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Friday, September 01, 2006

Causes and Effects

The OCR syllabus states that you need to know the causes and effects of one specific learning disability.

The example used here is that of Autism. The material is by Elizabeth Green as published in 'Psychology Review' (Vol 12, No2, November 2003)

The aim of research into autism is to progress towards a time when we can say "This is how it starts, this is what the biological implications are, and this is why autism is what it is'. At the moment we know a lot about different aspects of autism - the genetics, the biological abnormalities, the cognitive basis and the behaviour - but it is not possible to piece these together to form a coherent story of what causes the disorder. Years ago, people believed that autism might be caused by a lack of attention from parents or feelings of rejection in the early years of a child's life; this is not the case. Autism is now known to have a strong biological basis and the evidence suggests that there is often a genetic abnormality that makes a child more likely to develop autism. The best explanation of autism is that there are many factors which contribute to the disorder. New evidence also suggests that there may be a particular stage in development during which the major damage occurs.

Possible biological factors involved in causing autism -

Many anomalies in different areas of the brain have been implicated in autism and it seems clear that there is not one single abnormality that 'causes' autism.

General abnormalities: Many researchers have reported an overall enlargement of the brain (megalocephaly) in autistic people (e.g. Lainhart et al. 1997). They have found this by measuring the circumference of people's heads, by weighing the brain during autopsy and by ai using scanning techniques such as MRI and PET . Normally, the right side of the brain is bigger than the left side and it is thought -that the, enlargement seen in autopsies of autistic people is mainly of the left side, meaning that the brain is more of symmetrical than normal.

Abnormalities of the cortex: The most replicated cortical abnormalities are of the temporal and parietal lobes. Temporal lobe reduced blood flow has been reported, which indicates a decrease in normal activity. The temporal lobes have varied and complex roles, including a role in language and personality. This means that the effects of damage are also very variable. It is interesting to note that in some patients who have temporal lobe tumours, we see symptoms of autism, and further, there is the the reported case of a boy with a temporal lobe tumour whose symptoms decreased as the tumour regressed with treatment.

Abnormalities in the Limbic system: Probably the most solid findings of a biological basis of the disorder come from research into an area of the brain called the limbic system. The limbic system is located within and next to the temporal lobe and comprises several different structures that are important in emotion, learning and memory. Two important structures are the hippocampus and the amygdala, and abnormalities in both these structures have been found in the brains of people with autism. It is also known that humans with damage to the amygdala often show emotional problems that are similar to those seen in autism.

Similarly, solid findings of abnormality have been found in the cerebellum and brainstem of autistic patients. For example, some researchers have reported a decrease in the number of cells in the cerebellum and fewer connections with the limbic system. Other research has indicated an overall decrease in the size of both the cerebellum and brainstem.

Biochemical abnormalities: Messages are sent through the brain by neurotransmitters and therefore the balance of these chemicals in the brain is very important. Neurotransmitter dysfunction underlies many psychological disorders, such as depression and schizophrenia, and therefore it is important to look at the biochemistry of the autistic brain when searching for a cause. Most of the research has focused on the chemicals called serotonin and dopamine. Some studies have reported that there are high levels of serotonin. in .the brains of people with autism. however, high serotonin is found in several other disorders and may, perhaps, be a by-product of mental retardation rather than a causal factor. Other researchers have implicated dopamine abnormalities as a possible cause of the symptoms of autism, but there h is less evidence for this at the moment.

Genetic factors: The first piece of evidence for this is that, although it is extremely rare for autistic children to have a brother or sister who is also autistic, the rate of autism in siblings is much higher than in the general population. That is, the chance of your having autism is somewhere between 20 and 100 times higher than normal if you already have a sibling with autism. To look more at this familial link researchers use twin studies - a very important tool when examining the genetic influence on a disorder. Twin studies look at 'concordance rates', which means the percentage of twins where both twins have the disorder. To assess how much of the sibling effect is genetic and how much is because the twins develop and grow up in because the twins develop and grow up in the same environment, we compare the concordance rate of monozygotic (MZ) with dizygotic (DZ) twins. It is estimated that the percentage of both MZ twins having autism is between 60% and 90%, compared with less than 5% for DZ twins. This is very strong evidence for the role of genetics in the underlying cause of autism. However, it does not mean that autism is a completely genetic disorder. If autism were entrirely caused by genes, then MZ twins would have 100% concordance.

Conclusons: There is a range of evidence that there may be a specific period during foetal development when the biological abnormalities associated with autism originate. This period could be described as a 'window of vulnerability', because it may be that the brain is particularly vulnerable to damage during this time slot. Some brain abnormalities give us clues as to when they occur. For example, abnormal patterns of certain cerebellar neurones, when compared with normal patterns, indicate that damage must have occurred at or before the thirty-second week of pregnancy. Courchesne (1997) points out that many parts of the brain we know are abnormal in autism develop during the fifth week of gestation — maybe this is the window of vulnerability? Of course, there are abnormalities present in autism that could not have been caused during this window but it is very possible that these are either knock-on effects from the earlier damage, or they are caused by a different factor; we know that autism is not caused by one single factor.

The window of vulnerability hypothesis is probably one of the best theories we have to explain how autism occurs, as it pulls together the roles of biology, genetics and adverse events. It may be that an infection or trauma during this window could cause the damage, or it could be that a defective, gene acts at this point in foetal development. Thereafter, the damage that occurred during the window of vulnerability will have other .knock-on,effects and give rise to the multitude of abnormalities seen in the autistic brain.

Definitions, Types and Assessment

Definitions of Special Educational Need

The 1981 Education Act introduced the concept of identifying children with special educational needs. According to the Act a child has special educational needs if he or she has a learning difficulty, which calls for special educational provision to be made for him/her. A child has a learning difficulty if: S/he has a, significantly greater difficulty in learning than the majority of the children of her/his age; or S/he has a disability, which either prevents or hinders her/ him from making use of the educational facilities of a kind generally provided in schools within the area of the local authority concerned for children of his age. (Cited in Daniels et al, 1999)

Students with learning difficulties are generally categorised as follows -

Moderate Learning Difficulty (MLD); students who can be taught in mainstream education with some learning support.

Severe Learning Difficulty (SLD); students who require a much higher degree of specialist support - usually within special units or schools.

Profound and Multiple Learning Difficulty (PMLD); students with very serious intellectual difficulties, combined with sensory and other physical impairments.

However we are also concerned with providing special educational provision for those who are extremely able. This is known as 'giftedness'. There have been many definitions of gifted. For example, Robinson (1981) distinguishes between the 'garden variety gifted', children with high IQs in the range of 130-150 but without any extraordinary ability in any one given area, and 'highly gifted' children, children with high IQs and extraordinary abilities in one or more areas. The National Association for Gifted Children (2000) offers the following definitions:

'Openly able: enjoying their talent and excelling in all they do.'

'Concealed able: under-achievers who fade into and hide in their peer group'

'Rebellious able: disruptive under-achievers with a range of behavioural problems.'

''Creative able: "odd-balls" often with unusual divergent thought patterns, which can make them intense and abrasive.'

'Talented able: intellectually able but with a particular talent in one area.'

The National Association for Gifted Children (2000) finds this framework useful in that it points out the difficulty in diagnosis. They argue that a teacher would easily be able to pick up the openly able and talented able, but miss the concealed able and creative able, and label the rebellious able as just disruptive.

In conclusion, we can see that special educational needs refers to anyone who can not be easily catered for within 'mainstream' education, thus they require 'special' provision.

Assessment of SEN

The Code of Practice (1994) for SEN expands on the issue of special educational need and offers guidance to schools in regard to identifying, assessing. providing for and monitoring such students. The Code recommends 'general adoption of a staged model of special educational needs' known as key routes or stages.

STAGE 1: SCHOOL-BASED IDENTIFICATION, ASSESSMENT AND ACTION

The process begins when a parent, teacher or other professional expresses a concern in regard to an individual's progress. The concern could be of an academic, social,.or emotional nature. In terms of progress, concern would be expressed if the child were not attaining the age-appropriate levels as outlined within the key stages of the National Curriculum. At this stage all relevant parties including the headteacher and parents are informed. The issue of concern is investigated and the child's name is placed on the Special Needs Register. From the teacher's perspective this means that they need to keep a special watch on that individual's progress. A child may stay on stage 1 for a few months then come off, or a child may proceed to stage 2.

STAGE 2: ADVICE FROM SUPPORT SERVICES

Once a child's name is placed on the Special Needs register the school's special educational needs co-ordinator (SENCO) will take responsibility for making provision for that child alongside the child's teacher. A key element in this provision is the production, implementation and review of individual educational plans (IEPs). Advice may be sought from other professionals.

STAGE 3;.DIRECT INVOLVEMENT FROM SUPPORT AGENCIES

If there is continuing concern regarding whether current provision is he; child's needs, at this stage the teachers and SENCO will call for additional support advice and involvement from other professionals including an educational psychologist.

STAGE 4: STATUTORY (FORMAL) ASSESSMENT

The local education authority, LEA, on advice from the educational psychologist, will decide if a statutory assessment of the child is needed. The parents will be informed of this decision. The LEA will need to gather information about the child's special needs from the following sources: parents, school reports, educational psychologists' and medical reports. Once the relevant information is collected the LEA will then make a decision with regard to whether they will proceed to making a statement of special educational needs.

STAGE 5: STATEMENT OF SPECIAL EDUCATIONAL NEEDS

The parents can normally expect a decision on whether the LEA will proceed to making a statement within twelve weeks from commencement of assessment A statement is legal document issued by the LEA in circumstances where it has been found upon investigation that an individual has special educational needs which cannot reasonably be provided for within the normal resources available to a particular school. Resources aredefinedto;.in,clu

There are various assessment tools that may be used through this process -

  • Observation (e.g. of classroom behaviour).
  • Interviews (e.g. with teachers, the student concerned and parents).
  • Physical and Psychiatric Diagnosis (e.g. where a physical or mental illness is suspected).
  • Attainment Tests (e.g. the analysis of reading, speaking, writing, comprehension and numeracy achievement).
  • Ability Tests (e.g. intelligence tests).

The National Association for Gifted Children (2000) state that the following sources are used for the identification of gifted children -

  • Teacher observations (checklists)
  • Parental observations
  • Peer-group nomination
  • Evidence from pupil's work
  • Pupil's own interests
  • Tests (cognitive ability tests)
  • National Curriculum tests
  • Evidence from out-of-school activities

Types of SEN

There are many different categories of special needs, e.g.:

Physical difficulties - including physical and sensory impairments such as loss of limb and motor control visual /hearing impairments.

Social, emotional and behavioural difficulties - due, for example, to ADHD, autism, depression or schizophrenia.

Cognitive Difficulties - including general intellectual disability and specific learning difficulties,e.g. dyslexia.

Gifted and talented - e.g. those of general exceptional ability, aptitude and achievement, or those with a specific area of expertise, i.e. musical, artisitc, creative or athletic ability.

Strategies for Educating

Specific example for Autism: Andrew Bondy and Lori Frost developed the Picture Exchange Communication System (PECS) in the early 1990s when they were working with the Delaware"Autistic Program. Although originally the programme was used to foster communication with young autistic children, it is now used with older children and adults who have a range of communication difficulties. The aim of PECS is to give a means of communication to individuals who previously have had none. The system revolves aroundthe concept of exchanging pictures for desired objects. To begin with, the teacher needs to establish what the child finds rewarding. Several objects (crisps, a carton of juice, and various toys) are placed on a table and the child is observed in order to determine what his or her preferences are. Once preferences are established, pictures of preferred objects are made into cards. The next stage of the programme involves the child being shown the picture of the preferred object and the preferred object itself. To receive the preferred object the child must give the picture card to the trainer. Once the child has done this, they receive the preferred object. To begin with, the child might need some physical guidance and prompting. This is the first exchange. From these small beginnings other picture cards are introduced. Eventually children are encouraged to use picture cards in combination to form sentences. Children using this system will carry arouiid personalisie4 books of picture cards, which include a Velcro strip to which they add picture cards (backed with Velcro) to form sentences.

Bondy and Frost (1994) summarising work with eighty-five autistic pre-school children over five years found that:

Almost all children learned to use one picture to communicate a request within one month of starting the programme. 95 per cent of children learned to use two or more pictures. 76 per cent of the children developed some speech through the training programme.

In summary, the programme not only offered a practical form.pf , communication to those who had none but, for many, speech developed with the use of this programme.

Examples for other types of SEN

Acceleration

Stanley's (1976) radical acceleration model, initially developed primarily for students girted in mathematics, is an example of acceleration. Radical acceleration attempts to compress the ordinary curriculum to enable gifted individuals to complete a course of studies in only a fraction of the time ordinarily required. Many of these accelerated students are enrolled in university-sponsored courses for additional acceleration. For example, and Smyth (1995) describe a radical acceleration program at the University of Washington 14-year-olds are allowed to enroll in university courses. Robinson (1992) describes a similar program in China, and Gross (1992) outlines another in Australia. Their reports indicate that students often express boredom and frustration before acceleration, and higher levels of self-esteem, achievement, and better social relationships after acceleration.

Enrichment:

The enrichment approach is well illustrated by Renzulli's (1977) enrichment model, also called the revolving door model (Renzulli, Reis, and Smith 1981) this model advocates selecting, gifted individuals on the basis of three characteristics: high academic ability, high creative potential, and high motivation. No rigorous cutoff scores are used; instead, all students who's achievement or apparent potential places in the upper 25% of students in the school are designated as talented. Any of these students may then enter enrichment programs and drop out of them as they wish (hence, the revolving door). The programs vary according to the expressed interests of the students. When students identify a project and commit themselves are allowed to enter a resource room and work on the project. Under this model, enrichment programs tend to be schoolwide rather than restricted to specific classes or students (Renzulli & Reis, 1994).

Inclusion or Exclusion

There is an ongoing debate within educational communities as to whether including children with SEN within mainstream education is desirable or not. Currently there seems to be more support for inclusion rather than exclusion (special provision outside of mainstream education). To enable inclusion to occur effectively some factors need to be taken into account -

1. Providing special education teachers for the regular classroom on the basis offering, "collaborative, consulting teachers." This type of teacher would work with children with disabilities in the regular classroom on a regular basis. Thus, the consulting teacher would move from child to child and classroom to classroom as needed.

2. Designating cooperative learning as the basic form of instruction. This would include placing high- and low-ability students in cooperative groups. High-ability students would then tutor low-ability students. All members of the group would receive the same academic grade.

3. Providing intensive instruction in special education procedures to teachers.

Researchers hail dyslexia breakthrough

Polly Curtis
Thursday May 20, 2004
The Gaurdian Online

Researchers who have monitored a new treatment for dyslexia today hailed it "as close to a cure as there is".

Academics at Exeter University, who have been monitoring the technique, made up of a series of exercises, at Balsall Common primary school in Solihull, West Midlands, for two years, said the work of pupils with learning difficulties improved faster than that of their peers during the treatment and the year after.

"They were still behind the others kids, but they improved by more than the non-special needs kids in the schools," said Professor David Reynolds, who led the monitoring of the technique. "They hadn't caught up, but their learning was quicker. That's extraordinary."

He added: "We looked at the kids a year after they had treatment and the gains were maintained. It was remarkable. In most studies the improvements haven't lasted."

The treatment focuses on the back part of the brain, the cerebellum, which is long understood to be responsible for balance and co-ordination. More recently scientists have come to believe it is also responsible for the way in which reading and writing becomes an automatic process for people.

The treatment helps to exercise the cerebellum through balancing techniques, which in turn strengthen the ability to learn. Pupils might have to learn how to balance on a wobbly board, or throw a bean bag from one hand to the other.

"It's as close to a cure as we've come so far, but there is still variation between kids," said Professor Reynolds.

"I started as a cynic because my own background is educational treatments for dyslexia-type problems. We developed lots of hoops for it [the treatment] to jump through and each time it jumped every one. It's good science."

Twenty other schools in Solihull have now volunteered to take part in future research following the success seen at Balsall Common. The school's headteacher, Trevor Davies, said it got involved after he referred one pupil to the Dore Achievement Centre in Kenilworth, which developed the treatment.

"Just weeks after embarking on the exercise treatment, which called for a series of twice-daily exercises designed to stimulate the cerebellum part of the brain, Simon's class teacher and I both started to notice dramatic improvements.

"Within six weeks his self-esteem had risen and he began to express himself more, both in spoken and written words," said Mr Davies.

The wider trial followed.

"It would be wrong to suggest that this treatment will make a student with a low IQ a genius, but it will let them read and write with the rest of their peers.

"However, as we know, a lot of dyslexics are in fact very bright indeed and these students really shone, with some of them achieving above average results in their Sats tests."

Headteachers from schools in South Africa, America and Australia have all expressed an interest in visiting Balsall to learn from their experience using the treatment process known as DDAT - Dyslexia, Dyspraxia and Attention Disorder Treatment.