Dyslexia: If we must Diagnose, this must only be the Start

By Richard Skelton, Educational Psychologist

Every psychological label/diagnosis, whether it be anxiety, autism, or dyslexia describes the surface level behaviours that we see. For each of these, the label does not define that individual, but is a summary of what they are seeking support for. However, unlike a physiological diagnosis which often have a clear route map of treatment options, psychological diagnosis don’t. They simply bring to mind a series of factors/hypotheses to be explored to understand what is contributing towards this need.

Let’s take an example of a child struggling to read due to phonological awareness difficulties, and a child struggling to read due to having low confidence and performance anxiety resulting in an aversion (therefore less practice) and/or are fighting to focus their attention between reading and managing their emotional response. On the surface, a reading test will show the same pattern of results for both children. But the interventions that we take for each are entirely different, will require separate interventions, and are perhaps even undertaken by different professionals. 

Of course, there are some generalised approaches which will benefit both children. Developing an enjoyment of reading, for example, could lead to additional practice and exposure to text thereby improving these skills. However, if this is where we leave it for either of these children, their underlying need is not being met. The child with phonological awareness difficulties will continue to struggle, and the child with reading related anxiety will likely make very slow progress with this approach.

So, is the term Dyslexia redundant and useless if it is analogous to ‘struggling with reading’ i.e. something which everyone already knew and was (at least part) of the referral reason? After all, if you went to your GP with stomach pain, you’d want to know why, not just be told it’s ‘abdominal discomfort syndrome’. For Dyslexia, this term is not without some benefits; it is a term that brings about a shared understanding of the surface level need. Particularly in the context of high schools where each teacher sees hundreds of students, this gives these teachers the opportunity to begin to accommodate such needs. If portrayed well with the CYP, it can also help them to feel more empowered and motivated to develop these skills, and subdivide this from their overall learning to result in increased generalised academic self-esteem.

But if it doesn’t tell us what to do, is the more simple term ‘literacy difficulty’ not enough? Professionally, for a long time, I’ve been of the opinion that we need a clearer subdivision of psychological diagnoses. These should be the starting point of something more descriptive and meaningful to have a direct understanding of what may be leading to this. In the context of Dyslexia, possibly more so than many other psychological diagnoses, this is much more possible. The research and practice could account for the vast majority of literacy difficulties, for instance, by subtyping with:

In fact, this is how, as EPs, we work. We may describe the overall need, but seek to explain and develop a shared understanding with the CYP, parents and teachers as to what the main underlying barrier may be. We also seek to identify the strengths that a child may be able to use to circumvent / bypass these needs and develop reading skills through alternative methods.

To each, I would always add a ‘Dyslexia – emotional exacerbating factor’ since I would estimate from practice that this variably impacts over 90% of cases seen, and can be a major determinant of intervention success. Such a factor was increasing with the curriculum pressures placed on primary schools to teach literacy from increasingly younger age, and has unfortunately increased even more so after the COVID-19 restrictions,

I’d feel confident to say that almost all CYP, parents, and teachers would agree that we must always ‘get to know the child, not the behaviour’. So why then do we persist with behavioural diagnoses? Imagine if, instead, is we had more nuanced, and informative diagnosis. Something which directly leads to holistic intervention.

We're incredibly pleased to share that the Literacy: A Path For All is now live. Dr Joanna Stanbridge's CPD course for Educational Psychologists covers practical tools and approaches within EP practice at levels of casework and consultation through to systemic approaches which we can support schools with to create a system which works for all.