Child Neuropsychology

There is a very interesting debate in the US at the moment about how to tackle reading problems (dyslexia). There is increasing interest in the Response to Instruction (RTI) approach- summarized here. This approach focuses on how to teach reading for everyone rather than just identifying and treating children with dyslexia. It is a public health approach focusing on prevention rather than an individual disorder approach focusing on treatment. In the UK the focus is more individual and based on clinical identification of dyslexia- i.e. does this person have dyslexia or not. Parents and teachers need to find someone – often a clinical or educational psychologist to diagnose dyslexia. This in turn depends on the parent or teacher recognizing the problem in the first place and many children seem to slip through the net. The psychologist will normally write a report with recommendations, which in my experience are often not followed. It is an inefficient system. The RTI approach seems to be more about looking at the school population as a whole. They screen the whole school population at a young age and then the children identified with delayed reading are either provided with minimal intervention or if this doesn’t work more intensive intervention. The focus is on how reading is taught (instruction) and how the child responds to this instruction rather than identifying disability. The research findings suggests that instruction accounts for a lot of reading difficulty and there is a large body of impressive research looking at the effectiveness of RTI- see this site for details. There is a reaction from some neuropsychologists who feel that RTI doesn’t address children with more severe deficits and more complex neuropsychological profiles- RTI is a bit of a catch all that misses the more unusual kids. Also there is concern about the use of RTI in practice. Whilst as a neuropsychologist I have some sympathy with this view I feel more strongly that children should be leaving school being able to read especially when the research shows that nearly all children can be taught with the right teaching methods-see previous posts on dyslexia. I don’t think we have got it right in the UK and too many children are failing. I really like the public health aspect that RTI advocates. If a smaller group of children who need further assessment and more intensive intervention could be identified using this approach and that there are then clear referral lines to a psychologist, it would be a better use of resources and may prevent a lot of children having a miserable and unproductive time at school. It should theoretically be possible to eliminate nearly all reading difficulties in the UK. I am aware of the inspiring work of Tommy Mackay who virtually eliminated reading difficulties in one school district in Scotland, but I am not aware of this happening in other places in the UK or of a political will to address this. I would be keen to learn of other people’s experience of this and any other thoughts- please post a comment.