Dyslexia: the ethics of assessment.
The current situation in Northern Ireland, with regard to the assessment and intervention of children with dyslexia, poses important ethical dilemmas for many primary school teachers. Assessment is based largely on a discrepancy model, which this paper argues can result in many children with dyslexia failing to have their difficulties recognised and remediated. The paper calls for greater clarity regarding the means of assessment and allocation of resources for this group of children.
The United Nations considers an entitlement to literacy to be one of our basic human rights. Moreover, there is broad agreement amongst most parents that the world in which we now live is, more than ever, dependent upon communication through the written word (British Psychological Society 2003). Children who experience difficulties with reading and writing are seriously disadvantaged and may miss out on important life chances. One such group that can be identified are those children who have dyslexia. This is not an insignificant group. Riddick (1996), for example, has suggested that around four percent of the population are severely dyslexic, with a further six percent having mild or moderate dyslexia. The extent of this problem, therefore, has major implications for primary school teachers, especially in terms of their responsibility for the early identification and assessment of this condition since it is only through proper identification and assessment that many children with dyslexia will receive appropriate remedial provision (Ott, 1997).
The Northern Ireland Context
In Northern Ireland, additional and external specialist support for children assessed as having dyslexia is generally allocated using a discrepancy model. In practice, this generally happens as follows. On receipt of a referral from the child's school, an educational psychologist assesses the child and arrives at an Intelligence Quotient or IQ score derived most commonly from the Wechsler Intelligence Scale for Children (WISC III). Measures of literacy using a word recognition sub-test, a reading comprehension sub-test and a spelling sub-test taken from the Wechsler Objective Reading Dimensions (WORD) are also taken. These latter sub-tests are considered by many psychologists to fit well with those measures derived from the WISC III and are published by the same company. The difference between the WISC III and composite WORD scores yields a discrepancy, which forms the basis for important decisions being made about the child's future level and type of literacy support. In some instances, the discrepancy between the Verbal Scale IQ score (calculated from a number of the more verbally loaded WISC III sub-tests) and the WORD scores are taken.
To receive additional support from literacy specialists employed by the Education and Library Boards (ELB's) of which there are five in Northern. Ireland, the child is generally required to achieve an IQ score within the average range, being around 85 to 90 points (these ranges vary from one ELB to another). In addition, the criteria for support states that the child ought to demonstrate a discrepancy between their standardised WISC-IQ Full-scale score (in some circumstances their Verbal Scale IQ score) and a standardised composite score gained from all three literacy sub-tests of the WORD. The larger the discrepancy, the greater the chance of the child receiving additional support from literacy specialists employed by the ELB. A small discrepancy will place the child towards the lower end of the list and will almost certainly mean that the child will not receive additional specialist support from the ELB even though the child may experience major problems of a perceptual nature or with phonological processing, both of which are commonly found in children with dyslexia. Alternatively, a child may record a low IQ score and have been well taught in the area of literacy thus yielding a small discrepancy, or the child may record a high reading comprehension score, which can mask processing difficulties and raise the mean average composite score on the WORD sub-tests again reducing the discrepancy. Similarly, if the child is dyslexic and achieves an IQ score below 85 or 90 (average range 85 to 115) then he or she may well not receive additional support, as they do not meet the essential criteria. Each of the five ELB's have, in the past, stated different IQ cut-off-points. An example serves to illustrate this last case.
Angela was nine when she was referred to the educational psychologist because of persistent problems with reading and spelling. Assessment found Angela to have a high average Intelligent Quotient. However, Angela performed very poorly on three of the eleven WISC III sub-tests offering evidence of difficulties with processing and short-term memory. Whilst Angela's reading comprehension score fell within the upper half of the average range, her word recognition and spelling scores fell below the average range. When computed, the discrepancy between Angela's Full-scale IQ score and her standardised literacy score, derived from the reading comprehension, word recognition and spelling sub-tests of the WORD was not large enough for her to receive additional support from the literacy specialists employed by the ELB. Angela had scored better on the reading comprehension sub-test but very poorly on the word recognition and spelling sub-tests. What was apparent, however, was that Angela had severe problems in the areas of phonological processing, organisation and automatization. Though these problems were identified by the educational psychologist and brought to the attention of her teachers, Angela was not eligible for additional external support. When assessed two years later by the educational psychologist Angela's IQ score was calculated to fall at around the same level as previously. However, her spelling and word recognition sub-test standardised scores had barely improved. The result was that she now demonstrated a very large discrepancy and was eligible for additional external support. Sadly, Angela was due to transfer to secondary school where additional external support with literacy is generally not provided.
Dilemmas facing teachers
In addition to employing the discrepancy model, many teachers throughout Northern Ireland admit to feeling ill-equipped when it comes to recognising the signs of dyslexia. Furthermore, results taken from a survey carried out by one of the authors on a random sample of experienced teachers (n = 60) indicated that few teachers, less than five percent of the sample, felt they had the ability to accurately identify and assess dyslexia. Furthermore, only two percent of this sample could offer accurate definitions of the term dyslexia, despite over ninety percent of the sample strongly indicating that they wanted more training and greater expertise in this area. The result is that many children with dyslexia can slip through the net as they fail to have their condition properly recognised and remediated. An essential precursor to assessment, therefore, is identification. This is crucial, and, apart from remedying literacy problems, identification can prevent many secondary difficulties such as low self-esteem and behaviour problems thus breaking the cycle of failure that many children suffer (Ott, 1997). The primary aim in assessing children with literacy problems who are suspected of being dyslexic ought to be full clarification of the child's strengths, as well as the weaknesses (Miles and Miles, 1999). If a discrepancy model is employed then, in some situations, children who do not demonstrate a large enough discrepancy may fail to be diagnosed and may not receive additional remediation and support from professionals outside of the school who have particular expertise. Diagnosis, however, must not rely solely upon an assessment by an educational psychologist but ought to be made through observation and the careful collecting of appropriate information by teachers working in partnership with parents. This poses important questions for teacher trainers in initial teacher training and for school principals planning their staff's continuing professional development.
Teachers are increasingly faced with new and proposed legislation in the field of disability. Current legislation (Education--Northern Ireland--Order, 1996) in the field of special educational needs in the United Kingdom has its basis in the Warnock Report (1978). This report was instrumental in changing practice and led to the Education Act 1981 in England and Wales and the Northern Ireland Education Order 1986. This legislation placed responsibility with the Local Education Authorities in England and Wales, or, in the case of Northern Ireland, the Education and Library Boards, to undertake assessment of children who have special educational needs (Pumfrey and Reason, 1991). Subsequent to the Education Order in 1986 came a formal review of education in 1991, followed by a new Education Order in 1993. These set the scene for the introduction of the Code of Practice on the Identification and Assessment of Special Educational Needs (1994).
The Code of Practice had some major implications for the whole area of dyslexia. One particular problem has emerged from the Code's classification of dyslexia as one of a subset of specific learning difficulties, which include, for example: dyspraxia and attention deficit disorder. This has meant that many practitioners have come to use the terms "specific learning difficulty" and "dyslexia" interchangeably. The result has been increased confusion amongst parents, as well as teachers and related professional groups such as School Social Workers, Speech and Language Therapists and Medical Practitioners. A further problem has been that some practitioners such as educational psychologists involved in conducting assessments of children have, on occasions, been reluctant to use the term dyslexia, preferring instead to use the term specific learning difficulty. These terms have resulted in much confusion amongst many practitioners due mainly to the large number of definitions (Pumfrey and Reason, 1991). Use of the former term can lead to problems relating to provision. A child diagnosed as being dyslexic is likely to have a stronger case for receiving additional resources than a child assessed as having specific learning difficulties. The former suggests that the child has a condition. The latter implies that the child's difficulties are specific to the acquisition of reading or writing.
An additional problem is that the Code of Practice appears to embrace a particular model for the assessment of dyslexia. The Code differentiates between children who have dyslexia and children who are poor readers through its apparent acceptance of a discrepancy model for explaining dyslexia. This model differs from others such as the phonological deficit hypothesis (British Psychological Society, 1999, p. 30) in that it includes the measurement of intelligence as a core aspect. Such a model can, however, be considered against the World Federation of Neurology definition of dyslexia (1968), which differs from the definition of dyslexia offered by the British Psychological Society (1999). The former group have defined dyslexia as, "a disorder in children who, despite conventional classroom experience, fail to attain the language skills of reading, writing and spelling commensurate with their intellectual abilities". The British Psychological Society, however, stated that, "Dyslexia is evident when accurate and fluent word reading and/or spelling develops very incompletely or with great difficulty" (p. 18). This view, now accepted by many practitioners as a working definition, focuses on literacy learning at the word level and suggests that the problem is severe and persistent, despite appropriate learning opportunities. Its main contribution to the field of dyslexia, we would argue, is that it provides the basis for a staged process of identification and assessment through teaching. Yet, because the discrepancy model is stated in the Code of Practice, many educational psychologists in Northern Ireland employ it even though they may not agree with it. The main rationale for employing the model is fairness and transparency. It is felt to be a fair means of determining the allocation of resources. Whilst the Code of Practice is not mandatory, it does however, place a legal obligation upon Education and Library Boards to "have regard" to meeting the needs of pupils in their schools.
Fawcett (2003) highlights a particular limitation of the discrepancy model, which has implications for teachers in Northern Ireland. Determining a child's IQ score is a major part of the educational psychologist's assessment of any child referred by schools for literacy difficulties and the Wechsler Intelligence Scale for Children is the most commonly used test. The problem for many children with dyslexia is that they can perform poorly on some of the sub tests, giving a lower Full-scale score than might be expected, given their possible high ability. In addition, when WISC III Full-scale scores are provided in without explanation then valuable diagnostic information contained within the sub-scores can be lost. Miles and Miles (1999) affirm what is a crucial point. It is not enough to establish if there is a discrepancy between a child's intellectual ability and literacy scores, but what the child needs that is the key factor. Individual needs are not derived from diagnosis following static psychometric assessment but should also include careful observation and assessment by the teacher, in conjunction with the parent.
Prior to the introduction of the Code of Practice, many children with dyslexia were not given provision appropriate to their needs. This was because they were frequently not perceived as forming part of the continuum of children with special educational needs. Schools in Northern Ireland must now have regard to meeting the educational needs of all their children, either through their own resources or with the involvement of outside agencies. Such a requirement, however, has placed clear obligations upon staff to be active in identifying, assessing and recording their interventions. Ott (1996) has argued that the Code assists schools in this process and in making those important decisions, which are necessary in helping them work to ensure that a child makes progress, appropriate to their cognitive abilities. Whilst the Code offers guidance to schools, it was never meant to offer specific information on what is appropriate provision for individual children. Whilst it can be argued that it might be unrealistic to give specific guidance on appropriate provision for dyslexic children, it nonetheless raises two important points, namely the promotion of greater consistency in approach to provision and greater accountability.
The current situation poses an important ethical dilemma for many teachers in Northern Ireland. Should teachers continue to rely upon assessment by an educational psychologist to determine if a child is dyslexic or should they, themselves, develop skills in recognising and assessing the condition, and in providing appropriate support? The Code of Practice has brought about procedures for engaging in and recording appropriate intervention and provision for children. Failure to do so has resulted in cases of negligence being brought against Local Education Authorities in other parts of the United Kingdom. Such cases have confirmed the need for careful observation and record keeping. Recent disability legislation in England and Wales has attempted to improve procedures for the assessment of children's special educational needs. This legislation is not, as yet, in place in Northern Ireland, but is expected to reach the statute books in the next year or two.
Beveridge, S. (1999). Special Educational Needs in Schools. London: Routledge.
The British Psychological Society (2003) Dyslexia, Literacy and Psychological Assessment, Leicester, The British Psychological Society.
Department of Education for Northern Ireland (1998). The Code of Practice on the Identification and Assessment of Special Educational Needs. Bangor, DENI.
Department of Education for Northern Ireland (2002) The Education of Children and Young People with Specific Learning Difficulties: Report on the Task Group on Dyslexia, Bangor, DENI.
Department of Education and Employment (1997) Excellence for all children--Meeting Special Educational Needs, London, HMSO.
Education and Training Inspectorate (2002) A Survey of the Provision for Pupils with Special Educational Needs in Mainstream Schools, Bangor, DENI.
Fawcett, A. (2003). Definitions of Dyslexia, in Johnston, M. and Peer, L. (Eds.)The Dyslexia Handbook 2000. Reading: British Dyslexia Association.
Independent Panel for Special Education Advice (2003) Education negligence cases. http://www.ipsea.org.uk/phelps.htm (Accessed 27th November, 2003).
Miles, T. R. and Miles, E. (1999) Dyslexia 100 Years On, Open University Press.
Ott, P. (1997) How to Detect and Manage Dyslexia, Oxford: Heinemann.
Pumfrey, P. D., and Reason, R. (1991) Specific Learning Difficulties (Dyslexia) Challenges and Responses, NFER-Nelson.
Riddick, B. (1996) Living with Dyslexia, London, Routledge.
Sean MacBlain, Stranmillis University College, Belfast
Kate Hassard, Stranmillis University College, Belfast
Fiona MacBlain, College of Saint Mark and Saint John, Plymouth, England
Sean MacBlain Ph.D., is senior lecturer in education. Kate Hassard is a postgraduate student. Fiona MacBlain is studying public relations at the College of Saint Mark and Saint John, Plymouth, England.
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|Publication:||Academic Exchange Quarterly|
|Date:||Mar 22, 2005|
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