Profound and multiple learning difficulties


Peter Imray on the support required by learners with profound and multiple learning difficulties (PMLD) and complex learning difficulties (CLD).

In addition to profound learning difficulties, learners may have other significant difficulties such as physical disabilities, sensory impairments or severe medical conditions. Learners require a high level of adult support, both for their learning needs and also for their personal care.

■ For those with a profound learning difficulty, learning is best done when the learner is placed at the centre of the curriculum.

By placing the learners in control by giving them an environment that they can understand and they are allowed to keep changing in order to encourage development. They are likely to benefit from engagement across all senses and will need a curriculum which recognises that all learners will to a greater or lesser degree, have difficulties with object permanence, contingency awareness, declarative communications, making choices, learning by imitation and following instruction. Learners generally communicate by facial expression, body language and other non-verbal methods.

Barry Carpenter and colleagues are persuasive in their insistence that the burning question for teachers in the twenty-first century is how to engage learners, and this process of engagement must be at the heart of any curriculum development. For those with a profound learning difficulty, learning is best done when the learner is placed at the centre of the curriculum and where every moment and situation is regarded as a learning opportunity. It may be argued for example, that necessities like toileting and positional changes directly impinge upon schools’ ability to educate, since doing them efficiently, safely and with care and consideration, takes up so much of the working day. These are, however, precisely the areas of learning which challenge us to use learning time effectively.

Classroom Organisation
An essential part of engagement is to recognise that the complexity of their learning difficulties will mean that learners with PMLD cannot, and do not, learn effectively when taught in a compartmentalised and piecemeal manner. In practice, this means that we have to aim for as much consistency and continuity as possible, not just in what we teach, but how we teach and who is doing the teaching. With this in mind, I strongly recommend that the school organises its days around specific Class Groups taught by the same core staff of Teacher and TAs, and seeks to hold these Class Groups together over time.

Breadth and Balance
“Education should not and must not be tokenistic just for the sake of ticking a box. For those with PMLD, time in education is limited and precious, and we are duty bound not to waste it”.

While I accept the desirability of providing a broad and balanced curriculum, it must be wholly appropriate to the needs of each learner. Ongoing assessment may point to a need for concentration and intensity in one or two particular areas for some learners for a part, and sometimes a considerable part of their time in education. A learner might, for example, like people and enjoy spending time with them, but have not yet learned how to take the initiative in engaging with another person.When left to her own devices, the learner might have a tendency towards stimulatory, repetitive self-injurious behaviour such as biting her own hand, and staff might therefore consider it essential for the learner’s wellbeing to teach her to positively and clearly indicate that she wants to spend some time with another person(s). In this instance, I argue, it is absolutely essential that we narrow the curriculum offered to this particular learner in order to give her the maximum amount of time for learning, recognising that someone with PMLD may need hundreds and perhaps even thousands of opportunities to learn what for others might be a simple skill.

Transitions will always be a key part of all learners’ lives at any educational establishment and they are always bound to be challenging whoever you are. For someone with PMLD however, when so much emphasis has to be placed on staffs’ deep and intimate knowledge of the learner, transitions can be fraught and anxiety inducing times.There are of course major transitions such as to a new school, a post-19 college, a community care setting, a residential setting, a hospital stay, and in these situations it will be essential to pass on the learner’s Personal Communication Passport and timetable. We also however, need to look to less obvious transitions, such as to a new class or a new class team or a new therapist and the even more mundane transitions to different teams of staff at break times, lunch times, or home times, when at least the learner’s passport will be handed over.

Peter Imray
Author: Peter Imray

Peter Imray
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Peter Imray has worked in education for nearly 30 years, and is Director of Developments for the Equals charity.



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