Sunday 21 July 2019

Reform is vital if we want to end abuses of ADHD assessments

'The NCSE has proposed a reformed system, whereby access to resource teaching would no longer rely upon a formal diagnosis of learning difficulty, emotional or behavioural problems.' (Stock image)
'The NCSE has proposed a reformed system, whereby access to resource teaching would no longer rely upon a formal diagnosis of learning difficulty, emotional or behavioural problems.' (Stock image)

Thomas Byrne

If we accept what experts are saying, the way resources are allocated to students with learning difficulties has the potential to encourage the unnecessary labelling and possible over-diagnosis of behavioural disorders, such as ADHD in children from very early ages.

It needs to be said from the outset that ADHD or other emotional/behavioural conditions mentioned are real and they cause real effects and deserve proper support.

Practitioners make a convincing case that the increase in diagnosis for ADHD is reflective of the true prevalence of the disorder, which is finally being recognised after being drastically underestimated.

This is akin to the spike in autism diagnoses, which was also once a narrowly defined condition and was broadened into a spectrum in the 1990s. The number of children with an ASD diagnosis in Ireland has increased markedly in recent years, by 17pc since 2011 to 5,000 students this year.

The National Council for Special Education (NCSE), the body that has raised the issue of "diagnosis for dollars", seems to agree with this, too.

However, given what has been documented in other countries with regard to over-diagnosis and mislabelling of behavioural and emotional disorders in children, we need to take seriously warnings by the NCSE that professionals in Ireland are actively making some children "fit" into certain categories of disability.

Such 'over-categorisation' of behavioural or emotional problems in young children has the potential to be encouraged in Ireland due to the system we use for assessing and allocating additional resources for children with special education needs.

As the NCSE has said, many professionals see it as their duty to ensure these children can get access to additional teaching resources.

In these cases, they see themselves as acting as an advocate for the child.

I was shocked, even at this. There must be a line between diagnosis and advocacy.

Of course, some professionals could also be doing it for less august purposes, as the 'diagnosis for dollars' moniker suggests.

The relevant professional bodies need to respond.

The primary purpose of assessing a child who has been experiencing difficulty in a learning environment should be to inform parents on how to better support their children and to inform education authorities of what type of additional resources should be allocated.

It has been argued, by the NCSE and others, that over-labelling a child from an early age can potentially have negative impact on their self-esteem and may not in fact help to better support them.

Making a child 'fit' into diagnostic category simply for the purpose of gaining access to learning supports may mean that a temporary behavioural problem can become a more lasting one.

A wider issue with over-labelling is the effect it is having on the distribution of educational resources across schools. There are gross inefficiencies and inequities in the current system.

This is due to the fact that to gain access to additional resource teaching, a child must be assessed for learning difficulty by a psychiatrist, which can be done publicly by the National Educational Psychological Service (NEPS) or by a private consultant.

It is generally only better-off parents who can afford a private diagnosis of learning difficulty for their child.

The costs for private assessment can be €1,000.

By contrast, it takes at least a year (and often much longer) for students to be publicly assessed for learning difficulties by the NEPS.

Who can blame those parents who seek private assessment when the public waiting lists are so long?

This means that schools in more affluent areas also tend to be significantly advantaged under the current system, as more students with learning difficulties are diagnosed prior to entering junior infants and the schools can apply for supports prior to the student beginning school.

This means that schools in less advantaged areas also tend to have fewer resource-teaching hours per student.

The NCSE has proposed a reformed system, whereby access to resource teaching would no longer rely upon a formal diagnosis of learning difficulty, emotional or behavioural problems.

This would go a long way towards removing the need for psychiatrists to feel like they have to 'fit' a child into a specific diagnostic label.

However, there are also some legitimate concerns over aspects of the proposed new allocation model that will need to be addressed.

There is concern that instead of a child-centred approach, the new system gives an allocation of resource-teaching hours to schools based on their catchment demographic and socioeconomic profile. It should not be the case that any child with assessed needs is deprived of resource supports.

I also have concerns that, politically, any reformed system should not be used as an excuse for ignoring the glaring inequalities in access to psychiatric assessment for children.

A public assessment service should be available within a reasonable timeframe to ensure those children who need them do get the appropriate extra resources.

Irish Independent

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