Talking Things Over

When parents brought their children to me for assessment, my usual procedure was to start by seeing both the parents and the child together for about 15 minutes. My first task was to try to put the child at their ease in front of their parents, since the experience of meeting a stranger in these circumstances was likely to be rather alarming. (To avoid unnecessary circumlocutions I shall assume in this chapter that the child is male.)

I quite often started by addressing my remarks to the child, for instance I might say: 'Is it your spelling that you have problems with?' Then, if he nodded, I would say something like, 'Don't worry, as I am used to seeing people with spelling problems. What I will try to do is to find out what things you are good at and what things you are less good at. Then we can see how best to help you with the things you are less good at.' During this initial interview it was also possible to give the parents the chance to indicate if there were any special points which they wanted me to investigate.

The child was then seen on his own for perhaps one to one and a half hours, after which he rejoined his parents. For about 15 minutes I scored up the results and examined the child's school exercise books, which I always asked the parents to bring. Then for an hour or longer I saw the parents and child together. I have come to realise over the years that the final hour was the most important part of the assessment.

I was quite willing to modify this procedure if there were special reasons for doing so. For example, if the child was young or seemed extra anxious, I sometimes invited the mother to be present during the whole of the assessment. However, this happened only rarely. During the time when I saw the parents and child together it was possible for the child to switch off and not listen if he was tired, but he sometimes sat up and took notice if I said something which seemed to him to be important.

I usually began by reporting to the parents the results of the reading and spelling tests. There were times during my later assessments when I wondered if I should use more up-to-date tests of reading and spelling than the Schonell tests, since these dated from 1952. However, I decided that the Schonell tests gave me what I needed, and, had I changed to different tests, this would have cast doubt on any comparisons which I might have made between my earlier results and my later ones.

I never pretended to a child that he had done well on a reading or spelling test if this was not the case. Given that the child was dyslexic, however, as was almost invariably the case (see note 17.1), I might sometimes say, for instance, 'Considering your handicap I think you have not done at all badly.' However, it would have been wrong to give the child or the parents erroneous information simply in order to be encouraging.

I also told them the results of the intelligence test. Here it was almost always possible to be positive. This was because, even if the child was of fairly limited ability as judged by the results of the intelligence test, some parents feared, not surprisingly, that their child's lack of literacy skills meant that he was simply slow. For this reason it was a relief for them to be told that this was not the case. It was also possible to call attention to their successes, for example relatively high subtest scores on the Wechsler or passes at a high level on the Terman-Merrill. This was clearly more informative than citing a 'global IQ', which, for reasons given in Chapter 9, I always considered a virtually meaningless measure in the case of dyslexic children. There were other children whom the parents knew to be bright; here they were often relieved to have this confirmed, particularly if they had been told otherwise by one of their child's teachers.

It was always interesting to go through the results of the Bangor Dyslexia Test. I sometimes asked if they had noticed anything similar to what I had picked up, for instance confusion over 'left' and 'right' or becoming 'tied up' when trying to repeat long words. If they had, it was then possible to tell them that this was part of the overall dyslexic picture.

Parents have sometimes said to me in irritation: 'Yes, he was assessed by an educational psychologist who told us he was intelligent but a poor reader and speller. This was of no help because we knew that already.' As a result of such comments I began to ask myself, 'What else does a diagnosis of dyslexia provide?'

One way, I think, of describing what I was giving to those whom I assessed and their families is what in Miles (1988) I call a 'hermeneutic' account of the position. Hermeneus is the Greek for 'interpreter', and I think that what I was doing was to interpret (or make sense of) occurrences of which they were already aware but whose significance they may not have fully appreciated.

I remember assessing a student who had previously been in the navy. When I gave him the 'left'-'right' items on the Bangor Dyslexia Test, he was immediately able to recall that his commanding officer had sworn at him for confusing 'port' and 'starboard'. What had been an isolated event suddenly made sense to him.

When this sort of thing happens, it is likely that other seemingly unrelated incidents will then be recognised as forming part of the same pattern - forgotten messages, for instance, mistakes over times and dates and the existence of similar difficulties in other members of the family. If what I said made sense to my subjects, I sometimes found that they were starting to make sense for themselves of other episodes in their lives.

During my training at the Tavistock Clinic I had been expressly warned about the dangers of giving advice. Advice, I was told, often falls on deaf ears because for personal reasons the person is unable to accept it. However, in my assessments for dyslexia it would have been inappropriate for me to be non-directive: I was being consulted on the grounds that I had specialist knowledge of dyslexia. I therefore did not hesitate to give advice, but what I regularly did was to ask if what I was saying made sense to my subjects. Almost invariably the answer was yes.

One of the situations where I found it necessary to tread carefully was that in which parents asked me to tell the head teacher of their child's school that their child was dyslexic - and then tell him or her what to do about it! When this arose, I asked the parents if they could so manage things that the head teacher wrote to me in the first place. I explained that it was inappropriate and might even be counterproductive if, uninvited, I appeared to be teaching my colleagues how to do their job. For the most part I found head teachers very cooperative.

In the case of a small number of dyslexic children (surprisingly few, in my judgement, in view of the pressures which they experience) there were significant behavioural problems. I was fairly confident, however, that, once the nature of the child's dyslexia was understood, family tensions would gradually lessen and the undesirable behaviour gradually disappear.

In talking to parents at the end of my assessments I continually had occasion to emphasise that once the overall picture was clear a great deal depended on common sense. Thus the fact that a child was carrying a constitutionally caused handicap did not mean that no standards at all were possible; rather, what was needed was an adjustment of standards on the part of both parents and teachers. As a result it was necessary to take account in particular of the fact that reading and writing were likely to be extra laborious and that the child was likely to tire easily. It was a matter of common sense not to press the child too far if he or she was tired.

Another common-sense point is that careful thought is needed as to how fast the child should be 'paced': if the school work is not up to his intellectual level, he will become bored, whereas if too much is expected too soon, he may not be able to cope. Experience suggests that it is better that dyslexics should be over-stretched, particularly if they are warned in advance of possible disappointments, rather than that they should not be stretched sufficiently. I recently heard a successful adult dyslexic say that many of the problems in his earlier life had arisen not from what he was unable to do but from what he had not been allowed to do. The best answer that I know to the question concerning the rate at which a child should be paced lies in the wise words of Margaret Rawson: 'Go as fast as you can and as slow as you must.'

It is also a matter of common sense to appreciate that children who are carrying a handicap may need extra comfort and reassurance from their parents at times of difficulty, and I frequently used to encourage mothers to back their own judgement when it came to the extra cuddle or extra attention rather than be influenced by well-meaning friends or even professional 'experts' who might say the child was too old for such things.

There is the further point that by emphasising the need for common sense one is thereby conveying to the parents that one trusts their judgement and that one is not there to find fault. I suspect that the popular image of psychologists and psychiatrists who unearth 'complexes' and criticise people for the terrible way in which they bring up their children is not wholly dead, and it is therefore useful to make clear by word and gesture that one is taking what the parents say at its face value.

I was sometimes asked about the value of tinted overlays. There is now good evidence that for some people, including some dyslexics, they make reading easier

(Miles and Miles, 1999a, Chapter 7), probably because they reduce the amount of glare coming up from the page. It was necessary, however, to warn against exaggerated claims, for instance that at long last a cure for dyslexia had been discovered.

Occasionally, too, I was asked whether I would advise the family to spend money on a 'new' kind of treatment for dyslexia - sometimes one which had recently achieved headlines in the popular press. I knew well that desperate parents are sometimes willing to spend just about their last penny in getting help for their dyslexic child. I wondered, therefore, if I had a duty to warn them against wasting their money.

In practice, if I had reservations about it, I was very hesitant to condemn a particular kind of treatment out of hand. It would have been unfair to those offering the treatment, and, for all I knew, I might have deprived the person being treated of some help. There was also the possibility of what doctors call the 'placebo effect', where a patient's belief that a treatment is effective may make it so, regardless of what is done or of what drug is prescribed. Rather than advise against such treatment, I would tend to say something like, 'Do not be too disappointed if it does not work.'

I have sometimes found it helpful to discuss with families the role of laughter. I have noticed over the years that those families for whom the dyslexia was causing least stress were often those who, in the most sympathetic way, were able to laugh at some of the things which went wrong. A father who is himself dyslexic and who says, 'My spelling is still darned awful' is first and foremost showing sympathy; and if, in addition, mother then says, 'Yes, you made a right mess of that letter to Aunt Jane, didn't you, dear?', this establishes that dyslexic-type errors will be understood rather than punished. As long as one is not laughing unsympathetically at the child but rather with him, one can help him to laugh at the things which sometimes go wrong. For instance, if you say with a laugh, 'You silly idiot! You've gone and muddled up left and right again!', this is basically a sympathetic comment since it shows understanding. It is my experience that in many different contexts laughter is often a very effective way of removing tension.

It was my usual practice when I carried out assessments not only to talk about immediate present needs but to try to forestall possible problems in the future. With this in mind I would sometimes say in the presence of the parents, even to quite young children, 'There may be people who tell you that you are lazy or stupid, but we know that you are not lazy or stupid.' To those contemplating college or university courses I might say something like: 'Don't be put off going to college by your well-meaning friends if you feel in your heart of hearts that that is what you want to do. When you have got there, you may feel moments of doubt as to whether you have done the right thing, and do not be surprised if this happens - it does not mean your choice was wrong.'

I end this chapter by offering a checklist. This is reproduced from Miles (1993b, pp. 91-92), at a time when I was trying to take stock of what I was doing during assessments. I pass this list on in the hope that others doing assessments for dyslexia will find it useful.

1. Was it made clear to the child at the start that he is not on trial, but that what is being done is aimed at helping?

2. Did you make clear that you sympathised with the parents in their struggles to get help?

3. Was any attempt made to remove the impression which they could have been given in the past that they were 'over-fussy'?

4. Was anything said about the extra comforting and reassurance needed by many dyslexic children?

5. Was anything said about social problems such as missed appointments and forgotten messages?

6. How much was said about the person's strong points? Was the issue of the person's intelligence discussed? Was the question considered as to whether the person's intelligence may have been underestimated both by themselves and by others?

7. Were the parents/child/adult asked if the diagnosis made sense to them?

8. Was any attempt made to forewarn against possible future problems and prepare the person for them?

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Adult Dyslexia

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