The emerging new SENs of students born prematurely

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In an average class, there will be four children who have been born prematurely. Many of these students have emerging special needs that are different to what teachers have known before. Professor Barry Carpenter is leading work to help schools better sup

The survival rate of premature babies has risen sharply over the last decade.

Eighty thousand children are now born prematurely every year (and prematurely means anything before 36 weeks’ gestation). This means that in every classroom there are now four children who have been born prematurely.

Research has found, however, that 63 per cent of children born prematurely have some form of disability or SEN, and this figure is higher among children born before 28 weeks. Not only that, many have learning difficulties that have not previously been encountered.

Only last month, two studies published in the British Medical Journal said that thanks to advances in medical science, more babies are being born before 26 weeks and more are surviving. But the proportion suffering serious and developmental problems as they grow up remains largely unchanged.

My whole career has been in SEN and it is my belief that we as teachers must develop new generation pedagogy for this new generation of children. Since the pattern of children’s SEN has changed, then so our teaching strategies must change too. We have got a raft of special needs emerging that are different to what we have known before and it is important to raise awareness among teachers.

When I was leading the Complex Learning Difficulties and Disabilities research project (CLDD) for the Department for Education three years ago, a mother who had read about my work wrote to me. Her son had been born at 24 weeks’ gestation and was now five.

He had just had his first term at primary school and although it was a great school, with lovely teachers, at the end of each day they would say to her “could we just have a word” about some misdemeanour or other. What they didn’t understand, she realised, was that her son was “wired differently”.

My question to teachers, and this is not a criticism, is: if this boy is “wired differently”, in what way does he learn differently? And if he learns differently, in what way should we teach differently?

At the end of this month (Thursday, January 31), I will be chairing the annual conference of the SSAT’s National Forum for Neuroscience in Special Education. The conference aims to encourage a dialogue between teachers and neuroscientists around the learning needs of children born prematurely – not for quick-fix answers but to journey together towards discovering those answers.

As Professor Uta Frith, who is patron of the National Forum, has said: “Education is concerned with enhancing learning and neuroscience is concerned with understanding the mechanisms of learning. It seems only logical that the one should inform the other.”

One of the speakers at the conference will be Dieter Wolke, professor of developmental psychology and individual differences at the University of Warwick. He has headed up a longitudinal study called EPICure, which analyses a cohort of babies born extremely prematurely at key developmental junctures in their lives.

The EPICure study found that at the age of six, only 22 per cent of children born before 28 weeks had survived with no disability. When these children reached 11, there were four major developmental issues. More than 60 per cent had developed some form of attention deficit disorder (ADD), of the inattention type. They flitted from one thing to the next, with little focused attention to tasks – which is, of course, key in the classroom.

Prof Wolke also discovered that by the age of 11, 10 per cent of the children had a diagnosis of autistic spectrum disorders (ASD). My own thinking is that this is an attachment-based autism, perhaps stemming from the fact that you cannot hold, stroke or smile at your baby if they are in an incubator as you could if they are in your arms.

A third developmental issue was that the study found increased emotional problems with this group of children and a fourth was that they were showing increased risk of psychiatric diagnosis. As these children progress through our schools – and they are in a range of settings – it is clear that we must learn for them and with them. Teachers need to put their teaching on a platform of inquiry and try different teaching approaches, knowing that sometimes they will not work.

A recent US study has said that pre-term children are at high risk of learning difficulties and poor academic attainment by the age of 11, particularly in mathematics. It is mathematics that often proves to be the most challenging area of the curriculum and one pointer to teachers is that mathematics teaching should be as concrete as possible.

Numeracy and mathematical computation are dealt with in the parietal lobe in the brain and we need to hear more from neuroscientists about the function of the parietal lobe and how premature birth affects that.

It is important to bear in mind, too, that some of these children have lifelong medical conditions. Some have limited life expectancy and it is not unusual for teachers to find themselves liaising on a weekly basis with a hospice.

The lung function of prematurely born children may not be developed and they may be oxygen dependent. There are higher levels of sensory impairment (such as visual impairment or deafness) among this group and they are often what is called hyper-vigilant. They may get anxious, emotional and find it difficult to focus, concentrate and deal with the dynamics of a fast-moving classroom.

I am very confident that teachers can meet the challenges of these children – but only if we understand that engagement is at the heart of the process. So how do we engage these children as active learners? Bearing in mind that they can be hyper-vigilant and hyper-aroused, we need to consider aspects like lighting and acoustics.

Do not seat them in an area of intense sunlight, for example, or where there might be auditory distractions. Premature children may have delayed physical development and therefore their gross and fine motor skills may be less developed.

Their hand-eye co-ordination, an issue that is just as relevant in secondary education as in primary, may not be as refined, which can lead to poor handwriting. Clumsiness is often a feature but here new technology can help to bridge curriculum gaps. The growing use of iPads can be quite liberating. They may have language processing issues, so we need to be mindful about the amount of information we put into our instructions.

We also need to think about inter-relationships within classrooms because these children may have confidence issues, perhaps relating to their attachment disorder. Once they get to secondary school, students may find planning ahead and organising themselves really difficult. It is not that they can’t do it, but they will need learning support mentors to help them to organise their daily routine.

Visual supports like laminated digital photographs on doors, instead of labels saying “Gym” or “Office” are helpful. If their reading skills are not strong, these images give a visual clue and ensure that children do not get lost in school corridors.

Above all, our forthcoming conference will highlight the need for an interdisciplinary approach in order to further our understanding of the learning and neuro-developmental needs of children born pre-term. As well as Prof Wolke,

Professor David Edwards will be speaking about the premature brain, while psychologist Dr Patricia Champion will talk about interventions that work. Andy Cole, CEO of Bliss, the charity for premature and sick babies and their families, will give parents’ views.

After all, parents are charting new educational approaches, new care pathways and new therapeutic interventions long before we as teachers come into contact with their children. I know the teaching profession has the ability to respond to children with a whole range of special needs.

We do not have all the answers today but I believe we will have them tomorrow – and I want my profession to be proactive in that.

  • During his 36-year career, Professor Barry Carpenter has focused on finding ways to nurture, encourage and enable all children with SEN. He has held three headships, written scores of articles and books and in 2009 was appointed to lead the CLDD research project. He co-founded the SSAT’s National Forum for Neuroscience in Special Education in 2011.

Further information
  • The SSAT National Forum for Neuroscience in Special Education conference is suitable for teachers, academics, health professionals, psychologists, students and parents. Information is available at www.ssatuk.co.uk/ssat/neuroscience-conference/
  • The Complex Learning Difficulties and Disabilities (CLDD) research project developed a range of tools and materials to teach these new generation children. Three guidance sheets on premature birth – a briefing sheet, classroom support sheet and information sheet – can be downloaded at http://complexld.ssatrust.org.uk/project-resources/cldd-briefing-packs.html


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