‘Which School Advisor’ gathered some of Dubai’s top special educational needs (SEN) specialists, to answer our questions on the diagnosis and assessment process. We put; Dr Ruba Tabari, Educational Psychologist, working at Dubai Community Health Center, Dr Nadia Taysir, Dabbagh Child & Adolescent Psychiatrist at Camali Clinic, Dr Shola Faniran, Developmental Pediatrician currently working at Child Early Intervention Med Clinic and Dr Suzie Hanchez, Clinical & Educational Psychologist to the test and asked them the questions you wanted answered.
What are the legal requirements regarding diagnosis of special educational needs and behavioural issues in children?
Dr Shola- As far as I understand it, there are no Government regulations governing special needs in UAE, although there is a disability act, with a recent addendum. However, the UAE is also a signatory to the UN disability act.
Dr Nadia- I am not aware of a specific Government of Dubai policy. The KHDA writes a few simple guidelines for us when report writing. I suggest parents look at NICE (UK National Institute of Health and Care Excellence- website: www.nice.org.uk).
Which Special Educational Needs do see in Dubai?
Dr Suzie: “I see mainly learning delays, dyslexia, autism and Downs without forgetting those with AD(H)D.”
Dr Ruba: “I see a range of children. There are some on the autistic spectrum, others with ADD/ADHD; a number of children with developmental delays, children with working memory deficits and slow processing speed.”
Dr Shola: “This depends on the age of the child. In the younger ones, (zero to three years old) it’s usually some form of developmental delay, the highest being speech, and to a lesser extent motor. Some of those with delayed speech will have poor social skills which raises a red flag for autism. In older children it’s usually behaviour issues. With school aged kids its usually learning difficulties.”
Who should diagnose SEN?
Dr Nadia: “Dyslexia is more usually diagnosed by an educational psychologist or a clinical psychologist with a particular interest in learning.
For ADHD and ASD (autistic spectrum disorders) NICE recommends a specialist does the diagnostic assessment, this could be a child psychiatrist, paediatrician or psychologist who has specific experience in these areas. In an ideal world a child would be assessed by a psychiatrist, psychologist, speech and language therapist (SALT), occupational therapist (OT) and possibly a social worker.
In practice though, this is unlikely to occur, so the most important thing would be a suitably qualified/specialist psychiatrist, clinical psychologist and/or paediatrician. Paediatricians can do an excellent job diagnosis ASD and ADHD but their training is variable and they may not always feel comfortable with mental health co-morbidities. In some services the paediatricians will diagnose and manage ‘straight forward’ cases and then refer on more complex cases to mental health professionals.
What are the diagnostic tests used?
Dr Nadia: “There are a few structured questionnaires/assessment tools that are recognised to aid assessment in terms of screening and diagnosis; Strengths and Difficulties Questionnaire, The Conners questionnaire, Autism Diagnostic Observational Scale (ADOS) and Autism Diagnostic Interview (ADI) to name but a few.”
Dr Ruba: “I look at children holistically and so try to gain enough information about them across the various settings. I also use psychometric tools and projective techniques when working with children on a one to one basis. The aim is to help all concerned gain further insight and understanding of the child’s needs and to give recommendations and suggestions towards their support plan.”
Dr Shola: “I usually use a three appointment diagnosis format. The first appointment is with the parents alone to work out their/school/family concerns, get a good history from pregnancy to current time, medical history, developmental history, family history etc. I also give out an appropriate questionnaire to gather more information from parents and school.
At the first appointment, I begin to formulate what the issues are and then choose the appropriate questionnaires and tools for diagnosis. Second appointment is with the child during which I conduct an interview with the child (depending on age), and also administer a developmental assessment or an abbreviated IQ test and achievement test, or any other test I deem appropriate to assist with diagnosis. The third appointment is usually two weeks after the first and is with parents only. This is when I give feedback of the assessment and recommendations on a way forward.
Dr Suzie: Various standardised tests are used for diagnosis. Parents should always ask for a full cognitive and behavioural assessment and this takes many sessions. Reports must be comprehensive and supportive of the child's needs. They should not only look at the IQ but more about the processing skills of their child and his/her working memory. Ask how to change that and how to support their child's needs. This can be a team of therapist working together.
Tell us about a typical SEN diagnosis?
Dr Nadia: Ideally an assessment would mean meeting both parents and child separately and together as well as obtaining information from the school. Better still if the child is observed at school. Unfortunately, sometimes we can only get information from the school over the phone and via questionnaires – we only rarely are able to do school observations as would be the case in a specialist service the UK. This can still work well as teachers can be very informative and knowledgeable about children.”
Dr Ruba: “My work varies depending on the needs of the child for example; I may do regular visits and consultations in school, run parenting sessions and then complete an assessment with a comprehensive report.”
What do you see as the current problems associated with diagnosis in Dubai?
Dr Suzie: “Many recommendations are given in the diagnostic report for the school to implement. Unfortunately, as many parents are unable to pay to do the diagnostic assessment, the government has arranged for local hospitals to do so. However, their report just labels the child's difficulty or difficulties but doesn’t give a proper recommendation on how to support the child in a school setting.
Many prefer to do it back home as it is cheaper but than it is not going along with the curricula they study in (e.g. British school but parents would want the assessment to be done back in India since they are from there and cheaper too). Often their recommendations are not at par with the school's program. One needs to remember that being a cosmopolitan place, many parents are still in denial that their child might have a learning difficultly.
Dr Shola: “The main issues I encounter are related to attitude and previous experience. Attitude of parents e.g. misunderstanding of a diagnosis like ADD and ADHD, fear of medication, misinformation from friends and family, fear of labelling and rejection), the attitude of teachers (misunderstanding a diagnosis) and preconceived ideas on certain therapies. I have also experienced with other care providers in the past, poor ethics, poor knowledge, belittling of parent’s concerns and misdiagnosis.”
What should parents bring along to the appointment and mention during diagnosis?
Dr Nadia: “It helps to first of all be clear what are your the main reasons for seeking help. A small list of top three reasons is a good start. It really helps to also think through when and where these symptoms are occurring. The more description parents have, the more the clinician is able to develop a picture in his/her mind about the child or young person. And, don’t forget any previous reports or investigation results you might have!”
Who should prescribe medications?
Dr Nadia: “Ideally under the age of 18 they should be seen by a specialist child and adolescent psychiatrist – this is a training of three to five years on top of adult psychiatry training that means they have the expertise to assess young people and are familiar with drug prescribing in young people.”
Do you prescribe medications?
Dr Ruba: “I am not licensed to administer medication. I am licensed to diagnose and assess children. I work within my professional boundaries.”
Dr Shola: “Yes I do recommend medication in some children. Medication depends on the diagnosis and needs of a child. Not all children, even with same diagnosis are recommended for medication. Medications do have side effects. For the best outcome, I advocate proper education of the parents, family and older child. When choosing medication and the type, we discuss with and get full agreement with everyone involved before proceeding. Although medication has good research backing, it’s not always the best solution for every child. I always recommend medication in conjunction with relevant therapy as I find therapy provides a more long lasting effect.”
Dr Suzie: “Being psychologist, I cannot administer medication however if I felt they were required I would refer the child to a psychiatrist. I would first try any other way to increase his or her attention and concentration span, then if this didn’t work, I would go down the medicine route.
Ritalin is not available in Dubai. However Concerta and Strattera are. Parents are usually against medication as they’ve read many things against it. But it’s important to remember, every case is different and every medication too.”
What is your advice to parents who suspect their child should be tested but have no idea how to proceed?
Dr Ruba: “Do your homework and find out in detail what each psychologist is offering in terms of the assessment process because they do differ. Get advice from schools as they have already been through the process with other parents.”
What advice would you give to parents who have a child with SEN?
Dr Ruba: “Work with schools as a team. Include all other professionals involved with your child in the team and request regular termly review meetings.”
Dr Nadia: “I always recommend a read of the NICE guidelines – there’s a summary on line – once the diagnosis has been confirmed. NICE are great because they are a team who review all the available evidence from trials and then issue guidelines. They are guidelines and ultimately as long as you’re not causing any harm then do whatever works for your own individual child – in many ways I see parents as the ultimate expert on their child. We are here to help think things through, do a bit of detective work and try and build a holistic (bio-psycho-social) understanding of the child and then make a management plan based on this and sound evidence-based research.
Who decides the on the therapies required?
Dr Nadia: “A psychiatrist or psychologist would be a good start to suggest therapies – be they physical (diet, sleep, exercise, medication) or psychological (psychoeducation, cognitive behavioural therapy, applied behavioural analysis or other behavioural work, social skills training).
Dr Suzie: “I strongly recommend applied behaviour analysis therapy session (there are specific centres offering this service) along with cognitive behavioural session with a clinical psychologist before suggesting medication. I also advocate a change in parental approaches and changes in academic expectations.
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Dubai Special Educational Needs - What are they and How to Spot Them
Dubai Special Educational Needs - Diagnosis and Assessment
Dubai Special Educational Needs - A Q and A with Diagnosis Specialists
Dubai Special Educational Needs - Occupational Therapy Q and A
Dubai Special Educational Needs - What is ADHD?
Dubai Special Educational Needs - Applied Behaviour Analysis
Dubai Special Educational Needs - Speech Therapy
Dubai Special Educational Needs - Specific Learning Difficulties
Dubai Special Educational Needs - Downs Syndrome
Dubai Special Educational Needs - Autistic Spectrum Disorder