Embracing neurodiversity – an inclusive whole child approach
Neurodiversity is about all of us. It considers the diverse and different ways our brains work and how we process information. It’s also about understanding each person in the context of their lives, past and present. Neurodiversity is about inclusion and considering how we ensure everyone has an equal chance to be active and participate in society.
Our present diagnostic system benefits some children and young people who have particular characteristics and opportunities. It tends to focus on disorder, difficulties, and disabilities. We also often view these in separate boxes.
This is despite knowing that conditions like Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ADSD), Dyslexia, Dyspraxia (Developmental Coordination Disorder (DCD), Dyscalculia, Tourette’s syndrome and Developmental Language Disorder all often overlap with each other. This is also sometimes called co-occurrence.
The challenge is that often –
Children and young people only gain a diagnosis when:
- they have a significant challenge in one specific area e.g. difficulties with spelling, reading, or writing.
- there is awareness by others (teachers or parents) that challenges are related to a specific condition.
- opportunity to be screened for specific conditions are available (but this may miss important information).
- local services are available for a diagnosis.
- professionals having sufficient training across all conditions and not just some. So there is a child centred neurodevelopmental approach.
- there are short waiting lists in the area.
- parents are able to pay for a private diagnostic assessment.
The contra to that is –
Children and young people get missed, misdiagnosed or misidentified when:
- they have challenges in areas where teachers have less awareness e.g. developmental language disorder/communication difficulties or ADHD.
- the child moves schools several times so is not known well by the teachers.
- they have been excluded from school and so the focus is on their behaviour but not the reason for their behaviour. Children have higher rates of undiagnosed Developmental Language Disorder and ADHD in alternative provision settings.
- the child has a mix of challenges in more than one area. So is not ‘bad enough’ to be Dyslexic or Autistic for example. They may have a scatter of difficulties across areas, such as difficulties focusing, handwriting and speaking clearly.
- English is the child’s second language. So there may be an assumption that their literacy or communication challenges are because of this.
- they are ‘in care’ and so may move around home and school settings. Looked After Children or Young People have higher rates of undiagnosed neurodivergent traits.
- there is an assumption they have something else (diagnostic overshadowing) e.g. Autism when it is a specific language challenges, or Attachment Disorder when it is ADHD, or ADHD when the child has had a head injury.
- the child is not in full time schooling e.g. been ill.
- a genetic disorder that has not been identified.
- there are home factors e.g. being homeless, marital breakdown, or parent unwell.
- challenges in girls are seen as something else such as anxiety or self-harm rather than relating to Autism.
- other things are going on e.g. Covid-19 and children are then in and out of school.
Neurodiversity is dimensional and not categorical
The categorical basis of looking at a set of traits and behaviours isolations means to gain a diagnosis you have to have enough signs and symptoms to fit one specific condition but if you or your child scores below this score then they don’t gain a Dyslexia/ADHD etc and then often don’t gain support.
Neurodiversity is dimensional and not categorical. Our brains are not neatly compartmentalised. There is growing recognition that this dichotomous approach ( you have it or not) stops some children being supported especially those that have cumulative adversity ( i.e. have other challenges alongside the neurodivergent traits) they may interfere with them functioning and participating at school or at home.
By looking at parts of a child we can miss out on other areas (such as strengths) and not consider the young person overall.
The all-or-nothing approach can especially stop some children gaining support. As a result they may continuously get missed, misdiagnosed or misinterpreted. A possible consequence of this (not surprisingly) is an anxious, frustrated and in some cases angry child or young person.
The ‘spiky profile’
If we think about different challenges like different balls in the bucket, we can see by using Neurodiversity Profiler we can address challenges that a parent is more concerned about in a practical way.
Every child has their own ‘spiky profile’ with their unique pattern of strengths and challenges.
Most parents want to better understand the challenges their child is facing. To gain some practical strategies so they can help them as soon as possible. Waiting two years to gain a diagnosis for some families is hugely frustrating. Even when they get seen there may be a need to consider across neurodevelopmental conditions and not screen for one or another.
There are two sides to every coin. The other side to challenges is considering a child’s strengths so we can harness their talents, build confidence, self-esteem and increase resilience.
By providing practical child centred guidance and strategies we can help every parent today rather than having no advice whilst waiting for a diagnosis.
The time is now to move away from rigid lines and be child centred, equitable and inclusive, while remaining robust in what we do. Trying to understand each child in the context of their lives both past and present seems sensible.
Neurodiversity Profiler takes a person-centred approach
A person-centred approach means that strategies are tailored to each child’s spiky profile.
The Neurodiversity Profiler provides an indicator of traits associated with some conditions. It is NOT diagnostic test. We recognise a diagnosis is undertaken by professionals with appropriate training. It also means they need to have background including current and past factors to ensure that a complete picture is painted of the child and their life.
Alongside the Profiler we ask some key questions that teachers and other professionals may need to consider so that we don’t jump to one diagnostic conclusion or another.
We use flags that may alert teachers or other professionals that a child may be a ‘learner of concern’ .
This additional information builds a picture of the child so that conclusions can be drawn on a more complete picture. There is a lot of research evidence that some children are at higher risk of some conditions, such as Dyslexia running in families. Premature children also have a higher rate of some neurodivergent conditions. However, we need to remember that a higher risk doesn’t mean your child will definitely have ‘it’.
But by understanding a more complete picture of each child we are less likely to assume that attention difficulties are for example due to ADHD. When they could be related to a child having had a traumatic brain injury at some time. If we don’t ask relevant questions, we won’t know.
When we report traits in Neurodiversity Profiler associated with specific conditions this is an indicator only. We recognise that this information can help to stimulate further discussion or exploration with suitably trained professionals.
Cleaton and Kirby, 2018