When is a Child with Cerebral Palsy Ineducable?

THE term ‘ineducable’ is applied by educationists to children whose intelli- gence is so limited that they are incapable of formal learning in the basic school subjects. Most of those responsible for advising on provisions for the teaching of children of limited intelligence do not like to draw a sharp line of demarcation between children who need special school provision and the ‘ineducable’, because various other factors as well as mental subnormality must be considered before deciding that a child is ineducable. Moreover, when children are deemed ineducable they are removed from the responsibility of an Education Authority, and the flexi- bility of movement and ease with which a child can be re-admitted to an Education Authority school varies from one Local Authority to another.

Experience suggests that a non- handicapped child whose intelligence quotient is below 55 on a test such as the Stanford-Binet, provided of course that the test conditions make it a reasonably valid estimate, is likely to prove incapable of receiving education at school and would be more suitably catered for in a Training Centre. It is the Local Health Authority’s duty to provide such centres for these children, but the adequacy of the provision still varies considerably* and the quality of the centres themselves is also very uneven. Where there are good Training Centres and Medical Officers whose

interest embraces these children as well as those in special schools for subnormal children within the school system, move- ment between these two typ2s of provision can remain flexible enough to gather the fruits of observation and experiment without much harm being done to the child who has been wrongly assessed.

The ‘other factors’ that should be taken into account when estimating the educability of children of borderline capacity include family background, emotional stability, relevant personality traits, social adjustment, and capacity to fit into a group without seriously disrupting the other children. It is not normally the practice to make a hard decision on such borderline cases until they have had a trial period in a special school for educationally subnormal children.

Because of their multiple handicaps, the decision regarding cerebral palsied children is far more difficult, since their handicaps vary widely both in range

* According to ‘Community Care of the Mentally Handicapped‘, published by the National Associa- tion for Mental Health in 1960, the following Local Authorities then provided 60 or more places in Training Centres per 100,000 population: Barnsley, Bradford, Dewsbury, Dudley, Exeter, Great Yarmouth, Ipswich, Kingston-upon-Hull, Leeds, Lincoln, Oldham, Rotherham, Stoke-on- Trent, Wolverhampton, York, Cardiff, Swansea and Isle of Ely. The following provided less than 10 places per 100,000: Cornwall, Hunts, Rut- land, Suffolk West, Sussex East, Yorks (East Riding), Anglesey, Brecon, Caernarvon, Cardigan, Merioneth, Montgomery, Pembroke, Radnor, Isles of Scilly, Barrow, Worcester and Merthyr Tydfil.

43 5

CEREBRAL PALSY BULLETIN Vol. 3, No. 5, October, 1961

and severity. As well as mental and motor handicap, many cerebral palsied children suffer also from defects of vision, hearing, sensation and speech, and perhaps from epilepsy as well. Sensory defects, and lack of normal sensori-motor experiences owing to unavoidable environmental restrictions, must contribute to the difficulty of making a true measure of a cerebral palsied child’s potential for learning. Such children learn more slowly than their normal fellows and require more time to consolidate what they have learnt. Inevitably, also, more of their time and energy is spent on other necessary forms of training, such as motor or speech training. The cerebral palsied child therefore requires an assessment period of at least a year before a final decision regarding educa- bility is reached, particularly if his physical handicaps are severe and if difficulties in communication make it impossible for him to demonstrate his capacity for understanding through his response to ordinary tests. During this assessment period any therapy that seems likely to help the child should be available to him. But the assessment centre’s staff should also include teachers trained and equipped to catch the moment of the child’s readiness for ventures into learning by extending his skills and experience through play and experimentation. Unfortunately, most training or occupation centres do not yet provide this kind of highly skilled staff.

Educability, in its strict meaning of capacity to profit by formal teach- ing in the basic subjects of reading, writing, spelling and arithmetic, depends

primarily on the child’s inherent intelli- gence. The Education Act sets the lower limit for an unhandicapped child at an I.Q. in the fifties, but educationists’ opinions vary regarding the intellectual requirements for cerebral palsy children. In her survey of 1952, DUNSDON~ found that among cerebral palsied children whose degree and type of difficulty prevented them from attending a school for physically handicapped children, 70 to 80 per cent were of an intellectual dullness which debarred them from benefiting from formal education. She maintains that, during the early school years, attention can be directed more profitably to the social and physical aspects of training than to formal education, and that if social and physical training is begun early enough it should be possible to differentiate, by the time the child is about 9 years old, between those who have made good enough general progress to enable them to profit from formal education and those who are unlikely to do so. By this time, intensive therapy should no longer be required, and children are better able to attempt formal work and make educational progress when their energy is not simultaneously being drained by intensive physical treatment. DUNSDON holds that cerebral palsied children suitable for such transfer would need an I.Q. of at least 85. SCHONELL~. however, would place the base line at I.Q. 70, and she urged that physical treatment and formal education should be combined.

These widely divergent views are both concerned with children whose potential intelligence, whatever their physical handicap, can be estimated with reasonable certainty, and who,

436

Vol. 3, No. 5, October, 1961 CEREBRAL PALSY BULLETJN

given suitable opportunities and teach- ing, are capable of making some progress in formal learning. Here, however, we are concerned with border- line cases lying in the uncertain no- man’s-land between this potentially teachable group and those whose low intelligence leaves no doubt regarding their capacity to benefit from formal education, however rudimentary. For cerebral palsied children, many more factors must be recognised and evaluated before deciding whether they are edu- cable. If there is any doubt, these children should be on trial for at least a year, preferably in an assessment centre, but otherwise in a school for physically handicapped children or with a home teacher. During this trial period three factors should help in assessing the child’s potential: (1) the extent to which he can be helped to establish communication with his world; (2) his capacity and inventiveness for circum- venting his own physical limitations; and (3) the extent to which his capacity for understanding has increased during the assessment period-a valuable in- dication of his developmental potential.

While the legislative distinction between educable and ineducable chil- dren continues, it would be a useful safeguard to retain even grossly handi- capped cerebral palsied children in the ‘Educationally Subnormal’ category until a long trial-even up to three years-has clearly established that they

are ineducable. Children for whom it is possible to demonstrate, even if only in selected areas of intellectual functioning, a level equal to an I.Q. of 60 would be included in this group. We must not lose sight of these children’s .essential need for time. To quote Dr. MARJORIE WILSON:~ ‘Many of these cerebral palsied children are years behind in social and physical experience and may (quite irrespective of their chronological age) need the infantile approach to learning, or may even be at babyhood level. Many of them will progress from this stage and show their true potential when they have been given the chance to start from scratch, in spite of their age.’ For a large proportion of these chil- dren a Training Centre will undoubtedly be the best provision, but until each Training Centre can be staffed with at least one trained teacher capable of providing suitable learning oppor- tunities for children with a wide variety of defects, it seems wise to retain this trial period. The difficulty of deciding whether a child is ‘educable’ or not- and much of its concomitant anguish --could be minimised by providing, wherever they are geographically possible, small nursery schools for the cerebral palsied, where there would be an opportunity for assess- ment under trained nursery school teachers in a more relaxed atmos- phere for both parents and children.

JESSIE M. WILLIAMS

REFERENCES 1. Dunsdon, M. I. (1952) The Educability of Cerebral Palsied Children. London: Newnes, pp. 142-144. 2. Schonell, F. E. (1956) Educating Spastic Children. London: Oliver and Boyd, pp. 113-114. 3. Wilson, M. (1955) The Placement of Cerebral Palsied Children. Address given at a one-day conference

on ‘Cerebral Palsy: the Present Position and Future Possibilities.’ London : British Council for the Welfare of Spastics.

437