During
the summer I ran into this article: Psychiatrists
split on whether to ditch DSM by Antony Funnell, which deals with the
debate in the psychiatric community concerning the DSM5. This article enlightens an aspect related to
an issue that was discussed here – the relations between cognitive abilities
and reading, writing and math achievement.
Funnell writes, that psychiatrists around the world, led by the US
NATIONAL INSTITUTE OF MENTAL HEALTH are in open revolt against the DSM5,
demanding that psychiatry be based on science and not on conjecture. Traditional psychiatry, these psychiatrists
say, relies too much on diagnosis based on symptoms and clinical
observations . Treating people coping
with psychiatric conditions by the symptoms they present is not reasonable,
just as it's not reasonable for a physician to prescribe the same medicine for
everybody who feels chest pain, regardless of the pain's reasons: heartburn, a muscle spasm
or cardiac arrest.
Here we reach the differences between SLD (specific
learning disability) definition according to CHC theory, as developed by
Flanagan, and SLD (specific learning disorder) definition according to the
DSM5. The essential elements of both
definitions are presented here, along with the main differences between them.
As written in the presentation, Flanagan's definition
requires linking the symptoms (the difficulties the child has in achievement)
to the psychological/cognitive disabilities that lie at their base (empirically
or reasonably). The developers of the
DSM5 definition, represented here by Rosemary Tannock, write in the DSM5 text,
that specific learning disorder is "a neurodevelopmental disorder with a
biological origin that is the basis for abnormalities at a cognitive level that
are associated with the behavioral signs of the disorder". But they argue that the relations between
deficits in psychological/cognitive processing and reading are not proven
enough (they are probabilistic and not deterministic). That is, it's not possible to use a specific
cognitive profile to confirm or reject the diagnosis of a reading learning disability disorder, and
the psychological processes underlying math and written expression difficulties
are not clear.
The proponents of the CHC/Flanagan definition would agree
with the claim, that learning disability cannot be diagnosed only on the basis of the
child's cognitive profile. Even if the
cognitive profile shows difficulties, as long as they don't affect the child's
daily functioning in the achievement domains (reading, writing, math), the
child cannot be diagnosed as learning disabled according to this definition.
If the cognitive profile is not enough to diagnose learning
disabilities, why is it needed at all?
It's evident, that treating and addressing the symptoms
only (that is, remediating reading, writing or math directly) - only partially alleviates
the problems in learning disabled children.
If we could prove in a convincing way, that treating the cognitive
disability improves the child's achievement in reading, writing or math, we
would be able to say that identifying the cognitive/psychological difficulty
underlying the lowered performance in
the achievement domains, will help us plan an intervention that will assist the
child more than treating the symptoms only.
Our goal should be, in my view, to strengthen that evidence
base (of the relations between treating/strengthening cognitive abilities and improvement
in the achievement domain) so that we'll be able to reach an evidence based
diagnostic practice. Otherwise, the
diagnosis of learning disability will remain an empty and a general lable, that is not conducive to efficient treatment
for the specific child being diagnosed.
