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.…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.


Behaviour management using traits 

Emergency Services have a systematic approach when searching for missing people linked to behaviour studies. It struck me that there are parallels in how a school system could work when analysing behaviour. 

The Search and Rescue initial assessment of a missing person is vital. What follows is consistent with patterns of similar traits in a particular category of people. A ‘misper’ with Alzheimers for instance, means the search party will go in a straight line from the last point that person was seen. The behaviour traits of this type of disappearance means that a person with Alzheimer’s is likely to follow a path and once presented with a gate or hedge will go no further and just stop. It’s especially important in this instance to find out where they were last seen. This is in direct contrast to a person reported missing who is suicidal; here the search team will go to the nearest risk points; infamous cliff points of previous incidents, bridges and so on. A teenager who has not come home is most likely to be on a friend’s sofa so contact with close friends and family will be the first port of call. 

In the classroom, awareness of the traits students who have a learning difference or a social and emotional mental health issue may be planned for to minimise incidents. Teachers might argue that their job is to teach, that they are not social workers. I agree, but it stands to reason, a scientific approach to behaviour management and learning for students with SEND or SEMH would be useful.

Attachment issues has recently caused some controversy on Twitter and teachers questioned why they should know about such a seemingly complex mental health problem. I have sympathy with this view but think an awareness of traits with minimal training is useful. Actually for students with attachment difficulties, teachers may be relieved to hear that a firm and consistent approach is recommended. There are traits to be aware of however such as the possibility they may sabotage a seemingly positive relationship or can be prone to manipulating situations and not telling the truth. This is quite different to a student with ASD who tends to be more rule bound despite displaying similar characteristics in other areas of behaviour. Teachers don’t need to judge these students nor necessarily tolerate unwanted actions but an awareness of common behaviour patterns may help deal with a classroom issue.

An over generalisation of the individual based on diagnosis can be problematic and ‘treating the need not the label’ is advisable. We can however, using common patterns in a similar way to a Search and Rescue system, inform behaviour management.

Furthermore, an ability to recognise traits may also help schools to analyse progress and behaviour data. Is there is a rise in LAC students receiving behaviour points for example and would whole school attachment training be useful? Does the behaviour of a student with ASD get worse with cover teachers? This is quite common, but with such knowledge, the school can make reasonable adjustments, perhaps even have a policy for students with ASD and supply teachers to pre-empt any incidents.

Naturally, treating children as individuals is important and there is a danger of treating ‘all’ children with a difference in the same way but this issue is similar to missing people for the emergency services. Knowledge of common behaviour traits in certain groups is a useful tool if used as a starting point.

Moving on…

I’m leaving my dream job. 

Literacy Co-ordinator for DASP (a partnership of 12 first, 3 middle and 1 upper school in the Dorchester Area). 

Running an alternative curriculum for students who come out with me on Tuesdays.

Teaching yr 9 mixed ability English. 

SLE for the Dorset Teacher School Alliance.

And base leader of our specialist, LA funded, provision for students with speech and language difficulties. 

I love every element of my job, the comprehensive, Thomas Hardye School. the staff and the students. 

Why am I leaving? I said to the Head recently that I was having cold feet and how I wasn’t sure I’d made the right decision. He wisely told me that staff who felt like this were usually the ones who had done the right thing and that it was the teachers moving on with no mixed feelings he worried about more. 

But, the nearer to the end of term it becomes, the sadder I’m feeling about saying goodbye to the students and staff. I am also realising however that I have made the right decision. Much as I adore my job, I spread myself thinly and never quite feel I am doing any of my roles justice. I now know from my involvement with #WomenEd that I can strive for more, that I don’t need to think ‘it would be better if…’. I can dare to keep searching until I am in an even better job. I wanted to be able to focus on a single idea without distractions; I wanted to make a national impact rather than just a school one and I think I’ve found the place to do that in. I have dared to say out loud exactly what I want to achieve and not be concerned that I may sound arrogant, or listen to the voices in my head saying ‘who do you think you are?’. I’m done settling for ‘pretty good’, I want ‘nearly perfect’.
I was invited to join an expert advisory group scrutinising training materials for The Driver Youth Trust (DYT) and was struck by the insistence on including SEND alongside literacy. Their non-profit making values which had one aim; to improve education for children with poor literacy made me want to work with the DYT  as I knew I could have an impact.

After Easter I begin my new role and it’s very exciting. I want to empower teachers in mainstream to support students who have literacy difficulties and get the message across that some simple adjustments to classroom teaching can remove complex barriers to learning. 

The Driver Youth Trust provide free resources on their website. I know as a teacher that ‘free’ is a welcoming word so please take a look. Let DYT know what you think and if there are resources or advice you need, contact us. We’re listening.

Language Learning Impairment – the poor relation to dyslexia and autism?

Bishop 2015 Does a child’s diagnosis depend on professional seen?

Overlap of specific learning difficulties

After seeing this

Tweet which triggered this post.

 I glibly stated that I wanted to blog on Language Learning Impairment (LLI)/Specific Learning Impairment (SLI).

Do you know what it is? Perhaps you’ve heard of Specific Learning Difficulties (SpLD)? If you have you may think it’s dyslexia, dyspraxia, ADHD, ADD, dyscalculia or Autistic Spectrum Condition/Disorder ASC/D (used to be called Asperger’s or high functioning autism but now changed due to DSM-5) but not LLI. 

I’ll prompt you again, Speech and Language Therapy (SALT). Oh right yes, now I know what you mean. It’s speech problems, articulation? Or don’t SALT work with ASD and social communication? I think I may even have heard Complex Communication Difficulties used recently – what’s that? 

So, is LLI a communication difficulty?  
You can see the problem here…so many labels, many overlapping because it is the exception rather than the rule for difficulties to be pure – comorbidity is far more common; ASD with dyspraxia for instance or ADHD with dyslexia. Even the decision on diagnosis could be linked to which professional a student sees as shown in Professor Bishop’s slides above.

In the new SEN Code of Practice communication difficulties are described as Speech, Communication and Language Needs – SCLN – this is a catch all phrase and can mean various forms of difficulties in communication. 
Alternatively, it may be that a professional decides what the student’s primary need is, language disorder or autism? The really complex children are often a severe mix; so my students with speech and language difficulties will often struggle more if this co-occurs with ASD or dyslexia.

 It is also further complicated as language is the precursor to literacy. As an example I had two year 11 students whose language scores suddenly improved – it appears now they are soaking up phonics and their reading is improving rapidly. In the transition notes to college I have been very clear that they will need phonic based dyslexia support.

If you listen to SENDCos and specialists in schools across the country I’m pretty sure you’d hear the ‘ey’ diagnoses; ‘he’s a bit languagey’ or ‘she’s spectrumey ‘ – horrifying for psychologists  I’m sure!

Trends also show how certain labels fall out of use:  Asperger’s for instance and dysphasia are no longer officially used whereas verbal dyspraxia, attachment theory, sensory overload and auditory processing disorder are terms which seem to be common at present.

Returning to the above tweet however, LLI is one of the most common learning difficulties in mainstream schools yet possibly the least understood by teachers in both primary and secondary. It’s also had the least research which equates to less money spent on it. Language Learning  Impairment is the true hidden disability. 

SLI was until recently the preferred term but concerns that it suggested too narrow a group of children led to LLI which encompasses any child with language impairment regardless of underlying ability.

A crude comparison could be with dyslexia; whereas this signifies a set of behaviours linked to struggling with reading, writing and spelling, LLI behaviours are with talking and understanding language. These are expressive and receptive language difficulties. It is also possible to have strength in one and weakness in the other. 

LLI is at least as common as dyslexia and more common than autism. It’s expected that there is one student with LLI in every classroom (Bishop 2014).

A typical student in mainstream with LLI may have basic functional literacy (although not always) so does not get picked up by screening tests. Once a comprehension test is given, it may become more apparent but as these students often appear ‘typical’ and read and write OK, it’s not until you begin chatting to them individually that you start to see where the difficulty lies. They may even have hidden that quite well coming across as quiet or a bit rude, dismissive even and monosyllabic. Or perhaps, they’re quite chatty but don’t make much sense; I often say to teachers that these students may talk round a subject, never quite getting to the point. A good indicator is to ask yourself, what have they actually just said to me? If you struggle to work it out then there may be some language difficulties. Other students with LLI are often described as not listening, staring out the window, blank, in their own world. He or she might be incredibly frustrating as they never do what you ask, they clearly weren’t paying attention as what they’ve written has absolutely nothing to do with the task you set. Worse still they haven’t written anything.

The student may get into trouble in group situations, outside at break time or in class. They look guilty, they couldn’t explain what had happened whereas the other student was able to fluently describe the incident, the child with LLI just shrugged and walked off or was somehow appearing cagey so thought to be guilty.  

These are typical students with LLI. It is no surprise to learn that statistically, a student with language difficulties is more likely to end up in prison – perhaps they struggle to get out of tricky situations or may not have realised what they were being asked to do – everyone else has reacted quickly and run off. In the court room under cross examination, they become confused – it’s going so fast, so much language being fired at them – just as they’ve processed a question it seems another is asked, confusing them further. They appear truculent, aggressive yet are more likely to be frustrated and unable to react quickly. 

I’ve painted a depressing picture here haven’t I? It doesn’t need to be like this however, similar to dyslexia, although residual difficulties will remain in adulthood, the language deficit can be remediated through specialist support, by teaching language and offering strategies. By making reasonable adjustments in the classroom these students can thrive in a mainstream school.

Here are some tips

Time, time and more time – schools go so fast – but allowing the sudent with LLI just a little more time to answer a question of complete a task will make a lot of difference.

Visual visual visual – no, I’m not saying they’re a visual learner but when language is a barrier, using visual prompts can help to signpost activities for a student with LLI and trigger memory. By using images of the subject you’re discussing, it will help the student to link the information and categorise for storing. 

Modify language – for many students it is good to challenge them with extended vocabulary but for the student with LLI, it is the carrier language and phrasing which can confuse them. Try to concentrate on the knowledge you want them to learn and simplify the other bits of language. 
 Keep your sentences short and concise. Use simple language with the key words they need to learn.

Students with LLI may also need literal language, struggling to cope with metaphor and idioms. 

Break down instructions into small steps – you can get your TA to break tasks down with a tick box after each one. Chunk instructions and information.

Knowing that just because they’ve nodded at you does not necessarily mean they’ve understood is a vital skill for the teacher of a student with LLI. Asking them to repeat back what they have they to do is a useful strategy (but allow them time to do this).
Being sympathetic to language overload and spending 5 minutes with them explaining with some spot images (like bullet points but small pictures) can make a difference. 
Asking the student to repeat back what they have to do will help them.

Further reading 
Professor Dorothy Bishop researches and champions LLI. She is part of RALLI – raising awareness of language impairments (RALLIcam). There are many excellent YouTube clips.
Professor Bishop is also good to follow on Twitter @deevybee and her blog is one of the best out there.

Professor Pamela Snow (@PamelaSnow2) has influenced me and knows much about literacy and language (and phonics). Her blog, The Snow Report is here: I think she has persuaded me to change my mind on a number of occasions too.
Susan Ebbel, a speech therapist, has created shape coding – it’s a visual strategy for grammar using shape and colour.
Stephen Parsons (@WordAware) has been a useful contact and has a great book.

I Can Charity has many resources and knowledge on LLI (@iCANcharity).
@afasic is also an excellent source of information as is Communication Trust (@comm_ntrust).

NAPLIC is the association for language impairment in children.

There’s hashtags #LLI_ #SLpeeps and @WeSpeeches is a collective Twitter account for speech and language professionals. They often have useful chats on Twitter. Caroline Bowman as @speech_woman is another account to follow. 


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.  

Correlation and Causation – PX and Prison 

Correlation doesn’t equal Causation 

I had my first holiday Twitter spat on Saturday (I know I couldn’t even last one day). 

It was on permanent exclusions. After a tweet from the Prison Reform Trust arguing the case for criminal leniency for children in care, I drew a comparison with the fate of students excluded from school. 

Lord Laming who undertook the report, was on Radio 4 earlier this week with one example of the police being called because a child in care had taken food from a fridge without permission. 

This story horrified me; I look at my kids who have all done much worse and weep at the idea of them in the care system if my husband and I died. Statistically I know they’re likely to be separated as there are four of them; I know my son at 13 will be the hardest to place and having identical twins, they’d be kept together surely? But if they weren’t, the separation would be doubly damaging, so strong is their bond. 

I also know if one of them had SEN it would place further pressure on the care system and any behaviour issues (two are feisty, two compliant) would be dealt with more severely than we would at home. My goodness, if it’s food out the fridge; I may as well have 999 on speed dial. 

A criminal record for children in care, Lord Laming argues is assuring a future burden on society.

Back then to my Twitter spat; I claimed 47% (although probably a higher proportion as this includes non care system kids) of them, if excluded, were likely to end up in prison. This is the percentage of the prison population who have been permanently excluded from school. 
I was picked up here (probably fairly as I jump on anyone blaming parents for language and literacy difficulties using correlation as cause) because it doesn’t necessarily mean that those 47% wouldn’t end up in prison anyway and that schools may have done everything they could to prevent the exclusion. Fair enough, mea culpa.

My point though was that the label of being permanently excluded is as damaging as the criminal record Lord Laming was criticising. He’s not asking these to be lifted for dangerous criminals but for the petty  instances, allowing care children the best start in adult life.

Many excluded children have: 


experienced bereavement 

witnessed domestic violence

been sexually abused

been physically abused

There is a similar pattern for prisoners and with whopping percentages of language and literacy difficulties among the prison community.

Yet, we may not see these children as victims and neither will society when they have a criminal record and permanent exclusion stamped on their forehead before the age of 16. 

Can’t we do better for these kids? Find models known to work and replicate them? These children matter and are society’s responsibility. (75% of excluded pupils end up with a criminal conviction)

Segregation – a collection of responses

Edu blogging and edu Twitter can be extremely rewarding at times but also nail bitingly painful. When you work in SEN, it can be difficult reading ignorant comments and hearing views from teachers who clearly believe students should be elsewhere. These ‘outclusionists’ have less idea where they should go just ‘away from me and my class’.

When  QT wrote a blog post claiming to be playing devil’s advocate, I thought actually, it was not provocative just prejudiced and in poor taste. So I wrote a rather ranty blog. I also questioned how ‘normal’ you have to be for mainstream a while ago.

What happened next was better however: the Titans of SEN began to respond. I’ve used this image before; over the brow of the hill came the voices and it made me burst with SEND pride that such professionals champion those with the least resources available to them. Here they are: 

Nancy writes beautifully but harshly on ‘Rose tinted spectacles’ giving some statistics which we should all read.

Simon writes an excellent post challenging the views that we all find ‘like minded’ people and suggesting teachers should be looking for solutions to mitigate difficulties.

Chris tells us how children can be learning opportunities for teachers and that investigating options as a teacher is rewarding.

Jarlath responded with an aspirational blog lamenting how some dwell on the deficit model of SEN rather than seeing students who have a lot to give and achieve. 

New to me is  Kate, who writes a positive post on inclusion based on real experiences which was a pleasure to read.

OldPrimaryHead ‘s stonking blog sums up the problem but also the solution – a decent head who believes in inclusion past test results.

And Sue reminds us, of course, that #Everychildmatters.

Lena writes an interesting post encouraging more understanding and commitment to inclusion. 

Why is inclusion so important? Read Jude ‘s post – it brilliantly destroys the prejudiced arguments in favour of segregation.

A post from Liane on how teaching students with SEN has made her a better teacher is one which will resonate with many.

Beth reminds to to look for triggers behind the behaviours and that segregation could be yet another knock back for some vulnerable children.

Cherryl gives some examples of students in special school and asks the question; should all children be in mainstream?

JordyJax tells us SEND is not going away and gives some very practical advice on spotting SEN in students causing difficulties in school. 

Rob compares the lack of funding for flood defences with inclusion and how the subsequent fall back costs far more – he’s right, we need more money and more accountability for students with SEN – provision is currently a lottery.

Bennie has written a fantastically moving tribute to teachers on why we teach  – the stats are shocking too.

Maryisherwood, a special school headteacher writes how inclusion is personalised and inclusion for one student may mean a special school and for another mainstream.

Matt, a parent should have the final Words which are in the comments section of QT’s post.