Ruth Gwernan-Jones

Moderate Learning Difficulties: Searching for Clarity and Understanding.

The concept of moderate learning difficulties (MLD) is not clearly understood in its definition and in its general use. Nevertheless, as a distinct area of special educational needs (SEN) this category has constituted about a quarter of all of those pupils identified as having SEN in England. This paper reports the analysis of findings from an ongoing research project in an attempt to improve understanding of the MLD category. Pupils (aged 12–14 years) identified as having MLD were compared with others in the same classes identified as having either specific learning difficulties or low attainments in terms of literacy, reasoning and dispositional measures. The paper shows that the label of MLD is often used in an over-generalised way in schools and that although there are some differences in reasoning and literacy abilities between those identified as having MLD and those who have not, no such differences were found in learner self-concept and in pupils’ attitudes to education and learning questioning the current definition of MLD which includes associated low self-esteem. Reasons for lack of clarity in the definition/category of MLD are discussed, as are implications for future use of the term.

A Systematic Review and Synthesis of Qualitative Research: The Influence of School Context on Symptoms of Attention Deficit Hyperactivity Disorder.

This systematic review and synthesis of qualitative research explored contextual factors relevant to non-pharmacological interventions for attention deficit hyperactivity disorder (ADHD) in schools. We conducted meta-ethnography to synthesise 34 studies, using theories of stigma to further develop the synthesis. Studies suggested that the classroom context requiring pupils to sit still, be quiet and concentrate could trigger symptoms of ADHD, and that symptoms could then be exacerbated through informal/formal labelling and stigma, damaged self-perceptions and resulting poor relationships with staff and pupils. Influences of the school context on symptoms of ADHD were often invisible to teachers and pupils, with most attributions made to the individual pupil and/or the pupil’s family. We theorise that this ‘invisibility’ is at least partly an artefact of stigma, and that the potential for stigma for ADHD to seem ‘natural and right’ in the context of schools needs to be taken into account when planning any intervention.

The experiences of and attitudes toward non-pharmacological interventions for attention-deficit/hyperactivity disorder used in school settings: a systematic review and synthesis of qualitative research

School-based non-pharmacological interventions are an important part of the treatment of attention-deficit/hyperactivity disorder (ADHD). We aimed to systematically review qualitative literature relating to the experience of and attitudes towards school-based non-pharmacological interventions for ADHD. Systematic searches of 20 electronic databases were undertaken. Reviewers screened titles, abstracts and full reports of studies, before extracting data and critically appraising 33 included papers. Studies were synthesised using meta-ethnographic methods. Four-key interrelated themes were identified: (1) individualising interventions, (2) structure of interventions, (3) barriers to effectiveness, (4) perceived moderators and impact of interventions. The perceived effectiveness of interventions used in school settings is reported to vary. Therefore, flexible, tailored interventions ought to hold potential. However, highly individualised interventions may negatively affect children with ADHD. Findings point to the need for school-based interventions to take into account the wider school context, as well as core symptoms of ADHD.

‘.he was excluded for the kind of behaviour that we thought he needed support with…’ A qualitative analysis of the experiences and perspectives of parents whose children have been excluded from school

Exclusion from school is associated with adverse outcomes for young people. There is limited research that explores parents’ perspectives, particularly in relation to the exclusion of primary school aged children. The present study used semi-structured interviews with 35 parents of 37 children aged 5–12 years from the Southwest of England. Parents experiences were captured in a conceptual model through three main themes. Exclusion was described as part of a complex journey of difficulties reflected by a continuum of coping. The child’s place on the continuum was determined by an interaction between the child, family, and school with communication a key determinant. The study also highlighted the wider implications of exclusion, including emotional and functional impacts on the child and parent and highlighted the importance of the parents voice in the identification and support of their child’s needs. It also presents many complexities surrounding exclusion from school and limited support parents felt their child was offered.

Non-Pharmacological Interventions for ADHD in School Settings: An Overarching Synthesis of Systematic Reviews

Objective: This overarching synthesis brings together the findings of four systematic reviews including 138 studies focused on non-pharmacological interventions for ADHD used in school settings. These reviews considered the effectiveness of school-based interventions for ADHD, attitudes toward and experience of school-based interventions for ADHD, and the experience of ADHD in school settings. Method: We developed novel methods to compare the findings across these reviews inductively and deductively. Results: Key contextual issues that may influence the effectiveness and implementation of interventions include the relationships that pupils with ADHD have with their teachers and peers, the attributions individuals make about the etiology of ADHD, and stigma related to ADHD or intervention attendance. Conclusion: Although we found some positive effects for some outcomes and intervention categories, heterogeneity in effect size estimates and research evidence suggests a range of diverse contextual factors potentially moderate the implementation and effectiveness of school-based interventions for ADHD.

End‐user involvement in a systematic review of quantitative and qualitative research of non‐pharmacological interventions for attention deficit hyperactivity disorder delivered in school settings: reflections on the impacts and challenges

The benefits of end‐user involvement in health‐care research are widely recognized by research agencies. There are few published evaluations of end‐user involvement in systematic reviews.

When diagnosis is uncertain: variation in conclusions after psychological assessment of a six-year-old child

A six-year-old child was independently assessed by three licensed educational (school) psychologists and one interdisciplinary team in the UK. All but one of these practitioners believed their assessment to be the first. The aim was to compare the practice of assessors and their conclusions especially in diagnostic categorisation. The methods of assessment and conclusions of the four resulting reports were compared using thematic analysis. There was agreement about the childs specific learning difficulties, intellectual abilities and need for additional support. However, there were extensive differences in the methods of assessment and notable differences in three sets of conclusions, especially in the use of diagnostic terms: one practitioner identified the childs difficulties as dyslexic in nature, the second one identified them as primarily dyspraxic and the third one reported a ‘borderline probability of Aspergers Syndrome’. The diagnosis, therefore, remained uncertain from initial assessment, exposing inherent overlap between diagnostic categories. The disparities in conclusions are discussed in terms of differing contexts and methods of assessment. The validity of diagnostic categories as discrete is questioned. Even where practitioners describe uncertainty, the use of diagnostic terms may be interpreted unambiguously by other actors.

A Pilot Evaluation of the Reading Intervention 'Own-Voice Intensive Phonics'.

This work was supported by internal funding from theGraduate School of Education, University of Exeter.