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Moderate learning difficulties and inclusion: the end of a category?

Brahm Norwich

School of Education and Lifelong Learning

University of Exeter.

Paper presented at the British Educational Research Association Annual Conference, University of Manchester, 16-18 September 2004

Introduction and background

The term moderate learning difficulties (MLD) was introduced formally in the Warnock Report (1978) to replace the term for a group identified as being educationally sub-normal to a moderate degree (ESN(M)). The ESN(M) term was introduced in 1945 as one of eleven categories of educational handicap. Prior to this other terms (mental deficiency, mentally defective, feebleminded, mentally retarded, backward and slow learning) were used to refer to a group of children who have been widely seen as constituting the largest group of children designated as having special educational needs.

The term MLD sat uneasily alongside the Warnock framework for identifying children’s individual need for additional or different provision based on their learning difficulties. One of the main reasons for the Warnock recommendation to abandon categories, like ESN(M), was that categories did not indicate specifically what provision was required for the individual child. Nor did they take account of a child’s other characteristics, perhaps significant assets, nor of the child’s context, which might be supportive or inhibiting of their learning. Another reason was that categories like this became negative labels that were associated with stigma and personal devaluation. So, the concept of special educational needs was built on the assumption that special provision would be based on an individual needs assessment and that decisions about provision would not be in terms of general categories of difficulty or disability. A key concept introduced by the Warnock Report was the ‘continuum of needs’, such that those with SEN could not be distinguished clearly from those without SEN. There was no definitive basis for a general qualitative difference. This thinking still underpins the current system of identifying children with SEN and decision making about suitable educational provision.

Despite this, the Warnock Report and subsequent Government guidance, still made use of general concepts, but replaced terms like ESN with softer, less negative sounding terms, such as moderate and severe learning difficulties. The term MLD, which is a derivative of the term learning difficulty shares some of the benefits of this latter term. Learning difficulties does not mark out a group as different with as much negative connotation as the term educationally sub-normal. Learning difficulties is an inclusive term in that we all share difficulties in learning to some degree at some times; it is a term well suited to the continuum concept. However, the MLD term has come to be used as a general category. In this sense, its use has perpetuated aspects of the previous term ESN(M) in its use to distinguish one group of children from others with SEN, for example, severe learning difficulties or specific learning difficulties, as well as distinguishing the MLD group from those without SEN.

About twenty years ago Sally Tomlinson questioned the status of the concept ‘educational sub-normality’ on the basis that it was socially constructed rather than ‘being an innate quality within the child’ (Tomlinson, 1982, page 2). From a sociological perspective she aimed to question the status of this category and ask how some children came to be:

“excluded from important institutions of ‘normal education’, and included instead in a category which for historical reasons carries a stigma of inferiority and difference” (page 3).

Tomlinson rejected the view that this group of children presented educational characteristics that could be identified and assessed objectively with tools of diagnosis, like the IQ test. This was partly on the grounds that the ESN category had a disproportionate number of children from manual working class backgrounds and that in the 1960s there had been a disproportionate number of children from Afro-Caribbean background being sent to ESN(M) special schools. Her case was based partly on an analysis of how different professional groups defined the ESN(M) category. The underlying issues that she was dealing with continue to present issues for education and social policy and practice more generally.

Though the MLD group is widely recognised to be the largest group within those with special educational needs (Fletcher-Campbell, 2004), it is an area which attracts less interest by educational researchers and social scientists than others, such as, specific learning difficulties (dyslexia), emotional and behaviour difficulties and autism, for example. It is a poorly defined area of special educational needs and it is contentious whether it is rightly considered to be a special educational need in many respects.

At the root of these issues are questions about whether these children are more like those with sensory and motor impairments, where there are identifiable organic impairments, or more like those children whose school attainments are below and well below average. There is the view that these children come to be identified once they have started their formal schooling, unlike those with sensory, motor and more severe intellectual difficulties. This might indicate that there is something about their difficulties in learning which are specific to the demands made by the mainstream school. As educationalists and special educationalists have noted for well over a century, the predominant feature of this group is that they come from lower socio-economic class families. This was the basis for Tomlinson’s critique of the ESN category which argued that the so-called ‘dullness’ was being attributed to children from manual working class backgrounds. She argued that this implicated the wider social functions of schools and the role of schools in industrial society. Special schools for the ESN were seen from this sociological perspective to have various functions. One was to assist the smooth functioning of mainstream schools by acting as settings to receive those who were troublesome and difficult to teach. The second function was to legitimise the segregation and labelling of those who did not fit the mainstream and prepare them for low socio-economic positions in society, which has been called the ‘transmission of ignorance’.

However, over the last two decades there has been the move towards more inclusive education - to retain and provide support for children who are struggling in mainstream schools and to the transfer children from special schools into the mainstream. It is likely that many children who in the past would have been identified as being ESN(M), or more recently MLD, and transferred to MLD special schools, have been retained in the mainstream schools with support for their learning difficulties. This process would have contributed to the reducing proportions in special schools. It is also likely that some children in special schools for MLD would have come to have been included back into mainstream schools with various support arrangements. This is the group that many professionals consider to be the easiest to include in mainstream schools that are adapted for a greater diversity of children (Evans and Lunt, 2002). It is interesting that some ten years ago, Phillip Williams in a review about the integration of students with MLD noted that :

“The integration of children with MLD is the acid test of integration policies: they constitute the largest group in the special school population, their parents are not as strong a lobby as parents of other children with special needs, and they do not command the same degree of sympathy as do children with obvious sensory and physical handicaps” (Williams, 1993, page 314)

If inclusion is to proceed, then clearly the future of inclusion for this group is the ‘acid test’ for inclusion.

Focussing on MLD also highlights different interpretations of the SEN concept. The OECD (2000) undertook an international survey of the incidence and indicators used with respect to students with disabilities, difficulties and disadvantages. They adopted a system similar to the Warnock Report. Rather than focus on the nature of the child’s disabilities, they used ‘special educational needs’ to refer to those who require additional support. But, in doing so they see the SEN concept as extending:

“beyond those who may be included in handicapped categories to cover those who are failing in school for a wide variety of reasons that are known to impede the child’s optimal progress.”(OECD, 2000, page 8)

This is an interesting version of the SEN concept as it goes beyond the one that has come into use in this country. Though the SEN concept established in UK legislation is defined in terms of additional provision, it does not explicitly include those who require additional, provision for non-disability or impairment reasons, such as social disadvantage and language difference. In fact the current English legislation defines special educational needs in terms of learning difficulties, and defines these in terms that are confined to areas of disabilities and difficulties with connotations of impairment. The legislation also explicitly excludes English as a second language as a causal factor for learning difficulties. By contrast, the OECD recognises such linguistic factors in its category C. They are:

  1. “Category A: educational needs where there is substantial normative agreement, such as blind or deaf, severe and profound mental handicap and multiple handicap. These conditions affect students from all social classes and occupations… In medical terms they are considered as being organic disorders attributable to organic pathologies.
  2. Category B refers to educational needs of students who have difficulties in learning which do not appear to be directly or primarily attributable to factors which would lead to categorisation A or C.
  3. Category C refers to educational needs of students which are considered to arise primarily from socio-economic, cultural and/or linguistic factors. There is some form of disadvantaged or atypical background for which education seeks to compensate.” (page 9)

The OECD survey shows some consistency across countries in allocations to categories A (impairments) and C (disadvantage). However, in some countries children similar to those identified as MLD in this country might be in the impairment category A (clear impairment) or category B (neither disadvantage nor clear impairment). In some countries children with learning difficulties associated with social disadvantage might be in category C.

This three-way classification of SEN can be linked to the difference between what have been called the social and medical models of special educational needs. Category A connects with the medical model, while category C reflects aspects of the social model. However, category B, which is defined as neither based on impairment nor social disadvantage, appears to leave open whether special educational needs, or MLD in particular, can be simply attributed to external or internal causal factors. This opposition of social and medical models is untenable for various reasons. It confuses the role of the medical profession with assumptions often held in medical, but also other circles. The medical profession has traditionally had power and influence in special education, but less so recently, with the growth of the influence of other groups, such as psychologists. One version of the medical model criticises excessive professional power relative to the influence and voice of the parents and children, said to have special needs. Another interpretation of the medical model focuses on individual within-child causal factors. In this interpretation the model is better represented as an individual model where the analysis is in terms of causal factors impacting on individuals experiencing difficulties in learning.

It is quite rare to find professional and medical practitioners who would deny the significance of environmental and social factors in the development of difficulties identified as MLD. In this paper I assume that there is a false opposition between social and individual models. There is a place for individual and social perspectives, the preference for one or other depends on whether the focus is on individuals or social organizations. If the focus is on identifying additional provision required for an individual child, then some analysis of the interaction of within-child and environmental factors is relevant. If the focus is on planning curriculum and teaching programmes for groups and classes of children at the level of the school, then how they accommodate and include the diversity of children is relevant.

Individual and social models are inter-connected: inclusive planning at a school or class level requires taking account of individual children’s additional educational needs. How education institutions accommodate diversity requires considering what that diversity is in individual terms. This implies that a social model cannot exist without reference to individuals. Similarly, an individual model cannot exist outside the context of the social. It is difficult to make sense of an individual’s additional or special educational needs without considering how institutions and society accommodate and respond to diversity.

The kind of conceptual framework that we need for the education of children and others with difficulties in learning and disabilities is what has been called a bio-psycho-social model (Engel, 1977; Norwich, 1990; Cooper, 1996; Kiesler, 2000). This is an inter-disciplinary, multi-level and interactive framework. It is one where factors and processes within and between these 3 broad levels of analyses would be considered. When processes within a particular level might be seen as dominant, other levels might still be seen to have some contributory interactive impact. It is a framework which can avoid over-individualising problems in education, a tendency criticised by proponents of social models, while still recognising individual factors. Also, it is a framework which can avoid over-socialising problems, a risk noted by those who assert the reality of individual difficulties and disabilities. The social model has become the more dominant and popular model and this can be understood as a necessary development and corrective to over-simplistic and over-individualized models (Lindsay, 2003). However, the way that the social model has been presented and advocated has been exaggerated and over-simplistic. Much of the persuasive force of the social model has come from the commitment to the value of the social and academic participation of all children and young people in mainstream schools. The social model has provided the basis for an agenda to remove barriers in the society and schools to greater participation of all. How the model has come to be represented and used owes much to its role in justifying the push towards greater inclusion and less to the complexities about the origins and causes of learning difficulties and disabilities.

MLD as a category

The use of the term Moderate Learning Difficulties (MLD) in the UK reflects much of what is lacking in clarity in the system of additional and different provision for children with difficulties and disabilities. One of the confusing aspects of the term learning difficulties, is that in the current UK legislation, all children with special educational needs are defined as having learning difficulties. This meant that whether a child had a sensory, motor or intellectual difficulty, she or he would be defined as having a learning difficulty. In one sense this was an understandable turn in the 1981 Act, which was re-focussing special education as being about difficulties in learning and not as about medical categories. But, to avoid confusion between these two meanings of learning difficulties - as the replacement for the term ESN and the historic focus on children assumed to have lower intellectual abilities - and - as the term to cover all kinds of special educational needs - it would have been wise to abandon the Warnock terminology and adopt some other term for children with moderate to more significant degrees of low intellectual functioning. It is interesting that even after a quarter of a century since the Warnock Report, there is still little comment about this matter.

Recent history shows the continuing ambivalence about the Warnock philosophy of abandoning categories. In the current version of the SEN Code of Practice (DfES, 2001), the case against ‘hard and fast categories’ is stated in terms of the need to focus on the child’s unique circumstances. The second SEN Code identified four areas or dimensions of need related to:

  1. communication and interaction,
  2. cognition and learning,
  3. behaviour, emotional and social development,
  4. sensory and/or physical.

These areas of needs were presented as inter-related, so that individuals may have needs which spanned two or more areas. This move dealt with the continuing problem that many children have more than one kind of difficulty that can impact on their learning. However, within the dimension of cognition and learning, the Code refers to “children who demonstrate features of moderate, severe or profound learning difficulties or specific learning disabilities” (DfES, 2001, paragraph 7:58). This shows that the four overlapping dimensions of need were still not used to replace the category MLD.