Severe Learning Difficulties Research Articles

Together and apart: using Plasticine as a sensory therapeutic intervention for a service user diagnosed with severe learning disabilities

ABSTRACT Background The prevalence of mental illness among people diagnosed with severe learning disabilities is well documented, however limitations in verbal, cognitive, emotional and social skills are often used as reasons to withhold referrals for psychotherapeutic interventions within this client group. Context This paper describes the one-year art-therapy informed psychotherapeutic work carried out with Ioanna, a 61-year-old lady with a dual-diagnosis that took place in a Residential Unit providing psychosocial support for people with severe psychiatric disorders and/or learning disabilities in Athens Greece during 2018. Approach Within the case-vignette the use of Plasticine as a therapeutic medium is presented. Concepts from psychodynamic and object-relations theory are also used as a framework for understanding the course of this therapeutic intervention. Outcomes The contribution of sensory materials appeared valuable in this psychotherapeutic intervention with an apparently ‘untreatable’ institutionalised service user, helping to build a trusting psychotherapeutic relationship, and enable Ioanna to regulate some of her challenging behaviours. Conclusions The use of Plasticine and play, and the development of a ‘together and apart’ game within a psychotherapeutic intervention, appeared to modify Ioanna's challenging behaviour, and improve her ability to relate and communicate with the therapist and her carers. Implications for research Research into the use of Plasticine as part of an art therapy programme for people with severe learning difficulties, would provide a useful addition to the knowledge in this area. A review of the current psychiatric services in Greece and of what constitutes ‘clinical progress’ also seems necessary. Plain-language summary This paper describes the one-year art-therapy informed psychotherapeutic work I undertook with Ioanna, a 61-year-old lady with a diagnosis of severe learning disabilities and mental illness. This took place in a Residential Unit providing psychosocial support for people with severe psychiatric disorders and/or learning disabilities in Athens Greece during 2018. At this time, I was also undergoing my art therapy training. The practice description in this paper describes the contribution of Plasticine as a sensory, therapeutic medium. Theories related to the relationship that a baby or child develops with its primary care giver are used as a framework for understanding the course of this therapeutic intervention. The relationship between learning disabilities and mental illness is well documented in clinical literature, however people with dual diagnosis or severe learning disabilities are often overlooked where referrals for psychotherapy are concerned, as it is believed that they cannot take part due to a perceived lack of communication skills. This paper describes how the use of Plasticine and playing a ‘together and apart' game appeared to contribute to Ioanna’s development of a trusting therapeutic relationship, the modification of challenging behaviour, and improved communication through the medium of Plasticine and play. Research into the use of Plasticine and the ‘together and apart game' with this client group is recommended. It is also important to rethink and reflect on the provision of psychotherapeutic services within the current psychiatric services in Greece for this client group, and consider what constitutes clinical ‘progress' from the client’s perspective.

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.

LINC-31. TREATMENT OUTCOME IN CHILDREN WITH MEDULLOBLASTOMA IN MEDIUM-INCOME COUNTRY: AN EXPERIENCE FROM A SINGLE TERTIARY CENTRE IN KUALA LUMPUR, MALAYSIA

INTRODUCTIONMedulloblastoma is the most common malignant brain tumour in children. The overall outcome has improved however, this was not translated to developing nations.METHODThis was a retrospective review of patients from January 2000 to December 2017. Treatment was given using modified SIOP PNET 4 protocol: cranio spinal irradiation (CSI), a total of 54G with vincristine followed by 8 cycles of adjuvant chemotherapy. Prior to year 2007, patients had CSI with or without adjuvant chemotherapy. Those <3 years old received modified UKCCSG/SIOP CNS protocol with 2 weekly chemotherapy for a duration of 392 days followed by CSI when required. All patients had MRI brain and spine, and tissue histopathological examination but without molecular subtype.RESULTSMedulloblastoma comprised of 30% (n=31) out of total 103 brain tumour cases. Mean age at presentation was 7.6 years old (SD 4.4) with male to female ratio of 2:1. Average time of symptoms was 4.8 weeks. Majority, 77.4% was high risk and 19.4% was standard risk. There was high treatment abandonment rate (35.5%, n=11). Three patients returned and completed treatment after multiple surgeries in an average of 9 months. Three years OS and EF were 69.6% and 74.8%, respectively. Six patients aged < 3years; half had advance disease on palliative care post surgery. Other survivors had severe learning difficulty and two had second malignancy (meningioma and thyroid carcinoma) at average 15.5 years after diagnosis.CONCLUSIONStrategy to reduce treatment abandonment is crucial. Moreover, multidisciplinary management and molecular stratification are important in improving the outcome.

A qualitative study of the practice‐related decision‐making of Intensive Interaction Practitioners

Accessible summary People who use Intensive Interaction want to find the best ways to enjoy interacting with people with learning disabilities and/or autism. This study is about how the people who use Intensive Interaction (in this study called “practitioners”) decide how best to do it, often as they go along. This study found that the practitioners who use Intensive Interaction with people with learning disabilities and/or autism think about a lot of different things. They think about some things before they start doing Intensive Interaction with a person, other things while they are doing the Intensive Interaction and some more things when they have finished. The study also says that the practitioners who use Intensive Interaction could do it even better if they thought about it more or watched some video of their Intensive Interactions, either on their own or with the help of some other people who also do Intensive Interaction. AbstractBackgroundThis study looked to investigate the sometimes conscious and sometimes intuitive decision‐making processes of Intensive Interaction practitioners. More specifically, this study set out to develop a rich description of how practitioners make judgements when developing a dynamic repertoire of Intensive Interaction strategies with people with severe or profound learning difficulties and/or autism, how this decision‐making process is enacted in practice and what issues inform such decisions.Materials and MethodsThis research followed a “Template Analysis” qualitative methodology, informed by semi‐structured interviews with 13 experienced Intensive Interaction Practitioners (who had completed the Intensive Interaction Coordinators course as administered by the Intensive Interaction Institute). The participants included the following: speech and language therapists, parents, teachers, residential care staff and managers, and a clinical psychologist.ResultsThe findings of this study indicate why and how certain decisions are made by experienced practitioners before, during and after engagement in Intensive Interaction. Such decision‐making is indicated as sometimes being intuitive in nature, sometimes more conscious, sometimes moving between the two cognitive states as differing issues arise.Practitioner decision‐making was focused on a number of issues, including specific learning or care “agendas”; practitioner confidence and knowledge; environmental considerations; individual learner characteristics and behaviour; learner attention, “attunement” and arousal levels; building a shared “repertoire”; and issues of available time.ConclusionsThe issue of how novice Intensive Interaction practitioners may best be supported to more quickly and confidently develop improved Intensive Interaction practices is discussed, proposing the development of a cyclical process of experiential learning and supported reflection.

Demographic Features and Etiology of Congenital Hypothyroidism at the National Diabetes and Endocrine Center in Oman from 2004 to 2016.

ObjectivesCongenital hypothyroidism (CH) is the most common endocrine disorder in neonates as well as one of the few preventable causes of severe learning difficulties. Early screening, diagnosis, and treatment are mandatory to prevent later sequelae. We sought to determine the demographic and the clinical features of CH in Oman.MethodsWe conducted a retrospective cross-sectional study, including all Omani children newly diagnosed with CH from January 2004 to December 2016 followed at the National Diabetes and Endocrine Center at the Royal Hospital. Those with transient hypothyroidism were excluded from the study. Data collection involved demographic data, clinical manifestations, lab investigations, thyroid scan results, and initiation date of the thyroxine (T4).ResultsA total of 96 patients were newly diagnosed with CH during the study period. Out of the 96 patients, 43 were males (44.8%), and 53 were females (55.2%), and majority were asymptotic (n = 84; 87.5%). Only 78 patients had a thyroid scan. Among those who did the scan, thyroid dysgenesis was the most common (n = 40, 51.3%), followed by dyshormonogenesis (n = 35; 44.9%) and the least was central hypothyroidism (n = 3; 3.8%). The majority of patients (n = 72; 86.7%) were started on T4 therapy within 30 days of life. The remaining (n = 11; 13.3%) had a delay in starting the treatment due to compliance issues, which led to a developmental delay (p < 0.001).ConclusionsThis is the first epidemiological study conducted in Oman that highlights the unique demographic and etiology features of CH. Dyshormonogenesis has a high prevalence in the Omani population compared to other nations. The neurological sequelae in our patients were higher in compression to worldwide prevalence, which was mainly due to delay in starting T4 therapy.

The Sentient Spoon as broken puppet: Celebrating otherness with performing objects

Exploring speculations about new materialism and performance, this article discusses how we (re)consider the ‘puppet other’ as a subject in community performance, focusing particularly on work with youth who have severe and complex learning difficulties. The discussion of this project explores the ethics and politics of practice in applied puppetry (Smith 2014) through reflections about the use of performing objects in relation to specific communities and identities. The method employed in this article is to explore the world of objects in practice, using the ideas of object-oriented ontology. This viewpoint explores poetic processes and speculations about the inner reality of objects, in relation to human participants. This exploration of the materiality of objects is framed in reaction to the way power operates, specifically through the Foucauldian lens of biopower.

Investigating the role of temporal processing in developmental dyslexia: Evidence for a specific deficit in rapid visual segmentation.

The current study investigates the role of temporal processing in the visual domain in participants with developmental dyslexia (DD), the most common neurodevelopmental disorder, which is characterized by severe and specific difficulties in learning to read despite normal intelligence and adequate education. Specifically, our aim was to test whether DD is associated with a general impairment of temporal sensory processing or a specific deficit in temporal integration (which ensures stability of object identity and location) or segregation (which ensures sensitivity to changes in visual input). Participants with DD performed a task that measured both temporal integration and segregation using an identical sequence of two displays separated by a varying interstimulus interval (ISI) under two different task instructions. Results showed that participants with DD performed worse in the segregation task, with a shallower slope of the psychometric curve of percentage correct as a function of the ISI between the two target displays. Moreover, we found also a relationship between temporal segregation performance and text, words, and pseudowords reading speeds at the individual level. In contrast, no significant association between reading (dis)ability and temporal integration emerged. The current findings provide evidence for a difference in the fine temporal resolution of visual processing in DD and, considering the growing evidence about a link between visual temporal segregation and neural oscillations at specific frequencies, they support the idea that DD is characterized by an altered oscillatory sampling within the visual system.

We don’t play that way, we play this way: Functional Play Behaviours of Children with Autism and Severe Learning Difficulties

BackgroundResearch on play for children with autism and severe learning difficulties (SLD) has been limited; instead, much of the research focuses on higher levels of play, such as symbolic play. Those studies that present details regarding functional play are focused on examining the extent of the play deficit and limited in depth with respect to the precision of the categories presented. Therefore, the current understanding, the tools available to support, plan and measure play are not sufficiently detailed or focused on children with autism and SLD. AimsThe aim of the research was to analyse the functional play actions and establish precise functional play categories though direct observations of children aged 3–11 diagnosed with a combination of autism and SLD. MethodsFree-play observations of children diagnosed with autism and SLD (N-27) were conducted in a natural play situation across three special schools in England. Outcomes and ResultsThe results reveal four key areas of functional play: interacting with one object; interacting with two (or more) objects; interacting with self; and interacting with the environment. In addition, seven subcategories were established as additional components related to functional play. Conclusions and implicationsThe results suggest that functional play for children with autism and SLD is far more complex than currently recognised. Through the depth and detail established, the categories provide greater understanding of the play characteristics and the most detailed account of the functional play characteristics for this group of children. The analysis provides sensitive measurement scales to support accuracy and precision when planning, supporting and measuring small increments of progress in play.

Forysta sem samstarfsverkefni: Áhersla skólastjóra á valddreifingu og samstarf

Í nútímakenningum um skólastjórnun er kastljósinu jafnan beint að sýn skólastjóra á hlutverk sitt og tengsl við samstarfsfólk. Þá er átt við að skólastjórar og kennarar starfi saman að því að þróa skólastarf og kennsluhætti. Markmiðið með slíkum starfsháttum er að stuðla að auknum gæðum í skólastarfi. Í þessari grein er athyglinni beint að þeim afbrigðum samstarfsforystu sem fengið hafa mikið rými í fræðilegri umræðu á 21. öldinni, þ.e. dreifðri forystu (e. distributed leadership) og kennaraforystu (e. teacher leadership). Gögnum var safnað með spurningakönnun sem send var til allra skólastjóra vorið 2017 og var svarhlutfallið 69%. Í niðurstöðum er dregin upp mynd af aðstæðum í skólunum og greint frá hversu miklum tíma skólastjórar telja sig verja til samstarfs við millistjórnendur, kennara og annað starfsfólk, hversu mikla áherslu þeir leggja á þátttöku millistjórnenda og kennara í ákvörðunum og virkja þá til forystu um þróun kennsluhátta. Í umræðunum um niðurstöðurnar er bent á mikilvægi þess að skólastjórar horfi gagnrýnið á hvert markmiðið með virkjun millistjórnenda og kennara er, þ.e. hvort það sé einkum til að létta vinnuálagi af skólastjórum eða til að dreifa forystu um þróun náms og kennslu. Þá þarf að greina hvort launamál, vinnuálag eða aðrir starfstengdir þættir valdi því að meirihluta skólastjóra veitist erfitt að virkja kennara til kennslufræðilegrar forystu í þágu skólastarfsins alls.

Cognitive and Behavioural Weaknesses in Children with Reading Disorder and AD(H)D

Working memory capacity, an essential prerequisite for language learning and the development of arithmetic skills, has been reported as deficient in children with reading disorder (RD) and attention deficit (hyperactivity) disorder (AD(H)D). However, few studies to date have explored potential associations of working memory impairments and foreign language learning, mathematical skills and school achievement in these groups, in particular in children with a comorbidity of both. In the present study, we assessed working memory, language learning, arithmetic fluency and academic achievement in children (N = 166; Mage = 14.3, range 8–18 y), including typically-developing children (n = 89), subjects with RD (n = 27), AD(H)D (n = 43), and a comorbidity (n = 15). While children with AD(H)D performed similar to typically developing children on all tasks, RD children performed weakly on various language learning and working memory tasks, with major deficits in non-word span, phonetic memory and vocabulary learning. Combining weaknesses of the two groups, children with a comorbidity further performed significantly worse on arithmetic skills, learning of sound-symbol combinations and simple digit span forward. The findings suggest a reconsideration of working memory and learning impairments in AD(H)D, while highlighting the additional weaknesses of comorbid children and pointing out severe foreign language learning difficulties in RD children.

The conceptualisation of a modified formative assessment model for non‐verbal students with autism and severe learning difficulties

The popularity of formative assessment has increased since the publication of work by Black and Wiliam in 1998. Even though it is a useful teaching tool, in most cases it has only been possible to use it for students with high levels of cognitive and communicative ability. The aim of this article is to propose a modified, personalisable model of formative assessment for non‐verbal students with autism and severe learning difficulties. Five students with autism and severe learning difficulties participated in systematic video observations over a period of eight weeks, during which student behaviour and attainment were recorded. The behaviour checklist gave an accurate representation of the students' level of engagement and predicted attainment, but differences in passive learning objectives (those requiring passive co‐operation) and active ones (those requiring active contribution) were noted. The introduction of engaging resources improved engagement, but tangible rewards had a negative effect on attainment. Praise had a positive effect on engagement and attainment.

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.

An analysis of the five year outcomes of a cohort of 46 deaf children with severe (SLD) or profound and multiple learning difficulties (PMLD) and associated complex needs, including autism (ASD), tracked using the Nottingham Early Cognitive and Listening Links (Early CaLL): This framework monitors the relationship between sound processor use and listening, spoken language, cognition and communicative development, following

Objectives: In 2018, routine data of the five year outcomes from a cohort of 46 children, (18 PMLD and 28 SLD, including nine SLD children with an additional diagnosis of ASD), was analysed to investigate the type and amount of benefit provided by cochlear implantation and to examine any differences in outcome patterns across the populations.Methods: The level of functional sound processor use achieved over time was reviewed in relation to listening and spoken language outcomes, alongside social engagement, communicative and cognitive development. The extent to which children were able to close the gap between their overall development and their listening abilities was quantified. The outcomes of the children with an additional diagnosis of ASD, was compared to those of the SLD population as a whole.Results: Although equipment management presented long term challenges, after five years, 80% of children were able to attach some meaning to sound. Children with SLD acquired more auditory skills and spoken language than those with PMLD. Most of the children used a mix of augmentative and alternative communication approaches (AAC), with 7%, all SLD children, acquiring some simple spoken language. An additional diagnosis of ASD had a negative effect on outcomes.Discussion: For 80% of the patients, the provision of cochlear implants provided benefits, although changes were slow to develop and required high levels of adult persistence.Conclusion: Outcomes measures which are population specific and acknowledge challenges, alongside providing ways to recognise individual achievements, by matching them against individual capacity, are of great value to families and practitioners.

In-school eyecare in special education settings has measurable benefits for children’s vision and behaviour

ObjectivesTo determine whether implementation of comprehensive in-school eyecare results in measurable benefits for children and young people in terms of visual status, classroom behaviours and how well their visual needs are met.DesignSchool-based observational study.Participants & Methods200 pupils [mean age 10 years 9 months, 70% male, majority moderate (40%) or severe (35%) learning difficulty] of a special education school in the UK.A sector-agreed in-school eyecare framework including full eye examination and cycloplegic refraction, dispensing of spectacles (as appropriate) and written reporting of outcomes to parents/teachers was applied. Classroom behaviours were observed and recorded prior to, and after, the in-school eyecare. Surveys were employed to obtain visual histories from parents/teachers. School records and statutory documents were reviewed for diagnostic and learning disability classifications. Visual function and ocular health were profiled at baseline and significant visual deficits identified. Where such deficits were previously unrecognised, untreated or not compensated for (e.g. correction of refractive error, enlargement of educational material) they were recorded as ‘unmet visual need’. At follow-up, 2–5 months after initial (baseline) measures, eye examinations, parent/teacher surveys and behaviour observations were repeated. Follow-up measures were used to determine if measurable improvements were evident in visual function, ocular health, the level of unmet need and classroom behaviour following implementation of in-school eyecare.Results199 participants completed baseline and follow-up measures. 122 (61%) participants presented with at least one significant visual or ocular health deficit and 90 (45%) participants had at least one unmet visual need. Younger pupils and those with no previous history of eyecare were more likely to demonstrate unmet visual needs at baseline (OR 1.12 95% CI 1.03 to 1.21) p = 0.012; (OR 4.44 95% CI 1.38 to 14.29 p = 0.007 respectively). On follow-up, the number of pupils with unmet visual needs dropped significantly to 36 (18%) (McNemar’s test p<0.001). Visual and behavioural metrics of participants without significant visual deficits or whose visual needs were adequately addressed at baseline remained relatively unchanged between baseline and follow-up (Wilcoxon signed rank p>0.05). Where significant refractive deficits were corrected at follow-up, near visual acuity improved significantly (Wilcoxon signed rank p = 0.013), however, poor spectacle compliance was a persistent cause of unmet visual need. Off-task behaviour reduced significantly after actions to address unmet visual needs were communicated to parents and teachers (Wilcoxon signed rank p = 0.035).ConclusionsThe present study demonstrates for the first time measurable visual and behaviour benefits to children in special education settings when they receive comprehensive in-school eye examinations, on-site spectacle dispensing and jargon-free reporting of outcomes to teachers and parents.

Fighting for our Rights. Perceived Gains from Transforming the Curriculum through a Narrative of Activism

This paper will analyse the gains from ‘Fighting for our Rights’ project (2016-2018) focusing on the use of real-life experiences in HE teaching and beyond. This was a Heritage Lottery funded project that entailed collecting and sharing stories from people involved in the Disability Rights Movement (DRM) from 1960s to 1990s within Kingston in order to inspire future generations of care professionals and teachers in working with people with disabilities. It was the outcome of a collaboration between two university departments (Schools of Nursing and Education), a centre for independent living (CIL), two social enterprises, oral history consultants, and a local school for children with severe learning difficulties. It captured 30 years of local history (1960-1990) in a permanent digital record of the DRM and produced a school resource pack to enhance public engagement and inform university and school curricula.

Identifying the Linguistic Profile of Persistent Foreign Language Learning Difficulties: a Chinese Case Study

The present case study investigated the possible source of persistent English learning difficulties of a Mandarin-speaking adult learner of English as a foreign language. The case, Jo, a sophomore student receiving over 10 years of formal English education in Taiwan, demonstrated severe learning difficulties in a compulsory English class. The present study compared his linguistic coding abilities with those of two control participants, his university peers and elementary third graders. The first comparison showed that his English phonological/orthographic awareness, vocabulary, and syntax were at the same level as or lower than the 25th percentile of his university peers. To make sure that his deficiencies in English coding were not simply the result of a developmental delay in English learning, the second comparison examined his Chinese coding ability, along with English, in relation to that of third-grade elementary school children. The second comparison revealed that Jo also scored at the lower end of the distribution formed by the third-grade children in phonological memory, phonological awareness, and vocabulary, not only in English but also in Chinese, indicating that Jo’s linguistic coding difficulties were not specific to English. These results suggest that Jo’s English learning difficulties might be a result of a more general deficit in linguistic coding, which affects both English and Chinese learning.

Cinemimmunology-the use of cinema to learn immunology

Abstract Film can be a powerful educational tool known as cinemeducation. We at College of Pharmacy applied this universal learning method to the first year pharmacy class of basic immunology. Two workshops were introduced to the course and the student’s assessment pre- and post-workshop were analyzed. We used two Hollywood blockbuster movies, i.e., The Incredibles 1 and 2 to enhance first year pharmacy students to grasp concepts of basic immunology. The students watched movies. The main plot was that the immune system is like a family with dad, mom, girls, boys and babies. Giving due credit to Brad Bird, the writer and director of The Incredibles. In his words (changed within brackets)-quoted as follows: The characters of “The dad is always expected in the family to be strong, so we made him (T cell) strong. The moms are always pulled in a million different directions, so we made her stretch like taffy (B cell). Teenagers, particularly teenage girls, are insecure and defensive, so we made her turn invisible and turn on shields (Antibody). And ten-year-old boys are hyperactive energy balls. Babies are unrealized potential. So, we made babies as cytokines.” Our results showed a significantly enhanced conceptual learning and long-term retention of immunological concepts. Even students with severe learning difficulties and disabilities who struggle with any kind of academic curriculum can often relate to film. It was also an example of associated learning using common movies with high yield of performance within a short period of time. We recommend the use of such strategies in immunology education. Commonly accepted education method is known as cinemeducation for imparting medical education and when we used it to teach immunology, we called it cinemimmunology.

Autonomy, rights and children with special educational needs: the distinctiveness of Wales

ABSTRACTWales was the first UK country to incorporate the UNCRC into domestic law and the first to appoint a children’s commissioner. Wales is distinctive in the strong links between education and the promotion of the Welsh language as evidenced in successive Welsh language strategies. With regard to children with special educational needs, the 2018 Additional Learning Needs and Educational Tribunal Act makes provision for children’s voices to be heard in their own right. This paper examines the complexities in hearing the voices of children with severe and profound learning difficulties (SPMLD), and how these can be addressed in the language context of Wales. It concludes that there are cautious grounds for optimism about our ability to hear the views of children with SPMLD, as long as we are prepared to acknowledge the resource implications. However, there is a need for more debate about the potential tensions between the Welsh language strategy and making provision for children with special educational needs in their preferred language. This debate needs to be informed by research on the impact of immersion education on progress, access to the curriculum and inclusion for children with SPMLD, and on their views about all aspects of their provision.

A case report: Sjogren Larsson Syndrome

Sjogren-Larsson Syndrome (SLS) is an autosomal recessive disorder with 100% penetrance. It has a characteristic set of clinical features, ichthyosis, spastic diplegia, and severe learning difficulties. To educate the patients about the treatment of dry skin and proper counseling regarding the genetic basis of disease are needed. The recent discoveries of the responsible biochemical abnormalities have explained the underlying links between the neurological and the dermatological manifestations. Its early diagnosis can help the physician to institute proper supportive treatment and possible curative gene therapy. Hence, ichthyosis cases must be investigated thoroughly. We report a case of 19-year-old Indian male patient with clinical features favoring the rare disease, Sjogren-Larsson syndrome (SLS).

School absences and exclusions experienced by children with learning disabilities and autistic children in 2016/17 in England

PurposeThe purpose of this paper is to examine data on absences and exclusions from school amongst children with learning disabilities and autistic children in England in 2016/2017.Design/methodology/approachData were drawn from Department for Education statistics for the school year 2016/2017 on school absences (authorised and unauthorised) and school exclusions (fixed-period and permanent) for children in the primary special educational needs categories of moderate learning difficulty (MLD), severe learning difficulty (SLD), profound and multiple learning difficulty (PMLD) and autistic spectrum disorder (ASD).FindingsAuthorised school absence rates were higher for all groups of children investigated compared to children without special educational needs, primarily due to illnesses and health-related appointments. Rates of unauthorised school absences were low. Rates of fixed-period and permanent school exclusions were higher for children with MLD and ASD compared to children without SEN, and lower for children with SLD and PMLD. Reasons given for exclusions were similar across children (persistent disruptive behaviour, physical assault against a pupil, verbal abuse against an adult), although physical assault against an adult was also commonly mentioned for children with SLD, PMLD or ASD.Social implicationsReducing school absences for children with learning disabilities and autistic children will involve co-ordination of health and social care support arrangements to ensure they are convenient and efficient for children and families. In terms of exclusions, schools need to consider the extent to which they are making reasonable adjustments for children with learning disabilities and autistic children.Originality/valueThis paper presents in one place statistics concerning school absences and school exclusions for children with learning disabilities and autistic children in England.