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.
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
1. Give yourself enough time to write up notes or other paperwork.
2. Divide your ideas into sections and tackle one section at a time
3. Devise ‘templates’ or checklists for different types of documentation eg
patient assessment, discharge summaries, letters etc.
4. Use a laptop or PC to write notes on if one is available.
5. If your writing looks messy - experiment with different types of pen (chunky /
standard / slim) until you find one that helps.
6. 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.
7. Always carry something to write on and a pen
8. Use flow diagrams where procedures need to be remembered in a
particular order
9. Use coloured pens and highlighters to help organise and prioritise
10. 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 longterm 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
1.
2.
3.
4.
5.
6.
7.
8.
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 learning
differences
Which supports
individuals to make the
right career choices to
aid success
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.
18