By Alison Cox
What percentage of a population has to exhibit a trait or characteristic before it is regarded as ‘normal’? And who defines what’s normal anyway?
In her recent series on Radio 4, Vivienne Parry set out to answer the fundamental question “Am I normal?” through an exploration of the latest thinking on four topical themes: social phobia; dyslexia; dyscalculia and insomnia.
In the second programme, Ms Parry came to the conclusion that, as a nation, we have really got ourselves in a “bit of a bind” as far as dyslexia is concerned. How? By creating a system in which an individual can only get the extra support they need by having a label which marks them out as not normal. The programme gave air-time to a range of contrasting expert views on dyslexia, particularly about the merits and demerits of diagnosing what was generally acknowledged to be a varying pattern of vulnerabilities – or learning differences – rather than a single condition.
If there was broad agreement about dyslexia existing on a continuum of literacy ability in the population as a whole, there was anything but agreement about the underlying causes or the most appropriate age at which to identify it!
Within the space of forty years, have we gone from non-recognition to over-diagnosis? Ms Parry surmised that any system in which schools could identify 30% of its pupils as eligible for extra time in exams on account of dyslexia had to be flawed. The inherent problem with the diagnosis of dyslexia, she hypothesised, is that ‘diagnosis’ is a medical concept and implies a condition with defined boundaries and measurable signs and symptoms. Little wonder then that an industry has rapidly grown up around the testing for, and treating of, the ‘condition’. A panel of renowned researchers was invited to respond to this concern by explaining their respective stances on diagnosis and intervention.
In the “dyslexia is a dimension of normal” camp, listeners heard York University’s Professor of Psychology (Maggie Snowling) and UCL’s MRC Professor of Behavioural Genetics (Robert Plowman) put forward convincing arguments in favour of recognising variations in ability as opposed to drawing a line with ‘dyslexic’ on one side and ‘not dyslexic’ on the other. This view was also supported by Pauline Bentote, HM Inspector of schools, whose focus on specific learning difficulties had led her to the conclusion that dyslexia fits into the normal range of ability because it is too common in its occurrence to be regarded as a disorder. In advocating early identification of pupils who are struggling with literacy, so that extra support can be put in place, the HMI added that “a lot depends on the teaching the child receives”. She reported encouraging results in Hampshire schools since a decision had been made to target resources at improving phonic awareness amongst 4-6 year olds.
Whilst parents are understandably keen to have an explanation for any difficulties that their children experience with the acquisition of literacy skills, Julian Greenyear (a head teacher), urged against rushing to label pupils who in the majority of cases are developing at their own pace and will reach an acceptable level of competence in literacy. He offered a powerful analogy to support his stance that screening for dyslexia too soon (that is, at too young an age) raises real ethical issues. “We wouldn’t want a test at age 5 to determine who can ride a bike without stabilisers, only to label the children who can’t as having a movement disorder”.
But the desire to identify dyslexia as early as possible has underpinned the development of DEST (Dyslexia Early Screening Test) by Rod Nicholson, Professor of Psychology at the University of Sheffield. And he means ‘early’! Since it was first piloted in the 1990s, children as young as four have been profiled using this battery of 12 sub-tests. DEST has been shown to identify 10 – 20% of all children as having an ‘at risk’ (of dyslexia) quotient, which isn’t significantly out of step with other studies (reported by the British Dyslexia Association) that suggest an incidence of moderate to severe dyslexia in between 3 – 10% of the population.
Professor Nicholson championed the idea of casting the net widely, and at a young age, when screening for specific learning difficulties – on the grounds that it’s important to pick up anyone who is struggling, whatever the underlying cause. When asked by Ms Parry whether the detection of other learning difficulties (ADHD, dyspraxia, hearing impairment, etc.) using a screening test with dyslexia in its title might cause confusion, he acknowledged that he would name it differently if he were launching it today. But the naming of the test causes far less controversy than Professor Nicholson’s support of the theory that dyslexia is linked to a cerebellar problem, which is why postural stability (the ability to balance) and dexterity (fine motor co-ordination) are both assessed as an integral part of the DEST. On this point, Professor Snowling strongly disagrees.
In comparison with some recent articles and documentaries on diagnosing dyslexia, Ms Parry’s programme gives the subject a balanced hearing and reaches sensible, pragmatic conclusions. Well worth listening to the BBC podcast of the programme!