Multiple Learning Difficulties Research Articles

Curriculum Decision-Making for Students with Severe Intellectual Disabilities or Profound and Multiple Learning Difficulties

ABSTRACT Students with severe intellectual disabilities or profound and multiple learning difficulties (S/PMLD) have the highest complexity of needs of any student cohort. Decisions regarding curriculum inclusions for these students predominantly fall to their classroom teachers. These decisions directly correlate with students’ everyday learning experiences and have an influence on their life-long socio-economic, health, and well-being outcomes. This scoping review presents an overview of the factors that teachers consider when making these important choices. Online databases were used to identify peer-reviewed research undertaken internationally between 2011 and 2021 with 11 articles identified for inclusion. Results are presented using four key themes, (1) teacher as guardian, (2) teacher as educator, (3) teacher as employee and (4) teacher as (non)academic. Within, it details a paucity of research into understanding the decision-making schema of teachers of students with S/PMLD, revealing a lack of practical guidance or appropriate professional learning opportunities. Recommendations for future research and practice initiatives are detailed.

Curriculum in conflict: influences of Australian teacher’s decision-making for students with complex disabilities

ABSTRACT This paper is an exploratory study of the personal and systematic influences over the curriculum decision-making process of teachers of students with severe or profound and multiple learning difficulties in Australia. The way in which these influences impact teacher perceptions of the mandated curriculum and its day-to-day operationalization are discussed. The paper draws from both a national survey (n = 46) and in-depth case studies (n = 5) of teachers who work in government-funded specialist educational settings. Findings show that teachers have prominent levels of emotionality, a drive for creativity and dedication to inclusive practice, but ultimately work within a context perceived through conflict and dilemma. Previous related decision-making models are used to compare results, with some distinct differences emerging. Findings indicate that rather than enabling inclusion, standardized curriculums create an environment of professional (self)exclusion and reduce access to professional support. Increases in responsibility burden and negative emotional effects are explored. Although teachers view access to standardized curriculum programs as vital to educational inclusion and the enhancement of their professional expertise, the utilization of the current offering in Australia is makeshift at best and fraught with internal conflict. The implications of these findings are discussed, and future recommendations for research are prioritized.

Exploring teachers’ confidence in addressing mental health issues in learners with Profound and Multiple Learning Difficulties (PMLD) pre and post training

This research investigates the benefits of training for education professionals around the topic of mental health for learners with Profound and Multiple Learning Difficulties (PMLD). This includes raising awareness, alongside strategies and approaches to support this unique learning group. This study was conducted in a response to existing research, which concluded specific mental health training is needed for educational professionals working with learners with PMLD.

Exploring teachers’ confidence in addressing mental health issues in learners with Profound and Multiple Learning Difficulties (PMLD) pre and post training

Mae’r gwaith ymchwil hwn yn ystyried manteision darparu hyfforddiant i weithwyr addysg proffesiynol ar faterion iechyd meddwl ymhlith dysgwyr ag anawsterau dysgu dwys a lluosog (PMLD). Mae hyn yn cynnwys codi ymwybyddiaeth, ynghyd â strategaethau a dulliau i gefnogi’r grwˆp dysgu unigryw hwn. Cynhaliwyd yr astudiaeth hon mewn ymateb i’r ymchwil bresennol, a daeth i’r casgliad bod angen hyfforddiant iechyd meddwl penodol ar weithwyr proffesiynol addysgol sy’n gweithio gyda dysgwyr ag anawsterau dysgu dwys a lluosog.

Curriculum effectiveness for secondary-aged students with severe intellectual disabilities or profound and multiple learning difficulties in Australia: Teacher perspectives.

The active inclusion of students within education systems relies on a curriculum that caters to all. This article presents partial findings from Australian mixed methods research examining 46 teacher perspectives on the curriculum and its ability to support their practice in supporting students aged 12-19 years with severe intellectual disability or profound and multiple learning difficulties who attend specialist school settings. Results reveal that Australian teachers see the current curriculum as insufficient in its design and content and unable to cater to their students educational and social capacities or needs. Strengths essential to the reform process are highlighted, emergent challenges discussed and recommendations for future action are presented.

An investigation into the process and impact of introducing the ‘colour coded eye’ to learning assistants working with pupils with profound and multiple learning difficulties and cerebral visual impairment

With vision being our most powerful sense and cerebral vision impairment (CVI) being a growing concern in our special schools, it is crucial that support staff working with children have a thorough understanding of both CVI and how to support their individual levels of functional vision. Creating an inspiring new innovation to support learners with profound and multiple learning difficulties (PMLD) was the focus of this research. Using an approach provided by the Education Endowment Foundation, questionnaires were given to all 49 support staff; training via PowerPoint was then provided to volunteer participants who also spent time using the innovation in the classroom. The main findings were that the training increased participants’ overall confidence in CVI and how to support learners with a visual impairment. Using the innovation in the classroom also positively impacted the participants’ daily practice. Potential challenges such as ensuring staff all have a thorough understanding of the innovation and having a suitable learning environment for visual work were identified.

Understanding the views of children with profound and multiple learning difficulties for person‐centred planning

AbstractBackgroundAll children have the right to express their views about matters affecting them and participate in decision‐making for their future irrespective of their intellectual ability. This study explores the adult role in understanding the views of children with profound and multiple learning difficulties who are not using a formal communication system and require adults to speak on their behalf.MethodsThe study employs a qualitative multiple case study design involving three children with profound and multiple learning difficulties attending one special school. Social constructivist grounded theory approaches inform data gathering and analysis. Eight interviews are conducted with parents and professionals to explore how they understand the children's views and how this understanding informs person‐centred planning, combined with observations of the children in school and observations of their person‐centred planning meetings.FindingsAdult participants consider the children in the study to have agency and ability to affect the world around them. They believe the children can express their likes, dislikes and what they want but they think the children would have difficulty communicating their views about their health, medical needs and disability. They describe a range of observable actions made by a child to which they give meaning when interpreting the child's views. The actions a person takes as a child's communication partner can enable the child to develop and communicate their views. A process of observation and comparison allows adults to explore different interpretations of a child's views. Perspectives offered by professionals from different fields enable a child's views to be understood in different ways.ConclusionsAdults develop their understanding of the children's views over time in relational and social contexts. Different interpretations of a child's communication are considered when adults collaborate, leading to socially constructed understandings of a child's views. Adults infer the meaning of a child's views about what is important to them for the future from their understanding of the child's views in the present, which informs person‐centred planning.

Theatre for children with profound and multiple learning difficulties: A Winnicottian perspective

AbstractThe London‐based Oily Cart theatre company aims to produce shows that are suitable for all young people. This paper closely examines one of their productions, Splish Splash, which was developed for children with profound and multiple learning difficulties. The paper's central purpose is to understand the value of this type of theatrical experience for these children. It argues that Winnicott's conception of play, and his account of the conditions that enable the capacity for play to unfold, provide a persuasive theoretical framework that makes sense of Oily Cart's achievement. Winnicott's framework can integrate the views expressed (in interviews) by adults who were involved with or observed the show; arguably it is also corroborated by more recent infant research.

Practitioners' views about effective mental health and well‐being support for post‐16 students attending special school

Supporting children and young people's mental health and well‐being is central to UK Government policy, with statistics suggesting post‐16 students and those with learning difficulties are vulnerable. This case study explored how practitioners at a special school for students with severe and profound and multiple learning difficulties promote post‐16 students' mental health and well‐being. Data were drawn from four semi‐structured interviews and a follow‐up focus group. The thematic analysis identified a whole‐team approach to supporting mental health and promoting student well‐being, through staff knowledge and interpersonal skills, particularly related to communication and ability to build trusting relationships, providing experiences and preparing students for adulthood. Consideration was also given to facilitators and barriers to promoting such provision for students. The emotional needs audit from the Human Givens Institute (2006) could provide a framework for practitioners in special schools to promote mental health and well‐being, enabling practical and tangible strategies for intervention and support.

Enhancing wellbeing and independence for young people with profound and multiple learning difficulties: Lives lived well. AndrewColley, JulieTilbury, SimonYates. Routledge, 2021, ISBN: 978‐0‐367‐56406‐3, £27.99 (paperback/ebook), £120 (hardback)

Enhancing wellbeing and independence for young people with profound and multiple learning difficulties: Lives lived well. AndrewColley, JulieTilbury, SimonYates. Routledge, 2021, ISBN: 978‐0‐367‐56406‐3, £27.99 (paperback/ebook), £120 (hardback)

Mental health and subjective well‐being of staff in a secondary school for adolescents with severe and profound multiple learning difficulties

The main purpose of this study was to explore the mental health and subjective well‐being of staff working with adolescents with severe and profound multiple learning difficulties. The participants were 19 teachers and 25 teaching assistants working in an inner London, local authority, specialist day provision. A demographic questionnaire, the Hospital Anxiety and Depression Scale, the Connor‐Davidson Resilience Scale, the Positive Affect Scale, and the Satisfaction with Life Scale were used as data collection tools. The inferential statistical tools used were t‐tests and correlational analyses. The study brought to light a high number of borderline and abnormal anxiety scores among all staff. The study also found a significant difference in the resilience scores of teachers and teaching assistants, with teaching assistants scoring higher on the resilience scale. The results, alongside findings from previous research, call for better mental health support for teachers and staff working in the field of special educational needs and disabilities. The study highlights the emotional toll on educators, and the need for mitigation strategies that promote good mental health outcomes for both teachers and students.

Inclusive curricula for students with severe intellectual disabilities or profound and multiple learning difficulties: a scoping review

The capacity for all students to meaningfully access the curriculum is a central tenant of inclusion. Investigation into curriculum provision for students with severe intellectual disabilities or profound and multiple learning difficulties (S/PMLD) receives little consideration in the literature; however, it has increasing relevance in designing and implementing standardised curriculums intended to be inclusive of all students. This scoping review aims to analyse the structures and elements of a standardised curriculum that best enables the authentic inclusion of students who have S/PMLD. The philosophical, design and practice considerations in constructing an inclusive curriculum structure for students with S/PMLD in a standardised educational system are discussed. Results are further explored to create a basis for discussion, provide guidance for policymakers and outline a future research platform.

Online learning effects on students with learning disabilities: Parents’ perspectives

The study aimed to investigate the parent’s perspectives toward the effect of online learning on their child’s learning, particularly, the ones with learning disabilities. This descriptive study randomly selected one hundred and ninety-three parents with students with learning difficulties. All participants received an online designed form of survey to achieve study objectives. The results carryout that: the parents has medium perspectives toward the effects of online learning, while they have high perspectives toward factors related to their children . Furthermore, there is a statistically significant impact of online learning on the learning of students with learning difficulties and the effects of online learning on students learning disabilities differ based on their disability and are higher in case of multiple learning difficulties.
 
 Keywords: Online learning; Parents perspectives; Students; learning disabilities; Dyslexia; Dyscalculia; Dyspraxia.

The production of social spaces for children with profound and multiple learning difficulties: a Lefebvrian analysis

There is on-going debate about whether mainstream education is desirable for children with profound and multiple learning difficulties (PMLD). Whilst some hold that ‘inclusion’ is a human right, and that interaction with mainstream peers leads to socio-cognitive gains, others argue that profoundly disabled learners require developmental curricular provided by special schools. Despite such claims, there is little evidence to support either view. This paper contributes to the debate by presenting research that examined how mainstream schools and special schools, across nursery, primary, and secondary settings, provided alternative social spaces for children with PMLD. It applies a Lefebvrian lens to illuminate how social engagement depended on the extent to which prescribed practices (‘abstract spaces’) dominated the interaction (‘spatial practices’), and the conditions which allowed novel forms of engagement to emerge (‘lived spaces’). Novel forms of engagement correlated with positive social development. The conclusion challenges the ‘mainstream-special’ binary presupposed in inclusion debates.

Inclusive education for students with severe or profound and multiple learning difficulties: Identification of influencing factors and challenges

In the study reported on here we examined the extent of pre-service teachers’ supportiveness for educational inclusion (EI) of students with severe or profound and multiple learning difficulties (SPMLD) in order to identify their attitudinal predictors, as well as the challenges faced in such a process. An attitudinal survey with 33 items was developed to collect data from 542 participants. The results show that the attitudes/beliefs of pre-service teachers (ABpST) regarding inclusion were moderate to positive and strengthened across the teachers’ knowledge and experiences. However, some variations, based on their characteristics and study constructs were revealed. The findings also illustrate the combined effects of practical knowledge and courses, besides teaching and working experiences in shaping ABpST attitudes towards inclusion of SPMLD students. The implications of these results for educators and national education institutions and other international universities are discussed.

Management and Treatment Modalities in Traumatic Brain Injury

ABSTRACT Traumatic Brain Injury (TBI) is a very broad diagnosis. Some TBI patients have minimal complaints for a short period of time. Other TBI patients suffer from drastic life-altering, permanent brain damage. One particularly troubling class of TBI patients arises from people who experience one or more concussions in their youth. Later, as adults, the TBI manifests as multiple learning difficulties or even personality changes. As ophthalmic professionals, we are often the first to see potential TBI patients as they complain of visual disturbances. It is of utmost importance to find ways to help these people, but first we have to find the deficits. This paper will discuss some therapeutic measures given to TBI patients and the examinations that will provide vital information.

Onset Age of Substance Use and Neuropsychological Performance in Hospital Patients.

ObjectiveSeveral studies have found neurocognitive deficits in adolescents following substance abuse. Predisposing risk factors may further impact vulnerability to neurocognitive deficits. Little is known about the cognitive performance of adult onset substance users compared to earlier onset users. This study aims to explore differences in neuropsychological functioning between early (EOAs) and late onset substance abusers (LOAs) when the effects of confounding factors are controlled.MethodData for this cross-sectional study was collected from hospital patients. A total of 164 patients with substance use disorder (SUD) aged 19 to 65, 76 with single-drug diagnosis and 88 with multidrug diagnosis, underwent neuropsychological tests for verbal capacity, attention, speed of processing, perceptual reasoning, memory and learning, executive functioning, and inhibitory capacity. Associations between regular onset age and neuropsychological measures were analysed using in multi-way ANCOVA, and the effect of age, multiple substance abuse, education level and learning difficulties were controlled.ResultsCompared with LOAs, EOAs had weaker performance in the Digit Symbol test for mono-substance users. Meanwhile, compared with EOAs, LOAs had weaker performance in the Delayed Visual Memory test and the Raven test for mono-substance users, and the Block Design test for poly-substance users. From the confounding factors, early onset age of substance use is heightened among individuals with learning disabilities.ConclusionsOnset age of substance use is related to the deterioration of performance in neuropsychological tests. Premorbid poor learning and inhibitory capacity may be important predisposing risk factors of SUD. Conversely, high level of education may be a protective factor for cognitive performance in patients with SUD.

De novo missense variants in the RAP1B gene identified in two patients with syndromic thrombocytopenia.

We present two independent cases of syndromic thrombocytopenia with multiple malformations, microcephaly, learning difficulties, dysmorphism and other features. Exome sequencing identified two novel de novo heterozygous variants in these patients, c.35G>T p.(Gly12Val) and c.178G>C p.(Gly60Arg), in the RAP1B gene (NM_001010942.2). These variants have not been described previously as germline variants, however functional studies in literature strongly suggest a clinical implication of these two activating hot spot positions. We hypothesize that pathogenic missense variants in the RAP1B gene cause congenital syndromic thrombocytopenia with a spectrum of associated malformations and dysmorphism, possibly through a gain of function mechanism.

A narrative exploration of how curricula for children with profound and multiple learning difficulties shape and are shaped by the practices of their teachers

This article presents the findings of a study that asked teachers to narrate their interactions with learners from the perspective of the curriculum that the school adopted. Thirteen female teachers, employed at eight special secondary schools for children with profound and multiple learning difficulties in England, participated in the research. They narrated their experiences, which were consequently subject to phenomenological hermeneutic analysis. All the teachers displayed a high degree of individuality and conceptualised their work not straightforwardly as teaching the espoused curriculum, but rather as they themselves being the ‘curriculum‐in‐action’, with their practice lying alongside and only obliquely cognisant of their school's explicit provision. The narratives disclosed ongoing conflict with school leaders being interpreted as a threat to their specific pedagogic practices as well as their professionalism. The research raises questions about the ability of the ‘special curriculum’ to be truly responsive to pupils' needs within this complex pedagogical environment.

The development and implementation of the Nottingham early cognitive and listening links (Early CaLL); A framework designed to support expectation counselling and to monitor the progress, post cochlear implantation, of deaf children with severe (SLD) and profound and multiple learning difficulties (PMLD) and associated complex needs

Objectives: Appropriate outcome measures are required for deaf children with severe (SLD) and profound and multiple learning difficulties (PMLD). This paper describes the development and structure of the Nottingham Early CaLL Framework and via a series of case-studies, demonstrates its effectiveness in tracking progress over time.Methods: The materials were developed in-house in 2011–2012 and refined through the exploration of established approaches in health and education, an inter-rater reliability study and an extended pilot of the draft materials.Results: The Framework quantifies the long term benefit of cochlear implantation by recording the amount of functional sound processor use achieved, alongside incremental changes in auditory behaviours, in the context of cognition, interaction and communication development. The case-studies demonstrate how it can provide evidence of measurable changes and help to explain some of the underlying reasons for the range of long-term outcomes.Discussion: Within this population, the key predictive, within-child factors of post cochlear implant listening and spoken language outcomes, are an individual’s cognitive and physical capacities and their engagement in social communication.Conclusion: The Early CaLL Framework supports expectation counselling and decision-making in the assessment phase and post cochlear implantation provides monitoring tool, which encourages collaboration between families and professionals.