What is the Purpose: Prevention or Diagnosis?
“What was the purpose of that?” my principal asked before I was all the way through her door. The first time she asked me this question, to be honest, I think my eyes filled with tears. I believed by asking that question, she was implying my carefully planned lesson was pointless. It turned out, that was just “her thing.” She began every post observation and reflection session with that same question. She wanted to make sure that her teachers always knew why they were doing what they were doing. Twelve years later, I ask the same question of the teachers I work with. This fall though, I began to ask myself that question, however in a slightly different context, as I don’t often create lesson plans anymore. I began to wonder what the purpose was of teacher questions about lack of student progress. I began to wonder what the purpose was in reviewing instructional materials that teachers used with struggling students? I began to wonder if my purpose was to help prevent a child from slipping further from success or if my purpose was to help diagnose Learning Disabilities.
I recently read, Developmental Dyslexia: Predicting Individual Risk by Thompson & Hulme (2015). They aimed to explore and identify a set of predictors of dyslexia and determine risk to an individual at different developmental stages. For this study Thompson & Hulme (2015) recruited 260 children, ages 3.5-8 years old, from three groups: families with a history of dyslexia, children for whom there were concerns regarding speech and language development, and typically developing children from a control group. They compared competency in language, letter sound knowledge, phonology, rapid automatic naming (RAN), executive function, and motor skills between children with a family risk of dyslexia and children without a family risk of dyslexia. Data were collected at approximately yearly intervals between the ages 3.5 and 8 through a comprehensive list of assessments. Thompson & Hulme (2015) found that at 3.5 years old, family risk and a poor knowledge of letters indicated a risk for developmental dyslexia. This bit of information sent me into an internal conflict, that I have not quite come out of yet.
I have always been told that you cannot diagnose dyslexia early because by definition, it is poor word reading and spelling, which is not developmentally applicable to young children. However, utilizing these risk indications would allow us to diagnose “possible” developmental dyslexia and begin to provide targeted, intensive instruction in phonemic and phonological awareness, which may actually make a difference for a student that is headed towards dyslexia. As we know, from countless studies, the further behind you get, the harder it is to catch up. This early diagnosis might allow us to make a difference. The risk with this is that we might “label” a child incorrectly, as a false positive, one that may never show any symptoms of developmental dyslexia. What does that label do to that child, to that family, to the child’s educational future? As I found myself in this internal debate, early intervention vs false positive identification, I turned back to my principal’s famous words, “What’s the purpose?”. Is the purpose of utilizing the results of this study prevention or diagnosis?
I find myself wondering the same about the current state of RTI in Delaware. In 2006 Fuchs and Fuchs wrote an article titled, Introduction to Response to Intervention: What, Why, and How Valid is it?, the same question is posed as Fuchs and Fuchs present different models of RTI implementation. One model, the problem solving method, utilizes individual instruction and constant adjustment based on student need. Student growth is compared to the growth of other classmates and the scores or time spent in intervention groups may vary to determine if special education is needed. This approach is more likely to identify false positives, students receiving special education that may not actually need it. The second approach that Fuchs & Fuchs (2006) discuss is the Standard Treatment Protocol. Essentially, this approach utilized a standard, systematic instructional plan. There are specific cut scores and less “wiggle room.” This approach is more likely to identify true positives, as the path to special education is more defined, but also more likely to identify false negatives (students who are successful in a small group are released back to their mainstream classroom as though that are treated, even though a learning difficulty may actually exist).
I found myself again debating which approach was better and turned back to wondering what my purpose was. Do I believe it is better to provide prevention, to try to stop a problem before it happens or begin “treating” a learning disability as symptoms occur before waiting for definite knowledge on what is going on or do I believe it is vital to get a diagnosis and treat accordingly? When I think about this in terms of a having something medically wrong, like high cholesterol, I wonder would I rather make no changes in my diet or routine until I have definitive medical proof that I have high cholesterol or would I immediately start adjusting my diet at the possibility of a positive test result? I know I would start adjusting my diet (perhaps after one final indulgent meal), but I would adjust. Eating more greens isn’t going to hurt anyone and it might even help considerably if something is off. Can phonological instruction be considered a green? Does it do enough good to offset the negatives of “blind treatment?” Should all students, or many more at the very least, receive a daily, “healthy diet” of systematic, foundational skills, such as phonological awareness in an attempt to provide prevention, or perhaps even prevent the necessity of a diagnosis? I believe that answer is a resounding yes! Bring on the “greens!”
Thompson, P. A., & Hulme. (2015). Developmental dyslexia: predicting individual risk. Journal of Child Psychology and Psychiatry, 56(9), 976–987. http://doi.org/10.1111/jcpp.12412
Fuchs, D., & Fuchs, L. S., (2006). Introduction to response to intervention: What, why, and how valid is it? Reading Research Quarterly, 41(1), 93-99.