Supporting Disorders of Learning

and Co-ordination

This revised and updated third edition, previously titled The Effective
Teacher’s Guide to Dyslexia and Other Learning Difficulties (Learning Dis-
abilities), unravels the complexity of specific learning difficulties in an
accessible and user-friendly way.
Each chapter provides key information about the disorder in question,
giving a clear definition before discussing prevalence, causal factors, identi-
fication, and assessment and provision. Implications for the curriculum and
related assessment, pedagogy, resources, therapy/care, and school and
classroom organisation are explained, allowing providers to reflect and
adapt their practice in response to the needs of the individual. The book
informs effective provision, with the aim of encouraging the best achieve-
ment and personal and social development for children and young people.
The book authoritatively and lucidly addresses issues associated with

 impairment in reading/dyslexia,
 impairment in written expression/dysgraphia,
 impairment in mathematics/dyscalculia, and
 developmental co-ordination disorder/dyspraxia.

Recognising the importance and the challenge of multi-professional

working, the book relates provision to the roles of parents and carers
alongside that of the practitioner. Underpinned by research and widely
held professional judgement, this will prove a practical, readable, and
inspiring resource for professionals in the UK, US, and elsewhere including
teachers, therapists, psychologists, and students entering these professions.

Michael Farrell is a widely published private special education consultant.

He works with children, families, schools, local authorities, voluntary
organisations, universities, and government ministries. He has published
books extensively with Routledge, with recent titles including The Special
Education Handbook (4th edition) and Debating Special Education.
The Effective Teacher’s Guides Series, all by Michael Farrell

The Effective Teacher's Guide to Behavioural and Emotional

Disorders: Disruptive Behaviour Disorders, Anxiety Disorders
and Depressive Disorders, and Attention Deficit Hyper-
activity Disorder, 2nd edition
PB: 978-0-415-56568-4 (Published 2010)

The Effective Teacher's Guide to Sensory and Physical

Impairments: Sensory, Orthopaedic, Motor and Health
Impairments, and Yraumatic Brain Injury, 2nd edition
PB: 978-0-415-56565-3 (Published 2010)

The Effective Teacher's Guide to Autism and Communication

Difficulties, 2nd edition
PB: 978-0-415-69383-7 (Published 2012)

The Effective Teacher's Guide to Moderate, Severe, and

Profound Learning Difficulties (Cognitive Impairments), 2nd
edition
PB: 978-0-415-69387-5 (Published 2012)

Supporting Disorders of Learning and Co-ordination: Effective

Provision for Dyslexia, Dysgraphia, Dyscalculia, and Dyspraxia,
3rd edition
PB: 978-1-032-01271-1 (Published 2022)
Supporting Disorders of
Learning and Co-ordination

Effective Provision for Dyslexia,

Dysgraphia, Dyscalculia, and Dyspraxia
Third edition

Michael Farrell
Third edition published 2022
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2022 Michael Farrell
The right of Michael Farrell to be identified as author of this work has been asserted
by him in accordance with sections 77 and 78 of the Copyright, Designs and Patents
Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in
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invented, including photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks,
and are used only for identification and explanation without intent to infringe.
First edition published by Routledge 2006
Second edition published by Routledge 2011
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Names: Farrell, Michael, 1948- author.
Title: Supporting disorders of learning and co-ordination : effective provision for
dyslexia, dysgraphia, dyscalculia and dyspraxia / Michael Farrell.
Other titles: Effective teacher’s guide to dyslexia and other learning difficulties
(learning disabilities)
Description: 3rd edition. | Abingdon, Oxon ; New York, NY : Routledge, 2022. |
Series: The effective teacher’s guides | Revised edition of: The effective teacher’s guide
to dyslexia and other learning difficulties (learning disabilities). 2nd ed. 2012 | Includes
bibliographical references and index.
Identifiers: LCCN 2021019870 (print) | LCCN 2021019871 (ebook) | ISBN
9781032012735 (hardback) | ISBN 9781032012711 (paperback) | ISBN
9781003177975 (ebook)
Subjects: LCSH: Dyslexia--Great Britain. | Dyslexic children--Education--Great Britain. |
Learning disabled children--Education--Great Britain.
Classification: LCC LC4710.G7 F37 2022 (print) | LCC LC4710.G7 (ebook) |
DDC 371.91/440941--dc23
LC record available at https://lccn.loc.gov/2021019870
LC ebook record available at https://lccn.loc.gov/2021019871

ISBN: 978-1-032-01273-5 (hbk)

ISBN: 978-1-032-01271-1 (pbk)
ISBN: 978-1-003-17797-5 (ebk)
DOI: 10.4324/9781003177975

Typeset in Bembo
by Taylor & Francis Books
Contents

About the author vi

Preface to the 3rd edition viii

1 Introducing disorders of learning and co-ordination, and

provision 1
2 Impairment in reading/dyslexia 7
3 Impairment in written expression 28
4 Impairment in mathematics 48
5 Developmental co-ordination disorder 69
6 Multi-professional working 90

Index 101
About the author
 About the author vii

Michael Farrell was educated in the United Kingdom. After training as a

teacher at Bishop Grosseteste College, Lincoln, and obtaining an honours
degree from Nottingham University, he gained a Master of Arts degree in
education and psychology from the Institute of Education, London Uni-
versity. Subsequently, he carried out research for a Master of Philosophy
degree at the Institute of Psychiatry, Maudsley Hospital, London, and for a
Doctor of Philosophy degree under the auspices of the Medical Research
Council Cognitive Development Unit and London University.
Professionally, Michael Farrell worked as a head teacher and as a lecturer
at London University. He managed a national psychometric project for
City University, London, and directed a national initial teacher-training
project for the United Kingdom Government Department of Education.
For over a decade, he led inspections of mainstream schools and of special
schools and units (boarding, day, hospital, psychiatric). Currently, he works
with a range of clients as a private special education consultant. The coun-
tries where he has lectured or provided consultancy services include China,
Japan, the Seychelles, Australia, Peru, Sweden, and the United Kingdom.
Among his books, which have been translated into European and
Asian languages, are Looking into Special Education (Routledge, 2014) and
Investigating the Language of Special Education (Palgrave Macmillan, 2014).
Preface to the third edition

It is a great pleasure to be writing the preface to Supporting Disorders of

Learning and Co-ordination (third edition). When I heard from readers and
led conferences using the previous edition of this book, then called The
Effective Teacher’s Guide to Dyslexia and Other Learning Difficulties, it
became increasingly clear that it spoke to a wide range of people.
Certainly, these included teachers, head teachers, classroom assistants, and
school governors and managers. But equally important were psychotherapists,
audiologists, speech and language therapists/pathologists, and many
others. Parents of children and young people with a disorder of learning
or co-ordination were important participants.
In this new edition, I am pleased to better reflect this wide range of
interest not only in the book’s title but in its content. The book has also
been updated to reflect further developments in research and understanding.

Michael Farrell
Herefordshire, United Kingdom
[email protected]
Chapter 1

Introducing disorders of
learning and co-ordination,
and provision

Introduction
Here, I introduce disorders of learning and co-ordination. The chapter
explains aspects of these disorders such as ‘prevalence’ and ‘causal fac-
tors’, and, regarding provision, discusses examples such as, ‘pedagogy’,
‘therapy’, and ‘organisation’. I outline the content and structure of the
book, highlighting features of this new edition, and explain for whom
the book is intended.

Disorders of learning and co-ordination

Disorders of learning and co-ordination discussed in the present
book are

 impairment in reading/dyslexia,
 impairment in written expression/dysgraphia,
 developmental co-ordination disorder/dyspraxia, and
 impairment in mathematics/dyscalculia.

These disorders are sometimes called ‘specific’ in that, being cir-

cumscribed, they do not imply a generalised difficulty in learning (as
does for example cognitive impairment). The designation goes back
some years. In the US, ‘specific learning disability’ is one of the
designated disability codes (code 9) reflecting categories of disability
under federal law which include impairment in reading, impairment in
written expression, and impairment in mathematics (20 United States
Code 1402, 1997). In England, a similar classification, ‘specific learning
difficulties’, comprises dyslexia, dyscalculia, and dyspraxia (Department
of Education and Skills, 2005).

DOI: 10.4324/9781003177975-1
2 Introducing disorders

Aspects of disorders of learning and co-ordination

In each of the subsequent chapters on different types of disorders, I discuss
definitions, prevalence, causal factors, and identification and assessment.

Definitions of disorders
Defining a disorder as clearly as possible is naturally important. Definitions
may involve criteria such as those set out in the Diagnostic and Statistical
Manual of Mental Disorders Fifth Edition also known as DSM-5 (American
Psychiatric Association, 2013). These in turn relate to identifying and
assessing the disorder. However, these definitions are debated. For some
commentators, the term ‘dyslexia’ can be misleading when interpretations
separate it from difficulties with reading that many professionals and
researchers consider central (Elliott and Grigorenko, 2014).

Prevalence
In the present context, prevalence refers to the ‘amount’ of a disorder in a
population at a specified time. Often, it is given as a percentage (or pro-
portion) of the population in question. ‘Point prevalence’ therefore con-
cerns the percentage at a specific point in time, such as a stated date. ‘Period
prevalence’ refers to the percentage over a longer time between two spe-
cified dates. As to the population, it might be the wide general one, or a
smaller subgroup such as people in a certain age band. A related term,
‘incidence’ is a measure of the new cases of a disorder arising in a popula-
tion in a specified period, for example a day, a month, or a year. Such
information enables health care and education providers to plan provision.
Estimates of prevalence of a condition such as impairment in reading can
vary widely. People may disagree about the nature of the condition, and
therefore about the criteria used in identifying and assessing it. Where there
is such disagreement, it affects confidence in what represents suitable
provision.

Causal factors
Because it may not be possible to identify what directly causes a disorder,
the expression ‘causal factors’ is used. This allows attention to be drawn to
several potentially relevant influences. With impairment in reading,
researchers have examined many contributary candidates, including pho-
nological processing/deficit, visual processing, rapid naming, and auditory
processing.
 Introducing disorders 3

Identification and assessment

Identification and assessment of types of disorders is linked to definitions
and related criteria. Where a disorder has been defined and criteria have
been developed for it, it is unsurprising that this is used in identification and
assessment. Related to this is the use of psychometric tests, observations of
the individual, and discussions with others.

Co-occurrence of disorders
Some disorders commonly co-occur. To take just one example, the co-
occurrence of developmental co-ordination disorder with attention deficit
hyperactivity disorder is about 50% (American Psychiatric Association,
2013). Where disorders arise together, it may be because of common
underlying causal factors. Or the disorders may relate to shared difficulties
with ‘underlying’ skills such as attention and memory.

Aspects of provision for disorders

In later chapters, as well as aspects of disorders, provision for them is also
discussed regarding curriculum and related assessment, pedagogy,
resources, therapy/care, and organisation.
Curriculum refers to the content of what is to be presented to or made
available for an individual. It is devised with the intention that a student
will gain knowledge, build a skill or skills, and develop certain attitudes
and values. It is the ‘what’ of enabling learning and development. Such a
framework also involves structure, like the content being set out in a
certain order (for example from easy to harder aspects).
Where it is important to know that something has been learned,
curriculum-related assessment comes in. If an individual has been
learning aspects of phonics, then assessments may be carried out to see
if these have indeed been acquired.
Pedagogy concerns methods of teaching that enable learning. It may
involve encouraging the use of senses to enhance learning – looking, lis-
tening, touching, and so on. The learner may be encouraged to practice a
skill in small steps and build from these into more complex skill patterns.
Guidance (through discussion) may be given to help an individual develop
attitudes like respect for others.
Resources refer to the materials, equipment and other aids used to
enhance learning and development. Examples are pencil grips, computers
and software, rulers, microscopes, gymnasium equipment such as wall bars
and vaults, and maps.
4 Introducing disorders

Therapy refers to provision involving specialists in certain areas of

development. They include speech and language therapists/pathologists,
physiotherapists, psychotherapists, psychologists (clinical, school/
educational), physicians, and nurses.
Care relates to therapy. It concerns ensuring that the health and
well-being of an individual are enhanced and involves teachers, teaching/
classroom assistants, medical and nursing professionals, and others.
Organisation has to do with grouping arrangements made to encourage
learning and development. It may refer to learners interacting in pairs or
small groups. On a wider scale, it can denote the organisation of a setting
where a larger number of learners are present. This might be a school,
clinic, tuition centre, or similar, where decisions are made about grouping
learners, for example, according to age.

Provision and effectiveness

Aspects of provision such as ‘curriculum’ and ‘organisation’ interrelate.
Provision may comprise programmes or approaches in which content,
pedagogy, and resources overlap. However, distinguishing these aspects
can help providers to systematically review what they offer.
Provision is expected to be ‘effective’ in enhancing learning and devel-
opment. This implies that there is evidence from studies, or professional
consensus among those using the approaches, of their benefits. Important to
establish are the efficacy and anticipated outcomes of a particular practice,
whether expected outcomes match an individual’s needs, and potential risks
of protracted intensive interventions, including threats to family cohesion.
Approaches can be evaluated drawing on evidence-based practice. They are
also informed by professional judgement, and the views of the individual
with the disorder and of their family or carers. Provision for a particular
individual should encourage progress, development, and well-being.

Accommodations and modifications to programmes

A distinction is made between special education accommodations and
modifications. Essentially, accommodations are physical or environ-
mental changes an educator makes to the learning setting. Examples are
giving more time to complete a task, allowing short breaks within the
allocated time, changing the layout of the room or part of it, and using
computer software to ‘read’ text to the student. These enable the learner
to work round a potential difficulty.
Modifications may be made where learners have profound cognitive or
other difficulties. They change the core programme by using a parallel
 Introducing disorders 5

curriculum that does not include all standards typical of the age grade in
question. It may involve changes in standards required, courses followed,
and timing of programmes. This may include lower-level reading,
eliminating specific standards, and modifying the curriculum.

Order and structure of subsequent chapters

Remaining chapters of this book each cover a disorder of learning or
co-ordination:

 impairment in reading/dyslexia;
 impairment in written expression/dysgraphia;
 impairment in mathematics/dyscalculia; and
 developmental co-ordination disorder/dyspraxia.

New to this edition is a chapter on multi-professional working

reinforcing the importance of professionals understanding each other’s
role and pulling together with a common purpose.
Each chapter typically includes a definition of the disorder, prevalence,
causal factors, and identification and assessment. This is followed by a
description of provision, such as projects, approaches, and schemes found to
be effective and supported by professional judgement, brought together
under a framework of curriculum and related assessment, pedagogy,
resources, therapy/care, and organisation. Each chapter offers thinking
points to encourage discussion and reflection. Key texts are mentioned for
further reading. References are included at the ends of chapters so that they
are available if an individual chapter is copied or purchased electronically.

Proposed readers
Proposed readers include those involved in education, namely teachers,
head teachers, classroom assistants, and school governors and managers.
Also central are psychologists, audiologists, speech and language therapists/
pathologists, and many other professionals, as well as parents and carers.

Conclusion
Impairment in reading/dyslexia, impairment in written expression/
dysgraphia, developmental co-ordination disorder/dyspraxia, and
impairment in mathematics/dyscalculia may be grouped as disorders of
learning and co-ordination. They can be understood in relation to
their definitions, prevalence, causal factors, identification and
6 Introducing disorders

assessment, and co-existing conditions. Provision can be identified in

terms of curriculum and related assessment, pedagogy, resources, therapy
and care, and organisation.

References
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental
Disorders Fifth Edition (DSM-5). Washington DC, APA.
Department of Education and Skills (2005) Data collection by special educational
need(2nd edition). London, DfES. https://dera.ioe.ac.uk/7736/.
Elliott, J. G. and Grigorenko, E. L. (2014) The Dyslexia Debate. New York,
Cambridge University Press.

Legal citations
20 United States Code 1402, 1997 (Title 20 – education chapter 33 education
of individuals with disabilities, subchapter 1, ‘general provisions’ section 1402
Office of Special Education Programs) https://law.justia.com/codes/us/1997/
title20/chap33/ subchapi/sec1402.
Chapter 2

Impairment in reading/
dyslexia

Introduction
Reading involves word reading skills, reading fluency, and understanding/
comprehension. Impairment in reading/dyslexia is difficult to define, a
situation exacerbated by researchers using different criteria to characterise it.
Owing to this, estimates of prevalence vary widely.
Impairment in reading involves cognitive causal factors. These are
phonological processing/deficit, auditory and visual processing, rapid
naming, short term and working memory, and attention. There are also
possible neurobiological causal factors, but they are less well understood.
Identifying and assessing reading impairment includes using commercial
assessments.
Provision addresses three aspects: phonics learning, reading fluency,
and reading comprehension. Provision for phonics learning involves
explicit phonics teaching, generalising phonological skills to reading, and
group approaches that support phonics awareness and understanding.
Interventions to improve reading fluency include RAVE-O (Retrieval,
Automaticity, Vocabulary elaboration, Engagement with language,
Orthography), and structured reading programmes that are flexibly linked
with reading fluency approaches. Improving reading comprehension
involves, general strategies, vocabulary instruction, and multi-component
approaches to strategy instruction.
Such provision relates to the curriculum and assessment, pedagogy,
resources, therapy, and organisation.

Reading and reading processes

Receiving e-mails and text messages, poring over a newspaper magazine
or book, agreeing a contract, navigating a supermarket, and under-
standing labels are part of everyday life. In all these examples, and many

DOI: 10.4324/9781003177975-2
8 Impairment in reading/dyslexia

more, modern society demands that its members can read. It is under-
standable therefore that difficulties with reading and what can be done to
help people who experience them attract continuing interest and research.
Given that fluent, accurate reading draws on processes and skills, it fol-
lows that problems with reading involves such processes. Reading has been
described as, ‘a process of constructing meaning from print’ involving
‘decoding’ and ‘comprehension’ (Pullen and Cash, 2011, p. 409).
Decoding requires the reader to master subskills including

 phonological awareness and an understanding that written letters

represent sounds which are blended into words (the alphabetic
principle),
 recognising words,
 understanding concepts involved in print,
 developing vocabulary, and
 spelling (Ibid., paraphrased).

Reading comprehension involves

 recognising words,
 reading fluently, and
 accessing and using background knowledge relevant to understanding
passages of text (Ibid., paraphrased).

Key aspects of reading therefore include word reading skills, reading

fluency, and understanding/comprehension. As we shall see later,
developing these are central features of provision.

Definition of impairment in reading

The widely used Diagnostic and Statistical Manual of Mental Disorders Fifth
Edition (DSM‑5) (American Psychiatric Association, 2013, pp. 66–74)
proposes a category of ‘specific learning disorder’. This may involve com-
binations of impairment in reading, written expression, or mathematics.
Specific learning disorder broadly concerns ‘Difficulties learning and
using academic skills’. Importantly, attempts have been made to tackle
these difficulties with targeted interventions, but they have persisted. The
disorder begins during school age years and the ‘symptoms’ are not better
accounted for by other conditions or factors such as intellectual disabilities
or ‘inadequate educational instruction’. (Note that DSM-5 makes it clear
that difficulties arising from poorly targeted and inadequate ‘instruction’
must not be mistaken for a specific learning disorder.)
 Impairment in reading/dyslexia 9

Regarding reading, for at least six months there must have been
‘symptoms’ of ‘inaccurate or slow and effortful word reading’ and
‘difficulty understanding the meaning of what is read’. Reading is
‘substantially’ below levels expected for the individual’s age causing
‘significant interference’ with academic performance, work perfor-
mance, or daily living. This is indicated by the results of individually
administered standardised achievement measures and ‘comprehensive
clinical assessment’. The subskills involved are word reading accuracy,
reading rate or fluency, and reading comprehension (Ibid., pp. 66–67).
The vague notion of reading achievement being ‘substantially below’
expectations requires further clarification. One way of achieving this is
through using the standard deviation of reading scores. This is a statistical
indication of variation showing the spread of scores about the mean in a
‘normal distribution’. A reading score of two or more standard deviations
below the expected level would be considered ‘substantially below’.
Sometimes, for example where the disorder has significantly affected per-
formance in the test of general intelligence, a reading score falling one
standard deviation below the expected level may be sufficient.
A strength of the use of the term ‘specific learning disorder’ is that it
conveys a complex disorder which may involve combinations of
impairment in reading, written expression, or mathematics. A difficulty
in using the expression ‘dyslexia’ is that it may be seen by some com-
mentators as a separate condition detached from other seemingly related
disorders. Accordingly, DSM-5 (American Psychiatric Association, 2013,
p. 67) refers to dyslexia as ‘a pattern of learning difficulties characterised
by problems with accurate or fluent word recognition, poor decoding,
and poor spelling abilities’ (Ibid.). Related criteria specify that any addi-
tional difficulties, such as in mathematics reasoning should be specified
(Ibid.).

Prevalence
Prevalence estimates of reading problems vary widely. For ‘specific
learning disorder’, which, as we have seen, can include combinations
of disorders of reading, written expression, and mathematics, they
range from 5% to 15% for school aged children (American Psychiatric
Association, 2013, p. 70). Estimates of dyslexia range from 5–8% to
20% (Mather and Wending, 2012; Shaywitz, 2005). Regarding read-
ing comprehension, research found that about 3–4% of readers with
‘adequate’ word reading skills (above 90 standard score) had poor
comprehension (below 90 standard score) (Klingner, Vaughn, and
Boardman, 2015, p. 4).
10 Impairment in reading/dyslexia

Why do prevalence estimates vary so much? Impairment in reading and

related terms are defined and put into practice in different ways. Also, the
strictness of the criteria used varies. Where impairments are brought toge-
ther as ‘specific learning disorders’ researchers may not distinguish within
this group impairments in reading, written expression, and mathematics.

Cognitive causal factors

Reading problems have underlying them various interacting difficulties
with cognitive (mental) processes (Snowling and Hulme, 2011, p. 4).
Prominent among these are

 phonological processing/deficit,
 auditory processing,
 visual processing,
 rapid naming,
 short term memory and working memory, and
 attention.

Phonological processing/deficit
Phonological processing is important to reading, and someone with
impairment in reading may often experience problems with such
processing, that is, a phonological deficit.
Phonological knowledge enables us to understand that changing a
speech sound in a word alters meaning. This allows us to distinguish
between such words as ‘cat’ and ‘hat’ or ‘bit’ and ‘big’. Hearing our own
speech, we modify it as necessary to make the required word. Our
phonological system helps make the process become automatic. It lays
down a phonological representation of the speech sound sequence. We
draw on this cognitive representation when developing awareness of the
different sounds in a word.
In reading English, the speech sounds (there are 44 of them) are linked to
written marks (graphemes). This enables us, usually as children, to develop
a link between sound and written marks, a so-called phoneme–grapheme
correspondence.
In line with this understanding of phonological processing, Tunmer
(2011) proposes several aspects:

 phonetic perception (encoding phonological information);

 phonological awareness (accessing phonological information and
performing mental operations on it);
 Impairment in reading/dyslexia 11

 lexical retrieval (retrieving phonological information from semantic

memory which involves the meaning of words);
 short term verbal recall (retaining phonological information in
working memory); and
 phonological recoding (translating letters and their patterns into
phonological forms) (Ibid., p. x, paraphrased).

Having set out the complex nature of phonological processing, we

can now consider the impact of problems with it. A core deficit in
phonological processing may be a common cause of reading difficulties
(Elliott and Grigorenko, 2014). Children with dyslexia may have problems
processing spoken words in a precise manner because cognitively they are
not fully laying down representations of speech sounds.
As the representations become degraded, it becomes harder to acquire
phonological skills such as phonological awareness and decoding links
between letter and sound. Weak phonological decoding may mean that
the learner struggles to link the spoken and visual counterparts of printed
words. This in turn weakens the storage of high-quality representations of
word spellings which can impair rapid word identification and reading
fluency (Ibid., pp. 42–49).
Researchers reviewed studies looking at relationships between phonemic
awareness, short term verbal memory, children’s word reading skills, and
rime awareness, (Melby-Lervåg, Lyster and Hulme, 2012). (Linguistically, a
rime is that part of a syllable that comprises its vowel and any consonant
sounds following it. In the word ‘tub’ the rime is ‘ub’.) The researchers
found that poor readers, compared with typically developing younger
readers at the same reading level, had a large deficit in phonemic awareness
(Ibid.).
Also, various interventions based on a hypothesised phonological deficit
have been developed. These have been found to improve the skills and
performance of struggling readers at least in the short term (Olson, 2011).
However, the phonological deficit hypothesis is not a complete
explanation. Not all children with reading impairments experience a
phonological deficit. Indeed, children with poor phonological skills
can go on to develop good reading skills (Catts and Adlof, 2011).
Nevertheless, phonological deficit is likely one of several interacting
deficits leading to reading impairment (Ibid.).

Auditory processing
Auditory processing refers to a sequence in which a sound is taken in
through the ear and conveyed to the brain’s language area for
12 Impairment in reading/dyslexia

interpretation. A disorder or delay in auditory processing does not imply

abnormal hearing. It is a matter of processing rather than hearing.
Auditory processing likely influences phonological awareness. Impaired
auditory processing tends to limit our ability to reflect on the sounds and
words we hear, perhaps partly causing phonological deficits.
Various auditory processing deficits appear to be more likely in children
and adults with reading impairment (Elliott and Grigorenko, 2014, p. 68).
Training programmes can improve the auditory task performance of
children with auditory processing deficits, but there is less evidence that
this improves reading (McArthur, 2009).

Visual processing
Visual processing concerns the brain’s ability to use and interpret visual
information from our surroundings. Translating light energy into a
meaningful image involves many brain structures and higher-level
mental processes. When reading, visual analysis involves identifying each
letter, encoding its position in the relevant word, and (when reading a
sequence of words), establishing an ‘attentional window’ focusing
attention on a single word.
A feature partly explaining visual difficulties affecting reading is ‘abnor-
mal crowding’ which impairs the visual discrimination of nearby letter
contours. Features unrelated to the ‘target’ may be incorrectly integrated so
that letter discrimination is made harder (Schneps et al., 2013).
A study assessed the binocular vision of 26 ‘dyslexic children’ using visual
tests and ophthalmological tests (concerning the anatomy and functioning
of the eyes). Where assessments required visual convergence, and ability to
look with both eyes was unstable, the children had less control of their eye
movements (Castro, Salgado, Andrade, Ciasca, and Carvalho, 2008).
A ‘magnocellular’ (large cell) visual pathway may relate to reading
problems. This pathway appears to detect movement, contrast, and rapid
changes in the visual field. Lowered sensitivity in this system may limit
the suppression of visual information so that images last too long on the
retina. Therefore, visual information accumulates, reducing visual acuity
(clarity of vision) especially the precise recognition of small details.
Reduced visual acuity leads to impaired reading.
In line with a magnocellular theory, people with dyslexia may
experience lowered sensitivity to rapidly presented stimuli, which can
lead to poor performance in visual tasks and problems reading (Stein,
2008; Wright and Conlon, 2009). However, it is considered that there is
insufficient evidence of a possible magnocellular deficit to base treatment
on it (American Academy of Pediatrics, 2009).
 Impairment in reading/dyslexia 13

Rapid naming
Some children with reading difficulties have problems with ‘rapid
automatized naming’, the ability to quickly name items (visual stimuli)
they already know. In research demonstrating this, people are shown a
series of familiar items such as letters, numbers, colours, or objects, and
asked to name them. The naming speed tends to correlate with difficulties
in reading (Norton and Wolf, 2012).
There is debate about how much poor naming speed and phonological
deficit might sometimes combine creating a ‘double deficit’. More practi-
cally, it is doubted whether naming speed can be increased, and even if it
could, whether this would produce better reading performance (Ibid.).

Short term memory and working memory

Short term memory passively stores information. Working memory
concerns storage and processing, and involves a central executive system
and controlled processes relating to attention. Both types of memory
have been linked to reading problems. Opinions differ about whether
memory processes can be improved directly and, even if they can,
whether this would improve reading.
Educators sceptical about improving memory processes by direct
intervention may concentrate more on teaching relevant skills of reading
and spelling. In any event, teachers are likely to take account of any
difficulties a learner has with memory. They might avoid overloading
the learner with excessive information that could be presented in parts.
Educators may also teach students memory strategies like grouping
information in clusters (Gathercole and Alloway, 2008).

Attention
In the present context, ‘attention’ refers to focusing one’s awareness on
something while shutting out other stimuli. If someone is slow transferring
attention from one item to another, it may create difficulties in dealing
with sequences of visual or auditory information (Lalier, Donnadieu,
Berger, and Valdois, 2010). Accordingly, some individuals with impairment
in reading may find it hard to disengage from visual and auditory stimuli
presented in quick sequence.
Regarding auditory processing, slowness in shifting attention might
interfere with the perception of rapid streams of speech. This could hinder
the development of phonological representations and impair reading.
Turning to visual processing, a visual attention span deficit might limit the
14 Impairment in reading/dyslexia

number of letter string elements that the reader can process simultaneously
again impairing reading (Bosse, Tainturier, and Valdois, 2007).

Genetic and neurobiological causal factors in reading

There is ‘limited knowledge and understanding of the role genetic factors
play in reading development’ (Elliott and Grigorenko, 2014, p. 121).
Research indicates that impairment in reading has a genetic component.
However, genetic knowledge cannot presently enable such impairment to
be separately identified or point to individualised types of intervention.
Neurobiology concerns the biology of the nervous system. Regarding
brain anatomy and physiology, imaging enables the shape and size of brain
features and brain functioning to be studied. This indicates differences
between individuals with impairments in reading and typically developing
readers. However, such research does not differentiate a dyslexic sample
from a larger group of poor decoders. Neither can brain based measures
determine a sample of poor readers who are likely to benefit from a parti-
cular type of intervention (Elliott and Grigorenko, 2014, pp. 88–122).

Identification and assessment

Where there are concerns about a learner’s reading, educators, school/
educational psychologists, and speech and language pathologists/therapists
may review a range of evidence. Identifying and assessing difficulties with
reading may include

 developing a profile of the learner’s mistakes such as their omitting

words or confusing one letter with another,
 bringing together from different sources an account of how the
learner reads, for example, whether they hesitate over words, and
 establishing whether the learner prefers reading silently or aloud and
whether one preference leads to better reading comprehension than
the other.

Reading skills
Commercial assessments of ‘dyslexia’ and subskills of reading are available,
standardised for the country concerned. Sampling skills that relate to
reading and to impairments in reading, they include assessments of
phonological skills and rapid naming of visual stimuli.
Dynamic Indicators of Basic Early Literacy Skills (DIBELS 8) (University of
Oregon, 2020) takes a curriculum-based approach to assessing reading
 Impairment in reading/dyslexia 15

comprising a series of standardised assessments for learners in Kindergarten

through sixth grade. DIBELS 8 has six sub tests aimed at assessing compo-
nent skills of reading. These are letter naming fluency (LNF), phonemic
segmentation fluency (PSF), nonsense word fluency (NWF), word reading
fluency (WRF), oral reading fluency (ORF), and a maze.
Reading and word assessments may be part of a wider set of assessments.
The Woodcock Johnson IV Test of Achievement is a comprehensive set of tests
exploring strengths and weaknesses in cognitive, oral language and
academic abilities. It includes a standardised measure of sight word
knowledge (Woodcock, Schrank, McGrew, and Mather, 2014).

Reading comprehension
Reading comprehension is not assessed solely with one procedure. Rather,
several approaches are generally used, tailored to specific circumstances.
Assessments include tests standardised on a wider population, informal
reading inventories, interviews with the learner, questionnaires, and obser-
vations. Learners can be asked to retell what has been read or can be
encouraged to talk about what they are thinking as they read (Klingner,
Vaughn, and Boardman, 2015, p. 42). Taken together, several such assess-
ments show strengths and weakness in reading comprehension. Using a
range of carefully chosen assessments can reveal different insights into the
learner’s problems.
The Gray Oral Reading Test (GORT-5) (Widerholt and Bryant,
2012) covers a wide age range from 6 to 23 years 11 months.
Administered individually by a specialist teacher, it takes about 20 to
30 minutes to complete. The test uses 16 reading passages which are
placed in a developmental sequence. Each passage is followed by five
multiple-choice comprehension questions.
The Woodcock Reading Mastery Test (Woodcock, 2011) is used for
ages ranging from 4 years 6 months to 79 years 11 months. It takes
between 15 and 45 minutes to administer individually. The test assesses
reading readiness and reading achievement. Its subtests concern pho-
nological awareness, listening comprehension, letter identification,
word identification, rapid automatic naming, oral reading frequency,
word attack, word comprehension, and the comprehension of passages.

Provision
Approaches to reading impairment tend not to try to improve in isola-
tion deficits and skills underpinning difficulties (Friedmann, Kerbel, and
Shvimer, 2010). Rather, they tackle reading skills and knowledge
16 Impairment in reading/dyslexia

directly, not ignoring underlying skills, but expecting such skills to

improve in the context of more practical, direct learning of reading.
Accordingly, interventions tend to focus on provision for

 phonics learning,
 reading fluency, and
 reading comprehension.

Phonics learning
Approaches to enhance phonics learning include

 explicit phonics teaching,

 approaches to generalise phonological skill to reading, and
 group approaches supporting phonics awareness and understanding.

Explicit, systematic phonics teaching

Explicit and implicit phonics

Explicit, systematic phonics teaching begins with phonics and builds
up to words. On the other hand, implicit phonics teaching begins
with words and their context and works back to the phonics, as
necessary.
Explicit, systematic phonics teaching has been found to be effective
in helping people young and old with impairments in reading to learn
to decode words effectively (Roberts, Torgsen, Boardman, and Scam-
macca, 2008). See also https://www.readinghorizons.com/reading-stra
tegies/teaching/phonics-instruction/what-is-systematic-and-explicit-p
honics-instruction.

The Phono-graphix® Reading Intervention and Instruction Programme

In the phonemic code of written English, each sound in a spoken
word is represented by some part of the written version. The Phono-
graphix® Reading Intervention and Instruction Programme (The
Phono-graphix® Reading Company, 2020) centralises these phonetic
code implications. It teaches the phonological skills of blending, seg-
menting, and manipulating phonemes, which are required to use a
phonemic code. Phono-graphix® systematically, explicitly teaches
correspondences in sound-to-symbol relationships.
 Impairment in reading/dyslexia 17

Generalising phonological skills to reading

An approach intended to generalise learners’ skills to reading is the
PHAST Track Reading Programme. PHAST stands for PHonological
And Strategy Training. Aiming to encourage skills in reading, com-
prehension, spelling, and writing, it builds on two components.
The first, Phonological Analysis and Blending/Direct Instruction trains
the learner in sound blending and left to right phonological decoding stra-
tegies. The second component, the Word Identification Strategy Program,
helps develop metacognitive word identification strategies (for example,
identifying words by analogy, or looking for familiar parts of the word).
A sequence of strategies is used in conjunction with initial phonological
training. One is rhyming, introducing up to 120 key words which enable
other words to be read (as ‘and’ enables reading ‘hand’, ‘sand’, and so on).
A further strategy, ‘game plan’, enables the learner to apply all the other
strategies.
Developed for children with impairment in reading, the PHAST
Track Reading Programme allows for individual or group teaching.
Designed as a 70-hour lesson plan, classes last one hour, four to five days
a week for 14 to 18 consecutive weeks. An adaptation, PHAST PACES,
was developed for high school readers and young adults. See http://dys
lexia-ca.org/pdf/files/lovettmar07/lovett2.pdf for an overview.

Group approaches supporting phonics awareness and

understanding
What is the most suitable setting for systematic, explicit phonics teaching
and ensuring students generalise phonics skills to wider reading? Initially
it may require individual or small group teaching. However, supporting
activities and approaches can take place in larger groups.
Elements of such support are basic pedagogic principles. They include
drawing direct attention to features of language to raise awareness and
recognition, fostering an interest in language and how it works, and
encouraging learners to practice certain sounds, words, and expressions
that they may find difficult. Encouraging careful listening is also impor-
tant. Along with speech, aids like pictures or objects can be used to help
memory by presenting information in several sensory modes – auditory,
visual, and tactile.
Educators and speech-language pathologists can ensure that learners/
clients improve their awareness of sounds and sound sequences convey-
ing meaning in speech. Students can practise using and recognising key
sounds that change meaning. Examples are ‘er’ at the end of words such
18 Impairment in reading/dyslexia

as ‘fast’, ‘soft’, and ‘hard’ that convey an increased quality; or ‘un’ at the
beginning of words such as ‘tidy’ or ‘dressed’ that create an opposite.
Similarly, speech comprehension practice can be used to help learners
notice key sounds that convey meaning and signal changes in meaning.
Educators can teach learners to listen for and recognise the sound ‘s’ at
the end of a word when it signals a plural as in ‘cat’ and ‘cats’. Educators
can help a learner’s speech comprehension by using visual aids like a
picture of one ‘cat’ and several ‘cats’ when saying the respective words.
Similarly, objects such as toys or everyday items can also be used to
supplement speech and clarify the purpose of the activity.
Where new vocabulary is introduced, students can be encouraged to
take an interest in a word or phrase. Teachers and speech pathologists can
explicitly teach and check the learners’ understanding of various aspects of
vocabulary: word meaning, its grammatical function, and its phonological
make-up. Phonological aspects may include asking questions: ‘How do the
sounds of the word break up?’; ‘How do the sounds of the word blend
back together?’; and ‘What are the syllables of the word?’.
In a school, improving awareness and understanding of phonics can be
planned across the curriculum. This helps to ensure all teachers, not just
literacy specialists, recognise the importance of support for reading and
understanding. It can enhance subject teaching and improve reading
because all members of staff contribute.

Reading fluency
Among approaches to improve reading fluency are

 general strategies for reading fluency,

 structured reading programmes that are flexibly linked with reading
fluency programmes, and
 Retrieval, Automaticity, Vocabulary elaboration, Engagement with
language, Orthography (RAVE-O).

General strategies for reading fluency

General approaches for improving reading fluency use broad pedagogic
principles. These include repetition and practice, developing familiarity
with the material to be read, building confidence through nurturing
success, using a rich variety of attractive materials that generate readers’
interest, and creating an encouraging environment.
Before reading a passage, a few selected key words from the text can
be examined in preparation. They can be read, used in a sentence,
 Impairment in reading/dyslexia 19

spoken aloud, briefly discussed and in such ways made familiar. Working in
pairs using flash cards can add interest to this activity. With this preparation,
reading the passage soon afterwards becomes easier. Reading material
should be chosen so that it does not require too many preliminary key
words. Otherwise, it is harder for the reader to remember the words, and
the point is lost.
Where learners feel anxious about reading, teacher and student can
begin by talking about a picture accompanying the text. This can lead to
discussing what the passage is likely to be about and provide some of the
key words that will emerge. If this is done regularly, anxiety of thinking
that a reading session is always about diving straight into challenging text
is reduced and progress can be improved. More broadly, it is important
that the environment is relaxed but purposeful. Mistakes should be seen
not as failures but as the opportunity to try again and get it right.
Learners can read the same material several times. If this is not overdone
to the point of boredom, it can make reading a particular passage easier so
that the learner gains confidence. The reader begins to recognise the
rhythm and pace that is missed if reading is anxiously stilted.
Material that is interesting and stimulating to readers increases
motivation. Finding out what sort of material engages the reader can
give pointers. Short passages can be used initially. A limerick or other
short verse, pages from a well-illustrated book, comics with speech bubbles
and captions, extracts from a familiar story, passages of information on
computers, are just a few examples.
Learners should be encouraged to read at a manageable pace at which
they can understand, which may be slow at first. At the same time, they
should be guided to keep the pace steady. As reading fluency improves,
pace will increase.
As an educator, you can check that when using computer text, a
reader is adopting a font style and size and text spacing that aids reading
fluency. This is particularly important where a reader has difficulties with
visual processing but can also help other readers chose a font and spacing
with which they feel more confident, so long of course as it helps their
reading including fluency. Please also see articles at Read and Spell on
fluency strategies at https://www.readandspell.com/fluency-strategies-
for-struggling-readers.

Structured reading programmes linked with reading fluency

programmes
If learning to read accurately and being able to read fluently are both
important, combined interventions make sense. Accordingly, structured
20 Impairment in reading/dyslexia

reading programmes have been used with approaches for improving

reading fluency.
One intervention provided groups of two or three second-grade students
(age 7 to 8 years) with a daily 45-minute sessions for six months. It
developed instruction using the Responsive Reading Instruction Programme
(Denton and Hocker, 2006) and other suitable fluency interventions as
appropriate. These were used flexibly within a framework of lesson
components according to learners’ individual needs. Researchers com-
pared a group that experienced the intervention with a group receiving
typical school instruction. In word identification, phonemic decoding,
word reading fluency, and comprehending sentences and paragraphs,
the intervention group made significantly better progress. However, the
two groups were similar in reading pseudo words, text reading fluency,
and comprehending extended passages (Denton et al., 2013).
Such research suggests that combining approaches can lead to benefits,
but that not all aspects of reading are equally enhanced. This underlines
the importance of having flexible links between strategies so the overall
approach can be adjusted to improve aspects of reading where progress
was weaker.

Retrieval, Automaticity, Vocabulary elaboration, Engagement with

language, Orthography (RAVE-O)
RAVE-O is a programme to develop reading fluency by helping learners
to achieve automaticity in word knowledge. It is designed for certain
readers in second grade (age 7 to 8 years) through fifth grade (age 10 to 11
years). They will be reading below grade-level and/or will struggle with
fluency or ‘naming speed’. RAVE-O may also benefit English-language
learners. To achieve fluency, learners must be able to automatically retrieve
letter patterns and their related sounds. Importantly, they must be able to
automatically access the meanings of words, roots and affixes, and the role
of words in sentences.
In small groups, learners read text to form new knowledge and ideas,
and to improve reading achievement. RAVE-O connects phonics,
spelling, vocabulary, grammar, and morphology, to aid reading fluency
and comprehension. Sessions build skills in the sounds that form the
structure of words, in recognising common letter patterns, and in
developing knowledge of vocabulary. Learners practice parts of speech
and discuss the roots and suffixes of words. Eventually these skills are
connected to reading passages of text. Wolf, Barzillai, Gottwald, Miller,
and colleagues (2009) and https://www.voyagersopris.com/literacy/ra
ve-o/overview provide an overview of RAVE-O and related evidence.
 Impairment in reading/dyslexia 21

Reading comprehension
In examining reading comprehension, we look at general issues, vocabulary
instruction, and multi-component approaches.

General points on reading comprehension

Success in reading comprehension assumes that learners have a good
foundation of skills, knowledge, and understanding in phonics learning
and reading fluency. Therefore, if there are problems with reading
comprehension, it is important to make sure that the precursors have
been securely laid down.
Even where a learner has a grounding in phonics and reading fluency,
reading material must be pitched at the right level to enable comprehen-
sion. If reading material is too hard, a reader has to give attention to phonics
and fluency so that comprehension is likely to suffer. The teacher can
temporarily lower the reading challenge of the text being used to allow
comprehension to develop. Familiar reading material can be used enabling
attention to be focused on comprehension. A variation of finding easier or
familiar reading material is that it can be read as a preparation for building
up to more challenging text. This allows the reader to become familiar with
the content before tackling the harder text.
Reading aloud and reading in pairs or small groups can aid comprehen-
sion. If someone else is reading, a particular student can follow the text,
focusing on comprehension. When the student themselves is reading aloud,
they are also hearing themselves read, adding an auditory dimension to aid
comprehension. On the other hand, an individual might be anxious about
reading aloud in front of others and understanding may be diminished.
Discussing what is being read aids comprehension of both stories and
factual articles. Prior to reading students can be encouraged to think
about the title of a piece and ask what the passage might be about and
what aspects could be especially interesting. When reading, the learner
can sometimes pause to discuss the content, and what might follow.
Once material is finished, the reader can be asked to talk about it,
paraphrase it, and express their opinion of it.

Vocabulary instruction
Vocabulary instruction where it improves understanding of word
meaning contributes to reading comprehension. Vocabulary can be
taught a few words at a time so that new concepts are introduced
manageably and related to familiar concepts (Joseph, 2008, p. 1172).
22 Impairment in reading/dyslexia

Word meaning can be taught directly by introducing the word,

providing a definition, giving examples of its use, and encouraging
learners to use the word in context. Learners can make a visual ‘map’
or web to show links between the meaning of a target word, and
related words. This can stimulate the learner to make related mental
links. Sometimes a word’s meaning can be remembered by linking it to
a vivid or comical image that suggests what it conveys.

Multi-component approaches
We have already touched on general strategies aiding comprehension
before, during, and after reading. Multi-component approaches develop
this in a more structured way, helping learners use comprehension strategies
while they are learning content from text. Three examples are: reciprocal
teaching, transactional strategy instruction, and collaborative strategic
reading. Each uses discussion with peers to help readers to comprehend,
and to use independent reading strategies.
Reciprocal teaching involves prediction, summarising material,
generating questions, and clarifying. These guide group discussions of
material that has been read. As an educator, you initially model how to use
the comprehension strategies. You then use prompts, questions, and
reminders to support learners in using the strategies themselves while they
are reading and discussing the text. Gradually as students become more
competent, support is reduced. Prediction, summarising material, generat-
ing questions, and clarifying are used collaboratively and in dialogue to
make the text meaningful and help learners absorb the strategies (Please see
Klingner, Vaughn, and Boardman, 2015, pp. 173–179, for a summary).
In transactional strategies instruction, educators explain and emphasise
approaches used by learners with good strategies. Gradually educators give
learners responsibility for strategic processing, encouraging collaboration,
and nurturing interpretative discussions. Teachers describe the processes
both internal and external that they use while reading (predicting,
visualising, inferring, summarising, monitoring for understanding, and
activating existing knowledge). To encourage learners to transfer stra-
tegies, teachers indicate when and where they could be used, giving
prompts and cues so that eventually students apply the strategies on their
own initiative (Brown, 2008).
Collaborative strategic reading teaches learners to use comprehension
strategies while working collaboratively in small peer groups on exposi-
tory text. Teachers first present the strategies to the learner group using
modelling, role playing, and speaking their own thoughts while reading
or doing a related activity. As students begin to absorb the strategies, the
 Impairment in reading/dyslexia 23

teacher organises them into mixed cooperative learning groups. Each

group member carries out a specified role while implementing the stra-
tegies with the others, for example as leader, or helping the group work
out the meanings of difficult words (Klingner, Vaughn, and Boardman,
2015, pp. 184–192, provide a summary).

Curriculum and assessment, pedagogy, resources,

therapy, and organisation
Having looked at a range of interventions, approaches, strategies, and
programmes, it is now possible to draw together issues in relation to
broad areas of learning and development. These are curriculum and
assessment, pedagogy, resources, therapy, and organisation.

Curriculum and assessment

Where learners have impairment in reading and are taught in a school, the
curriculum may emphasise language and reading by providing more time
for these with necessary support. Within other curriculum areas such as sci-
ence or history, the reading element will be an important focus of support.
Small steps of assessment may be used with language and reading to
ensure that a student’s progress is recognised. Within the wider curriculum
there may be programmes encouraging phonics skills and understanding,
reading fluency, and reading comprehension like those described earlier.
These often combine curriculum content, approaches to pedagogy, and
specific resources.

Pedagogy
Individual specialist tutoring may be necessary to accelerate the progress of
learners with reading impairment. In teaching structured information such
as phonics, pedagogy should be systematic and explicit. Multi-sensory
teaching can help a learner remember new material. Educators model
strategies and approaches, ensuring that students gradually adopt them so
that support can be gradually lowered. Paired and small group discussion is
used for example with reading comprehension. Encouragement and a
supportive ethos are created to reduce any anxiety felt by learners.

Resources
Some assessments involve commercially developed tests. For some phonics-
based interventions, commercially produced programmes are available.
24 Impairment in reading/dyslexia

Computer software that supports reading may also be used. Materials like
printed lessons and computer activities associated with programmes may be
employed. Photographs and objects are used to stimulate interest and aid
memory for example in aspects of phonics teaching.

Therapy
A speech-language pathologist may work directly with individual learners
or small groups. They may take a consultancy role supporting teachers and
parents for example to help with learners’ phonological difficulties.

Organisation
Supporting learners with impairment in reading is likely to involve small
group work. Some will require intensive one-to-one sessions with a
specialist tutor or speech-language pathologist. Such individual work
may take place in a resource room, or tutoring room. Where individual
work is necessary in a school, it should not prevent the learner experi-
encing a rich, relevant curriculum. Schools and clinics may offer training
workshops for parents wishing to learn about their approaches and who
may wish to continue them at home.

Conclusion
Reading involves word reading skills, reading fluency, and understanding/
comprehension. Widely used guidance identifies impairment in reading as a
‘specific learning disorder’ which may involve combinations of impairment
in reading, written expression, or mathematics. Where the term ‘dyslexia’ is
used, guidance suggests that additional difficulties like reading comprehen-
sion or mathematics reasoning should be specified. Estimates of the pre-
valence of impairment in reading and dyslexia vary widely. Cognitive
causal factors include phonological processing/deficit, auditory and visual
processing, rapid naming, short term and working memory, and attention.
There is limited understanding of the role of genetic factors in reading
development. Identifying and assessing reading impairment includes the use
of commercial tests.
Provision for reading impairment involves phonics learning, reading
fluency, and reading comprehension. Phonics learning concerns explicit
phonics teaching, generalising phonological skills to reading, and general
group approaches supporting phonics awareness and understanding.
Provision to aid reading fluency includes general strategies, structured
reading approaches linked with reading fluency programmes, and
 Impairment in reading/dyslexia 25

RAVE-O (Retrieval, Automaticity, Vocabulary elaboration, Engagement

with language, Orthography). Among reading comprehension interven-
tions are general strategies, vocabulary instruction, and multi-component
approaches. All these aspects of provision relate to the curriculum and
assessment, pedagogy, resources, therapy, and organisation.

Thinking points
What justifications are there respectively for using direct approaches to
improving reading, and for tackling apparent underpinning skills deficits?
In a larger group setting, how can effective strategies to improve
reading fluency and comprehension be encouraged?

Key texts
Brooks, G (2016) (5th edition) What Works for Children and Young People
with Literacy Difficulties?
This book describes a wide range of interventions accompanied by
evaluations of their effectiveness.

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Chapter 3

Impairment in written
expression

Introduction
Just as reading is a crucial skill in contemporary society, so writing is
important for success in study, work, and everyday life. Before examining
disorder of written expression, I outline the components of writing. These
include spelling, grammar and punctuation/capitalisation, and written
composition. Disorder of written expression is then defined in terms of
spelling accuracy, correctness of grammar and punctuation, and clarity/
organisation.
I give estimates of the prevalence of the disorder. Causal factors are
examined regarding problems with spelling, and difficulties with punctua-
tion accuracy and capitalisation, written grammar, and written expression.
Assessments are discussed in relation to spelling accuracy, grammar and
punctuation, and writing composition.
Provision for spelling is described involving multi-sensory aspects,
Directed Spelling Thinking Activity, and target words. For grammar, I
discuss direct teaching, modelling, and the use of the learner’s own
writing. Punctuation and capitalisation approaches are examined. They
are systematic, based on assessments, adjusted according to individual
needs, and combine explicit teaching with opportunities for applying the
necessary skills and knowledge. I describe provision for writing compo-
sition namely, developing self-regulation strategies, reducing task
demands, using frameworks for writing, writing for a purpose, teaching
reading and writing combined, and computer-aided learning.
Finally, implications for the curriculum and assessment, pedagogy,
resources, therapy, and organisation are outlined.

Components of writing
Written language comprises several components:

DOI: 10.4324/9781003177975-3
 Impairment in written expression 29

 handwriting;
 vocabulary;
 spelling;
 usage; and
 written composition/text structure.

Handwriting involves fine motor skills, letter memory, and the

ability to form letters. If a computer keyboard is used instead of writing
by hand, fine touch skills are needed to use the keys, and memory of
letters is required to recognise them, although the need to form letters
by hand is made unnecessary. Handwriting is discussed in the context
of developmental co-ordination disorder in Chapter 5.
Vocabulary involves word knowledge, word retrieval, and morphology.
Morphology concerns the study of the form of words and phrases. More
specifically, it involves understanding word formation in language like
inflection (for example, a change in tense), derivation, and compounding.
Spelling is a complex accomplishment. It implicates as well as morphol-
ogy already mentioned, semantics (the meaning of words), orthography
(the system of writing), and phonology (the sounds of language).
‘Usage’ embraces punctuation, and capitalisation and grammar. In this
context, grammar is usually subdivided into syntax and morphology.
Syntax refers to how words and other linguistic elements are combined
into constituents such as clauses or phrases. As already mentioned, mor-
phology involves understanding word formation in language such as
inflection, derivation, and compounding.
Written composition also called text structure comprises cohesion and
coherence of writing, narrative, and expository text. (Mather, Wendling,
and Roberts, 2009, pp. 8–30 and Figure 2.2).
Key aspects of writing, namely spelling, usage (grammar and
punctuation/capitalisation), and written composition arise in impairment
of written expression.

Definition of impairment in written expression

In the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5)
(American Psychiatric Association, 2013, pp. 66–74) is a description of the
essential features of ‘impairment in written expression’. This is presented
within the context of specific learning disorder which may involve combi-
nations of impairment in reading, written expression, or mathematics.
In its wider sense, specific learning disorder concerns ‘difficulties learning
and using academic skills’. Within the definition it is specified that despite
targeted interventions having been used to tackle these difficulties they
30 Impairment in written expression

have persisted. Specific learning disorder begins during school-age years

and its indications are not better accounted for by other conditions or fac-
tors such as intellectual disabilities or ‘inadequate educational instruction’.
Subskills of disorder of written expression set out in the diagnostic
criteria involve spelling, grammar and punctuation, and written com-
position. They are

 spelling accuracy,
 grammar and punctuation accuracy, and
 clarity or organisation of written expression (Ibid., p. 67).

In line with guidance in DSM-5 (American Psychiatric Association,

2013), Berninger (2009) discusses learning disability relating to writing.
He mentions the processes of memory for word meaning and working
memory. Also mentioned are problems with spelling, grammatical
structures, morphological awareness, organising information, and com-
mitting thoughts to writing (Ibid.).

Prevalence
When research is carried out to try to establish the prevalence of
impairment in written expression, it does not often separate the impair-
ment from impairment in reading or mathematics, making prevalence is
difficult to determine.
A study in Brazil investigated the prevalence of DSM-5-specific
learning difficulties (American Psychiatric Association, 2013, pp. 66–74)
in samples of students. Educated in second to sixth grades, they came
from median cities in four geographic regions. Prevalence rates of SLDs
for writing were 5.4% (Fortes et al., 2016).

Causal factors and associated factors relating to

impairment in written expression
Offering a direct cause of impairment in written expression is difficult and
it is more accurate to speak of features which may contribute, that is,
‘causal factors’. Also, while some factors are ‘associated with’ impairment
in written expression, the nature of the relationship is unclear. Bearing this
in mind, related to disorder of written expression are

 spelling accuracy,
 grammar and punctuation accuracy, and
 clarity or organisation of writing.
 Impairment in written expression 31

Spelling
Because correct spelling requires knowledge of phonology, orthography,
morphology, and semantics, difficulties with these affect spelling. For
example, for some learners, difficulties remembering orthographic patterns
can impair spelling that involves irregular patterns (Mather, Wendling, and
Roberts, 2009, p. 111).

Grammar and punctuation

For some students, difficulties with punctuation accuracy and capitalisation
may reflect problems recognising and learning the necessary rules and
applying them to their own writing (Mather, Wendling, and Roberts,
2009, p. 141).
Problems with written grammar may arise from lack of opportunity to
see and read examples of accepted grammatical forms. Lacking opportu-
nity or encouragement to try writing simple pieces, moving on to longer
ones, the student may have struggled. With guidance, such activities
enable grammar to be developed (Ibid., p. 143).

Writing composition
Given the complexity of written expression, many areas of the brain
are likely to be implicated. Executive deficits and working memory
deficits, which have been associated with poor sentence coherence
and lexical cohesion may be particularly important. However, any
educational implications of brain imaging findings are unclear (Pugh
et al., 2006)
Learners struggling with writing may have associated problems. These
may include difficulties with attention, self-regulation, and memory,
including working memory, and language and reading skills. Struggling
writers tend to be weaker in their knowledge of the genres, devices, and
conventions of writing. Unsurprisingly perhaps, they also tend to be less
motivated. Among more social and contextual influences associated with
weak writing skills are family poverty and poor instruction. (Also see
Graham and Harris, 2011, pp. 424–426.)

Identification and assessment

Identifying and assessing apply to the key areas of spelling accuracy, to
both grammar and punctuation, and to writing composition.
32 Impairment in written expression

Assessments of spelling accuracy

Spelling problems show themselves in several common ways. Confusion
about words ending in ‘er’, ‘or’, and ‘ar’ may result in spellings such as
‘docter’ or ‘doctar’ for doctor. Sounds such as ‘s’ and ‘z’ may cause
problems. Spelling may be inappropriately phonetic (‘cof’ for ‘cough’).
The middle or end of a word may be missed out. Some words may be
spelled in different ways at different times (‘nesesery’, ‘nececary’, and
‘nesacary’ for ‘necessary’). Letters or syllables may be written in the
wrong order. In response the assessor (psychologist, specialist teacher,
regular teacher) may construct a profile of the sorts of errors the student
makes relative to the above characteristics.
Informal assessments of spelling can be made using phonics charts of
commonly used letters and blends. One example is a ‘check off chart’
(Mather, Wendling, and Roberts, 2009, p. 223, Figure 8.5). It covers

 consonants,
 initial digraphs (such as ‘ch’ in chip),
 initial consonant blends (‘bl’, as in ‘black’ and ‘cl’ as in ‘club’),
 initial digraph blends (‘sch’ as in ‘school’),
 final consonant blends (‘lt’ as in ‘melt’),
 final digraphs and trigraphs (‘ct’ as in ‘fact’ and ‘tch’ as in ‘match’), and
 final digraph blends (‘nth’ as in ‘seventh’).

Also used are commercially available standardised spelling assessments

which may be a part of broader tests including reading and writing. An
example is the Wide Range Achievement Test (WRAT5) (Robertson and
Wilkinson, 2017). It covers the age range 5 to adult and takes about 15 to 25
minutes to administer for ages 5 to 7 and around 35 to 45 minutes for ages 8
and above. As well as subtests for word reading, sentence comprehension,
and maths computation, the assessment has a spelling test which measures
the ability to write letters and words from dictation without a time limit.

Assessments of grammar and punctuation

Cloze tests can help reveal accomplishment and difficulties with grammar.
Consider that a student is told that a boy visited the shop yesterday. They are
then asked to complete the cloze sentence ‘Yesterday Tom … to the shop’.
Completing the task correctly shows understanding of past tense. These
assessments might be accompanied by pictures or demonstrations to make
clear what is being asked. In this way, cloze procedure assessments can
establish a learner’s understanding of speech parts and how they are used.
 Impairment in written expression 33

As a curriculum-based assessment, a teacher may use the criterion of

‘correct writing sequences’ covering spelling accuracy, grammar,
punctuation, and capitalisation. This begins at the start of a writing
sample and looks at each successive pair of writing units. A writing unit
in this context is a word or an ‘essential’ punctuation mark. Credit is
given for a writing unit that is spelled correctly, is grammatically correct,
and makes sense within the context of the sentence. Capital letters
must also be used appropriately. (Mather, Wendling, and Roberts,
2009, p. 234–238, provide a full description of the scoring system.)

Assessments of writing composition

Among assessments of writing are analytic scales and primary trait scales.
Analytic scales provide scores on aspects of writing and can be interpreted
to inform instruction. Aspects include ideas, organisation, sentence struc-
ture, and vocabulary. Primary trait scales provide scores based on the main
purpose of the writing assignment being assessed. In a ‘for and against’ piece
of writing the quality of the argument can be judged. In a story, plot
development can be rated.
Writing and Reading Assessment Profile (WRAP) is an informal profile that
includes assessment of writing. It enables educators to gather information
on learners’ literacy development and behaviours. This information is used
to analyse and interpret reading and writing samples, select suitable literacy
resources, and support skills and strategies enhancing literacy.

Provision for spelling

General issues – emphasising spelling clusters or using

motivational context
When teaching and supporting spelling with children generally,
approaches can either emphasise explicit direct instruction, or use the
context in which the word arises. Direct instruction allows similarities in
spellings to be highlighted to aid memory. For example, groups of
words can be taught with similar spellings such as ‘ill’ as in bill, fill, hill,
mill, pill, and so on. Once you recall the ‘-ill’ part of the spelling you
can produce several, sometimes many, words correctly. This gives a
sense of achievement and boosts confidence, precious commodities for
students who are having difficulties. On the negative side, drill can be
boring and unmotivating.
A contextual approach rather teaches the spelling of a word when it is
needed, and the student is motivated to remember it because they want
34 Impairment in written expression

to use it. On the downside, context does not give the opportunity to
develop from a required word to clusters of words that have the same
spelling sequence. Given that there are weaknesses and strengths with
either approach, they are in practice often used together or at different
times according to the perceived needs of the student.
All this applies to learners in general. However, individuals with
impairment in written expression tend to learn better with intensive
practice to help them remember the spelling securely. If the strategies
are tilted too far towards learning from context, this practice is reduced,
hindering spelling.
Drawing on phonics knowledge, a student can develop a grasp of
phonologically recognisable spellings and make plausible attempts like
‘hows’ for ‘house’. Eventually however the learner will have to move
on from this to being able to check if a word looks correct (visual
checking) based on knowledge of how other words are spelled. A
learner with impairment in written expression will likely require much
support at this phase.

Multi-sensory approaches
Various multi-sensory aids are used to teach spelling. This can involve
speaking, hearing, seeing, and movement so that approaches involve
speech-motor, kinaesthetic, visual, and auditory memory. Underpinning
this is a broad pedagogic principle that memory and recall is improved if the
learner can draw on several memory sources linked together. Associated
with this the educator uses material and examples that interest and motivate
the student and are familiar to them.
Teaching early letter sounds can be linked to what the learners
knows, illustrating the sounds with pictures or objects. These are taught
phonetically as the sound the letter makes rather than the pronunciation
of the letter name. For example, ‘a’ pronounced as in ‘cat’ not as in
‘cape’. If the learner is interested in or has pets, the sound ‘c’ can be
linked with ‘cat’ and perhaps a picture of their own cat. Similarly, with
‘d’ and ‘dog’. Other items that interest the learner can be used for this
early work to build confidence and competence. Examples are letter
sounds that can be illustrated by sports items, and objects and pictures
linked to the student’s hobbies. When links have been made with the
letter sound and the item or picture, the learner will gradually visualise
the aid on seeing the letter and will recall the letter sound accordingly.
Developing from learning letter sounds, the teacher can give learners
cards to place in front of them and on which the letters are written. The
teacher then talks about the letter sound and its shape, leading to basic
 Impairment in written expression 35

word building. Using the first few letters that have been introduced, the
teacher helps the student develop words like ‘pat’, ‘mat’, ‘cat’, and so on.
To help visual recall educators can show learners a written word and
ask them to look carefully at it and remember as much as possible. Then
the word is removed from view, and prompt questions are asked like,
‘How many letters were there in the word?’, ‘What was the first letter?’,
‘What was the last letter?’, or ‘Were any of the letters the same?’.
Auditory recall of words can also be encouraged. Rhymes, poems, and
songs enjoyably help to highlight the sounds of words. Younger learners
can clap out syllables. Students can group words according to their
sound, as with ‘dog’, ‘bog’, ‘log’. A learner with auditory difficulties
might not hear the similarities of words taught in clusters to aid
spelling (‘wish’, ‘dish’) so the teacher must ensure that they notice
the common rhyme, ‘ish’.
The learner may finger draw letters in a sand tray to emphasise their
shape and sequence. Progressing to tracing smaller letters, this leads to
writing letters on paper. The learner can say and sound out phonetically
regular words to embed this, using speech-motor memory as they
articulate the word, and auditory memory as they hear the sounds.
Using ‘look-say-finger trace-cover-write-check’ can include looking
at the word shape overall as well as individual letters. This recognises
that the words may not be phonetically regular ones guessable from
knowing their sounds. In ‘simultaneous oral spelling’, the learner says
the letters while writing them, helping link kinaesthetic memory and
auditory memory (See also Pollock, Waller, and Pollitt, 2004.)

Directed Spelling Thinking Activity

In the Directed Spelling Thinking Activity (e.g. AdLit.org, 2008) groups
of learners are helped to contrast, compare, and categorise two or more
words according to similarities and differences. Raising awareness of
spelling patterns and more complex ‘grapho-phonological’ principles is
the aim of this activity.
Consider that learners are examining words with a long /i/ sound as
in ‘thigh’, ‘by’, and ‘pie’. The educator encourages them to discover that
the long /i/ can be made by the letters ‘igh’ as in not only ‘thigh’ but
also in ‘sigh’. It can be made with the letter, ‘y’ in ‘by’ but also in ‘try’
and ‘cry’. The long /i/ can be made by ‘ie’ as in ‘pie’ and in words like,
‘lie’ and ‘die’. Learners classify other similar words into groups or notice
that they do not follow the common principle. To consolidate the
learning, they might examine a passage in which are included examples
of words conforming to the rule.
36 Impairment in written expression

Target words for spelling

Target words are selected for particular attention to improve spelling. In
line with recommendations for spelling programmes, target words can
include high frequency core words, personal words, and word patterns
illustrating some morphological or phonological principle. Personal
words prepared with the learner will include ones that they use often in
various contexts and may also be high frequency core words. In schools,
older students and subject teachers can collaborate to make groups of
words often used in subjects, like science, history, or geography.
When a learner has misspelled words in free writing sessions, only a few
should be selected for correction. This avoids overloading the student
with too many words to learn at one time, which is likely to be ineffec-
tual and to sap vital confidence. It is also sensible to select more com-
monly used words for correction because they will have the greatest
impact on future correct spelling. While some work on correcting spelling
is necessary, repetition of spellings does not have to be tedious drill but
can be made interesting. Short daily activities with weekly checks of
progress will be more stimulating than long drills. Games, puzzles, and
computer activities focusing on the important words can be motivating
and helpful. Personalised lists can also be made. Mnemonics and word
associations may help learners remember the spelling of target words.
Encouragement, confidence building, and quick recognition of success are
important themes of such work.
Resources or improving and consolidating spelling accuracy include com-
puter software allowing the user to decide how words are grouped and to add
chosen words. Other software employs a ‘look, cover, write, and check’
approach to learning spellings. The words are in ‘families’ or subject groups.
Among commercial spelling packages for the US market for example
is Spellography (Sopris West, www.sopriswest.com). This teaches word
roots and multisyllabic skills using various games and activities. SpellWell
(Education Publishing Services, www.epsbooks.com), intended for lear-
ners in the second through to fifth grades, (ages 7/8 through 10/11
years) teaches skills cumulatively. Each book includes grade-suitable
words that follow a particular spelling pattern or rule.

Provision for grammar and punctuation

Principles discussed below for grammar and for punctuation are good
practice for all students. For those with disorder of written expression,
learning may take longer and require more practice, application, and
support.
 Impairment in written expression 37

Grammar
Learners struggling with grammar will tend not to learn its structures by
a sort of absorption or pick up the necessary skills and knowledge from
reading. Rather they tend to learn better with explicit instruction.
An educator can directly teach simple sentence patterns, and as the
learner progresses these simple structures can be elaborated. Most rules
are taught using the student’s own writing. After modelling the
acceptable forms of written grammar, the teacher can guide and praise
the learner’s attempts to do the same. An example might show how
aspects of grammar can be conveyed using direct teaching/modelling,
verbal practice, written practice, group and individual work, and
encompassing the learner’s own writing.
Consider that a teacher is dealing with sentence combining. The learner
is shown how to combine two or more short sentences into a longer one,
using direct teaching and modelling. The educator might then provide
three or more sentences and ask a group of students to suggest how two or
more might be combined, writing acceptable versions on a board. After
such verbal practice, learners are asked to write several examples of com-
bined sentences. Next working individually with learners, the teacher uses
simple sentences from their work, to discuss how sentences might have
been effectively combined perhaps by using conjunctions like ‘and’, ‘but’,
and ‘however’.
Another example is teaching the use of adjectives to enrich writing
which begins with the teacher suggesting several nouns and giving exam-
ples of how each can be described by adjectives. Eliciting from the learners
their own descriptive word, the teacher discusses how some of the sugges-
tions are stronger or more appropriate than others. They then provide a
sample of short sentences in which a weak adjective is used and ask for
better examples. (Instead of a ‘nice’ cake, try a ‘tasty’ cake.) This can be
done verbally at first and then supplemented by the teacher writing exam-
ples down. Several short sentences with weak adjectives can be provided
which learners are asked to improve, or sentences may be used with blanks
where an adjective might be inserted. Next working individually with
learners and using simple sentences from their work, the teacher discusses
how adjectives, or better adjectives could be used.
In checking and editing their work written on a computer, students
can use grammar checking software. Grammatically-based cuing of
words on such software can also help learners to expand their gramma-
tical repertoire. Teachers can support learners having difficulties with
grammar by discussing what is required and checking their
understanding.
38 Impairment in written expression

Commercially available resources for grammar include books and

related material. An example is Noun Hounds and Other Great Grammar
Games (Egan, 2001) which is intended for third through to sixth grade
(ages 8/9 through 11/12 years).

Punctuation
Approaches for teaching punctuation and capitalisation are systematic,
based on assessments, and are adjusted according to the requirements of
each individual. Combining explicit teaching with opportunities for the
student to apply the new learning, the strategies are carefully structured.
To improve a learner’s punctuation, teachers need to teach punctua-
tion rules and reinforce them within the context of their writing. This
uses the principle of explicit instruction and applying what has been
learned in a writing context. Learners must understand the rule and be
able to apply it in their own writing activities. The most common
punctuation marks are introduced first.
Accordingly, a justifiable sequence for instruction would be the
following:

 full stop/period;
 question mark;
 comma;
 exclamation point/mark;
 apostrophe;
 quotation marks;
 colon;
 semi-colon;
 hyphen; and
 parenthesis.

It is possible to further break down the presentation and teaching of

each punctuation mark. For example, teaching a full stop/period could
involve a sequence of using a period after

 a sentence,
 a command,
 an abbreviation,
 numbers in a list,
 an initial, and
 letters or numbers in an outline (Mather, Wendling, and Roberts,
2009, p. 141–142).
 Impairment in written expression 39

Each punctuation mark may be systematically taught one at a time,

drawing on explicit teaching, guided practice, and modelling. The teacher
explains when and how the punctuation mark is used. Students gain prac-
tice using the punctuation mark in a sentence (or sometimes elsewhere as in
a list). They are then encouraged to use the punctuation mark in their own
writing. Where errors are made the teacher reviews the rules for using the
mark and asks the learner to proofread their work for that particular mark
(Ibid., p. 142).
Capitalisation can be taught in a similar way. Firstly, the learner’s
writing is assessed to establish what rules and examples they need to
learn, and instruction is adapted accordingly. Using the principle of
teaching the most common usages first, instruction might begin with

 first names and last names of people,

 the first words of a sentence,
 the word ‘I’,
 days and months of the year, and so on.

As with teaching spelling, words can be incorporated in which the

learner has an interest to encourage better motivation.
Cloze procedures can be used. The student is given a passage in which
some letters have been omitted. They must insert a small or a capital
letter as required. The teacher can provide examples of the two ‘missing’
letters from which the learner choses (Ibid., pp. 142–143).
Resources used for developing correct punctuation include routinely
available computer software. This offers alternative suggestions where
it appears punctuation is incorrect or where it makes the expression
unclear.

Provision for writing composition

The work and writing of learners having disorder of written expres-
sion tends to have certain features. Students may do little planning
before they write and carry out minimal monitoring and evaluation
of their work. Compositions tend to be short, with little detail or
elaboration. Spending little time writing essays, learners may require
prompting to do more. Difficulties with the mechanics of writing
(spelling, punctuation, and shaping letters) further reduces the
amount that is produced. Students’ revisions of their own work focus
on mechanical aspects and neatness rather than compositional aspects
of writing. Interventions take account of this.
40 Impairment in written expression

Developing self-regulation strategies

‘Self-regulated strategy development’ teaches learners with difficulties in
writing to use the same types of strategies as more competent writers. As a
‘cognitive strategies’ instruction model, it aims to enhance students’ strate-
gic behaviour, self-regulation skills, content knowledge, and motivation.
The following guidance draws on the approach described in research which
involved students who were struggling writers, including students with
disabilities (Harris, Graham, and Mason, 2006).
Outside the regular classroom, an assistant teaches small groups planning/
writing strategies for persuasive writing and for story writing. For example,
with persuasive writing, a general strategy is introduced involving

 picking a topic,
 organising ideas before writing, and
 writing and saying more while writing (continuing planning while
writing).

Learners are taught a strategy for organising ideas:

 generating ideas;
 selecting from them; and
 organising them according to basic elements of persuasive writing.

Assessing an earlier piece of their writing, students evaluate aspects to give

a baseline. Modelling how to use the strategies by ‘thinking aloud’, the
assistant enables the learner to listen and understand. Before student begin
the piece of persuasive writing, they are reminded to use all the basic ele-
ments. When the writing task is finished, they discuss what has helped. They
develop several self-statements to use while they write. Assistant and learner
write the next piece together setting objectives, using self-statements, and
graphing their performance. Gradually the assistant withdraws support.

Reducing task demands

Reducing task demands helps to build learners’ confidence by providing
initial success. In story writing, the teacher can provide the beginnings of
a series of sentences in a writing frame. This can be tailored to the
learner’s interests.

 When the light faded quickly, we found ourselves on the moor,

without food or water and …
 Impairment in written expression 41

 At first, we …
 Then we took stock and realised …
 So, we made a …

To aid a learner’s fluency in writing longer pieces of work and bypass

the need to use a dictionary, the teacher can provide key words likely to
arise, or that the learner asks for.
Reducing task demands can help a learner’s note taking/dictation, a
complex skill that is challenging for anyone. Where learners struggle to
concentrate on what is being said at the same time as keeping hand-
writing legible, they could reduce demands by writing down only key
words. At the end of the dictation, the teacher gives the learner a copy
of their notes to go through highlighting the key words identified. This
forms a revision aid and a basis for reading the notes.
Reducing task demands enables the learner to concentrate on and
improve upon smaller aspects of the overall task. The educator provides
the structure for other aspects of the work, so the student completes a
finished product. Gradually, supports are faded out so that the learner
can carry out the whole process.

Frameworks for writing

Supporting frameworks for writing gets the learner started, gives direction
to a task, and builds confidence. Educators encourage a learner’s under-
standing of the processes of developing ideas for writing, composing, and
editing. Processes are modelled, posing questions that the learner can later
use to structure their own attempts. Questions for generating ideas for a
fictional story might be, ‘Who is in the story?’, ‘Where does it happen?’,
‘What is the main event?’, or ‘What happens, first, next, finally?’.
In composing a non-fiction piece where the ideas have been generated,
the teacher can model setting out the ideas in an understandable order.
Questions might be, ‘What are the main ideas?’, ‘Which should be first?’,
or ‘What should come last?’. In composition each main idea can be taken
in turn and expanded into a sentence or two.
In editing, the teacher shows the learner how to check if the structure
and shape of the piece of writing is good, whether paragraphs are used
effectively, if grammar is clear, and if punctuation and spelling are correct.

Writing for a purpose

Writing for a purpose aids motivation and gives an incentive to produce
good quality work. It might involve writing a letter of thanks to a
42 Impairment in written expression

visitor, contributing to a newsletter, designing then writing a poster,

writing to a distant friend, formulating a set of instructions for a piece of
equipment, or sending e-mails. Other purposes include making shopping
lists for projects or events, writing to the local newspaper, applying for a
job, creating a story book for young children, composing letters on behalf
of elderly and infirm people in a local residential home, or preparing a
cooking recipe.
As well as being motivational, such work requires learners to consider
requirements of writing for different audiences, a very subtle skill. At
first, it may be easier to judge the audience if they are people that the
learner has met.

Teaching reading and writing together

Self-regulated strategy development approaches for reading and writ-
ing were used in a study by Mason, Snyder, Sukhram, and Kedem
(2006). Educators adopting this approach would act as follows. Stu-
dents are taught a reading strategy (acronym TWA) involving the
following:

 Think, before reading about the author’s purpose, about what you
want to know and what you want to learn.
 While reading, think about reading speed, linking knowledge, and
rereading parts.
 After reading, think about the main ideas, summarising information,
and what you learned.

Learners must be able to use the TWA strategy independently to

produce a written outline and talk about the main points of what they
have read. The educator then teaches the writing strategy helping stu-
dents apply the information gleaned from their reading, under the
(rather weak) mnemonic PLANS:

 Pick goals,
 List ways to meet goals,
 And make
 Notes, and
 Sequence them.

All this breaks the required task of planning what to write into
more manageable subtasks making it easier for learners to use what
they have read.
 Impairment in written expression 43

Resources for writing composition

Software packages are helpful at different stages of writing a piece of
work: planning, composition, checking and correcting, and publishing.
They help users develop and organise ideas, employing diagrams, allowing
ideas to be arranged which helps to structure essays. Templates can be
used for different areas of knowledge such as science and history. Some
programmes provide partial or complete sentences to support writing,
allowing personalised ‘cloze procedure’ exercises to be created.
Software enables users to hear, through synthetic speech, the sentences
that they are constructing as they are being typed. This can reassure learners
that what they are writing makes sense, and, where it does not, allows them
to go back and check accuracy. Once writing is completed, text can be
highlighted and a ‘read aloud – speech’ tool used to hear a synthetic voice
read the whole text.
Commercially available material includes approaches using the fra-
mework in Write Traits® incorporating ideas, details, organisation,
sentence fluency, voice, and conventions. Great Source (www.grea
tsource.com) provides such materials and workshops. Language Circle/
Project Read Written Expression Curriculum (www.projectread.com)
offers a systematic multi-sensory approach to teaching writing skills.

Curriculum and assessment, pedagogy, resources,

therapy, and organisation

Curriculum and assessment

In the setting of a school, tuition centre, or similar institution, writing is clearly
central to other subjects and areas of learning likely to be taught, such as
English, history, and science. Attainment in these subjects may be lower than
is age typical where written responses are required. In the balance of subjects
that are provided, writing may be emphasised to encourage and support stu-
dents’ progress in it. Planning across the whole curriculum will help to ensure
that other subjects and areas of learning contribute to supporting literacy. For
example, key words may be identified that will be explained and reinforced in
other curriculum areas. Small steps of assessment may be used to recognise
progress in written expression and related areas of learning.

Pedagogy
Interventions to improve spelling include multi-sensory approaches,
Directed Spelling Thinking Activity, and focusing on target words.
44 Impairment in written expression

Grammar is improved by using direct teaching/modelling, verbal practice,

written practice, group and individual work, and encompassing the lear-
ner’s own writing. Punctuation and capitalisation teaching is systematic,
based on assessments, shaped to individual needs, and combines explicit
teaching with opportunities for application. Pedagogy for writing compo-
sition involves developing self-regulated strategies, reducing task demands,
using frameworks for writing, writing for a purpose, and teaching reading
and writing in conjunction.

Resources
To aid spelling, computer software is available, sometimes mimicking
strategies used generally. Commercial packages are used which may teach
spelling skills through games and activities. Also available are commercially
produced resources for grammar, for example, focusing on teaching a
specific part of speech. Regarding punctuation, computer software routi-
nely has punctuation correction facilities and can make suggestions for
punctuation. In writing composition, computer software packages help
users develop and organise ideas, employing diagrams and templates.
Computer synthetic speech facilities allow a learner to hear what is being
written both as it is written and at the end. Bought materials may use
approaches that are systematic and may be multi-sensory.

Therapy
There appears to be no distinctive therapy necessary for the aspects of
disorder of written expression discussed in the present chapter. For the
movement aspects of written expression, there are therapeutic implications
for physical therapy/physiotherapy, which are discussed in the Chapter 5.

Organisation
Individual, paired, and small group work all contribute to improving
written expression. Group settings may be organised to encourage learners
to share their writing with others. For example, writing may be edited
and developed in pairs or groups.

Thinking points
You may wish to consider when and how to emphasise (for particular
students) essential skills learning, which may lead to observable progress,
or learning in context, which may be more meaningful.
 Impairment in written expression 45

Key texts
Gunning, T. G. (2013) Assessing and Correcting Reading and Writing
Difficulties. 5th edition. Boston, MA, Allyn and Bacon.
Well-grounded in theory and research, this practical book for teachers
has ideas and lesson plans for helping with literacy including strategies
for developing word recognition skills, vocabulary, and comprehension.
Mather. N., Wendling, B. J., and Roberts, R. (2009) Writing Assess-
ment and Instruction for Students with Learning Disabilities. 2nd edition. San
Francisco, CA, Jossey-Bass/ John Wiley.
This well-structured book considers handwriting, spelling, usage,
vocabulary, and text structure using extensive examples of students’
writing. Some chapters give examples of learners’ writing and guidance
on its assessment.

Conclusion
Components of writing include spelling, grammar and punctuation/
capitalisation, and written composition. Disorder of written expression
is defined in terms of spelling accuracy, grammar and punctuation
accuracy, and clarity or organisation of written expression.
A Brazil study sample of students from the second to sixth grades (ages
7/8 through 11/12 years) in median cities from four geographic regions
found prevalence of specific learning disorder for writing of 5.4% (Fortes
et al., 2016).
Turning to causal factors, difficulties with knowledge of phonology,
orthography, morphology, and semantics, hinder spelling. Poor punctua-
tion accuracy and capitalisation may reflect problems recognising and
learning the necessary rules and applying them to writing. Problems with
written grammar may arise from lack of opportunity to develop literacy
more generally. With written expression, possible causal factors range from
executive deficits and working memory deficits to family poverty and poor
instruction.
Identifying and assessing apply to the key areas of spelling accuracy,
grammar and punctuation, and writing composition. Informal assess-
ments, records of patterns of errors, phonic check charts, commercially
produced tests, analytic and primary trait scales, cloze procedures, and
curriculum-based assessments are variously used.
Provision for spelling involves skills or content, multi-sensory aspects,
and Directed Spelling Thinking Activity, and target words. Grammar is
conveyed using direct teaching/modelling, verbal practice, written
practice, group and individual work, and encompassing the learner’s
46 Impairment in written expression

own writing. Teaching and support for punctuation and capitalisation

is systematic, based on assessments, and shaped to the requirements of
individual learners. It combines explicit teaching with opportunities for
application. Provision for writing composition includes developing
self-regulation strategies, reducing task demands, frameworks for writ-
ing, writing for a purpose, and teaching reading and writing together.
All these aspects of provisions inform curriculum and assessment,
pedagogy, resources, and organisation. Therapeutic aspects relating to
written expression are discussed Chapter 5, concerning developmental
co-ordination disorder.

References
AdLit.org (2008) Directed Reading Thinking Activity. AdLit.org.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental
Disorders Fifth Edition (DSM-5). Washington DC, APA.
Berninger, V. W. (2009) ‘Assessing and intervening with children with written
language disorders’ in Miller, D. (Ed.) Best Practices in School Neuropsychology.
New York, Wiley (pp. 507–520).
Education Publishing Services. SpellWell. www.epsbooks.com.
Egan, L. H. (2001) Noun Hounds and Other Great Grammar Games. Scholastic.
www.scolastic.com.
Fortes, I. S., Paula, C. S., Oliveira, M. C., Bordin, I. A., Mari, J. de J., and Rohde,
L. A. (2016) ‘A cross-sectional study to assess the prevalence of DSM-5 specific
learning disorders in representative school samples from the second to sixth grade
in Brazil’. European Child and Adolescent Psychiatry 25, pp. 195–207.
Graham, S. and Harris, K. R. (2011) ‘Writing and students with disabilities’ in
Kauffman, J. M. and Hallahan, D. P. (Eds.) Handbook of Special Education.
New York and London, Routledge.
Great Source. Great Source Write Traits®. www.greatsource.com.
Harris, K. R., Graham, S. and Mason, L. (2006) ‘Improving the writing, knowledge
and motivation of struggling young writers: Effects of self-regulated strategy
development with and without peer support’. American Educational Research
Journal 43, 295–340.
Project Read. Language Circle/Project Read Written Expression Curriculum. www.
projectread.com.
Mason, L. H., Snyder, K. H., Sukhram, D. P., and Kedem, Y. (2006) ‘TWA
+PLANS strategies for expository reading and writing: Effects for nine
fourth-grade students’. Exceptional Children 73, 69–89.
Mather. N., Wendling, B. J., and Roberts, R. (2009) Writing Assessment and
Instruction for Students with Learning Disabilities. 2nd edition. San Francisco, CA,
Jossey-Bass/John Wiley.
Pollock, J., Waller, E., and Pollitt, R. (2004) Day-to-Day Dyslexia in the Class-
room. 2nd edition. London, Routledge Falmer.
 Impairment in written expression 47

Pugh, K., Frost, S., Sandak, R., Gillis, M., Moore, D., Jenner, A., and Menci, E.
(2006) ‘What does reading have to tell us about writing? Preliminary questions
and methodological challenges in examining the neurobiological foundations of
writing and writing disabilities’ in McArthur, C., Graham, S., and Fitzgerald, J.
(Eds.) Handbook of Writing Research (pp. 433–448. New York, Guilford.
Robertson, G. S. and Wilkinson, G. S. (2017) Wide Range Achievement Test
(WRAT5). 5th edition. Pearson.
Scholastic. Noun Hounds and Other Great Grammar Games. www.scolastic.com.
Schoolhouse Rock! Grammar Rock. www.schoolhouserock.com.
Sopris West. Spellography. www.sopriswest.com.
Chapter 4

Impairment in mathematics

Introduction
After mentioning the complex nature of mathematics, I discuss ‘number
sense’ as a foundation for mathematical understanding and skill. Definitions
of impairment in mathematics, specific disorder of arithmetical skills, and
dyscalculia are examined. I indicate the prevalence of impairment in
mathematics and its co-occurrence with other disorders. Possible
physiological and emotional causal factors relating to mathematics impair-
ment are discussed. I examine identification and assessment through com-
mercially available tests, early identification based on observation of
apparent difficulties, and assessment based on an individual’s response to
intervention.
Concerning provision, the chapter discusses the curriculum and related
assessment. Examples of pedagogy are examined: explicit teaching and
practice of number sense, the progress from concrete experience to
symbolic representations and basic number facts, developing under-
standing of mathematics language, learning from everyday experiences
of mathematics, using computer for mathematics learning, and reducing
mathematics anxiety.
Regarding resources, I consider concrete materials like rods and blocks,
adapted equipment, and computer software. Concerning therapy, coun-
selling for severe mathematics anxiety is discussed. Group organisation is
examined including opportunities for learners to respond and to talk about
their thinking, and small group and paired discussions.

The importance of mathematics and mathematics

learning
Mathematics, like literacy, permeates modern society, understanding of
at least basic numeracy being a requirement of everyday life. Dealing

DOI: 10.4324/9781003177975-4
 Impairment in mathematics 49

with household bills, bank accounts, shopping (on-line or in stores), and

eating out, are among the many examples. In occupations too there are
varying degrees of demand for an understanding of mathematics. As well
as jobs where a high degree of mathematics understanding is essential,
such as engineering or computing, many other occupations from building
and carpentry to shop keeping and working on public transport require
good mathematical skills.
Learners are likely to be aware of the importance of mathematics. But it
is a real educational skill to convey the wonder and excitement of it.
Still harder is the task of encouraging and building the skills and
confidence of learners who dislike mathematics and who feel anxious
in even approaching it.

The nature of mathematics

Shelves of books have been written about what mathematics is, ran-
ging from philosophical analyses to practical guides. But for current
purposes, mathematics can be briefly defined as being an abstract area
of knowledge concerning number, quantity, and space. Pure mathe-
matics deals with these as abstract concepts. Applied mathematics is
concerned more with the use of mathematics in other disciplines and
areas such as physics, and engineering. Accepted fields of mathematics
are arithmetic, algebra, geometry, and analysis and many further
subdivisions are also used.

A foundation to understanding and skill in mathematics

In coming to understand and develop skill in mathematics, an important
foundation is number sense. As we will see shortly problems with
number sense is a feature of impairment in mathematics.
Number sense involves

 ‘number concept, number combination – arithmetic facts, computing

and place value’,
 ‘ways of representing and establishing relationships among numbers’,
 ‘visualising the relative magnitude of collections’,
 ‘estimating numerical outcomes and mastering arithmetic facts’ and
using them proficiently,
 ‘flexibly using number relationships’, and
 ‘making sense of numerical information’ in different contexts
(Sharma, 2015, p. 277).
50 Impairment in mathematics

An aspect of number sense that develops early is subitising. If you are

shown two clusters of items, you can see immediately when one cluster
is significantly greater than another without counting. You are also able
to see the number value of small clusters of items straight away. As
number sense develops it becomes possible to represent and use a
number in many ways influenced by context and purpose. You should
be able fluently and easily to decompose and recompose numbers (break
them down into their parts and put them together again such as 9 being
5 and 4, and 5 and 4 being 9) (Sharma, 2015, p. 277).
Proficiency in number sense helps in developing numeracy – the
ability to carry out whole number operations correctly, consistently,
fluently, and with understanding. Numeracy also involves being able to
estimate and to calculate accurately and efficiently. A learner should be
able to do this mentally and ‘on paper’ using various strategies and
means of calculation (Sharma, 2015, p. 277).

Definitions relating to impairment in mathematics

Relevant definitions relate to impairment in mathematics, specific disorder
of arithmetical skills, and dyscalculia.

Impairment in mathematics
A difficulty in understanding and learning mathematics, impairment in
mathematics is not associated with general intellectual disability. Lower
than typical mental ability does not explain the disorder and general ability
may for example be within the typical range while mathematics is below.
In the Diagnostic and Statistical Manual Fifth Edition (DSM-5) (American
Psychiatric Association, 2013, pp. 66–74) the impairment is a form of spe-
cific learning disorder which may involve combinations of impairment in
reading, written expression, or mathematics. Broadly speaking, a specific
learning disorder concerns ‘difficulties learning and using academic skills’.
Targeted interventions have been used to rectify these difficulties, but they
have persisted. Specific learning disorder begins during school-age years
and its indications are not better accounted for by other conditions or fac-
tors, such as intellectual disabilities or ‘inadequate educational instruction’.
Impairment in mathematics concerns two broad difficulties. The first
involves number sense, memorisation of arithmetic facts, and accurate
and fluent calculation. An individual has ‘a poor understanding of
numbers, their magnitude, and relationships; counts on fingers to add
single-digit numbers instead of recalling the math facts as peers do; gets
lost in the midst of arithmetic computation and may switch procedures’
 Impairment in mathematics 51

(Ibid., p. 67). The second area of difficulty concerns accurate

mathematics reasoning, involving severe difficulties in ‘applying
mathematical concepts, facts, or procedures to solve quantitative
problems’ (Ibid., pp. 66–74).

Specific disorder of arithmetical skills

Relatedly, the specific disorder of arithmetical skills is described as ‘a
specific impairment’. Like mathematics impairment, this disorder is not
explicable owing solely to general cognitive impairment (or inadequate
schooling). It concerns ‘mastery of basic computational skills of addition,
subtraction, multiplication and division rather than of the more abstract
skills involved in algebra, trigonometry, geometry or calculus’ (World
Health Organisation, 2010).

Dyscalculia
In England, ‘dyscalculia’, like dyslexia and dyspraxia, is seen as a ‘specific
learning difficulty’ (Department for Education/Department of Health,
2014, paragraph 6.31). Dyscalculia relates to certain core deficits
including importantly, ‘poor number sense that affects the acquisition of
the four basic operations – addition, subtraction, multiplication and
division’ and their application to solving word problems (Emerson,
2015, p. 221).
A distinction is made between ‘primary’ and ‘secondary’ developmental
dyscalculia. Showing itself in different ways in different people, the first
arises from individual deficits – behavioural, cognitive, neuropsychological,
and neuronal impacting on numeracy. ‘Secondary’ developmental dyscal-
culia refers to numerical/arithmetic dysfunctions caused by impairments
not specifically relating to numeracy, for example, attention disorders
which would be expected to impair performance more generally (Kauf-
mann et al., 2013).

Impairment in mathematics: Prevalence and

co-occurrence with other disorders

Prevalence
Several factors make it hard to specify the prevalence of impairment in
mathematics. Given that definitions of mathematics and arithmetic are
complex and excite debate, so impairment in mathematics is difficult to
pin down. Relatedly, the severity threshold at which mathematics
52 Impairment in mathematics

difficulties become an impairment is not universally agreed. Adding to

the confusion is overlap between aspects of specific learning disorder
(reading, writing, mathematics).
All this leads to rather wide estimates of prevalence for specific learning
disorder ‘across the academic domains of reading, writing and mathematics’
of 5% to 15% as proposed by DSM-5 (American Psychiatric Association,
2013, p. 70). Estimates of the prevalence of ‘dyscalculia’ are 6.5% or more
(Butterworth, 2010). Prevalence of ‘developmental dyscalculia’ is ‘about 5
to 7%’ (Zhou and Cheng (2015, p. 78).

Co-occurrence of impairment in mathematics with

other disorders
The way specific learning disorders are understood suggests a likely
overlap in the different expressions of the disorders in reading, writing,
and mathematics, as well as co-ordination. Other disorders or difficulties
also occur along with impairment in mathematics.
Unsurprisingly, individuals with deficits in arithmetic often also have
reading disorder (Landerl and Moll, 2010). Deficits in visuo-spatial working
memory occur together with arithmetic difficulties (Schuchardt,
Maehler, and Hasselhorn, 2008). Attention deficits co-occur with
mathematics problems (Czamara et al., 2013).
Because their presence can have implications for provision, it is impor-
tant to be aware of the possibility of co-occurring disorders or difficulties.
An individual who has dyscalculia with no other disorders may be able to
use compensatory mechanisms when doing arithmetic. However, if lear-
ners have other accompanying disorders or difficulties, compensation
mechanisms may not be so easy, suggesting that different approaches could
be necessary for learning to be effective (Landerl, 2015, p. 121).

Causal factors
Although it may sound pedantic even evasive, the phrase ‘causal factors’
(rather than just ‘causes’) conveys the notion that there are no known
direct and unequivocal causes of mathematics disorder. Rather there are a
range of factors that may in combinations lead to an increased likelihood
of an individual experiencing mathematics disorder.
Developmental dyscalculia may be caused by differences in function-
ing and/or structure in brain areas associated with mathematics. But
disagreement emerges about the existence of such neural correlates
(Bugden and Ansari, 2015) and if they do exist, whether they explain
the disorder (Cowan, 2015, p. 1028).
 Impairment in mathematics 53

Studies have been made of numerical magnitude processing and of

arithmetic. One reason why these are important is because some
research suggests that individual differences in mathematics achievement
relate to basic number processing skills such as the ability to process
numerical magnitudes (Orrantiaa et al., 2018)
For example, neuroimaging studies of children with developmental
dyscalculia have examined the parietal cortex of the brain. Associated
with (among other functions) mathematical problem solving, the parietal
cortex is the surface of the parietal lobe. Research has shown abnorm-
alities in the structure and functioning of this part of the brain (Bugden
and Ansari, 2015, p. 37).
Studies have been made of the intra-parietal sulcus (an area of the
brain which processes mathematics). These include research involving
people with Turner’s syndrome, children with foetal alcohol syndrome,
and those with low birth weight. In these groups there is a higher than
typical occurrence of dyscalculia and individuals tend to show less brain
activity in the intra-parietal sulcus. Dehaene (2011) gives an overview of
neurological evidence.
Anxiety can exacerbate difficulties with mathematics. Mathematics
anxiety is a ‘negative and potentially impairing emotional reaction to
mathematics’ (Moore, McAuley, Allred, and Ashcraft, 2015). Such a reac-
tion can be precipitated by fears of failure or of appearing stupid which may
relate to a learner’s experience of mathematics or perceptions of it.

Identification and assessment

In identifying impairment in mathematics, assessors bear in mind its
definition and its characteristic difficulties such as set out, for example, in
DSM-5 criteria (American Psychiatric Association, 2013, pp. 66–74).
Forms of assessment include commercially available tests, early identifi-
cation, and assessment based on an individual’s response to intervention.

Commercial assessments
Examining underlying neurodevelopmental processes supporting
mathematics skills, the Feifer Assessment of Mathematics (Feifer, 2016)
covers the age range from pre-Kindergarten to college. It includes a
short (15 minute) screening form. As well as a total index score, the
assessment gives three index scores (Verbal, Procedural, and Semantic)
each intended to represent a subtype of dyscalculia. A Verbal Index
score concerns automatic fact retrieval and linguistic components of
mathematics, while the Procedural Index score concerns ability to
54 Impairment in mathematics

count, order, and sequence numbers or mathematical procedures.

Finally, the Semantic Index score measures visual-spatial and conceptual
components (e.g., magnitude representation, patterns and relationships,
higher level maths problems solving, and number sense).
Comprising a book and copiable assessment sheets used for investigating
numeracy abilities, The Dyscalculia Assessment (Emerson and Babtie, 2013)
provides evidence of a learner’s number sense and ability to calculate. This
informs a personalised teaching programme for individual learners or small
groups having difficulties with numbers. In England, it is used mainly
with children aged 5 to 11, but is adaptable for older learners.
The Beery Tests of Motor and Non-Motor Skills (Beery, Beery, and
Buktenika, 2010) recognises that non-verbal deficits such as spatial per-
ception may influence mathematics performance. This may relate to
non-motor dyspraxic effects in interpreting visually presented material
(Emerson, 2015, p. 221).

Early identification
Early identification applies to spotting difficulties in young children
before the problems are compounded by later failure and frustration. It
also concerns recognising indications of difficulties at any age that may
impair difficulties with mathematics learning.
Consequently, it is important to understand factors supporting early
mathematics development even prior to formal instruction, to try to
develop a framework for assessing young children’s mathematical abilities.
Core number deficits for instance have been identified in ‘non-symbolic
approximate magnitude and/or small quantity representation’ (Reeve and
Gray, 2015, p. 44). An aspect of this is subitising. Other factors that may
support symbolic mathematics development and contribute to identifying
potential difficulties early are

 the role of language,

 everyday mathematics experiences,
 general cognitive functions, and
 a learner’s ability to attend to number events in the environment
(Ibid.).

Relatedly, ‘warning signs’ of dyscalculia are suggested:

 poor number sense;

 slow responses;
 difficulties with mathematics language;
 Impairment in mathematics 55

 difficulty with memory for mathematics facts and procedures;

 difficulties with sequences; and
 difficulties with position and spatial organisation (Hannell, 2013,
pp. 13–14).

Response to intervention assessment

A student may not make expected progress in mathematics, seemingly
owing to problems with mathematics learning rather than another cause,
such as illness, leading to missed education. In these circumstances, further
investigations can be made.
As interventions are tried relating to the difficulties identified, what is
taught and how it is taught are gradually modified. Essentially, this is a
diagnostic ‘response to intervention’.

Provision
Having different emphases, views of impairment in mathematics may
have different foci. Some concentrate on core deficits. Others empha-
sise features of the disorder associated with impairment of reading (e.g.,
difficulties with phonological representations, auditory processing, and
auditory perception). Yet others look to features associated with
developmental co-ordination disorder such as visuo-spatial problems.
Spatial position, length, area, weight, shape, and volume have
numerical aspects. Our focus is looking at provision in number. We also
look at features such as co-ordination difficulties that may further hinder
mathematics learning and discuss approaches that can help learners with
impairment in mathematics.

Curriculum and assessment

Curriculum
A plan or programme of what is to be taught and learned, a curriculum can
apply to various settings. Included are schools, tuition centres, a student’s
home (where programmes are taught by parents and others), and centres/
clinics specialising in provision for specific learning difficulties.
For learners with impairment in mathematics, attainment in aspects of
mathematics will be lower than that of others of the same age. Curriculum
planning will therefore start from lower levels in mathematics (or parts of
it). In a school or a tuition centre for example, where various areas of
learning are taught, staff will identify areas where mathematics is a major
56 Impairment in mathematics

component, such as various sciences. In these sessions, mathematics learning

may be supported by pre-teaching the skills to be used, follow-up teaching
to ensure understanding, and extra staff support for the learner.
In larger settings such as schools, curriculum content may reflect attain-
ment levels that are lower than is typical for a learner’s age but taught in age-
appropriate ways ensuring that learners are engaged. Functional, everyday
mathematics where the purpose and relevance of learning is made clear can
motivate struggling learners. In planning mathematics in all aspects, educators
should ensure that learning begins with concrete, practical examples, and
experience before moving on to more abstract approaches.

Assessment
As well as the assessment involved in identification and assessment of
mathematics disorder, curriculum-related assessment also occurs as the
content of mathematics is taught.
Ongoing assessment while teaching is taking place does not just
establish whether an answer to any problem is correct. It also takes
account of the processes used by the learner to engage with the mathe-
matics involved. The teacher will ask learners to explain their process of
working out so that any misunderstandings come to light. Once any
errors in understanding and the processes involved are recognised and
put right, the solution to the problem tends to fall into place. This is
often done with the teacher and learner sitting together. Simply marking
a calculation as incorrect is useless to the learner if the reasons for a
mistake are not identified and remedied. If group work is taken away to
be ‘marked’, the teachers written comments will either ask the learner to
speak with the teacher or will be detailed enough to explain the error
and how it can be put right. Showing the learner how to improve is the
best evaluative marking, which cannot be done unless the teacher knows
why a mistake was made.
Consider reasons why a learner may have difficulties with place value.

 They may be confused because in a number line (1, 2, 3 …),

numbers to the left are progressively smaller in value. Yet with
digits, the value to the left is bigger in the sense that it represents
tens, hundreds, etc. (e.g., in ‘24’ the ‘2’ on the left represents ‘20’).
 Numbers may be misread so that the correct information is not used.
 Numbers may be written incorrectly, concealing that the learner
may know the correct answer to the calculation.
 The student may not understand place value because of difficulties
with the language used.
 Impairment in mathematics 57

To rectify any mistakes relating to place value the teacher must ask
the learner to explain their working out, revealing the exact mis-
understanding so the best remedy can be determined. For further
examples of types of errors and possible teacher responses see Hannell
(2013, p. 31).

Pedagogy
Under pedagogy, we examine

 explicit teaching and practice of number sense,

 progressing from concrete experience to symbolic representations
and basic number facts,
 developing understanding of mathematics language,
 using everyday experiences of mathematics,
 using computer for mathematics learning, and
 reducing mathematics anxiety.

Explicit teaching and practice of number sense

As Hannell (2013, p. 49) states, to properly understand the number
system, learners must

 ‘understand the number line and how numbers are positioned on it;
 have a strong sense of the order of magnitude of numbers;
 understand the relationship that numbers have with each other;
 count accurately and apply the skill of counting flexibly;
 understand how to use the base ten system in counting;
 understand place value in written numbers;
 understand the composition and decomposition of numbers’.

Learners with dyscalculia (compared with others of similar intelligence)

need extra practice in many areas: more activities to help develop intuitive
number sense; extra intensive, explicit teaching about the number system
and extensive practice using it; plenty of time to acquire the basics; and
concrete experience with large and small numbers (Ibid., p. 48, paraphrased).
Part of developing number sense is being able to form and auto-
matically access the spatial representation of numbers (Kucian et al.,
2011). This involves understanding the location of numbers relative to
one another. Confident mathematical reasoning emerges from just
‘knowing’ how numbers are arranged in order of size and starting from
this knowledge.
58 Impairment in mathematics

Helping learners begin to see how numbers relate, a physical number

line shows that the differences between adjacent numbers is the same.
The difference as represented by the spatial distance between 5 and 6 is
the same as that between 7 and 8. Educators can teach understanding of
the number line through activities including board games and play-
ground pursuits. Given individual number cards, students can be asked
to lay them in numerical order. In mental exercises, the teacher can ask
student which number comes before or after a specified one. Learners
can be shown the patterns of number sequences for example that the
numbers from 20 to 30 echo the numbers from 1 to 10 in their repeated
sequence of units. Hannell (2013, pp. 53–55) gives further examples.
If confused by simultaneously touching an item and counting, a student
can be given tasks involving touching and naming items. These might be
a sequence of coloured objects touched and named in correct order, such
as ‘red, blue, green, black, red, red’. This gets the learner to automatically
touch and talk. After this is consolidated the learner might name items by
numbers, ‘one, two, three’, perhaps picking up each item as it is counted.
They might then count without touching. Next comes extensive practice
of counting in a wide range of situations and using the skill in many
practical real-life situations (Hannell, 2013, p. 57–58).
Longer term, moving from understanding number to basic calculation
involves various skills and levels of understanding. It is important that the
learner recognises and understands number patterns, such as patterns of
twos or tens. Place value must be taught. Number composition and
decomposition needs to be familiar to the student. Operations of addition,
subtraction, multiplication, and division are directly taught.
Throughout, practical examples are used where possible, the learner
is explicitly taught and given plenty of practice and opportunities to
apply the new learning, and misunderstandings are detected early and
corrected. Hannell (2013) provides examples of activities supporting
this development. Such approaches are used more intensively for those
experiencing severe difficulties in mathematics (scoring in the lowest
5%).
One such intervention is Mathematics Recovery (e.g., Wright, Stanger,
Stafford, and Martland, 2014), which has several elements. These
include ones aimed at students with difficulties emphasising methods of
counting and number representation, as well as elements including
other aspects of arithmetic. Following an in-depth initial assessment,
the intensive programme involves a daily half hour of individualised
intervention, delivered by people having received 60 hours of training.
Number Count, another intensive intervention (Dunn, Mathews, and
Dowrick, 2011) also involves a thorough initial diagnostic assessment
 Impairment in mathematics 59

and half an hour individualised intervention per day delivered by people

with Master’s level training.

Progressing from concrete experience to symbolic representations

and basic number facts
In teaching and learning mathematics, researchers have proposed a con-
crete–semi-concrete-abstract teaching sequence. Teaching first uses
concrete representations (manipulatives) to represent concepts, followed
by semi-concrete representations like tally marks or pictures, then
abstract representation involving symbols (Bryant, Bryant, Shin, and
Pfannenstiel, 2015, p. 251).
For learners with poor number sense who use ones-based counting
strategies, concrete manipulatives can be used that students can see, touch,
move, and talk about (Emerson, 2015, pp. 223–225). Initially, discrete
materials are used like blocks, counters, or strings of beads. Teachers can use
a ten-row Slavonic abacus with ten beads on each row, five of one colour
and five of another. This helps the learner recognise a group of five beads,
being the same colour. It aids counting on from five if there are say seven
beads in a row (because five is easy to recognise as a group). When the
learner is experienced using three-dimensional items, the items can be
represented two-dimensionally by drawings, perhaps done by the learner.
Later, ‘continuous material’ is used such as Cuisenaire rods (physical
aids using size and colour to help learners better understand aspects of
mathematics). Numbers from 1 to 10 are represented by different length
rods. Counting objects in lines of ten, students talk about what they see
to reinforce the tens-based character of the number system. Items can be
arranged in lines of ten on number tracks to emphasise the sense of items
in groups of ten. Similarly, dot arrangements up to ten help familiarise
learners with the patterns. Learners place the patterns in order according
to the counting sequence while developing a quantitative awareness of
the numbers relative to each other (Emerson, 2015, p. 223).
As learners comprehend how numbers are decomposed and composed
(10 can be separated into 6 and 4; while 6 and 4 can be put together to
make 10) they can use this understanding to help with number operations.
Certain approaches to number operations can help children with
‘learning difficulties’ to acquire mathematics skills (Hamak, Astilla, and
Preclaro, 2015). To help retrieve number facts, learners are taught to
break down larger quantities into manageable chunks. Helping develop
learners’ ability to visualise numbers, concrete materials like connectable
blocks are used. They enable students to break quantities down and assist
mental mathematical activities.
60 Impairment in mathematics

Breaking down quantities into manageable values helps learners

having difficulties retrieving mathematical facts from memory. A learner
may know the number bonds of 10 but may initially struggle with the
task ‘9 + 8 =’. The 8 can be broken down into 1 and 7. The 1 can then
be added to the 9 to make 10, given that this is a basic number fact that
the learner already knows. The remaining 7 is then added to the ten to
make 17.
Relatedly teachers can help learners recognise when, in linear addition
sums, they can group numbers together to use already known mathematics
facts. Consider the following:

5+6+9+8+4+2+1

Learners can group together the 9 and 1 to make 10, the 8 and 2 to
make 10, and the 6 and 4 to make 10. They will see that this makes 30.
They then add to this the 5 that has not been paired. This can be initi-
ally done using movable number tiles enabling the learner to pair them
more easily (Hamak, Astilla, and Preclaro, 2015, pp. 210–213).

Developing understanding of mathematical language

Aspects of mathematical language are

 developing and using mathematical language itself,

 mathematical stories, and
 mathematics word problems.

Learners can develop and use mathematical language through direct

instruction in mathematical terminology (Hamak, Astilla, and Preclaro,
2015). Words which are commonly used in other circumstances, but
have a specific mathematical meaning, are taught, such as ‘even’, ‘odd’,
and ‘table’. Words commonly seen in mathematics are also taught as
they arise, for example, ‘circumference’, ‘area’, and ‘radius’.
Developing such language is linked with concrete examples and
hands-on experience. Once the concept (say, ‘circumference’) is grasped
then picture cards can be used to remind learners of the word and its
meaning. By initiating talk about the concept and encouraging learners
to use the words with increasing confidence, terminology is reinforced.
This enables students to relate the new word and concept to what is
already known.
Intended for 5-to-11-year-olds, Talking Mathematics (Education
Works, 2011) can be used as a distinct approach, or integrated into
 Impairment in mathematics 61

current mathematics teaching. Typically taking about ten weeks to com-

plete, the programme focuses on speaking and listening skills important
when developing thinking strategies and tackling mathematical problems.
Supporting the use of mathematical vocabulary and terminology, the
intervention develops ability to reason, make generalisations, predict, and
recognise patterns and relationships in mathematics. It is suitable for learners
with some mathematical competence who need help in using and under-
standing mathematical language in the context of mathematics. The inter-
vention provides guidance for teachers and classroom aides on how to use
good mathematical language and questioning that the learners can ‘model’.
Turning to mathematical stories, number stories can give learners a
better understanding of word problems and how they are constructed.
Making up and telling a story about ‘3’ and ‘7’, the student might tell of
campers in a forest camp. There were seven at first. Three of them went
out to explore and four were left. The learner then writes the different
sums that could be made from the story such as ‘7 − 3 = 4’. This can
build the confidence of learners struggling with terms such as ‘subtract’
and ‘minus’, helping them to develop the language necessary to picture
and understand some principles in basic arithmetic.
Teachers can provide a framework by initially telling mathematical
stories, which learners can elaborate before inventing stories of their
own. Story-related props can be used to help the transitions between
concrete and abstract representations of mathematical ideas (McGrath,
2015, p. 371).
As they develop mathematical language knowledge and skills, learners
are taught how to deal with mathematical word problems, which involve
more than might be apparent at first. Students must be able to

 understand the language and information to define the problem,

 construct a representation of the problem using the ‘relevant elements
and relations among quantities’, and
 plan how to solve the problem, carry out the plans, and interpret the
‘appropriateness and reasonableness’ of the outcome relative to the
original problem situation (Jitendra, Dupuis, and Lein, 2015, 357).

Teachers first introduce problems verbally rather than in writing,

while students listen for key words in the sentence that will help an
understanding of what is requested. They then translate the sentence
into mathematical form and tackle it. First presenting simple sentences,
teachers build up to more complicated ones to give a grounding for
later written mathematical problems (Hamak, Astilla, and Preclaro,
2015, pp. 213–216).
62 Impairment in mathematics

Relatedly, teachers provide instruction making the common underlying

problem structures explicit (Gersten et al., 2009). This enables learners to
move beyond the surface features of the problem, like vocabulary, the
way it is expressed, and any irrelevant information, and instead uncover
the underlying mathematical structure, perhaps by drawing a diagram
(Ibid., pp. 26–27).

Using everyday experiences of mathematics

When shown that mathematics is part of everyday life, learners can
improve their number sense. This helps learners who are having
memory difficulties by giving mathematics learning a relevance that aids
memory. Everyday situations can convey that mathematics is part of the
real world and not just of mathematics lessons.
To take a few examples relating to number, students can count books
and items of equipment to be given out to a group to ensure there are
sufficient amounts. In shopping, quantities of items can be checked.
Calendars and sequences of days of the week can be confirmed. Introduced
in many contexts and using many examples, understanding of the concept
of ‘more than’ and ‘less than’ can be made secure and generalised.
Such experience of objects and number are helpful before using
‘manipulatives’, which involve abstraction that is hard for learners with
impairment in mathematics to grasp. Manipulatives represent objects,
making them one step removed from real experience.

Using computers for mathematics learning

Using animation or favourite characters to teach a mathematical skill,
computers can be motivating. They enable tasks to be pitched accurately
at a particular learner’s level of skill and understanding, allowing well-
structured individual work.
Harskamp (2015, p. 384) distinguishes two categories of software. The
first is ‘tutorials’, which are suited to practicing knowledge and skills.
These help educators allowing practice or re-teaching of mathematics by
giving the learner demonstrations, explanations, and guided practice.
‘Exploratory environments’, the second category of software, encourage
active learning through exploration and discovery. For example,
hypermedia-based learning allows access to information through links
within text, images, animation, audio, and video. Its non-linear nature
and flexibility enable different learning needs to be accommodated.
Also, computer simulations (including in computer games) can improve
learning. They enable learners to simulate real-life situations in a
 Impairment in mathematics 63

programmed environment, when it might be too expensive or unsafe to

experience the real-life equivalent (Harskamp, 2015, p. 384).

Reducing mathematics anxiety

A ‘negative and potentially impairing emotional reaction to mathematics’
(Moore, McAuley, Allred, and Ashcraft, 2015), mathematics anxiety
diminishes achievement and career opportunities. Learners with mathe-
matics anxiety tend get worse grades than peers in high school and college
and are less likely to follow mathematics courses and degrees or take up
mathematics-related careers (Ibid., p. 328). A learner may fear appearing
incompetent in front of peers. Mathematics anxiety inhibits learning by
essentially rerouting working memory resources towards emotional reg-
ulation centres of the brain (Ibid., p. 332).
This seems to correspond with perceptions that some learners become
unusually anxious when expected to demonstrate competence in apply-
ing mathematical skills. Sometimes attention difficulties are exacerbated
by stress and anxiety about doing mathematics.
By reassuring the learner and making mathematics enjoyable, perhaps
using games, anxiety can be reduced, helping the learner to relax, and to
concentrate and attend better. Where a student experiences high levels
of anxiety about mathematics, individual tuition can help ensure early
success and reduce the worry about getting the task wrong.
Temporarily minimising the learning challenge (Fuchs et al., 2008)
builds the student’s confidence by providing many foundational experi-
ences of success. As an educator, you can give precise explanations to
anticipate the problems that the learner will likely encounter. Where
worries about mathematics are part of a more general, severe level of
anxiety, counselling may be provided.

Resources
For learners with mathematics disorder, concrete materials are important
in laying down a foundation to learning. Cuisenaire rods, Dienes MAB
blocks, Stern’s equipment and Unifix blocks are used in developing
understanding of computation and other mathematical understanding.
Equipment may be adapted. With linear measuring, a learner having
difficulties with fine motor co-ordination may use a ruler with a small
handle on the flat broad side.
Through exploration and discovery, computers can encourage active
learning. Commercially available materials include The Number Race
(www.thenumberrace.com) designed to improve number sense for those
64 Impairment in mathematics

with dyscalculia particularly for ages 4 to 8 years. Another resource, Bubble

Reef (www.sheppardsoftware.com) comprises 12 multimedia games
involving basic number activities of counting, numeral recognition,
sequencing, and simple operations. Set underwater, it involves various
aquatic characters. MathBase 1 (www.mathbase.co.uk) is UK software
focusing on basic number concepts, which offers more advanced modules
as the learner progresses. Using the familiar setting of an open-air market
and day-to-day experiences to develop number sense, To Market to Market
(www.learninginmotion.com) is US software package.

Therapy
Where a learner experiences severe mathematics anxiety, perhaps in the
context of wider anxiety disorder, counselling may be provided.

Organisation
Explicit systematic instruction is helpful to learners with mathematics
disorder and should offer opportunities for learners to respond and to
talk through their thinking (Gersten et al., 2008; the Instructional
Research Group, California, www.inresg.org). Therefore, classroom and
group organisation that facilitates this should aid learning. If well
focused, opportunities for small group discussions and for learners to
speak with partners can be beneficial.

Conclusion
Mathematics is complex, suggesting that dealing with impairment in
mathematics is likely to be challenging. Developing number sense is
a foundation for mathematical understanding and skill. Definitions
of impairment in mathematics, specific disorder of arithmetical skills,
and dyscalculia differ in detail. Estimates of the prevalence of
dyscalculia are 6.5% or more. Impairment in mathematics overlaps
with disorders in reading, writing, and mathematics, as well as co-
ordination. Deficits in visuo-spatial working memory occur together
with arithmetic difficulties, and attention deficits co-occur with
mathematics problems.
Some neuroimaging studies of children with developmental dyscal-
culia have shown abnormalities in the structure and functioning of the
parietal cortex. In groups with Turner’s syndrome, children with foetal
alcohol syndrome, and those with low birth weight, dyscalculia is more
frequent than typically, and there tends to be less brain activity in the
 Impairment in mathematics 65

intra-parietal sulcus. Mathematics anxiety can be precipitated by fear of

failure, or of appearing stupid (both possibly relating to a learner’s
experience of mathematics or perceptions of it). Commercially available
tests, early identification based on observation of apparent difficulties,
and assessment based on an individual’s response to intervention are used
for identification and assessment.
For learners with impairment in mathematics, curriculum planning
starts from lower levels in mathematics (or parts of it). In settings where
various areas of learning are taught, including subjects where mathe-
matics is a major component, mathematics learning may be supported.
This can be by pre-teaching the skills to be used, follow-up teaching to
ensure understanding, and extra staff support. Ongoing assessment
during teaching takes account of the processes used by the learner to
engage with mathematics.
Pedagogy includes explicit teaching and practice of number sense,
concrete experience to symbolic representations, and basic number
facts, developing understanding of mathematics language, using every-
day experiences of mathematics, using computer for mathematics
learning, and reducing mathematics anxiety. Concrete materials like
rods and blocks, adapted equipment, and computer software are used.
Counselling may be provided for severe mathematics anxiety. Learners
are given opportunities to respond and to talk through their thinking
and participate in small group and paired discussions.

Thinking points
You may wish to consider the relative effectiveness of approaches dis-
cussed in this chapter and how these approaches can be rationalised into
comprehensive and coherent provision.

Key texts
Chin, S. (Ed.) (2017) Routledge International Handbook for Dyscalculia and
Mathematical Learning Difficulties. London and New York, Routledge.
This book comprises articles from different countries outlining various
aspects of mathematical learning difficulties and dyscalculia. These vary
from comprehensive reviews to journal-type contributions presenting a
single piece of research.
An example of an Internet site giving a brief overview of mathematics
disorder is www.schwablearning.org/articles.
66 Impairment in mathematics

Resources
The Number Race (www.thenumberrace.com).
Bubble Reef (www.sheppardsoftware.com).
MathBase 1 (www.mathbase.co.uk).
To Market to Market (www.learninginmotion.com).

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Chapter 5

Developmental co-ordination
disorder

Introduction
In this chapter, I discuss definitions of developmental co-ordination dis-
order (DCD) (with its origins in notions of clumsiness), understandings
of DCD and dyspraxia, and types of motor difficulties. I consider the
pervasive nature of DCD, its prevalence and co-occurrence with other
disorders. Possible genetic and neurological causal factors are touched
on. Considering identification and assessment the chapter looks at
screening tests, implications for tests at different ages, standardised tests,
multi-professional assessments, and eligibility for special provision.
I examine curriculum and related assessment. Pedagogy is discussed in
relation to general classroom approaches, specific skills training, and accom-
modations to increase student participation. Also examined is pedagogy in
relation to the important areas of physical education, personal and social
education, and handwriting. I look at resources with reference to special and
adapted equipment, and the different uses regular resources. Physical therapy
is considered relative to two interventions Neuromotor Task Training and
Cognitive Orientation to Daily Occupational Performance. I discuss orga-
nisation including the layout of furniture and equipment in rooms.

Definitions

DCD is more than clumsiness

Formerly, it was common to use the expression ‘clumsy child syndrome’
for what is now called developmental co-ordination disorder (DCD).
Indeed, a recent succinct description of DCD is that it refers to children,
‘whose clumsiness has no known medical cause’ and ‘whose everyday
social and academic functioning is significantly impaired’ (Cairney, 2015,
pp. 5–6).

DOI: 10.4324/9781003177975-5
70 Developmental co-ordination disorder

While the focus on clumsiness may convey a common feature of the

condition or at least a possible subtype, it misses some subtle implications
which are more complex than just the idea of clumsiness suggests.
Consequences of DCD can include an impact on socialisation, physical
health and fitness, and mental well-being.

Developmental co-ordination disorder and dyspraxia

Widely used diagnostic guidance (American Psychiatric Association, 2013)
defines DCD as a condition in which, acquiring and carrying out co-ordi-
nated motor skills is ‘substantially below that expected’. Such expectations are
based on the person’s chronological age and previous opportunities to learn
and use the skills in question. Difficulties show themselves as ‘clumsiness’ and
‘slowness and inaccuracy of performance of motor skills’ (Ibid., p. 74).
Furthermore, the motor skills deficit ‘significantly and persistently
interferes with activities of daily living appropriate to chronological age’.
It inhibits ‘academic/school productivity, prevocational and vocational
activities, leisure and play’ (Ibid., p. 74). Symptoms start in the ‘early
developmental period’.
Care is taken to avoid confusing DCD with the effects of other condi-
tions. Broad intellectual disability can lead to poor and uncoordinated
movement, as can visual impairment. Other conditions affect movement
because of neurological conditions. A neurological disorder of movement,
affecting muscle co-ordination, and balance and impairing walking, ataxia,
for example, is caused by damage to the cerebellum a part of the brain
controlling muscle co-ordination. To avoid confusion with such condi-
tions, criteria for DCD state that evident deficits in motor skills are not
better explained by ‘intellectual disability … or visual impairment’. Nor are
they attributable to ‘a neurological condition affecting movement’ (Ibid.).
Some countries still use the term ‘dyspraxia’ (from the Greek for
‘difficulty in doing’). It is sometimes regarded as a subtype of DCD. For
example, the Dyspraxia Foundation describes it as ‘a form of develop-
mental disorder’ which affects ‘fine and/or gross motor coordination’
(www.dyspraxiafoundation.org.uk/about-dyspraxia).
Definitions of dyspraxia tend to emphasise the planning and organisation
of movement.

Types of motor problems

Helping to provide a fuller picture of the condition, as well as definitions
of DCD there are descriptions of motor problems experienced with the
condition. Such descriptions convey the variable nature of DCD.
 Developmental co-ordination disorder 71

Problems with fine motor control make activities involving manipula-

tion with the fingers and hands exceedingly difficult, as illustrated by
dressing, eating with cutlery, writing, and drawing, and using scissors.
Individuals may experience difficulties with gross motor movements when
finding a route around furniture, participating in sports, and sitting on a
chair safely. Motor co-ordination difficulties may be behind secondary
problems such as limited participation in activities, poor physical health,
and frustration-led disruptive behaviour (Cairney, 2015, pp. 10–11).
Geuze (2005) identified three types of problems experienced by lear-
ners with DCD:

 poor postural control or difficulties with static and dynamic balance;

 poor sensorimotor co-ordination covering motor planning, timing,
anticipating, and using ‘feedback’ to respond to environmental
changes; and
 problems with motor learning involving learning new skills, adapting
to changes, and automatisation (focusing on a task while carrying out
other movements required for co-ordinated action with little or no
conscious attention).

Compared with children of the same age, children with DCD tend to
be much slower in processing visuospatial information.

Implications of developmental co-ordination disorder

Implications of DCD are many. DCD can limit participation in physical
pursuits and in social activities at work, at school, at home, and in the
community. Reduced involvement in activities in turn affects the
development of skills and of physical and emotional well-being (Engel-
Yeger, 2015, pp. 47–48). Restrictions in play and leisure activities can
limit opportunities to develop socially and in other ways (Cairney, 2015,
p. 62). Leading to reduced physical activity, low motor competence can
affecting health, especially cardiovascular health (Ibid.).
Studies of interactions between DCD and its social and emotional
consequences suggest possible relationships with anxiety, depression,
self-perception, and social skills (Piek and Rigoli, 2015, p. 126).
Missiuna, Polatajko, and Pollock (2015) convincingly state that

Twenty-five years of research has produced compelling evidence

that the motor problems of children with DCD are lifelong … and
that these motor difficulties are strongly associated with the sub-
sequent development of physical and mental health difficulties,
72 Developmental co-ordination disorder

including decreased physical fitness … obesity … anxiety …

depression … low self-esteem … and also academic failure ….
(Ibid., pp. 215–216)

Prevalence and co-occurrence with other disorders

Prevalence of DCD
In children aged 5 to 11 years, the prevalence of DCD is 5% to 6%. A
male:female ratio ranging from 2:1 to 7:1 is found (American Psychiatric
Association, 2013, p. 75). However, population-based studies of children
with DCD suggest that more equal numbers of boys and girls may be
affected (Edwards et al., 2011).

Co-occurrence of DCD with other disorders

Co-occurrence of DCD with other conditions can be high. Regarding
attention deficit hyperactivity disorder, co-occurrence is about 50%.
Other conditions commonly co-occurring with DCD are speech and
language disorder, specific learning disorder, autism spectrum disorder,
and disruptive and emotional behaviour problems.
Clusters may occur with severe reading impairment, handwriting dif-
ficulties, and fine motor problems. Impaired movement control and
motor planning is another cluster (American Psychiatric Association,
2013, p. 77).

Causal factors
We do not yet understand the aetiology of DCD fully. Some researchers
have proposed a possible genetic element (Gaines et al., 2008). Originating
early in life, the condition may develop while the child is in the womb or
soon after birth. DCD may result from damage as the brain is developing
when neural pathways governing motor co-ordination and control are
forming. Preterm birth appears to be a risk factor (Cairney, 2015, p. 15).
While complex, neurological evidence is beginning to point to pos-
sible causal factors. Brain imaging studies suggest that DCD may be
associated with dysfunction of the parietal lobes and the cerebellum, a
part of the brain involved in motor co-ordination and postural control
(Zwicker, Missiuna, Harris, and Boyd, 2010a; Zwicker, Missiuna, Harris,
and Boyd, 2010b). In children with DCD, neurological mechanisms
involved in predicting motor control may be compromised. Also, there
are deficits in executive control (Wilson, 2015, p. 157).
 Developmental co-ordination disorder 73

Identification and assessment

We consider identification and assessment of DCD in relation to

 screening tests,
 implications for tests at different ages,
 standardised tests,
 multi-professional assessments, and
 eligibility for special provision.

Screening tests
Given the potential for secondary difficulties to develop, early iden-
tification of DCD is important. However, there are some reservations
about the sensitivity of screening tests in identifying DCD and motor
difficulties more generally. Despite these limitations, screening ques-
tionnaires can provide important information about functional motor
abilities of children at home and at school (Schoemaker and Wilson,
2015, pp 169–191).

Implications of assessments at different ages

In carrying out an assessment, the assessor needs to be aware of pos-
sible characteristics of the condition at different ages and periods of
development. Children of 4 or 5 years old with DCD may find it
harder than peers to go up and down stairs. They may learn to use
the toilet independently much later than other children and have
difficulty handling toys and performing tasks requiring dexterity, like
completing jigsaws.
Because skills are neither secure nor automatic, a child around 5 to 11
years old with the disorder might have difficulty generalising them. Most
typically developing learners find little difficulty in tasks such as adapting
to catching various balls of different sizes. For individuals with DCD,
adapting for such activities will be almost like learning a new skill each
time. Tending to knock things over or bump into objects, they may be
accident prone.
Older learners may be disorganised, finding it difficult to move
around large buildings and to get to different parts of it punctually,
especially if there are stairs to negotiate. In a school or college, some
subjects pose challenges for example, safety implications where hazar-
dous substances are handled. These will require risk assessments to be
made for individual learners.
74 Developmental co-ordination disorder

Commercial assessments
A variety of assessments is commercially available reflecting the varied
nature and manifestations of DCD.
Used to identify visual motor problems associated with dyspraxia, the
Beery-Buktenica Developmental Test of Visual-Motor Integration – VMI (Beery,
Beery, and Buktenica, 2010) shows how well an individual can integrate
visual and motor skills. It is standardised for ages 2 years to adult.
The Movement Assessment Battery for Children (second edition) or
Movement ABC-2 (Henderson, Sugden, and Barnett, 2007) contains
eight tasks in each of three age ranges (3–6, 7–10, and 11–16 years).
Covered are the three areas of manual dexterity, ball skills, and static and
dynamic balance. Percentile scores are used to allow comparison of the
child’s scores with those of typically developing peers. A checklist covers
ages 5 to 12 years and is a means of assessing movement in everyday
situations.
An individually administered assessment of gross and fine motor
skills, the Bruinincks-Oseretsky Test of Motor Proficiency (BOT-2) (Brui-
nincks and Bruinincks, 2005) is for ages 4 to 22 years. Eight subtests
assess fine motor precision, fine motor integration, manual dexterity,
bilateral co-ordination, balance, running speed and agility, upper limb
co-ordination, and strength.
Standardised for the UK, the Detailed Assessment of Speed of Handwriting –
DASH (Barnett, Henderson, Scheib, and Schulz, 2007) analyses the speed
and legibility of handwriting. Used with ages 9 to 17 years, it identifies
words per minute in relation to national averages, under both test and non-
test conditions, giving a more accurate description of why the individual
struggles to write legibly and at a normal speed. Occupational therapists use
DASH to assess improvements made during therapy.
Subtests examine fine motor and precision skills, the speed of
producing well-known symbolic material, the ability to alter speed of
performance on two tasks with identical content, and free writing
competency. DASH17+ is used for students aged 17 to 25 years in
further and higher education.

Multi-professional assessments
Multi-professional assessments, like the range of commercial tests, reflect
the complex nature of DCD. They may involve a physician, physical
therapist/physiotherapist, occupational therapist, school psychologist,
speech therapist/pathologist, and teacher. Such assessments recognise
that movement and movement difficulties occur in a context.
 Developmental co-ordination disorder 75

Indeed, it is evident that ‘movement is a product of innate (neurological),

biological, and environmental factors (stimuli)’ (Cairney, 2015). The indi-
vidual is embedded in the task or the setting in which movement is being
assessed (Ibid., p. 12, paraphrased). Accordingly, where possible several
assessments are taken over time. This enables the assessor to consider
variability in rates of change for the individual being assessed and those
changes when compared with others of the same age (Ibid., p. 14).

Eligibility for special provision

In the United States, while DCD is not considered a designated learning
disability, students may receive services within the education system
based on its impact on academic performance. In Canada, some parents
have been able to acquire special education identification for their child
under the umbrella of learning disability because of academic impact; or
under the physical disability remit if the child raised self-care or safety
concerns at school (Private communication, C. Missiuna, McMaster
University, Ontario, 2010).

Curriculum and assessment

In institutions such as schools, colleges, and tuition centres, the curriculum
for students with DCD is likely to be similar to that of most learners.
There will be some differences of emphasis and of detail. Overall, the
balance of subjects in the curriculum may emphasise areas where learners
need extra practice and support.
Refinements may be made in programmes where motor co-ordination
is central, including handwriting, physical education, art, geometry, and
social and personal skills development. Craft or technology where tools
are used, and laboratory work in science also require careful planning.
This reflects the need for planning to be more detailed where the tasks are
difficult for learners with DCD and helps ensure that activities where
there is a risk of accident are made as safe as possible.
In developing planning, the educator will review learning sessions to
highlight the motor skills that they require or that they develop. Teachers
can then ensure that all learners can carry out the required motor activ-
ities, and that they are taught these directly where the skills are new.
Taught individually or in small groups, these skills may be developed and
practised during extra-curricular time in activity groups or clubs. Impor-
tantly, the skills should be developed and practised in context and regular
opportunities provided to apply the skills in varied situations with different
demands.
76 Developmental co-ordination disorder

Assessment of motor development may be particularly detailed to

ensure progress is monitored. Small steps of assessment will also help to
demonstrate that some progress has been made so this can be recognised
and affirmed.

Pedagogy
In this section, I look at

 general classroom approaches,

 specific skills training,
 accommodations to increase learner participation,
 physical education,
 personal and social education, and
 handwriting.

Clearly, the first three sections examine approaches, while the

remaining three look at areas of learning that can be particularly
challenging for those with DCD. In each of these areas, I describe
combinations of motor skill teaching and accommodations to help
participation and achievement. Specialised approaches used with
learners having severe, complex difficulties associated with DCD and
mainly delivered by occupational/physical therapists are discussed in a
later section of this chapter, on therapy.

General group approaches

Missiuna, Polatajko, and Pollock (2015, pp. 218–232) suggest a framework
for learning which includes a general approach to encouraging and teaching
motor skills. It implies that educators and aides need to be trained to
understand typical motor development in learners, the motor skills expec-
ted at different ages, and how these skills can be encouraged (Ibid., p. 220).
Accordingly, motor skills are promoted for all learners through general,
curriculum-based activities. In planning a session where motor tasks will
arise, the educator ensures that the necessary skills are directly taught in
context. In a school or tuition centre, for example, this could involve
cutting out shapes with scissors during an art or mathematics session. In
helping ensure that everyone can participate in ball games, the skills of
throwing and catching a ball would be directly taught (Missiuna, Pola-
tajko, and Pollock, 2015, p. 220).
Implied in all this is a sort of universal design for learning applied to
motor skills and development (Missiuna, Polatajko, and Pollock, 2015,
 Developmental co-ordination disorder 77

p. 220). A group room (such as a classroom in a school) is designed to

promote motor development for example through changes in the physical
environment. These might be exploration areas set up temporarily or for
longer periods. To enable learners with DCD to reach the same learning
goals as peers, a range of educational materials and approaches is used.
Consider that the learning goal is to improve fitness and participation
in a physical activity. In this instance, the educator may need to find
activities in which a learner with DCD can participate. The teacher
might give the student a specific role that they can manage and later
offer more demanding roles. Such approaches, while appropriate for all
learners, are likely to especially benefit those with DCD. These roles
should be part of the group activity which can sometimes require inge-
nuity. They should not be an isolated task where the student with DCD
sits on the side lines deprived of the opportunity to develop team and
social skills.

Specific skill training

General group approaches and specific teaching will not be sufficient to
encourage the development of motor skills for all. A more focused
group training in specific skills may be required. Missiuna, Polatajko,
and Pollock (2015, p. 225) summarise some of the key aspects of what
works in this respect.
They maintain that motor skills interventions are more effective

 when applied to learners over 5 years old,

 when specific skills training is a particular focus, and
 when the intervention is delivered in a group setting or through a
home programme.

To have a positive impact, the intervention needs to be provided at

least three times per week. In a school or tuition centre, the activities
may take place during physical education sessions or as extra-curricular
activities and can target learners having motor learning difficulties. Tsai,
Wang, and Tseng (2009) report that they trained groups of children in
the motor skills required in the game of football. Subsequently, they
found that the task performance of children with DCD improved.

Accommodations to increase participation

Accommodations (as distinguished from ‘modifications’) are physical or
environmental changes such as giving more time to complete a task,
78 Developmental co-ordination disorder

allowing short breaks within the time set for the task, changing the
layout of the room or area, and using computer software to ‘read’ text
to the learner. These enable the learner to work round a potential
difficulty.
Accommodations may be used to enable a learner with DCD to par-
ticipate in activities and to make progress in acquiring motor skills.
These may be developed as the teacher, occupational therapist, and
physical therapist work together.
Resources may be adjusted, or different resources may be used. Saving
a student the labour of typing every word in a report or essay, predictive
computer software can be used. At a low-tech level, a pencil grip can
help the learner control the fine motor movements of handwriting.
Paper with guidance lines can enable the learner to keep their writing
within acceptable parameters. In physical education, a larger ball might
be used to make catching manageable and perhaps over time reduced in
size as the learner develops the skills of catching.
Detailed steps of an activity might be taught while retaining its overall
purpose and context. In cooking, the exact steps of making pastry may
be taught. This may be done using behavioural chaining, an instructional
procedure used to reinforce (increase the likelihood of) individual
responses that occur in a sequence. Each step is prompted by verbal,
visual, and physical prompts. As the learner makes progress, these
prompts are gradually withdrawn.
Environmental changes such as ensuring the teaching area is not
cluttered and that there is space to move across the room can help the
learner with DCD. Such changes are discussed later in this chapter in the
section ‘Organisation’.

Physical education

The importance of physical health and physical activity

While physical activity and physical health are important, individuals
with DCD struggle with organised sport and free play. This is owing to
gross motor difficulties relating to balance, poor eye-hand co-ordination,
and poor skills in catching and throwing and kicking.
Accordingly, learners with DCD tend to avoid such activities, so
limiting opportunities for physical and social development. Leading to
poorer opportunities for friendship and socialisation, lost play can
ultimately create isolation. As well, lack of play and participation in
sports and physical activities diminish physical health (Cairney, 2015,
pp. 62–63).
 Developmental co-ordination disorder 79

DCD and challenges of physical education and activity

Evident for all is the importance of physical education, physical
activity, and the enjoyment of sports and play. For those with DCD
there are challenges. Skipping with or without a rope may be diffi-
cult. Riding a bicycle involving balance, co-ordination, and con-
stantly processing and responding to visual information for steering is
hard for someone with DCD and tends to take longer to accomplish.
Posing difficulties moving about among apparatus, physical education
sessions may be unwelcome. Problems judging distance and velocity
make many ball games daunting.

Strategies in physical education sessions

In physical education sessions, such as gymnastics, the teacher can
ensure that there is a space for each learner to which they may return.
Providing a reassuring sense of predictability and security, this can help
to build confidence. Floor markings can be used to indicate the paths
that students are expected to follow to help with orientation and
direction.
Changing into appropriate clothing for physical education and chan-
ging back into day clothes afterwards can be laborious. Time limits
where this is expected to be done quickly can add to the pressure
involved. To help with this, learners can use adapted clothing using false
buttons and Velcro fasteners. With such items the adaptations can be
discrete, and the clothing can still be smart and fashionable.

Adapted Physical Education

Adapted Physical Education is ‘an individualised programme including
physical and motor fitness, fundamental motor skills and patterns, skills
in aquatics and dance, and individual and group games and sports
designed to meet the unique needs of individuals’ (Winnick, 2010, p. 4).
An Adapted Physical Education teacher concentrates on fundamental
motor skills and physical performance of individual learners. This may
involve working with learners for a certain number of designated hours
per week. In a school for example, a classroom teacher and the Adapted
Physical Education teacher can work together to develop and teach
programmes of physical education as well as leisure and recreation.
Benefiting students with DCD, such approaches also help others, for
example, those with health or orthopaedic impairments (www.teachinga
daptedpe.com).
80 Developmental co-ordination disorder

Personal and social development

DCD and potential limitations on leisure activities and socialising

Co-ordination difficulties hamper involvement in team games requiring
high levels of motor co-ordination, some computer games, and board
games. Poor co-ordination may inhibit participation in social activities
such as dancing, ice-skating, and bowling, limiting opportunities to
socialise and participate. Teachers and others should be able to identify
at least one sport or activity that the learner is motivated to try. This can
then become the focus, while teaching the motor skills involved directly
and in context.

Handling money
In using money visiting a cinema, a dance venue, or when shopping,
older individuals may use debit or credit cards which, depending on the
amount, may allow contactless payments. For younger children, or
where physical cash is required, handling small coins can be problematic
particularly if one is under time pressure at the front of a busy line.
Taught directly, such activity can then be practised in various settings.

Domestic skills
Domestic skills, such as cleaning a room, keeping an area tidy, cooking,
laying a table, and arranging shelf contents, pose challenges relating to
co-ordination and movement. Often adaptations in routines or in the
use of items of equipment can help. In preparing a meal, using a hand
can-opener may be tricky but a wall can-opener should be much easier
to operate. Applying butter or other spread on bread or biscuits can be
difficult but using cutlery with thick rubber handles is a possible
adaptation.

Personal hygiene and personal appearance

Both personal hygiene and personal appearance can influence peer
acceptance and self-esteem. Individuals with DCD may have difficulty
with washing hair, cleaning teeth, and cutting fingernails. For younger
students, using the toilet may be problematic.
Dressing and undressing can take an inordinate amount of time for
individuals with DCD. False buttons above Velcro fasteners on clothing,
and trousers with an elasticised waist, can save time. If a learner needs to
 Developmental co-ordination disorder 81

use the toilet in education settings where recreational times are limited,
such adaptations can be helpful.
In high school, hygiene may still be hard to achieve consistently. Girls
may find changing sanitary products difficult. Requiring sensitive gui-
dance from parents and the school, they may find it hard to apply facial
cosmetics sparingly so that the effect is inadvertently smeared and garish.
Some of these skills can be taught in school and at home. Intimate
aspects of hygiene may be more appropriately taught by parents with
advice from a physical or occupational therapist.

Encouraging self-worth
Learners with DCD can become frustrated and demoralised and come to
have low self-worth partly because of the persistent difficulties they face
that may not always be understood by others. In these circumstances
teachers and others will try to establish the root cause of the behaviour.
They will try to understand DCD and enhance their own skills in sup-
porting students, improving the likelihood that the learner will be able
to meet the challenges of education and other day-to-day demands.

Handwriting and alternatives

Dysgraphia
‘Dysgraphia’ refers to learning disorder related to difficulties with hand-
writing ‘such as forming letters or words or writing within a defined
space’ (Pullen, Lane, Ashworth, and Lovelace, 2011, p. 191). In teaching
handwriting, the principles already discussed apply, namely, teaching
explicitly and directly, rather than expecting the learner to acquire the
skill by watching others. Writing is taught in context and for a purpose.
In the physical aspects of handwriting, support may be provided by a
physiotherapist/physical therapist or an occupational therapist.

Writing posture and positioning

To avoid discomfort and improve performance, a learner with DCD may
need to be taught a good writing posture. Desks and chairs should be the
correct size in the sense that both the writer’s feet can rest flat on the floor
and the desk height is slightly above the elbows. Positioning the paper to be
written on should align it with the writer’s arm. To help ensure that the
position is maintained marks can be put on the desk or a large card template
may be used (Mather, Wendling, and Roberts, 2009, pp. 89–90).
82 Developmental co-ordination disorder

Writing implements
Helping the writer to hold the utensil more comfortably, a three-cornered
pencil grip or a pen with a rubber finger grip can be used. Pencil pressure
on the paper may be too light or too heavy because of proprioceptive
difficulties affecting co-ordination and the sense of exerting pressure. A
pen that illuminates when pressed for writing can help the writer become
more aware of the pressure exerted. An individual pressing too lightly will
be encouraged to increase pressure to make the implement light up. By
contrast, a writer pressing too heavily will be expected to reduce it so as
not to illuminate the pen.

Lined paper
Students can work on pre-writing patterns to help develop the rhythm
and fluency necessary for writing. When learning to write letters of the
alphabet, using a special lined paper can help the formation of the correct
shapes. This specially printed paper has a central line and a line above and
below. The upper line indicates the height of the ascending letter and the
lower line signifies the depth of the descending letter. Mather, Wendling
and Roberts (2009, pp. 91–93) provide further suggestions to help
develop good letter formation.

Movement control
With regard to movement control, learners must know the forms of
letters and how they join cursively. Because of processing difficulties,
they may have difficulty stopping a letter. They may run the line of
a letter on so that, for example, a ‘c’ has a bottom tail that is far too
long. It follows from this that the writer must learn that the letters
have a beginning and an end. This can be helped by providing some
practice writing a series of letters in a specified short horizontal line
in which the start and finish are marked by vertical lines. Such drill-
like activities can be made more engaging if the teacher makes clear
the purpose of the task and its importance. Also, the activity can be
kept short and repeated at intervals rather than being a long and
laboured task.
Where letters and words are poorly spaced, cursive writing can be
introduced early and the writer can be encouraged to leave a finger
space between words. This works best when using a pencil rather than a
pen (which may smudge). Fluency in writing is difficult to attain for a
learner with DCD.
 Developmental co-ordination disorder 83

Moving from pre-writing patterns to the formation of letters with

joins/integral exit strokes to cursive writing can assist fluency. The learner
is not taught to write ‘separate’ letters. Teachers may also consider using
commercial writing programmes.

Alternatives to handwriting
Given the difficulties of handwriting for individuals with DCD, some
may think that the effort necessary to accomplish good handwriting is
hardly worth it. This may be reinforced by knowing that computer-
aided alternatives are available. Even business contracts can now be
‘signed’ electronically. However, the skill of handwriting has not been
replaced by computer alternatives and remains necessary in many situa-
tions. Furthermore, alternatives are not problem free.
Several computer-based strategies are available for bypassing hand-
writing problems, but each has its own demands which learners may
find challenging. Examples include

 using a keyboard,
 dictation with a voice recognition system, and
 word prediction programmes.

Keyboard skills are an alternative to handwriting. But a learner must

be able to automatically use the letter finding skills and keyboard skills
involved in word processing. Otherwise, word processing may not be
fluent enough to be a viable alternative.
Dictation using a voice recognition system can eventually lead to better
and longer text than a learner may produce by handwriting. Nevertheless,
it still involves learners mastering the commands for monitoring and cor-
recting errors. They must be able to dictate, monitor if there have been any
errors, and use the programme commands effectively. All this places con-
siderable demands on working memory.
In word prediction software the ‘predictions’ are based around syntax,
spelling, and the frequent or recent use of words. However, the software
may also pose difficulties for individuals having poor working memory or
problems with attention or executive function. This is because the learner
must monitor the list of options that changes with each letter that is typed.

Resources
Aids to more fluent writing include pencil grips and illuminating pens as
described earlier in this chapter. Special equipment for physical
84 Developmental co-ordination disorder

education may be used such as extra light balls and extra-large bats.
Adapted equipment like cutlery with thick rubber handles may be
employed. False buttons above Velcro fasteners may be attached to
clothing, and trousers may have an elasticised waist.
As well as sometimes using special resources, students’ participation and
achievement can be enhanced by using existing resources differently. An
example is decreasing the distance between the thrower and catcher when
passing a ball so that the task is easier, then extending the distance as the
necessary skills and confidence are developed.

Therapy
Involving team working and examples of specialist interventions,
approaches to therapy can be identified as follows:

 innovative multi-professional working;

 Neuromotor Task Training; and
 Cognitive Orientation to Daily Occupational Performance.

Innovative multi-professional working

Good opportunities for innovative team working arise between the
teacher of physical education and a physical therapist or occupational
therapist. Since DCD affects activities of daily living, the occupational
therapist has an important role. Working individually with the student
for some of the time, therapists will also work with the teacher, parents,
and others so that all concerned can ensure that motor skills are
encouraged and applied in different contexts.
In current practice there is a tendency to move away from ‘bottom-
up’ approaches, such as perceptual motor training, which attempt to
remediate supposed underlying motor deficits, expecting this to lead to
improvements in motor performance. Evidence of effectiveness of such
bottom-up strategies tends to be weak. Accordingly, and increasingly,
‘top-down’ approaches are preferred which focus on a goal and on the
context of the motor learning. Being able to tie a shoelace or being able
to pass a ball accurately in a basketball game are examples having a goal
and a context.

Neuromotor Task Training

Neuromotor Task Training was developed in the Netherlands for the
treatment of children with DCD by paediatric physical therapists
 Developmental co-ordination disorder 85

(Niemeijer, Smits-Engelsman, and Schoemaker, 2007). Based on motor

control and motor learning principles, it also takes account of principles of
motor teaching and motivation. Fundamental to the approach is a neuro-
motor assessment and a task analysis of the skills that the individual child
finds problematic.
As a task specific intervention, Neuromotor Task Training focuses
directly on teaching the skills that the individual needs in daily life. Tasks
are learned in a variety of contexts to help the child generalise the skills
involved to real-life settings. Learning is directed by the physical or
occupational therapist, who gives spoken instructions, visual prompts, or
physical assistance, to help the learner to get the feeling of the movement
and to learn it.

Cognitive Orientation to Daily Occupational Performance

Developed in Canada for children with DCD, Cognitive Orientation to
Daily Occupational Performance (CO-OP) (Levac, Wishart, Missiuna,
and Wright, 2009) typically involves an occupational therapist working
closely with parents and the student. It aims to help children discover
the cognitive strategies that will improve their ability to carry out
everyday tasks such as handwriting, riding a bicycle, using cutlery, and
catching a ball.
CO-OP employs global and domain specific strategies and guides
individuals to discover strategies, enabling them to achieve the goals they
have selected. Used to determine when a student has difficulties per-
forming an activity, ‘dynamic performance analysis’ makes it possible to
identify points where performance breaks down. The therapist teaches
the student a global strategy called ‘Goal-Plan-Do-Check’ to act as a
framework for solving motor-based performance problems, then guides
the student to discover domain specific strategies that will enable the
activity to be performed.

Organisation
Group organisation can be a vehicle to encourage younger children to
develop and practice motor skills. In a larger group setting such as a
school classroom, there may be several activity centres where children
can be shown and taught fine motor and gross motor skills. In play areas,
teachers can directly teach children the skills needed to participate.
Also, the physical organisation of larger group settings can help miti-
gate the effects of DCD. It can ensure relatively free movement around
the room without unnecessary clutter. The student may sit close to the
86 Developmental co-ordination disorder

front of the group in a seat near to the entry door to avoid bumping
into others and into objects when they enter or leave the room. Ideally,
the room will be large enough to allow furniture arrangements for dif-
ferent activities such as group work or whole class work to be laid out
permanently.
This enables the learner with DCD to become accustomed to the
layout rather than having to constantly adapt as furniture is moved into
different arrangements for new activities. However, if space is limited,
stable layouts may not be possible. In this situation, the positions into
which furniture is moved for different activities can be marked on the
floor of the room so that the positions are at least predictable and
consistent.

Conclusion
Understanding DCD, dyspraxia, and types of motor difficulties began with
notions of clumsiness, as reflected in their definitions. Dyspraxia tends to be
defined in terms of the planning and organisation of movement. DCD has
a pervasive detrimental effect on many aspects of daily life. In children aged
5 to 11 years, the prevalence of DCD is 5% to 6%. It may be more
common in boys. DCD co-occurs with many other conditions sometimes
very strongly as with attention deficit hyperactivity disorder.
DCD may have a genetic element. It may originate prenatally or soon
after birth and may result from damage as the brain is developing. Pre-
term birth appears to be a risk factor. DCD may be associated with
dysfunction of the parietal lobes and the cerebellum. In children, neu-
rological mechanisms involved in predicting motor control may be
compromised and there may be deficits in executive control.
Identification and assessment can involve the use of screening
instruments, standardised tests, and multi-professional assessments.
There are implications for tests at different ages, and eligibility for
special provision.
Curricula for learners with DCD tend to differ in emphasis and in
detail from that of other learners. It may emphasise areas where learners
need extra practice and support. Programmes may specify achievement
in greater detail where motor co-ordination is central, and where tasks are
difficult or potentially unsafe for learners with DCD. Required motor
activities are taught directly and in context where necessary. Detailed
assessment of motor development is carried out, allowing progress to be
monitored, recognised, and affirmed.
Pedagogy involves general classroom approaches, specific skills training,
and accommodations to increase student participation. It also relates to
 Developmental co-ordination disorder 87

key areas including physical education, personal and social education, and
handwriting.
Resources include special and adapted equipment as well as the use
of regular resources in a different way. Examples of physical therapy
are Neuromotor Task Training and Cognitive Orientation to Daily
Occupational Performance. Suitable organisation includes the layout of
furniture and equipment in rooms.

Thinking points
Readers may wish to consider

 the effectiveness of approaches that will help students with DCD

across all areas of school life and, in particular, subject lessons, and
 how teachers, classroom aides, and others can work more effectively
with physical therapists and occupational therapists to enhance
overall provision.

Key text
Cairney, J. (2015) (Ed.) Developmental Coordination Disorder and Its
Consequences.
Toronto, Canada, University of Toronto Press.
Intended for teachers, parents, and physicians, this book includes
information on diagnosis, the consequences concerning mental health,
social functioning, and physical health and activity, and the neu-
ropsychological foundations of DCD. As the title suggests, there is an
emphasis on the consequences of DCD.

References
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental
Disorders Fifth Edition (DSM-5). Washington DC, APA.
Barnett, A., Henderson, S. E., Scheib, B., and Schulz, J. (2007) The Detailed
Assessment of Speed of Handwriting – DASH. Pearson Clinical.
Beery, K. E., Beery, N. A., and Buktenica, N. A. (2010) The Beery-Buktenica
Developmental Test of Visual-Motor Co-ordination. Pearson Clinical.
Bruinincks, R. H. and Bruinincks, B. D. (2005) Bruinincks-Oseretsky Test of Motor
Proficiency (BOT-2). Easel, TX, AGS Publishing.
Cairney, J. (2015) ‘Developmental coordination disorder, physical activity, and
physical health: Results from the PHAST project’ in Cairney, J. (Ed.) Devel-
opmental Coordination Disorder and Its Consequences. Toronto, CA, University of
Toronto Press.
88 Developmental co-ordination disorder

Edwards, J., Berube, M., Erlandson, K., Haug, S.et al. (2011) ‘Developmental
coordination disorder in school-aged children born very preterm and/or at
very low birth weight: A systematic review’. Journal of Developmental and
Behavioural Pediatrics 32, 9, 678–687 (November).
Engel-Yeger, B. (2015) ‘DCD and participation’ in Cairney, J. (Ed.) Developmental
Coordination Disorder and Its Consequences. Toronto, CA, University of Toronto
Press.
Gaines, R., Collins, D., Boycott, K.et al. (2008) ‘Clinical expression of
developmental coordination disorder in a large Canadian family’. Paediatrics
and Health 13, 9, 763–768 (November).
Geuze, R. H. (2005) ‘Postural control in children with developmental coordination
disorder’. Neural Plasticity 12, 2–3, 183–196, discussion 263–272.
Henderson, S. E., Sugden, D. A., and Barnett, A. L. (2007) Movement Assessment
Battery for Children (MABC-2). London, Pearson.
Levac, D., Wishart, L., Missiuna, C., and Wright, V. (2009) ‘The application of
motor learning strategies within functionally based interventions for children
with neuromotor conditions’. Pediatric Physical Therapy 21, 4, 345–355 (Winter).
Mather, N. and Wending, B. J. (2012) Essentials of dyslexia assessment and inter-
vention. Hoboken, NJ, Wiley.
Mather, N., Wending, B. J. and Roberts, R. (2009) Writing Assessment and
Instruction for Students with Learning Disabilities. San Francisco, Jossey-Bass.
Missiuna, C., Polatajko, H. J., and Pollock, N. (2015) ‘Strategic management of
children with developmental coordination disorder’ in Cairney, J. (Ed.)
Developmental Coordination Disorder and Its Consequences. Toronto, CA, Uni-
versity of Toronto Press.
Niemeijer, A. S., Smits-Engelsman, B. C., and Schoemaker, M. M. (2007) ‘Neuro-
motor task training for children with developmental coordination disorder: A
controlled trial’. Developmental Medicine and Child Neurology 49, 6, 406–411 (June).
Piek, J. P. and Rigoli, D. (2015) ‘Psychosocial and behavioural difficulties’ in
Cairney, J. (Ed.) Developmental Coordination Disorder and Its Consequences. Tor-
onto, CA, University of Toronto Press.
Pullen, P. C., Lane, H. B., Ashworth, K. E., and Lovelace, S. P. (2011)
‘Learning disabilities’ in Kauffman, J. M. and Hallahan, D. P. (Eds.) Handbook
of Special Education. New York and London, Routledge.
Schoemaker, M. M. and Wilson, B. N. (2015) ‘Screening for developmental coor-
dination disorder in school-age children’ in Cairney, J. (Ed.) Developmental Coor-
dination Disorder and Its Consequences. Toronto, CA, University of Toronto Press.
Tsai, C. L., Wang, C. H. and Tseng, Y-T. (2012) ‘Effects of exercise interven-
tion on event-related potential and task performance indices of attention
networks in children with developmental coordination disorder’. Brain and
Cognition79, 1, 12–22.
Wilson, P. (2005) ‘Visuospatial, kinesthetic, visuomotor integration, and visuo-
constructional disorders: Implications for motor development’ in Dewey, D.
and Tupper, D. E. (Eds.) Developmental Disorders: A Neurological Perspective.
New York, The Guilford Press.
 Developmental co-ordination disorder 89

Wilson, P. H. (2015) ‘Neurocognitive processing deficits’ in Cairney, J. (Ed.)

Developmental Coordination Disorder and Its Consequences. Toronto, CA, University
of Toronto Press.
Winnick, J. P. (2010) Adapted Physical Education and Sport. 5th edition. Chapaign,
IL, Human Kinetics Publishers.
Zwicker, J. G., Missiuna, C., Harris, S. R., and Boyd, L. A. (2010a) ‘Brain
activation associated with motor skills practice in children with developmental
coordination disorder: An fMRI study’. International Journal of Developmental
Neuroscience 29, 2, 145–152 (April).
Zwicker, J. G., Missiuna, C., Harris, S. R., and Boyd, L. A. (2010b) ‘Brain
activation of children with developmental coordination disorder is different
than peers’. Pediatrics 126, 3, e678-e686 (September).
Chapter 6

Multi-professional working

Introduction
Policies in children and family services have long called for a more
‘joined-up outcomes-based approach’ to delivering services. This is
expected to be founded on precise processes of ‘referral, recording,
information sharing, assessment, management, planning, delivery,
monitoring and evaluation’ (Davis and Smith, 2012, Chapter 1).
In this chapter, as a preamble to examining multi-professional working,
I examine the roles of the various professionals potentially working with
special learners. Looking at examples relevant to provision for individuals
with specific learning disorders, I consider speech pathologists, physical
therapists/physiotherapists, school/educational psychologists, occupational
therapists, and school social workers.
Discussed are multi-professional collaboration including multi-agency
working, different service delivery models, and common links across services.
I examine the challenges of multi-professional working, especially co-ordi-
nating numerous professionals, and dealing with professional differences.
Aids to good multi-professional working are considered. These are
developing overlapping perspectives, sharing a joint purpose, as well as
communicating clearly, having agreed responsibilities, developing a one
stop venue for parents and students, forming strong parent–professional
relationships, participating in shared training and assessments, working
together in the school classroom, and co-ordinating support. This
chapter draws on the fuller discussion of multi-professional working in
Looking into Special Education (Farrell, 2014, pp. 89–108).

Professional roles
Many professional roles and responsibilities are involved in working with
special students. They include administrator, advocate, art therapist,

DOI: 10.4324/9781003177975-6
 Multi-professional working 91

audiologist, behaviour therapist, child and adolescent psychiatrist, classroom

aide, clinical psychologist, cognitive-behavioural therapist, conductor
(involved in conductive education), counsellor, dance and movement
therapist, school psychologist, music therapist, neurologist, ophthal-
mologist, orthoptist, paediatrician, prosthetists, school social worker,
and teacher (Farrell, 2009, passim).
Various professionals contribute to provision for specific learning
disorders each with its own insights, training, and remit. Examples are

 speech pathologist,
 physical therapist,
 school psychologist,
 occupational therapist, and
 school social worker.

Speech-language pathologist
‘Speech-language pathologist’ is the term used in the US while ‘speech
and language therapist’ is preferred in England and ‘speech pathologist’ in
Australia. Their work involves assessing and treating disorders affecting an
individual’s speech, language, voice, swallowing, and mental processing to
improve communication. Interventions may include practice and exercises
and providing support with communication aids such as manual signing or
using symbols.
A speech-language pathologist may qualify through a degree or diploma
course. In the US, different states regulate practice under state laws. The
basic standard required by the American Speech Language Hearing
Association (2021) for certified speech-language pathology membership
is a degree in speech-language pathology, a clinical fellowship year, and
passing a further examination.
A qualified speech-language pathologist may work in a school, clinic,
or hospital. In a school, they often work closely in a team with teachers
and others. They may work directly with a student or in a consultancy
role with a teacher and parents who contribute to interventions to
improve the learner’s communication.

Physical therapist
A physical therapist in the US (physiotherapist in England) is a health
professional who has undergone training and has received certification.
They may be based in a hospital or community clinic and may visit
schools or clients’ homes and provide treatment to improve posture and
92 Multi-professional working

movement and particular functions relating to them. This may be done

through exercises, movement, positioning, physical aids, hydrotherapy,
and the use of vibration or warmth. Specialisms include developmental
physical therapy with special children, and rehabilitative physical therapy.
A developmental physical therapist will carry out an assessment of a
child’s level of functioning and physical abilities and develop a treatment
plan that often involves contributions from other adults. Those caring
for the child will take note of the physical therapist’s advice on
positioning, exercises, and the use of appliances and aids. Paediatric
physical therapy involves the treatment of children with conditions
such as cerebral palsy, spina bifida, and juvenile arthritis.
Professional bodies include the American Physical Therapy Association
(2021) and in the UK the Chartered Society of Physiotherapy (2021).

School psychologist
School psychology is essentially psychology applied to children’s learning
and development in the context of their schooling. A school psycholo-
gist (in England an ‘educational psychologist’) applies the skills and
knowledge of educational and clinical psychology. They carry out
assessment and interventions to help children and young people develop
and learn better. Postgraduate training is likely to include the study of
assessments and their interpretation, child development, personality,
child and adolescent learning, the social psychology of groups, and the
wider organisation of schooling.
Working closely with teachers and others, a school psychologist may
observe students in classroom settings and advise teachers on suitable
approaches to learning and behaviour management. Among professional
associations are the Association of Educational Psychologists in the UK
(2021) and in the US the National Association of School Psychologists
(2021).

Occupational therapist
An occupational therapist treats perceptual, motor, and motor learning
disorders. Occupational therapy concerns assessing and intervening in
response to various requirements arising from physical disabilities, psy-
chological difficulties, and problems with sensory awareness, perceptual
skills, and motor awareness.
An occupational therapist can provide therapy, aids, and adaptations
which may involve implementing training programmes for self-help,
work, and leisure skills. Paediatric occupational therapists work with
 Multi-professional working 93

families and schools to maximise students’ abilities at home and at

school. Professional bodies include O T Australia (2021) and the
American Occupational Therapy Association (2021).

School social worker

School social workers address social and psychological issues hindering a
learner’s academic progress. In the US, training and qualification may be
through specialist degree courses followed by licensing. Through coun-
selling, crisis intervention and prevention programmes, school social
workers help young people overcome life difficulties, improving their
chances of succeeding in school.
They help young people with academic problems and assist others
whose social, psychological, emotional, or physical difficulties put them at
risk, such as students with physical or mental health disabilities. A school
social worker may be involved in violence-prevention programmes. They
also have a working knowledge of relevant law, and advocacy skills. The
largest social work professional body is the National Association of Social
Workers (2021) based in Washington DC.

Multi-professional working

Multi-professional and multi-agency working

Multi-professional working and a subset of it, multi-agency working can
be distinguished. In multi-professional working, professionals holding
different perspectives and backgrounds work together successfully as a
team or organisation. Sharing a common enterprise of day-to-day prac-
tice, assessment, or liaison they work for to benefit individuals with
disabilities and disorders. Such working may involve professionals from
the same agency as when in an education service a teacher and classroom
aide work together, or when a nurse, physician, and physiotherapist
cooperate within a health service. Extra challenges are posed by multi-
agency working where professionals from different services work toge-
ther for example health, social services/welfare, youth justice services,
and education.

Service delivery models

Multi-agency working can range from periodic meetings to highly
integrated working in a single venue. A multi-agency panel might meet
monthly. Members of different services might be seconded to a multi-
94 Multi-professional working

agency team, full- or part-time, perhaps to a team concerned with

challenging student behaviour.
Integrated services might work in a single location, developing a
common approach involving extended schools, full-service schools or
children’s centres. Special schools can be useful hubs for this, offering
opportunities for better communication because of the common venue
and opportunities to train together and develop a more holistic approach
to the individual.

Common links across services

Some links across and between services are comparatively common. School
(educational) psychologists tend to work with staff from social/welfare ser-
vices like school and community social workers and staff from community
health services. Staff members responsible for school attendance liaise with
social workers who know the respective families. Specialist hospital physi-
cians work with teachers for students with sensory impairments. Teachers
educating learners having language impairments form partnerships with
speech pathologists/therapists, while educators of students with physical
disabilities cooperate with occupational therapists. Education-based staff
working with students having conduct disorders or anxiety or depressive
disorders liaise with mental health professionals.
In different countries the exact arrangements and inter relationships
vary but essentially a typical range of professional relationships are likely
to be formed.
Other less common relationships that have the potential to be beneficial
to a special student may require extra effort and planning. Networks of
charities and national or local/state initiatives may encourage better
professional partnerships.

Challenges of multi-professional working

Among advantages of good multi-professional working are meeting the
requirements of children and their families, and ensuring improved
outcomes for them, as well as benefits for staff and services. While there
are many areas of good practice, attempts to secure multi-disciplinary
and multi-agency working too often fall short.

Challenges of co-ordinating numerous professionals

Part of the challenge is dealing with the sheer number of professionals
drawn in. Just to take one example, for someone experiencing traumatic
 Multi-professional working 95

brain injury, a large team of professionals is initially involved. This may

include medical personnel (physician, nurse), nutritionist or dietician, psy-
chologist, speech and language pathologist/therapist, teacher, occupational
therapist, recreational therapist, physical therapist/physiotherapist, a social
worker, and a swallowing therapist (a speech pathologist who undertakes
swallowing assessments and provides advice on safe feeding). As the child
makes progress, the team becomes smaller, perhaps being reduced to a
physician, teacher, psychologist, and social worker.

Professional differences from salaries to power struggles

Among inhibitors of good multi-professional working is different pro-
fessionals’ training, perspectives, aims, and responsibilities. Health and
social care may have different local organisation arrangements and dif-
ferent links to national government. Geographical boundaries covered
by various services may not coincide creating potential problems where
there is overlap or gaps in service coverage. Power struggles and self-
indulgent personality clashes can sour joint working. Management
structures, educational background, perspectives, priorities, and salaries
differ. Notions of confidentiality, where information ought to be shared,
can be over-precious.

Aids to multi-professional working

Features that enhance multi-professional working include

 developing overlapping perspectives,

 sharing a joint purpose and communicating clearly,
 having agreed responsibilities,
 developing a one stop venue for parents and students,
 forming strong parent–professional relationships,
 participating in shared training and assessments,
 working together in the school classroom, and
 co-ordinating support.

Developing overlapping perspectives

While congruent perspectives between members of different professions
may be unachievable, overlapping viewpoints can be developed. Consider
multi-professional working between teachers and a speech-language
pathologist/speech therapist with a student having speech and commu-
nication disorders. Here the speech-language pathologist’s perspective (for
96 Multi-professional working

example, a psycholinguistic view of communication) will be informed by

specific training and expertise. Any such perspectives will influence the
frameworks for understanding for speech and language development,
pathology, and remediation which will in turn influence clinical terminol-
ogy (‘dysarthria’, ‘verbal dyspraxia’, ‘dysphonia’, and ‘dysphasia’).
The educational overview of teachers and others may differ from that
of the speech therapist. Where this is so, teacher and speech pathologist,
school psychologist, and others must work closely together to ensure
that their aims coincide and that the educational and speech pathology
terminology and perspectives are integrated for proposed interventions.

Sharing a joint purpose and communicating clearly

Where the purpose of multi-professional working is unclear, it is less
likely to be fulfilled because no one will know when the goal is near.
Clear practical needs should influence the size and make-up of a team of
professionals co-ordinating and delivering provision. In a well-organised
Individualised Education Programme meeting, the purpose and the
respective roles of the learner, parent, and professionals will be clearly
understood. After the meeting, there should be evaluation and monitoring
to help determine the effectiveness or otherwise of the proposed actions.
Jargon creeps so invidiously into all professions that professionals may
be unaware of the acronyms, special expressions, or unusual terms that
they use and which muddy communication. As some unfortunate
speaker once advised, ‘avoid jargon like the plague!’.

Having agreed responsibilities

All professionals must be well-informed about the contribution of other
colleagues and how they can work together to benefit of the individual
learner and their family. Responsibilities of individual professionals can
be specified and linked to the academic and personal progress that stu-
dents make. A school seeking the services of an educational/school
psychologist may be able to link their work to learner outcomes.
Consider a psychologist helping a school introduce a system of behaviour
management expected to improve the behaviour of learners with opposi-
tional defiance disorder. An agreed outcome might be a reduction in the
number of learners excluded from school annually. Teachers’ opinions
could be gathered before and after the introduction of the intervention to
see if their view of learner’s behaviour improves. This helps to assess the
efficacy of the intervention enabling school and psychologist focus on the
task and their respective roles in achieving desired aims.
 Multi-professional working 97

Developing a one stop venue for parents and learners

For special learners, many professionals may be involved, making it
worth considering the use of a single ‘one stop’ centre. Here staff could
draw together information and advice to inform educational and other
judgements to help the student to learn and develop best.
This centre may be a special school, a mainstream school, a clinic or
similar. Practical advantages for parents and students will be apparent. Instead
of needing to separately visit a hospital, a clinic, and a therapist’s office, all the
relevant professionals can be seen in one venue. For their part, professionals
can schedule time to talk, share information and work together as necessary.
Potential drawbacks are that a particular professional may find it harder to
keep in touch with colleagues in the same field (say psychology) and may
lack the support, information, and shared vision of single professional groups
at their best. This suggests that some of the time in a typical week could be
spent with colleagues of the same profession where issues require it.

Forming strong parent–professional relationships

Parents may be unprepared for the many professionals they encounter
when their child is assessed with a disability or disorder and be temporarily
disorientated. They will value emotional support, practical help, and clear
information at this time. Parents and professionals develop good partner-
ships when they value each other’s involvement, and when professionals
recognise that the parent may be highly knowledgeable about their child’s
specific disorder. Discussions should be realistic, involve practical advice and
listening, and recognise a learner’s strengths and weakness. Parents
appreciate professionals who do not have pre-conceived ideas of what the
child can do. Parents find talking to staff when dropping the child at school
useful as well as the use of e-mails, phone calls, occasional meetings, and a
daily log help home–school communication. Parents often help each other,
sharing similar experiences and professionals may facilitate this.

Participating in shared training and assessments

Joint training may be offered to several different professional groups so
long as it is well-planned, and it is clear what each group will gain from it.
Speech and language therapists/pathologists, teachers, and aides working
with students having speech and language disorders may attend joint
conferences and training to hear about and discuss new approaches or
research. Regional conferences can offer a useful source of information
and sharing for professionals from surrounding areas.
98 Multi-professional working

Joint assessments of the learning and development of special stu-

dents can involve various professionals. Rather than each professional
assessing the student individually, contemporaneous assessments can
be made. In such arrangements, the professionals communicate with
the student and each other to try to better understand the student’s
learning and development and what can enhance these. As three or
four separate assessments are replaced by one detailed and holistic
assessment, this approach also saves time.

Working together in the school classroom

Joint working between teacher and classroom aid/teaching assistant is
central. The aide may work predominantly with special learners. In a
preparing role, they help the teacher plan work or get curriculum
materials ready. Organisationally, they arrange the classroom to
enable work to be pitched accurately for different learners and
groups. Managerially, they help general behaviour management,
keeping individual learners focused on their work. Practically, they
work with individuals or groups, give extra explanations, and support
the outcomes of Individual Education Plans.
When the teacher is speaking to the whole class, the aide might note
the contributions of different learners to ensure equitable participation
over time, feeding this information into subsequent teacher planning.
Teachers’ lesson planning should indicate the aide’s role in assisting
learners to reach the lesson outcomes and this (like the teacher’s con-
tribution) can be evaluated. In the US, a classroom teacher and an
‘adapted physical education teacher’ work together to develop and teach
programmes of physical education as well as leisure and recreation,
helping to include learners with DCD, or health or orthopaedic
impairments.

Co-ordinating support
One person being responsible for co-ordinating support to a learner can
help reduce service duplication and expose gaps in provision. In Eng-
land, a special educational needs co-ordinator (SENCO) is a teacher
bringing together support and interventions within and beyond school.
For teachers, parents and learners within the school who have concerns
about progress and provision they are the point of contact. Beyond
school, SENCOs help to co-ordinate the support of professionals like
psychologists, physicians, physiotherapists, occupational therapists, and
mental health workers. Other countries appoint staff with similar roles.
 Multi-professional working 99

Co-ordinators must know learners and their families. This enables

them to evaluate changes to the learner’s well-being or academic
progress noticed by themselves or reported to them by others. Also,
co-ordinators must know what local services can be deployed and
have the professional credibility to bring together professionals with
competing commitments.
Meetings called to frame or to review an Individual Education Program
(IEP) can assist multi-professional collaboration especially if there is a clear
agenda, explicit roles for each participant, and agreement about what the
outcomes of the meeting should be.

Thinking points
With reference to services that you work in or that you know of,
identify two or three challenges to effective multi-professional working.
For each challenge, try to identify what could be done to improve
matters. What time scale and resources would likely be involved?

Key texts
Davis, J. and Smith, M. (2012) Working in Multi-professional Contexts: A
Practical Guide for Professionals In Children’s Services. London, Sage.
Drawing on examples from the UK, this book covers key areas of
multi-professional working.

Conclusion
Among professionals potentially working with special students some
often work with individuals with specific learning disorders. These
are the speech pathologist, physical therapist/physiotherapist, school/
educational psychologist, occupational therapist, and school social
worker. Multi-professional collaboration includes multi-agency
working, different service delivery models, and common links across
services.
Challenges include co-ordinating numerous professionals and dealing
with friction ranging from salary differences to power struggles. Aids to
good multi-professional working are developing overlapping perspec-
tives, sharing a joint purpose, and communicating clearly, having agreed
responsibilities, developing a one stop venue for parents and students,
forming strong parent–professional relationships, participating in shared
training and assessments, working together in the school classroom, and
co-ordinating support.
100 Multi-professional working

References
American Occupational Therapy Association (2021) www.aota.org.
American Physical Therapy Association (2021) www.apta.org.
American Speech Language Hearing Association (2021) www.asha.org.
Association of Educational Psychologists (2021) www.aep.org.uk.
Chartered Society of Physiotherapy (2021) www.csp.org.uk.
Davis, J. and Smith, M. (2012) Working in Multi-professional Contexts: A Practical
Guide for Professionals In Children’s Services. London, Sage.
Farrell, M. (2009) Foundations of Special Education: An Introduction. London,
Wiley-Blackwell.
Farrell, M. (2014) Looking into Special Education: A Synthesis of Key Themes and
Concepts. New York and London, Routledge.
National Association of School Psychologists (2021) www.naspweb.org.
National Association of Social Workers (2021) www.naswdc.org.
O T Australia (2021) www.auscot.com.au.
Index

abnormal crowding 12 Berninger, V. W. 30

accommodations 4–5, 69, 77–78, 86 Bosse, M. L. 14
adapted equipment 48, 65, 69, 84, 87 Brooks, G. 25
Adapted Physical Education 79, 98 Brown, R. 22
adjectives 37 Bruinincks, R. H. 74
AdLit.org 35 Bruinincks-Oseretsky Test of Motor
alphabetic principle 8 Proficiency (BOT-2) 74
American Academy of Pediatrics 12 Bryant, D. P. 59
American Occupational Therapy Bubble Reef 64
Association 93 Bugden, S. 52–53
American Physical Therapy Butterworth, B. 52
Association 92
American Psychiatric Association 2, 8, Cairney, J. 87
29, 50 capitalisation 28–29, 39, 45
applied mathematics 49 Castro, S. M. 12
Association of Educational Catts, H. W. 11
Psychologists 92 causal factors 2; developmental
attention 10, 13–14 co-ordination disorder 72;
attentional window 12 impairment in mathematics 52–53;
attention deficit hyperactivity disorder impairment in reading 10–14;
3, 72, 86 impairment in written expression
auditory processing 2, 7, 10, 11–12 30–31
auditory recall of words 35 cerebellum 70, 72, 86
autism spectrum disorder 72 Chartered Society of Physiotherapy
automatisation 10, 13, 15, 20, 71 92
check off chart 32
Balance 70, 71, 74 children and family services 90
Barnett, A. 74 Chin, S. 65
Barzillai, M. 20 clinic 4, 91, 97
basic number facts 48, 57, 59–60, 65 cloze tests/procedures 32, 39
Beery, K. E. 54, 74 clumsiness 69, 70, 86
Beery-Buktenica Developmental Test of cognitive causal factors: attention
Visual-Motor Integration – VMI 74 13–14; auditory processing 11–12;
Beery Tests of Motor and Non-Motor phonological processing/deficit
Skills 54 10–11; rapid naming 13; short term
102 Index

memory and working memory 13; Denton, C. A. 20

visual processing 12 Department of Education and Skills 1
cognitive impairment 1, 51 Detailed Assessment of Speed of
Cognitive Orientation to Daily Handwriting (DASH) 74
Occupational Performance developmental co-ordination disorder
(CO-OP) 69, 84, 85, 87 (DCD)/dyspraxia 1, 5, 69, 70;
collaborative strategic reading 22–23 causal factors 72; co-occurrence 3,
commercial assessments 7, 14; of 72; curriculum and assessment
DCD 74; impairment in 75–76; definition 69–71; eligibility
mathematics 53–54 for special provision 75; identifica-
composition writing 33 tion and assessment 73–75; impli-
computer aided learning 28 cation 71–72; organisation 85–86;
computer simulations 62 pedagogy 76–83; prevalence 72;
computer software 24, 36, 44, 48, resources 83–84; therapy 84–85
62–63, 78 Diagnostic and Statistical Manual of
concrete experience 48, 57, 59, 65 Mental Disorders Fifth Edition
consonants 32 (DSM-5) 2, 8, 29, 50
co-occurring conditions 3; develop- DIBELS 8 see Dynamic Indicators
mental co-ordination disorder 72; of Basic Early Literacy Skills
impairment in mathematics 52 (DIBELS 8)
CO-OP see Cognitive Orientation to Dienes MAB blocks 63
Daily Occupational Performance digraphs 32
(CO-OP) Directed Spelling Thinking Activity
counselling 48, 63, 65, 93 28, 35, 43, 45
Cowan, R. 52 direct instruction 33
Cuisenaire rods 59, 63 disorder of written expression 28, 30,
curriculum and associated assessment 36, 44, 45
3; cursive writing 82, 83; disruptive and emotional behaviour
developmental co-ordination problems 72
disorder 75–76; impairment in domestic skills 80
mathematics 55–57; impairment Dunn, S. 58
in reading 7, 23; impairment in Dynamic Indicators of Basic Early
written expression 33, 43 Literacy Skills (DIBELS 8) 14
cursive writing, 82–83 dyscalculia see impairment in
Czamara, D. 52 mathematics/dyscalculia
Dyscalculia Assessment 54
DASH see Detailed Assessment of dysgraphia see impairment in written
Speed of Handwriting (DASH) expression/dysgraphia
Davis, J. 90, 99 dyslexia see impairment in reading/
DCD see developmental co- dyslexia
ordination disorder (DCD) dyspraxia see developmental co-
decoding 8, 11 ordination disorder (DCD)/
definitions 86; developmental co- dyspraxia
ordination disorder 69–70; disorder Dyspraxia Foundation 70
2; impairment in mathematics 48,
50–51; impairment in reading 8–9; Early identification 48, 54, 65; of
impairment in written expression DCD 73; impairment in mathe-
29–30; specific disorder of matics 54–55
arithmetical skills 51 education publishing services 36
Dehaene, S. 53 Education Works 60
 Index 103

Egan, L. H. 38 Henderson, S. E. 74
Elliott, J. G. 2, 11, 12, 14 hypermedia-based learning 62
Emerson, J. 51, 54, 59
Engel-Yeger, B. 71 Identification and assessment 3;
evaluation 90, 96 developmental co-ordination
evaluative marking 56 disorder 73–75; impairment in
explicit teaching 28, 38, 44, 48, 57, mathematics 53–55; impairment in
65; and number sense practice reading 14–15; impairment in
57–59; phonics 7, 16, 17, 24 written expression 31–33
exploratory environments 62 IEP see Individual Education Program
expository text 22, 29 (IEP)
eye-hand coordination 78 illuminating pens 83
impairment in mathematics/
Farrell, M. 90–91 dyscalculia 1, 5; causal factors
Feifer, S. G. 53 52–53; co-occurrence 52;
Feifer Assessment of Mathematics 53 curriculum and assessment 55–57;
fine motor skills 29, 74 definition 50–51; identification
foetal alcohol syndrome 53, 64 and assessment 53–55; importance
Fortes, I. S. 30, 45 mathematics learning 48–49; nature
frameworks for writing 28, 41, 44 of mathematics 49–50; organisation
Friedmann, N. 15 64; pedagogy 57–63; prevalence
51–52; provision 55; reducing
Gaines, R. 72 mathematics anxiety 63; resources
Gathercole, S. E. 13 63–64; therapy 64
generalising phonological skills to impairment in reading/dyslexia 1, 5;
reading 7, 17, 24 cognitive causal factors 10–14;
genetic causal factors 14, 69 curriculum and assessment 23;
Gersten, R. 62, 64 definition 8–9; genetic and
Geuze, R. H. 71 neurobiological causal factors 14;
Gottwald, S. 20 identification and assessment
Graham, S. 31, 40 14–15; organisation 24; pedagogy
grammar 29, 30, 32–33, 37–38 23; prevalence 9–10; provision
graphemes 10 15–23; reading and reading
grapho-phonological principles 35 processes 7–8; resources 23–24;
Gray Oral Reading Test (GORT-5) 15 therapy 24
Great Source 43 impairment in written expression/
Grigorenko, E. L. 2, 11, 12, 14 dysgraphia 1, 5, 81; causal factors
group approaches 7, 16, 17–18, 24, and associated factors 30–31;
76–77 components of writing 28–29;
group discussion 22, 23, 64 curriculum and assessment 43;
guidance 3 definition 29–30; grammar and
punctuation 36–39; identification
Handwriting: alternatives 83; impair- and assessment 31–33; organisation
ment in written expression 81; 44; pedagogy 43–44; prevalence
lined paper 82; movement control 30; resources 44; spelling 33–36;
82–83; writing implements 82; therapy 44; writing composition
writing posture and positioning 81 39–43
Hannell, G. 57, 58 implications, of DCD 71–73
Harris, K. R. 31, 40 implicit phonics teaching 16, 24
Harskamp, E. 62 inadequate educational instruction 8
104 Index

incidence 2 maze 15
Individual Education Program (IEP) McGrath, C. 61
98–99 Melby-Lervåg, M. 11
information sharing 90 mental health difficulties 71
innovative multi-professional Miller, L. 20
working 84 Missiuna, C. 71, 76
intellectual disabilities 8 mnemonics 36
modelling 22, 28, 44, 45
Jitendra, A. K. 61 modifications 4–5, 77
Joseph, L. M. 21 monitoring 22, 83, 90, 96
Moore, A. M. 53, 63
Kaufmann, L. 51 morphology 29, 31, 45
Kedem, Y. 42 motivational context 33
keyboard (for writing) 29, 83 motor difficulties 69, 70–71, 73,
Klingner, J. 9, 15, 22, 23 78, 86
Kucian, K. 57 motor skills 76–77
Movement Assessment Battery for
Lalier, M. 13 Children 74
Landerl, K. 52 multi-agency working 90, 93, 94, 99
Language Circle/Project Read Written Multi-component approaches 7, 21,
Expression Curriculum 43 22–23
language disorder 72 multi-professional assessments 69, 73,
learning and co-ordination disorders 74–75, 86
1; accommodations and modified multi-professional working: agreed
programmes 4–5; aspects of 2–3; responsibilities 96; aids to 95–99;
provision 3–4 challenges 94–95; common links
letter memory 29 across services 94; co-ordinating sup-
letter naming fluency (LNF) 15 port 98–99; developing overlapping
Levac, D. 85 perspectives 95–96; and multi-agency
lexical retrieval 11 working 93; parent–professional
lined paper 82 relationships 97; participating in
LNF see letter naming fluency (LNF) shared training and assessments
lowered sensitivity 12 97–98; service delivery models
93–94; sharing joint purpose and
magnocellular visual pathway 12 communication 96; venue for parents
manipulatives 59, 62 and learners 97; working together in
Mason, L. H. 42 school classroom 98
MathBase 1 64 multi-sensory approaches 23; spelling
mathematical language, understanding provision 34–35; for writing skills 43
60–62
mathematical stories 60, 61 Narratives 29
mathematics: anxiety 48, 57, 63, 64, National Association of School
65; everyday experiences in 62; Psychologists 92
foundation to understanding National Association of Social
49–50; learning 48–49; nature of Workers 93
49–50; using computers for learn- neurobiological causal factors 7, 14
ing 62–63; word problems 60, 61 neuroimaging 53, 64
Mathematics Recovery 58 neurological causal factors 69
Mather, N. 9, 15, 29, 31–33, 38, Neuromotor Task Training 69,
81–82 84–85, 87
 Index 105

Niemeijer, A. S. 85 phonemic segmentation fluency

nonsense word fluency (NWF) 15 (PSF) 15
Norton, E. S. 13 phonetic perception 10
Noun Hounds and Other Great Grammar phonics learning 3, 7, 16–18, 24, 34;
Games 38 awareness 16, 17–18; explicit and
Number Count 58 implicit 16; Phono-graphix® Reading
Number Race, The 63 Intervention and Instruction Programme
number sense practice 49–50, 57–59 16; phonological skills 17
nurses 4, 93, 95 Phono-graphix® Reading
NWF see nonsense word fluency Company 16
(NWF) Phono-graphix® Reading Interven-
tion and Instruction Programme 16
Occupational therapists 74, 87, 90, 91, Phonological Analysis and Blending/
92–94, 98 Direct Instruction 17
Olson, R. K. 11 phonological awareness 8, 10, 11,
one-stop venue 95, 97, 99 12, 15
ongoing assessment 56, 65 phonological processing/deficit 2, 7,
oral reading fluency (ORF) 15 10–11, 13, 24
ORF see oral reading fluency (ORF) phonological recoding 11
organisation 4; developmental phonological skills 7, 17, 24
co-ordination disorder 85–86; phonology 29, 31, 45
impairment in mathematics 64; physical education: Adapted Physical
impairment in reading 24; impair- Education 79; DCD and challenges
ment in written expression 44 of 79; importance of 78–79;
Orrantiaa, J. 53 strategies in 79
orthography 7, 18, 20, 29, 31, 45 physical therapy 44, 69, 87, 91–92
O T Australia 93 physician 4, 74, 93, 95
physiotherapists 4, 74, 81, 91, 93,
Paired discussions. 48, 65 95, 99
parietal lobes 72, 86 physiotherapy 44, 92
pathologists 4 Piek, J. P. 71
pedagogy 3; developmental co- PLANS mnemonics 42
ordination disorder 76–83; point prevalence 2
impairment in mathematics Polatajko, H. J. 71, 76
57–63; impairment in reading 23; Pollock, J. 35
impairment in written expression preterm birth 72, 86
43–44 prevalence 2; developmental co-
pencil grip 78, 82 ordination disorder 72; impairment
period prevalence 2 in mathematics 51–52; impairment
personal and social education 69, 76, in reading 9–10; impairment in
87; DCD and potential limitations written expression 30; period 2;
80; domestic skills 80; encouraging point 2
self-worth 81; handling money 80; primary developmental dyscalculia 51
personal hygiene and personal professional roles 90; occupational
appearance 80–81 therapist 92–93; physical therapist
personal hygiene 80 91–92; school psychologist 92;
PHAST (PHonological And Strategy school social worker 93;
Training) Track Reading Pro- speech-language pathologist 91
gramme 17 provision: developmental co-
phoneme–grapheme correspondence 10 ordination disorder 75;
106 Index

impairment in mathematics 55; language, Orthography

impairment in reading 15–23; (RAVE-O) 20
impairment in written expression rime awareness 11
33–36; learning and co-ordination Roberts, G. 16, 29, 31–33, 38, 81–82
disorders 3–4 rods and blocks 48, 65
PSF see phonemic segmentation role playing 22
fluency (PSF)
psychologists: clinical 4, 91; school/ Schneps, M. H. 12
educational 4, 14, 90, 94 Schoemaker, M. M. 73, 82
psychotherapists 4 school 4; psychologist 14, 90–92;
Pugh, K. 31 social workers 90, 91, 93
Pullen, P. C. 8, 81 Schuchardt, K. 52
punctuation 38–39; assessment 32–33; screening tests 69, 73
and capitalisation 29, 30 secondary developmental dyscalculia 51
self-regulation strategies 28, 40
Rapid automatized naming 13 self-worth 81
rapid naming 2, 7, 10, 13, 14, 24 semantics 29, 31, 45
RAVE-O (Retrieval, Automaticity, service delivery models 90, 93, 99
Vocabulary elaboration, Shared assessments/training 90, 95,
Engagement with language, 97–98, 99
Orthography) 7, 18, 20 Sharma, M. C. 49–50
read aloud–speech tool 43 Shaywitz, S. E. 9
reading: achievement 9, 15, 20; and short term memory 10, 11, 13
reading processes 7–8; score 9; skills small steps assessment 23, 43, 76
14–15 Snyder, K. H. 42
reading comprehension 7, 8, 15; gen- special equipment 83
eral points 21; multi-component specific disorder of arithmetical skills
approaches 22–23; vocabulary 48, 50, 51, 64
instruction 21–22 specific learning difficulty 1, 51
reading fluency 7; general strategies specific learning disability 1
18–19; RAVE-O 20; structured specific learning disorder 8, 9, 24, 29,
reading programmes linked with 30, 45, 50, 52, 72
19–20 specific skill training 77
reciprocal teaching 22 speech and language therapists/
recording 90 pathologists 4
reducing task demands 28, 40, 41, 44 speech comprehension practice 18
Reeve, R. A. 54 speech-language pathologist 91
referrals 90 speech-motor memory 34–35
resources 3; developmental co- spelling 8, 29, 36; accuracy 28, 30,
ordination disorder 83–84; 31–33, 36, 45; clusters 33;
impairment in mathematics provision 33–36
63–64; impairment in reading Spellography 36
23–24; impairment in written SpellWell 36
expression 44 standardised tests 69, 73, 86
response to intervention 48, 53, standard score 9
55, 65 Stein, J. 12
Responsive Reading Instruction Stern’s equipment 63
Programme 20 strategy instruction 7
Retrieval, Automaticity, Vocabulary structured reading intervention
elaboration, Engagement with programmes 19–20
 Index 107

subitising 50, 54 Widerholt, J. L. 15

Sukhram, D. P. 42 Wilson, P. H. 72–73
symbolic representation 48, 57, Winnick, J. P. 79
59–60, 65 Wolf, M. 20
syntax 29, 83 Woodcock, R. W. 15
Woodcock Johnson IV Test of
Talking Mathematics 60 Achievement 15
target words for spelling 36 Woodcock Reading Mastery Test 3rd
teachers 18, 22; Adapted Physical edition 15
Education 79; lesson planning 98; word associations 36
mathematical stories 61; specialist 15, Word Identification Strategy
32; teaching punctuation rules 38 Program 17
teaching/classroom assistant 4, 5 word knowledge 15, 20, 29
therapy and care 4; developmental word prediction programmes 83
co-ordination disorder 84–85; word reading fluency (WRF) 15
impairment in mathematics 64; word reading skills 7, 8, 9, 11, 24
impairment in reading 24; impair- word recognition 8
ment in written expression 44 word retrieval 29
To Market to Market 64 working memory 10, 11, 13
transactional strategy instruction 22 World Health Organisation
Tsai, C. L. 76 (WHO) 51
Tseng, Y-T. 76 WRAP see Writing and Reading
tuition centre 4, 43, 55, 76, 77 Assessment Profile (WRAP)
Tunmer, W. 10 WRAT5 see Wide Range
Turner’s syndrome 53, 64 Achievement Test, 5th edition
tutorials 62 (WRAT5)
TWA strategy 42 WRF see word reading fluency
(WRF)
Unifix blocks 63 Wright, C. M. 12
University of Oregon 14 Wright, R. J. 58
Write Traits® 43
Velcro fasteners 79, 80, 84 writing: composition 43;
visual processing 2, 7, 10, 12, 13, 19, 24 implements 82; posture and
visuo-spatial working memory 52, 64 positioning 81; for a purpose
vocabulary 29 28, 41–42, 44
vocabulary instruction 7, 21–22 Writing and Reading Assessment
voice recognition system 83 Profile (WRAP) 33
written composition 28, 29, 30, 45
Wang, C. H. 76
Wide Range Achievement Test, 5th Zhou, X. 52
edition (WRAT5) 32 Zwicker, J. G. 72