Assessment and diagnosis

Can a 7 year old be assessed for dyslexia

This is a question that we are often asked. For instance:

Dear Educational Psychologist
We are interested in an assessment with you for our daughter she is 7 years old. We suspect she may have dyslexia. Is it still possible to detect with any certainty that she does/does not have dyslexia?

My reply:


Dear Mr and Mrs Another,
I can test underlying ability (IQ) and literacy skills then make a statistical comparison, this would lead to, two possible conclusions that there is or is not a statistically significant discrepancy between individual literacy scores e.g. word reading accuracy and underlying ability to a reasonable degree of scientific certainty.  At this point if there is a discrepancy to a reasonable degree of scientific certainty, then the psychologist makes a judgment call based upon historical evidence of intervention to diagnose a specific learning difficulty, such as dyslexia. If there is no statistically significant discrepancy then the psychologist may reject the hypothesis of a specific learning difficulty or based upon the totality of the assessment identify anomalies in functioning and performance that whilst they are not statistically significant still cause concern, for instance the psychologist might observe an inconsistent pattern to reading for comprehension performance, and suggest intervention  All of this assessment would be included in our fixed fee assessment.  

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The Difference Between Learning Difficulties and Learning Disability

“What the difference is between the term learning difficulties and learning disability.”

This question is often asked by clients via our email advice service.  We prefer to use internationally recognised and agreed terms such as those defined in DSM-5 and ICD 10.  The most recently reviewed being DSM-5.  DSM-5 is the diagnostic manual produced by the American Psychiatric Association.  It has international acceptance.  The ICD 10 also has international acceptance and is produced by The World Health organisation (WHO) With respect to both DSM-5 and ICD 10 the terms learning difficulties and learning disability are not found. 

The term Specific Learning Disorder is found in DSM-5 and refers to difficulties with reading, reading fluency, reading comprehension, spelling accuracy, grammar and punctuation accuracy and organisation of written expression. Dyslexia is cited as an alternate term. 

DSM-5 also refer to Intellectual Disability this term is used to describe people who find learning generally difficult, there will be difficulties learning both in the academic setting and home and social settings.  IQ would generally be in the bottom 2% of the population (IQ 70 or below).

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This is an American examination and the report must be made according to the diagnostic criteria in DSM-5, which is the guide to diagnosis used in the USA.  There is a requirement that a substantial body of evidence is referred to in the report.  It is important that you have evidence form your past, such as old school reports, assessment reports, letters etc. 

It can be very difficult to find an educational psychologist to make this type of assessment in the UK.  

Moderate Learning Difficulties, General Learning Difficulties, Intellectual Disability, what does this mean and are they the same?

We are often asked this question by parents.  All of the above refer to difficulties with learning across multiple contexts, so difficulties with learning academic and non-academic material.   In Wadeson Street Dyslexia Centre we prefer, when we can, to use internationally agreed and recognised terms, this is because educational psychologists reports are accepted as evidence in a variety of countries and contexts including law courts, tribunals and when claiming benefits etc. In fact we would go further and take the view that there is a professional duty to use diagnostic terms that would be internationally recognised, by professionals such as, legal, psychological and medical where possible.  There is a trend within LEA educational psychology services to use the term: moderate learning difficulties to describe children who are experiencing difficulties with accessing the school curriculum despite skilled differentiation and support.  The term moderate learning difficulties is not an internationally recognised term and does not appear in ICD 10 or DSM-5.  Whilst a psychologist or physician in a country other than UK could deduce what was meant by the term moderate learning difficulties it could cause difficulties when seeking to access support or provision because moderate learning difficulties is not a clear internationally agreed diagnostic definition. It is also entirely likely that even within the UK, because there are no clear diagnostic criteria, that a diagnosis of moderate learning difficulties could be challenged. Below you will find a description of moderate learning difficulties published on the Institute of Education web site. Then below that is a summary of the criteria for the diagnosis of intellectual disability provided by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM -5)  The DSM-5 is produced by the American Psychiatric Association and is used across the world.

Moderate learning difficulties (MLD)
Pupils with MLD will have attainments well below expected levels in all or most areas of the curriculum, despite appropriate interventions. They will have much greater difficulty than their peers in acquiring basic literacy and numeracy skills and in understanding concepts. They may also have associated speech and language delay, low self-esteem, low levels of concentration and underdeveloped social skills. 

The school environment/curriculum can present a range of barriers to participation and learning for pupils with MLD. The SEN Code of Practice says that pupils who demonstrate features of MLD, require specific programmes to aid progress in cognition and learning. In particular, pupils with MLD may need support with:

understanding instructions and the requirements of tasks " acquiring sequencing skills − for example, when following a recipe or science experiment " understanding how they affect and relate to their immediate surroundings " personal organisation over the short, medium and long term, and " visual and auditory memory for information, processes and instructions. "

Careful assessment of baselines and monitoring of progress will help ensure that their progress can be recognised and built upon.

DSM-5 Criterion for the diagnosis of intellectual disability from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, APA 2013). 

Severity is assessed across three domains, a summary of the diagnostic criteria for each domain are as follows:

1. Deficits in intellectual functioning
2. Deficits or impairments in adaptive functioning
3. Deficits in intellectual and adaptive functioning were present during the developmental period. 

Deficits in intellectual functioning
This includes various mental abilities:
•    Reasoning
•    Problem solving
•    Planning
•    Abstract thinking
•    Judgment
•    Academic learning (ability to learn in school via traditional teaching methods)
•    Experiential learning (the ability to learn through experience, trial and error, and observation)

These mental abilities are measured by IQ tests. A score of approximately two standard deviations below average represents a significant cognitive deficit.  This is typically an IQ score of 70 or below.

Deficits or impairments in adaptive functioning
This includes skills needed to live in an independent and responsible manner. Limited abilities in these life skills make it difficult to achieve age appropriate standards of behaviour. Without these skills, a person needs additional supports to succeed at school, work, or independent life. 
Various skills are needed for daily living: 
•    Communication: This refers to the ability to convey information from one person to another. Communication is conveyed through words and actions. It involves the ability to understand others, and to express oneself through words or actions.

•    Social skills: This refers to the ability to interact effectively with others. We usually take social skills for granted. However, these skills are critical for success in life. These skills include the ability to understand and comply with social rules, customs, and standards of public behaviour. This intricate function requires the ability to process figurative language and detect unspoken cues such as body language.

•    Personal independence at home or in community settings: This refers to the ability to take care of oneself. Some examples are bathing, dressing, and feeding. It also includes the ability to safely complete day-to-day tasks without guidance. Some examples are cooking, cleaning, and laundry. There e are also routine activities performed in the community. This includes shopping for groceries, and accessing public transportation.

•    School or work functioning: This refers to the ability to conform to the social standards at work or school. It includes the ability to learn new knowledge, skills, and abilities. Furthermore, people must apply this information in a practical, adaptive manner; without excessive direction or guidance.

Adaptive functioning is usually measured using a recognised test instrument such as the Vineland II.

Deficits in intellectual and adaptive functioning were present during the developmental period. 
This means problems with intellectual or adaptive functioning were evident during childhood or adolescence.  This information can come from the Vineland II, but primarily from an in-depth interview, either with the client if an adult or a parent or care giver.

You can see that there is much in common, but the identification of moderate learning difficulties as described does not require measurement using test instruments whereas it is a requirement for the diagnosis of intellectual disability.  

Dyspraxia Checklist

Dyspraxia Checklist.

Dyspraxia is caused by an immaturity of the brain resulting in messages not being properly transmitted from the brain to the body.  It may help if you think of it as a problem with the internal wiring of the brain.  The incidence of Dyspraxia is approximately 2 people in 100 (2% of the population).  Within the group of people with this difficulty there is a spread, with some affected much more than others.  There is a much greater chance of males being affected, the male female split being 70% and 30% respectively.   As with any diagnosed condition, as educators or parents we always have to view things, not from the position of what is wrong, but from the standpoint of what works.  What strengths does the child have?  How can we teach this child?  To achieve a level of knowledge sufficient to teach the child and thus assist in the child maximising their development and potential we must ask questions.  Questions such as, when did the child show evidence of really engaging in a task?  When was the child put off by a task?  What was different about the two tasks?  It is only by the use of reflective and analytical teaching approaches that we will discover the way to teach any child who has special needs and difficulties.  The educational psychologist is often crucial in facilitating this approach to learning about the child's learning.

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As with any parent or teacher applied checklist, you are not making a diagnosis.  The diagnosis of Dyspraxia is a highly skilled task.  Please use this checklist to see if it seems to “fit” the child.  Not all Dyspraxic children will meet all the indicators.  If there does seem to be a good “fit” then it would be useful to refer the child to a professional who is in a position to provide an accurate assessment and diagnosis.  In the UK this is often done by a speech therapist and occupational therapist working together.

Dyspraxia checklist.

  1. People describe the child as being clumsy, you suspect this is due to a weak sense of body awareness.
  2. The child has poor posture
  3. They may walk awkwardly.
  4. Laterality confusion, check this by: Asking which hand s/he writes with, which foot s/he takes kicks a ball with, ask them to look through a cardboard tube, which eye do they hold it up to?  Hand them your watch, which eye do they hold it up to?  Does everything happen with the same side or are
  5. some things done left sided and others right sided?
  6. The child may have difficulties throwing and catching, even with quite a large soft ball.
  7. You may notice that the child is much more sensitive to touch than other children.
  8. There may be objections to wearing some clothes and other routine events such as the application of plasters, having their hair brushed or teeth brushed because the child finds this uncomfortable.
  9. Parents and teachers may be frustrated or have noticed that the child forgets tasks learned the previous day or there is evidence to suggest that the child has a weak working memory (short term memory).
  10. There will probably be reading and writing difficulties
  11. There is a very strong chance that the child cannot hold a pen or pencil properly.
  12. Does the child have a weak sense of direction?
  13. The child has had real difficulties with or cannot hop, skip or ride a bike.
  14. The child was much slower than most children to learn to dress or feed themselves.
  15. Parents and teachers may have noticed there is a difficulty in answering simple questions even though they know the answers.
  16. There may be evidence of speech problems perhaps with the child being slow to learn to speak or speech may be difficult to understand.
  17. It is possible that the child has a difficulty with phobias and perhaps obsessive behaviour.
  18. The child may be frustrated and impatient more than one would expect for a child of their age.

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Diagnosis Of Dysgraphia

The Diagnosis of Dysgraphia
The term dysgraphia is taken from the Greek word, (dys) meaning "bad" or "difficult" and (graphia) meaning "writing." Thus, "dygraphia" literally means "bad writing". In contemporary terms, this has been defined by DSM-IV (2000) – now superseded by DSM-V (2013) - as a learning disability with impairment in written expression: the inability to write primarily referring to handwriting, but also in terms of coherence.

DSM V does not offer diagnostic criteria for dysgraphia, but does include difficulties with written expression within the criteria for diagnosing specific learning disorder. For a student with no difficulties with written expression but with generally hard to read and illegible handwriting there is no internationally recognised diagnostic criteria, such as ICD-10 or DSM V, that a clinician can refer to.

Searches of the internet reveal many definitions of dysgraphia which include difficulties with: fine motor co-ordination, organisation and presentation of written material, writing to be distorted or incorrect, letters and numbers may be backwards and out of order, expressing thoughts in writing, not understanding the spellings of words, having trouble with punctuation, more than simply “untidy” writing; it affects people’s ability to write effortlessly, a neurological condition that impairs writing and memory processing.

Using the latest DSM 5 definition of specific learning disorder most of the above would now fall within the diagnostic criteria for specific learning disorder, except for difficulties with the act of writing by hand. Because of this some practitioners now consider dysgraphia to be defunct as a diagnosis.

Dysgraphia is a very useful descriptor for handwriting that is so hard to read that it is generally illegible. Wadeson Street Dyslexia Centre use a very simple criteria: If a free writing sample is more than 25% illegible; that is more than one out of four words are illegible, or can only be read by reading around the target word to deduce what the word is, then the person’s handwriting is considered to be dysgraphic. We use a technique whereby the sample is read from the bottom in reverse, which helps to ensure that each word is read in isolation.

Wadeson Street Criteria for dysgraphia

More than 25% of handwriting sample hard to read or illegible when the sample is read from the bottom backwards.
 

Two samples of dysgraphic handwriting.

Clinical Evaluation of Language Fundamentals (CELF)

The Clinical Evaluation of Language Fundamentals®–Fourth Edition (CELF®–4) is an individually administered test for determining if a student (ages 5 through 21 years) has a language
disorder or delay. assesses four aspects of language (morphology and syntax, semantics, pragmatics, and phonological awareness).

 

 

 

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Observation, Checking A Child Is Accessing The Curriculum

This technique is primarily aimed at children who are not accessing the curriculum due to language difficulties.  You should, however, also be aware and take note of the child's propensity/ability to make appropriate use of peers for support and assistance as this may contribute to the evidence gathering process shedding light upon areas such as approach to learning, social skills and self esteem.

Usually I prefer to observe a child before they know who I am. This technique is usually used after some assessment which has lead to a hypotheses of some difficulty. At the very least it may be that the child is not comprehending the verbal learning environment very well for a range of reasons such as specific or general language problems.  You could use this technique for a child that has difficulties concentrating by being very overt and telling them that you are going to be looking to see how many questions they can answer if they concentrate.   Similarly this may be used just before a review is due to gather information to compare with a base line specified prior to your intervention.

You will need the observed session to have a strong verbal component; carpet time is often suitable.  You will be keeping one eye on the child and noting their behaviour, but you will also be noting down questions that can be asked about what is being taught, the story that is being read out etc. 

You will then be left with a series of age appropriate questions that relate to the 15 to 20 minute session that they have just taken part in.  You will also have some notes on the presenting behaviour. Was it restless? Helpless? Actively involved?  Below is an example layout with example questions:

Question Appropriate Answer Child's Answer
Who was asked to come to the front and talk about an award they got? Ben and Tom Ben and Tom
What did thy get the award for? Football Reading?
Your teacher read you a story, what was it about? Harry Potter looks at me for a clue no answer
Your teacher asked you all to tell your parents some things about sports day.  Can you tell me something she asked you to tell your parents? Next week on Wednesday, white shirt, will get letter later this week with details. They can come?

Naturally you would have a few more questions but you should get some ideas about their behaviour.  The little boy in this example is confirming our hypothesis gained from assessment or professional judgement: he has real difficulties processing the spoken word into usable information or remembering it once he has processed it.  You are now able to illustrate in your report the scale of the child's difficulties by detailing the questions asked and the responses.  You may wish to ask other members of the class the same questions to develop a contrast between the target child and peers.

Advanced Observational Techniques (use of a control pupil)

Once you have got the hang of observing using the methods suggested in the previous paper on basic observation techniques, you may wish to strengthen your reports or evidence gathering with a comparison to other members of the class.   This technique involves the observer making a primary observation on the target child using the same methodology advocated in basic observation.  However, after the target child has been observed, the observer will make a secondary and nearly simultaneous observation by quickly looking at the control child (a child selected at random from within the same class) and note what they are doing.  Thus an observation record would look something like this:

Time           Target Child                                    Control Child                        
 10.00  Fiddle with pencil case 30 sec. LA 10 sec. Talk 20 sec.  OT
 10.01  Talk 30 sec. W 30 sec, talk to blonde girl  OT, talk 10 sec.
 10.02  W 40 sec talk to blonde girl T> sit down, to seat  OT >T for help
 10.03  LA 10 sec, talk 30 sec T> stern look. OT 20 sec  With T, OT
 10.04  W 40 sec girl red jumper T> warn, OT 10 sec  OT
 10.05  OT 20 sec, talk40 sec  OT
 10.06  T> final warn, argue 60 sec.  OT, Talk 15 sec, to pencil sharpener

OT =  on task
LA = look around
W = wander around classroom
T> = teacher instigates interaction with target pupil
>T = pupil instigates interaction with teacher

You are now able to report in a more professional way that the target child was, for instance, on task (OT) for 60 seconds (control 5 minutes plus) and engaged in the following restless and off task behaviours: talking 3 minutes 10 seconds (control 10 seconds), wandering 3 minutes 30 seconds (control 0 seconds), teacher needed to approach pupil 4 all disciplinary in nature escalating from non verbal to final warning (control  one approach to Teacher for help).

You will note that the control pupils behaviour is notably different from that of the target child.  The use of a control has made the behaviour of the target child more notable due to the contrast.  By using a control you have also made a point with regard to the behaviour of the rest of the class, it is very good if surmised from the above.  However, you may be asked to report on a child who is in a very noisy class, use of a control may highlight the need for a whole class approach due to the behaviour of the control which may be nearly as poor as the target child. 

You may wish to note in your report onhow the control was selected.  Did you choose them at random? Or did you ask the teacher to point out an average child.  Personally I have usually gone for a child with similar coloured and styled hair or a similar jumper.  There is no science in this and once or twice I have selected a child that also has difficulties, however this soon becomes apparent and you can switch control very easily.  I prefer to be able to report that I selected the control at random using hair colour in my reports rather than report that the control was selected by the teacher because I feel that it adds credibility.

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Observation In Playground And Classroom

Classroom and Playground Observation

There are books and chapters in books and no doubt countless pages on the internet describing various techniques for undertaking this part of a child’s assessment. Over the years I have practiced, I must have looked at hundreds of examples. For a parent or teacher seeking information on observation techniques it must seem very confusing. The following techniques are the methods I have settled on and used successfully for years; both are very simple. I always use both techniques sometimes in sequence but more often in tandem. If you are new to observation I would suggest doing them in sequence, you will naturally begin to use them in tandem as you gain experience. All you need is a note pad a pen and a watch.

Minute by minute observation:

I tend to do a 20-minute observation using this technique. You need to establish some codes for yourself. Some codes you will use for every observation, other codes you will need to generate as the child presents particular behaviors. For instance >T means child approaches teacher, whilst T> means teacher approaches child. I tend to embellish this with a note as to the reason for the approach, teach, help, reprimand for example. If the child makes animal noises, I might code this as AN – Dog. If the activity changes note this down and carry on with the observation

Here are some of my regular codes:

· >T help = Child approaches teacher you can note why if you wish.

· T> teach = Teacher approaches child to teach task individually

· W 20 sec sharpen pencil = The child wandered the classroom for 20 seconds and sharpened pencil

· OT 30 sec. = On task for 30 seconds

· Off T 60 sec. = Off task 60 seconds

· LA 20 sec = look around 20 sec.

These are just to give you some idea; it may be best if you figure out your own codes. You use codes to increase your head up observing time, the observation sheet does not have to be lovely and neat. Mine are only really decipherable by me, but I get a lot of head up observing time. Here is a fun example to give you an idea of what part of an observation note might look like.

Bill Clinton observation 2.2.99

Pencil and paper task, write news

10.00 fiddle with pencil case 30 sec. LA 10 sec. Talk 20 sec.

10.01 Talk 30 sec. W 30 sec, talk to blonde girl

10.02 W 40 sec talk to blonde girl T> sit down, to seat

10.03 LA 10 sec, talk 30 sec T> stern look. OT 20 sec

10.04 W 40 sec girl red jumper T> warn, OT 10 sec

10.05 OT 20 sec, talk40 sec

10.06 T> final warn, argue 60 sec.

Here we can see that Bill either can’t write his news or would prefer to talk to the girls. His teacher can bring him to heel but this only lasts a short time.

This observation technique will allow you to be very scientific. You will for instance be able to say that when a child is offered a pencil and paper task they will be off task for so many minutes in a 20 minute observation. You will be able to include in your report the noises the child made or the number and amount of time they spent wandering around the classroom. You will be able to baseline the most used off task behavior and use this as the data to measure any improvements against. When you look at the observation as a whole in a quiet moment you may see patterns.

Observation technique two

This technique is quite the opposite of the above technique. Here you simply clear your mind and watch the child in the learning context. I tend to note down what the set task is and if it changes note this, thus the set task note breaks up my notes. I tend to watch in five-minute blocks then write down anything I feel is relevant. I am looking for patterns of behaviour, friendships, alliances, evidence of relationships both individual and group. You are observing as a human not as a psychologist, parent or teacher. No matter how odd your perception of what is happening note it down.

An example may look like this

A. Child Observation, Science. 2.2.99

Task: to watch teacher demonstrate an experiment to the whole class.

Seems keen and interested. Puts hand up to assist. No negative interaction between target child and peers or teacher. 15 min

Task: to copy notes about the experiment from the board.

Appears to look up at the board more frequently that the other children. Poor visual memory?

Gets on with task, no negative behaviors. 8 min.

Task: teacher does question and answer session to round off lesson.

Off task, pays little attention to teacher. Rarely makes eye contact with teacher, but seems to be trying to gain the attention of peers by engaging in various acts of silliness. He is not disruptive because the other children choose to ignore him. If they were bored or badly taught they may use him as a catalyst to disrupt the lesson. 5 min

Task, sit and listen to teacher rounding off the lesson. (Telling them what he has told them)

Much better but not looking at the teacher and not really on task but not seeking to be disruptive. 3 min

Footnote:
This is a real example. Subsequent assessment suggested this child did have a weak visual memory. However, this was not the problem. When I asked what the lesson was about, just as the teacher had done in the Q and A session the child shrugged shoulders and told me "don’t know". I had noted down some of the vocabulary used in various parts of the lesson and the child could offer good or fair definitions of the words related to the content of the lesson. The child therefore understood the lesson in its parts but not as a whole. We hypothesized that the child was not able to "chunk" information. We implemented a simple intervention using mind mapping and much improvement was made. At the time of my observation this child was at serious risk of being permanently excluded (expelled). This is no longer the case.

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Inconsequent Behavior

Inconsequent behaviour

Children who repeatedly get into trouble for the same or similar behaviours are a great strain on their teachers and parents. They leave the adults responsible for their care confused, possibly angry and most certainly with a feeling that they lack the skills to cope.  Some people may advocate comprehensive and instant punishment for these children.  You have tried it and still nothing much changed.  Two questions must surely come to mind.  Why? What can I do about it? 

Children will engage in repeated naughty behaviours for a whole variety of reasons.  Some may be seeking attention and if they find a naughty behaviour that gets attention, not surprisingly they use it over and over.  For other children there may be an unintended pay off.  For instance they are told the next time you do that your parents will have to come into school.  As parents are separated the child feels that getting the parents together is a good thing and sure enough the behaviour is repeated.  The purpose of this paper is to focus on children who have a social comprehension difficulty.  A social comprehension difficulty describes a specific difficulty that may be likened to any other specific difficulty.  It could be riding a bike, dancing (me), dyslexia and so on. 

A very convenient way of analyzing behaviour is to view it using ABC analysis. 

  • A = Antecedent (that which come first, the trigger)
  • B = Behaviour (what happens as a result of the antecedent)
  • C = Consequence (much more than a sanction it also includes the effect on others)

An every day situation may be, Gill looks strangely at John when he can’t read a word.  John hits Gill.  The teacher keeps John in at playtime.  The other children get scared of John.  Gill really doesn’t like John and so on.  The consequences are huge. 

 

The first question to address is why does the adult impose a sanction, what are the assumptions behind it.  First assumption is that the adult does not really want this type of relationship with the child, they would rather be praising, but needs must, so a punishment is imposed.  The second assumption is that the next time John feels provoked he will think “The last time I hit someone I got kept in at break and I didn’t like that”.   This is where the adult could be wrong. 

Let’s assume that the child has a specific social comprehension difficulty.  In other words the process of learning via reward and punishment and the associated feed back via thought isn’t working too well.  Just as a child with dyslexia can’t process written text too well and the bad dancer can’t process music to movement efficiently.

If this were true what would happen.  Presumably the child would be getting into trouble over and over again for the same type of naughty behaviour.   One way to prove that this is the case would be to teach the child very actively about the behaviour consequence cycle.  Just as we provide dyslexics with multi-sensory teaching and the poor cyclist with extra support and time to learn these skills, we must give children who do not appear to have strong social comprehension skills a suitable intervention.   

What to do:  If you have picked up the reason for the child’s behaviour then an intervention called choice points is very effective.   It is probably best delivered as part of a general social skills development programme that is specifically tailored to the children in the group.  However, it can produce results if used as a one to one intervention.  I would suggest three sessions per week; each session only takes about ten minutes.   

The first step is to tell the child why you are doing this.  You are not doing it so that you can punish them but to help them because you think they are getting into trouble not because they are naughty but because they don’t understand.  The child will probably be rather lacking in trust so it may be best to use imaginary incidents at first.  As the child gains confidence in you s/he will be willing to be forthcoming about real incidents. 

Ask the child “What happened?”  You will probably get an answer that puts no blame on them, such as, “Jimmy hit me”.   Get a piece of paper and write this in the middle of the page and draw a circle around it.

 

Then ask, “What happened before that?”  Repeat what you did above, write it to the left of the previous comment and circle it.

Continue asking, “What happened before that?”  Until you are satisfied that you have a reasonable account of the beginning of the incident.

Read how the incident began to the child.  For instance, “Paul and Jimmy had an argument.  I walked into the classroom.   Paul told me that Jimmy had said rude things about my Mum.  I swore at Jimmy.  Jimmy hit me.”  Then ask, “What happened next?”  Continue as before but this time working your way to the right until you have a reasonable account of the whole incident.  Read back the whole incident to the child.  At this point they often want to add something.  If they do, add it and then read the whole incident back again.  If the child agrees with the map of the incident draw in some arrows so that the flow of the incident is clear and graphical.

Put the map in front of the child and ask if s/he can spot where they had a choice.  At first they find this difficult and you will probably have to help them.  After a while they get very adept at it.  Mark in the choices on the map.

Once the child has identified all the choice points ask, “What were the choices here?” Pointing to one of the choice points.  Write the choices they give you. As ever, at first the child will find this difficult, so the adult can take the lead and offer them some choices for their agreement.  For the first choice point some of the choices are:

  • Ignore Paul.
  • Tell Teacher
  • Swear at Jimmy
  • Hit Jimmy.
  • Ask Jimmy if it is true.

The next step is to use gently probing questions to help the child to understand the consequences for each choice.  You write this up in front of them.  It may look something like this:

  • Ignore Paul -- Nothing happens to me but I would be a bit cross for a while
  • Tell Teacher -- She would probably ask Jimmy if it was true or do nothing.  Nothing would happen to me.
  • Swear at Jimmy -- All sorts of trouble.  I ran out of school.  Mum is involved now.  
  • Hit Jimmy -- Probably get suspended.
  • Ask Jimmy if it is true --  If he did do it, I would probably hit him.  If he said he did not then nothing would happen.  I quite like Jimmy and we would still be friends.

The next step is to gently encourage the child to select the best choice for them.  

As time goes by you will be able to run through this procedure with the child or explore incidents in a group very efficiently with the child/children identifying choice points and the choices then selecting the best choice very rapidly.  They will transfer these skills to their life.  This can be a life changing experience for a child.

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How To Set A Reading Book At The Learning Level

Children read or look at books for a number of different reasons.  We ask children to read and look at books for a number of different reasons.  One of the reasons we ask children to read to us is to teach them to read.  If that is the activity we are engaged in with the child it is absolutely crucial that the book you are reading together is set at the learning level.  The following general rule is suggested by Marie Clay who became famous within the world of education due to her Reading Recovery system. 

Learning level = Child able to read 95 words in 100 (95%) 
Frustration level = Child able to read less than 95 words in 100 (<95%) 
Non learning level = Child able to read more than 95 words in 100 (>95%)

 

Obviously a few words either way is fine.  This is a general rule.  Ensuring a reading book is at the learning level is very easy.  All you need is a piece of paper, the back of an envelope will do.  A book, a child and you.  Ask the child to read the book to you.  As s/he reads, for each word correctly read do a / on the paper.  For each word the child is unable to read do an X.    You don’t actually need to let the child read 100 words, 50 will do and simply double the error count.  It is probably best if you do the scoring away from the child’s view.  Some people like to use an alternative to an X.  / and – for instance, then the child doesn’t see an X.  There is an example below done on the back of an envelope to give you a better idea.

 Good luck, stick at it and most children get there in the end.  If you feel that a child is not making progress we offer an advice service via e-mail.

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Handwriting Assessment For Teachers And Parents

Educational analysis of handwriting

This paper is concerned with the analysis of handwriting from an educational perspective, with a view to understanding the difficulties that a student may be experiencing in connection with writing by hand at school, college or university.  It will address the assessment of hand writing using standardised tests which are readily available to teachers and other professionals as well as describing how a standardised test of handwriting can be enhanced and supplemented using dynamic assessment techniques and describe how handwriting can be assessed without use of standardised tests.

The first step is to gather hand writing samples.  This can be done using standardised tests or using dynamic assessment techniques.  The Detailed Assessment of Speed of Handwriting (DASH), and its sister test, the Detailed Assessment of Speed of Handwriting 17+ (DASH 17+) are the standardised tests that my organisation has settled on.

The DASH is used to measure the handwriting speed of students from nine years to 17 years of age.  The DASH 17+ is used to measure the speed of handwriting of students from 17 years of age up to a test ceiling of 24 years 11 months.  This does not mean that the test cannot be used on students who are older than the test ceiling, although a note should be included when reporting the results that the scores are not offered as a truly standardised and accurate score.

The DASH and DASH 17+ tests the handwriting speed of a student under four different stresses: copying best, alphabet writing, copying fast and free writing.

The sub-test scores for all four can be cumulated in order to derive a standard score with associated percentile.

After the administration of a standardised test of handwriting speed you may wish to explore the student’s handwriting further using dynamic assessment techniques.  Alternatively you may not have standardised tests available or have objections to standardised tests.  If so the use of dynamic assessment techniques is very powerful.  Whilst this approach will not offer a standardised and statistically reliable score, it can allow students to be placed under higher levels of stress than the DASH or DASH 17+ where the free writing sample is provided under conditions of low cognitive demand: students free write about their life so far. 

To gather samples of a child or adults handwriting without use of standardised tests.  First type the standard sentence containing all letters of the English alphabet: The quick brown fox jumps over the lazy dog and print it out (Aerial 18).  Organise some sentences which will be presented visually at distance to emulate copying from the white board etc. during lessons/lectures.  Provide the student with pen and lined paper and ask them to:

  • copy the standard sentence in their best handwriting repeatedly for one minute.
  • copy the standard sentence in their fastest handwriting repeatedly for one minute.
  • copy from distance for one minute.  
  • free write about something simple, such as their day so far (low cognitive demand).  Allow five minutes for this with one minute for planning.
  • free writing about something complex (high cognitive demand).  This task needs to be appropriately challenging and set in relation the student and their course of study.  The task would be the equivalent to an examination question. Explain that they will need to spend 10 minutes on this task. Allow two minutes for planning.
  • Write to dictation (for secondary age students and above only).  Take your dictation sample from a text book they are currently using.

If a student has fast, average or generally slow handwriting it is likely that the words written per minute will be similar for each sample.  If using a standardised test very accurate tables will be available to you.  If using dynamic techniques the following writing speeds offer a rough rule of thumb 

Age                WPM

9                    10

10                  12

11                  14

12                 16

13                  18

14                  20

15                 22

16                 24

Adult          25

 

Analysing the Results and Intervention.

If you conclude that the writing speed is slow, then it may be useful to discuss making an alternative method of recording such as a lap top, tablet PC or a net book, the main method of recording at school, college or university.  To facilitate the effectiveness of this intervention it may be necessary for the student to further develop their touch typing skills.  This is usually done by use of software, there is an excellent training programme on the BBC web site: http://www.bbc.co.uk/schools/typing/ which is free of charge at the point of use.

Analysis of spelling error. You may wish to analysis the free writing sample for spelling errors under the following types.

  • phonetic errors: This type of error may occur due to phonetic attempts to spell a word, for example, ‘right’ may be spelled as ‘riyt’. omitting suffixes: for example, I am go to the park.  Rather than  I am going to the park. 
  • omitting plurals: for example, The Doctor had many patient waiting.  Rather than The Doctor had many patients waiting.
  • vowel substitutions: for example brothor, for brother
  • insertions, for example, whinning, for whining.
  • omissions, for example, beining for beginning.
  • transpositions, for example,  pharacuetical for pharmaceutical.
  • Substitutions, for example, subsidice for subsidise. 

During the hand writing sampling students may balk, become distressed or present behaviours that indicate they are under stress.  If so stop testing.  If this happens during the copying samples, an exploration of alternative ways of recording would be an appropriate intervention, this could include dictation using a scribe or voice recognition software, use of a personal computing device: lap top, net book, tablet.  If it occurs during the free writing samples then further training in academic planning skills with some additional time in examinations (if possible) would be a useful intervention. 

It is useful to report the student’s pen grip.  There is a progression in pencil grasp from early childhood onwards Schneck and Henderson (1990).  In general pen holds are broken down into functional and inefficient grasp.   

Functional Grasp Patterns 
Tripod grasp with open web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb and index finger form a circle. 

Quadripod grasp with open web space: The pencil is held with the tip of the thumb, index finger, and third finger and rests against the side of the fourth finger. The thumb and index finger form a circle. 

Adaptive tripod or D'Nealian grasp: The pencil is held between the index and third fingers with the tips of the thumb and index finger on the pencil. The pencil rests against the side of the third finger near its end. 

Immature Grasp Patterns 
Fisted grasp: The pencil is held in a fisted hand with the point of the pencil on the fifth finger side on the hand. This is typical of very young children. 

Pronated grasp: The pencil is held diagonally within the hand with the tips of the thumb and index finger on the pencil. This is typical of children ages 2 to 3. 

 

Inefficient Grasp Patterns 
Five finger grasp: The pencil is held with the tips of all five fingers. The movement when writing is primarily on the fifth finger side of the hand. 

Thumb tuck grasp: The pencil is held in a tripod or Quadripod grasp but with the thumb tucked under the index finger. 

Thumb wrap grasp: The pencil is held in a tripod or Quadripod grasp but with the thumb wrapped over the index finger. 

Tripod grasp with closed web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb is rotated toward the pencil, closing the web space. 

Finger wrap or inter digital brace grasp: The index and third fingers wrap around the pencil. The thumb web space is completely closed. 

Flexed wrist or hooked wrist: The pencil can be held in a variety of grasps with the wrist flexed or bent. This is more typically seen with left-hand writers but is also present in some right-hand writers. 

On occasion difficulties may be identified that will necessitate onward referral to an educational psychologist or occupational therapist.  For instance, if the percentage of illegible words exceeds 25% then there is a strong likelihood that an educational psychologist or occupational therapist may consider a diagnosis of dysgraphia supported by the results of test instruments such as the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) this would enable an assessment of the underlying skills associated with the development of hand writing to be explored.

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References:

http://www.bbc.co.uk/schools/typing/

Beery, K.E. & Beery, N.A. (2010) The Beery-Buktencia Developmental Test of Visual Perception and Motor Coordination. Bloomington: Pearson (6th ed.).

Frith, U., 1982. Cognitive Processes in Spelling and their Relevance to Spelling Reform. Spelling Progress Bulletin, 6-9.

Handwriting Identification: Facts and Fundamentals   Roy A. Huber, Alfred M. Headrick 1999 crc press LLC

JCQ/AA/LD Form 8.  Application for access arrangements – Profile of learning difficulties

Min, K., Wilson, W.H., Moon, Y., 2000. Typographical and Orthographical Spelling Error Correction. LREC Conference.

Spelling Progress Bulletin, Summer 1983, pp14-16] Spelling and Handwriting: Is there a Relationship?,by Michael N. Milone, Jr, Ph.D. James A. Wilhide, and Thomas M, Wasylyk** Zaner-Bloser, Inc., Honesdale, PA.

SpLD Working Group 2005/DfES Guidelines.

Varnhagen, C.K., Varnhagen, S., Das, J.P. 1992. Analysis of Cognitive Processing and Spelling Errors of Average Ability and Reading Disabled Children. Reading Psychology, 17(3): 217-239.

Exam Access Arrangements Form 8

The examination boards in the UK have, for some years now, allowed a variety of access arrangements for candidates with specific learning difficulties if diagnosed and recommended by an educational psychologist.   

The type of access arrangement will very much depend upon the results of testing, history,  interview with the young person and their normal method of working.  This will be undertaken by an educational psychologist.  The psychologist can recommend a variety of adjustments such as, extra time, the use of a scribe,  the transcription of the candidates script, use of a computer if this is the candidates main method of recording at school/college etc.  The aim is to allow, as far as is possible, a fair and level playing field for the candidate to operate on, without giving them unfair advantage.

In the UK, access arrangement assessments can be undertaken by the schools allocated educational psychologist.  However, pressure of work often leads to only the very serious cases being assessed and offered access arrangements.  Some children who have parents that can afford it are privately assessed, however this seems to annoy some teachers and there was some very dubious research which gave JCQ the excuse to make a series of regulations that in our opinion are counter to the 2010 Equality Act. Nevertheless at the current time if your child has not been assessed by an EP and no moves are being made to request access arrangements and you feel that this is wrong, then you need to liaise with the school and ask them to complete sections A and B of the Form 8, this must then be sent to the independent EP of your choice, who must then make a  diagnostic assessment, write a report and complete section C of the Form 8, which is then sent to school. In other words the school are in total control over who gets to ask JCQ for access arrangements.  Our reading of the Act is that reasonable adjustments (access arrangements) must be applied if a person has a recognised disability within the Act, such as a specific learning difficulty, however until this is challenged by legal means we must play by the current rules.  The costs for this can vary greatly, to see our current fees click here.

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Dyslexia Checklist

The diagnosis of Dyslexia is generally undertaken by an educational psychologist or a specialist teacher who has obtained additional qualifications in this area.  However, diagnosis only has meaning if it leads to a different approach to the education of the child.  Diagnosing Dyslexia and then doing nothing different in the classroom is as daft as diagnosing a broken leg, then failing to plaster it,  leaving the person without a crutch and a lift home.   What matters to the person with a broken leg will be the plastering of his leg, which prevents movement and pain, the crutch to help mobility and participation in society and the lift home because it’s an act of kindness and demonstrates consideration to his/her needs.  

There is no divine law of the universe that says classroom practice can only be adjusted after advice from a psychologist who has diagnosed Dyslexia.  If we saw someone struggling to walk, would we say they couldn’t be helped until they are diagnosed as having a broken leg by a doctor?   Wouldn’t the sensible approach be, to deduce that they might have a broken leg?  Then try some strategies like tying a stick to the bad leg to lessen movement and improvise a crutch. 

For a child that is experiencing literacy difficulties, but they are good at lots of other things it would be useful to use the following checklist.   By all means refer the child to an educational psychologist if they seem to fit lots of the indicators.  What would be really useful would be to see what effect changes to the way the child is expected to engage with learning materials has.  To experiment by adjusting approaches, finding what works and what doesn’t.  Reflective teaching in essence, is what will really matter to the child.  This is where the educational psychologist can be useful, they can ask perceptive questions and guide the process of learning about the child's learning.

Seek advice from an educational psychologist.

  1. Dyslexia checklist
  2. Did you worrythat s/he spoke later than other children of his age?
  3. Is there a family history of literacy difficulties?
  4. Is the child good at things that have a strong visual element?  But inexplicitly poor in other set tasks?
  5. Is there evidence of laterality confusion?  Check this by: Asking which hand s/he writes with, which foot s/he takes penalties with, ask them to look through a cardboard tube, which eye do they hold it up to?  Hand them your watch, which eye do they hold it up to?  Does everything happen with the same side or are some things done left sided and others right sided?
  6. Can the child follow a number of instructions in sequence?  For instance, “go to the living room and get my slippers, then bring them to me.”
  7. Is there evidence of reversals when writing? 
  8. Does s/he have particular difficulty with literacy or one area of literacy, such as spelling or reading?
  9. Is the child noticeably inconsistent when reading, recognising words then being unable to read the same wordlater in the day/book/page ?
  10. Can the child spot when a word is spelt correctly when offered a range of spellings for the same word? 
  11. Does the child spell the same word in different ways on the same page?  If asked the difference between the various spellings can they identify them?
  12. If you observe the child when engaged in literacy tasks is there a noticeable difference between on task time than when they are engaged in other tasks, such as drawing, practical activities?
  13. Is the child able to talk out an answer or story but produces little when asked to write it?
  14. Do people describe the child as clumsy?
  15. Can the child add a rhyming or alliteration word to a sequence of rhyming or alliterating words?
  16. Is the child on a much easier reading book than most of his/her close friends?
  17. Is the child in a much lower spelling group than their close friends?
  18. If you observe the class during a note taking or copying activity is there a marked difference between the child and the rest of the class?
  19. Is there a noticeable difference in work output if the child is given help with planning their work?
  20. If the child is taught strategies to develop sequencing skills, does this have an effect on their work output and general happiness at school?
  21. Has the child begun to resist writing because they are bad at it?
  22. If you observe the child during a copying from the board activity, do they appear to be looking up at the board much more often that the children around them?  Suggesting a weak short term visual memory.
  23. Has the child responded to a handwriting development programme?
  24. Have you noticed that the child has lost confidence over time in an educational setting.

 

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Dyscalculia Treatment And Intervention

If a child or adult has been diagnosed with dyscalculia or if they are experiencing difficulties with basic number processing then intervention is needed. Whilst there are well known, well used and recognised intervention plans and resources for dyslexic students the position with dyscalculia is less clear. If you are seeking to help a student with number processing difficulties access to an expert teacher with specialised training in the teaching of students with specific learning difficulties would be a good first step. Before appointing a specialist teacher it would be essential to discuss the approaches that they have found useful in the past and ask for an account of their depth and length of experience in dealing with dyscalculia. 

Some well tested and trailed resources are available such as the Oxford Publications Kinaesthetic Multiplication Table

The Davis Dyslexia approach to treatment of dyscalculia uses an array of approaches and makes much use of multi-sensory teaching methods, which some of our clients have found very effective.

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Dyscalculia Assessment And Diagnosis

A child or adult who presents significant difficulties with basic number processing and calculation, that is to say adding, dividing, subtracting and multiplying may be dyscalculic.

In the Dyslexia Centre, we take as a definition for dyscalculia that which was provided from the department for educational skills 2001 and the definition provided in DSM-5.

Dyscalculia is a condition that affects the ability to acquire arithmetical skills. Dyscalculic learners may have difficulty understanding simple number concepts, lack an intuitive grasp of numbers, and have problems learning number facts and procedures. Even if they produce a correct answer or use a correct method, they may do so mechanically and without confidence (DfES 2001).

Definition provided in DSM-5: specific learning disorder (F81.2) impediment in mathematics, problems with:

•    Number sense;
•    Memorisation of arithmetic facts;
•    Accurate and fluent calculation
•    Accurate math reasoning.
 

In order to make an evaluation and diagnostic assessment for dyscalculia in the Dyslexia Centre, we work to the guidance provided by the specific learning difficulties working group 2005/DfES. In order to conform to all these guidelines, the following process must take place; 

•    an in depth interview focused on mathematical history and experience
•    the administration of a dyscalculia screen
•    the administration of a standardised test of core mathematical processing and calculation skills.

In-depth interview
This interview can be undertaken with an adult client, an older child, a parent or teacher. It will focus on areas of difficulty which are then presented in the final diagnostic report.

The history section will include identified areas of difficulty such as; feeling anxious or nervous when asked to do maths or algebra, there will also be a section in the report where a mathematical support history is presented for instance; the level and intensity of support and intervention focused on the development of mathematical and calculation processing skills.

The report will also reflect any difficulty with everyday number experience for instance; difficulties with managing money or time management.

The report should also encompass a section where observations are made of the student when undertaking mathematical processing tasks.

Dyscalculia Screen:
There are many dyscalculia screens available, both commercially and free of charge. For students of 14 years + dyscalc 2013 is available free of charge on this website.

Standardised Test of Basic Numeracy Skills.:
The administration of a standardised test; number processing should take place using a reputable well known and well standardised test instrument such as: the WIAT-II numerical operations subtest.

The professional undertaking the diagnostic assessment, will need to take all information into account and furnish the reader with a diagnostic conclusion based on the evidence presented in the report.

Drug Misuse, A List Of Indicators

Signs of Drug Abuse

The misuse ofdrugs is a highly destructive event in the life of a teenager/young person and their family.  Generally speaking there is a period of time before families realise what is going on.  Naturally families go into denial and can't believe that this would be happening, this causes delay.  Time and time again it has been shown that early intervention is most likely to produce a favourable outcome. 

The following are well know and researched indicators.

1. Neglected appearance/hygiene  
2. Poor self image
3. Grades dropping
4. Violent outbursts at home
5. Frequent use of Eye Wash
6. Unexplained weight loss
7. Drug Paraphernalia and language
8. Slurred speech
9. Curfew violations
10. Running away
11. Skin abrasions
12. Hostility towards family members
13. Chemical breath
14.Glassy eyes
15.Red eyes
16.Valuables Missing
17. Possessing unexplained property often quite valuable
18. Stealing/borrowing money
19.Change in friends
20. Depression
21. Withdrawal
22.Apathy
23.Reckless Behaviour
24.No Concern about future
25. Defiles Family Values
26. Disrespectful to parents
27. Lying/Deception
28. Sneaky behaviour
29. Disregards Consequences
30. Loss of Interest in healthy activities
31. Verbally abusive
32. Manipulative/Self-Centred
33. Lack of Motivation
34. Truancy

The reader may find our page on addictions useful

Children Who Get In Trouble For The Same Thing Repeatedly

Inconsequent Behaviour

Children who repeatedly get into trouble for the same or similar behaviours are a great strain on their teachers and parents. They leave the adults responsible for their care confused, possibly angry and most certainly with a feeling that they lack the skills to cope. Some people may advocate comprehensive and instant punishment for these children; you have tried it and still nothing much changed.  Two questions must surely come to mind. Why? What can I do about it? 

Children will engage in repeated inappropriate behaviours for a variety of reasons.  Some may be seeking attention; if they find a naughty behaviour gains attention, not surprisingly they will use it over and over. For other children there may be an unintended pay off, for instance, they are told the next time they exhibit a certain behaviour, their parents will have to come into school.  The child may believe that, as their parents are separated, getting them together is a good thing; threrefore the behaviour will be repeated.  The purpose of this paper is to focus on children who have a social comprehension difficulty.  A social comprehension difficulty describes a specific difficulty that may be likened to any other specific difficulty.  It could be riding a bike, dancing (me), dyslexia and so on. 

A very convenient way of analyzing behaviour is to view it using ABC analysis.

A = Antecedent (that which comes first, the trigger) 
B = Behaviour (what happens as a result of the antecedent) 
C = Consequence (much more than a sanction, it also includes the effect on others) 
An every day situation may be: Gill looks strangely at John when he can’t read a word.  John hits Gill.  The teacher keeps John in at playtime.  The other children get scared of John.  Gill really doesn’t like John and so on.  The consequences are huge. 

The first question to address is why does the adult impose a sanction, what are the assumptions behind it?  The first assumption is that the adult does not really want this type of relationship with the child; they would rather be praising, but needs must, so a punishment is imposed.  The second assumption is that the next time John feels provoked he will think 'the last time I hit someone I got kept in at break and I didn’t like that'.   This is where the adult could be wrong.

Let’s assume that the child has a specific social comprehension difficulty, in other words the process of learning via reward and punishment and the associated feed back via thought isn’t working too well.  Just as a child with dyslexia can’t process written text too well, and the bad dancer can’t process music to movement efficiently. If this were true what would happen?  Presumably the child would be getting into trouble over and over again for the same type of naughty behaviour. One way to prove that this is the case would be to teach the child very actively about the behaviour consequence cycle; just as we provide dyslexic students with multi-sensory teaching, and the poor cyclist with extra support and time to learn these skills, we must give those with reduced social comprehention a suitable intervention.  

What to do

If you have highlighted the reason for the childs' behaviour, then an intervention called 'choice points' is very effective.  It is probably best delivered as part of a general social skills development programme that is specifically tailored to the children in the group.  However, it can produce results if delivered three times per week. Each session takes around ten minutes.   

The first step is to tell the child why you are doing this; you are not doing it so that you can punish them. You want to help them because you think they are getting into trouble not because they are naughty, but because they don’t understand.  The child will probably be rather lacking in trust, so it may be best to use imaginary incidents at first.  As the child gains confidence in you s/he will be willing to be forthcoming about real incidents. 

Ask the child “What happened?”  You will probably get an answer that puts no blame on them, such as, “Jimmy hit me”.   Get a piece of paper and write this in the middle of the page and draw a circle around it.

Then ask, “What happened before that?”  Repeat what you did above, write it to the left of the previous comment and circle it.

Continue asking, “What happened before that?”  Until you are satisfied that you have a reasonable account of the beginning of the incident.

Read how the incident began from the page to the child.  For instance, “Paul and Jimmy had an argument.  I walked into the classroom.   Paul told me that Jimmy had said rude things about my Mum.  I swore at Jimmy.  Jimmy hit me.”  Then ask, “What happened next?”  Continue as before but this time working your way to the right until you have a reasonable account of the whole incident.  Read back the whole incident to the child.  At this point they often want to add something.  If they do, add it and then read the whole incident back again.  If the child agrees with the map of the incident draw in some arrows so that the flow of the incident is clear and graphical.

Put the map in front of the child and ask if s/he can spot where they had a choice.  At first they may find this difficult, and you will probably have to help them.  After a while they will become very adept at it.  Mark in the choices on the map.

Once the child has identified all the choice points ask, “What were the choices here?”, pointing to one of the choice points, and write them in. If this is a social comprehension difficulty, then it is highly likely that they will have very few options to tell you.  Teach the child about some that they had missed out.  Four or five for each choice point is enough.

For each choice point you have four or five possible ways of responding (options).  For each option ask the child, “What would happen if you chose that one?”  Write in their response.  If they don’t know, or come up with something very unlikely, help and teach them. Do this for every option.

Now you have a complex map of the incident.  It contains a clear graphical map of the incident with the points at which the child had choices, and the choices that were available.  Attached to each choice is a prediction of the likely consequence for the child for each option.  For each choice point ask the child, “Which option would be best for you?” 

Give the child the map to look at. Do this every time the child is involved in an incident. 

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