Educational Access for students with PMLD

Allaa Gawish

How can schools provide greater curriculum access to students with PMLD?

What is PMLD?

When a child has more than one learning disability, it is referred to as profound and multiple learning disabilities (PMLD). These children may have major communication difficulties, and their capacity to understand and express themselves might be limited. In addition, sensory or physical disabilities, complex health needs, and mental health difficulties are all aspects to consider when dealing with PMLD. If the child with PMLD does not receive adequate support, he or she will develop behavioural issues as a result of the combination of these demands. Children with PMLD might require a high level of personal care and support in their everyday activities (e.g: help to eat, to wash hands), to ensure for them high quality of life. PMLD can affect children with autism and Down syndrome. PMLD can be caused by a hereditary condition, or it can develop prior to, during, or after birth as a result of a serious brain illness or damage.

These types of complex learning difficulties will require adjustments to learning activities. There are many ways to increase access to the curriculum and create active learning environments where everyone can thrive. Education staff in special schools have found inventive ways to address both severe learning difficulties and moderate learning difficulties in classroom environments. This type of inclusive education requires a lot of skill and knowledge and teachers don't always get the credit they deserve. In this article, we will explore some of the implications of PMLD and look at some of the learning activities schools can consider when designing an active learning environment. As our knowledge of complex learning disabilities has grown and our thinking evolved around neurodiversity so have the innovative learning activities.

Profound and Multiple Learning Disabilities

Complex learning disabilities can be very different and the individual needs of each child will always have to be taken into account. A school would usually have to get multiple viewpoints from different education staff including SENDCo's and educational psychologists. What teachers might initially see is the behaviour at school of the pupil, it's important to utilise all the professional school services available in order to fully understand the issues. Severe learning difficulties and moderate learning difficulties might include an interplay of the following:

  • Poor recall, trouble taking turns, and difficulties with taught subjects are all examples of severe learning problems.
  • Physical limitations include a lack of muscle coordination, which makes it harder to carry out daily duties, and restricted mobility, which limits muscle flexibility.
  • Sensory impairments include things like eyesight and hearing loss.
  • Complex health needs, such as epilepsy or respiratory issues, as well as eating and drinking issues
  • Acting out, having trouble interacting socially, and not following directions are all examples of challenging behaviour.
  • Restricted communication: limited speech, difficulty comprehending what others are saying, and difficulties interacting socially with others.

The Education Endowment have created a great tool for schools to plot out the needs of their SEND pupils. This tool might be a useful way of framing the needs of your PMLD students.

Addressing unique PMLD learner needs
Addressing unique PMLD learner needs

Addressing the education needs of PMLD students

People with profound learning disabilities, like people with any other disability, will continue to improve and learn throughout their lives if they are given the proper support and care. This necessitates offering early intervention to help the student build their early development skills. Learning the concept of cause and effect, for example, putting your hand on a hot cup can burn you, or taking turns rolling a ball between us. Also, keep in mind that the child will learn at a slower pace because he or she is still absorbing the concept. Some pupils, for example, may have very short-term memories, so they will need more time and may need to repeat the concept multiple times before they get it. In order to teach new concepts, it is necessary to repeat it. Furthermore, it is vital to be able to set appropriate aims while taking into account any other extra needs, such as physical or sensory needs.

Communication Needs:

Face expressions, voice noises (whispering, shouting), body language, and behaviour are the primary means of communication for children with PMLD. They may be able to communicate using a limited set of formal tools such as speech, symbols, or signs. They have trouble understanding and using verbal communication in situations and with people. As a result, individuals feel safe sticking to their daily pattern and avoiding unexpected incidents. It is critical to understand and identify the most effective means of communication that suits the specific needs of each child in order to assist them.

Dual coding using visuals
Dual coding using visuals

Physical Needs:

Some people with PMLD can walk and move around easily, but many will need to use wheelchairs. Others may have trouble moving and coordinating their bodies. Those youngsters will require specialist equipment to help them support, protect, and develop their muscle tone, as well as to improve their overall quality of life. They must also be provided with physiotherapy, occupational therapy, and hydrotherapy, as well as training for parents and caregivers on how to deal with their children's lack of confidence in everyday tasks (e.g., going to the toilet, taking a shower).

Complex Health Needs:

A child with PMLD may suffer from a variety of conditions, including epilepsy and Down's syndrome. They may require "technology-dependent" equipment, such as oxygen, feeding tubes, or suctioning equipment, depending on the circumstances. Aside from that, they have a number of health difficulties, including chest infections. As a result, they will require specialised health care in order to maintain their current circumstances. Persons without PMLD may have the same health problems as people with PMLD, but the issue is how to learn about these illnesses and symptoms from people who struggle to communicate and express themselves. As a result, an annual health check should be performed to recognise, maintain, and assess general health care and the effectiveness of the support offered.

Sensory Needs:

Children with PMLD might have varied degrees of visual and hearing impairments, as well as a mix of the two. However, as a side effect of the medicines they are taking, individuals may have unusual senses of taste and smell. Others may be hypersensitive to touch or hyposensitive to touch. It is critical to have a solid understanding of the child's vision, hearing, and other senses in order to design the most effective learning and communication technologies and to develop the necessary strategy and support.

Behavior Needs: 

As a result of their needs, people with PMLD may show challenging behaviours. Pushing individuals and biting are examples of ways they desire to interact with others but are unable to do it verbally. Other behaviours may be motivated by a desire to be noticed for a specific need or by a medical condition. Running in class, for example, could indicate that the child is bored and unable to cope with the learning purpose. Scratching his/her face because of a toothache is another example. Some behaviours, on the other hand, will be the result of doing something comforting to them, such as putting their hands under the tap, which triggers the sensory need to feel the water. The most important thing is to understand the behaviour and respond appropriately by screening for health issues or making appropriate environmental changes.

Mental Health Needs:

Children with PMLD may have a variety of mental health issues. Any changes in behaviours must be taken into consideration. For example, a student may sit quietly so it may be seen as progress in their behaviour, despite the fact that they are depressed. It is critical to be aware of the changes in order to provide correct treatment and assistance to meet their needs.

Practical support to Support Childern with PMLD

Providing appropriate support for children with severe learning difficulties is clearly a very individual task. Each child will require a bespoke type of support to address their individual needs. In this article, we have attempted to bring your attention to different areas that an education institution might need to think about. Within different parts of the world, provision for children with PMLD is very different. The following points could provide a school with some areas to think about when designing a truly inclusive educational experience.

  • Try to recognize and manage pain in a child with PMLD.
  • Annual health checks and assessments must be performed on a regular basis.
  • Seek advice from and involve professionals who can assist you in improving child's quality of life (e.g: learning disability specialist, health facilitator, nutrition expert, physiotherapist, speech and language therapist).
  • Don't make assumptions about the child's health.
  • Keep an eye on your child's teeth and oral hygiene, as well as child's weight and skin condition.
  • Always keep an eye on your child's vision and look after their eye hygiene. 
  • Follow a healthy eating plan.
  • Keep in mind that communication can be hampered by vision and hearing issues. 
  • Using visual aids will assist children in understanding circumstances and giving instructions.
  • Allow time for the children to respond and comprehend what is going on in their environment.
  • Speak with others who are familiar with the child since the child may be communicating through facial expressions or body language (nonverbal communication). Ensure that the child's preferred ways of communication are documented on the individual plan.
  • Assist the learner with communication skills (e.g., communication apps).
  • Encourage the learner to participate in discussion and storytelling.
  • To improve communication, provide a variety of sensory experiences and objects, such as objects to touch, sounds, flashcards to look at, and activities that utilise the five senses.
  • Assisting with positioning and mobility - laying, sitting, standing, and moving
  • Exercises and physical therapy on a regular basis
  • Provide them with a safe place to move around.
  • Allow children to hold a variety of objects in their hands.
  • Allow them to open and close their hands as they please.
  • Give them objects and ask them to grasp them.
  • Take them up and down the stairs with you.
  • Participating in games by taking turns
  • Provide children with a clear daily routine.
  • Use tactics to attract their interest, such as motivational techniques.
  • Use games that are dependent on following instructions.

PMLD References: 

https://www.mencap.org.uk/sites/default/files/2016-11/PMLD%20factsheet%20about%20profound%20and%20multiple%20learning%20disabilities.pdf

https://www.cornwallft.nhs.uk/profound-and-multiple-learning-disabilities/

https://www.mencap.org.uk/sites/default/files/2016-06/NHS%20EM%20-%20PMLD.pdf

https://www.gov.scot/publications/keys-life-improving-quality-life-people-learning-disabilities/pages/11/#:~:text=The%20causes%20of%20PMLD%20are,peri%2D%20or%20post%2D%20nat