Session chair: Lena Lindenskov
Assessment and Treatment of Dyscalculia
Organiser: The Nordic Dyscalculia Research Network. Co-ordinators of the Symposium: Lena Lindenskov, firstname.lastname@example.org and Pekka Räsänen, email@example.com
Mathematical skills are essential for both individuals and societies. People with poor numeracy have poorer educational prospects; they earn less and are more likely to be unemployed, more likely to be in trouble with the law, and more likely to be sick physically and mentally. The consequences for society are also dramatic. The OECD’s report (The High Cost of Low Educational Performance, 2011) demonstrated that maths skills directly affect GDP growth. Another OECD calculation showed that if we would be able to raise the skill level of those below the minimum to the minimum level (as defined in the PISA), the cumulative effect on the GDP growth would be nearly one-third of the average GDP growth. Besides the economic perspective on societal level, citizens’ mathematical skills and experience in complex ways relate to civil society and democracy. Therefore, actions to prevent failure in learning maths are of vital importance to our information societies.
The prevention starts with the identification of the target group. In this case, we need to be able to identify as early as possible those who perform below the expected minimum and whose performance shows a “hard-to-remediate” profile. I.e., persons whose remedial education requires something more and/or something different compared to standard support offered within inclusive education. In educational psychology the term typically used in these cases, is mathematical learning difficulties/disabilities, but neuroscientific and medical sciences use the term dyscalculia for the most severe cases. The terms mathematical learning difficulties/disabilities and at present also dyscalculia, are also used in mathematics education.
Dyscalculia is typically defined as a specific lack of numeracy skills, which cannot be explained by mental retardation or inadequate schooling. Multiple studies conducted in different countries and with different test batteries have provided estimates that the prevalence of dyscalculia would be somewhere between 3 to 7 percentages. The latest versions of the diagnostic classifications call it as Mathematics disorder (ICD-10; F81.2) or Specific learning disorder with impairment in mathematics (DSM-5; 315.1). In these diagnostic models, the key indicators are that the skills are markedly below age level and that the difficulties in learning have manifested themselves already in the early school years. A narrower definition is also in use, termed primary dyscalculia or isolated dyscalculia (Kaufmann & von Aster, 2012, 769-771; von Aster & Shalev, 2007, 1,8% p. 870).
However, there is no common agreement on what kind of tasks should be used to diagnose dyscalculia. The tasks vary from a test battery to another. We do not know how the differences between the test batteries affect the diagnosis. In addition, there is no consensus whether dyscalculia could be considered one unitary syndrome or if dyscalculia should be divided into multiple subtypes, each requiring different types of remedial actions. We do not know if we can identify these subtypes reliably with the current assessment tools and methods we have.
The second step of the actions is the research on and applications of interventions. Currently, there are no commonly agreed evidence-informed best practices for remedial education of dyscalculia available. Most of the studies on dyscalculia treatment show positive, median level effectiveness, but less is known about the permanence of these intervention effects. However, some diagnostic models, like a dynamic assessment of response-to-intervention school, require combining the assessments with interventions as part of the diagnostic procedures. More research is needed.
To increase awareness about this specific learning disorder and to fertilize the Nordic research collaboration on assessment and interventions on dyscalculia, an open discussion and collaboration “the Nordic Dyscalculia Research Network” has been created. This network aims to build joint cross-cultural studies within the Nordic countries on dyscalculia diagnostics and remedial education. This symposium presents the state-of-art and the latest work done in different Nordic countries on dyscalculia research to encourage new researchers to join this network and our collaboration.
The symposium will consist of country-specific presentations about the current state in dyscalculia assessment and interventions as well as a panel discussion about the future directions and the next concrete steps on Nordic collaboration in Dyscalculia Research.
Organising group of The Nordic Dyscalculia Research Network: Ulf Träff, Pekka Räsänen, Ola Helenius, Bent Lindhardt, Lena Lindenskov, Daniel Lindau, Carina Ode, Jonas Walfridsson, Olof Tyche, Nabi Amanuel.
Kaufmann, L., von Aster, M. (2012). The Diagnosis and Management of Dyscalculia. Deutsches Ärzteblatt International, 109(45), 767-778.
von Aster, M., Shalev, R. S. (2007). Number development and developmental dyscalculia. Developmental Medicine & Child Neurology, 49, 868-873
Paper 1: Danish model of dyscalculia assessment
Lena Lindenskov & Bent Lindhardt (Denmark)
The 2014-17 project developed preliminary assessment with four elements for grade 4 students and teacher guidance materials. The 2020-21 project developed the IT-design of the assessment, validated part of it, and tried out some interventions.
Paper 2: The Danderyd Model of Dyscalculia Assessment
Carina Ode & Daniel Lindau (Sweden)
The assessment model developed and used through 25 years will be described in more detail as well as the challenges encountered in clinical practice within in the healthcare system.
For almost 25 years, dyscalculia has been assessed at Danderyd Hospital, Stockholm, Sweden. The assessments have from the very beginning been performed by speech-language pathologists (SLP). During brief periods of time, a psychologist has been available to the clinicians for consultation.
The reason for this, from an international perspective highly unusual clinical practice, is that SLP is the profession that performs dyslexia assessments in Sweden, and assessment of dyscalculia has evolved from this practice. Since dyscalculia is a medical diagnosis, it is required that a medically authorized professional perform the assessment. Another reason why the diagnosis remains within the health care system is that it results in difficulties in everyday life and not only in the learning environment. The majority of patients assessed are, however, referred from schools or higher education because of difficulties in academic achievement in arithmetic and mathematics more generally.
Every year, about 500 patients are referred to Danderyd Hospital for a dyscalculia assessment, both from the Stockholm region and other locations around Sweden. The reason for this is that dyscalculia assessment is only performed within a few regions.
The assessment model and the test battery related with it has been revised on a number of occasions, to make sure it is relevant with regard to the scientific progresses made on the field. Broadly speaking, the model used today consists of three stages. Background information is provided by the patient, and depending on circumstances, parents, school and other health care professionals. It is not unusual that the patient has undergone other assessments, mainly of dyslexia and within neuropsychiatry. In the next phase, a test battery built up of both standardized and qualitative tests of a range of different number skills and associated skills is administered. The results are merged with the background information to enable diagnostic decision making. Difficult cases are thoroughly discussed within the whole group of SLPs.
Along with the diagnostic decision and the written report based upon it, general and specific recommendations are presented to the patient (, parents and teachers). What kind of adaptation, specific measures and tools could prove to be helpful to the individual is discussed.
Working as a clinical practitioner within a field as complex as that of mathematical difficulties, means that a number of challenges are encountered. Among these is the lack of consensus about what defines the diagnosis. Another issue is the quality of the tests available and that norm data is often lacking for certain age intervals.
In our presentation, we aim to describe the assessment model used in more detail as well as address the challenges encountered in clinical practice within in the healthcare system.
Paper 3: A digital ecosystem of curriculum-based math education
Pekka Räsänen (Finland)
A digital ecosystem of curriculum-based math education, special educational interventions with systematic progress monitoring, assessment of intervention effectiveness and dyscalculia screening: an award-winning research-informed model in practice.
Panel discussion: Cross-cultural collaboration within the Nordic context
Lena Lindenskov, Pekka Räsänen, Carina Ode, Daniel Lindau & Bent Lindhardt
 GDP = Gross Domestic Product, is the total monetary or market value of all the finished goods and services produced within a country’s borders in a specific time period, typically one year.