Friday, 12 December 2014

DIAGNOSIS

Such a fetish

Here is a 'natural experiment' as bizarre as one may meet in a professional system as unfit for purpose as may be found in the United Kingdom. Harriett Sherman reported this story in the Guardian newspaper last month.

A life

David Hayes is now 58. In 1956, when he was five years old, he was diagnosed with cerebral palsy. He went to special school and the aid of callipers began to walk. At eight he transferred out of special school. He left school at 16 and as a young adult set up his own business. He, married and had two children, but had to give up his work when his hip dislocated at 28. He spent some years of his adulthood using a wheelchair, and in continual pain.

He joined the then Spastics Society (now Scope) and became an active member, rising to Vice-Chairman. He stood down in 2007 when his severe chronic pain became too much for him.
By then, a specialist in London had questioned the original 1961 diagnosis, partly prompted by Hayes’s children, who themselves suffered from intermittent joint pain. Three years ago, Hayes began to undergo a series of operations on his hip, knee and shoulder – the last just 12 weeks ago - that have finally left him pain-free.
The medical consensus now is that he never had cerebral palsy, but a congenital condition that he has passed on to his children in a mild form. 
http://www.theguardian.com/lifeandstyle/2014/nov/23/spent-my-life-believing-i-had-cerebral-palsy-scope

The place of diagnosis

In the event – for many or most of the important activities of life – what is the prime question, where and how how should it be posed? Surely the question should be directed first and foremost into the domain of what one might be done about given childhood problems, what works to achieve desired results, and what does not.

In this context, medical conditions that may lie at the root of movement problems are of practical relevance where they specifically indicate or counter-indicate some course of action  which in most real-life circumstances they may rarely do (never more so than in matters of teaching and learning).

In other words, act by intervening and steer by outcome (within which, act by teaching and steer by learning).

Doing this might also contribute to the medical problem of determining a diagnosis. Where this happens, then intervention and its effects are contributing towards coming to a diagnosis – not vice versa as is the model behind a model of diagnosis → treatment. Quite reasonably, definite diagnosis may take time but it must be rare that practical action for the benefit of child and family needs wait upon this. More relevant grounds to act upon will usually be nearer to hand

In 2014 his is hardly a revolutionary notion, being reminiscent of the much ignored principle that prime indication for a diagnosis of oligophrenia should be response to teaching.

Had Mr Hayes met a conductor over the course of his childhood or beyond, then how long might it have taken to raise the question that the roots= of his problem lay in his joints rather than his central nervous system? How many minutes?

Mr Hayes' childhood was forfeit to factors that we can only guess – professional incompetence, lack of skills and knowledge, bureaucratic inertia and indifference. Perhaps most of all, however, it was shaped by the mindset, the paradigm, the unthinking preconceptions that prevailed fifty years ago. Surely in 2014 the world has moved on:
  • paediatric and therapeutic concepts have had fifty years to establish new understandings and qualitatively different practices
  • there has been time too for all sorts of new special educational techniques and approaches to have been developed
  • in England (and doubtless soon across the United Kingdom) new administrative structures and procedures are designed to guarantee appropriate 'support' for every disabled child.
Such a tale as Mr Hayes' could never unfold nowadays. Could it?

Reference

Sherwood, H. (2014) I spent my life believing I had cerebral palsy’, Guardian, 23 November

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