Sunday, 3 June 2018

Behaviour as a form of communication: What's the issue?

There's been quite a lot of discussion in the Twittersphere, on and off in recent months about the notion that "(all) behaviour is a form of communication". I've bracketed the word "all" here quite deliberately, as I think it is part of the problem, and will come back to that later. 

I'll state my position up-front here, as someone who has spent the last two decades researching young people in the youth justice, out-of-home care, and education systems (both mainstream and flexible/alternative settings): 

To overlook the role of behaviour as a form of communication is to do a great disservice to students and teachers alike. 

Why do I say this?

My research concerns a poorly-understood, phenomenon that is much more wide-spread than most people realise - developmental language disorder (DLD). It may come as a surprise to some readers of this blog that DLD is far more common than autism or dyslexia - and is what Professor Dorothy Bishop of the University of Oxford describes as "the most common condition you've never heard of", affecting approximately two children in every classroom

What does DLD* "look" like?
Well this is part of the problem. In many cases, DLD has no obvious outward signs at all. DLD can be a comorbidity with other neurobiological disorders (e.g., autism spectrum disorders, attention deficit hyperactivity disorder), but language disorder can also occur all by its sneaky, quiet self. These students don't have a bar-code on their forehead (metaphorical or otherwise) that helpfully causes a buzzing noise when they enter the classroom, flagging for teachers that their verbal comprehension abilities are reduced, or that their ability to draw on their (limited) vocabulary skills to put ideas into sentences is lacking.  

Some other common issues for students with language disorders include problems with

  • Getting jokes;
  • Understanding idioms and sarcasm;  
  • Keeping up with social banter;
  • Using narrative discourse to organise experiences into a logical, coherent story to share with communication partners;
  • Understanding and observing the rules of conversation, e.g., about how and when to change topics, how to end a conversation, and how to repair misunderstandings that occur between communication partners;  
  • Giving a verbal presentation on a curriculum-related topic;
  • Drawing inferences / making extrapolations from incomplete information;
  • Understanding indirect requests / instructions, e.g., "There won't be enough time today for you to start a new document on this project" as an indirect message to the student that really means "Please start saving your work and close your computer";
  • Discerning good humour from unintended (or intended) offence;
  • Reading - (decoding and / or comprehension);
  • Spelling;
  • Written expression;

Students with language disorders often have poor working memory abilities, which means that they have difficulty holding visual and/or verbal information in temporary storage so that it can be manipulated (worked with) in the process of learning new information and/or solving problems. This means that new information decays even more rapidly for them than it does for typically-developing children, and they are more prone to the effects of distraction, such as the noise from other students' chatter, or the sound of the leaf-blower outside the classroom. Their need for more repetitions and opportunities for mastery reflects their underlying language processing and production difficulties, not laziness and/or a wilful desire to frustrate teachers and parents.

Now, it's not hard to see how things could go awry in the verbally demanding and busy environment that is the everyday classroom. But what does language disorder have to do with behaviour?

Mental health comorbidities are common with language disorders, and behaviour disturbance is in itself, a significant marker of mental health problems in children and adolescents. It is tempting to think of mental health problems on the one hand, and behaviour problems on the other, but this is not correct and does not align with major international classification systems of psychiatric conditions, such as the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) or the Word Health Organization  International Classification of Diseases (ICD-10). Now you can love or loathe these classifications, but they represent international consensus on the fact that behaviour disturbances are a form of "pathology" (for want of a better word) and (a) often signal dysfunction in the child's environment (e.g., neglect and/or maltreatment of various forms) and/or neurodevelopmental disorder(s), and (b) flag a need for specialist services. It would be helpful and convenient if the world divided into "good children" and "bad children", but that is not the case. The world consists of large numbers of children whose needs are complex and whose developmental profiles and backgrounds are multi-factorial. These children make their presence felt in the classroom in a variety of direct and indirect ways.

Sometimes, these children experience mainly internalising problems, such as anxiety and depression, while sometimes they experience mainly externalising problems, such as conduct disorder, oppositional defiant disorder, and ADHD. Though it is convenient to think of these as separate, mutually-exclusive categories of disorder, it is not unusual for the same young person to present with mental health problems in both categories - so the child whose behaviour is oppositional and challenging also experiences anxiety and/or low mood. The problem here, of course, is that adults (parents and teachers most particularly) are more likely to notice the oppositional behaviour, but not necessarily the internalising problems, and are even less likely to notice a language disorder. As I have reported previously:

Cohen, Davine, Horodezky, Lipsett, and Isaacson (1993) observed more than 20 years ago, that children find their way into the service delivery system by virtue of what the key adults in their world see as the primary handicapping condition. It is hardly surprising that conduct and attentional disorders attract the attention of parents and teachers, but it is notable that, when such children undergo formal language assessments, high percentages of them (34.4% in the above study) are found to have clinically significant expressive and receptive language difficulties and these children have more severe externalising behaviour problems than their non-language impaired peers.

More recently, Beitchman and Brownlie (2014) in referring to students with language disorder, observed that "Children may be assumed to be uncooperative, disobedient, or oppositional when they have not understood specific instructions or the broader context" (p. 41). They point out that language skills are used to self-regulate emotionally, and to express one's state of mind (e.g., confused, anxious), and note that children who cannot do this verbally, will, of necessity, do so behaviourally.

These findings are more than borne out in my two decades of youth justice research, in both community-based and custodial settings (see recent papers here and here; readers who can't get past journal pay-walls can reach an open-access overview paper here). Young people who are the subject of youth justice orders, by definition, demonstrate externalising mental health problems - they wouldn't be serving community orders or custodial sentences if that were not the case.  However in our 2015 study of 100 young people completing custodial sentences in NSW, we found that 31% scored in a clinical range on a measure of depression and 26% for anxiety. Further, 59% had either probable or likely alexithymia - difficulty finding words that attach to one's own feelings, which in itself, is associated with marked emotional and interpersonal dysfunction. Around 50% of these young people also had a previously undiagnosed language disorder.

It is not surprising, given their offending histories, that 87% of our 2015 study sample had experienced suspensions and expulsions from school. They are the classical embodiment of what has been described in the literature as the School-to-Prison pipeline. Whilst this construct obviously refers to young people exiting school by entering the youth justice system, I always like to stress that we should not think about prison too literally. Social and economic exclusion that extends across the life-span (largely as a result of shockingly low literacy and numeracy levels), is a far more chronic sentence than the 6-12 months that a young person might serve as a 16-year old. Either way, we all lose (and pay) when young people are disconnected from education at an early age. Exclusion is an understandable short-term response but an ineffective long-term one, and we need to come to grips with the challenges embedded in this disjuncture.

I have had a great deal of contact with teachers over the years, both through my research, and as a course coordinator of a postgraduate course for teachers about mental health problems in children and adolescents. 

These experiences, together with my own research affirm three things
  1. we don't do enough to support teachers to "peel the onion" on understanding challenging behaviour;
  2. we don't do enough to support schools and teachers to meet the complex developmental needs of students with language disorder +/- mental health comorbidities, and 
  3. teachers typically respond with interest and openness when they are given clinical frameworks for re-conceptualising the otherwise perplexing and frustrating behaviours of some students. 

In the broadest sense, I guess it is true to say that "all" behaviour is a form of communication, but that is, in my opinion, a little glib and simplistic. However, inviting teachers and parents to think of behaviour as a form of communication, might be a very good start in widening the lens on behaviour, and increasing collaboration opportunities between teachers and allied health professionals, such as speech pathologists, psychologists, and occupational therapists. 

This is not about "excusing" problematic behaviour in the classroom, it is about trying to better understand and respond to it.

What won't help, though, is turning this discussion into the behaviour version of the Reading Wars.

I think we all know how unhelpful that has been.

*The term "language disorder" is recommended when language difficulties occur as part of another diagnosed condition, such as autism, with DLD referring to the condition in the absence of comorbidities (see Bishop et al. 2017 - open access for further explanation). In practice, comorbidities are common, so I have not dwelt on this distinction here, as the behavioural correlates may occur regardless of the presence of other diagnoses.

(C) Pamela Snow (2018)

Saturday, 24 March 2018

Education's West Gate Bridge

Imagine that some time later today, you start to feel creeping pain in your chest. You also feel a little sweaty and nauseated. A concerned family member doesn't like the sound of your symptoms (or the look of your increasingly pallid complexion) and decides to take you to the nearest Emergency Department.

What do you expect will happen next? Do you think you will be receiving care that is based on state-of-the science evidence (that will, among other things involve a pretty immediate ECG), or is it OK for the resident medical officer on duty to suggest that you should have a seat back in the waiting room for a bit, while the nursing staff observe you? After all, you may not be having a heart attack at all; you may simply have over-eaten at lunchtime, and be experiencing severe indigestion. You could also be having a panic attack, because of the stress you've been under of late.

The doctor, you see, as the expert in the room, is charged with the responsibility for deciding what happens next.

Our unstated assumption, of course in these scenarios, is that some pretty good science is going to be applied, via an empirically-derived algorithm that dictates to doctors how they should respond in this situation. Yes, you read that correctly - dictates to doctors. But hang on a moment, aren't doctors professional people who make autonomous decisions?

Well, yes but no.

What does it actually mean to be a member of a "profession"?
Here's what the Professional Standards Councils website has to say on the nature of a profession:

A profession is a disciplined group of individuals who adhere to ethical standards. This group positions itself as possessing special knowledge and skills in a widely recognised body of learning derived from research, education and training at a high level, and is recognised by the public as such. A profession is also prepared to apply this knowledge and exercise these skills in the interest of others.

I'm going to focus here on these key words contained above:
  • adheres to ethical standards
  • body of learning derived from research
  • education and training at a high level
  • prepared to apply this knowledge and exercise these skills in the interest of others.

We would expect, I think readers will agree, that the medical registrar at our local Emergency Department has an in-depth body of knowledge derived from research, has been educated and trained (yes, trained!!!) to a high level, and is prepared to apply this knowledge and skill in your best interests. If you really are having a heart attack and our med reg opines that you'll be OK in the "watchful waiting" triage category, we (and you in particular) have a problem.

But the key thing here is that being a professional does not mean "choosing your own adventure" with respect to decisions made and approaches adopted. Being a professional is actually about accountability - both to scientific evidence, and to the community.

Education's problematic relationship with evidence has been the subject of many commentaries, including this one, by Dr Kerry Hempenstall, Senior Industry Fellow, School of Education, RMIT University in Melbourne (note, the bolded emphasis is mine):

“Education has a history of regularly adopting new ideas, but it has done so without the wide-scale assessment and scientific research that is necessary to distinguish effective from ineffective reforms. This absence of a scientific perspective has precluded systematic improvement in the education system, and it has impeded growth in the teaching profession for a long time (Carnine, 1995a; Hempenstall, 1996; Marshall, 1993; Stone, 1996). Some years ago in Australia, Maggs and White (1982) wrote despairingly, “Few professionals are more steeped in mythology and less open to empirical findings than are teachers” (p. 131)”.

Fidelity to the scientific method is central to the notion of professionalism in fields such as medicine, aviation, and engineering, all of which, like education, have human civilisation and progress at their core. 

Education and medicine, for example, have a great deal in common; they both concern people, interactions between people, complex co-occurrences, and hard-to-control (actually impossible to control) variables, such as race, gender, ethnicity, religion, intelligence, empathy, sometimes unpredictable and seemingly inexplicable behaviour, resource limitations, and the need to establish trust and rapport. 

Most importantly, both have to deal with uncertainty, coupled with a weight of responsibility and accountability to communities, peers, and policy-makers for outcomes

The definition of profession above also refers to adherence to a set of ethical standards. In medicine, there are four ethical pillars: respect for autonomy (that of patients, not professionals), non-maleficence, beneficence (doing good for others), and justice. I'd like to focus here on non-maleficence, a term that may be new to people who work outside health. In a nut-shell, it means, not doing harm to others. 

Now the number of teachers who set out to do harm to their students, is, I would think, as low as the number of doctors who set out to do harm to their patients. Practitioners who set out to do harm (e.g., disgraced UK GP Dr Harold Shipman in the 1990s) are fortunately rare. In some cases, harm accrues from incompetence rather than maleficence, but the community outcry is no less impassioned.

It is easy to forget that employing practices that are unintentionally harmful (such as discredited reading instruction approaches) is still harmful to the end-user, in this case young children. Children (and their parents) are not in a position to give or withhold informed consent to their exposure to sub-optimal reading instruction, and nor can they press "re-wind" and have the experience again in a more beneficent way. They need to be able to trust that they are receiving scientifically-informed, current best-practice, in the same way that you need to be able to trust the care you will receive in your local Emergency Department.

Why use analogies concerning other professions such as medicine and engineering when discussing education? Because they give pause for thought about the balance between autonomy and accountability that all professions must strike. The only people who object to such analogies are the ones who know how well they hold up, and in what a poor light they portray education.

Let's have a look at the catastrophe that occurred in 1975, during the construction of Melbourne's West Gate Bridge. Tragically, computational errors made by engineers resulted in the collapse of an incomplete span, and the death of 35 workers (and serious injuries for a further 18). Like medicine, when mistakes occur in engineering, the results can be not only catastrophic, but immediately visible.

In education, the results of mistaken practices based on poor or non-application of the best available scientific evidence can also be catastrophic, though rarely so immediately visible. This makes education's mistakes easier to re-attribute, e.g. to the family backgrounds of students, or to the funding levels of the school they attend. Sub-optimal reading instruction in the first three years of school, for example, forms the basis of a corrosive disengagement from learning and invites a raft of psychosocial sequelae that are painful for students, teachers, and parents, and costly for communities to redress (if indeed true redress can be achieved).

Are education academics displaying public accountability for the fact that we have a long tail of under-achievement in Australian schools? Are they displaying public accountability for poor teacher knowledge about basic language constructs and how these inform the early teaching of reading? Not that I can see.

Contrast this, with the Engineering Garden at Melbourne's Monash University, that houses an installation of pieces of the twisted wreckage of the ill-fated West Gate Bridge.

Why are these tortured pieces of metal displayed outside the University's Engineering Building? To remind engineering students of the consequences for society of errors in their practice.

Perhaps education could take a leaf out of engineering's book on this level of sober self-reflection. Doing so would elevate the community-standing of its graduates enormously, by privileging ethical standards and accountability alongside autonomy, and education and training at a high level, in the way that the Professional Standards Councils demand.

Children's futures are sold-out by ideology-driven early instruction, but the catastrophes that ensue don't make front-page news like air crashes or bridge collapses. However, if planes fell out of the sky, and bridges collapsed with the regularity with which children reach secondary school with severely under-done language, literacy, and numeracy skills, you'd be reading about it on the front page for sure.

The Engineering Garden at Monash University, Clayton
 Image source

(C) Pamela Snow, 2018

Tuesday, 27 February 2018

Here we go again: Fact checking the anti-phonics movement in Education

This week, on the Australian Association for Education in Research (AARE) Blog, Professor Robyn Ewing of the University of Sydney asserts that there are "seven things teachers agree on" about the teaching of reading. As far as evidence-based claims go, this is one of education's more journalistic flourishes. There is no substantiation at all provided for this grandiose claim, but that it is the least of the article's evidence-based problems.

Let's look at these seven "points of consensus", one by one:

Learning to be literate is crucial for children’s life chances.

Well this is good. We're off to a great start on a point of furious agreement.  The problem here, is that our performance in teaching all children to read in Australia is not up to the same standard as our ability to state the obvious. Let's move on. 

Socioeconomic status has a big impact on how well children read 
Socio-economic status (SES) is a powerful driver of children's early oral language exposure, which in turn, exerts a significant influence on children's ability to understand what they are reading. There is a strong body of literature (see this earlier blog-post) indicating that children's early oral language skills are influenced by where they (and their parents) sit on the social gradient.

But where is the scientific evidence that this "impacts on how well children read", assuming they are exposed to quality instruction?

This is a veiled way of blaming parents for their children's poor reading skills, rather than looking at the role of sometimes ill-informed early reading instruction. It is a great injustice to children to deprive them of scientifically validated (yes, sometimes by cognitive psychologists!!) teaching approaches, in favour of dogma that protects education academics and teachers from having to come to grips with some hard-stuff about the structure of language and how this impacts on the knowledge and skills that need to be conveyed to beginning readers.

Unfortunately education has given away the family china when it comes to the precious knowledge its graduates should posses as the sine qua non of a primary education degree, in favour of feel-good, starry-eyed rhetoric about beautiful children's literature. Before anyone has conniptions, I love beautiful children's literature, but as I will outline below, writers such as Professor Ewing conflate the books we should be reading to children, with the books that they should be asked to tackle as novice readers. This shows a fundamental misunderstanding about how learning works.

By this logic, children who are born into homes where Mozart, Bach, and Beethoven are played constantly in the background, should seamlessly blossom into talented musicians. Oh that it were so!

Learning to be literate is a highly complex contextualised social practice – not a series of hierarchical skills
This is another sound-bite that is designed to be cosy and reassuring, particularly for teachers who have not been taught how to teach with scope and sequence in mind. In reality, it dumbs-down the fact that, as Dr Louisa Moats has observed, teaching reading IS rocket science and it is something that should be done by highly skilled, knowledgeable practitioners. There is a science to the teaching of reading, but education academics seem to have conspired to keep their own students in the dark on this science, perhaps because much of it has been generated by those tricky cognitive psychologists.

Learning to read is about making meaning. There are no easy, one size fits all recipes.
There's actually two assertions here.  Let's deal with them separately.

Yes, of course, the ultimate aim of reading is to derive meaning, in the same way that the ultimate aim of learning the piano is to be able to play some beautiful music, and the ultimate aim of learning how to drive is to be able to do so in a range of complex conditions, including at 110kph on a freeway in the rain. But these end points are not starting points in other complex skills that humans have to learn, so why is reading a stand-alone exception to the ways in which humans transition from novice to expert?

I have never heard anyone (let alone advocates of cognitive science on reading instruction) argue that "one size fits all" for beginning readers.  This is a flimsy, straw-man argument. However, the inverse ("all children are different") does not bear up under scrutiny either. There are more similarities than differences between children. If there were not, then teachers would never benefit from the pattern recognition that comes with years in the classroom.

I would also like advocates such as Professor Ewing to explain why, if reading is all about meaning from the start, five year olds are sent home with lists of de-contextualised sight-words to somehow magically learn by rote. The equivalent task would be giving adults a list of wing-dings to learn as stand-alone units of meaning. 

Rich literature, real texts should play an important role in any literacy program
As noted above, yes, of course children need to be exposed to "rich" literature* - to inspire them about the magic of reading, to expand their vocabularies, and to widen their horizons about the world.  This implies, however, that early reading materials that haven't won a literary prize are unwelcome in the early years classroom. Nothing could be further from the truth. Decodable texts are an important beginning point for novice readers and in many cases have a more "authentic" narrative flow than those repetitive look-at-the-picture-to-find-which-word-is-different-on-this-page levelled readers that are used so commonly in Australian classrooms. 
*I'm not 100% sure what this term actually means, particularly given the logical inconsistency of using predictable texts, as noted above.

Phonics and other code-based literacy practices are widespread in early years learning contexts in Australia. Where is the evidence that teachers aren’t using these strategies?

The first part of this point is another non-evidence-based statement.  Where is the evidence that supports this claim? By contrast, have a look here, for a list of references that show that teachers (including those in Australia) are inadequately prepared with respect to their knowledge of the structure of language to be able to teach reading effectively to all children (not just those from nice middle-class homes, who were read to since birth). 

While you're at it, have a look at this study published by Australia education academics, showing how poorly-prepared practising teachers think education graduates are for teaching reading. This quote (from p. 41) will give you a taste for the findings:

Just over half (54 per cent) of the respondents also agreed that ‘generally, graduate teachers have an in-depth knowledge of a range of instructional strategies that can be used to meet student literacy needs’. Nearly half (48 per cent) of the respondents agreed that ‘generally, graduate teachers know how to interpret the results of standardised assessment tools that measure student achievement in English’.

Another test is highly problematic and will disadvantage our EALD (English as an additional language or dialect) learners as well as many in vulnerable situations
Again, this is non evidence-based dogma, though I do tend to agree that a trial of the Phonics Screening Check might be "highly problematic" - particularly for education academics, who are anxious that their ideological fervour in opposing anything other than incidental/analytic phonics will be exposed. This will be particularly unfortunate for teachers (as well as children), if they are unjustly "held to account" by politicians and the media. If medical educators were failing to teach trainee doctors evidence-based approaches to preventing and treating disease, that would be front-page news, but we would be asking for answers from the medical academics, not their graduates. It should be front-page news when education academics similarly withhold critical, scientifically established knowledge, for whatever reason, and they are the ones who should be asked to account for this.

As for children from non-English speaking backgrounds - where is the evidence to support this claim? There's actually good reasons to predict that such children would benefit from explicit phonics instruction, but let's do some research before we make bold proclamations one way or the other.  

In fact, basing our claims on rigorous research rather than rhetoric is probably a reasonable expectation across the board. How about it, Education?

(C) Pamela Snow, 2018