To diagnose, or not to diagnose…

Is labelling a child with special learning needs doing more harm than good? We spoke to our in-house education team to get their thoughts.

struggling child diagnosed with learning problems
Dr Selina Samuels Chief Learning Officer BA(Hons), LLB, PhD, MEd Wednesday, 26 June 2019

It seems that nowadays, every student has a potential learning problem. Past controversy around the number of HSC students who apply for special consideration has led to calls for regulatory bodies, such as NESA in NSW, to tighten the application provisions. There’s even some cynicism creeping into public discourse around the “epidemic” of learning problems amongst our children and the dangers of false diagnoses. 

We’re all familiar with the overzealous labeller — the teacher whose classes routinely defy all reasonable statistics because over half of her students are “on the spectrum”, or the parents who insist that their child is “borderline ADHD” and “a bit OCD”. 

Are diagnoses reliable?

Learning problems pose particular challenges as, unlike most mainstream medical conditions, the official diagnostic process relies to some extent on subjective interpretation and trial by error. Nonetheless, there are well-accepted clinical approaches to diagnosing and treating most learning problems.

There’s also the argument that even if a diagnosis correctly identifies an underlying problem, it could be counterproductive. Do we really want a student to carry around a special needs label through their early years of school? Are we creating unnecessary stigma and reduced expectations for them in class and within social situations?

Some educators are also concerned that medicalising behaviour doesn’t allow for meaningful treatment. Special learning needs are lifelong. The argument goes that to medicalise first, without giving students the skills they need to manage their behaviour, will make it harder for them to navigate daily life as adults. Below we’ll discuss the fact that medication often allows children to focus and move past their learning barriers, ultimately gaining the necessary skills to develop in life.

People point to the danger of stigmatising certain behaviour when the reality is that we’re all on a spectrum of learning behaviours. What’s normal? Are we narrowing the definition of normal and creating an increasingly exclusionary model of learning and education? An ASD diagnosis might encourage a student to self-limit. It may also encourage parents and teachers to treat a child as vulnerable, to over protect and thus give them fewer skills and resources to cope as adults. 

Lazy labels might exist, but diagnosis is still important

There’s been particular controversy around diagnoses of Attention Deficit Hyperactivity Disorder (ADHD) and the use of medication as a therapy. The media has been noisy with reports and studies (medically qualified and otherwise) that overdiagnosis of the condition is leading to an over-prescription of Ritalin.

These arguments against over diagnosis are persuasive. But just because some students are mislabelled, doesn’t mean that the majority of cases don’t benefit from diagnosis and treatment.  

Not all diagnoses lead to medication

Most interventions for special learning needs are behavioural and psychological. Some of the most successful of these are relatively minor but hugely beneficial, such as providing students who are easily distracted with noise-cancelling earphones for quiet work or giving them some one-on-one support. If students and their parents or teachers don’t understand the challenges they face, they’ll never receive the support they need. 

In some cases, medication is the appropriate avenue to help a child stay calm and focus so that they can learn the skills that will in turn set them up to self-manage as they get older. 

It’s certainly important to avoid lazy labels based on small amounts of information. We’re always going to discourage teachers from progressing instantly from observation to diagnosis and parents from relying too much on Dr Google. But listen to a parent who, after a formal process of diagnosis (which often spans months and multiple specialists), now knows that their child is not alone and can learn. When diagnosis and treatment are successful, students can experience a revelation, taking them from a point of feeling stupid or broken, to understanding that they have equal abilities but just work in a slightly different way. In this case, knowledge is power. 

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