Disorders and labelling in school

The conversation continues.

It’s true, as Sandie Hobley points out, that ‘labels open doors’ for children with Special Educational Needs (February issue). But doors should open regardless of diagnosis. Nor should local authorities be using a diagnosis as a criterion for issuing an Education, Health and Care Plan (which replaced the old Statements of Special Educational Need); under English law all special educational support should be needs-based.  

It’s also true, as Katina Offord says, that many families want a label or diagnosis because, rightly or wrongly, it does sometimes open doors (January issue). But rather than seeking to ‘abdicate responsibility for their child’s behaviour’, as Offord claims, they’re far more likely to see a diagnosis as affording some protection from being blamed for the child’s behaviour, which isn’t quite the same thing. Clements & Aiello’s 2021 report Institutionalising parent carer blame shows how widespread this phenomenon is.

‘Diagnoses’ based solely on behaviour have a history of unwanted and unintended consequences, and are long-overdue for a fundamental re-think.

- Sue Gerrard
SEND parent 

One of the problems with funding structures in special education being tied to labels is that it discriminates against children who are not medically labelled. There are plenty of children who could benefit from the additional support that being identified as having special educational needs provides but whose difficulties arise mainly from living in poverty rather because they have a disorder.

- John Quicke
Formerly Professor of Educational Psychology, University of Sheffield

As a practising Educational Psychologist of 25 years, I would like to point out some inaccuracies in Sandie Hobley’s description of the SEN education system (February issue). Statements of SEN have not existed since 2014, when they were replaced with Education, Health and Care (EHC) Plans. These were intended, at least, to give a more holistic picture of children’s additional needs, bringing together assessments and support plans from the Education, Health and Social Care spheres. Whether this has worked in practice is another issue. However, in the Local Authorities where I have worked, and currently work, huge efforts have been made to help parents, school staff, and other professionals to understand that a diagnosis (such as ADHD or ASD) does not automatically lead to a need for an EHC Plan, nor is a diagnosis necessarily needed for an EHC Plan. The plan itself should be issued based on the level and complexity of need experienced by the child/young person and whether or not those needs can be supported in mainstream schools, with the types of support that are ‘ordinarily available’. Schools are increasingly asked to support complex additional needs as part of their day to day responsibilities. Additional funding no longer goes hand in hand with an EHC Plan. In many Local Authorities, there is the possibility of the school applying for high needs funding for a pupil, without recourse to an EHC Plan. Likewise, an EHC Plan does not deliver additional funding; if a child remains in a mainstream school, that school has an obligation to deliver the support described in the plan regardless of whether they receive the aforementioned high needs funding.

Therefore I disagree with Hobley’s view that without labels, children cannot receive an EHC Plan, and schools will be deprived of funding. Hobley’s view of the system seems to me somewhat outdated. I agree with Katina Offord, that a thorough understanding of the child or young person’s additional needs and how these can be supported, is far more important than a label. I am not suggesting that labels, or diagnoses, are not sometimes, or even often, helpful in understanding – but rather that the link that Hobley talks about between labels and provision does not automatically exist.

- Sarah Evans
Educational Psychologist

ADHD and autism etc. are neurodevelopmental disorders (NDD) with clear biological abnormalities. ADHD behavioural symptoms are accompanied by various comorbid issues including severe sleep issues, increased cortical thickness, structural abnormalities, slower frontal and temporal brain development than peers, issues with network and functional connectivity, imbalances with synapse functioning and neurotransmitter regulation, etc. Some advocate that those who work with children with ADHD should ‘actively promote’ medical assessment due to these frequent comorbidities. Does this happen? Is there an awareness and protocols within services to this effect?
It seems not.

Psychology continues to skirt around underlying issues for NDD, stuck in a psychosocial model that pays lip service and downplays biology (or simplistically limits the focus to stress, cortisol, HPA). The recurring emphasis on psychosocial factors while ignoring or downplaying the biological aspects, is an uninformed and limited viewpoint.

There is a risk that some members of this society do not appreciate the limitations of this discipline and its correct boundaries. From reading this publication for over a decade, I often see groupthink in action. There is little understanding or awareness of the neurological and neuroscientific understanding and findings for NDD or other disorders. It is true that full causation and mechanisms are a work in action, as is label validity and overlap, but just because the finish line has not yet been reached, there are no excuses for lack of integration.

I suggest that this magazine includes a recurring section to briefly present major findings in neuroscience and neurology to bridge this gap. Perhaps this will lead to increased empathy across members and services.

- Robert Daly
Organisational Psychology & Change
France/Switzerland

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