Treat the Need not the Label

Every few months a newspaper report comes along to claim ‘dyslexia doesn’t exist’ or ‘ADHD is made up’. Of course, this is usually a sensationalist version of a new report showing controversial research in the field. Yesterday, Tom Bennett wrote an article on the misdiagnosis of ADHD and dyslexia.

https://www.tes.com/news/school-new…r-dyslexia-and-adhd-are-over-diagnosed-crypto

For a SENDCo this can become tricky as teachers may begin questioning your advice citing this example from a ‘behaviour tsar’ as evidence. They would be right to question you, after all Bennett influences government policy, he must know what he’s talking about, right? This is my response.

It is perfectly valid to question the validity of diagnoses such as ADHD and dyslexia. There has been an increase in children with ADHD and medication such as Ritalin is being prescribed more. There are correlations with government policy (in US) and it is sad if normal behaviour is being pathologized. In contrast, figures for diagnoses of dyslexia in state schools is going down which appears to correlate with the reduction in Local Authority SENSS services. Dorset for instance, which still has a service has more dyslexia recorded than other counties who no longer have a service. You could, I’m sure find a similar picture in the quality of NHS services when assessing for ADHD. It’s complex, and it’s not perfect. 

But none of this should matter to the day to day practice in a mainstream, classroom. What would a teacher do differently if a child was diagnosed with ADHD compared to one who wasn’t?
As teachers we have no right to question a paediatrician even if we want to. We have no right telling a parent that we believe their child doesn’t have ADHD because a ‘behaviour guru’ told us that misdiagnosis is rife. We have no right to tell another teacher that if they just set some boundaries that the ADHD is likely to disappear. We have no right, morally or, as it happens, legally. 

We have no right telling a 15 year old who can’t read that the diagnosis of dyslexia isn’t true because it doesn’t exist. The Equality Act and the teaching standards mean that as a classroom teacher we must put reasonable adjustments in place to meet the needs of all our students, not just the typically developing ones.

This may seem harsh but it’s true. What we do have control over however is the classroom, our students, and their right to learn. We have the right to expect support from the leadership team, our SENDCo and outside agencies should we need it. All our children have the right to an education and we have the right to deliver it in whatever way we wish as long as we are meeting the needs of the class.

A professional teacher must be informed, know their students well and teach responsively. Where does the label come in? Well, only as a starting point. It’s part of an holistic picture of the child. It doesn’t matter if the child has ADHD or not. If she is exhibiting behaviour traits which seem similar them treat the need not the label. A child with ADHD is impulsive, struggles to filter out irrelevant information and can become easily overwhelmed. This is really useful information.

Let me give you an example of responsive teaching based on this. A child comes bouncing in from the playground. She’s been playing a game of ‘wee and poo’ with her friends. Not under adult supervision the children have been shouting wee and poo at each other and giggling. The bell goes; her typical friends find it easy to transition back into the classroom and ‘turn off’ the game, walking quietly into class, sitting themselves down and preparing for learning. The girl with ADHD however struggles to self-regulate; she’s still mentally in the game and runs into class blurting out ‘poo’. She’s immediately in trouble and is sent to sit away from the group. Becoming upset, the pupil screams at the TA who is trying to keep her away from the group and the incident escalates until she’s sent out of the classroom to prevent disruption to the rest of the class.

As a teacher, observing behaviour traits which appear similar to those of ADHD, I can anticipate this impulsivity. Putting my hand up to the little girl as a physical reminder to self-regulate. I then tell her playtime is over and it’s time for learning. She’s given a few minutes for the transition to ‘check in’ then I ask her to enter the classroom calmly for learning. 

It doesn’t matter if this child has an official diagnosis of ADHD or not, recognising behaviour traits and responding is the same, label or no label.

 

No Excuses

When I watch those videos from the No Excuses schools in the US, I am scanning the room for the type of children I teach. The ones that have sensory difficulties; that really isn’t an excuse.  In fact it’s probably one of the most research heavy areas there is in SEND.

I see the ones who look slightly bewildered; that’s not an excuse either. The pace of some of the teachers’ chorusing would not be helping those with slow processing and/or language learning impairments. 

And I see the eye tracking thing.  Eye contact is very difficult for some students with autism (also not an excuse) and I often ask teachers who say a child is never listening whether they’ve checked by asking them. Some students (often with ADHD in my experience) might be concentrating when they are not looking at the teacher. Others are really listening while playing with Lego or fiddling with play doh. In fact,sometimes I think that when you ask a child to look at the teacher it might be when she is listening the least: have they noticed the mole on an eyebrow? Are they looking at the detail of a patterned shirt?

And then I see the students who are not following the words to the songs, and the chants and the recitals because they can’t remember the words; they are pretending by moving their mouths but they’re out of sync with the rest. These are the ones that are just about coping. I wonder however about the ones who have walked out, sworn at the teachers, won’t sit still, won’t keep quiet, I wonder about them – where are they? They exist, I know they do.  

What makes it better for children who struggle is a differentiated curriculum, an understanding of their needs, strategies to recognise why they blow and places to go when they do. Reasonable adjustments are not excuses.  

The Last Post (on this anyway)

I’m responding to this where @thinkreadtweet replies to a blog I wrote about dysteachia.

We’re in danger of playing ping pong at who is the most successful at teaching children to read I know. But @thinkreadtweet says children with low intelligence cannot be taught to read and I vehemently disagree.  I’ve taught lots of students with SEN to read in special schools, FE college and in mainstream. To imagine children of a lower IQ can’t learn to read would be dreadful – I’d definitely be marching to a different tune if this were the case.

The trouble is when you attempt to highlight the exception rather than the rule you can get backed into a corner with a seemingly ridiculous stance:

‘No-one can read, there is nothing we can do for the poor loves’

The other side, the ones who insist everyone (who is clever enough) can read and dyslexia does not exist, become the do gooders.
‘I am challenging the low expectations of teachers who refuse to help these poor souls, this soft bigotry is why there’s an achievement gap between rich and poor – it’s not dyslexia it’s dysteachia bla bla’

I’ve had similar discussions regarding synthetic phonics. 

Me: ‘obviously phonics is an evidenced base route to reading but it’s not so simple – reading is complex, 50% of early vocabulary is irregular, oral language is key, analytic phonics really helps many children and we need familiarity of exception words. Creating a high stakes phonics check for year 1 teachers where the success of it is linked to their pay may mean a disproportionate amount of time is spent on learning how to decode ‘jound’ rather than immersing children into a language rich environment surrounded by real books (OK I went on a bit there).

Them: “Heretic – phonic denialist – you and your soft bigotry is why this country is riddled with illiteracy – it’s teachers like you who have caused the massive gap between the rich and poor’.

And so it goes on…

Progressive = Blob

Traditionalist = Tory 

Knowledge curriculum = Rows and Rote

Discovery Learning = chucked in a swimming pool when you can’t swim

I know we are getting into a cyclical argument of doom here so, I will correct a few inaccuracies in @thinkreadtweet’s post, watch Monty Python, then go to bed.  I’ve no doubt we will have to agree to disagree after this.

Firstly, my post where this all started suggested (for an articulate boy with dyslexia) a 1:1 systematic and cumulative reading programme alongside being taught with his typically developing peers in a mainstream English class. I did not say he wouldn’t learn to read but implied that putting him in a bottom set for English with students who, although read better than him, did not understand as well as him, was not addressing his specific needs.  

Secondly, Professor Julian Elliot never said discrepancy does not exist; he argues that using this as the sole marker for dyslexia, as a model, is unscientific and discriminatory. The Rose report showed that dyslexia can affect students across the ability range and cannot be identified via a pure discrepancy model but by deficits in phonological awareness, short term memory and rapid automatic naming. This does not however mean that there are no students who will have a disparity between their cognitive ability and reading/spelling. Of course these students exist! (And I imagine these are the ones Andrew was referring to when discussing non-responders).

Thirdly – Assistive Technology is not just for the physically disabled – what nonsense. There are many students (and lecturers) with specific learning difficulties at university using equipment such as Dragon Dictate.

Fourthly – when I write a post encouraging people to go to university despite having difficulties with reading and writing, how can that be low expectations? Especially when the other student I used as an example was going to be excluded because his dyslexia was ignored. 

As I repeatedly say, reading can be taught but many with dyslexia will still suffer from a lack of fluency or poor spelling – it is a life long condition. We try our hardest nevertheless to remediate the deficits. 

My students will never hear the term Dysteachia 

I wrote this:

https://mainstreamsen.wordpress.com/2015/06/24/we-dont-call-it-dyslexia-anymore

David Didau wrote this.

  
After early Twitter conversations with David Didau I don’t usually engage with him on dyslexia anymore. His version of dyslexia “I just showed him how to spell a few words” compared to mine “identical twins with the largest disparity between verbal ability/comprehension and reading and spelling I have ever seen” is so vastly different there’s no point. 

But I’m going to this time; I’m also responding to @ThinkReadTweet who has named me in her blog and questions why interventions are linked to SEN not the English department. She also uses a term I vociferously disagree with ‘dysteachia’. http://wp.me/p4hKgx-cf

It’s a shame as I admire her greatly and enjoy many of her blogs.

To ensure students with dyslexia access the curriculum and are able to record their work at a quality commensurate with their ability  I have seen the benefits of assistive technology and promote it widely. This does not replace reading instruction just enhances it. For I too would like every child to read before they leave school – in fact in my interview for a new post I start in September I said “I want to ensure every one of the 1500 students can read before they leave us”. 

Now back to this twin; he’s at university. He’s partly there because I told him he could, because I made sure he understood that his poor reading and spelling was due to his dyslexia not his intelligence. 
When I wrote his assessment for his Disability Student Allowance (it is a disability for him) I wrote how over the two years I’d known him, he had increased in confidence and that he’d told me how he uses Dragon in the library (he was far too embarrassed to do this when he arrived) how a peer came up to him and asked what he was doing. When he told her she said ‘but you sound so clever in class’ – his response was ‘dyslexia doesn’t mean you’re stupid’. This belief in himself was the most important thing – he’d come to college with a complex history, a school refuser and then statemented and he was now off to university (we’re still in contact and I’ve shown him this post).

I also teach young ones and as we know early intervention is best; I’ve created a six week booster for year 1. It’s pretty pragmatic but intensive – under a score of 85 they have a 6 week booster; if they reach 85 they go back – we’ve had some whose spelling went up 8 months, their handwriting improved, their confidence improved and some have sailed through the phonics check since. 

I am obsessed with getting children to read through picture books, oral language and phonics but I also recognise some students do have difficulties and dyslexia for those children is an empowering term and explains to them, simply, why they struggle more than their peers. 

This does not mean we give up on them, that we stop teaching them to read but it does ensure we put appropriate strategies in place. And if this means assistive technology in mainstream classes with their typically developing peers then that’s a good thing in my opinion. 

So if you don’t mind, I’m going back to my job of teaching all ages to read while letting them know there may be a reason why they find it harder than their peers to read, that they can still learn to read but may always find it hard. I will also tell them that no matter what, there is now assistive technology available to them which means they can still succeed and I will remind them that despite poor reading and spelling, they can go to University and flourish like many students I have met over the years. 

Oh, and my new role as literacy and language co-ordinator for 1500 children is not linked to SEN but nor is it part of the English department because it’s for all teachers to take seriously; across the curriculum – whole school.

You carry on using Dysteachia if you like but it will never be used for my students. 

We don’t call it dyslexia anymore

Teacher 1: It’s a shame about John; he will get excluded soon.

Teacher2: Why what’s up?

Teacher: I don’t know, he seems fine when you speak to him but he can barely read and write. 

Teacher 2: Does he have dyslexia?

Teacher 1: We don’t use that term anymore, it’s unscientific -dyslexia doesn’t exist. We call it dysteachia.

Teacher2: So you haven’t taught him properly?

Teacher 1: Well not me, he came to us with very poor skills now he just won’t engage in our lessons. 

Teacher 2: But his friends can read and write? So the teaching can’t have been that bad? Surely John is confused why he can’t read and write when his typically developing peers can? Do you tell him he’s got dysteachia? 

Teacher 1: No we tell him he’s got a severe reading difficulty.

Teacher 1: Like dyslexia?

Teacher 2: Well last year he would have had dyslexia but it doesn’t exist, it’s unscientific …

Teacher 1: So now you say severe reading difficulty?

Teacher 2: Yes which wouldn’t have been so severe if he’d been taught properly.

Teacher 1: Right – I thought dyslexia, sorry, severe reading difficulty or is it dysteachia? Anyway, whatever you call it, was when a reading difficulty persists despite interventions?

Teacher 2:  *Shrugs* He doesn’t get on with most of the class. The others tend to spend time in the nurture group, come here for lunchtimes and enjoy the quiet little class we have. 

Teacher 1: Where’s John at break and lunchtime?

Teacher 1: Well he’s outside with his friends – they’re all much brighter than him though – yet you wouldn’t know that to talk to them all – John’s got excellent language skills.

Teacher 2: There’s a discrepancy between his reading and verbal ability?

Teacher 1: But you can’t diagnose dyslexia using the discrepancy model – dyslexia (even though it doesn’t exist) affects all abilities.

Teacher 2: Well it’s not diagnosed purely on a discrepancy model but that can be one factor and dyslexia may well explain why he can’t read and write.

Teacher 1: Well he’s actually weaker than the rest of the group with his reading and writing despite his verbal ability -he’s the worst and needs to learn to read and write.

Teacher 2: But he’s not learning anything because of his behaviour. Do you think John would be better in mainstream English?

Teacher 1: How can he? His reading and writing is like a 6 yr old.

Teacher 2: Well you say he has good language skills, could he not use audio books? Text-to-Speech? Speech recognition?

Teacher 1: He needs to learn to read and write.

Teacher 2: Yes but that could be in a daily 1:1 session;  using a systematic and cumulative reading programme. How is he accessing text and recording his work in the meantime? 

Teacher 1: He’s not, he just plays up, gets sent out of classes and as I said, will be excluded soon. 

Teacher 2: Right.

‘The Challenges of learning to read and write in English’ – notes from Dr Powell’s keynote

Dr Daisy Powell of Reading University gave this talk at Imperial College last Saturday.

I can’t hope to cover all Dr Powell’s keynote but will attempt to summarise the salient points (I have omitted the writing research which I’d like to cover at a later date – but let’s just say it’s linked to reading and there aren’t enough studies).

Opaque/transparent languages

Dr Powell first reminded us how difficult the opaque English language is compared with more transparent languages such as Italian. This means we have an inconsistent relationship between graphemes (letters, or groups of letters) and phonemes (sounds that make up spoken words).

English is still an alphabetic language however so teaching children how to map phonemes to graphemes will allow them to read and spell. There is strong evidence that fostering these decoding skills is effective for early literacy. (Bradley & Bryant 1983, Hatcher et al, 2006)

Causes of Reading Difficulties

Since The Rose Report (2009) reading difficulties have been predominantly linked to a phonological deficit and ‘visual processing has been broadly ignored in research’. Dr Powell however has been researching reading difficulties using a particular visual element called Rapid Automized Naming (RAN).

Denckla and Rudel (1974, 1976) first showed that the fluency with which children can name familiar items is strongly related to reading. This is called RAN and is now a common test used in reading difficulty assessments due to strong RAN-reading links (RAN is tested used a standardised test involving children naming objects, colours, digits or letters at speed).

There are three main profiles then for reading difficulties:

  • Phonological deficit
  • RAN deficit
  • Or RAN-phonology deficit (known as the Double Deficit theory) – this is the least common but causes the most severe reading difficulties        (Wolf, Bowers and Biddle, 2000)

A randomised control trial was set up using a norm group (no deficits), then three other groups using the phonological, RAN and double deficit profiles (Powell, Stainthorp and Stuart 2007).

Initial findings were consistent with the double deficit account of dyslexia; that those with both poor phonological awareness and RAN had the most severe reading difficulties and those with a single deficit had a more moderate reading problem. The low RAN group were however significantly worse at both reading and spelling than the control.

Children with a RAN deficit also performed more poorly than a control group on low level visual processing tasks (Stainthorp et al, 2011).

There are children then who do have reading and spelling difficulties which are not linked to a phonological deficit. This raises the question about the type of intervention given to children with poor RAN.

Policy on Phonics

To try and identify children with poor letter sound correspondence, the government has introduced a screener known as the Phonics Screening Check (PSC) in Year 1. The PSC comprises 40 real words (e.g.‘shut’) and non-real words (e.g.‘jound’) and the pass mark usually sits around 32.

An interim study looked at younger children with intensive phonics teaching (post phonics check) and found exception words (irregular) were significantly harder to read than regular words or non-words whereas older, pre-phonic check children could read irregular words, regular words and non-words equally successfully (Powell, Atkinson & Stainthorp 2014).

Those students who do not have a phonological difficulty but a RAN deficit are currently receiving a phonics rich environment but what they may require, are opportunities to memorise irregular words and receive lots of exposure to print. The possibility also arises that for those with RAN difficulties who have little print exposure in the home environment, could be doubly disadvantaged.

Interestingly children with poor RAN showed better performance on a visual memory task than the control group. This may also point to requiring alternative strategies other than phonics. There is still a chicken or egg question here: are strengths in visual memory and comprehension a cause or consequence of deficits in RAN? Early perceptual difficulties could lead children to adopt strategies other than alphabetic decoding (e.g. relying on visual memory/semantics).

Is phonics all you need?

Some questions which need answering:

  • What about words with inconsistent spellings (50% of early vocabulary).
  • What about children whose reading difficulties make alphabetic decoding very difficult?

There are also teacher concerns that such an emphasis on phonics, led by the statutory phonics check, may be leading to laborious and dis-fluent (or dysfluent?) reading in some children.

The home literacy environment

Dr Powell said there was a clear link between children’s reading experience in and out of school and their progress learning to read.

Cunningham and Stanovich (1991) developed a checklist which measures exposure to print using an Author/title recognition task – this was asking children to recognise familiar story books.

‘Exposure to print accounted for unique variance in reading over and above IQ and phonological processing skills’.

Similar results were found by Sénéchal and LeFavre’s (2002) home literacy model. This showed better oral language and early literacy for children with positive home reading habits.

What might be relevant for schools?

In conclusion then, there is little doubt that phonics is the best way to foster decoding skills, but in a very rich phonics environment, students may be finding irregular words more challenging to read and spell. There might be a need to memorise irregular words and have opportunities to be exposed to inconsistent spellings through exposure to print. Phonics rich teaching could come at a cost to those students with RAN difficulties who also lack print exposure in the home environment. (Dr Powell did say longitudinal data was necessary to confirm this).

Impact on Literacy

Predictors of reading are print exposure, vocabulary and home literacy environment. In addition, the precursor to reading is oral language (Snowling 2014). Writing skills come from good reading skills and habits.

I would also add that comprehension is an ongoing concern when teaching reading and a rich language environment in the classroom is vital for early literacy alongside phonics and print exposure.

 Thank you for Dr Daisy Powell who gave us such an insightful keynote at the Patoss Conference last week; I hope I haven’t misquoted her or plagiarised or stated speculation as fact or done anything else awful.

Thanks also to Patoss for a great day at Imperial College. 

Day 20 – Can’t Write Won’t Write #28daysofwriting Assistive Technology Series

I’ve been busy today being all #teacher5aday, the initiative run by @MartynReah. So this is a quickie.

I blogged about ‘How to train your Dragon’ on Day 4. Using speech recognition takes practice and lots of training – it works brilliantly but not straight away. It also gets better with age as it begins to learn from your vocabulary and documents. Training your dragon takes commitment and patience.

Cue Dragon Dictation on the iPad – this is a simple, free app which allows you to talk while it writes. It’s a marvellous little app. The iPad has in-built voice-over (Day 13) which does the same but I prefer Dragon Dictate. We’ve put it on the SEN Ipads in a school and it has really helped some students. One particularly, who refused to write, refused to let a TA help but would contribute really well in class discussions. This has been perfect.

Dragon Dictate Is not as sophisticated as the ‘proper’ Dragon but it’s less complicated too.

A student could use a wireless headset with mic but if they want to blend in, it works well just talking to the iPad. You can still use simple voice commands such as full stop, new line and correct.

For the student who can’t write and won’t write this may nudge them in the right direction.

(They can also hear it read out using ‘speak’ Day 13)

Warning – I know the IT hated me for this app as it took them ages to work out how to enable it on the school network. If you’re having trouble let me know and I’ll ask what they did.

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