‘Interesting’ article on overdiagnosing in Times.

[Soontobe60]

Just putting this here for discussion.
https://www.thetimes.com/article/9f82545c-57f5-4db2-8a47-9a8cc2304243?shareToken=c0f809004b0c59cf1b96f6b6eb6129c3

I agree with you here. The country needs plumbers, gas fitters, builders, roofers, and sparkies. The push to send kids to uni has led to a shortfall in tradies. Meanwhile, ever more jobs that don't actually need degrees are having "degree in related subject" added to the job advert just to reduce the numbers of applicants, and graduates are retraining in the trades because getting a graduate job is so hard. I know someone who was told to do a PhD part-time on top of his job or be made redundant. He taught construction site management degrees at a former poly. Turning the polys into universities was another mistake. It's insane that managing a building site is now thought to need a degree in the first place. Reader, he quit and now works teaching construction skills at an FE college for about the same money and less stress.

The technical school model was never actually realised, only a handful were ever opened. It was grammar or secondary modern and the secmods were deemed "Ark B" for "also-ran" kids instead of as a place to learn a different skillset better suited to those kids. Framing the 11+ as something that one passes or fails instead of as a sorting hat didn't help. If the technical schools had been opened, perhaps we'd not have comprehensives and we'd also all be able to find plumbers when we need them.

Mainstreaming children who need 1:1 to cope in a mainstream class was never going to work and it would never scale well. Blair shafted SEND kids by closing the special schools.

You did.

What we need to do as a society is consider whether that definition and criteria, which is simply put together by theory, its not tested by blood, DNA, x ray, brain scans, any other tangible test, is actually valid for the vast majority of what used to be called Aspergers or high functionings

Bearing in mind that suspension of schooling and EHCP provision is literally why so many SEND kids are struggling so much right now compared to six years ago, this would be an incredibly counter-productive course of action. Don't people learn from history, especially history that is so recent?

There's also plenty of children like my son who fall in this 'inbetween' where they absolutely need 1:1 (2:1 in my son's case) to access a mainstream school but don't have learning difficulties or behavioral issues so would never in a million years get a place at a special school.

Challenge and disregard? I said that? Dont make up things that people have said

I said that we need to consider the criteria, it happens for many disorders, particularly as an example for MH disorders as has been set out, the criteria for ND is not set in stone, it has changed and will continue to change, there is controversy about categorisation and having one set diagnosis for many different severities of behaviour, that is causing consternation among clients, parents and professionals.

It also isnt the case, and Ive been part of many assessments for ASD and ADHD, that all of the criteria is always present to result in diagnosis, the clinician will make a judgement and decision based on other presentations and on balance. The word nebulous was used by another poster and I think thats accurate.

You'll be aware Im sure of the new and growing way that suicidal and self harm behaviour is being supported, often not by diagnoses of a MH disorder now, whereas it would have been in the past, but as a 'behavioural' issue for the client, ie a choice they make to behave and create habitual coping mechanisms. That is but one example of how theories and practice change over the years.

Why it would be different for ND disorders you have to set out as I said earlier

What does "consider" mean in this context, other than "challenge with a view to disregarding"?

You can download that paper for free from the Autism Research Centre at Cambridge University.

https://autismresearchcentre.com/tests/autism-spectrum-quotient-aq-adolescent and it's under References.

But all that means is other SEN kids get even less provision. You can't magic money up that does not exist

You can't blame parents for doing everything they can to help their kids in a situation that has been made dog-eat-dog by successive Govts making piss-poor decisions. In roughly chronological order:

• launching the "comprehensive secondary" social experiment
• turning polytechnics into universities, devaluing degrees and hamstringing technical and vocational education in the process
• increasing the number of kids going to uni beyond what is sensible, which in turn increases the pressure on kids to be academic instead of practical
• closing most of the special schools and mainstreaming SEND kids who cannot cope in mainstream
• chronically underfunding schools
• permitting academy trusts to deliver an education service that is unaccountable to the LEA and allowing those academies to exclude kids more easily than their LEA counterparts, turning LEA schools into sink schools and also leaving the SEND kids who've been excluded because the Academy didn't want them dragging the league tables down with no choice other than to go to a sink school

Grant-maintained schools failed and got scrapped the first time around, so the Govt rebranded them as "academies" and brought them back.

Why it would be different for ND disorders you have to set out as I said earlier

Because being unable to understand the absolutely Byzantine, constantly-changing, and completely inconsistent social rules that NT people live by is not a choice. Self-harm, at some level, is.

https://autisticscienceperson.com/2023/03/06/neurotypical-accommodations-and-unwritten-rules explains the hypocritical absurdity of just one example of what NT people consider "normal behaviour". https://autisticscienceperson.com/2021/05/17/be-honest-autistic-vs-neurotypical-honesty/ explains another. The screencapped comment from https://autism-all-stars.org/autistic-literal-thinking/ explains yet another absurdity: the notion of "common sense" and the inconsistency of "common sense's" application.

I was fired from my first job for failing to understand and conform to neurotypical behaviour. This is not a choice.

Your comment "Ive been part of many assessments for ASD and ADHD" implies that you work in mental health. That frightens me, that someone so dismissive is responsible for vulnerable people's care.

The screencapped comment from _https://autism-all-stars.org/autistic-literal-thinking/_explains yet another absurdity: the notion of "common sense" and the inconsistency of "common sense's" application.

In all fairness, that situation sounds completely unreasonable and most people would be bamboozled by it.

@selffellatingouroborosofhate you seem to think that people don’t believe autism exists. That isn’t the situation, but there is an argument (as made in the book from the OP) that it, and other neurodiversity, is being overdiagnosed and also that some accommodations are not practicable in most of the settings we have.

As an example, you can’t refuse a place to a child with an EHCP because you’re oversubscribed- but in a specialist centre all the children will have EHCP, so at some point you will be full up and have to refuse people. The system is utterly flawed and cannot cope with the rising levels of need, so some way will have to be found to adjust things. The argument is, what things? Could more people with less severe needs make their own adaptations and could school policy make that easier (rules around uniform, for example)? How would that affect the kids who need really rigid rules to support their behaviour? Are there people being given EHCP who actually don’t need them? Does that mean other people aren’t getting them because of the finite pot of money?

Neurodivergence is not the only thing that needs accommodating- and I agree with pp about inclusion. It’s great for some, like children in wheelchairs or who are deaf but who absolutely can be in a mainstream setting, and appalling for others. I started teaching at the time when it was getting going and we all said this back then, that it couldn’t work for everyone. As another illustration, some teachers (eg in RE) see half the kids in a school over the fortnight, maybe 15 classes of 30+ kids each, and needs to be aware of and accommodate everyone who has any modifications needed (from MyPlan all the way to EHCP). It could mean photocopies on coloured paper. It could mean wearing a microphone or remembering to sit Kevin at the front and exaggerate lip movements. It could mean remembering that Tracey needs a desk at the back on her own. And all the other kids and school processes might not help those processes, because Tom and Jeff want that desk at the back, and Kevin hates being sat at the front, and there wasn’t any yellow paper and the photocopy technician is off sick. Or your child was up ill for three nights and you haven’t got to the planning for this class until that morning. And your classroom is so far from the staffroom where the toilet is that you haven’t had a wee or a drink since 7:45 this morning. Where teachers are accused of being uncaring, these are often the circumstances they’re operating in. And on top of all that, they are expected to show progress with each child, no matter what is going on around them, and have perfect paperwork and data, otherwise they could easily be put onto a competency pathway and lose their job.

Or, the private clinic are incredibly thorough and identify ASD etc when CAMGS, after months of years of waiting for them, do a cursory chat and decide all is well because by then the child has learned to mask. My son was told no by CAMHS at 5. It took ten years and a v expensive clinic to show that he has an incredibly "spiky" neuro profile. By then, he had been bullied, disenfranchised from state education and is now failing his GCSEs at an expensive fee paying school where at least he can cope socially the 60% of the time he makes it in. I'm in huge debt. If the state system and life in general were less intense and crowded and pressured as it was in the past maybe more ND people could cope.

Someone needs to tell the SENCOs in my school cluster then! We can quite easily appoint regular classroom TAs, but massively struggle to retain SEN TAs even at a far higher pay grade. Our school has, over the past year, advertised several times for 2 SEN TAs at HLTA pay grade. We have had at most 2 applicants each time, and not one applicant has been remotely suitable. It really is almost impossible to recruit SEN support staff.

I wrote previously that we need to be sceptical about false certainty, especially when it comes to ASD and ADHD because the science isn't anywhere as robust as people often believe it is and there is huge disagreement within the scientific community about the cause of these conditions, whether the parameters have been drawn to widely and even if everyone that is currently diagnosed as having Autism or ADHD actually has the same condition at all.

Whilst of course you are right that there are other physical and mental health conditions that are diagnosed without a definitive physical test, there is a strong argument that the need to do this is essential for something like psychosis due to the nature of the condition and the imminent danger it can often present to the patient and other people. In short it's treated as illness that needs immediate treatment.

ADHD and ASD are completely different. There is disagreement on almost every aspect of these conditions. Is Autism a difference or a disorder? Does a Broad Autistic Phenotype exist and if so should the threshold for an ASD diagnosis be Vs someone with BAP? What is the association between ADHD and trauma? Are we seeking to medicalise unusual behaviour that is within the scope of 'normal'? Are those most severely impacted by Autism actually experiencing the same condition as someone that would have historically been considered as having HFA/Asperger's? The list is literally endless.

All of this is relevant because we need to be aware that we actually have a very limited idea about what we are actually diagnosing in lots of cases. It is all best guess and what school of thought is prevailing at any given time. For example we currently we even have two different approaches between the UK and America about whether you can assign someone a level for their Autism as part of a diagnosis.

@JoyousGreyOrca that shouldn’t put parents off. It isn’t the fault of the individual child or young person. Other parents can, and should be supported to, pursue support for their DC.

@Soontobe60 I said LAs. Not schools. If the provision is detailed, specified and quantified in F of EHCPs, it is ultimately the LA’s responsibility and they will be able to fund the role at a significantly higher level than schools can even compared to a normal well paid HLTA role which are mostly still quite poorly paid. For example, someone I helped to enforce their DC’s 1:1 LSA at the end of last year now has LSAs (the role is split into 2 because the 1:1 covers lunchtime) funded in line with the teaching main pay scale. I know other examples of funding in line with the MPS when LAs have been forced to act.

@AlertCat while LAs can’t just refuse to name a non-wholly independent school because they claim it is full, there is a point where they are some full admitting DC is incompatible with the efficient education of others &/or use of resources and that is a lawful reason not to name a placement. Issues arise because the bar is higher than many LAs and some schools admit and requires something more than the vague reasons LAs often use.

A tangent: it seems to be accepted on faith here that of course the state and private systems should be totally separate, but in many countries private schools are subsidised via voucher-style systems and it means that private schools are a lot less elitist than they are here, so there is a lot of diversity in school "types" available. Similar to the funded hours in nursery: your funding can follow you around, and you can choose a LA nursery for no extra, or an expensive private one or a Montessori one or whatever you want.

I think a lot of issues are solved in a school setting with a mainstream curriculum, much smaller classes and a setting aligned to how you work (whether that's clear rules in the classroom but an outdoor play break every hour, or flexible learning with lots of art classes, or whatever).

I know there is deep hatred of private schools here but people are obviously happy to spend money on getting diagnoses, legal support etc for their kids (just not £8k per term) - a school system that is able to capture those amounts and direct them to education would seem to be superior to the current one.

(I should say that I am overall pessimistic about the state of Britain's public finances, which is why I'm not suggesting that the state should simply provide more funding)

I just really disagree that there exists a group of "NTs" for whom everyday life is a walk in the park, who go about their business with no struggles, who easily fit into every social situation and never lose their keys. And that there are "NDs" who are individually and measurably different from this clear norm and who need very different help from the NTs. (Which is what diagnosis is.)

@OneAmberFinch
I don’t think life is a walk in the park for anyone and NTs have many struggles too. And vary hugely.

BUT…I have a NT child and a ND child. The latter has no intellectual disability, but is autistic (would probably previously have been described as Aspergers), dyslexia, dyspraxic, has adhd and MH difficulties.
The difference in how accessible ‘life’ is to my children is staggering. My ND child has a much, much more limited life as a result. It is indeed a measurably different life and he needs very different help from his brother and from any other NT child I know.

Just because you haven’t seen this, and don’t understand it, doesn’t mean it’s not true.

When my child joined a private school I was shocked by how many of the kids shared similar traits. They were quite anxious, sensitive kids that got easily overwhelmed. I have no doubt that a state school setting with 30 kids in each class would have been too much for many of these children but the quieter and calmer smaller classes seemed to keep many of them on a more even keel. Small adaptations were more easily made that meant a huge deal to the children in question and they could just avoid obvious triggers for specific kids in a way that a teacher dealing with so many more kids simply couldn't. My child actually isn't really like these kids so doesn't benefit from these things in the same way but I am utterly convinced now that setting can make a huge different to kids with traits that are incompatible with certain school environments.

I now think you should receive a set amount from the state to educate a child and this can be used to fund a free place in a state school or to subsidise another place elsewhere that best suits your child. Obviously a lot of parents would need to top up the state allowance if they wish to use private schools or tutors etc but it could end up saving the state and awful lot of money as kids could access settings that better suit them and the requirement for SEN support could drop substantially.

@Bumpitybumper this is exactly my experience too. Not all private schools are uber selective academically and many, just by virtue of being smaller and more flexible, can accommodate students in a mainstream setting with minor tweaks . Staff tend to be more accessible to parents so communication is better and the focus can be on individual solutions that simply aren't possible in schools with 1000+ kids.

I agree @Bumpitybumper . I've said in some previous posts that I'm one of these kinda "borderline" people who isn't quite autistic but shares a lot of traits. I went to school overseas in a private school in a system similar to what I describe, not posh but class sizes in secondary of 10-20 people, and honestly never needed "accommodations" because the setting already accommodated me.

And I think my later career was similar, @Acheyankles . My industry is a technical field which includes a lot of autistic and adjacent people (I mean - all across the spectrum including people who barely talk out loud, and also a lot of people who are "just" socially awkward and a bit geeky). And actually, by and large the industry as a whole has social norms that suit that cohort, and it's much less of a struggle for people.

So I think this influences me to genuinely see it as a full spectrum where it is hard to say "well this set of people should have 1-1 TAs and this set should just lump it in a 30-person class". The people I'm talking about live really full lives, have professional success etc because they're in an appropriate career setting - but they would probably be very very "disabled" in an HR office job, for example. I think the same is true for schools as @Bumpitybumper 's example shows.

What would happen to the families with SEN kids who still couldn't afford a private school even with the set amount from the state because they couldn't manage the top ups? Are you hoping it would free up state money to help SEN children with parents who can't afford private school as overall, SEN support would be lower?

Who knows. At some point we have to decide what is a reasonable % of the education bill to spend on SEN and hold the line there. Right now my DD’s school is a SEN school in all but name, as so much of the day to day is structured around the SEN children while the non SEN kids are somewhat left to their own devices. I don’t think sending the SEN kids to independent schools is the answer, we may as well offer independent schools the money we spend on the non-SEN kids to take them instead, because the state schools already seem to have all the necessaries set up, SENCOs, 121s, quiet areas, fidget toys etc

Sorry if this has been covered, not had time to read whole thread.

I'm going to change the tack a bit.
I've just read the piece about over diagnosis.

I'm reading Tim Spector's 'Spoonfed' at the moment.

He gives a statistic that has made me sit up and think:

Of 1,000 women who undergo breast screening, one life will be saved. But 12 women will undergo treatment for a cancer that would not have progressed, or are simply misdiagnosed.

In older women the number of overdiagnoses increases massively to >50% in women over 80.

I'm not saying don't go, and I'm not saying refuse treatment, but it's making me a bit more thoughtful.

Well it would only help wouldn't it? Realistically if you can get as many 'borderline' or 'mild' SEN kids into settings where they can cope without loads of state funded SEN support then this would leave more money and resources available to help those who have needs that couldn't be realistically met through private schools or those who have parents that can't afford to top up the state funded element to access private provision.

I really don't understand why the government aren't looking into this considering the SEN crisis we are facing rather than trying to make it harder for SEN parents to access the schools through adding VAT etc.

You can’t just give borderline SEN kids expensive private school places, there would be uproar, and rightly so. Why should some children be given places at schools with five star facilities/teaching and tiny classes while others are 30-a-class which a 23 year old newly qualified and a bit of concrete as a play area?