Chapter 1
Raising the issues
An overview
In the opening years of the twenty-first century, there has been an astounding 80 per cent increase in the number of children who are being identified as having a specific difficulty which hinders their learning (Keen 2001). This means that there will be children with these difficulties in every class. Members of staff therefore have to understand both the distinctive aspects of and the considerable overlap between each specific learning difficulty. While there are many such difficulties, the ones considered in this book are dyslexia, dyspraxia, the attention deficit disorders (ADD), or with the added hyperactivity (ADHD), Aspergerâs syndrome, specific language impairment (SLI) and the Scandinavian-named DAMP (deficit in attention, motor control and perception). âSpecific learning difficultiesâ is an umbrella term which indicates that children display discrepancies across their learning, exhibiting areas of high competence alongside areas of significant difficulty.
Whether in reality there are more children than ever before or whether parents and other professionals are more aware of the symptoms which indicate that problems may be looming and are more anxious to push for diagnosis and help is a moot point; but âmore childrenâ there certainly are, to the extent that physiotherapists, occupational therapists and psychologists say they cannot cope with the increased demand on their services. Certainly in schools, teachers find that the number of possible referrals is very limited and waiting times to see specialists are unacceptably long. To offset this and to try to ensure that all children are enabled to fulfil their potential and make the most of their time in school, teachers are being urged to make a comprehensive assessment of childrenâs difficulties. This includes evaluating the strategies they put in place to help them, e.g. reflecting critically on any learning materials which have been adapted to meet the childrenâs needs.
Many caring professionals would claim that they are doing much of this already, for they are constantly on the look out for difficulties as a natural part of their teaching and supporting the children. When these appear, they consult the support for learning staff or SENCOs (special educational needs coordinators), plan the most appropriate learning materials together and then monitor the childrenâs progress. Others, however, claim that this seemingly ideal cooperation just canât happen. They explain that with the best will in the world, âitâs almost impossible to find time to understand all the complexities of each specific learning difficulty and prepare differentiated work for children, taking into account their different levels of physical, intellectual, social and/or emotional difficultyâ. Many blame the priority given to âgetting children to meet the [externally imposed] targetsâ and find that teaching to meet this outcome results in other important aspects of education having to go on the back burner! Nursery staff often feel particularly aggrieved that they have no in-house experts to help them identify difficulties. At a critically important time, when early intervention could be particularly effective and when some difficulties could be ameliorated before the children were even aware that they had them, these professionals have to cope alone. Across the board something has to be done.
The premise of this book is that there are common features within specific learning difficulties and that understanding these will also show how the children can be helped in groups. This would prevent feelings of isolation, even âbeing picked onâ which children describe and reduce the amount of differentiated planning which would need to happen if each child was supported individually. This sounds ideal ⊠but what evidence is there to show that this overlap exists? In Canada, Kaplan et al. (2001) present data from a study of 179 school age children assessed for seven disorders: reading disability (dyslexia), developmental coordination disorder (dyspraxia), attention deficit disorder (ADD) with the addition of hyperactivity (ADHD), conduct disorders, depression and anxiety. They discovered that âfully 50 per cent of the sample met the criteria for at least two of the diagnosesâ, and also claimed that âchildren with ADHD were at a higher risk of having a second disorderâ. As the numbers of children with difficulties are increasing so that there may be several in each class, this book offers parents and teaching staff help in identifying children with difficulties, in understanding their symptoms and in designing strategies to facilitate teaching and learning. In the ethos of an inclusive culture, it
âą highlights the overlap of difficulties within different special needs conditions
âą considers the process of assessment
âą explains the source and the implications of these difficulties
âą lists tried and tested strategies to help the children, their parents and the school professionals cope
âą confirms that these steps complement the new inclusive policies.
This information means that parents and children can be reassured that new, inclusive ways are evolving and that a greater understanding of childrenâs difficulties will lead to them being given the most appropriate help for the correct length of time.
In the past, children who did not match some hypothetical ânormâ were often simply urged to cope as best they could. There was one lesson for all, albeit with some extension work for the âableâ ones and some less challenging work for those needing more practice. Very often this resulted in the latter group believing they were stupid or inadequate, when indeed the education system had made no real provision for their difficulties. Trying to make the children match the norm, teachers often concentrated on the things the children could not do â to little avail â and failed to recognize and develop the competencies the children had. It is no wonder that many children and adults floundered and eventually rejected a system which saw them as failures. Children with the most severe difficulties were educated in special schools where specially trained teachers understood and managed their problems and where the more favourable teacher:child ratio allowed for individualized care. But then the children were seen as âdifferentâ and they missed out on opportunities for social interaction which is such an important part of development. Neither could they benefit intellectually from sharing lessons with their peers and so their difficulties were compounded by the very arrangements which had been designed to help them.
The policy of inclusion means that this should no longer happen, and while this is very good news, there is much progress still to be made. There are many unanswered questions about ways to make inclusion âworkâ in a culture of meeting targets and gaining a high place in league tables â goals which do not appear to consider that all aspects of the childrenâs education are of equal importance. There are conflicting pieces of advice as to what to do and how to do it and many theories still to be evaluated in terms of realistically making them work in schools. Much rests on the debate as to what education in school is for and the place competencies like âcompassionâ and âempathyâ have in the value system that drives the ethos of the school.
Why should there be confusion and even conflict when everyone has the same goal, i.e. to understand the childrenâs difficulties and to develop strategies to overcome/circumvent them? There are several reasons why:
âą the large number of children who have to be assessed
âą the correspondingly large number of assessors involved
âą the pressure these assessors feel in âhavingâ to give a diagnosis in case children are subsequently denied individual programmes of help
âą the overlap of symptoms making assessments complex
âą the fact that there are different levels of impairment and that childrenâs competence may fluctuate, making accurate assessment problematic.
The sheer number of children presenting with specific difficulties means that different groups of professionals are making assessments and advising what is to be done. Their own professional training is likely to have concentrated on different aspects of the childrenâs development, so this may cause them to focus on things which are familiar to them. The overlap of key indicators means they are likely to identify these before âthe whole childâ has been assessed. Classroom teachers are likely to focus on the skills of reading, spelling, talking and writing because developing these fundamental and pervasive skills is an important part of their initial training. And so, when children find these areas difficult, the teachers may well diagnose dyslexia (Croll and Moses 1985), missing the possibility of SLI (specific language impairment). On the other hand, teachers of physical education, physiotherapists and occupational therapists, trained in the observation of perception and movement, may first consider dyspraxia because they have focussed on the practical, âbeing able to doâ side of things and they know that competent movement underlies much learning. Moreover, they know that they have the expertise to help poor coordination, balance and any movement difficulty, which impacts on the childrenâs learning.
And what of psychologists and/or psychotherapists who have studied behaviour difficulties? Perhaps when they see children who canât pay attention or concentrate, they will most readily suspect ADD (attention deficit disorder) or, if constant movement is a key disabling factor, ADHD (attention deficit hyperactivity disorder). Again these are competencies which strongly impact on the ability to learn, for children who disrupt others, by moving around, interrupting inappropriately or being aggressive, may soon find that they are rejected and blamed even for things they did not do. Yet this inability to sit still and concentrate may have been caused by poor muscle tone which affected the childrenâs balance or they may have poor body awareness and need continuous tactile feedback to let them know where they are functioning in space. These children need help for these specific competencies. They may not have ADHD at all. Farnham-Diggory (1992) claims that 80 per cent of children are misclassified. This is a very frightening statistic.
This being the case, i.e. that different experts concentrate on different aspects of the childrenâs behaviour (see Figure 1.1), it is not difficult to understand the perplexity and bewilderment of parents who discover that other children, with ostensibly the same difficulties as their own, have been given a different diagnosis. They are left in a quandary, wondering who is right. The whole child must be assessed.
Figure 1.1 Diagnostic difficulties
How can this confusion arise?
Case study 1
Listen to Gayle, Leahâs mum, talking about her daughter who is eight years old and âtotally miserable at schoolâ. Gayle âis at her witsâ endâ and has had several interviews with professionals at school which were helpful but still havenât resolved the problem. She explains,
Leah is a fragile, dainty child, very pretty but rarely smiling. She appears to cooperate with anything sheâs asked to do but she never finishes a job and never seems to realize that this is unacceptable. She avoids getting involved in games with other children, or going swimming where she has to get undressed and dressed again â this is a real difficulty for her. Generally she seems to have no confidence in herself at all. Her teacher says she comes into class, sits quietly and just dreams the day away. She has a wonderful imagination and sometimes will tell a long story, but getting her to write even a short one is practically impossible yet she can write and spell. If she isnât hurried, her writing is neat, but she only offers a few words. Sometimes we worry that the imaginative scenarios become too real for she is so immersed in the characters and the plot that she doesnât seem to differentiate between that and reality.
In most curriculum areas sheâll begin a task and then she gives up. She says she canât remember what to do next so she drifts into a world of her own and then comes out with a poem that is simply amazing. She doesnât smile when the other children give her a clap for this â they just donât understand her and so no one has her as a friend now. Itâs agony for her and for us.
She can follow instructions if they are given one at a time but finding her way in a new environment is impossible for her. She loses her coat regularly and never feels the cold so she doesnât miss it. At school she is always being scolded and at home too Iâm afraid that we sometimes get impatient because she canât or wonât hurry up and has no idea about getting herself organized for the day. She is bright Iâm sure, but sheâs in all the bottom groups and so schoolwork doesnât motivate her either. Whatâs wrong and what can we do?
This real life scenario perhaps helps to explain why discrepancies in assessments sometimes occur. Leah doesnât communicate her feelings to other children readily â could she have Aspergerâs syndrome? And yet she has a wonderful imagination and can pretend â competencies which some children with Aspergerâs find difficult. She has the planning and organizing difficulties often found in children with dyslexia, yet she can read and spell. Could she then have dyspraxia? She has difficulty with getting dressed and that involves hands crossing the midline of the body which is difficult for children with dyspraxia and she has the forgetfulness and the lack of awareness of temperature which some dyspraxic children display. She avoids any kind of contact activity, but her fragile build could explain that. She doesnât pay attention â could she have ADD? But she is very still and quiet so that rules out hyperactivity or impulsivity. Certainly assessments like this are complex!
The overlap of indicators
At first glance it would seem straightforward that all children presenting with certain difficulties would be given one diagnosis or âlabelâ. However, each syndrome or specific learning difficulty has a number of indicators and while there may be a key difficulty which would seem to point to one particular condition, there can also be a significant overlap or co-occurrence of others and this confuses the picture. (This has happened with Leah (Case study 1).) As many as 50 per cent of children diagnosed as dyslexic may well have the poor coordination which is also seen in dyspraxia. Poor concentration or poor short term memory (a possible component of both dyslexia and dyspraxia) may also be found in children with attention disorders or communication difficulties yet they may have been diagnosed as having Aspergerâs syndrome. Other children with dyslexia may be nimble and dexterous while children with dyspraxia may have no reading difficulties at all, yet both may find difficulty making friends â a symptom which can also present in children with Aspergerâs syndrome and SLI. Diagnosis can never be easy when children present different blends of difficulties at different levels of severity and when symptoms overlap between conditions (see Table 1.1). Kirby (1999) explains, âit is very difficult to find the âpureâ childâ. Recognition of this results in some children having a double label, e.g. dyslexia and dyspraxia and even then traces of other conditions may be present too. These difficulties will be dicussed in Chapters 3, 4 and 5.
Table 1.1 Some key overlapping difficulties
Some important indicators, e.g. low self-esteem, can result from the difficulties which the children experience. Many children with specific learning difficulties have low self-esteem arising from frustration and disaffection.
Variability of performance
A further problem for those making the assessments is that children may be able to do a task satisfactorily one day yet be totally unable to comply the next. For children with specific learning difficulties, progress is often...