a modern day trivium

In the two previous posts, I’ve criticised Martin Robinson’s argument that traditional and progressive education are mutually exclusive approaches characterised by single core values; subject centred and child centred, respectively.

Martin describes himself as an “educationalist with an interest in culture, politics, creativity, and the Liberal Arts (especially grammar, dialectic and rhetoric)”. Grammar, logic and rhetoric are the three strands of the mediaeval trivium and Martin’s educational consultancy and his blog are called Trivium 21C. In response to my comments, he suggested I produce a graphical representation of my understanding of the trivium.

liberal arts, trivium and quadrivium

In Ancient Greece and Rome, the liberal arts were the knowledge and skills it was considered essential for a free man to learn in order to participate in civic society. The liberal arts were revived during the reign of Charlemagne in the 8th century, in an effort to improve educational and cultural standards across Western Europe. Seven subjects were studied; grammar, logic and rhetoric made up the foundational trivium, and the quadrivium consisted of arithmetic, geometry, astronomy and music.

The trivium essentially trained students to think, and the quadrivium gave them the opportunity to apply their thinking to mathematical concepts (considered fundamental to all knowledge by the Greek philosophers). The seven liberal arts formed the foundation that enabled students to proceed to study theology, medicine or law.

Up until the early 19th century, the body of collective human knowledge was relatively small.   It was possible for a well-educated person to master all of it.   In order to acquire the knowledge, and to understand and apply it, you’d have to learn Latin and probably Greek, and also how scholars (who would have written in Latin) reasoned. The trivium made explicit the structure of language, how language was used to reason, and how to explain and persuade using language.

Since the early 19th century our collective knowledge has expanded enormously and much of that knowledge is recorded in English. There are good reasons why English-speaking students should learn the structure of their native language, how to reason in it, and how to use it to explain and persuade. But those skills wouldn’t be much use without the knowledge to apply them to.

I can see how those principles could be applied to our current body of knowledge, and that’s what I’ve mapped out below.Slide1

Grammar would make explicit the structure of the knowledge (including the structure of language). Logic would make reasoning explicit – and common errors and biases in thinking. (Martin replaces logic with dialectic, a process by which different parties seek to arrive at the truth through reasoned discussion with each other.) Rhetoric would make explicit the representation of knowledge, including how people conceptualise it. Incidentally, the body of knowledge has a fuzzy boundary because although much of it is reliable, some is still uncertain.

modern liberal arts and cultural literacy

Many modern colleges and universities offer liberal arts courses, although what’s entailed varies widely. Whatever the content, the focus of liberal arts is on preparing the student for participation in civic society, as distinct from professional, vocational or technical training.

So… I can see the point of the trivium in its original context. And how the principles of the trivium could be applied to the body of knowledge available in the 21st century. Those principles would provide a practical way of ensuring students had a thorough understanding of the knowledge they were applied to.

But… I do have some concerns about using the trivium to do that. The emphasis of the trivium and of liberal arts education, is on language. Language is the primary vehicle for ideas, so there are very good reasons for students mastering language and its uses. And the purpose of a liberal arts education is to prepare students for life, rather than just for work. There are good reasons for that too; human beings are obviously much more than economic units.

However, language and the ideas it conveys also appears to be the end-point of education for liberal arts advocates, rather than just a means to an end. The content of the education is frequently described as ‘the best which has been thought or said’ (Arnold, 1869), and the purpose to enable students to participate in the ‘conversation of mankind’ (Oakeshott, 1962).

The privileging of words and abstract ideas over the nitty-gritty of everyday life is a characteristic of liberal arts education that runs from Plato through the mediaeval period to the modern day. Plato was primarily concerned with the philosopher king and the philosophers who debated with him, not with people who grew vegetables, made copper pots or traded olive oil.   Charlemagne’s focus was on making sure priests could read the Vulgate and that there were enough skilled scribes to keep records, not in improving technology, or the fortunes of the wool industry.

This dualistic rift still permeates thinking about education as evidenced by the ongoing debate about academic v vocational education. Modern-day liberal arts advocates favour the academic approach because, rightly, they see education as more than preparation for work.   Their emphasis, instead, is on cultural literacy. Cultural literacy is important for everybody because it gives access to ideas. However, the flow of information needs to be in two directions, not just one.

Recent events suggest that policy-makers who attended even ‘the best’ private schools, where cultural literacy was highly valued, have struggled to generate workable solutions to the main challenges facing the human race; the four identified by Capra and Luisi (2014) are globalisation, climate change, agriculture, and sustainable design. The root causes and the main consequences of such challenges involve the lowest, very concrete levels that would be familiar to ancient Greek farmers, coppersmiths and merchants, to mediaeval carpenters and weavers, and to those who work in modern factories, but might be unfamiliar to philosophers, scholars or politicians who could rely on slaves or servants.

An education that equips people for life rather than work does not have to put language and ideas on a pedestal; we are embodied beings that live in a world that is uncompromisingly concrete and sometimes sordidly practical. An all-round education will involve practical science, technology and hands-on craft skills, not to prepare students for a job, but so they know how the world works.  It will not just prepare them for participating in conversations.

references

Arnold, M (1869).  Culture and Anarchy.  Accessed via Project Gutenberg http://www.gutenberg.org/cache/epub/4212/pg4212-images.html

Capra, F and Luisi, PL (2014).  The Systems View of Life, Cambridge University Press (p. 394)

Oakeshott, M (1962).”The Voice of Poetry in the Conversation of Mankind” in Rationalism in Politics and Other Essays. London: Methuen, 197-247. Accessed here http://english.ttu.edu/kairos/2.1/features/brent/oakeshot.htm

traditional vs progressive: visualisation

In the previous post about the traditional vs progressive education debate, I suggested that visual representation of the arguments might make them clearer. Here, I attempt to do that, starting with Martin Robinson’s conceptual model that he sets out in a post on his blog, Trivium 21c. The diagram below obviously represents my understanding of Martin’s model and might be wrong.  It appears to involve only two mutually exclusive pathways from values and beliefs to customs and practices.

Slide1

I then mapped out my conceptual model. Here’s a first draft:

Slide1

And an explanation:

evidence

You could describe the importance of systems principles, errors and biases, a body of knowledge, human rights and a varied population as my ‘values and beliefs’. But they’re not values and beliefs that sprang fully-formed into my head, nor have they simply been handed down via cultural transmission. They’ve all emerged from a variety of sources over several decades, have been tried-and-tested, and have changed over time.

errors and biases

Everyone views the evidence for what’s optimal politically, socially and educationally through the lens of their own knowledge, understanding and experience. We now know quite a lot about the errors and biases that affect our interpretation of the evidence. Knowing about the errors and biases doesn’t eliminate them, but it can reduce their impact.

systems principles

We also know quite a lot about the features of systems (features of systems generally, not just specific ones). Applying systems principles is essential if an education system is to be effective.

body of knowledge

I agree with Martin that a body of knowledge handed down from the past is crucial to education, but I wouldn’t frame it in terms of ‘the best which has been thought and said’, mainly because that definition begs the question of who decides what’s ‘best’.  I’d frame it instead in terms of validity (what’s been tried-and-tested) and reliability (what’s generally agreed on by experts in relevant fields). It’s important to note that reliability alone isn’t enough – history is replete with examples of experts being collectively wrong. This is one reason why I’m sceptical about Hirsch’s model of cultural literacy.

varied population

Education is a universal good in most countries, and as such has to take into account the characteristics of individuals in a large population. And large populations vary considerably. 70% of children would probably cope with a one-size-fits-all subject-centred education, but 15% would be bored or might question what they were taught because they’d be running ahead of it, and a different 15% would struggle to keep up. I’m not making those claims because I’m an IQ bell-curve believer, but because that’s how large populations work and that’s a pattern that’s emerged over time, from universal education systems.

human rights

I’ve called this core element of education ‘human rights’, but I’m thinking more ‘life, liberty and the pursuit of happiness’ and ‘liberté, égalité, fraternité’ than UNHRC.  General principles tend to be more flexible than statutory ones.

customs and practices

Applying these underlying principles would result in particular educational customs and practices based on teaching an interconnected body of knowledge rather than ‘subjects’, a curriculum that was adaptable rather than ‘personalised’, and a framework for personal and social development. I haven’t detailed the customs and practices because they would vary across and within schools, classes and groups of students.

questioning assumptions

My conceptual model of education is very different to Martin’s, and to other traditional/progressive models.   I would question some of the fundamental assumptions of the traditional/progressive dichotomy.

  1. There has to be one core educational belief or value. Why not two, three, six?
  1. ‘Traditional’ and ‘progressive’ are polar opposites.  The core concepts are, but life is not just about core concepts. Some beliefs, customs and practices that have been handed down are invaluable; others aren’t. Some changes are mistakes; others change everyone’s life for the better.
  1. The traditional v progressive model assumes that the body of knowledge that’s been handed down is valid and reliable, when in fact some parts aren’t and need revising; that’s how knowledge works.
  1. The traditional v progressive model assumes that the only alternative to teaching ‘the best which has been thought or said’ is a ‘personalised curriculum’. It isn’t. The body of knowledge can be adapted to particular groups of students. That’s where professional expertise comes in.

why does any of this matter?

Some of the points of the traditional v progressive debate have been pretty obscure and not everyone recognises the divide, so I can understand why people might be asking why the debate matters.  It matters because a simple but wrong idea can be halfway round the world before a more complex but right idea has got its boots on. And simple but wrong ideas can have a devastating impact on many people, especially when they creep into public policy because politicians are in a tearing hurry to implement vote-winning wheezes.

At one time, a government-commissioned committee of enquiry might take years to examine research findings and evaluate opinions. The Warnock committee’s Enquiry into the education of handicapped children and young people for example, was commissioned by a Conservative education secretary in 1973, reported to a Labour government 5 years later, and some of its recommendations were enacted under another Conservative government, three years after that.

In contrast, Nick Gibb’s recent speech to the Centre for Independent Studies in Sydney relies heavily on anecdotal evidence and references to the opinions of particular contributors to social media. It’s a speech, not a committee of enquiry, but clearly there’s been a shift in the level of rigour.

traditional vs progressive: the meta-debate

The traditional vs progressive education debate has been a contentious one. Some have argued that there’s a clear divide between traditional and progressive education, and others that it’s a false dichotomy. So in addition to the traditional/progressive debate, there’s been a meta-debate about whether or not a traditional/progressive divide actually exists.

the meta-debate

Two features of the meta-debate have puzzled me. One is; amongst those who recognise a traditional/progressive divide, which educational practices are considered traditional and which progressive? The other is; why those who recognise a traditional/progressive divide feel so strongly about people who don’t.

Here for example is the usually mild-mannered Martin Robinson, on his blog Trivium 21C.

So the next time someone argues that progress and tradition are a false dichotomy, think why would they argue this? They are either lying and are using this argument to hide the fact that they are either on one side or the other.”

My initial understanding of Martin’s argument was as follows;

  1. In general, the term traditional means ‘belief, custom or practice being handed down’, ‘from the past’, and ‘conservative in the sense of keeping things the same’. Progressive means ‘advocating reform in political or social matters’, ‘toward the future’ and ‘radical in the sense of reforming things’.
  1. In education, “traditionalists argue for the centrality of subject and progressives argue for the centrality of the child”.
  1. It’s not just Martin who defines the terms in this way; the general meanings are used widely, and the specific educational meanings are shared by John Dewey and Chambers etymological dictionary, no less.
  1. The beliefs, customs and practices referred to by the terms traditional and progressive are mutually exclusive; you can’t prioritise what’s handed down from the past and prioritise reform at the same time, and “the classroom can’t be both subject centred and child centred.”   Therefore the categories traditional and progressive must be mutually exclusive.

I agreed with Martin on some points. Beliefs, customs and practices have indeed been handed down, and political and social reforms have been carried out. Subject centred and child centred education has certainly happened. And there’s widespread agreement on what traditional and progressive mean generally, and in education. However at this point Martin appears make some assumptions, and this is where we parted company.

assumptions

The first assumption is that because certain beliefs, customs and practices exist out there in the real world, the categories to which people assign those beliefs, customs and practices, must also exist out there in the real world; the categories have external validity.

The second assumption is that if there is widespread agreement on what the terms traditional and progressive refer to, the categories traditional and progressive have, for all intents and purposes, a universal meaning; the categories are also reliable.

The third assumption is that the beliefs, customs and practices assigned to the categories traditional and progressive are mutually exclusive, therefore the categories traditional and progressive must be mutually exclusive.

Those assumptions were the only reasons I could think of that would prompt Martin to accuse people of lying or covering up if they claimed that tradition vs progress was a false dichotomy.

I think the assumptions are unfounded, largely because, although there might be widespread agreement about what traditional and progressive refer to, that agreement isn’t universal. Other proponents of the traditional/progressive divide apply different criteria.

differences of opinion

Here’s Old Andrew’s definition from 2014; “Progressive teaching is that which rejects any of the pillars of traditional teaching. These are 1) the existence of a tradition i.e. a body of knowledge necessary for developing the intellect. 2) The use of direct instruction & practice as the most effective methods of teaching. 3) The authority of teachers in the classroom.”*

And here’s Robert Peal, in his book Progressively Worse;

It has become fashionable to pose the ideas of progressive education against those of, for want of a better term, ‘traditional’ education. Educational commentators are likely to say that such ‘polarising rhetoric’ establishes ‘false dichotomies’. When in reality a sensible mix of the two approaches is required. This is true. …Such dichotomies, (skills/knowledge, child-centred/ teacher-led) are perhaps better thought of as sitting at opposite ends of a spectrum.” (p.8)

Each of the three commentators appears to believe that a traditional/progressive divide exist out there in the real world, but they have different ideas about where the divide lies. Or if there are several divides. Or whether the divide is actually a spectrum. But despite differences of opinion about exactly where the divide is, or whether there are any divides as such, each of the commentators cheerfully castigates anyone who questions the location or the existence of the divide.

Robert Peal says in a blogpost that those criticising the categorisation of issues in education are “more often than not just trying to shut down debate.”  Old Andrew has also alleged that those who think the divide is a false dichotomy are in denial about the existence of the debate.

I was perplexed. I just couldn’t see how a wide range of educational theories or practices could be shoe-horned into two mutually exclusive categories, but I wasn’t lying about that, or covering anything up, and I can hardly be accused of wanting to shut down debate.  Then a recent Twitter exchange shed more light on the subject.

trad:prog values

Although proponents of a traditional/progressive divide often refer to values, I’d had no idea that they were basing the divide primarily on values. Or for that matter, what values they might be basing it on.   Martin’s post now made more sense. If he defines traditional and progressive education in terms of single mutually exclusive core values that he believes exist out there in the real world, then I can see why he might feel justified in accusing people who disagree of lying or covering up.

who disagrees?

One problem for people who disagree with proponents of the traditional/progressive divide is that the proponents appear to assume their definition of traditional and progressive education is valid (which is questionable) and reliable (which it clearly isn’t if other proponents of the divide don’t agree about where the divide is).

A second problem is an assumption that the core values that characterise traditional and progressive education are mutually exclusive. I would question that as well. Clearly, education can’t be subject centred and child centred at the same time, but who decided a label can be attached to only one value? Or that education has to be centred on only one thing?

A third problem is that although proponents of the traditional/progressive divide might be arguing that the divide exists only at the level of values (and in Martin’s case might involve only two core values), each of the proponents I’ve cited has made numerous references to practice. This might explain why I, and others, have gone ‘Dichotomy? What dichotomy?’, or have claimed to be eclectic, or somewhere between the two, or whatever.

I’ve argued previously that it might be helpful to represent abstract concepts like traditional and progressive diagrammatically. I still think this would be a good move. A few Venn diagrams and a bit of graphical representation would force all of us to clarify exactly what we mean.

*I can’t locate the original tweets, but blogged about them here.

play or direct instruction in early years?

One of the challenges levelled at advocates of the importance of play for learning in the Early Years Foundation Stage (EYFS) has been the absence of solid evidence for its importance. Has anyone ever tested this theory? Where are the randomised controlled trials?

The assumption that play is an essential vehicle for learning is widespread and has for many years dominated approaches to teaching young children. But is it anything more than an assumption?  I can understand why critics have doubts.  After all, EY teachers tend to say “Of course play is important. Why would you question that?” rather than “Of course play is important (Smith & Jones, 1943; Blenkinsop & Tompkinson, 1972).”  I think there are two main reasons why EY teachers tend not to cite the research.

why don’t EY teachers cite the research?

First, the research about play is mainly from the child development literature rather than the educational literature. There’s a vast amount of it and it’s pretty robust, showing how children use play to learn how the world works: What does a ball do? How does water behave? What happens if…?  If children did not learn through play, much of the research would have been impossible.

Secondly, you can observe children learning through play. In front of your very eyes. A kid who can’t post all the bricks in the right holes at the beginning of a play session, can do so at the end. A child who doesn’t know how to draw a cat when they sit down with the crayons, can do so a few minutes later.

Play is so obviously the primary vehicle for learning used by young children, that a randomised controlled trial of the importance of play in learning would be about as ethical as one investigating the importance of food for growth, or the need to hear talk to develop speech.

what about play at school?

But critics have another question: Children can play at home – why waste time playing in school when they could use that time to learn something useful, like reading, writing or arithmetic? Advocates for learning through play often argue that a child has to be developmentally ‘ready’ before they can successfully engage in such tasks, and play facilitates that development ‘readiness’. By developmentally ‘ready’, they’re not necessarily referring to some hypothetical, questionable Piagetian ‘stages’, but whether the child has developed the capability to carry out the educational tasks. You wouldn’t expect a six month-old to walk – their leg muscles and sense of balance wouldn’t be sufficiently well developed. Nor would you expect the average 18 month-old to read – they wouldn’t have the necessary language skills.

Critics might point out that a better use of time would be to teach the tasks directly. “These are the shapes you need to know about.” “This is how you draw a cat.” Why not ‘just tell them’ rather than spend all that time playing?

There are two main reasons why play is a good vehicle for learning at the Early Years stage. One is that young children are highly motivated to play. Play involves a great deal of trial-and-error, an essential mechanism for learning in many contexts. The variable reinforcement that happens during trial-and-error play is strongly motivating for mammals, and human beings are no exception.

The other reason is during play, there is a great deal of incidental learning going on. When posting bricks children learn about manual dexterity as well as about colour, number, texture, materials, shapes and angles. Drawing involves learning about shape, colour, 2-D representation of 3-D objects, and again, manual dexterity. Approached as play, both activities could also expand a child’s vocabulary and enable them to learn how to co-operate, collaborate or compete with others. Play offers a high learning return for a small investment of time and resources.

why not ‘just tell them’?

But isn’t ‘just telling them’ a more efficient use of time?   Sue Cowley, a keen advocate of the importance of play in Early Years, recently tweeted a link to an article in Psychology Today by Peter Gray, a researcher at Boston College. It’s entitled “Early Academic Training Produces Long-Term Harm”.

This is a pretty dramatic claim, and for me it raised a red flag – or at least an amber one. I’ve read through several longitudinal studies about children’s long-term development and they all have one thing in common; they show that the impact of early experiences (good and bad) is often moderated by later life events. ‘Delinquents’ settle down and become respectable married men with families; children from exemplary middle class backgrounds get in with the wrong crowd in their teens and go off the rails; the improvements in academic achievement resulting from a language programme in kindergarten have all but disappeared by third grade. The findings set out in Gray’s review article didn’t square with the findings of other longitudinal studies. Also, review articles can sometimes skate over crucial points in the methods used in studies that call the conclusions into question.

what the data tell us

So I was somewhat sceptical about Dr Gray’s claims – until I read the references (at least, three of the references – I couldn’t access the second). The studies he cites compared outcomes from three types of pre-school programme; High/Scope, direct instruction (including the DISTAR programme), and a traditional nursery pre-school curriculum. Some of the findings weren’t directly related to long-term outcomes but caught my attention:

  • In first, second and third grades, school districts used retention in grade rather than special education services for children experiencing learning difficulties (Marcon).
  • Transition (in this case grade 3 to 4) was followed by a dip in children’s academic performance (Marcon).
  • Because of the time that had elapsed since the original interventions, there had been ample opportunity for methodological criticisms to be addressed and resolved (Schweinhart & Weikart).
  • Mothers’ educational level was a significant factor (as in other studies) (Schweinhart & Weikart).
  • Small numbers of teachers were involved, so individual teachers could have had a disproportionate influence (Schweinhart & Weikart).
  • The lack of cited evidence for Common Core State Standards (Carlsson-Page et al).

Essentially, the studies cited by Dr Gray found that educational approaches featuring a significant element of child-initiated learning result in better long-term outcomes overall (including high school graduation rates) than those featuring direct instruction. The reasons aren’t entirely clear. Peter Gray and some of the researchers suggested the home visits that were a feature of all the programmes might have played a significant role; if parents had bought-in to a programme’s ethos (likely if there were regular home visits from teachers), children expected to focus on academic achievement at school and at home might have fewer opportunities for early incidental learning about social interaction that could shape their behaviour in adulthood.

The research findings provided an unexpected answer to a question I have repeatedly asked of proponents of Engelmann’s DISTAR programme (featured in one of the studies) but to which I’ve never managed to get a clear answer; what outcomes were there from the programme over the long-term?  Initially, children who had followed direct instruction programmes performed significantly better in academic tests than those who hadn’t, but the gains disappeared after a few years, and the long-term outcomes included more years in special education, and later in significantly more felony arrests and assaults with dangerous weapons.

This wasn’t what I was expecting. What I was expecting was the pattern that emerged from the Abecedarian study; that academic gains after early intervention peter out after a few years, but that there are marginal long-term benefits. Transient and marginal improvements are not to be sniffed at. ‘Falling behind’ early on at school can have a devastating impact on a child’s self-esteem, and only a couple of young people choosing college rather than teenage parenthood or petty crime can make a big difference to a neighbourhood.

The most likely reason for the tail-off in academic performance is that the programme was discontinued, but the overall worse outcomes for the direct instruction children than for those in the control group are counterintuitive.  Of course it doesn’t follow that direct instruction caused the worse outcomes. The results of the interventions are presented at the group level; it would be necessary to look at the pathways followed by individuals to identify the causes for them dropping out of high school or getting arrested.

conclusion

There’s no doubt that early direct instruction improves children’s academic performance in the short-term. That’s a desirable outcome, particularly for children who would otherwise ‘fall behind’. However, from these studies, direct instruction doesn’t appear to have the long-term impact sometimes claimed for it; that it will address the problem of ‘failing’ schools; that it will significantly reduce functional illiteracy; or that early intervention will eradicate the social problems that cause so much misery and perplex governments.  In fact, these studies suggest that direct instruction results in worse outcomes.  Hopefully, further research will tell us whether that is a valid finding, and if so why it happened.

I’ve just found a post by Greg Ashman drawing attention to a critique of the High/Scope studies.  Worth reading.  [edit 21/4/17]

References

Carlsson-Paige, N, McLaughlin, GB and Almon, JW. (2015).  “Reading Instruction in Kindergarten: Little to Gain and Much to Lose”.  Published online by the Alliance for Childhood. http://www.allianceforchildhood.org/sites/allianceforchildhood.org/files…

Gray, P. (2015). Early Academic Training Produces Long-Term Harm.  Psychology Today https://www.psychologytoday.com/blog/freedom-learn/201505/early-academic-training-produces-long-term-harm

Marcon, RA (2002). “Moving up the grades: Relationship between preschool model and later school success.” Early Childhood Research & Practice 4 (1). http://ecrp.uiuc.edu/v4n1/marcon.html.

Schweinhart, LJ and Weikart, DP (1997). “The High/Scope Pre- school Curriculum Comparison Study through age 23.” Early Childhood Research Quarterly, 12. pp. 117-143. https://pdfs.semanticscholar.org/c339/6f2981c0f60c9b33dfa18477b885c5697e1d.pdf

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Sue Cowley is a robust advocate of the importance of play in learning https://suecowley.wordpress.com/2014/08/09/early-years-play-is/

behavioural optometry: pros and cons

MUSEC is Macquarie University’s Special Educational Centre. Since 2005 it has been issuing one-page briefings on various topics relevant to special education; a brilliant idea and very useful for busy teachers. One of the drawbacks of a one-page briefing is that if the topic is a complex one, there might be space for a simple explanation and a couple of references only. The briefings get round that problem, in part, by putting relevant references on a central website.

Behavioural optometry is based on the assumption that some behavioural issues (in the broadest sense) are due to problems with the way the eyes function. This could include anything from poor convergence (eyes don’t focus together) to variations in processing visual information in different coloured lights. The theory is a plausible one; visual dysfunction can cause considerable discomfort and can affect balance and co-ordination, for example.

Behavioural optometrists are sometimes consulted if children have problems with reading, because reading requires fine-grained visual (and auditory) discrimination, and even small variations in the development of the visual system can cause problems for young children. One of the reasons systematic synthetic phonics programmes are so effective in helping young children learn to decode text is because they train children in making fine-grained distinctions between graphemes (and between phonemes). But phonics programmes cannot address all visual (or auditory) processing anomalies, which is the point where behavioural optometrists often come in.

The MUSEC briefing on behavioural optometry (Issue 33) draws on two references; a 2011 report by the American Academy of Paediatrics (AAP), and a 2009 review paper by Brendan Barrett, a professor of visual development at Bradford University.  Aspects of the briefing perplexed me.  I felt it didn’t accurately reflect the conclusions of the two references because it:

  • doesn’t discriminate between treatments
  • overlooks the expertise of behavioural optometrists
  • equates lack of evidence for efficacy with inefficacy
  • assumes that what is true for a large population must be true for individuals
  • gives misleading advice to readers.

Discrimination between treatments

In its second paragraph the briefing lists three types of treatment used by behavioural optometrists; lenses and prisms, coloured lenses or overlays, and vision therapy. But from paragraph four onwards, no distinction is made between treatments – they are all referred to as ‘behavioural optometry’ and evidence (for all behavioural optometry treatments presumably) is said to be ‘singularly lacking’. Since lenses and prisms are used in what Barrett calls traditional optometry (p.5), this generalization is self-evidently inaccurate. Nor does it reflect Barrett’s conclusions. Although he highlights the scarcity of evidence and lack of support for some treatments, he also refers to treatments developed by behavioural optometrists being adopted in mainstream practice and to evidence that supports claims involving convergence insufficiency, yoked prisms, and vision rehabilitation after brain disease/injury.

Expertise of behavioural optometrists

The briefing also appears to overlook the fact that behavioural optometrists are actually optometrists – a protected title, in the UK at least. As such, they are qualified to make independent professional judgments about the treatment of their patients. As Barrett points out, some of the controversies over treatments involve complex theoretical and technical issues; behavioural optometry isn’t the equivalent of Brain Gym. But teachers are unlikely to know that if they only read the briefing and not the references.

Lack of evidence for efficacy

Both references cited by the MUSEC briefing are reviews commissioned by professional bodies. Clearly, the American Academy of Pediatrics, the College of Optometrists or MUSEC cannot endorse or advocate treatments for which there is little or no evidence of efficacy. But individual practitioners are not issuing policy statements, they are treating individual patients. If they are using treatments for which a robust evidence base is lacking, that’s unsatisfactory, but a weak evidence base doesn’t mean that there is no evidence for efficacy, nor that the treatments in question are ineffective. Setting up RCTs of treatments for complex issues like ‘learning difficulties’ is challenging, expensive and time-consuming. As a parent, I would far rather my child try treatments that had a weak evidence base but were recommended by experienced practitioners, than wait for the Cochrane reviewers to finish a task that could take decades.

Populations vs individuals

The briefing paper says that “there is clear consensus among reading scientists that visual perception difficulties are rarely critical in reading difficulties and that the problem is typically more to do with language, specifically phonological processing.

Although this statement is right about the consensus and the role of phonological processing, one can’t assume that what’s true at a population level is true for every individual. Take, for example, convergence insufficiency (one of the areas where Barrett found evidence to support behavioural optometrists’ claims). According to the AAP report, the prevalence of convergence insufficiency is somewhere between 0.3% and 5% of the population (p.832).   So the probability of any given child having convergence insufficiency is low, but in the UK it still could affect up to 500,000 children. Although the report found no evidence that convergence insufficiency causes problems with decoding, comprehension or school achievement, it points out that it ‘can interfere with the ability to concentrate on print for a prolonged period of time’.   So even though in theory convergence insufficiency could be contributing to the difficulties of a quarter of the UK’s reluctant readers, it isn’t screened for in standard eye tests.

Advice to readers

The briefing recommends visual assessment for problems with acuity and refractive or ‘similar’ problems, but that’s not what the AAP recommends. It says:

Children with suspected learning disabilities in whom a vision problem is suspected by the child, parents, physicians, or educators should be seen by an ophthalmologist who has experience with the assessment and treatment of children, because some of these children may also have a treatable visual problem that accompanies or contributes to their primary reading or learning dysfunction.” (p. 829)

In the UK, that would require considerable persistence on the part of the child, parent or educator, although physicians might have more success.

The briefing also suggests an alternative to behavioural optometry; ‘explicit instruction in the specific areas causing difficulty’. Quite how ‘explicit instruction’ would improve problems with eye tracking, visual processing speed, visual sequential memory, visual discrimination, visual motor integration, visual spatial skills and rapid naming, never mind attention or dyspraxia where the difficulty is often discovered because the child is unable to carry out explicit instructions, is unclear.

Conclusion

I’m not claiming that behavioural optometry ‘does help children with reading difficulties’ because I don’t know whether it does or not. But that appears to be the nub of the problem – in the absence of evidence nobody knows whether it does or not. Nor which treatments help, if any. As the AAP paper says “Although it is prudent to be skeptical, especially with regard to prematurely disseminated therapies, it is important to also remain openminded.” (p.836)

I also had problems with the MUSEC briefing’s reading of Barrett’s conclusions. Although I wouldn’t go so far as to say the briefing is wrong (except perhaps about the lenses, and I’m not sure what it means by ‘explicit instruction’), its take-home message, for me, was that behavioural optometrists lack competence, that visual problems are unlikely to play any part in developmental abnormalities, and that if there are visual problems they will be limited to acuity and refractive or ‘similar’ factors. That’s not the message I got from either of the papers cited by the briefing. Obviously, on one side of A4, the authors couldn’t have covered all the relevant issues, but I felt that what they included and omitted could give the wrong impression to anyone unfamiliar with the issues.

References

American Academy of Pediatrics (2011). Joint technical report – Learning disabilities, dyslexia, and vision. Pediatrics, 127, e818-e856.

Barrett, B.T. (2009). A critical evaluation of the evidence supporting the practice of behavioural vision therapy. Ophthalmic and Physiological Optics, 29, 4-25.