‘Dyslexia from assessment to intervention’ interview with Professor Maggie Snowling

Matt Kempen
Marketing Manager for ACAMH

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Interview with Professor Maggie Snowling on 29 September 2017, at the Welsh ACAMH Branch conference, ‘Dyslexia from assessment to intervention’.

Professor Maggie Snowling
Professor Maggie Snowling

Bio via St John’s College, Oxford
I came to St. John’s in September 2012 as President and Honorary Professor in the Department of Experimental Psychology. I also hold an honorary contract as a clinical psychologist in the Department of Psychiatry. Before this, I was Professor of Psychology at the University of York where I co-directed the Centre for Reading and Language.

I completed my first degree in Psychology at Bristol and my doctorate at University College London under the supervision of the eminent psychologist, Uta Frith. Later I qualified as a clinical psychologist. I am a Past-President of the Society for the Scientific Study of Reading and was one of the Joint Editors of the Journal of Child Psychology and Psychiatry. I served as a member of Sir Jim Rose’s Expert Advisory Group on provision for Dyslexia in 2009 and as an expert member of the Education for All: Fast Track Initiative group in Washington DC in 2011. I have offered advice to the Government Departments of Education and of International Development, particularly in relation to the early years and specific learning difficulties (SpLD).

I am a Fellow of the British Academy and a Fellow of the Academy of Medical Sciences. I hold honorary doctorates from Goldsmiths London (2010), University College London (2014), Warwick University (2016) and University of Bristol (2019) for contributions to the science of reading and dyslexia and was appointed CBE for services to science and the understanding of dyslexia in 2016.

My research focuses on children’s language and learning and I am specifically interested in the nature and causes of children’s reading difficulties and how best to ameliorate them.  In recent years, my work has focused on longitudinal studies of children at high-risk of reading problems, and I have been involved in the implementation of randomised controlled trials assessing the efficacy of reading and language interventions in projects led by Charles Hulme in the Department of Education.

Transcript

Dyslexia is a specific learning disorder, and it primarily affects the ability to learn to read accurately, fluently, and also it affects spelling abilities. Well, like many people in the field I got interested in dyslexia because I had dyslexia in the family. I have a brother who and is severely dyslexic. He was in a lot of trouble at school. He became disengaged. He got into trouble as a young offender. I think one of the things that for me that I remember of those years though, was the impact it had on my mother and on her mental health. How she was often crying and that affected me quite deeply.

I didn’t deliberately decide to work on dyslexia, though, I should say, because I actually wanted to work on autism and when I went to see my supervisor she suggested, well, what about dyslexia? And it just sort of said, oh, yeah that’ll be quite interesting. So it did spark my interest, but it wasn’t that I sought it out in any conscious way and of course my own son is dyslexic.

So I’ve kind of seen it from many different angles. I suppose my feeling is that it is primarily a reading problem, but it has all sorts of ramifications and they need to be understood. Well, you have to be the mum in the end, and I should say that my son was not someone who was very easy to persuade to have any interventions and I think partly because I was in the field, he really didn’t want to have any special things.

In fact, he even refused to have extra time in GCSEs, although his school did force him in the end to have it. One of the things I remember is working as a psychologist, assessing a six year old and saying to the parents, I think this child really is at risk of dyslexia and you should be doing something and then thinking, hang on, my child is six and I’m not doing anything. But we actually taught him on a daily basis at breakfast time.

You know, we did some. In the early years we did a lot of reading, every day, reading but right through to age 11 I used to do spellings with him. I mean just a few in a structured way and actually he says, he still says if you hadn’t done that mum, I would be completely illiterate. He can now spell but actually if he’s writing his spelling is terrible, but if you stop him and ask him to spell something, he’s pretty good.

Identifying dyslexia is something that would normally be done by some kind of reading measure or reading check. In England at the moment we have the phonics screening check, and I think that’s the first kind of point in school when you might actually be able to determine whether a child is really at risk of dyslexia because they’ll have had some reading instruction. End of year one they get to read 40 words and onwards. If they don’t reach the expected level for their age then an intervention ought to be being put in.

If the child doesn’t respond to that intervention, then we’re getting pretty certain to think that child could well be dyslexic. So that’s how it should be being done. Having said that, if it’s a severe problem in those early years the assessment should go beyond just reading words. It should involve reading comprehension, spelling and also possibly some language measures, something like vocabulary. I think the label dyslexia is an important label because it identifies a group of children with a core impairment in word reading that’s normally associated with some problem with phonological processing.

I think that if you don’t use a label those children’s difficulties are not easily recognised. The problem becomes hidden and that has all sorts of negative ramifications further down the line in development. The tools for assessing dyslexia should really be the tools for assessing reading and reading related skills, and there are a lot of good standardised measures available. In my view, the assessment should look at reading words, decoding long words that the child hasn’t seen before.

So you get a real estimate of their phonological reading skills. It should also include an assessment of reading comprehension because sometimes children’s problems of decoding are accompanied by comprehension problems, and then because we know that phonological awareness is very important in learning to read, there should be a minimum assessment of phonological awareness. Then, in my view, if there’s any indication that the child has any spoken language difficulties there should also be some measures of oral language, and a measure of vocabulary is a good proxy for oral language in the first level assessment.

The Rose Review recommended evidence based intervention, which includes training in phonological skills, training in the context of reading in a rich language environment. On the back of the Rose Review there was funding to train specialist teachers and that happened, but unfortunately since then, or since the money ran out the resources for teacher education have dwindled and also many specialist teachers who were teaching in local authority settings, for instance, have also, unfortunately been made redundant. So I think at the moment the landscape is looking rather poor.

It’s quite a concern. One of the dyslexia organisations which has been pioneering in the last 30, 40 years has actually closed down. So I think we are in danger of losing the momentum that really came on the back of 40 years of scientific progress, a government report, and actually now these children again, not necessarily being recognised. So it’s a concern. If a child’s at family risk of dyslexia, we know the probability that they’ll have a reading difficulty is much greater, probably three or four times greater than it is for a child growing up in a family where there isn’t a history.

So it’s an important marker and it’s particularly useful, I think, in addition to an assessment, for perhaps identifying children who might have a more persistent reading problem, but I don’t think it carries any specific implications for intervention. The other thing I’d say about family risk is in the pre-school years, I mean, there’s always been a lot of interest in early identification for dyslexia and there are various commercial packages around that will, you know, early identification screening.

They’ve got a lot of tests that really are not very useful for screening, for reading problems. If you actually want something that’s quick and easy for thinking about screening in pre-school you could just look at letter knowledge and family risk and children who had letter knowledge and are at family risk you might start saying, okay, we need to be doing something about the foundations of reading for that child.

Carrying out any research in schools these days is quite difficult because of concerns about safeguarding and ethical issues and pressure on teacher time. Having said that, we often find that practitioners and education professionals have a huge amount of interest in this field and they tend to be rather welcoming. In terms of interventions obviously there are robust trials involved randomised control trials. That means recruiting schools in the knowledge that some of those schools won’t actually get the intervention, at least not in the first place, and that takes a lot of explaining to some schools and some schools are reluctant to take part in a trial which is going to involve children being assessed over a period of time when essentially nothing is happening.

Having said that, we have implemented randomised trials. It is possible and I think it is an important part of the evidence base that we do have to generate and there isn’t enough, I should say, on children with severe reading difficulties beyond the early stages of reading. There’s rather little research, for instance, on what you do with a child with dyslexia who’s, you know, reasonably able to read but has a significant spelling and writing problem.

We still don’t have an evidence base as to what to do with that child. Well, children who are socially disadvantaged bring with them a whole host of risk factors, I think, for reading problems. As you indicate, many of their parents might themselves be dyslexic or have a language impairment and almost certainly those parents wouldn’t know that. They will probably just think, you know, they didn’t do well at school and they’ve got a terrible job or they’ve got no job.

So there is… I think those communities are disempowered. They’re not seeking any kind of help for their kids because actually that’s just what happened to them and they just think that’s the norm. So I think there’s a problem of advocacy in relation to some of those children. The other thing is that often the home literacy environment is blamed for poor literacy. The home literacy environment we can do a lot about that.

Indeed, it does strongly predict children’s early reading and reading related skills. It powerfully mediates the impact of social class. So if social class is mediated by that home literacy environment there is a lot we can do to help people to produce better home literacy environment for their young children, and I guess the other thing I would say is that to the extent to which some of those children also have spoken language difficulties, they probably have some other problems as well which are going to affect their school readiness.

So I think that it’s not exactly confounding, but I think it’s an additive risk factor. I would see that as one of the additive risk factors that accumulate to lead to a child having a dyslexic difficulty.

Well our work in recent years, probably in the last 15 years, has moved really towards understanding the language foundation of learning to read and the risks that children with language difficulties bring to the task of reading, and through that we’ve developed language interventions using randomised trials.

I suppose what I would like to see in the end is a kind of, you know, a sort of, almost a school, pre-school through school, not exactly a menu, but a system whereby children would be identified early in nursery school with difficulties or likely to have difficulty with language, parent intervention programmes which are evidence based to promote oral language going into pre-school with oral language interventions, strengthening the foundation for learning to read and then children going on to reading interventions.

And what I’d like to see is a system whereby children with the most severe problems, but with a changing profile over development actually get sustained intervention, but inevitably that would be with different sorts of intervention as time goes on, and unfortunately what you see quite often, if you take the example of dyslexia, is you have a child with a persistent dyslexic problem. They get, let’s say, a phonological intervention and then the next year they get another phonological intervention and the next year they get another phonological intervention until everybody’s fed up with it.

Or people have said this child doesn’t seem to be improving, but there hasn’t really been a careful analysis of, well, why is that? And is there something else that’s missing from the programme? Maybe this child needs, for instance, some help with spoken language that can help them with some of the compensatory strategies that they need to learn to read and then we could go back to phonics or something like that. So we need a sort of, through… I don’t know, a sort of staircase or something where children have interventions of different intensity and of different nature depending on the child’s age and stage and we’re nowhere near having the evidence base. So we have to rely on good practice, things that we think are theoretically motivated and are good practice.

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