The lesser known learning differences ~ Supporting students with dyspaxia and dyscalculia. Michelle Cowen Lecturer / Academic Lead for Disability & Dyslexia University of Southampton, Faculty of Health Sciences Consultant in Dyslexia, Dyspraxia and Dyscalculia Royal College of Nursing mdc4@soton.ac.uk

Aims of this session To explore the pattern of difficulties associated with dyspraxia and dyscalculia and the challenges which they in turn create. With regard to the specific theoretical, practice and professional aspects of healthcare programmes to identify what constitutes a ‘reasonable adjustment’. To identify ways in which we can support students with dyspraxia or dyscalculia whilst ensuring that ‘competence standards’ are met.

What is dyspraxia? Dyspraxia is a Developmental Co-ordination Disorder or (DCD) The Dyspraxia Foundation describe dyspraxia as an:  “impairment or immaturity in the organisation of movement. Associated with this there may be problems of language, perception and thought”. (Dyspraxia Foundation, 2010) Dyspraxia is felt to often coexist with other developmental conditions including Attention Deficit Disorder and Aspergers.

Possible causes of dyspraxia Dyspraxia occurs when parts of the brain fail to mature properly as they develop – resulting in atypical brain development. (Kaplan et al, 1998) Reasons for this are complex but may be linked to factors affecting foetal development during pregnancy such as maternal diet (including low intake of long chain polyunsaturated fatty acids or LCP’s) prolonged labour effects of prematurity (birth before 38 weeks) effects of postmaturity (birth after 42 weeks) breastfeeding as docosahexanoic acid (DHA) a chemical found in high levels in breast milk is felt to play a part in the developing brain. (Portwood, 2000).

As the brain develops a series of neural networks are created As the brain develops a series of neural networks are created. The body creates an excess number and over the first 3 years of life removes the less efficient networks. At the same time appropriate (efficient) pathways are reinforced. Where this does not happen there is an opportunity for messages to go along the extended (inefficient) pathways resulting in a delay in processing information.

Dyspraxia may affect Fine motor movement resulting in poor manual dexterity Gross motor movement resulting in problems with balance Organisation of ideas (in written work) General organisation

Diagnosis Due to its potential overlap with certain neurological conditions, it is important that these are ruled out before a diagnosis of dyspraxia is made. Primary contact therefore tends to be with the individuals General Practitioner (GP) Other specialists who may be involved include Psychologists – educational, occupational, neuro or clinical Psychiatrists Neurologists (mainly in the case of acquired dyspraxia) Paediatricians who specialise in developmental disorders (will see adults where dyspraxia is suspected). Physiotherapists Occupational Therapists Speech Therapists

Dyspraxia : top tips to help yourself or others Give yourself enough time to write up notes or other paperwork. Divide your ideas into sections and tackle one section at a time Devise ‘templates’ or checklists for different types of documentation eg patient assessment, discharge summaries, letters etc. Use a laptop or PC to write notes on if one is available. If your writing looks messy - experiment with different types of pen (chunky / standard / slim) until you find one that helps. Consider using a handheld recording device to record your ideas verbally – you can then copy it into the notes but you don’t have to think and write at the same time. Always carry something to write on and a pen Use flow diagrams where procedures need to be remembered in a particular order Use coloured pens and highlighters to help organise and prioritise Practice handling instruments and equipment – if possible ask if you can borrow a piece of equipment to practice.

What is dyscalculia? “a condition that affects the ability to acquire arithmetical skills. Dyscalculic learners may have difficulty understanding simple number concepts, lack an intuitive grasp of numbers, and have problems learning number facts and procedures. Even if they produce a correct answer or use a correct method, they may do so mechanically and without confidence.” (Department for Education and Skills, 2001, p2)

Incidence of dyscalculia Opinions vary enormously as to how common dyscalculia is. Based on the broad DfES definition some authors estimate the incidence to be between 4 and 6% of the population (Bird, 2007) Geary (1993) an American Psychologist, attributes the difficulties that people with dyscalculia have with maths as due to a poor long-term semantic memory (memory for facts) and poor working memory (a temporary storage facility for information that is currently being processed), both of which are commonly associated with dyslexia. This leads to the inevitable question of whether someone really has dyscalculia or if it is in fact dyslexia which is causing their difficulties? …….. Or something else?

‘True’ dyscalculia Dyscalculia is : Much more than being bad at maths Very rare in its true sense Often ‘self diagnosed’ And is really about : An inability to conceptualise numbers

Dyscalculia may cause General numerical problems Calculation related problems Time related problems Other specific problems with day to day life

Diagnosis of dyscalculia Unlike dyslexia and dyspraxia where there are a variety of screening tools and standardised assessments to assist the diagnostic process, the situation is less advanced in relation to dyscalculia. The ‘Dyscalculia Screener’ developed by Butterworth (2003) is known to only give reliable results up to the age of 14. Loughborough University are currently testing a more adult focussed tool DysCalculiUM to use within Higher Education. However early indications are that it might not provide reliable results for those on science based courses due to the areas it seeks to assess (Beacham and Trott, 2005).

Dyscalculia : top tips to help yourself or others Carry a cue card around with you to remind you of drug calculation formulae Look at one of the many books available to teach you different types of calculation Practice, practice, practice until you feel confident Calculate your answer independently before checking with a colleague – if you don’t agree bring in a third person, your colleague might have got it wrong not you… If your employer allows the use of calculators use one to check your answer Consider enrolling on adult numeracy classes to brush up key skills Help colleagues to feel open about asking for help / someone to check a complex calculation – it might take a little bit longer but it is better to be safe In emergency situations where calculations need to be performed quickly and with lots of potential distractions allow a colleague to ask someone else to do it Have a picture of a 24 and 12 hour clock to show the differences

What do we need to do to help? Under the terms of disability legislation students are entitled to receive “reasonable adjustments” to help them overcome their difficulties. However students with a disability are still expected to demonstrate that they are “Fit for Practice” and must meet all of the learning competencies and skills that all other students are required to do. The key factor is that adjustments must be put in place before competence is assessed.

Inclusivity throughout the student journey – we need to Debate the challenge of balancing reasonable adjustments and Professional Standards Raise awareness to create a truly inclusive culture Which is free from discrimination Which supports individuals to make the right career choices to aid success Which supports individuals learning differences Where we define what we mean by Fitness to Practice

Conclusion Education providers and their Practice partners have both a legal and moral responsibility to guarantee that all students are not disadvantaged, irrespective of any disability. This creates a professional challenge to ensure that the students receive a high-quality education, both in theory and whilst on practice placements. This must meet their individual needs, whilst maintaining academic and professional standards. There is an urgent need for everyone involved in nurse education to embrace this challenge. Through staff development we must ensure that we have the necessary knowledge and skills to make the individual adjustments deemed necessary.