This series of short essays is intended as an introduction to TAC or as a refresher course for everyone around babies and infants who need special support for their development and learning. The article can be translated for use in newsletters, networks and websites in any country
EIGHTH PRINCIPLE: ‘For the child’s development and learning, TAC practitioners do not use the term multiple or complex disabilities and think instead of a single unique multifaceted condition. Their task then is to integrate all their work into an individualised multifaceted response for each unique child.
In my understanding, the term ‘multiple disabilities’ is entirely inappropriate when supporting a baby or infant’s development and learning. First of all, the word ‘disability’ is wholly negative and comes from the medical world. It contributes to a negative mind-set in the family and practitioners around the new child and lowers expectations for progress.
Secondly, the term assumes that challenges to a young child’s movement, dexterity, seeing, hearing, cognition, etc. are existing separately from each other. This cannot be true. For example, when a baby has cerebral palsy and impaired vision, each challenge will impinge on the other and jointly influence hand-eye co-ordination. Similarly, when there are challenges for a child in hearing and also in the development of relationships, the two challenges will interact with each other as the child learns first skills in relating to and communicating with parents and siblings.
The ill-considered medical approach to these children in countries with high economies has been to provide a separate practitioner for each diagnosis. This overloads babies and infants, exhausts parents and creates confusion and contradictions. It offers the child no help in internally integrating the work in each area of development. In this unhelpful approach the child above with cerebral palsy has to work out for herself how to join together the skills she is developing in hand and arm movement with the skills she is developing in making the best use of her limited vision. (Perhaps, children who do not also have diagnoses of intellectual disability will do better at this.)
The positive side of challenges interacting with each other rather than staying separate is that progress in one area of child development, for instance hearing, will support progress in another, for instance developing social relationships. We come to see that the traditional separate areas of child development are not so separate after all and that, in supporting their development and learning, there is merit in seeing each new baby and infant in the whole – and then seeing all their challenges and diagnoses as a single unique multifaceted condition.
This brings us to the TAC multifaceted response. In this, practitioners move away from discipline-specific programmes and exercises towards relevant, functional and purposeful play/work activity. For instance, an exercise of rolling on the floor is replaced with the challenge of getting to the toy box or biscuit tin and arriving with one hand in a good position for reaching. The presence of an encouraging parent, sibling or practitioner adds social and communication elements. The baby or infant now has opportunities to develop purpose, sequential activity and a sense of achievement.
All natural baby and infant activities are opportunities for multifaceted support to promote development and learning. Suppose a parent has asked for help in teaching her child to sit at a table or tray and drink from a cup. The starting point for TAC is to observe the present understanding and skills in this activity and then agree collectively how to move forward. This discussion will very likely include chair, posture, grasp, choice of appropriate cup and drink, hand-eye co-ordination, support at elbow/wrist, understanding of the task, listening to verbal prompts, pleasure when the task is achieved and so on. Each TAC practitioner will have a valuable professional contribution to the plan.
This is collective activity in which TAC practitioners and parent learn skills from each other rather than having all of them around the child at drinks time. This achieves collective competence, the end product of which can be allocation of just one practitioner to support the child and parent for a period of time. I described this approach in ‘Primary Interventionists in the Team Around the Child Approach’ (before I came to feel that ‘intervention’ is not an appropriate word for this work). Here are two extracts:
‘Within the TAC approach, primary interventionists are not a defining feature. They are an option for a TAC to adopt if it is felt necessary for the child and family. A primary interventionist is the person chosen in TAC discussion to work with a child and family for a period of time when TAC members (remember parents are fully involved) feel there should only be one person offering most of the direct support...
‘All the necessary expertise, knowledge and skills for teaching these multifaceted activities reside not in the child’s primary interventionist, but in the whole TAC team – practitioners and parents. It is the TAC members who fully brief and support the primary interventionist to become competent in supporting parent and child in the chosen activity.’ (Pages 20 and 22.)
The TAC multifaceted response can reduce the number of ractitioners around the child and reduce busyness for child, parents and practitioners. This supports the family in keeping family life as normal as possible.
First TAC Principle here
Second TAC Principle here
Third TAC Principle here
Fourth TAC Principle is here
Fifth TAC Principle here
Sixth TAC Principle here
Seventh TAC Principle here
Eighth TAC Principle here
Ninth TAC Principle here
Tenth TAC Principle here