Some children are bestowed from their first months with a whole bunch of labels about disability. I worked in the UK in the 1990s with many such babies and young children in a combined early interventionist and keyworker role. Some of these children and families had support from a children’s hospice and this brought me into contact with a movement I admire greatly.
In this work I met infants with diagnoses (confirmed or unconfirmed) of cerebral palsy, hearing impairment, vision impairment, learning disability and autism occurring in some combination and all impacting on the child’s learning. I am not going to suggest these children are not severely challenged in how they live and learn, but I am suggesting we might re-think, to their advantage and to the advantage of people providing education and therapy, the term ‘multiple disability’ which is too often applied to their condition.
Less effective interventions
In this article I am going to argue that thinking in terms of a child having multiple and separate disabilities has lead us all up the wrong track with the result that we offer them inappropriate interventions – or offer our interventions in ways that are less effective than they otherwise might be for the child’s learning.
Suppose we have a baby with cerebral palsy and impaired vision. Reaching for a bauble brings the dual challenge of keeping some focus on the moving bauble and directing the arm and hand in that direction. As, over the hours or days or months, the child notches up more and more successful hits, so a neural pathway develops for hand/eye co-ordination. The pathway is useful and relevant to the child’s life and is strengthened by practice. For most children it will later be incorporated into more advanced skills requiring use of hands and eyes together.
The neural pathway for making contact with the bauble is a success story about ability and will surely be celebrated by those who witnessed its emergence. It is a single neural pathway connecting hands to eyes and does not have within it any elements of visual impairment or posture/movement disability. This new pathway brings together all the shoulder/arm/hand skills and all eye movement and focus the child could muster for this important activity. The new learning has transcended impairment and shown that there is no ‘multiple disability’ in a child’s development and learning. The learning child is fusing together her abilities as she develops new understanding about her world and new skills in manipulating it.
While we remain stuck in thinking about ‘multiple disability’ we continue in some countries to provide for each child a group of separate discipline-specific professionals to cater for posture and movement, vision, hearing, language, hand function, cognition, behaviour and so on. Even when a child’s complement of professionals is incomplete for some reason, we still aspire to one professional for each diagnostic label as the ideal. In my experience this attitude is dominant in the UK, USA, Canada, Australia and many parts of Europe.
Multifaceted condition
Logically, my argument against separate multiple disabilities must proceed towards integration of our teaching, therapy and play interventions in anticipation of their inevitable fusion in the child’s neurology as new understanding and skills develop. If we could move our thinking from the child with ‘multiple disabilities’ to the child with a single and unique ‘multifaceted condition’, then we might be inspired to work together on a multifaceted approach to each child’s development and learning. This multifaceted approach would anticipate each child’s success in building neural pathways that bring together abilities in posture, movement, vision, hearing, cognition and all other interconnected elements of a young child’s global functioning.
Recognising that teaching and therapy interventions for some disabled infants can best focus on a single multifaceted condition can provide a different mindset for service providers in countries where resources are severely limited. The traditional UK approach in which a handful of separate professionals each work directly with a child is counter to a whole-child approach, is very expensive and falls far short of the creative and imaginative response these children and families deserve.
Any discussion around this topic would be welcomed. Please contact Peter if you would like a (free) PDF of his essay, ‘TAC for the 21st Century: A unifying theory about children who have a multifaceted condition’
Peter Limbrick established and directed a voluntary organisation called One Hundred Hours in the UK in the 1990s. Its purpose was to develop and validate keyworker support for families whose baby or young child had neurological impairment and consequent multifaceted disability. From this experience Peter developed and published TAC Team Around the Child (TAC) model and has since promoted this approach in England, Scotland, Wales, Northern and Southern Ireland, Sweden, Australia and Canada. Peter’s new book, Horizontal Teamwork in a Vertical World: Exploring interagency collaboration and people empowerment describes in detail how TAC principles can be used to join services together for people of any age and need who are supported by two or more agencies at the same time.From his home on the border between England and Wales he writes, publishes and continues his international consultancy to promote interagency collaboration.
peter.limbrick@teamaroundthechild.com
http://www.teamaroundthechild.com
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