Join us for a live webchat with Professor Dorothy Bishop, Tuesday 16 December 1-2pm

[KateHMumsnet]

We've had a few requests for a webchat with Professor Dorothy Bishop on academic research into language disorders, dyslexia and literacy issues - so we're delighted to announce that she will be joining us for a webchat on Tuesday 16 December at 1pm.

Dorothy is a Wellcome Trust Principal Research Fellow and Professor of Developmental Neuropsychology at the University of Oxford, where she heads a programme of research into children’s communication impairments. She is also a supernumerary fellow of St John’s College Oxford, as well as a Fellow of the British Academy, the Academy of Medical Sciences and the Royal Society. As well as publishing in conventional academic outlets, she writes a popular blog and tweets as @deevybee.

Please join us in welcoming Professor Bishop on Tuesday 16 December from 1-2pm, or post your questions in advance on this thread.

DS (6) with dyskinetic cerebral palsy has huge difficulty coordinating muscles so speech is no more than a couple of sounds, also few teeth (enamel hypoplasia due to IUGR) and therefore eats very little and is tube fed, so multiple impediments to speech. Is there anything we can do to help train the muscles around his mouth?

He desperately wants to speak and struggles with the physical side of alternatives like signing and iPads.

@MostHighlyFlavouredLady

Hi Dorothy,

Thank you so much for coming. I hope you don't mind but I have two urgent questions. A specific one and a general one.

Specific: I am home educating my 8 year old son who has ASD and his progress has been fantastic, even in literacy. However what he struggles with is verbally forming a sentence he wants to write, and then remembering what it was he was going to write. Does this difficulty have a name or be recognised, and if so, are there any resources or interventions you could recommend that he might benefit from?

General: Has anyone ever broken down how children acquire language in enough detail for a curriculum to be written to teach children who do not learn typically which is systematic and devoid of gaps? Like a 'learn language from scratch' tool. My daughter is typically developing in a mainstream school and it appears the usual curriculum is exposure with some elements of practise and then an expectation that she will just fill in the gaps herself through inference, observation and experience. My son will never learn this way.

Thanks again for coming.

I recognise what you describe in your son, but I don’t think there is a name for it and not any systematic research as far as I know. Most tasks benefit from being broken down into simpler steps, e.g. you might start by having him say the sentence he wants to write, and the teacher write the first few words with him completing it, gradually decreasing the amount of help he gets.
Re more general issues regarding language learning: we still understand rather little about how to help children who aren’t proceeding along the usual course. You can divide language into different components. Basic language structure – how to put words together in sentences etc, is something most children just pick up, which is why it is hard to know what to do when they don’t. Obviously you can teach children new vocabulary, but putting words together coherently isn’t usually taught formally.

@clairewitchproject

How exciting! Dorothy, my question is:

A few years ago I read an address you had done at a conference ( I think) about how the developmental disorders (ASD, SLI, ADHD etc) were arbitrary cutoffs on a continuum (absolutely agreed!) and that you expected in the long term that the separate 'labels' for clusters of behaviours would fall away and we would have a more general understanding of neurodiversity with descriptions of a youngster's specific issues within the neurodevelopmental spectrum rather than calling this thing 'aspergers' and that thing 'NVLD' and this other thing 'SLI' (I hope I have that essentially correct!)

Can you tell us a bit more about this as it is a subject I find very interesting but have struggled to get more information and can no longer find that conference address! Is it something you still think will happen? (I notice aspergers has dropped from DSM IV but they seem to have stuck in a load of other new 'disorders' so I am not sure if this is as much a step in that direction as it may at first appear) - and would you be happy if it did?

Hello clairewitchproject
I can’t remember which talk that was but it was probably based on this blogpost.

Even when I wrote that, though, I suggested a change in terminology that would be my preference but which I don’t think will ever be accepted. There is so much invested in existing labels.
Nevertheless, there’s no doubt that we aren’t dealing with various distinct conditions – there’s a ton of research showing that problems with language, social interaction, attention, maths, motor skills all tend to co-occur, so the label a child is given can depend on which professional they see.

@Islander79

What an opportunity! I have a very specific question, I hope that's ok.

My son, who is almost 4, has suspected ASD. He is very verbal but largely echolalic. He does have functional language and can make his needs known - eg, ask for a drink or the loo etc.

The main concern for me is his receptive language/conceptual understanding. He can follow instructions and answer yes/no questions, but he doesn't understand ideas! So he doesn't understand how old he or anyone else is, or understand Christmas, or tomorrow/yesterday. He has never asked or answered a 'why' question.

So my question really is how can I teach him things when he doesn't understand the concepts/language? He is very concrete but visuals haven't worked because he can't seem to grasp the concept behind the visual...

Sorry, that was long! Thanks for any advice or info.

One of the things that ASD teaches us is how much we just take for granted. Understanding of past and future is one of those things we assume we can all grasp, and then you meet someone for whom it makes no sense, and you wonder how on earth we do it.
I don’t think there is any research that can help here, and I don’t have any good ideas, I’m afraid, beyond maybe using photos or videos to talk about past events. If he can recognise himself in a photo doing something last week, for instance, this might help develop a sense of time. But don’t push it too hard.
This is just anecdote, but my experience is that parents often start to feel desperate at how much their child does not understand, but even being aware of the limitations can be helpful. It may not seem like much, but a parent who can put themselves in their child’s shoes and have some sense of their inner world can help anticipate what will be upsetting or confusing for them, and make life easier. And remember that we do know that outcomes of 4-year-olds with query ASD are very variable with many making good progress.

@youarekiddingme

most excellent questions - both of which I'd love to know the answers too.

I have a DS (10yo) who is suspected of having aspergers. (Still on assessment waiting list).
Although he has an amazing vocabulary which can seem very advanced at times he struggles to communicate through speech and writing very simple sentences. He also tends to make statements about things rather than ask direct questions. I'm not sure if it's a confidence, language or inability to gage the reaction thing.

How can I work on helping him explain things using his language skills and understand the listener doesn't know what he's thinking?

The kinds of communication problem in Asperger’s syndrome are exactly as you describe: the child has mastered all the structural aspects of language and may have a good vocabulary, but the way language is used is odd, and doesn’t lead to much to-and-fro communication. This is what is often termed a pragmatic language impairment, or in the current US classification, a social communication disorder. We’ve done quite a lot of work trying to understand what is behind this kind of problem. One possibility that does seem to apply to many children is that, as you suggest, they don’t have a ready understanding of what other people are thinking. There are a few specialist speech and language therapists who work on this, but sadly, they are thin on the ground and most people won’t have access to one.
We do have a RALLI video on this topic, with associated slides, and I hope this will be helpful:

@lionheart

Excellent choice MN.

I'd like to ask what is the best way to improve on early diagnosis. I work in a University where 30% of the students registered for dyslexia only get that diagnosis after they arrive. And related to that, it is possible that they are missed because their difficulties aren't absolutely in evidence at the age of 7 or 11 or 14?

Lionheart and JeanneDeMontbaston
I’ll treat your queries about dyslexia together, as they raise similar points. The difficulty is that dyslexia really isn’t a distinct condition with clearcut boundaries. People tend to think there are definite symptoms that indicate dyslexia, but that is not the case. It is a label that is usually applied for someone with unusual difficulty in reading that doesn’t have a ready explanation, but that definition is obviously open to interpretation and will depend on how it is assessed and how severe a problem needs to be. Quite often, people use the label ‘dyslexia’ for other educational difficulties, but there’s no consistency about this. If you get a diagnosis, this can have big consequences in terms of accessing specialist help and getting extra time in exams etc. All this means this is an intensely political issue, because in times of scarce resources there will be pressures to reduce the amount spent on extra help.
See deevybee.blogspot.co.uk/2011/04/special-educational-needs-will-they-be.html
deevybee.blogspot.co.uk/2014/03/my-thoughts-on-dyslexia-debate.html
It’s not a very cheerful answer, but I doubt that you will make much headway in improving on early diagnosis, because all the indications are that things are moving in the opposite direction. Recent government policy changes have taken the line that most educational problems are caused by poor teaching, and it is getting harder to get identified as needing extra provision unless you have a severe disability.
It’s possible that things will change if we find a more definite biological basis for dyslexia, but at present that seems a long way off.
Meanwhile, the one light on the horizon is that I am picking up vibes that there is growing interest in improving teacher training to help identify children with both language and literacy problems. In the longer term that is going to be helpful.

Thank you so much for answering my questions Dorothy.

I have just recognised the expressive phonological problems you describe in my 2.5 year old from your other answer too. Such a relief to have a starting point. As is usual in this country, no-one is interested in anything but 'wait and see' pre-school, and then in many places 'wait and see' until the child is pushed into the adult social care budget, or prison.

@Upandatem

DS1 is 8 and is just being assessed for dyslexia. He already has a diagnosis of HFA/PDA. It's difficult to know if his difficulties with reading and writing are due to demand avoidance or something else going on cognitively. Do you know how an assessor might be able to ascertain this please? Thanks.

And a sneaky second - is there any cognitive reason to insist on lots of handwriting in this era? If not, why are we persisting with spending so much time on this when there are lots of other ways to communicate information?

Hello Upandatem!
Research on reading in children with autism spectrum conditions is intriguing. Some of them have almost the opposite of dyslexia, in that they can read accurately, but without really understanding what they read. Others, though, don’t make much progress with literacy, but I suspect this does also have more to do with comprehension problems than specifically with mastering the mechanics of reading. The task confronting them might be as if someone tried to get you to read in Arabic (assuming you don’t know Arabic!). There are all those squiggly lines and they link to sounds, but if you don’t understand what it means, it is not likely you will be motivated to learn. Again, lack of good data means I have to revert to opinion, which may prove wrong, but I suspect the best approach may be to focus on reading materials that relate to a favourite topic.
I hadn’t thought about the handwriting issue, but it’s an interesting one. I seldom write by hand these days, and am getting worse at it!

My 9 yo daughter has SLI both expressive and receptive which is less severe now we had had intervention - my question is, can she improve her expressive language to be similar to those of her peers? She is very bright and has learned concepts to help her with the tenses but still struggles to give detailed description and set her thoughts in context.

She doesn't have motor skills issues and her social interaction problems are only related to what she says, otherwise she is more emotionally clued up than a lot of otherwise 'mainstream' children. It is very specifically language based but is more to do with processing and memory as well.

@JugglingFromHereToThere

Hi deevybee My dd is in Y11 and doing very well but may well have mild dyslexia as this was mentioned as possibility at primary, especially as reading - and writing - didn't quite take off according to NT trajectory in her earlier years. Has caught up very well now though. Still some probs mainly with organisation, time management, and idiosyncratic spelling (including in exams - has just done mocks and not attempting all questions due to lack of time has meant not quite reaching ambitiously set targets just yet - hopefully practice papers and consideration of exam techniques/planning may bring grades up a little by next spring/summer)

She has also been taking part in a research project at a leading Uni (though not yours!) looking at auditory processing in children with dyslexia. So, I suspect this indicates she has some dyslexic tendencies, though technically she could, like her friend, be in the control group of NTers.

So, my question, would you recommend we sought an assessment and possible diagnosis (almost definitely privately) for dd, and what would be the advantages for her if we were to do so?

Please see responses to lionheart. The main advantage of a dyslexia diagnosis is that it could provide access to additional help. I think you’re right: you’d need to go private for an assessment. But please bear in mind ‘dyslexia’ is really not clearcut: it’s a very general term that is defined differently by different people.

Thank you!

I am aware it's a spectrum as I'm dyslexic/dyspraxic and my assessments have all varied. But that seems to be precisely the difficulty! People think dyslexia means one very narrow thing, and it seems even less true at HE level than elsewhere.

There seems to be little recognition that you could get as far as university, and suddenly be overwhelmed.

@dontknowwhat2callmyself

What would be the optimal age for dyslexia testing and would an Ed Psych be the best person to test? Thanks

A short question but a difficult one! I don’t really have an answer. I’d personally only worry about a child who was falling behind in reading and writing, and that’s hard to judge until they are around 7 years. I know some people would suggest earlier, but many children are still at a pretty basic level of literacy before 7. Yes, ed psych is the profession best qualified to assess – but quite a lot of them don’t accept that dyslexia is a meaningful term, e.g. Prof Julian Elliott is prof of ed psych who is concerned it's not a useful label

@mumof4boys72

I have a child who is 7 i belive has high functioning autism and sensory issues,we have been under the peadatrician and salt since he was 2 and are still waiting for diagnoses. Now he has a lot of meltdowns especially after school,he seems to cope well within school but as soon as he gets home its like fireworks, now my problem is trying to get to the bottom of why he is having a meltdown without it taking hours to get there, sometimes he will tell us sometimes he wont,he can be very very violent,like last week he pulled handfuls of my hair out,kicked,punched,scratched and bitten,salt told us a few weeks ago we need to go on a socail commnication course.

Is this because of the socail communication problems?

School can be a very stressful place for children with communication problems: they often are struggling to understand and may also be teased or bullied. I’m not an expert in behaviour management, but if there’s a marked change in a child’s behaviour, it may be because something at school has changed and it’s worth discussing with the teacher.

@PolterGoose

My interest is in the subtle language and communication difficulties of children with Asperger's.

My ds is 11, has superficially excellent spoken language and an immense vocabulary, can lecture on, and explain, very complex scientific and other stuff, but can struggle not only with social communication but with fairly basic level language and communication, simple requests are often greeted as if I'm speaking another language.

Why is this, how do we identify what's going on and how do I not only help him, but help others, like school, understand the difficulties this brings.

Hello PolterGoose
Please see response to youarekiddingme who has v similar issues

Sorry, I am hogging questions, but I do hope you can just ignore them if they're a pain.

I am familiar with Julian Elliott's work and with many other people writing about definitions of dyslexia, and whether the lable is ueful.

But do you think there is any coherency at all to the cognitive profile someone with any of these related conditions has?

What I mean is, I can often tell a student is dyslexic/dyspraxic/'something like that' without them disclosing it - not just because of spelling issues or that sort of thing, but because they seem to me to think and structure argument in a distinctive way.

Is that something you'd agree with, or are you really just saying you wouldn't bother with labels except to get support?

@Seriouslyffs

A very general question. Do you think we start formal teaching too early? And does this have an impact on literacy in general and in particular boys' attainment?

Yes I do. As noted in response to totoro7ssidekick, this has changed substantially in recent years. I was amazed when I found that children these days are expected to learn phonics at 4 years and are sent home with spelling homework at 5 or less. The thing is, there are a lot of children who can cope with this and do well. But for those who are still developing basic skills in language, attention and so on, I think it is quite damaging, as they are confronted with something they fail at and they develop an aversion to school. It’s particularly worrying that pressure is put on 4-year-olds as there is a world of difference between a child who has just turned 4 and one who is ‘rising 5’ in terms of cognitive skills, yet it seems they are lumped together.

*label.

I can spell, honest.

Jeanne

My Dad was a Primary Teacher and then a University Lecturer in Teacher Training. It was only when he became overwhelmed with the paperwork aspect of the job in the later years (there wasn't so much earlier) and was put on capability, that the Occupational Health suggested dyslexia.

He was diagnosed age 60 with severe dyslexia.

@zzzzz

I'm going to ask more than one question because like many on this board I have more than one child with these sort of issues.

Firstly and most urgently,

My ds2 is 9 and has struggled to learn to read (siblings read abnormally early and well ie Harry Potter/Anne of green gables at 6/7, at min a paperback a week). He has put enormous (think at least an hour after school a day) effort into reading, yet is still struggling though has made progress (can read a paperback haltingly aloud), he can't seem to read questions on homework accurately though and struggles with writing and spelling. However if I read the questions on a standard verbal reasoning test to him he scores 90%+. . He is quite obviously very clever and has a good understanding of documentaries etc. He very badly wants to attend grammar school with his siblings. What sort of school would suit such a child? His interests are science based and I find it hard to see a path for him that will satisfy that very able part of him while supporting the reading that he finds so hard.

My other questions are more general!

Is there any evidence that speech and language therapy is effective for children with language disorders (not speech disorders)? If so could you point me in the direction of any studies?

Is there any data as to outcomes for children with severe language disorders? What helped and what didn't?

And a second to mosts question about the development of speech and possible syllabus for those who don't acquire language spontaneously! has anyone tried to produce one and if so who and where?

Finally thank you so much for your time. There are SO many of us who post on this board struggling to help our children. We get little or no support and are often at a loss as to what to try next. Your thoughts and ideas will give us so much to think over and that in itself is a huge help.

Hello zzzzz
Sorry, I really can’t advise on educational provision – it’s outside my expertise.
Re speech and language therapy, there is a literature but it is surprisingly limited. James Law and colleagues did a systematic review a few years back, which I think you can get off the web
Law, J., Garrett, Z., & Nye, C. (2003). Speech and language therapy interventions for children with primary speech and language delay or disorder (Cochrane Review). The Cochrane Library, 3.
Problem was that this review just lumped together very different kinds of intervention, just making a broad distinction between intervention for speech, expressive language and receptive language. I guess they had to do this because the literature was so scant, but it’s not very satisfactory. The conclusion was that there was best evidence for effectiveness for speech problems, moderate for expressive language and little evidence for effectiveness for comprehension problems (receptive language).
Since that report, there have been a few mores studies, but unfortunately there’s not much that involves proper clinical trials, without which it’s hard to evaluate. There are other bits of evidence about much more specific interventions: e.g. Susan Ebbels has published work where she demonstrates effectiveness of training for improving children’s mastery of very specific aspects of language, such as passive sentences. This Australian study is the most recent I’m aware of: Smith-Lock, K. M., Leitao, S., Lambert, L., & Nickels, L. (2013). Effective intervention for expressive grammar in children with specific language impairment. International Journal of Language & Communication Disorders, 48(3), 265-282. doi: 10.1111/1460-6984.12003
Outcomes of severe language disorders: there are quite a few studies on that, including some by me and colleagues. I’ll aim to assemble some information and post later. Unfortunately, these studies don’t tell us about what leads to better outcomes, because they aren’t set up as trials of intervention. In fact, typically more intervention is associated with worst outcomes, but that’s almos certainly because the most severely affected children are more likely to have therapy.

YY, most, can totally believe that. Lots of late-diagnosed dyslexics in my family too. Fascinating, isn't it?!

@JeanneDeMontbaston

Sorry, I am hogging questions, but I do hope you can just ignore them if they're a pain.

I am familiar with Julian Elliott's work and with many other people writing about definitions of dyslexia, and whether the lable is ueful.

But do you think there is any coherency at all to the cognitive profile someone with any of these related conditions has?

What I mean is, I can often tell a student is dyslexic/dyspraxic/'something like that' without them disclosing it - not just because of spelling issues or that sort of thing, but because they seem to me to think and structure argument in a distinctive way.

Is that something you'd agree with, or are you really just saying you wouldn't bother with labels except to get support?

Nobody has ever managed to get an objective cognitive profile index that separates a dyslexic group from other poor readers, and many have tried. Doesn't mean it doesn't exist, but Elliott reviews most of the evidence in his book. I'm conflicted about the label, as may be evident from my blogpost. I'm pretty sure it's not a coherent category (but then many diagnostic categories in medicine aren't either), but it does have some advantages - not just in terms of getting help. My blogpost on the Elliott book outlines my views)

@totoro7ssidekick

Another question just in case there is time...

Do you know of any credible research on the pros and cons of teaching children cursive handwriting at the beginning of primary school? Do you have an opinion on the practice?

My son's school insist that their choice to teach cursive from reception is evidence -based, but I can't find the evidence. And it seems counterintuitive - this is not how letters look in books, it's more difficult to read, etc...

Ooh sorry, that's way outside my expertise. You need an education person for that one.

Thank you! This is so helpful, and I am really grateful to you for answering a (greedy) follow-up question.