportunity may be the key disabling factor.

Children’s communication is often restricted too, especially if mobile phones limit the mother/carer and child interaction. The first three years is the time when children practise the sounds of their own language and develop skills in listening, in responding and gradually building words and sentences. If they are restricted, the whole acquisition of language, both articulation and comprehension, can be delayed.

Alex voiced the concerns of many practitioners when he explained:

If mothers spoke to their children instead of always being on their mobile phones as they bring them in to nursery, then the children would have a much better chance of learning to speak clearly and build a better vocabulary. Many of our children have plugs [dummies] too, preventing them practising speech sounds. When they do try, their speech is thick as if they still had their plug in. But how do we tell the parents without being se...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of illustrations
• Acknowledgements
• Introduction: setting the scene
• 1 Supporting children through providing early interventions
• 2 The intervention process: the continuous sequence of observation, planning, assessment, intervention and evaluation
• 3 Listen to the children explain their difficulties
• 4 Understanding the development of movement: dyspraxia – the importance of crawling using the cross-lateral pattern
• 5 Understanding speech and language difficulties: dyslexia
• 6 Understanding difficulties with perception and sensory integration: autistic spectrum disorders
• 7 Understanding behaviour difficulties: ADD and ADHD
• Appendix 1 Milestones of motor development from 18 months to 6 years
• Appendix 2 Milestones for language development: signs of difficulties
• Appendix 3 Down’s syndrome
• Appendix 4 An introduction to cerebral palsy
• Bibliography
• Index