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1
Defining overlapping and co-existing conditions
This chapter sets the scene for the rest of the book by:
- presenting case studies of two children as illustrations of overlapping and co-existing disorders
- explaining how the terms used to describe childhood disorders have changed over time
- discussing the meaning of overlapping disorders and ones that co-exist
- defining the four main groupings of developmental disorders that are the focus of this book.
What’s in a label?
It is a comparatively recent phenomenon that children with developmental disorders may be given not just one diagnosis but two or more. This has happened at a time when the number of terms being used to describe different disorders has increased. For instance, ‘specific learning difficulties’ now covers not just dyslexia, but dyspraxia, dyscalculia and dysgraphia as well. Other terms, such as autism, have broadened their definition to become ‘autistic spectrum disorders’ (ASD), which includes Asperger’s syndrome. As the numbers of labels being used have both increased and expanded, it has become apparent that children with different disorders may exhibit some of the same symptoms. It has also become clear that there are certain conditions that quite often go together, so that what were once seen as entirely separate disorders now need to be viewed as ones that may overlap or co-exist. The question then arises as to how to educate these more complex children, while not detracting from the educational experiences of their peers. This book has been written to shed light on the current situation, to consider the impact of certain conditions on children’s ability to learn effectively, and to look at the approaches and strategies that might assist all children to become successful learners.
Case study 1.1: Tommy, 8 years old
Tommy was seven years old when he received a diagnosis of attention deficit hyperactivity disorder (ADHD) from the family doctor. He had struggled to cope in his infant school, and the staff had struggled to cope with his behaviour, which combined impulsiveness with an inability to concentrate on anything for more than a few minutes. As he moved to his junior school and the same pattern of behaviour continued, his parents agreed with the doctor that it would be worth putting him on medication for a trial period. Unfortunately, this seemed to have little effect, so after a few months the medication was stopped. Tommy’s behaviour continued to be erratic. When he was eight, and after being involved in several playground fights, the school excluded him for lashing out at a member of staff who was trying to direct him to go back to class at the end of playtime.
On his return to school after his fixed-term exclusion, he was seen by the school’s educational psychologist (EP), who sent him to a paediatrician. After assessing Tommy, the paediatrician explained to his parents that their son met the criteria for a diagnosis of Asperger’s syndrome and that ASD would be a more accurate description of Tommy’s difficulties than ADHD.
Case study 1.2: Sylvie, 12 years old
Sylvie had been diagnosed with dyslexia when she was eight years old. Her teachers had always expressed surprise that someone who was so keen to do well had struggled to get off the ground with both reading and written work. Not only was her spelling very weak, but her handwriting was almost illegible. For the rest of her time in primary school, Sylvie received extra help twice a week from a teaching assistant who worked with a small group and concentrated on improving the pupils’ reading ability. Although Sylvie made some progress, as the gap between her and her peers widened, she became less motivated and her behaviour deteriorated. She also found it hard to make friends and was often the last one to be picked for team games, mainly because she was slow at running and her ball skills were poor.
When she reached secondary school, Sylvie was placed in the learning support unit (LSU), where the teacher in charge decided to look more closely at the nature of her difficulties. From the assessments the teacher carried out in conjunction with a specialist teacher for dyslexia, there seemed to be no doubt that Sylvie had severe dyslexia. However, in addition, she was referred to the local child development centre, where her difficulties with coordination resulted in the physiotherapist and the occupational therapist agreeing that she had dyspraxia in addition to her dyslexia.
In the first of these case studies, Tommy begins by having a diagnosis of ADHD, which is later replaced by one of ASD. This is an example where a label is changed over the course of time, as the child’s development seems to indicate that a different term might be a more accurate one. At first glance, it may seem that ADHD and ASD are two very different conditions; yet, children with either condition can appear to be inattentive and socially inept. In Tommy’s case, as he grew older, one label was changed for the other; in other cases, a child may be diagnosed with both ADHD and ASD.
The second case study is that of a child who acquires the label ‘dyslexia’ and it is later discovered that she also has another specific learning difficulty in the form of dyspraxia. In this case, the first label was not wrong, but it may have prevented professionals working with her from realising that dyslexia was not her only difficulty. In Sylvie’s case, it was not so much a question of overlapping symptoms (although, as discussed later in this chapter, all four of the specific learning difficulties recognised to date do have some symptoms in common), but that specific learning difficulties can co-exist. Later on, it will become apparent that they can also co-exist with some of the other disorders explored in this book.
At first glance, it may seem that there is a clear distinction between the terms overlapping and co-existing disorders.
Key points Overlapping and co-existing disorders
Overlapping disorders
Overlapping disorders are ones that have some symptoms in common (as in the case of Tommy in Case Study 1.1).
Co-existing disorders/co-morbidity
Co-existing disorders or co-morbidity is the term used when the same child has more than one condition (as in the case of Sylvie in Case Study 1.2).
Note: The terms condition and disorder are used interchangeably in this book.
However, there may come a point when two conditions that are seen as overlapping, share so many symptoms, that it is no longer sensible to talk of them as being separate disorders. For instance, time will tell whether or not dysgraphia will establish itself as being sufficiently different from dyslexia, or whether the definition of dyslexia will broaden to encompass dysgraphia. (The four types of specific learning difficulties are described later in this chapter.)
- Can you think of a child you know who was diagnosed with one condition, which was subsequently changed to a different diagnosis?
- Do you know of any children who have been diagnosed with more than one condition?
- Can you think of any children who have not been given a label beyond the general one of having special educational needs (SEN)?
Changing terminology
In the 1970s, when a committee chaired by Mary Warnock was asked to look into the education of children and young people who, at that time, were described as handicapped, the emphasis was on placing pupils in categories of handicap, rather than seeing them first and foremost as unique individuals. The small percentage of pupils who we...
