Diagnostic Overshadowing

Hey 👋

Happy equinox. While the earth finds its balance, let’s dig further into effective inclusive teaching…

Big idea 🍉

Diagnostic overshadowing is a term originating in medical contexts (and introduced to me by Jen Barker). It describes the phenomenon where doctors inadvertently place too much emphasis on a patient's diagnosis, overshadowing other significant health concerns.

For example, a patient diagnosed with depression might have their physical symptoms—like fatigue or headaches—mistakenly attributed to their mental health condition, potentially overlooking a critical underlying physical illness requiring separate treatment.

The same can occur in education. The high-stakes nature of special educational needs (SEND) can inadvertently lead us to over-rely on diagnoses when making instructional decisions, potentially neglecting more foundational aspects of student learning and wellbeing.

For example, a student with ADHD might struggle with homework due to inadequate study skills, but we might mistakenly attribute this to their attention difficulties. Similarly, students with autism often receive disproportionate resources based on their diagnosis, even if their specific needs don't warrant this additional support. In short, over-reliance on labels can lead to unfair resource allocation and weaker outcomes for all.

This issue is compounded by the variable quality of evidence supporting some SEND responses. For instance, interventions like fidget spinners, often recommended for students with attention difficulties, have been shown in multiple studies to negatively impact attention and academic performance.

Special educational needs diagnoses serve important purposes, but they are only one piece of the puzzle—we must avoid allowing them to overly influence our instructional decisions at the expense of what we know about that students' specific learning needs or distort our judgment of how to balance one student’s needs relative to others.

Instead, we must balance diagnoses with core learning strategies—such as explicit instruction, high-structure-high-routine environments, and retrieval practice—while using regular, precise assessments and professional judgment to ensure our teaching remains effective and equitable for all.

🎓 For more, check out this report outlining evidence informed strategies for inclusive teaching.

Summary

• The high stakes nature of SEND means we can sometimes over-rely on diagnoses when making instructional decisions.

• This ‘diagnostic overshadowing’ is exacerbated by the variable quality of evidence around some SEND interventions.

• We must balance label-driven prescriptions with core learning needs (using precise teacher assessment).

Little updates 🥕

• Study on effects of school knowledge in later vocational learning → suggests that more prior knowledge leads to greater future learning gains, supporting the ‘knowledge is power'​ hypothesis.

• Report on how school absence affects pupil attainment → finds increased absence among disadvantaged pupils largely explains the achievement gap.

• Analysis of the state of children's play → finds schools are offering fewer spaces for play and less time for play than ever before 😭

• Helpful synthesis of evidence informed practices for recruiting and hiring highly effective teachers.

• Plus a new repository for effective inclusive practices → check in out and contribute if you can.

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