Memorandum from Scope (EY 45)
Scope's response to the government's Action
Programme "Meeting Special Educational Needs" welcomed
the emphasis on quality early years educational provision.
Research suggests that early intervention programmes
are of particular relevance to infants with cerebral palsy (cp).
Early years education for children with cp provides opportunities
for the early identification of additional educational needs,
and early intervention.
It also provides an early opportunity for the
vital involvement of parents in the educative process. Parents
often are the experts on the way cp affects their child. It is
important to talk to them to find out as much as possible before
the child joins a group.
Scope supports the Disability Rights Task Force
recommendation (4.3) that "Both the National Curriculum and
the Early Learning Goals should continue to reflect the needs
of children with Special Educational Needs".
Scope's wide-ranging professional expertise
marks us out as a potential partner in developing good practice
guidelines for the provision of the means to enable communication
and for ascertaining the views of children with communication
difficulties, including those using non-verbal means of communication.
A more child-centred approach must take into
account the ascertainable wishes of the child. Disabled children
must have the right to early, pre-school provision of alternative
and augmentative communications systems when the need has been
Improved provision requires improved training.
Involvement of all providers, public and private,
local authority social services, education services, relevant
voluntary organisations and parents in effective and equal partnership
is vital for early years inclusion to work.
The section "Including the pre-school child
with cerebral palsy" outlines some specific difficulties
faced by pre-school children with cp.
The Liverpool Early Years Centre illustrates
the opportunities and challenges of an inclusive pre-school environment
which empowers children by providing choices and promoting independence.
"Children are children first". But disabled children
often miss out on these critical early years because not enough
thought has been given to the rights of the disabled child.
Two case studies provide evidence for the need
for inclusive early years settings.
Conductive Education is presented as one of
the options available for meeting the needs of children with cerebral
palsy and their families.
1.1 Scope welcomes this opportunity to contribute
to the Education Sub-Committee's inquiry into aspects of early
years education. Scope is a member of the Special Educational
Consortium (SEC) which is submitting a separate document based
on a wide range of policy issues around early years, agreed through
an ongoing process of discussion and consensus-building. Our own
paper aims to highlight some of the specific issues concerning
disabled pre-school children, particularly those with cerebral
palsy (for more information on cp, please see Annex 1) (Not printed).
1.2 Early years education is important as
it provides an opportunity for the early identification of additional
educational needs, and an opportunity to start tackling them as
quickly as possible. It also provides an early opportunity for
the vital involvement of parents in the educative process. As
more children with very complex disabilities (who may have multi-sensory
disabilities, severe and physical disabilities) are surviving,
there is a challenge to meet their needs on a local basis, with
access to regional and national specialist multi-agency support
and advice where necessary.
1.3 The Department for Education and Employment
consultation document "Meeting Special Educational Needsa
programme of action" of November 1998 promised that the government
would improve the support and advice for parents and carers by
providing "high quality early years education and childcare".
It would also encourage "earlier identification of difficulties
and appropriate early intervention", for "children with
physical disabilities, sensory impairments, severe learning difficulties
or speech and language impairments" when their special needs
are first suspected. Early Excellence Centres would give "priority
to multi-agency support for children with SEN and their parents".
1.4 In her analysis of ten evaluation studies
of educational interventions for infants and pre-school children
with cerebral palsy, senior educational psychologist Lisa Woolfson
concluded that "Early intervention programmes are of particular
relevance to infants with cerebral palsy because motor difficulties
can limit the sensori-motor experiences available to them, affecting
subsequent learning and developmental progress. Helping these
children access the learning experiences normally available to
non-disabled infants would seem to be an important intervention
1.5 In Scope's response to the Action Programme
we welcomed the emphasis on quality early years education and
support for parents, and the principle of early intervention and
identification of difficulties. We also highlighted the Schools
for Parents Network which, in conjunction with local authorities,
provides opportunities for early intervention and demonstrating
excellent early years practice.
1.6 Given our wide-ranging professional
expertise, Scope is well placed to be involved in developing good
practice guidelines for providing the everyday means to enable
communication and for ascertaining the views of children with
communication difficulties. This includes the highly specialised
expertise within Scope of working with disabled children who use
non-verbal means of communication, and with their parents. Scope
also has a strong child protection policy backed up by a wealth
of experience and in-depth training.
1.7 The Disability Rights Task Force recognised
that "the increasing provision of childcare together with
education for under fives is ... problematic. Childcare is already
covered by Part III of the DDA [Disability Discrimination Act]"
and it "did not wish to see some providers subject to two
different pieces of disability legislation whilst providing complementary
activities" and "recognised that work needed to be done
to determine where the dividing line should be so that providers
were left in no doubt to which legislation they were working".
1.8 Scope strongly supports the Disability
Rights Task Force recommendations (4.3) that "Both the National
Curriculum and the Early Learning Goals should continue to reflect
the needs of children with Special Educational Needs".
1.9 A key requirement for improved provision
is improved training. There is a need for qualified personnel
with appropriate qualifications and adequate rates of pay, and
for a quality environment. Qualified staff can make a difference
through an early analysis of children's strengths or additional
1.10 Involvement of all providers, public
and private, local authority social services, education services,
relevant voluntary organisations and parents in effective and
equal partnership is vital for early years inclusion to work.
2.1 From the moment of birth, or very soon
after, the child with cp has very different learning experiences
than his/her non-disabled peers. Babies experience a short, frustrating
period of helplessness quickly followed by an increasingly active
exploration of their world. They experience their world through
lying, sitting, reaching, rolling, crawling and standing. In a
few short months they are up and away.
2.2 Babies born with cp do not explore their
world independently at the same times as their peers, if at all.
Many, in addition to the physical difficulties, also have altered
perception of space and altered sensations of touch. The picture
they build of their world may well be a very different one than
others of their age.
2.3 The pre-school setting commonly understands
the needs of a broad range of children. Staff are used to realising
the potential of the bright, articulate and confident alongside
nurturing the sensitive, quiet and slow. Staff will quickly identify
the child who regularly plays in a garden and the child who is
used to playing in a group. Those who work in pre-school settings
feel confident with these differences and even biting, snatching
and tantrums are coped with calmly and positively.
2.4 When a small child with cp joins the
group staff will have little or no previous experience to draw
on and will be unsure of their ground. The reassuring thing is
that they already have a broad range of experience and this will
form a firm foundation. Knowledge will bring confidence.
2.5 Four out of ten babies with cp have
other difficulties. Some children have great difficulty unscrambling
the messages they receive from their eyes. This is associated
with damage to the cortex. In the most severe cases the child
may appear blind but more commonly she will have difficulty making
sense of pictures or writing.
2.6 Many children have difficulty with spatial
awareness. If they are walking or moving their own wheelchair
this may mean they bump into things and cannot judge the speed
of care as they cross the road. In the group they may find it
difficult to judge how much space they need and may "push
in". When they are asked to hold the image of a shape in
their head they may find this very difficult. E.g. "Imagine
a square and tell me how many sides it has got". This becomes
even more difficult when the shapes are three dimensional like
cubes or pyramids.
2.7 It is important to be able to recognise
early communication skills and the need for targeted therapy for
children. If a more child-centred approach is to be developed,
taking into account the ascertainable wishes of the child, they
must have the right to early, pre-school provision of alternative
and augmentative communications systems when the need has been
2.8 Hearing difficulties are most commonly
associated with the athetoid form of cp but it is important to
remember that colds and glue ear affect all children. Many children
are sensitive to sounds and startle at loud noises. Usually they
become more tolerant of noise as they become used to the group.
2.9 Speech problems may result from difficulty
in getting messages from the brain to the tiny muscles of the
mouth and tongue or may come from actual abnormalities in the
speech centres of the brain. The advice of a speech therapist
is vital to suggest the best way to help the child communicate
and also give advice if there are chewing or swallowing problems.
Alternative forms of communication
2.10 Most children will use speech to communicate
but some will need an alternative form to either help them make
their meaning clear or as their best way of talking. If the child
gets his speech aids early it can help reduce frustration. Using
a speech aid will never prevent speech and it can help the child
take part in group work and shout out with the others. Speech
and language therapists will help to recommend what the child
needs. Pictures and symbols are also useful and fit into the pattern
of pre-school life. The child with fine motor difficulties may
need to be assessed as to how he will use the computer. Switches
may be large for the hand or small for the knee or head. Most
children who have fine motor difficulties will need to rely on
computers as they go through school and need to use them from
the earliest age.
2.11 Early communication difficulties may
be symptomatic of a learning or other disability, and an approach
which would merely tackle the communication difficulty would be
ineffective without addressing the child's wider needs.
2.12 Epilepsy affects three out of ten children
and is usually well controlled. The medicines themselves may affect
the child's behaviour and learning and the likely effects should
be recognised. Where children may have a "fit" in the
group it is important to reassure staff by doing a thorough risk
assessment and gaining confidence in how it will be handled.
Other factors affecting learning
2.13 Many youngsters with cp have odd sleep
patterns that can affect their readiness to learn. They will be
frustrated by their disability and may be angry.
2.14 Many children, even those with average
or above average ability, will have difficulty with speaking,
reading, drawing and mathematics. When the children are young
it can be difficult to know whether the learning difficulty is
because of ability or because of the barriers. It is important
to spend time observing the child in different situations: eg
watching the eyes, watching for signs of anticipation, realising
when s/he gets angry with him/herself when unable to complete
her task. These signs will help gauge the level of ability.
Support for parents
2.15 Each child is an individual. In most
cases the parents have already become the experts on the way cp
affects their child. It is important to talk to them and also
the therapists or other carers to find out as much as possible
before the child joins the group. It is vital that staff other
than the child's support assistant become confident in handling,
positioning and communicating with the child. A child may visit
the group without this happening, a child may be made welcome,
but for the child to be included everyone has to feel confident.
3.1 Liverpool Early Years Centre (LEYC)
provides a nursery in which disabled and non-disabled children
play and learn together. LEYC is supported by funds from Liverpool
City Council for a maximum of 40 children per day (20 disabled,
20 non-disabled) from the ages of 18 months to five years. They
enjoy an integrated environment which aims to meet the physical,
emotional, educational and social needs of all the children who
3.2 Referrals for non-disabled children
are via social workers and health visitors, and for disabled children
also through other health professionals.
3.3 All the children are deemed as "in
need" as defined by the Children Act 1989.
3.4 The nursery has undergone many changes
in recent years to keep abreast of current Government initiatives
as outlined in its Early Years Strategy, and is currently working
towards inspection by OFSTED, whilst in receipt of the Government's
funding for three and four year olds.
The need for training
3.5 Physical disability is a very complex
area. The spectrum of physical disability is wide and varying
causesphysical, neurological, metabolicproduce very
different and changing educational needs. Staff need to be aware
of this complexity and have some knowledge of the mechanisms of
motor education and the speech and language needs of children.
Standardised accredited assessment of their acquired competencies
could be developed into recognised qualifications.
3.6 LEYC has identified training as an area
in which there are huge gaps. These need to be addressed during
the initial training period for early years workers, supported
by an ongoing training programme for all qualified staff in order
to ensure that practice is current and relevant.
3.7 Through the links the LEYC has established
with Liverpool's Early Years Development and Childcare Partnership,
the Centre has been able to access additional training for staff,
specifically in the area of curriculum planning.
3.8 training is an important issue in regard
to staff working with children with additional needs. The content
of related topics in current training courses for Early Years
Practitioners is minimal and does not prepare an individual for
work with a child who may have complex needs.
3.9 The LEYC believes that an additional
period of six to 12 months' specialised training, aimed at staff
who wish to work with children with additional needs, and one
which would provide a further qualification would address the
issue. The current Diploma in Nursery Nursing is a two-year full-time
course and is still one of the most widely recognised by employers.
The emphasis on educationconcerns
3.10 The LEYC's concerns and that of many
of their colleagues working in other Early Year settings is that
the emphasis on "education" is overriding all else.
3.11 "Education" and "teaching"
need to be considered in the broadest possible sense. It is critical
that whilst practitioners are ensuring that children are achieving
their "goals" they do not lose sight of the importance
of preparing a child emotionally and spiritually for their journey
3.12 With the changes in inspection arrangements
it is critical that Early Years inspectors have the skills and
experience that matches the diversity of settings they will be
required to inspect, from voluntary playgroups through to maintained
nursery schools and classes.
3.13 There is concern over the perceived
pressure on the smaller voluntary groups to either "conform"
or "close". For these groups the majority of which are
non-profit making, possibly relying in small grant aid from the
Local Authority, their existence is about providing a service
which enables parents and carers and children to have a choice.
With limited funds and equipment, staff by dedicated volunteers,
small local playgrounds offer an alternative to large nursery
classes and schools.
3.14 Parents/carers of pre-school children
who also have a special or additional need face considerably more
challenges and difficulties than the parents of a non-disabled
3.15 The most common route for a child into
education is via parent/toddler group, playgroup, nursery class,
and finally school. This is often not an option for a disabled
child. Ignorance and fear of inexperienced workers can block a
child's passage into school as much as the hospital, physio, speech
and occupational therapy appointments that need to be kept. This
disruption can mean that even the brightest child does not progress
in the recognised way. The LEYC believes that the DfEE has not
sufficiently recognised this problem.
3.16 Disabled children need individual learning
goals. They also need good Early Years workers who are experienced
in devising individual learning programmes and can develop these.
Using a baseline assessment format as the starting point, and
taking the child's stage and level of development into consideration,
means that evidence of all the child's progress can be recorded.
3.17 It is important that children have
access to appropriate and timely provision whether or not they
have a Statement of Special Educational Needs.
3.18 With a limited choice of providers
it means that some disabled children do not access any form of
play and learning environment until their statement of educational
needs is complete. For the fortunate ones this may happen when
they are as young as three, but LEYC's experience is that many
children are not afforded this luxury.
3.19 LEYC currently has a waiting list of
eleven disabled children aged between 13 months to four years.
To bring any of these children in, other children need to move
on. Of the 16 three and four year olds currently on register 11
are disabled children who are awaiting statements. All of these
children have been referred to the LEA, but with a depleted and
over worked educational psychology department the children are
waiting considerably longer than the recommended time as stated
in the Code of Practice.
3.20 These children can neither move into
a mainstream or specialist nursery without their statements.
3.21 The children who attend LEYC are fortunate.
It offers an environment that empowers children by providing choices
and promoting independence. There, it is recognised that all children
are individuals and that their needs are different.
3.22 Its dedicated staff are experienced
in working with children from a variety of backgrounds, often
with very complex needs. They recognise that children are children
first. Without a stable environment that nurtures and stimulates,
children of any age cannot learn.
3.23 Unfortunately not all disabled children
are as fortunate. Far too many miss out on these critical early
years because not enough thought has been given to the rights
of the disabled child. Authorities use the "non-statutory"
provision as a means of escape. Concerns exist that this could
be an argument for the lowering of the formal school age. And
some regard this as the wrong way to address the issue. Quality,
choice and access of provision should not relate to whether or
not it is a legal requirement of a local authority to provide.
3.24 The following examples provided by
the Liverpool Early Years Centre show how disabled pre-school
children are disadvantaged by the current procedures.
S.born January 1995
Recently moved into the area from abroad. Formal
request for statutory assessment 15 June 1999.
To date (January 2000) the final statement is
not complete and no offer of an appropriate school has been made.
(Recommended timescale for this: 26 weeks).
If S. had not attended the LEYC there would
have been a considerable lack of continuity and support for her
and her family.
S.'s parents could not just enrol her in their
local primary school.
The local playgroups did not feel confident
in their ability to meet S.'s needs, also she would not have been
with her age/ability related peers.
C.born April 1997
C. has a rare syndrome causing significant respiratory
problems. She has a tracheotomy.
The LEYC arranged with the Local Authority,
on the parents' behalf, an additional worker who was trained and
confident in the management of C.'s condition.
This enabled her to attend her local playgroup
as her older siblings had done. It was not therefore necessary
for her to be transported out of the area to attend the LEYC nursery.
This arrangement took nine months to arrange
and was funded through the Social Services Department.
4.1 As one of the options available for
meeting the needs of children with cp and their families, Scope
has been supporting the development of Conductive Education. Originating
from the work of Andras Peto in Budapest, Hungary, almost 50 years
ago, Conductive Education is a system of learning appropriate
for people with neurological disorders such as cerebral palsy.
It is a learning process and not, as has been described, treatment,
therapy or exercises. It takes a holistic approach and aims to
teach individuals skills which are needed to meet the challenges
of everyday life.
4.2 As part of developing this option, Scope
in partnership with Budapest set up Peto (UK) in London in 1992,
to provide assessments and follow-up courses for families of children
with cp aged 0-14 years. It also works in partnership with Keele
University and Budapest to provide training for teacher/conductors
at Keele, and has pioneered a "Schools for Parents Network"
in England and Wales, with now almost 40 Schools for Parents.
Within its own direct services Scope currently maintains two special
schools that offer Conductive Education (Ingfield Manor in Sussex,
and Rutland House in Nottingham).
16 Dr Lisa H Woolfson (1999) "Educational interventions
for infants and pre-school children with cerebral palsy: methodological
difficulties and future directions in evaluation research",
European Journal of Special Needs Education, Vol 14, No 3 (1999),
From exclusion to inclusion, a report of the Disability Rights
Task Force on civil rights for disabled people. December 1999,
This section is based on an article by Lindsay Brewis, a Scope
Education Officer (1999) "Including the child with cerebral
palsy", Practical pre-school, Issue 16. Back
In 1999, the number of under-fives with Statements was more than
8,500 (DfEE News Release 186/99 28 April 1999). Back