Disability, Leadership, Preparing for Adulthood, SEND

Special educational needs and disability: time to restore a differential diagnosis approach

By Anita Devi

In a previous blog, I have written about synthesis of assessment.  Today, I want to share my thoughts on why differential diagnosis is an important part of supporting children and young people with SEND and their families. To be clear, this is not a debate about the medical model or the social model of inclusion.  It is a conversation about ‘how’ we identify needs accurately, so that we can put the right support in place.  I will use examples from my own professional journey as a SENCO, SEND Advisory Teacher and SEND Consultant to illustrate some key issues.

Differential diagnosis is the process of differentiating between two or more conditions which share similar signs or symptoms. To be effective differential diagnosis requires three key components:

  1. Firstly – everyone round the table has a voice and difference is to be welcomed.  On many occasion, children and young people may present with some symptoms and behaviours in one environment and not in another.  What is relevant here is the difference.  By accepting both observations as correct, we are better placed to consider the environmental factors that are having an effect.  No one voice should be given more weighting than another and where possible, evidence should be sought.  Awhile back I was training panel members in a local authority to make consistent decisions regarding 9.14 & 9.54 of the SEND Code of Practice 2015.  An evidence-based approach is vital for consistency.  In one case that we reviewed, throughout the paperwork practitioners referred to a conversation where the child was said to have a diagnosis of X.  This conversation was repeatedly referred to as the primary need of the child.  It was a medical condition.  Yet, in fact there had been no formal diagnosis.  The comment (and subsequent basis for the plan) arose from anxious parents raising the possibility of this condition.  This possibility condition turned into, “She has …” in the reports and subsequent decisions (to the detriment of the child) were based on that possibility condition. Further investigations revealed the child did not have this condition and any support, intervention or treatment put in place had simply served to delay accurate identification and provision.  How different the story would have been if someone had asked for evidence of the diagnosis.
  2. Symptoms need to be perceived as holistic patterns in the current moment and over time (i.e. historical).  As a SENCO, I devised a form for teachers to record symptoms they were seeing in the classroom and over time / year groups. A symptom is a physical or internal feature indicating a condition or need. This form helped us collectively discuss with parents and understand the child’s needs better.  Too often, it is possible to consider only one or two things and depending on the lens adopted, a label is attached.  Two case studies edify how easy it is to misdiagnose.

Child A was presenting with symptoms that everyone including a private assessor diagnosed as dyslexia.  As a SEND advisory teacher, I met with the parents and ask them questions about Child A’s development history and daily routines.  Child A regularly bumped into things and presented with other co-ordination difficulties that the parents had assumed was Child A being clumsy.  Further investigation revealed Child A had dyspraxia. Whilst there is an overlap between symptoms of dyspraxia and dyslexia; the latter predominantly focuses on a difficulties in learning to read, write and spell.  Therefore, any interventions put in place may have missed other significant areas of need.

Child B was a bright year 5 student, who took part in several community team sports and orally was able to articulate high levels of knowledge and creativity.  The difficulties arose with reading and writing.  Parents engaged the services of a dyslexia specialist, who diagnosed dyslexia and suggested a 10-week intervention programme, that only the specialist could provide.  I undertook a reading test of real and nonsense words.  As Child B read, I noticed erratic eye movement.  Child B’s eyes would jump three letters forward, then two letters back.  A similar patter emerged when reading high frequency words in a sentence. I referred Child B to an eye specialist, who confirmed my observation and Child B was given eye movement corrective glasses. Entering Year 6 (with his glasses), Child B was a quite different student.

3. The third component is possibly the hardest for stakeholders to take on board.  Differential diagnosis works through 5 core thinking skills:

      • analysis
      • interpretation
      • inference
      • deduction
      • problem-solving

Therefore, differential diagnosis requires up-to-date knowledge of research and accepting the possibility ‘of getting it wrong’.  Child C was unable to access the maths curriculum.  Demonstrated ability placed Child C as working three years below his age.  One option would have been to place the child in an intervention group and support development of mathematical foundation skills.  However, the SENCO decided to commission a dynamic assessment test.  This basically assesses cognitive processes, in the moment i.e. as they are happening.  Child C was cognitively age appropriate.  However, a look through the historical records showed Child C had had many supply teachers for maths and as a result had significant ‘gaps’ in learning.  This was not a SEN issue.

As part of the work I do, I am often asked for a good-practice example of an Education Health Care Plan (EHCP) and 5-star examples of well-written outcomes.  I have yet to find one and I have worked across several local authorities.  The issue is the plan has become about form filling, not the connected bigger picture of understanding the child and presenting symptoms.    In one local authority project, I reviewed the Advices written for more than 30 EHCPs.  I also then reviewed the associated plans.  What was apparent was the reports by specialists focused on one or two voices, at the expense of their own professional knowledge.  When I then met these specialists, they then shared with me their reluctance to express their opinion, as it differed to others.  I regularly undertook statutory assessment of pupils and a key part of my report writing was to consolidate conflicting pieces of evidence to clearly discern the child’s needs and then the provision needed to be put in place to meet those needs (sometimes multiple).  On many occasions, less is more meant I had to acutely define a catalyst approach for supporting the child.  The current system (post SEND Reforms) shies away from difference and differing opinions.  I think this is a mistake and as a result, I am not convinced we are identifying needs and provision accurately.  The system is resources-driven, not identification-based from differing evidence-based perspectives.

One of the areas I lead training on most regularly is enabling SEND Leaders to discern ‘why’ an intervention / support is needed and ‘how’ it should be delivered.  The why and how are intrinsically linked.  To discern this knowledge, SEND Leaders need to look beyond the data and look at patterns across several factors. Knowing the why really does change the how.

What is needed for improvement?

I would suggest two factors are needed to drive improvement and ensure a better system for identification.  The first is ‘protected CPD time’ for SEND Leaders.  This is in complete contrast to current SENCO Workload Survey approach and I have written more about this here  The SENCo workload survey, mistakenly focuses on ‘protected work time’.

The second is a recognition and acceptance of difference at all levels.  This needs to be evident within settings and at local authority level. Only then can we begin to discern patterns, environmental factors, and historical issues for accurate identification of needs.

If both were in place, over time we would see a system where open conversations were prevalent and the single goal of ensuring the child progresses becomes the focus.  Naturally, this involves a conversation about defining progression.  However, this is the 21st century; young people and adults with an educational need and/or disability should be able to contribute to society through employment, they should be able to live independent healthy lives and be included in the community.  So, if we are serious about the ‘preparing for adulthood’ outcomes, we have a responsibility to employ a differential diagnostic approach to accurately identify need and the provision needed.  I would be interested in your thoughts, especially if you disagree with me!

About Anita Devi

Anita has had an extensive career in education.  Her why is based around the ‘Joy of Learning’.  As such, she focuses on what enables learners and what hinders them and more importantly, what can she do to improve the system.  Amongst her many other roles, Anita leads #TeamADL

To find out more visit www.AnitaDevi.com

#Curriculum, #Teaching&Learning, Disability

Scaffolding support in primary PE curriculum for SEND pupils into adulthood

Interview with Jonathan Bhowmick (JB)

With a renewed focus on curriculum this year, Anita Devi (AD) caught up with Actions Mats to ask more about how we support pupils with special educational needs and disability (SEND) in Physical Education (PE), as part of the inclusion agenda and active lifestyles.

AD: Hi Jonathan, thank you for your time today.  Tell us a little about yourself.

JB: Hi Anita Well, I am the designer and founder of Action Mats. My background is playground design and working with a school, I was asked by the headteacher to design a solution for engaging pupils for whom English is an additional language (EAL).  Hence Action Mats were born.  The mats are a unique PE and active-learning resource created for children between 4 and 11 years old.  The thinking behind Action Mats is to create fitness stations.  These can used in multiple configurations.  They enable ALL pupils to engage in the PE curriculum as well as participate in team building challenges and competitive games. What we have also discovered since from user feedback is Action Mats work well for pupils with a special educational need and disability.  In effect, we have fulfilled our AIM in creating Action Inclusive Mats.

AD: How long have you been operating?

JB: Action Mats was launched in October 2017 and we are now in over one hundred schools in four countries. They were originally created for EAL pupils.  Our vision is for them engage in the lessons and so feel part of the school community.  The unique feature of Action Mats is the simple, yet fun, instructional graphics and symbols printed on each mat. Children of all ages, from any country, can understand these graphics without the need for explanation or translation. This empowers children, giving them the ability to work independently or collaboratively, without the need for teacher/ adult input.  Action Mats are active members of Youth Sports Trust, the Association for Physical Education and UK Active.

Action Mats 1

AD: Did you test the mats with the children?

JB: We tested the Action Mats quite extensively.  In late September 2019, we ran a new trial session at a primary school in Hertfordshire to test our active-learning mats, which incorporate the literacy and numeracy packs.  Thirty-two children in year 4 (8-year olds) tested our level 2 challenge jigsaw race mats.  Each challenge includes sixteen activities.  The activity was delivered as a race.  So, the pupils carry random pieces jigsaw pieces over a course of fitness stations to reach the ‘build zone’. In the Build-Zone, pupils must connect the piece they carry to existing pieces already there. The class was a mixed ability group.

AD: Sounds like quite a high-pace activity?

JB:  It is.  However, from a designer’s point of view, the successful completion of the jigsaw is rather secondary. The objective is for pupils to engage fully in the exercises on each mat. We want our children to be active and see sport, as an important lifestyle choice. A secondary objective is for the whole team to coalesce in the jigsaw build zone to assemble the pieces as a team, collectively. The game fosters teamwork on two levels, during the race section and working together to achieve a common goal.  Ideally before the other team.

AD:  What did you learn from this new trial?

JB:  I was really pleased with how successful the game was. The rationale behind the idea worked perfectly and, as the photos testify, the children were completely engrossed in the challenge.  In particular, the children shared they preferred the numeracy tasks linked to Action Mats and found it helped their concentration.  School leadership commented, “We found the sense of purpose linked to PE activities helpful or children’s learning and we believe teachers could use this accessible resource in many different ways, to engage the children”. As a follow-up, Action Mats was invited to run an active session at a PE Conference in Worcestershire at which we invited twenty PE Teachers to participate in the same game.  There was some initial reluctance, but once the teachers got into it, they found it more challenging than they had originally thought.  Their competitive side also surfaced.  We found their feedback useful.

Winning is important to me, but what brings me real joy is the experience of being fully engaged in whatever I’m doing – Phil Jackson

Action Mats 2

AD: The jigsaw appears to also help the slow down rest period, after an intense period of activity.  Is that how they were designed?  What is the recommended warm up to the fitness stations?

JB: In this scenario, the objective was to race the other team.  However, it is possible to use the jigsaw for downtime.  The Action Mat stations are used for the warm-up through a circuit-based activity.

AD: Can you give us an example where the mats have benefited children with special educational needs and disability (SEND)?

JB: Action Mats are be used by some special schools and we have anecdotal feedback about impact for SEND in mainstream schools. This is an are we are currently developing.

Sports England 2018

(Source: Sport England, 2018)

AD: London 2012, enabled us as a nation to take sport to a new level. Our pledge was to “Inspire a generation”. Yet, in 2018 Sport England reported just over 40% of children in England do an average of more than 60 minutes of physical activity a day. Our Active Lives Children and Young People Survey (2018), which was the first of its kind carried out by Ipsos MORI, showed that around 3 million children (43.3%) lead active lives.  However, of that group, only 1.2 million (17.5%) are meeting the Chief Medical Officer’s guidelines of more than 60 minutes of activity a day, every day of the week.  So, there is clearly a need to do more. The report also concluded an insignificant difference in the amount of sport and physical activity that takes place inside school, compared to activity levels outside of school.  Both have a critical role to play. With 22% of children active for at least 30 minutes per day outside of school, while 28% of children do so in school.  How do you think Action Mats can contribute to the national agenda for children of ‘being active and staying healthy’?

Life need not have limits – Richard Whitehead, a British athlete and Paralympian

JB: Action Mats can be delivered through structured teacher-led pedagogy.  The mats come with easy-to-follow activity cards.  Action Mats can also have high impact through learner-led activities.  So, the mats cover both differentiation and personalisation.  In some schools, Action Mats have promoted Family Fitness Sessions, where parents/carers join their children for stay healthy exercise sessions.  This helps promote good family relationships and positive role models, as well active lifestyles outside school.  Action Mats are portal and on suitable external surfaces can be used outside, in the fresh air.

Sports England 2017

(Source: Sports England, 2017)

AD: At #TeamADL, our vision is ‘Everyone thriving in education, employment and life’.  We were therefore concerned when we read in the 2015/16 survey 51% of adults with three or more impairments are inactive compared with 21% of those without a disability. So, my final question to you, what can we do differently to increase activity for those with impairments?

JB: Take the principles of Action Mats and apply them widely.  In other words, simplicity, accessibility and inclusivity.  Richard Whitehead, a British athlete and Paralympian once said, “Life need not have limits”.  This is so true of the philosophy of Action Mats.  The mats are enablers for children to stretch themselves that little bit further, with the hope it becomes a lifestyle choice for their adulthood.  Do check out our video and hear what teachers and PE specialists have said.

AD: Thank you Jonathan once again for your time.  We wish you the very best going forward.  Keep us posted of any updates!

To find out more about Action Mats visit: https://www.actionmats.co.uk/

Chrispina Wilson from #TeamADL is also actively involved in supporting healthy lifestyles and reducing obesity for all children and young people. Contact us to find out more.

Disability, Employment, Preparing for Adulthood, SEND

Awards are not that we have made it, but proof that organisations are trying to get better!

By Maya Thomas

Awards, I have found are very marmite – you either love them or you don’t.  But do they convey much more than just winners and possible winners? The recent Disability Smart Awards are a great example of this.  Led by Business Disability Forum, these awards where a celebration of breakthrough, innovation and better best practice in businesses, large and small, when it comes to inclusion in the workplace for those with disabilities.

We arrived at the Locarno Suite at the Foreign & Commonwealth Office and found our place at a table with others who were also finalists for various awards. We sat with representatives from the Dubai Police, Bank of England, Vindhya e-infomedia and the Highways Agency – each team with a story of making real change for those with disabilities. Each team representing organisations going well beyond what is a legal requirement or policy minimum.

What I really enjoyed was, that it wasn’t just projects that had won that were given the limelight. Our hosts, including Paralympian, Stef Reid, gave a brief synopsis on each of the finalists before the winner in each category was announced. There were so many people in the room who are being responsive in their focus on workplace inclusion and transforming the life chances for those with disabilities.

Herbal Essences won the Disability-Smart Design Award 2019 for a change in design on their bottles that makes it possible for those who cannot see, to tell the difference between the shampoo and conditioner. To put it simply, there are now indentations on each bottle to differentiate one from the other – such an ingenious and brilliant idea!

Herbal essence

The Dubai Police were finalist for numerous awards, and they won the Disability-Smart Technology for All Award 2019 for creating the World’s first smart police station free from human interaction. The impact of this project is cutting edge for everyone, especially where anonymity is vital. In this case, real barriers to access have been removed.

Towards the end of the evening the hosts did a superb job adlibbing for about 10 minutes, delaying the announcement of the Disability-Smart Workplace Experience Award 2019. There was a hushed entrance and the seating of a late guest, before it was announced that MI5 had won the award! Having gone the extra mile, the award was in recognition of 10 years of “Raising Awareness, Removing Barriers and Fulfilling Potential” in the workplace, particularly for those with disability and ill health.

The stories that where shared that night, where often personal and I enjoyed meeting many wonderful people at the awards. It was inspiring to be in the room with people who are passionate about influencing and transforming the life chances and experience for those with disabilities. And, as a finalist for the Disability-Smart Influencer Award 2019 #TeamADL we were in great company, which was a real honour!

#TeamADL are passionate about bridging the gap between education and employment, giving everybody opportunities to thrive in education, employment and life. If you feel are able to get involved, or if you already have a project that is making a difference in this area, please do get in touch. We love to hear stories of what is already happening out there, and journey with others for greater creative solutions. Better still sign our #SENDcareers Pledge or view our case studies page.

To find out more visit #TeamADL

About Maya Thomas

Maya wears many hats! She is Anita’s part-time PA and also Operations Lead for #TeamADL Her role continues to grow and evolve, as Maya unfurls the many layers her skills and talent.  In her own time, Maya gives to the local community as a SEND Governor and takes an active interest in her children’s schools.