“The kids are alright” On how medical frames and models fail children who find learning hard.

In early 1941 Albert Alexander was admitted to Oxford’s Radcliffe Infirmary with abscesses around his face. This infection was caused either by the scratch of a rose thorn or an injury he sustained in a German bombing raid – accounts vary.

There was no way to stop the infection and it spread rapidly to the rest of his head. Soon he lost an eye.  

With death imminent and nothing to lose Albert accepted an experimental drug called penicillin. The results were miraculous. Within 24 hours his fever was down, his sores were healing and beginning to close up.

But there wasn’t enough of the drug to completely cure him. He relapsed and died on 15th March, 1941.

While the new drug had failed to heal him this unsuccessful trial marked the beginning of a new era.

Infections that had been death sentences could now be cured with relative ease. Today billions of people live free of a fear that had stalked humans for hundreds of thousands of years.

Penicillin is just one example of how medicine has transformed life on earth for the better.

Medical science and the medical model are simple yet powerful frames. They identify clear problems and then use recognised scientific methods and procedures to find solutions.

It is a very successful tool – a powerful hammer.

But a problem for those with hammers and those who admire the work done by the people who wield them is how tempting it becomes to use them inappropriately. The medical model is such a hammer and should not be routinely applied to the education of children.

All human populations encompass a wide range of characteristics. A few find learning easy, a few find it difficult and most are somewhere between the two extremes. Finding learning hard does not make anyone a deficient human and it doesn’t mean they are special or that something has gone wrong.

Applied to education the medical model rejects this.

It draws lines distinguishing those who learn quickly from those who are learn slowly and incorrectly labels slower learners as somehow deficient. It then seeks to intervene like a doctor or drug to fix the problem. In practice a SEND register can easily become a list of the supposedly unwell with their disease next to their name and suggested treatments on associated documentation.

For some this might be practically useful. A child who is hard of hearing may have this issue in a classroom largely resolved through a hearing aid and sitting them close to the teacher. A child who is struggling to read because they have not mastered the phonic code will benefit from having this identified and then receiving instruction to fill this gap.

Things are more problematic when the reasons a child struggles to learn is because of an aspect of their identity rather than a specific need or problem that can be fixed – and given the bell curve distribution this is a lot of people.

Some children – for example – have specific genetic conditions which result in smaller than average working memories making learning a huge challenge. Many children without any condition will find learning harder than others simply because of their position on the bell curve of normal human intelligence.

For these children the medical model is disastrous because it snares them in a trap they cannot escape and constructs them as failures regardless of what they do. To escape the trap – perhaps through hypothetical brain-boosting therapy to increase working memory or insert ‘missing’ genes – these children would have to be transformed, and they would not emerge from this process intact as the people they are.

While this is not yet possible the medical model does indeed inform the way children who struggle to learn in lots of well-intentioned ways. The comparative simplicity of the medical method – diagnose – prescribe – treat – is beguiling. This can very easily create an oversimplified and consequently inaccurate view of why a child hasn’t learned something. Still worse it can lead to children being labelled with medical, scientific, pseudo-medical and pseudo-scientific conditions that try to explain normal variation in rates of learning by conceptualising them as diseases.

This leads to back-to-front assumptions learning slowly means there must be something wrong and provides an incentive to medicalise perfectly healthy children – to attempt to explain and justify a failure to get high enough marks by saying this must be down to disorder or condition. Children who don’t learn as fast as some peers or can’t learn something because they haven’t got the prerequisite knowledge can quickly come to believe they have an illness that prevents them progressing unless very specific and sometimes dubious conditions are met. These – for example a belief in Irlen’s Syndrome and coloured lenses as a cure – can then become lifelong obstacles.

The success of the medical model in its own field can dazzle those working in education into using what they think are medical frames and methods to try and get equally revealing and transformative results. Sometimes this is done appropriately and properly but often it isn’t, and this can lead to unsafe conclusions and associated actions. It can also lead to shaky diagnosis made by people unqualified to do so. It is worrying how little oversight there is over non-medically trained professionals diagnosing conditions such as dyslexia and ADHD, and how common phrases such as “he’s clearly on the spectrum” have become.

Medicalising normal human distributions is dangerous. It problematises lots of human behaviour and constructs many people as unwell, different to, less than or worse than an equally constructed and artificial conception of healthy and normal. It leads to the misidentification of issues that slow learning and strategies that at best do no good and is inadvertently humiliating.

The model frames slower learners as ‘special’ (The S of SEND) which implies they require ‘additional’ and ‘different’ curriculum and pedagogy. This is almost inherently othering in application in the implication it means someone who learns slowly learns in a different way to others. In some cases this is true – for example there is evidence children with Williams Syndrome may benefit from some instruction through music – but often it just isn’t. A child who learning to read more slowly than another is far more likely to need greater quality and quantity of what works for the majority of children than they are something different.  

Children are human and while rates of learning vary humans usually learn in similar ways – believing large numbers of children are ‘special’ in the ‘special case’ sense just isn’t logical – the more there are the less possible it is for the term to have any useful value.

I hope to explore this in the next of this series of blog posts.

What proportion of children can be assigned a SEND diagnosis before it becomes meaningless? How many people can we say are ‘special’ for how many different reasons before the definition collapses? Is this more or less than the 39% of the Y11 2016 cohort who were identified as having SEND at some point in their schooling?

Suggested actions:

  • Challenge the assumption a failure to achieve academically is the result of a special educational need.
  • Interrogate and challenge medical/pseudo-medical diagnosis – both formally and informally – made by those not properly trained to make such diagnosis.
  • Introduce more rigour and oversight in policies and procedures that result in children being added to SEND registers.

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