Research School Network: Building understanding of pupils and their needs The fourth blog in this series on SEND, considers key influences on a young person’s development & the thorny issue of diagnosis

It goes without saying that to be able to deliver a quality SEND provision at your school, you would definitely need to comply with the second recommendation from the recent guidance report:

Absolutely, we need to know and understand the pupils to be able to support them in the best ways we can – let’s know their strengths and difficulties so we can praise where we can, and implement strategies when needed.

In fact, this aspect is so important, there are also versions of it within the guidance report on Improving Behaviour in mainstream schools:

Obviously, the behaviour guidance is considering pupils who have challenging behaviour, which may or may not be due to an SEMH need. However, all the guidance is pulling in the same direction: for the learning playing field to be level for all pupils, allowing them to flourish and use education as a springboard for their adult life.

There are various models which can be used to ensure we build this understanding: the SEN Code of Practice gives us the graduated approach to follow – there is an excellent worked example in the guidance report for more detail and clarity around this.

It is within the first stage of ​‘assess’ that the notion of building understanding of pupils lies. Where do some of these difficulties come from?

In truly understanding a young person, then the key influences which have impacted on that young person need to be considered and brought to the fore. There is a growing body of evidence in regards to epigenetics and its contributions to SEMH needs; of particular interest is the diathesis-stress model.

If we consider Attention Deficit and Hyperactivity Disorder (ADHD), then evidence points us towards considering that one of the potential causes is genetic. The diathesis-stress model says that a young person could have a predisposing gene to a diagnosis of ADHD, but that it is in combination with environmental factors that the ADHD presents itself. Indeed, a child’s upbringing can impact on whether their genetic predisposition to Attention Deficit and Hyperactivity (ADHD) develops into the disorder or not (Belsky et al, 2007).

It’s the classic nature/​nurture debate, but it is fascinating to consider the pupils we know who have an ADHD diagnosis, and then to consider what we know of the environmental circumstances of each one.

This diagram by Bronfenbrenner supports our considerations of the key influences on a young person’s development: time, environment and personal characteristics all play their part in affecting development, for better or worse.

So our ​‘assess’ process will consider these key influences and may be carried out by a key person within the school, or it may be carried out by another agency – EP, CAMHS, social services, OT, SALT. I would suggest that a thorough assessment would have contributions from all appropriate ​‘agencies’ in the child’s life, including the child and parents/​carers.

But within this notion of building understanding of pupils lies the thorny issue of labels and diagnosis. Some may not enjoy the connection between the two concepts – surely diagnosis is an important tool, whereas labelling feels like it has negative stigma and connotations associated with it. Without really careful application of diagnosis, then these two notions can be interwoven and easily become conflated.

Is diagnosis important?

I have seen, as I am certain that you have as well, polar opposites in terms of the push for diagnosis.

There have been parents who want to know all the labels and letters they can ascribe to their child; there have been parents who don’t want to know in regards to diagnosis as they are concerned about the stigma attached to the label.

There have been teachers who discuss children amongst themselves, using the diagnosis as reasons for poor work/​behaviour/​effort: ​“What do you expect?”; there have been teachers who go above and beyond, altering their lessons and physical spaces to adapt and ensure that the diagnosed child has all the suggested strategies implemented for them.

And in the middle is the child. What do they want? I often find that they are bewildered and baffled by what is happening around them. Some will roll their eyes at their parent’s obsession: ​“They’re always like that, Miss.”, whilst others just seem to float around wide-eyed – unable or unwilling to really engage in the conversation.

So my question can only really be answered with another question: how will it help?

If we know that William meets the criteria to be given a diagnosis of X, will it help him to better understand himself? Will it mean that he and his parents might have access to medication which may support his learning? Is he willing to be medicated? Will it help the teachers to have a better understanding of his needs?

Or, will it mean that he always considers himself by that diagnosis, thus impacting on his self-esteem? Will it mean that other adults box him off and underestimate him because of it? Will it only give an overview of his needs, which are clearly going to be unique and specific to him?

Children do not always need a diagnosis to be given the right support in a mainstream school. In fact, it’s more helpful for their teachers not to consider them as within a ​‘category’ (which is all that a diagnosis does), because it may mean that the specific learning needs get overlooked.

Similar diagnoses do not result in similar children. Consider the Bronfenbrenner model again, and think about the differences each child has in the key influences of time, environment and personal characteristics.

Is diagnosis important? you ask. If you can answer how it will help (both now and considering the child as an adult), then yes. If not, work out where the ​‘push’ is coming from and have candid conversations with them about the pros and cons.

See below for a note on working with parents/​children