Implications for practitioners Tim Hannan FAPS LDA 8 August 2015 - - PDF document

1

PSY523

Implications for practitioners

Tim Hannan FAPS

LDA 8 August 2015

Do children who struggle to learn to read have a biologically-based problem? What are the defining features of a reading problem? What is the contribution of “non-reading” skills such as verbal knowledge and motivation to reading? Do the various terms and labels used refer to distinguishable problems? What is the place of intelligence in the definition, diagnosis and assessment of reading problems?

2

What causes a reading problem? What are the core cognitive deficits which cause dyslexia? Can we diagnose dyslexia by cognitive profiles? What is the role of “response to intervention” in the diagnosis and treatment of reading problems? How common are reading problems? What interventions should be employed? How effective are they? Should interventions be selected on the basis of types of reading problems? Should interventions be tailored to an individual’s cognitive profile?

3

Assessment, diagnosis and classification

IQ

IQ-achievement discrepancies are not a diagnostic marker or indicator of learning disorders IQ test profiles do not identify subtypes of RD IQ test profiles do not predict response to intervention

Other cognitive tests

test score discrepancies do not identify subtypes of RD measures of specific cognitive variables do not predict response to intervention

So...

testing does not add to knowledge concerning the presence of a reading difficulty, its nature, its cause or likely prognosis task is to recognise when a child has a reading difficulty and respond to it, then examine response (RTI)

But...

accepting that assessment does not add to information about reading does not lead to the conclusion that assessment is unnecessary and uninformative

Assessment

identifying a reading difficulty through observation (or measurement of reading alone) provides no information about co-morbidity, no information about secondary consequences, no data for a full case formulation

4

Interview Testing Questionnaires Observation Formulation Diagnosis Intervention

Differential diagnosis

• reading disorder
• language disorder (SLI / DLD)
• intellectual disability / low intellectual abilities

DSM-5 Neurodevelopmental Disorders

Intellectual disability (Intellectual Developmental Disorder) Communication disorders

• Language disorder
• Speech sound disorder
• Childhood-onset fluency disorder
• Social (pragmatic) communication disorder

Autism spectrum disorder Attention deficit hyperactivity disorder Specific learning disorder Motor disorders

• Developmental coordination disorder
• Sterotypic movement disorder
• Tic disorders

Comorbidities

• ADHD
• ASD
• arithmetic disorder
• behavioural problems
• anxiety, mood

Aims of assessment

Two hats

clinical administrative

5

70 100 85 115 130

reading abilities

reading disorder

5%ile 70 100 85 115 130

reading abilities

reading disorder

70 85 115 130 5%ile 85 70 115 130

intelligence reading abilities

low intellectual abilities intellectual disability

10%ile

reading disorder

70 85 115 130 10%ile 85 70 115 130

grammar phonology

language disorder (poor comprehender)

10%ile

specific phonological deficit (probable reading disorder) language disorder

Interventions

6

“Scientific evidence does not support the claims that visual training, muscle exercises,

• cular pursuit-and-tracking exercises,

behavioral / perceptual vision therapy, “training” glasses, prisms, and colored lenses and filters are effective direct or indirect treatments for learning disabilities. There is no valid evidence that children who participate in vision therapy are more responsive to educational instruction than children who do not participate.”

A Joint Statement of the American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, and American Academy of Ophthalmology (2012) “Multisensory learning involves the use of visual, auditory, and kinesthetic-tactile pathways simultaneously to enhance memory and learning of written language. Links are consistently made between the visual (language we see), auditory (language we hear), and kinesthetic-tactile (language symbols we feel) pathways in learning to read and spell.”

IMLE (accessed May 2015)

Samuel Orton “The [Australian Dyslexia Association] supports and provides accredited training in evidence based instruction with the addition of a multisensory component. Direct, explicit and structured instruction with a multisensory component can assist all students including those with dyslexia and related difficulties.”

dyslexiaassociation.org.au (retrieved 7 August 2015)

7

At last the Dodo said, “everybody has won, and all must have prizes”.

Carroll (1865)

“Dyslexia”?

“The era of applying the label “dyslexic” is rapidly drawing to a close. The label has served its function in drawing attention to children who have great difficulty in mastering the arts of reading, writing and spelling but its continued use invokes emotions which often prevent rational discussion and scientific investigation”

Yule (1976)

“The term “dyslexia” is so rooted in everyday discourse that, for some, the articulation of theoretical and ethical concerns about its use can do little to reduce its hold”

Elliott & Grigorenko (2014), p.182

Directions

ruthless commitment to empirically-supported theories and procedures articulation of best practice guidelines for practitioners education, training and professional development thorough response to pseudoscientific methods