Peter Limbrick writes: First of all, when we are involved in helping a baby or young child to develop new skills and understanding, I believe the phrase ‘multiple disabilities’ has no validity – hence the single quote marks in the title. Coming to the view that the child has, instead, a single multifaceted condition can begin a process of reducing multiple practitioners and multiple programmes to a single coherent multifaceted intervention system. A direct consequence of this can be reduced demands on infants, families and support services.
The following is an extract from Early Childhood Intervention without Tears (page 31) –
The infant’s single, unique, never-been-seen-before multifaceted condition
In my view we have all made a serious mistake during the last fifty years or so. We have known that an infant with a motor disability, or a language delay, or a visual or hearing impairment would most likely benefit from a physiotherapist, or a speech and language therapist, or a specialist teacher. The mistake we then made, for the best of reasons, was to decide that an infant with all of those conditions needed all of those practitioners and, probably, at the same time.
This additive and fragmented approach has put a massive strain on infants, families and support agencies. My argument, with all of those infants, families and practitioners in mind, is that we stop thinking in multiples, stop thinking that multiple disabilities mean multiple practitioners and multiple programmes. I want to go further and suggest that, in respect of a particular infant’s development and learning, there cannot ever be 'multiple disabilities' - only a single and unique multifaceted condition.
I have found it useful to use the difference between ‘pantry’ and ‘pastry’ to explain the multifaceted condition. The baking ingredients on the pantry shelf represent the multiple diagnoses or labels of disabilities, while the resulting pastry is the multifaceted condition. Systems thinking tells us that flour, fat and sugar each have their own characteristics as they sit in their separate packets on the pantry shelf. We can move them to new shelves, replace any of them with better brands and use each of them in a variety of ways. But once they are cooked together into pastry, they emerge as a new whole entity with entirely new characteristics of nutritional value, texture, taste and smell. It is too late now to wish we had used wholemeal flour or brown sugar or vegetable fat. These ingredients can no longer be found in the pastry in the form in which they existed in the pantry nor can they be separated out from the pastry.
The TAC systems approach suggests an infant’s ‘separate’ disabilities of movement, vision, cognition, etc get cooked together as new multi-component skills are achieved. When an infant with cerebral palsy and vision impairment reaches for a bauble with increasing success, can we think of the motor skill separately from the visual skill? When an infant has hearing loss, intellectual disability and autism, they face a triple challenge in relating to and communicating with others. When they master the skill of answering the question, ‘Do you want a drink?’, I do not imagine the neurological pathway established in this new learning will have three separate strands in it corresponding to the three diagnostic labels. They are surely fused together in the infant’s learning.
So, by this thinking, these infants are not carrying a bundle of separate impairments and disabilities as they struggle to learn. Instead, each has his or her own multifaceted condition with the multiples of separate entities existing only in the minds of others. It is to this unique multifaceted condition that each early childhood intervention service must respond, eliminating its own multiples of separate practitioners and programmes and coming to an integrated system.
It is encouraging to remember that, while disabilities and impairments interact with each other as the infant’s neurology matures, so too do the infant’s emerging abilities, skills and understanding – all part of rich interactive mix of the globally functioning infant.
I welcome comments on this systems approach, perhaps as the beginning of a fruitful dialogue.