Work in developmental paediatrics, and you're going to work with schools.
I've met and chatted with many gifted and dedicated teachers over the years. Some grownups tell the story of how, growing up, a schoolteacher took a genuine interest in them and their wellbeing, more than anyone else in their lives, and this is what kept them going.
But some aspects of modern schooling can come as a surprise to those outside the sector. Some of it can be pretty shocking. There are many 'systems problems' of course, just like for hospitals both public and private. More on that below.
Something which I'm more attuned to now than in the past, is the wide range of skill level and qualities possessed by individual teachers. This should be expected, it's certainly the case for any collection of doctors, even within small specialties.
An education researcher recently published a paper with some first-hand accounts of just how big a difference a teacher's abilities and approach can make, for the young kids in their class. As background, this was a prospectively designed study, the specific classrooms described below weren't picked out especially to serve a prejudged argument. And these were two adjacent classrooms in the same school. Not only that, but all the kids from both classes come together for maths lessons with one of the two teachers.
These were grade 2 classes; the kids mostly aged 7 or 8yo.
[Field notes, recorded by researcher, Classroom 1]: [Mr Smith] writes a word on the board, but it is quite small and I can't read it from where I'm sitting. Charlie, whose desk is nearest me, just outside the main classroom, yells “How do you spell 'description'?" Another child shouts back “it's on the board". Charlie says, “I know, but I can't read it from here." After a while he moves his desk closer to the board, but [Mr Smith] picks up the desk and moves it back to where it was. Charlie says, “But I can't see the board" to which [Mr Smith] replies “if there's a problem, put your hand up and ask." Charlie puts his hand up and I start my timer. After 3 minutes, he's still waiting. Charlie's now banging on his desk and complaining that his hand has been up for ages. [Mr Smith] comes over to Charlie's desk and puts his hand, absently, on the blank sheet of paper on the boy's desk, but he quickly becomes distracted by another student and wanders off. Charlie howls with frustration and gets up to follow the teacher, who turns around and tells him if he has a question he must sit in his seat and raise his hand. The boy goes back to his seat and puts his hand up. It's still up after 5 minutes when the teacher tells them to pack up.
[Field notes, Classroom 2, maths lesson i.e. both classes combined]: The children from [Mr Smith's] class come in and sit quietly on the rug in [Miss Jones's] class. Hands on heads, they know exactly what to do. Aiden, from [Mr Smith's] class, comes into the room talking and [Miss Jones] says softly, but firmly “Shush." She asks generally, “who can remind me of the rules?" and gently reminds them of her behaviour expectations for the activity: “Play fair, no cheating, is there one person in charge? No." She quickly puts them in groups and says “As soon as that timer goes off, where do I expect you to be? Sit down on the carpet and show me you're ready for your Dojo points." She then sends them into their groups by saying “tip-toe to where you're supposed to be' and they do, except Bailey from [Mr Smith's] class, who she calls back and tells him to tip-toe, which he does. She has a lovely manner, saying “thank you, sir" and “beautiful walking." Charlie, from [Mr Smith's] class, has come to work with [Miss Jones] in a small group. She gently strokes Charlie's back to welcome him. She has tubs full of plastic coins. Charlie goes to touch the coins and she says, “we're not touching yet" and he stops. There is shouting from next door and Charlie says, “Why do they have to be so naughty all the time?"
Later, after seven-year-old Charlie has returned to the chaos of his own classroom, he puts his head down on his desk and says quietly: “I want out of this fucking class."
Readers will be relieved to hear that Charlie received no punishment for his profanity, though apart from these field notes he probably received no response either.
The researcher calls it as she sees it: "Mr Smith's classroom is chaos. His relationship with the students is mutually disrespectful." But she does have her eye on the big picture: "Mr Smith clearly requires more support and guidance on proactive classroom management but, in the apparent absence of such support, he resorts to physically manhandling students, even with two other adults in the room: the researcher and the teacher aide."
The main point which the researcher makes in the paper is that past and recent calls for 'no excuses' discipline in schools is not only misguided, it's incoherent, nonsensical, divorced from real life. I entirely agree. How would a 'no-excuses discipline' policy be enacted in Mr Smith's class? Sounds like he could be equipped with a firearm and a set of thumbscrews, and there'd still be bedlam.
My own point is more straightforward - anyone working in developmental paeds or related disciplines should really get hold of this paper and read it. Observations and interpretations of a kid's behaviours and performance, provided by a teacher, can't always be taken at face value. What those observations might mean will depend a lot on whether the teacher making them is a Ms Jones, or a Mr Smith. That's not always immediately apparent.
And I've previously worried out loud about the practice of basing ADHD 'diagnosis' on little more than a parent and teacher questionnaire, dressed up as a 'standardised assessment instrument'. I'd hope that anyone reading this paper could only hesitate to rely on such flimsy pseudoscience before rushing to define a kid they've just met, or pulling out the script pad.
I always want to talk direct with a kid's teacher or wellbeing officer or assistant principal. Not rely on written observations, reports, letters back and forth. For the same reason I want to take a history in real time in real life, not just rely on a 1 page written summary. This often leads to an amazing amount of phone tag. Can be frustrating but I think the main reason for it is that schools and teachers just aren't accustomed to anyone outside school wanting to take the time to actually talk with them.
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| Aren't they beautiful giant wheat containers |
'The researcher' is Prof Linda Graham. Prof Graham has published excellent papers for the last 15 years, many of them on the important questions of how reliably modern schooling really does deliver education to all children; and on the intersection of education, psychology, and medical practice, and its associated dangers, for many kids in the system.
You'll no doubt hear more from me, on the Prof and her work. I only came across it all a couple of months ago. This amazes me, since I follow the related literature fairly closely. But none of Prof Graham's output has come across my line of sight, for the last 15 years.
No doubt this is largely because Prof Graham's academic home - in terms of university faculties, conferences, and journals - is in Education. Whereas the stuff I read, and people I talk to, are mostly in neuroscience, or dev medicine, or psychology, etc.
This is a problem! I wish all paediatricians and paediatric trainees had the benefit of access to Prof Graham's work. I'm sure that many would find it as informative as I do. But I wonder how many, through lucky chance like mine, have ever read a paper of hers - 5? 50? None??
Same query for clinicians in other disciplines. Some excellent speechies, child psychs, and OTs work closely with a school to support a particular kid. Often they have an ongoing working relationship with a particular school, which must add value exponentially - as would familiarity with Prof Graham's research. I'd guess that a fair few such non-medical dev clinicians are familiar with it. At least one is, the redoubtable Pamela Snow, speech pathologist and scourge of education reactionaries.
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Literacy. Put at least an hour aside, perhaps have a stiff drink or Valium handy. Then google 'reading wars'.
Behaviour vs. attention. A widespread belief among schools and teachers is that child behaviours must be addressed first, other progress will follow. For 'ADHD', this belief entails that the first step and priority is to get the kid sitting quietly in their seat, not roaming around the classroom or cracking jokes. Once that's achieved, the kid will naturally concentrate on the teacher's instruction, so the story goes. The reality is of course entirely in the opposite direction - some kids who have their attentional control ability boosted will better engage with classroom activities. But only if the instruction itself is sufficiently engaging.
The Prep year used to be just that, a preparatory year, before school proper. Not anymore. Now a kid's '4 Year Old Kinder', the year before Prep (Victoria, Australia) is treated as the year in which the kid better get their act together. Or for some kids I see, their plain (i.e. 3yo) kinder year is their first encounter with expectations and standards. This push is well intentioned, the rationale being that possible future learning problems can be headed off, early. The problem is that all kids, but especially very young kids under 6yo, naturally learn through spontaneous play and exploration. This is as scientifically well established as the periodic table. But in order to 'start educating' very young kids, a reflexive tactic from our very clunky system has been to try the same approach in kindergarten, as in Years 1+. With the expectation that all very young kids will as readily sit on the mat, listen to the teacher, and not spontaneously wander off or interact with their neighbour, as most 6yos can. I read reports in which sitting-quietly-on-the-mat is talked about as if it was its own standalone developmental ability. This. Is. Nuts.
Much of which are addressed in the Prof's research. Along with plenty else of great importance.
Further reading:
https://drlindagraham.wordpress.com/
http://pamelasnow.blogspot.com/
Papers:
Graham LJ, "Student compliance will not mean ‘all teachers can teach’: a critical analysis of the rationale for ‘no excuses’ discipline" (2018) 22 International Journal of Inclusive Education 1242.
https://www.researchgate.net/profile/Linda_Graham3/publication/322100123_Student_compliance_will_not_mean_'all_teachers_can_teach'_a_critical_analysis_of_the_rationale_for_'no_excuses'_discipline/links/5affe0360f7e9be94bd7ef85/Student-compliance-will-not-mean-all-teachers-can-teach-a-critical-analysis-of-the-rationale-for-no-excuses-discipline.pdf
Graham LJ, "The politics of ADHD" (2006) Australian Association for Research in Education Annual Conference.
https://eprints.qut.edu.au/4806/1/4806.pdf
Graham LJ et al., "A longitudinal analysis of the alignment between children’s early word‐level reading trajectories, teachers’ reported concerns and supports provided" (2020) Reading and Writing, doi 10.1007/s11145-020-10023-7.
