National Conference, May 2015: Learning Difficulties: What Do We Know and How Should We Be Using This Knowledge?

This was an important conference, since it marked a number of interesting points of transition. It was the last OUPS conference to be held over the summer, changes in the Open University schedule for exams and course timing, mean that after 40 years the conference will move to the autumn. It also coincided with the recent death of one of the founders and guiding lights of OUPS Dr Lilli Hvingtoft- Foster and the conference itself captured the many points of transition in the field of education and the issue of learning difficulties and disabilities.

The conference was remarkable for the quality of speakers and the range and depth of their presentations. The OUPS committee was very appreciative of the speakers' willingness to give their time and explore the issues that have an impact not only on the individual child, but also into wider society. Sometimes the impact is directly in terms of the costs incurred through youth justice (Sonia Blanford - Achievement for All), or indirectly such as the cost of parents' reduced health (Richard Hastings, Warwick University), or to parents and Local Authorities through legal costs (John Stein, Oxford University and Julian Elliot, Durham University). Other aspects covered by the speakers explored how quality scientific exploration can highlight the limitations of current understanding, as well as evidence for innovation and intervention.

An example of this was the presentation by Julia Caroll from Coventry University, which highlighted an effective study of two groups of pupils with phonological processing deficits (impaired capacity to process the usual sound units of language), one with hearing impairment and one with reading difficulty. The groups showed both similarities and differences for the impact of the phonological deficit they experienced. The study demonstrated that the difficulties for children with dyslexia profiles are not just limited to phonological deficits, but in contrast to the hearing impaired, extend to language structures as well. However, it also illuminated that those with hearing impairment have specific learning needs with respect to phonological processing.

This illustrated the importance of nuanced critical evaluation of both 'common understanding', and the development of interventions. Julia Caroll's study also demonstrated that phonological deficits only accounted for a proportion of the underlying deficit profile for those with dyslexia, with a range of other cognitive deficits associated with the presentation of the profile.

Richard Hastings' work explored the theme of evaluation from another perspective. Richard examined the construction of different levels of evidence, its evaluation, and how gaps in the structure of knowledge contributes to, or masks understanding. Such gaps also impact on theoretical and funded applications for interventions. He illustrated this with a detailed examination of work around Intensive Early Behavioural Intervention for children with Autism, and the types and nature of the evidence of its impact for the child, family and wider educational access. A lively question and answer session following his presentation gave an opportunity to probe the points raised, and got the conference off to a good start.

Extending the exploration of communication, Nicola Yuill (Sussex University - Children and Technology Lab) looked at what technology can and cannot offer to the child and to the field. Nicola explored how a potentially useful mechanism for increasing communication, if thoughtlessly or badly applied, can produce the opposite impact of social isolation. This was referred to as "the curse of personalisation".

Nicola focused on an area often seemingly undervalued or underestimated, namely the extent to which social collaboration has been critical at an evolutionary and developmental level to individual, as well as wider social development and functionality, and continues to be so. Like Julia Carroll, Nicola drilled down into a common explanation/observation about social communication deficits to examine the limits of understanding and application. In this case, that children and youth with autism spectrum disorder (ASD) have difficulty with collaborative working. She explored the use of synchronised shared space and awareness of others, through commonly accessed technology as well as innovative applications. An example of the novel use was technological initiated speech prompts applied to joint play spaces such as medieval castles with characters. Both forms of technology mediated shared space, impacting on the ability to engage in collaborative work for both typically developing children and children with ASDs. There was also an effect on awareness of others in the children and on how their actions needed to be linked together, with the work challenging some common assumptions.

Nicola recounted an amusing anecdote from her own research experiences of how forthright a child with ASD could be on occasions, and this was a point of exploration by David Bottomley (Open University) a student who has Asperger's. David challenged aspects of the concept of ASDs by describing what he called NSD (Neurotypical Spectrum Disorder) which was characterised by a difficulty telling the truth, and emphasised the importance of recognising that other's realities may have very different constructions and interpretations. He highlighted how different social frameworks and seemingly fundamental features are valued by different communities and individuals of experience.

In contrast to Julian Elliot, whose session had preceded this one, David did not to agree that diagnosis was of no importance, actually from his perspective diagnosis is important, but not for simplistic explanations, rather it served many subtle as well as overt functions. The importance of the lived experience and the personal in research was also emphasised.

In keeping with the tradition of the summer conference, vigorous debate is valued and Julian Elliot in contrast argued that diagnosis was not of value. Unlike the other speakers Julian took up both the speaker time (1 hour) and the question and answer session (30 min) talking, so there was no opportunity to examine his evidence or explore the topic. However, drawing on a wide range of sources from the Daily Mail to the Rose Report (2009) and personal reflections he presented a case for the social construction of disability, in particular for dyslexia, and the way social justice is impacted by the legal framework. Julian presented himself as the outsider and common sense speaker against the establishment in this discussion, but what was of interest was the number of areas of commonality and broad agreement his arguments had both in John Stein's work and across other speakers. His basic argument was that a diagnosis was not required if it was known that there was a reading difficulty, and he believed it was already known what needed to be done. This blanket position was challenged by the evidence from John Stein, Julia Carroll and David Messer (Open University) and as mentioned David Bottomley, who all highlighted in different ways that definitions serve important purposes in a nuanced approach to understanding cognitive mechanisms for difficulty and the development of interventions. Nevertheless less Julian's talk was usefully challenging.

John Stein's presentation highlighted how a very useful important piece of legislation, the Disability Discrimination Act (1995) - now superseded by the Equality Act (2010) - had been both the source of great help and challenge, because to access the provisions of the legislation, definitions are important. Recognising this he argued Local Authorities had effectively resisted legal obligation for provision by denying access to services that could provide the diagnostic classification. The people who could have the resources and drive to navigate the system were over represented in the middle classes.

John Stein went on to explore how differences in brain structure and architecture were associated with circumscribed aspects of the dyslexia profile. In contrast to Julia Carroll, he argued that there were characteristic differences for sub groups with reading difficulty and that dyslexia did involve a significant differential within the cognitive profile. He went on to argue that there was some evidence suggesting this differential could be linked to brain architecture. This was not the same differential definition between groups of high and low IQ ability that Elliot had challenged earlier. John Stein suggested that there were differences between those whose reading level was reflective of an overall cognitive profile and those where there was inconsistency on the overall profile. This did not distinguish between intelligence levels, rather overall profile.

However, the main focus of his talk centred on dyslexia and how processing issues lead to distorted output. He argued it was the quality of incoming sensory information and its processing that gave rise to the profile. There was then a discussion of differences within brain structure and architecture that were of significant importance. The differences in genetic and biochemistry profiles associated with dyslexia were used to explore how a chemical and environmental intervention (Omega 3 and light sensitivity) could impact on outcomes and the mechanisms for the intervention.

ldconf4David Messer provided a very thorough and comprehensive overview that anchored many of the weekend's discussions. He started off by examining the evidence that specific learning difficulties were circumscribed deficits that left other parts of cognitive architecture untouched. He focused this on an examination of Central Executive Function (CE) and Speech and Language Impairment (SLI). The evidence suggests that this circumscribed deficit assumption is not supported. To further complicate matters, interventions addressing assumed core deficits of CE such as Working Memory had very limited impact on the complex task of reading and spelling. David went on to examine another specific impairment, Cerebral Palsy, where despite typical language and communication development a common problem was ability to read. Close examination revealed difficulties with phonological segmentation which were linked to poor reading capacities.

David Messer then went on to illustrate how a technological app called "Our Story" (a free app available via i-tunes), developed in conjunction with the Open University and Natalia Kucirkova had been used through a case study. The app enabled a child to use pictures, sound and text to generate shared book reading and personal stories which are gateways to literacy. This linked well with Nicola Yuill's work.

David concluded by reflecting on how knowledge of learning difficulties has moved on in recent years, but that difficult issues of theory, research and practice remain a continued challenge for researchers in the field. He also stressed the importance of examining ways to support children who have learning difficulties and evaluating interventions.

However, OUPS member Kate Papageorgiou's account of living with a child who has dyspraxia, painfully highlighted how failure by professionals to recognise there was a problem, acknowledge need, or listen to parents' voice considerably added to the difficulties for the child assessing/ engaging in education and experiencing success. This was not to mention the difficulties for parents navigating the system. Sadly a very common feature. The difficulty in getting accurate diagnosis, accessing services and the reliance on parents being able to have enough wit and wisdom to pick up and cover when services fail is a salutary reminder of how system structures can fail and disable children.

This point was eloquently made by another keynote speaker, Sonia Blanford, who managed to shoehorn a visit to the conference in-between a number of other commitments. Sonia established Achievement for All (AfA), now a nationally supported charity. AfA looks to help schools engage and support children who are failing to make appropriate progress, particularly for those with any form of learning difficulty. At the heart of the intervention, is a designated experienced coach who works with a school, helping them to evaluate their evidence and work with parents who have been difficult to engage. The challenge is to address the mistaken belief that disability should be a reason to have lowered expectations of outcomes. The impact has been very positive with evidence of substantial improvement for both parents, children and schools. Sonia Blanford also pointed out that the cost of not addressing this failure to access education was remarkably high in damage to social fabric and to taxpayer costs of dealing with disengaged young (and older) adults.

Unfortunately, Paula Clark, an expert on reading comprehension, was ill and unable to make the conference. However, she kindly provided her slides to the conference delegates. This presentation examined how comprehension is so much more than decoding text, and that in contrast to the dyslexia profile where decoding deficits are linked to inability to comprehend, Paula's slides examined what happens when children can decode but still do not understand text. This draws attention to the complexity of the cognitive processes in what seems to be regarded by many as basic naturally occurring skills.

In conclusion the conference highlighted the complexity of the field of learning difficulties, how progress has been made in some aspects of understanding and intervention, but also the many gaps that require further investigation. The contribution of all the speakers was very much appreciated and left a lot of room for reflection.

Angela Thompson was co-chair of the conference with Alan Pechey. She completed her Open University degree in Psychology in 2013 and is currently in the 2nd year of her PhD at the Research Centre for Psychology, Behavior and Achievement, Coventry University. Her studies focus on aspects of Specific Learning Difficulties.