Essay on Academic Achievement
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Example Essay on Academic Achievement
Poor academic performance in a primary school aged child could be a symptom of a myriad of biological, psychological and social conditions. These may vary from child abuse and neglect to learning disorders, to attention deficits, giftedness, and anxiety disorders. Initial assessment arising from such a broad complaint as ‘poor academic performance’ should involve a structured elimination process. This could involve various qualitative and quantitative assessment tools including interviews, observation, psychological tests, and neuropsychological measures. Hypotheses would be developed, depending on the evident deficits and difficulties being encountered by the child, and tested with a view to developing informed and efficacious intervention.
The discussion of assessment will focus on the importance of a multiaxial approach, such as that which is endorsed by the American Psychiatric Association (2000) and by Silver and Hagin (2002). Given the limited word limit and scope of this essay, and because intervention depends on what has been found during assessment (making it impossible to discuss all of the possible treatments), the focus here will be on differential diagnosis of and treatments for Dyslexia.
Thus the starting point is ‘poor academic performance’. Assuming the child was referred to a school psychologist, the role of the clinician in this situation is to determine why the child is performing poorly, to develop a suitable intervention plan, and predict outcomes. The DSM-IV-TR (American Psychiatric Association, 2000) focuses on five Axes of assessment: I) Clinical disorders, and Other conditions that may be a focus of clinical attention; II) Personality disorders, and Mental retardation; III) General medical conditions; IV) Psychosocial and environmental problems; and V) Global assessment of functioning. Similarly, Silver and Hagin (2002) have developed a multiaxial approach they believe to be optimal when assessing a child with the complaint at hand. It involves the thorough investigation of the child’s: 1) educational achievement; 2) educational opportunity; 3) peripheral sensory functioning; 4) cognitive functioning; and 5) neuropsychological and psychiatric functioning. There are two major differences between these two multiaxial approaches to assessment. The latter proposal is focused solely on disorders that impact on a child’s learning capacity, whereas the former focuses on adults, and not specifically on learning. Second is the lineal, step-by-step approach to diagnosis taken by the latter, compared to the DSM-IV-TR, which encourages a multiaxial approach but also acknowledges that it may not always be necessarily followed, nor is it a step-by-step method of assessment, rather a way of promoting a biopsychosocial approach to assessment and intervention. Groth-Marnat (1999) suggests a typical assessment in the educational setting would consist of behavioural, intellectual and personality measures. In addition, the nature and quality of the child’s learning environment should be assessed, as should academic skills, and biomedical disorders (Messick, 1984).
Ultimately, the purpose of diagnosis is to establish the child’s abilities and disabilities, assess environmental supports, narrow-down and pinpoint the causes of the child’s difficulties, guide the intervention process, provide a prognosis, and provide a timeline for revaluation (Silver & Hagin, 2002).
To begin, a structured and/or an unstructured interview could be carried out in order to obtain a thorough case history of the child. Information regarding past medical history, developmental history and attainment of milestones, pregnancy and other related complications, educational achievement and educational opportunity, social and family history, and current familial context should be obtained. The interview therefore provides important contextual information regarding the child’s background, a standard situation where the clinician may observe and assess emotions and abilities, as well an opportunity to establish rapport and the basis for a future therapeutic relationship with the child and their family (Harris, 1995). From this interview critical information may be obtained, and might need to be further investigated. For example, if it is found that a child’s home environment is not conducive to learning due to neglect or abuse, the clinician would need to consider the various steps that could be followed considering the situation. Other intervention might proceed, but if the child’s home environment is detrimental to their learning, these interventions may be futile.
Assuming nothing such as neglect is uncovered by the initial interview, Silver and Hagin (2002) recommend assessment of the child’s peripheral sensory functioning (information on this may be obtained through the initial interview). If visual or hearing impairments are found, further investigation and relevant intervention is required. If no peripheral sensory functional impairments are uncovered, a test battery, aimed at establishing where the child is performing cognitively, within age-appropriate norms, would follow. Validity and reliability of the measures used would of course be critical. Along these lines, it is advisable not to limit the battery to one or two tests only. Within reason, a wide variety of psychometrically sound tests should be used. Silver and Hagin (2002) advice that the chosen test battery should address three key areas of educational achievement: reading achievement, spelling and written language, and mathematics achievement.
The Wechsler scales are a standard place to begin. The Wechsler Intelligence Scale for Children-Third Edition (WISC-III) (Wechsler, 1992) would be the suitable scale for use with a primary aged child. This scale is an individually administered clinical instrument aimed at assessing the general intellectual ability of children aged 6 through 16 years 11 months. It may be used for the purposes of psychoeducational assessment, diagnosing giftedness and mental retardation, clinical, and neurological assessment. Being the third version of the WISC, the instrument boasts a substantial body of research addressing its psychometric features (Braden, 1995). In addition, different subtests of the scale focus on particular areas such as attention and speed of information processing, and verbal functions. Other tests of cognitive and intellectual function, suggested by Harris (1995), that could be utilised with a primary-school-aged child are the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) (The Psychological Corporation), Stanford-Binet (4th edition) (Riverside Publishing Company), Kaufman Assessment Battery for Children (K-ABC) (American Guidance Service), and the Hiskey-Nebraska Test of Learning Aptitude (H-NTLA), and the Wide Range Achievement Test (WRAT).
Behaviour and personality should also be attended to (Beck, 1995). Some of this information may be gathered throughout the initial interview, or even while administering the test battery. Otherwise, some relevant behaviour scales include the AAMR Adaptive Behaviour Scales: Residential/Community and School Versions (American Association on Mental Retardation), the Vineland Adaptive Behavior Scales (American Guidance Service) (both suggested by Harris, 1995), and inventories such as the Beck Depression Inventory (BDI).
If at this point the child demonstrates below average or generally limited cognitive functioning, a special education program would be developed (Silver & Hagin, 2002). However, if the child’s cognitive functioning is adequate, but they have nevertheless encountered difficulties in learning and their academic achievement is poor, the reason for the child’s difficulty needs to be further explored. The many tests administered so far would provide much information about the child’s language and problem solving capabilities. The clinician would at this point need to examine and evaluate the information already available and look for apparent deficits to be further investigated.
Neuropsychological and psychiatric functioning are the next steps in Silver and Hagins’ (2002) model. A clinical interview such as the Child Assessment Schedule (CAS), the Child and Adolescent Psychiatric Assessment (CAPA), the Schedule for Affective Disorders and Schizophrenia for School-age Children, Present and Lifetime Version (K-SADS-PL), and the Diagnostic Interview for Children and Adolescents (DICA) may be used to look at psychiatric functioning. Of course, when diagnosing a psychiatric disorder, elements such as general appearance, affect, and impulse control, which can be observed during an interview, should also be given due attention.
Although Silver and Hagin’s (2002) model is thorough and its linearity makes theoretical sense, different aspects of the assessment model may be addresses at different times, not necessarily in the order suggested, during diagnosis. For example, it may be that psychiatric assessment appears crucial to the clinician at the outset. This is not to discount the importance of other aspects of the model, but rather to leave room for professional discretion and expertise.
A neurological examination could look at areas such as movement, coordination, sensory integration (Silver & Hagin, 2002), attention/inhibition, mood and motivation, orientation and memory, speech and linguistic function (receptive language, language structure, phonological skills, lexical and semantic skills, syntactic skills, pragmatic language, and story narration), visuospatial function, visual-motor functioning, and executive functions (such as planning and decision-making) (Harris, 1995). Given the focus on Dyslexia, some specific language assessment tests that may be used in order to obtain a differential diagnosis are the Test of Language Competence (TLC-E), the Clinical Evaluation of Language Fundamentals-R (CELF-R), Spoken Narrative Analysis Procedure, Pragmatic Analysis (suggested by Harris, 1995), and the Neale Analysis of Reading Ability. Neurological factors, such as abnormal development of auditory areas of the brain, have been implicated in the development of Dyslexia (Pumfrey & Reason, 1993). Some research, although far from prolific, has found physical anomalies in particular areas of the brains of dyslexics post-mortem. However, non-invasive techniques would obviously be of more use when considering diagnosis and intervention. Some of these techniques involve brain stimulation, use of the electroencephalogram, and imaging techniques. Different language related activities would elicit different brain functions and show areas of dysfunction. These techniques are not commonly used in the diagnosis of Dyslexia.
Stanovich (1991) describes dyslexic children as children who “display deficits in various aspects of phonological processing. They have difficulty [with] sound segments at the phoneme level, … utilisation of phonological codes in short-term memory is inefficient, their categorical perception of certain phonemes may be [abnormal], and they may have speech production difficulties” (pp.6-7). Zillmer and Spiers (2001) categorise Dyslexia a learning disability and explain that it can be acquired “by insult to a previously normal functioning brain or be developmental in origin” (p.262). Two subtypes of Dyslexia are that which is caused by visual anomalies, and the other which is associated with auditory-language dysfunction. Individuals with the first affliction experience blurriness resulting from prolonged afterimages, which interferes with the ability to read. The second subtype, however, has been widely investigated and has received better support from the literature. This research has focused on phonological processing (the process whereby the grapheme/letter components of words are translated into phonemes/sounds). The specific difficulty dyslexic children display is translating letter combinations into a spoken word (decoding).
The DSM-IV-TR (American Psychiatric Association, 2000) states that children with Reading Disorder (RD) (otherwise known as dyslexic) is diagnosed when the individual demonstrates below average reading achievement, including reading speed and accuracy, given their age, intelligence, educational opportunity. The disturbance must significantly interfere with age appropriate academic demands and daily life where reading skills are required. If it is found that a sensory deficit is present, the reading difficulties experienced must be greater than that expected to be caused by the specific sensory deficit. Although the DSM-IV-TR states that RD is often referred to as Dyslexia, not all definitions of Dyslexia describe it as only a reading disability. The literature repeatedly includes in the definition of Dyslexia impairments in writing and spelling as well as with reading. Assessment, therefore, can be a complicated feat considering the myriad of definitions in the literature (Reid, 1998; Turner, 1997; Pumfrey & Reason, 1993). As discussed earlier in relation to general assessment for the complaint of ‘poor academic achievement’, RD must be differentiated from environmental and social causes of deprivation, such as lack of opportunity. Of course, normal variations in academic achievement must be allowed for. RD may sometimes be concomitantly diagnosed with mild Mental Retardation, or with Pervasive Developmental Disorder, and Communication Disorder. In addition, RD is often dually diagnosed with Mathematics Disorder and/or Disorder of Written Expression.
Defining and diagnosing Dyslexia is not as straightforward as one would like, due to the many definitions of the disorder. Reid (1998) describes at least five different approaches for the assessment of Dyslexia, each of which utilise different diagnostic tools. The standardised and diagnostic approaches use tools such as the Wechsler scales, the Neale Analysis of Reading Ability, analysis of miscues, and the Reading Assessment for Teachers (RAT Pack) to establish how the child is performing in comparison standardised norms. Phonological assessment is based on findings that link phonological skills training with reading skills development, and can be carried out using tools such as the Phonological Assessment Battery (PHAB), and the Lindamood Auditory Conceptualisation Test (LAC Test). Metacognitive assessment looks at the child’s self-awareness of learning, and observational assessment, which looks at a child’s attention, organisation, interactions and so on. These need of course not be exclusively used, but rather should be used in conjunction with one another in order to obtain a reliable diagnosis.
Treatment, as might be expected when the definition and assessment procedures are not unified, is also varied. HШien and Lundberg (2000) focus remediation for dyslexics around word decoding. They suggest six principles that have been found to benefit dyslexics. The first is ‘early identification and early help’. When students begin having difficulties reading they tend to fall into a self-defeating cycle where everything seems too difficult. This can cause loss of motivation and the development of a general negative attitude towards school. Programs such as ‘Reading Recovery’ have been found to have positive results with this population.
The second is ‘basic phonological work’. Studies with dyslexics have had promising results although better longitudinal research is required. Similar but slightly different, the third is ‘direct instruction’. Dyslexic children need to be given direct instruction about the written language, rather than simply being expected to ‘pick things up’. Much support has been found for these types of approaches (Pennington, 1991)
The fourth is ‘multisensory stimulation’ where auditory, visual, kinaesthetic, and tactile principles are applied to learning. The fifth is ‘mastery, overlearning, and automatization’. Because dyslexic children struggle with written language, they quickly fall behind what is normally expected of children their age. Therefore teaching and learning should be slowed down, and they should be given the opportunity to master the material before they are required to move on. The sixth and last principle proposed is the provision of a ‘good learning environment’, one that is conducive to learning and provides the required stimulation for each individual learner.
Although there are many available avenues implicated in the treatment of Dyslexia, parents and therapists should practice caution because there are also many ineffective therapies. Pennington (1991) cautions against the many visual therapies touted as effective, such as convergence training and eye movement exercises.
In summary, assessment for a child with poor academic performance should begin broadly, be mutiaxial, covering the many possible causes of such a manifestation and ensuring reliable and valid assessment. Having focused on Dyslexia, assessment becomes complicated due to the divergent ways of defining the disorder. However, decoding appears to be widely implicated by research and should therefore be a focal feature of intervention. In addition to phonics training, environmental and personal variables such as early detection and motivation should be central to an intervention plan.