Children With Learning Differences and Special Needs in International Schools: An Education Psychologist’s Perspective

*This article will be published in the forthcoming 2013 ITS Schools Guide Asia print edition.

Caleb Knight Ed.D

As a Psychologist working with children from international schools in Hong Kong and the surrounding region for over 20 years, I have a unique perspective on learning differences and special needs children that are referred for difficulties. An outline of the difficulties and challenges that these children and their families and schools encounter will be presented.

One of the most common reasons for referral falls under the broad behavioural category of attention problems. The problems can be defined in various ways by schools and parents, such as “focus problems” or “problems processing verbal directions”. The bottom line is that the individual has difficulty paying attention, blocking out distraction, getting started and finishing tasks, listening, following through on instructions and is disorganised. A high percentage of children with attention problems also have difficulty with written expression. These problems are more pronounced when the individual engages in tasks that are boring or difficult especially in large groups. With younger children, in addition to attention problems, you may have a high degree of hyperactive impulsive behaviour. The child has difficulty sitting and settling to a task, moves quickly from one activity to another, seems to always be on the go, may disturb other children and display impulsive behaviours such as shouting out answers before questions have been completed. Impulsive behaviours can also manifest in social problem solving situations. The child may get angry very quickly and display a verbally or physically aggressive response when they get frustrated with a peer. When these symptoms cause significant impairment to the persons academic and/or social functioning, a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) is likely indicated. This is assuming you have ruled out all other possible contributing factors that could cause the behaviours, such as difficult family circumstances or a medical condition.

ADHD has two prevalent types; (Predominately Inattentive Type, i.e. no or minimal hyperactive impulsive behaviours) and Combined Type where there are inattentive behaviours combined with impulsivity and hyperactivity. People tend to think of ADHD as all or nothing but the fact is that the ability to attend, focus, block out distraction, organise yourself, regulate your activity level and impulsive behaviour are variable traits among human beings. A frustrating aspect of ADHD for parents and teachers is that the child does not seem to learn from their mistakes and behaviour management techniques provided. Despite parents’ and teachers’ best efforts the behaviours continue to interfere with the child’s functioning.

A diagnosis can be made in children as young as age 3 or 4 but most children are 6 or older. The percentage of children with ADHD is about 6% to 8% in the school age population. ADHD often overlaps with other difficulties such as Dyslexia, Asperger’s Syndrome, Anxiety, Depression and anger control problems. If a child with ADHD goes untreated long term there may be a gradual decline in their school functioning, and if they have hyperactive impulsive behaviours it can result in peer rejection and social isolation. When a child with ADHD is in primary school, teachers tend to be more tolerant and marks are not as important. However, when the child hits secondary the level of sympathy from teachers typically goes down and the child will start to get low grades with the resulting complications of low self esteem, behavioural difficulties and conflicts with parents and teachers that can develop into an overall negative attitude towards school.

Dyslexia may be referred to with all kinds of different terms (Specific Learning Difficulties in Reading and Written Language, Learning Disability in Literacy Areas, Disorder of Reading or Written Expression). Dysgraphia is used to describe children who have impairment with their written language skills and Dyscalculia for children who have difficulty with mathematics. Basically these terms mean that the child is not achieving in one or more basic academic area given their age, year in school and intellectual ability (IQ). Specific learning difficulties like ADHD are on a spectrum with some children severely impaired, some in the middle and some that learn more slowly than others but may eventually achieve age appropriate levels. The earliest signs of Dyslexia are general problems with colour/ letter recognition and basic phonics skills (sound-symbol association). As the child moves into primary school, it becomes apparent that their progress is slower than average. The most common specific learning difficulty is typically what is referred to as Dyslexia which means the person has difficulties in both reading and writing. Specific difficulties with working memory may be apparent and the child can sometimes develop behavioural difficulties along the lines of inattentive type ADHD or it can co-occur with ADHD.

Due to variation in the criteria for diagnosis, exact prevalence rates for Dyslexia are not clear. It is estimated that about 10% of school age children make slower progress than average with development of their literacy skills. About half of these children may improve to the point of reaching age appropriate levels but some continue to experience difficulty throughout their schooling. Early intervention is crucial for specific learning difficulties as this gives child the best chance for a positive outcome.

Children with social/communication difficulties, problems regulating emotions and rigid behaviours/interests are another reason why children are referred from international schools. These may be children that have a high functioning Autism Spectrum disorder referred to as Aspergers Syndrome (AS). However the triad of behavioural difficulties (socialisation, communication and rigid/restricted behaviours interests as well as problems with emotional control) are variable from one child to the next. AS is very much a spectrum disorder with some persons falling at the high end with a minimal number of symptoms, others in the middle and some children can be quite impaired.

The basic difference between a diagnosis of AS and Autistic Disorder is cognitive ability. A person with AS has an IQ which is average or above. A person with Autistic Disorder would have significantly delayed language development (verbal cognitive ability). Children with AS always have some difficulty socialising with peers. In some cases they can be quite withdrawn and there is a marked lack of interaction. In other cases they can be socially motivated but have difficulty with social communication skills such as maintaining appropriate conversation, listening to others and they may go on and on about subjects which they find interesting but may not be typical when compared to their peers.

Most AS children have difficulty controlling their emotions. This is most pronounced in social situations. They can get upset quite easily with their peers or become rigid and refuse to problem solve when they have difficulties. In some cases, you will see a high level of anxiety or depression. AS children typically have some combination of rigid restricted behaviours and interests and insistence on following routines and schedules, difficulty making transitions and an unusual specific interest. Difficulties with non-verbal communication skills (eye contact) are also noted. It is also quite common for AS children to have a number of symptoms of ADHD. In my experience, 70% to 90% of all children who receive a diagnosis of AS would also qualify for a diagnosis of ADHD.

Prevalence rates for AS vary depending on the diagnostic criteria used in the research. Some studies put the numbers at about 1% to 2% of the school age population but there are certainly many children that would be considered borderline. AS has received much attention over the last 15 years with an increase in the number of children receiving the diagnosis. AS children typically find it the most difficult to adapt to an International school and the school staff sometimes faces big challenges in meeting their needs. It has been my experience that if the child can receive proper treatment and intervention from outside professionals and the school is willing to be flexible, the child may be able to adapt to an international school and be successful.

Children with ADHD, Dyslexia/Specific Learning Difficulties and AS are the majority that are currently placed in international schools in regular mainstream classes. Most of these children can get by and have their needs met and make adequate if not good to excellent academic progress with proper support. I would also emphasise that there are children with similar behaviours that are less severe who may not meet a specific diagnostic criteria but they still need some help. The majority of international schools provide some support for children who have special needs or learning differences. Most employ teachers and educational assistants that have special needs credentials and experience who work in and out of the child’s regular classroom. The ratio of special need teachers to student is variable among international schools. Some schools also employ Counsellors and Psychologists.

In the case of children that have higher needs, parents may be asked to fund a full or part time educational assistant for the child. The model of intervention can be variable from one school to the next. I feel that all of the international schools do their best with the resources they have to meet the needs of these children and maximise their chances of success. However, it does come to the point with some children when the school comes to the conclusion that the child’s needs are just too high and they are not able to support them in the long term.

At this point I think it is important to make a distinction between mainstream special needs and children who have a higher level of difficulty. This is where confusion with the term “special needs” can come into play. As noted, children with ADHD, Dyslexia and AS can usually have their educational needs met in an international school as long as there is some support. This is because the child’s overall cognitive ability (IQ) is such that they are able to access enough of the curriculum to be successful. Children with a higher level of difficulty such as Autism, Cognitive Disability (sometimes referred to as Moderate Learning Difficulties, Mental Handicap or Global Delay) or serious emotional behavioural disorders typically cannot have their needs met in most international schools. There are a few schools that have programmes specifically designated for these children where the ratio of child to teacher may be much better and they receive a lot of support and modification of the curriculum. Unfortunately, special education to meet these children’s needs can be quite costly and international schools may not have the resources to implement a programme.

If your child is experiencing difficulties similar to what is described above, parents should seek some professional advice. Schools typically find it most useful (and may require) a comprehensive psychological / educational assessment from a Psychologist. After the report is completed sit down with the appropriate staff at your child’s school and discuss interventions that could be put in place given the child’s needs and the resources of the school. Most schools will give parents some sort of written plan as to what will be provided for their child. Sometimes this is a frustrating process for parents and they feel they are not always getting what they would like and schools may have difficulty in providing what parents feel is the right level of support. But the school will usually provide something and typically it is enough (combined with help from community professionals and cooperation with parents) to keep the child in the school and experience success. There will typically be some ups and downs in the child’s functioning as they move through school but this is normal and expected. Most of these children improve as they mature. The factors that make for a positive outcome are early identification, a cooperative working relationship between parents and school and some help from appropriate outside professionals. Having worked in the Asia Pacific region for over 20 years and witnessed the boom in the number of international schools, I am pleased to note that it is my experience that they have improved their provision for children who have learning differences and special needs and hopefully this trend will continue.

About the Author:

Dr Caleb Knight is an Educational Psychologist that has worked in Hong Kong and the surrounding region for over 20 years. He has maintained a private practice (Child and Family Centre) in Hong Kong since 1998. Dr Knight is also an adjunct professor at the University of Wisconsin-Superior where he teaches summer and extension courses in Special Education. For more information on Dr Knight’s practice please go to www.childandfamilycentre.com.hk