The Handicapped Child At School

Reprinted with permission from The Lancet, March 11, 1967, p. 553.

Over the years the pattern of physical handicap in children has changed greatly. According to the latest report from the Department of Education and Science, the main causes of severe physical disability among children in special schools are now hereditary or congenital, and relatively few children attend these schools because of rheumatic heart disease, osteomyelitis, or tuberculosis. Whereas the number affected by residual paralysis from poliomyelitis has fallen dramatically, more and more children with spina bifida are now surviving as a result of skilled surgery and control of infection in the first few days of life.

The changing prevalence of disabling diseases calls for a reassessment of the educational facilities for handicapped children-the more so because the prevalence of individual diseases appears to vary widely from region to region. An epidemiological basis for the differences is improbable: a much more likely explanation is that lack of special schools or classes leads to a lower ascertainment rate in some areas.

Some would argue that the present emphasis upon the need for special schools is misguided. Since not all children with spina bifida can be accommodated in special schools, would it not be wiser to devote more effort to placing them in local schools, as Eckstein and Macnab suggest? On the other hand, it would be unwise to follow such a dictum blindly, as some social workers have been ready to do. In haemophilia, for example, a residential special school would have advantages in that children could be treated without interrupting their education. It is interesting to note that the parents of many "thalidomide" children have asked for their children to be educated in ordinary schools.

There are, however, many practical difficulties for the handicapped chilwho attends a local primary school. Classes are usually large, facilities may be inconvenient, overprotective attitudes by parents may make excessive demands upon teachers, and the provision of even minor medical or nursing care may be impossible. Even travelling to and from school may create problems. The attitude of the other children must also be considered, for they can sometimes be extremely cruel to a handicapped child.

The parents' reluctance to agree to special educational facilities may be a symptom of a more general failure to accept the implications of their child's handicap. In such circumstances the doctor's assurance that the standard of education is satisfactory will be a valuable compensation. The introduction of the Certificate of Secondary Education has provided a tremendous impetus for special schools to offer improved educational opportunities. It should be remembered that many deaf children transferred to ordinary schools fail to achieve their expected academic potential. Moreover, frequent short absences from ordinary primary schools impair educational performance, and such absences will be more likely in a handicapped child.

The problems of the handicapped child do not cease when he leaves school, and a working-party concluded that there should be a functional assessment of all physically disabled school-leavers to help the youth employment service in finding suitable work for them. Following these recommendations, the Department of Education and Science has prepared a draft medical report form for this purpose. Ideally, the school health service should assume responsibility for the care of the young handicapped school-leaver in his early years in industry.