The objective of this assignment is to explain the identification process of dyslexia by looking at the legal framework and the diagnostic tools used. It will also look at how to identify students with dyslexia and how to meet an individual learners needs by creating a dyslexia friendly learning environment. Current research will be critically analysed and reflected upon particularly to explain the causation theories. Theory will be related to practice by focusing on a student with dyslexia.
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The student will be referred to as Student X in order to maintain anonymity and his place of study will be referred to only as the School of Pharmacy. Student X is a mature student and was referred in 2009 for an assessment for SpLDD whilst at the School of Pharmacy following concerns regarding his work. He has not received any support prior to studying at the university to address the difficulties he experienced in school. Student X has succeeded in gaining nationally recognised qualifications at GCSE and A Level, and has gained a HNC and BSc in Chemistry, but unfortunately has to re-sit his Level 2 dispensing assessment from the previous academic year.
There are many definitions of dyslexia and the definitions have changed over the last 100 years because of advances in research. Early definitions talked of a ‘word blindness’ or inability to acquire literacy skills. In a text by Horby dyslexia was referred to as a disability that can be overcome. Her programme of training resulted in people making miraculous recoveries as if they were suffering from a medical condition giving the impression of an illness. However, in research the terminology has changed to talking about learning difficulties rather than disabilities. Stein (date) talks about how a dyslexic’s brain is wired up differently to non-dyslexics, not wrongly, but just differently. Most definitions focus on the unusual balance of skills in reading, writing, and spelling compared to generally ability. Phonological processing may be a problem as can information processing and many definitions state that dyslexia is a problem that persists across a lifetime although strategies can be developed with correct teaching that will enable the learner to achieve. My favourite definition of dyslexia is ‘Dyslexia should be seen as a different learning ability rather than a ‘disability’ (Pollock and Walker 1994 day to day dyslexia in the classroom find ref). This removes the idea that the learner is not academically able, but that they learn in a different way. In education, learning theories describe the various ways in which people learn and dyslexics may need to use a different learning approach to the non-dyslexic but can still reach the same end goal.
Before looking at the causal models of dyslexia, I will discuss how dyslexia can be identified and diagnosed. A simple checklist can be used to look for dyslexic tendencies but these are not designed to give a diagnosis. There are a variety of screening tests available that can be used in an initial assessment to look for dyslexic tendencies and can be used by non-specialised, however the results may be misinterpreted and only give a probability of the person being dyslexic. Diagnostic tools can be used to diagnose the specific areas of difficulty or to identify specific support strategies. Specialist or physiological assessments take a long time and can be costly but show the specific strengths and weaknesses of the person. Diagnostic tests are designed to be used for different age ranges from 3 year and 6 months for the PREST test and up to 74 years of age with the WRAT-3 test (Wilkinson 2002).
In order to be effective, the tests need to take into account cultural or even regional differences. Tests over ten years old may no longer be relevant, for example, technology has changed rapidly and young children would struggle to name a picture of an original Sony Walkman cassette player compared to an MP3 player. Tests should be conducted each time in the same conditions as the tests are normed in order to provide reliable and valid results each time the test is taken. Factors that can affect the results include the level of noise, warmth and brightness in the room. The person being assessed should be comfortable and relaxed so that low self-confidence or anxiousness does not affect the tests. Although the literature is dated, McLoughlin, Fitzgibbon and Young (1994) state that formal diagnosis of dyslexia involves psychological testing using careful observation and clinical judgement. Professional judgement has to be used with regard to the personality and current situation of the person being assessed, meaning that the assessor may have to quickly establish if the person had arrived at the assessment centre without any stress or recent problems in their personal life which could affect their ability to concentrate during the assessment process.
The assessor that carried out student X’s assessment commented on the conditions in which the test took place in order to validate the results of the test against the norm. The assessment report takes into account Student X’s background and personality. His family history was taken into consideration to see if other members of the family may be dyslexic and therefore establish if there is a genetic predisposition and his medical background was investigated to see if there could be any other reasons for his difficulties. There were no health/medical circumstances or family circumstances identified.
Which tests can be used depends on the qualification of the person conducting the assessment. For example the WAIS-III (Wechsler Adult Intelligence Scale) is restricted to use by educational psychologists whereas the WRIT (Wide Range Intelligence Test) can be used by non-psychologists yet are both designed to establish the intelligence levels of the person being assessed. A wide range of tests are needed in order to obtain a detailed picture of the areas of difficulty and to eliminate the possibility of other types of learning difficulties such as dyspraxia or dyscalculia. A generally low achiever would not perform well in most areas and a high achiever would perform well in all areas, but a dyslexic would have a discrepancy or a ‘spikey’ learning profile with a high ability in certain areas but some specific areas of weakness depending on the nature of their difficulty.
Current research by the British Psychological Society (2009) raises concerns about the comparison of the WRIT and WAIS-III, specifically that the validity of using the WRIT as part of a diagnostic battery appears to have discrepancies between the comparable scores which could have diagnostic implications, in that it can mask a working memory deficit. However, in my opinion, if other tests are used in conjunction with WRIT, then validity of the results should be achieved. Using one test alone, even though broken down into several subtests, could produce a false result especially if adult learners have developed their own strategies for overcoming their difficulties. For instance, when given an opportunity to write freely, a person can select topics and words that they are confident at getting right even though they understand or could verbally express a much higher level of knowledge and understanding.
Student X was assessed by a qualified specialist teacher with an OCR Diploma for Teachers of learners with Specific Learning Difficulties (AMBDA). The tests used were the Wide Range Achievement Test (WRAT), Spadafore Diagnostic Reading Test, Wide Range Intelligence Test (WRIT), Dyslexia Institute digit memory test, Specialist Matters test, Wordchains test and the Comprehensive Test of Phonological Processing (CTOPP). These tests are used to diagnose specific areas of difficulty. For example, the Spadafore Diagnostic Reading test assesses word recognition, oral reading comprehension, silent reading comprehension and listening comprehension, whereas the Dyslexia Institute Digit Memory test assesses verbal memory difficulties by asking the person to repeat pairs of digits forwards and backwards until the person reaches a point where they cannot recite the pairs. Being able to repeat a string of numbers after being told them would involve recalling information and this is different from the listening comprehension as this would require a demonstration of understanding the content of what has been heard.
The assessment results for Student X showed a ‘spikey’ profile (find ref) with areas of strength in verbal and non-verbal ability, understanding information presented orally, single words reading/spelling skills, good decoding skills, and being able to articulate ideas well. The weaknesses identified by the tests were auditory/visual sequencing memory which affects the ability to make sense of and recall information, and the ability to process at speed or multitask when processing blocks of information or units of sound within a word. So, although student X does not seem to have difficulties with reading and decoding single words, reading and extrapolating information slows down his reading/writing speed.
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The dispensing assessment involves reading and interpreting text from key reference books in order to verify whether prescriptions are clinically appropriate and safe for patients. Students are given three hours to complete five prescriptions and they are expected to complete a worksheet as well as interact with the prescriber of the prescription in order to rectify any errors. Not all students manage to finish the exam in the time given, and if a student has a specific learning difficulty with processing speeds, such as Student X, then the task may take a longer than somebody without difficulties. Other dyslexics with different areas of difficulty such as letter reversals or omitting the end of words or whole words, may not need the extra time to process information, but could make use of the extra time to check for accuracy which is also vital in dispensing.
A variety of definitions for dyslexia have already been discussed and they are not specific enough for a diagnosis to be made and some only describe the symptoms of dyslexia (Roderick and Fawcett 2008). There is no one agreed upon definition due to there being various theories about the causes of dyslexia. Frith (1999) has created a causal model which focuses on the biological, cognitive and behavioural links between the main theories including the phonological deficit theory, magnocellular deficit theory and the cerebellar deficit theory. There are other theories such as Wolf and Bowers double-deficit hypothesis (1999) which suggests a deficit in phonological processing and a processing speed deficit. Dyslexics with the double-deficit have the most severe problems as they show a slowed response to tasks even when language is not involved e.g. pressing buttons to choose a response (Fawcett 2001).
In a review for the Department for Education and Skills, Fawcett outlined the main theories of dyslexia. This review was carried out in 2001 and therefore some of the content maybe out-dated. Using the review, the main theories have been outlined below.
The phonological deficit theory is the most accepted theory for the cause of dyslexia and there is evidence of a difference in the anatomical structure and function in the peri- and extra-sylvian fissure and planum temporale area of the brain which is involved with language. In Friths causal model, this biological factor has a cognitive effect on phoneme/grapheme knowledge which results in poor reading skills because of a poor phoneme awareness and poor short-term memory resulting in a poor naming speed. The phonological theory however, does not account for the visual problems that some dyslexics have such as scotopic sensitivity, known as Meares-Irlen Syndrome, where text seems to move or swim on the page making it difficult to follow from word to word, or line to line (ref), or the difficulties in organisation or knowing left from right. This could imply that a person is not regarded as dyslexic as they do not have problems with phonology. On the other hand, some people without phonological difficulties (non-dyslexics) do not learn to read and write because of environmental factors such as culture or teaching methods.
It was thought that visual magnocellular deficit causes a ‘visual persistence’ when the eye moves meaning that there is still an image from the previous letter when moving onto the next one. This causes words to blur and drift therefore making reading difficult and cause problems with rapid processing (Stein and Walsh 1997). However in later research, Stein claims that the magnocellular system is not responsible for visual persistence. Tallal, Merzencih, Miller and Jenkins (1998) report that magnocellular deficits impact upon the auditory pathways and that this causes problems with telling the difference between sounds that are presented closely together and this would account for phonological difficulties associated with the magnocellular deficit.
The cerebellar deficit theory focuses on the fact that dyslexic children have problems with a wide range of skills including motor skills, balance and rapid processing. The theory also acknowledges the phonological difficulties but suggests that the phonological theory does not explain the reason for the non-language based problems. The pattern of difficulties fits in with another theory of ‘automatisation deficit’ where there is a problem with acquiring skills that should come automatically after extensive practice. This theory was disputed as there were no known links between the cerebellum and language but this is now being contested with the advance of science and it is known that the cerebellum is linked with the frontal cortex including Broca’s language area.
Lee’s 4th theory – emotional.
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