AARE CONFERENCE 1993 (Post-graduate paper) The marriage of education and psychology - creating balanced wizz kids! Presented by : Patrick Jones B.A., B. Theol., B.Psych.1/10/93 Table of contents 1. Abstract 2. Purpose of study 3. Background information 4. Method i) Process of Assessment ii) Exploratory study iii) Secondary assessment iv) Program implementation 5. Results 6. Summary 7. References Abstract This paper examines a Perth clinical psychologist's innovative work with children presenting behavioural and learning problems at school. Dr Julia Solomon (M.Ed., Ph.D.) has devised a program, Reading for Sure aimed at reintegrating problem children back into the school. The systems process accesses resources such as; Reading for Sure educationalists, individual and family therapy, play therapists, emotional needs specialists, motor-coodination specialists and others according to the child's needs. A within- subjects t-test was conducted comparing Reading for Sure results with expected results using the standard educational programme. Using pre and post-test reading age scores over approximately six month periods, there was found to be significant differences with the introduction of the new program. The implications of these sorts of results are heightening national and international media interest and increasing demand for the program. Purpose of study This study sought to explore the contribution of clinical psychology in the area of education and learning difficulties. Acknowledging some of the organisational restrictions endemic to the school system, it explores the services offered in the private clinical system. The study examines the theory and practice of clinical psychologist Dr Julia Solomon. It assesses the methodology she uses, the instruments she employs and then analyses results obtained.Background information Initially Dr Solomon started with the traditional clinical client - therapist model. Presented with children with dyslexia and other learning difficulties, she found over time that there were many other concomitant recurring difficulties that were part of the problem and the treatment model she was using was too limited. McDaniel, Wynn and Weber (1986) touch on this issue when the patient is given a diagnosis and treatment that is defined in the medically derived tradition as a disorder. This can be restrictive for both patients and professionals Due to Dr Solomon's multi disciplinary background - education and psychology - she developed a comprehensive treatment model. Instead of taking the traditional view that the family unit is a system that is more important than its individual members, Dr Solomon construed the family and its problems in a new way as a subsystem within the context of shifting and larger systems. This is backed up by the work of researchers like Greene (Kids who Hate School, 1984) who found that family disharmony may be caused by either a single, specific causal factor or a complex web of factors. Due to the difficulty to uncover the appropriate problematic linkages, Dr Solomon decided to look at multiple systems of interaction and to be concerned with transactions across several systems, both inside and outside the waiting room. McDaniel et al. (1986) believe that in many circumstances professionals who are based in such diverse fields as psychotherapy, education and community services can be most effective if they work from the perspective of consultation rather than immediately and automatically engaging in, therapy or teaching. Dr Solomon found that sometimes a student may not learn because of a specific learning disability. Others may be suffering from emotional or behavioural disorders which affect their ability to learn. For some it was to do with personality or a deprived environment around them. Often, however it is simply because some children's different styles of learning were not suited to the general teaching approach. The education system was failing for certain children. When working with children with behavioural and learning disorders, Dr Solomon found that an early negative experience of learning to read could lead to all types of problem behaviours. When someone finds they are having problems learning to do what many take for granted there are many traumatic reactions. Unable to fully communicate with others around them their self-esteem can become damaged, their motivation to learn suffers, children can start having behaviour problems at school, they pretend or withdraw from reading and anxiety often increases. English especially caused problems with its many confusing and contradictory pronunciation rules. Dr. Solomon found that most children learn by looking at the whole word (global approach). But there are others who need to break up the word into parts (analytical approach). It is these that often have problems and need special help. She reasoned that, given that everyone with a mental age of six can learn a phonetic code (sounds represented by symbols), a set of rules using a symbol for each sound would enable the student to read English without confusion. Dr Solomon's solution to the literacy difficulties of her clients was to devise a phonetic system of symbols (diacritical marks), similar in concept to those used in other languages and assign them above or below letters so that the exact pronunciation made by a combination of letters was unmistakable. This would in fact tell the reader the precise sound which was being represented by the letter or combination so that they could be sure that what they were reading was correct . It is on this system that the Reading for Sure programme is based. Students are progressively introduced to one of 18 different signs (marks) each of which represent a different sound in the English language. As they become competent, they progress to another sign and sound type. After sufficient use of the system, it is found that the student no longer needs the assistance of the signs, but is then competent to read written English without the "prop" of the code. They can now read normally. Combining this literacy program with the attention to the other behavioural and emotional dimensions of the children, Dr Solomon began a comprehensive recovery program under the name; World Literacy International. Method Process of Assessment Stage One : Exploratory study If a child is sent to Dr Solomon there are number of cognitive issues that need to be examined. The rationale behind this is that any major psychological problem that the child may have, in it preoccupying the child, will reduce intellectual functioning. Exploring the options can involve breaking up the assessment into psychodynamics, neurology and environmental/cultural deprivation. Stage Two : Secondary Assessment The above categories that are not dealt with by the clinical psychologist are networked with other members of a multidisciplinary team. They undertake specialised assessments particular to the client's areas of deficiency. They include; Reading for Sure educationalists, play therapists, emotional needs specialists, motor-coodination specialists Stage Three : Program Implementation The clinical psychologist works as a coordinator with the above consultants and participants. They all meet together and based on their particular assessments, they mutually devise a program tailored to the specific needs of the client. This is then administered in a parallel, collaborative effort with periodic monitoring. Exploratory study Though parents may come to her direct, the first step in the process is usually the referral. A doctor or specialist may refer a child to her because the parent needs a doctor's referral for a rebate or the doctor finds a problem which he can't find a medical solution and posits a psychosomatic one. A school may refer a child based on behavioural problems or learning difficulties. From this primary level of assessment a base is found from which the enquiry begins. After the clinical psychologist's own assessment the referee can be consulted. For example if a child is referred by the school they can be consulted for further clarification. Similarly if a parent brings in the child the school can be contacted to get a perspective from the school and to confirm the parent's presentation. Once the initial processes have been carried out the next step is to explore the possible problematic areas. The first area usually examined is the psychological state and context of the child. The rationale behind this is that any major psychological problem that the child may have, in it preoccupying the child, will reduce intellectual functioning. The family system is assessed with the first session being with parents, child and therapist. The psychologist takes a history as parents describe behaviour problems. Ways in which they can assist any future program in the home are examined. It is important during this phase to be alert to the implicit requests and political ramifications of the proposed consultation. It is especially important to connect with those members of the system who are powerful and central to determining how decisions are implemented in the system. The child's individual psychological issues are looked at through assessing general intrapsychic conflicts or personality problems like anxiety, dependency problems or sensitivity to failure. Self-concept is assessed as this involves security to express oneself and the capacity to assimilate information and experiences within a socially threatening context. An appraisal of the child's neurological state is done by checking for such things as brain dysfunction, neurological delay, hyperactivity and spatial disorganisation. The latter - an inability to organise materials and themselves causes the child to become stressed with its inability to coordinate motor/kinaesthetic skills with input from the senses. Possible eyes/ears problems are also checked. Finally environmental and cultural deprivation is examined by estimating the lack of stimulus in the school/home context. Emotional deprivation due to such things as family instability or favouritism is considered as is cultural identity. Throughout all this the doctor who gives the referral can be consulted for more details or to discuss the case further. Similarly the school's guidance officer can be contacted to corroborate the parents' presentation and to gain information particular to the school setting. The child's teacher can also be questioned regarding the particular behaviour exhibited in the class room. Secondary assessment The clinical psychologist based on her assessment usually opts for a program of both family therapy and individual psychotherapy. She also sees the need for combining her own therapy with a number of specialists. Some of these could be: play specialists - they will assess the various media through which the child will be give the opportunity to express him or herself; emotional needs specialists - this person is a volunteer and her agenda is to satisfy the child's attachment needs and offer unconditional regard; paediatrician - tests for hyperactivity; optometrists would measure visual skills, acuity; audiologists would examine hearing, auditory processing; motor coodination specialist - this therapist is trained in the Doman & Delacato method; Reading for Sure educationalist - he/she would assess the level of education to see if there were any literacy deficits. The child's education level is examined through the administering of full reading, comprehension and intelligence tests. This compares chronological age with reading age and determines what need they have of the Reading for Sure program. By integrating psychological and educational and medical services, this approach aims to move from an individual to a person-environment unit of analysis. Through the use of a variety of systems there is a greater chance that the child's needs will be truly served.Program implementation Prior to the program implementation the clinical psychologist works as a coordinator with the above consultants and participants. They all meet together and based on their particular assessments, they mutually devise a program tailored to the specific needs and deficiencies of the client. The clinical psychologist's role could mainly be in the area of therapy. The whole family is brought in as part of group therapy. This can be due to there being far reaching problems within the family structure. For example, if the father is violent, the mother has an unhealthy relationship with the child, the marriage is dysfunctional etc. The family can also cooperate in various parts of the program's implementation (eg. education) The parents need to be trained in the various exercises associated with the gross motor skills program. They will then be part of the system by implementing the program at home. They will also be encouraged to put in place insights gained from their group therapy. This approach acknowledges the parent as having some expertise and being capable of active participation. Along side this, the clinical psychologist would conduct personal individual therapy with the areas she found problematic in her original assessment. The emotional needs specialist's agenda is to satisfy the child's attachment needs and offer unconditional regard. The aim is to initially just watch him and overtime slowly lead him into a more directed program. The play therapist gives the child the opportunity to express and reveal himself symbolically through various media such as painting, clay modelling, sand pit play, psychodrama. If the child is hyperactive the paediatrician can prescribe Ritalin and the parents with the clinical psychologist consult the paediatrician as to how and whether to implement the drug therapy. The motor coodination specialist can teach the child tracking exercises to become aware of left and right sides of the body. This development, linked in theory to the left and right sides of the brain, is a necessary part of his neurological maturity. The specialist can also train some members of the family to carry out these exercises. The Reading for Sure educationalist conducts remedial reading lessons. Studentsare enroled for a series of 45 - 50 minute lessons on a one to one or group basis in which they progress through the scheme. Initially two lessons per week are generally required but they can move to once a week. The rate of progress cannot be predicted as it is dependent on the severity of the reading delay and on the amount of practice with the diacritically marked text. A minimum period of three months is usually required before the student begins to move from marked to unmarked reading. All except the pupils with severe learning problems become automatic "global" readers after sufficient practice. Results The Reading for Sure program has been assessed on a number of occasions and has found to have had significant results. This study evaluated the performance of eighteen subjects who underwent the program in the World Literacy International clinic. Subject number three was classified as an outlier (due to low chronological and reading age) and was deleted. The age of the subjects varied from seven years six months to twelve years three months. Table One (Unit-months)----------------- ----------------------------------------------------------------- --------------------------Subject Expected score Program score Difference------------------------------------------------------- -----------------------------------------------------1 86 91 52 108 135 273 73 106 33 (del.)4 94 97 35 85 99 146 77 101 247 95 113 188 124 135 119 97 105 810 117 121 411 95 99 412 103 102 -113 96 106 1014 91 96 515 96 124 2816 93 102 917 98 114 1618 91 96 5------------------------ ----------------------------------------------------------------- ------------------- Si = 1642 Sii = 1844 SD = 223 mi = 96.58 mii = 108.47 mD = 11.18----- ----------------------------------------------------------------- -------------------------------------- Assessed in terms of months, each subject's expected score was calculated by comparing his or her chronological age with reading age. The proportional difference was taken as the present developmental capacity of the child and this ratio was applied to determine the expected reading age as if continuing in the same school reading system. This score was then compared to the score actually obtained in the Reading for Sure program. The difference between the predicted score and the actual score was analysed. As it was predicted that the Reading for Sure program would score more highly, one-tail significance levels were used. The critical value at .0005 is 3.965 and thus the obtained value of t (Xi - Xii) = 5.898, d.f. 17 (n-1) is significant. Summary The service offered is multifaceted. Dr Solomon's relationship with the client has, over time, been significantly redefined from a one-to-one relationship to a consultative one. Her belief is that by attacking both the reading problem through the Reading for Sure program and addressing the factors that create learning difficulties, the child's emotional and behavioural problems will reduce. Its emphasis is developing the child's whole self, intellectually, emotionally and behaviourally. References Greene, L. (1984). Kids who hate school. Atlanta: Humanics. Wynn, L. C., McDaniel,S. H., & Weber,T . T. (Eds.). (1986). Systems consultation: A new perspective for family therapy. New York: Guildford Press.