Responsibility: The Ethical Discourse of Labelling Dyslexia for Educational Psychologists

Labelling

The American Psychological Association [3] describes a label as a term that distinguishes individual groups by a set of definable characteristics for research and treatment purposes, assigning a suggested homogeneity. In its simplest form, a label is a generalised term attributed to individuals to create a specific identity defined by societal influences [4]. EP practice is embodied within consultation, assessment, and labelling. However, there remains uncertainty around the utility of labelling for CYP raising an ethical dilemma for EPs due to the undefined risks of harm posed by labelling e.g. identity crisis.

Arguably, Artiles [5] allege that labels are affected by biological variation, rooted in assumptions about an individual’s identity. However, labelling is habituated within historical belief systems across biology, ideology, psychology, and politics which permeate into policy and practice [6]. This argument reflects a deep seeded tradition of educational inequity using labels to segregate society based on individual characteristics [7]. Consequentially, this inequity permeation may alter an individual’s ability to achieve relative levels of educational aptitude [8].

Conversely, Anderson, et al. [9] argue that labelling is essential. The researchers claim that labelling aids realistic policy developments and innovative practices to improve educational outcomes [9]. Accordingly, EPs hold an ethical responsibility to reduce the risk of harm by mitigating for ideologies threatening to ostracise CYP with additional learning needs [2].

“Dyslexia is one of the Most Well-Known, but Possibly Least Understood Difficulties Facing Young People” [10]: The British Psychological Society [11] provide a cursory working definition that “Dyslexia is evident when accurate and fluent word reading and/or spelling develops very incompletely or with great difficulty.” Due to the lack of exclusionary criteria, this definition does not prevent alternative hypothesis generation [11]. Furthermore, the BPS [11] adopt a word level focus implying that the problem is severe and persistent despite appropriate learning opportunities. There are no semantic or syntactic cues at the word level that aid decoding therefore, only letters are available to make sense of the word [10].

Alternatively, the British Dyslexia Association portray dyslexia in the words of Rose [12] “Dyslexia is a learning difficulty that primarily affects the skills involved in accurate and fluent word reading and spelling. Characteristic features of dyslexia or difficulties in phonological awareness, verbal memory, and verbal processing speed.” Rose [12] further explains dyslexia as a continuum with no clear cut-off points to determine a dyslexic subgroup within a wider population of poor readers. Based on finite characteristics, current practice labelling dyslexia sustains ambiguity and the arbitrary assessment industry which compounds inequity of provision [13]. Most definitions are attempts to describe dyslexia, yet this only further magnifies the complex and multi-faceted nature of the difficulty [14].

Elliot [10] claims that professionals do not like the synonymous nature of the dyslexia label. However, denoting dyslexia as a reading disability is problematic as it can become either too inclusive or exclusive. Hence, EPs have the ethical responsibility to be aware of the labelling discourse to reduce the risk of harm to CYP. Nevertheless, Gibbs, et al. [13] offer the label ‘literacy difficulties’ ascribed to an increased level of confidence this provides to professionals working with CYP.

The theoretical basis of dyslexia remains unclear [15]. To achieve a better understanding of the EPs ethical responsibility to CYP, the Phonological Deficit and Magnocellular Deficit theories are presented according to the robust nature of research surrounding these two perspectives.

The Phonological Deficit theory has accumulated substantial attention over the past 40 years alongside interventions based on high-frequency phonological training [15]. The theory proposes that dyslexic individuals have a sound manipulation impairment within three components: poor phonological awareness, poor verbal short-term memory, and slow lexical retrieval [16]. These components are well documented and easily exposed through phonological awareness tasks e.g. phoneme deletion and phonological sequence memory [15]. Ramsus [17] state that these components are accountable for information processing at the cognitive level and a failure in any of these may explain various dyslexic behavioural manifestations. Despite providing a coherent theoretical basis, the phonological deficit theory is reductionist in nature and not all individuals display difficulties with phonological processing skills [17].

Similarly, brain imaging techniques such as Magnetoencephalography (MEG) have been used extensively to analyse the dyslexia label [18, 19]. The Magnocellular

Deficit theory proposes decreased sensitivity levels in the magnocellular region of the visual system caused by a lack of organisation in the Lateral Geniculate Nucleus and shrinking of magnocells [15]. This sensitivity decrease reduces the ability to rapidly detect visual stimuli and can cause visual stress, common dyslexic characteristics [20].

Biological explanations have been used to justify the dyslexia label when challenged due to the functional understanding offered. For example, Norton, et al. [21] discovered a reduced neuron firing rate at rest and increased firing rate when reading, hence, more effort is required when a dyslexic individual is reading; reading ability is not automatic, yet improves with practice [15]. However, the culmination of biological research only emphasises the similarities of suggested reading difficulty eitiologies [22]. There is a complex relationship between genetic and environmental influence which make it difficult to distinguish a dyslexic subgroup with the current evidence base [23]. Consequently, EPs must carefully consider potential risk factors associated with ascribing any homogenous deficit explanation, to decrease the risk of harm and achieve the most productive outcome for the CYP.

Label Utility

A label is a generalised term that can never be fully inclusive [24]. Thus, the obscurity of the dyslexia label may lead to an over-population of dyslexic diagnoses [25]. Over- population can paradoxically increase the risk of harm to CYP, as professionals are unaware of how to mitigate the issues presented by the dyslexia label [10]. Hence, historic views of affiliating dyslexia and intelligence may be reverted to despite empirical discreditation [10, 26].

Kirby [27] asserts the influence of socioeconomic background on the likelihood of labelling dyslexia since parents from middle-class backgrounds are more likely offered the label as a function of their amenable resources. This assertion does not prove that within this socioeconomic band a high number of CYP have literacy difficulties, instead, exemplifies subjectivity toward affluence [21]. Here, there is a purported paradox that EPs function as gatekeepers to a finite level of resource, therefore whilst increased resource is required, quantity is restricted [28]. Prior to government recognition, affluence being coequal to resource compounds the reality of inequity and reveals a feature of social history yet to dissipate [29].

Elliot [10] argues this middle-class alignment engenders power imbalance denoting a hierarchy. Parents from lower socio-economic backgrounds are seen as having questionable intellectual ability and adopting little educational regard [10, 30]. However, this discernment is fatuous; worth does not indicate label access, rather, access is a product of wealth [31]. Accordingly, EPs must remain acutely aware of this socio-economic disparity and work systematically to promote an inclusive system, decreasing the risk of harm to CYP displaying literacy difficulties.

Dweck [32] offers the concepts of a fixed and growth mindset, verifying the direct influence of labelling on self- perception. Labelling enables external affliction, reducing feelings of blame and stupidity which is essential for fostering a growth mindset [32]. Nevertheless, many CYP are label averse due to fixed beliefs about aptitude and worth [32]. Consequentially, EPs hold the ethical responsibility to elicit CYP views and individually tailor provision to reduce the risk of harm posed by a fixed mindset.

Furthermore, Snowling [33] acknowledges the influence of labelling on teacher perception by uncovering a sympathy bias toward CYP with the dyslexia label. The teachers’ endeavoured to increase motivation and hope for CYP with the label, disregarding others [33]. This subjective influence demonstrates the power of sympathy and understanding to bolster self-concept.

Comparably, Gibby-Leversuch, et al. [34] investigated the experiences of CYP with literacy difficulties and those labelled with dyslexia. The research highlighted label vitality for adequate support, however, an increased rate of negative self-perceptions; without the label, CYP experienced negative judgements and lack of belonging [34]. These findings elicit that although CYP with the dyslexia label have greater negative self-perception, this does not correspond into overall self-worth [34]. In response, EPs have the responsibility to educate professionals in the systems around CYP on their subjective influence due to the risk of harm to a CYP’s self-perception.

Lauchlan, et al. [35] offer an intriguing stance, asserting that labelling can be helpful if assessment results (from cognitive tests) contribute to label identification and resource provision. Howbeit, the individuality of the CYP may be lost within the demands of the system [10]. EPs maintain a vital role in the assessment process; EPs have the responsibility to reduce the risk of harm by adopting a person-centred approach and eliciting individual needs devoid of quantitative reduction [36].

The discourse of labelling conveys observable individual characteristics which can precipitate stereotyping and stigmatisation [37, 38]. Accordingly, beliefs, perceptions, and norms of professionals trigger discriminatory practice and labelling which form how an individual perceives and reacts to the world. Reducing others’ negative attributions of the dyslexia label is difficult however, reducing these attributions would sequentially impact the elimination of stigma and prejudice [39]. Combatting stereotyping and prejudice is a salient aspect of the EPs role [2]. Utilising aspects of Personal Construct Psychology [40] for example the ideal self- paradigm offered by Moran [41], EPs can employ a strengths- based approach to empower CYP and reduce the risk of harm discussed.

Similarly, Rosenthal, et al. [42] accentuate the influence of expectations on CYP behaviour. Originally described as the Pygmalion Effect, the researchers assessed the degree of which teacher expectation would produce pupil achievement [42]. Pupils randomly labelled as having ‘potential for growth’ exhibited higher test scores comparable to peers upon follow-up, ergo, the expectations one holds about another serves as a self-fulfilling prophecy [42, 43]. Self-imposed prophecies occur when one’s expectations influence their behaviour. Whereas other-imposed prophecies occur when someone else’s expectations influence your behaviour [43].

Soloman [44] demonstrated that self-fulfilling prophecies occur when a teacher holds expectations for CYP, for example ‘X is lazy and does not listen’. Through social interaction, the CYP adopts the behaviours associated with these expectations e.g. not handing in homework and being disruptive, to confirm the original false expectations. Consequentially, adhering to the attributions of others decreases a CYP sense of self [44].

Upon reflection, EPs have an ethical responsibility to ensure they do not hold pre-conceived expectations about CYP. By acknowledging the influence of the pygmalion effect and putative power dynamics, EPs can remain open- minded, reducing the possibility of self-fulfilling prophecy [45]. This cognisance actively reduces the risk of harm to CYP by exerting positive influence over EP practice [45]. EPs can also encourage the development of a growth mindset by educating CYP and professionals on the influence of self- fulfilling prophecies [32].

Two critical inferences are accentuated via the dyslexia discourse: the ‘winners’ are the CYP who receive the dyslexia label and benefit from the provision [46]. The ‘losers’ are all other struggling readers whom the benefits associated with the dyslexia label are not expected [10]. Incongruently, Ramus [47] assert that the potential costs of labelling do not matter, instead, what matters is if these costs are outweighed by benefits of greater value and the alternatives available. This assertion highlights the dichotomous nature of the dyslexia label and offers insights to the political nature of labelling [10].

Social Constructionism

All labels are social constructs [48]. Research defined by economic and socio-cultural factors define norms, albeit whilst labelling individual variability in the process [49]. Acknowledging the social constructionism in labelling dyslexia requires individuals to be reflexively aware of the labelling purpose, as opposed to merely representing one’s difficulties. Accordingly, the ontology of constructionism is relativist in nature, where multiple realities of human experience are acknowledged [50]. Foucault [51] makes it abundantly clear that we all label others and must position ourselves in society by assuming identities constructed by social relations. Doing this legitimises our responses to others and carries behavioural expectations [49].

The epistemology of social constructionism claims that via acknowledging co-constructions between individuals’, researchers can understand multiple realities. Regarding the dyslexia discourse, social constructionism offers an increased understanding of the underlying processes in development and perceptions about the nature of change Kelly. Understanding multiple truths is a key aspect of EP practice, to comprehend the dynamic and transactional nature of shared meaning Kelly. Thus, by adopting a social constructionist epistemological stance, the EP can collaboratively work to construct a shared understanding around labelling to decrease the risk of harm to CYP.

Critical realism offers an integrative solution to the difficulties posed by both relativist and positivist thinking, denoting that objective reality exists but is interpreted variably Kelly. Farrugia [52] profess that realism is crucial for explaining how an EP works and clarifies the processes underlying values and concepts for meaningful change. Accordingly, EPs can utilise emancipatory questions to explore CYP value systems and reality interpretation to reduce the risk of harm associated [52]. This approach can further social progress and individual development by linking findings to ethical, political, and social systems.

Research offers evidence for all theoretical explanations in the dyslexia debate [10]. Despite this, the theories regarded most suitable are based on the researcher’s ontological and epistemological stance [53]. Taking a critical stance toward taken for granted knowledge, how an EP identifies their ethical responsibility with both the BPS and HCPC guidelines will impact their practice [50]. For example, within this paper the EPs responsibility to reduce the risk of harm is discussed, nevertheless, what constitutes harm to one EP may not be the same for another. This issue raises the ethical relationship with CYP and the appropriation of ethical rhetoric [54]. Thus, EPs must remain aware of their own ontologies and acknowledge their social constructions [1]. However, the EP must be able to set aside their biases and explicitly ask to clarify shared knowledge to retain objectivity [50].

Furthermore, EPs must also consider the CYPs ontology, including the accessibility of information [55]. Although labelling dyslexia may assist with generating a shared understanding, this may alternatively pathologise the CYP [10]. Accordingly, EPs are ethically responsible to facilitate this shared understanding and reduce the stigma associated with labelling dyslexia, despite the etiological ambiguity [43]. This course of action decreases the risk of harm to the CYP by ensuring accessibility and specificity of provision.

An interesting conception is whether dyslexia exists in Wales, as welsh is a phonetic language [56]. Schemas are culturally heterogeneous; therefore, misinterpretation is easy, especially with the diversification of the world and the interracial nature of society [57]. However, curricula can be culturally manufactured, a benefit of the new Welsh Curriculum, implemented in 2022 [58].

In welsh schools, CYP are not taught the English language until eight years old. Learning a second language is challenging for anyone, however, when a CYP has literacy difficulties this can exacerbate the magnitude of difficulties faced [59]. Miles [56] asserts that welsh being a phonetic language makes word acquisition easier due to the strictly phonic approach, assembling words from constituent phonemes. However, CYP labelled with dyslexia still appear to decode and encode at a slower rate than their peers with other literacy difficulties [56].

Nevertheless, Miles [56] affirms that there are still inconsistencies observed in the welsh language further increasing the processing difficulty. For example, initial and occasionally final consonants mutate, these nuances are noticeable in oral language but to CYP with dyslexia, these are not clear [56]. Even in phonetic languages, there are sounds which have synonymous articulation but are written differently i.e. ai and au, which causes confusion for welsh speakers labelled with dyslexia [59].

Despite marked difficulties in the welsh language, the dyslexia discourse has provoked welsh local authorities to either decrease or stop assessments for dyslexia [60]. This decision is rooted in queries over label beneficence and the shared reality extracted from Elliot, et al. [61] dyslexia debate argument. This shift in practice has caused angst for CYP struggling with literacy difficulties due to familial social constructions attributing the label as a gateway [10]. Consequently, EPs could reduce the risk of harm to CYP by facilitating a shared understanding with families and ensuring a person-centred process despite label assignment.

Interestingly, in September 2018 Staffordshire and Warwickshire decided to discontinue assigning the dyslexia label: the first attempt for English local authorities to abandon the label after being deemed “scientifically questionable” [62]. The authorities claimed to have “embraced a policy of not differentiating” between dyslexic and other CYP with literacy difficulties [63]. This embrace raises ethical issues for an EP due to the potential harm caused by inaccurate representation of CYP difficulties. EPs have the responsibility to find alternative solutions as a result [64]. Adopting a social constructionist perspective, evidentially authorities were not trying to eradicate the label due to beliefs of existence; instead, an attempt to encourage early intervention for all CYP with literacy difficulties [63].

Without a definitive dyslexia diagnosis, it is questionable how EPs can objectively and ethically offer a label to CYP. The ambiguity of the dyslexic rhetoric creates room for subjectivity and error, subsequently threatening the EP’s credibility [29]. Moreover, we live in a realist society professing existence irrespective of human experience, therefore, adopting a social constructionist perspective is problematic due to the scarcity of resources presided by realist structures. Nevertheless, these structures enable the dissemination of resource provision [50].

Legislative Climate

EPs must consider the legal status of the dyslexia label [2]. The key term ‘disability’ is included in the Equality Act [65] and the Disability Discrimination Act (DDA) [66]. Although ‘dyslexia’ is not directly quoted in the DDA it is understood under ‘g’ of the statutory definition of disability as “memory or ability to concentrate, learn or understand” (Schedule 1). Therefore, the dyslexia label is embedded in primary legislation which assures EP involvement in the ethical rhetoric. Furthermore, in response to the Children and Families Act [67], EPs are becoming increasingly involved with learning difficulties in CYP [68]. Hence, considering the dyslexia discourse EPs are responsible to remain informed with current legislation and practices to reduce the risk of harm to CYP.

The Additional Learning Needs (ALN) and transformation programme has been live across Wales since September 2021 [58]. The reform aims to transform experiences, expectations, and outcomes for CYP aged 0-25 years old identified with ‘special educational needs’ (SEN) and ‘learning difficulties and/or disabilities’, replacing them with the new term ALN (Additional Learning Needs and Education Tribunal (Wales) Act, [69]. This unified system utilises a single statutory plan: The Individual Development Plan (IDP), replacing existing statements of SEN [58]. SNAP Cymru [70] assert that the reform improves planning and delivery of support by adopting a person-centred approach and a bilingual support system. Furthermore, through an integrated, collaborative process, the reform strives for fair and transparent systems to deliver a fully inclusive education system [70].

The ALN reform is comparable to the Special Educational Needs and Disability (SEND) Code of Practice [71] in England. Both acts are driven by innovative curriculum design and affective instructional practice, however, SEND and statutory Education Health and Care Plans are synonymous to ALN and IDPs [71]. Adopting ‘ALN’, multiple learning needs are catered for consequentially, CYP do not have to meet rigorous criteria for labels [58]. This change reduces the influence of labelling as a gateway and improves inclusivity, a valuable contribution toward the dyslexia discourse [10].

Adopting a cohesive approach decreases the risk of harm to CYP by removing the stigma associated with ‘special’ educational needs [72]. Likewise, ALN can serve to increase CYP’s sense of identity due to the broad nature of the concept [73]. An EP being a multifaceted professional is crucial during the reform for systems working and the ethical implications of labelling. EPs can reduce the risk of harm to CYP by advocating for inclusion amongst marginalised groups threatened by fear of being further ostracised by a label.

An interesting contention is whether assessment is a valuable use of EP time and resources amongst the reform. A CYPs primary area of need is communicated within the IDP, yet due to the decreased value of labelling, the risk analysis must contend value above reducing individuals to a series of numbers. For EPs to reduce the risk of harm to CYP close consideration is required to eliminate further pathologisation [74].

The inclusive nature of the ALN reform is encouraging however, the individualised nature of support will undoubtedly increase EPs’ caseloads due to the quantity of CYP who up until this enactment were ineligible for additional provisions [75]. Hence, EPs hold the ethical responsibility to ensure they maintain good working practices, keep up to date with current research, and have effective multi-agency communication [1]. By holding accountability, EPs can ensure they work in the most effective way. For instance, if there are recurring difficulties within particular schools, an EP can work systemically and train staff to deliver interventions with the ability to reach a wider cohort of CYP.