Teaching children with PMLD is an extremely rewarding, but challenging profession. These wonderfully unique pupils have a high level of need in all aspects of their life and our understanding of how to support them and ensure they thrive is constantly evolving. Here we are going to explore what PMLD is and how we can adapt our teaching and support styles to support each area of their development.
What is PMLD?
Profound and Multiple Learning Disabilities (PMLD) refers to a child who has more than one learning disability. PMLD is sometimes also referred to as complex medical needs, as many children also have medical conditions which can be caused by genetics or be a hereditary condition. Children with PMLD often have major impairments in many aspects of their lives and may require a high level of support in their every day activities.
The causes of PMLD are many and varied and could include ante-, peri- or post-natal complications, genetics or an acquired brain injury following an accident. It is estimated that there are 16,000 people in the UK living with PMLD.
The compounded impact of a profound intellectual disability combined with other disabilities is multi-faceted and pervasive, so these individuals will require support with most or all aspects of their life. All pupils, however, have the capacity to participate in everyday life in a way which is personalised to their needs and abilities, to benefit from good health care and education and are able in various ways to communicate their satisfaction or otherwise with their quality of life.
Addressing Educational Needs of Pupils with PMLD
A school should obtain multiple viewpoints from educational, psychological and medical staff when planning the pathway for a child with PMLD. Children with PMLD, like with any additional needs, will continue to learn and grow throughout their lives if given the proper support and care and early intervention is key. By offering early support, you can help children build on their early developmental skills such as learning the concepts of cause and effect. It is important to keep in mind that these children have learning disabilities, and so may be slower to fully grasp concepts and may need to repeat them multiple times. Therefore, the earlier you can start an individualised education for the child, the better.
Communication Needs;
Children with PMLD will often have limited communication skills, and many will be non-verbal. They may also struggle in understanding what is being said to them and how to socially interact with others. How each child communicates will be different, so it is worth trying various techniques to find one that works for them - bare in mind it may take a lot of trial and error!
Here are some ways you can practically support the communication needs of pupils;
Use lots of facial expressions, various tones of voice and body language
Speak in simple language, using short sentences that convey key words or requests
Speak with others who are familiar with the child since the child may be communicating through facial expressions or body language
Find a communication method that works for each child (PECS, Makaton, AAC, Eye Gaze)
Use visual aids appropriate for their sight ability
Allow extra time for the child to respond to you
Physical Needs;
Not all children with PMLD are wheelchair users; some can walk around and be perfectly mobile without assistance. Other children may be mobile but could be prone to falls or need support with longer walks due to low muscle tone. Many children will require specialist equipment to support their physical needs and protect them from injury, but also to improve their overall quality of life. Most schools who cater for children with PMLD will offer physiotherapy, occupational therapy and/or hydrotherapy and be fully kitted out to safely move students around school and access all activities.
Here are some ways you can practically support the physical needs of pupils;
Always talk through the steps you are taking when moving a child to ensure they are involved in the process. For example, "We're going on to the mats now, Joe, so we will be using your sling."
Gently assist in positioning and mobility - laying, sitting, standing, moving
Use safe manual handling techniques
Support with regular physical exercise and movement
Support children in holding various objects in their hands to aid fine motor skills
Health Needs;
As already mentioned, many children with PMLD will also have complex medical needs that can impact on their day to day functioning. They may require technology dependent equipment such as oxygen tubes, PEG feeding ports, or suctioning. As a result, children are often extremely susceptible to a number of health difficulties such as chest infections or the flu and since they have limited communication skills, it is important to recognise when a child is displaying different symptoms than usual.
Here are some ways you can practically support the physical needs of pupils;
Learn signs to recognise pain or illness and how this can be managed
Ensure health and wellness checks are performed on a regular basis
Don't make assumptions about a child's health
Keep an eye on a child's dental and oral hygiene, weight and skin condition
Ensure that the child is following a healthy eating plan
Sensory Needs;
Children with PMLD may have visual or hearing impairment, or a combination of the two. Some children may also be hypo- or hypersensitive to touch so therefore, 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.
Here are some ways you can practically support the sensory needs of pupils;
Ensure lessons are sensory based and can appeal to each child based on their individual need
Make sure that visual aids are available
Have a variety of sensory toys, lights, and materials all around the classroom
Behaviour Needs;
As a result of their needs, some children with PMLD can show challenging behaviour such as pushing, biting, or hitting. As we know, behaviour is a form of communication and these behaviours may be a way of displaying their desire to interact with others or as a call for attention because they are feeling a certain way and they need to express it. For example, running around in class may indicate boredom or hitting their face may indicate a headache. Other behaviours, especially repetitive ones, will be more of a comfort for them.
The most important thing to remember and to understand is that behaviour is communication and that we should respond appropriately. Look for the causes of the behaviour and if you spot any trends, note them down and you can then use this knowledge to prevent any future environments where a child may become distressed.
Teaching children with PMLD or complex needs requires a lot of creativity, awareness and compassion. The curriculum will need to be completely adapted to meet the individual needs of each child and there are many ways in which this can be done in order to create a learning environment where each pupil can thrive. This type of education requires a lot of knowledge and skill and often teachers and TA's do not get the credit they deserve.