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The partial text of my PhD thesis (unpublished) 2000 is included here.  Please follow the links to the relevant sections.  The full text is available at Manchester Metropolitan University library.  (Copyright of this text rests with the author.  Extracts or copies may only be made in accordance with instructions given by the author.)

Title and list of contents	Abstract	Introduction
Review of Literature	Methodology	Conclusions

 TITLE AND LIST OF CONTENTS

Skills, Rules, Knowledge and Three Mile Island.
Accounting for failure to learn in individuals with Profound and Multiple Learning Disabilities.
Mark Barber

A thesis submitted to Manchester Metropolitan University for the degree of Doctor of Philosophy
Department of Psychology & Speech Pathology
Manchester Metropolitan University
July 1999

Acknowledgement

This thesis is dedicated to my wife Andrea, whose constant loyalty and support made it possible.
My thanks go to the staff of Melland High School, especially Mrs.Judy O’Kane and Miss Joanne Belshaw for their support and also to the pupils of Melland High School who inspired the whole process.
Thanks also go to Dr Gary Munley for his support and guidance through the dark corridors of statistics and analysis. This thesis would not have been completed but for the tireless support of my friend, mentor and supervisor Dr Juliet Goldbart whose inspirational efforts on my behalf have frequently been above and beyond the call of duty.

CONTENTS 

LIST OF TABLES

Table 1 Showing disabilities experienced by participants and other relevant information

Table 2 Showing creditable social behaviours                                 

LIST OF FIGURES

Figure 1  Schematic representation of Generic Error Modelling System              

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  ABSTRACT

This study involves an examination of a number of competing accounts of the adaptive behaviours of a small group of secondary school aged children with Profound and Multiple Learning Disabilities [PMLD].

A number of common mechanisms and themes, are identified from various perspectives of learning, to illustrate the accumulation of experience and intellectual resources that support the emergence of both intentional communication and increasing control over objects in space.  They are then used to try to account for the apparent failure to learn noted in individuals who experience profound and multiple learning disabilities.

These approaches are extended by the introduction of a perspective of interaction used to account for slips, errors and mistakes in complex environments.   The Generic Error Modelling System [or GEMS][Reason 1987iii,1990] presents a rationale of interaction that describes the break down of cognitively guided action with the environment.  Exchanges with the environment are seen to breakdown not as a result of the complexity of the psychological mechanisms involved, but as a result of the complex demands made by a fluidly changing environment on cognitive resources.

The switch-related and social actions of a small group of school age participants with profound and multiple learning disabilities [PMLD] are viewed from a number of conventional perspectives.  Their reactions to changes in opportunities for interaction are then discussed with reference to GEMS which accounts for the participants’ behavioural repertoires in terms of strategies chosen, from a compromised resource, on the basis that they meet the requirements of the encounter on a ‘least worst’ match.

The use of GEMS to view encounters in this manner suggests a rationale of intervention based on mediating experiences whose critical features are ‘signposted’ or brought to the attention of the learner.  In this way it is speculated that encounters will be recognised and differentiated from each other and thus be more readily included into the cognitive resources that support interaction.

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  INTRODUCTION

The World Health Organisation suggest that people with Profound and Multiple Learning Disabilities [PMLD] are those whose IQ, if it were measurable at these levels, would correspond to below a measurement of 20, indicating a very early level of development [WHO 1992].  Sebba [1988] alternately provides the suggestion that individuals with PMLD function at levels less than or equal to one fifth of their chronological age.

The Department of Education and Employment do not currently hold any statistics on the number or prevalence of pupils with profound and multiple learning disabilities attending schools in England, [Taylor,1999].  Manchester Education Committee’s Inspection and Advisory Service suggest that the population of profound and multiply disabled pupils is approximately one third of the population of pupils in Schools for Children with Severe Learning Disability [SLD] [Molloy,1999] which contrasts sharply with Hogg & Sebba [1986] assessment that approximately 25% of the SLD population experienced profound levels of intellectual impairment. Difficulties of definition are reflected by Browning et al [1981] who reported that 71% of those attending SLD schools were thought by staff to have PMLD.

The prevalence rate of PMLD in children between 5 and 14 years old was assessed by Fryers [1986] to be less than one in one thousand.  Surveys from other sources suggest that the prevalence of this population within special schools is increasing. [Male, 1996; Ouvrey, 1987]  In a survey of 36 schools Evans & Ware [1987] found that more children were entering ‘special care’ classes than were leaving them, but this was partly attributed to children returning to their communities from hospital settings and distant residential provision [Ouvrey, 1987]. The trend, however, was confirmed more recently by Male [1996], who attributed the rising number of individuals with PMLD entering special educational provision to improved rates of infant survival and medical care.  Certainly, personal experience suggests that the medical support requirements of children currently in schools has increased dramatically compared to those in similar placements 20 years ago, “the last ten years have seen an enormous increase in the numbers of children arriving in schools who are tube fed or need oxygen several times a day” [Lacey, 1998]. 

Remington [1996] describes individuals within this population as functioning at the “extreme lower levels of cognitive attainment and adaptive behaviour... this description reflects the fact that such children typically acquire few self care, communication, social or leisure skills...in short they are children with extremely limited behavioural repertoires” [p2]. In addition to profound intellectual disability, “many of these children experience secondary sensory and physical impairments or medically debilitating conditions” [Rainforth 1982].  Although characterised as having profound and multiple learning difficulties, individuals within this population experience a great diversity of combinations of conditions creating highly individual disabilities. The cumulative effect of these multiple disabilities is that individuals are grouped homogeneously as individuals experiencing PMLD.  However the nature and make up of their disabilities requires that the individuals also be recognised as a heterogeneous group.  For this reason, detailed descriptions of the disabilities and impairments experienced by each participant in this study will be presented in sub-section M.4 and summarised in Table 1 [see Sect V  p 95].

This study follows on from twenty years experience of providing structured learning experiences to individuals of school age who experience profound and multiple learning disabilities. During this period a number of teaching approaches and philosophies have emerged that have been shaped by research and investigation into the learning characteristics of animals, typically developing infants and the disabled population itself. While rudimentary learning mechanisms have been demonstrated through the observation of animal behaviour, the dominant portion of published literature has described a variety of learning processes in terms of the typical development of infants. While these paradigms have great relevance to individuals with PMLD in their early years, experience in the classroom has led to the questioning of their continued relevance as the individuals’ chronological age increases and their prolonged experience of the consequences of their disability changes the actual experience of their encounters.

The present study came about following the experience of trying to account for the behaviour of an individual who had profound and multiple learning disabilities.  Jon would accept a cup and drain its contents, even when his affective behaviours appeared to indicate his dislike for the drink.  From his affective responses it appeared that Jon enjoyed drinking milk, but, if the milk was flavoured in any way, or the cup contained orange juice, his facial expression and general demeanour, consistently suggested strong dislike. If a cup of orange juice or flavoured milk was offered, or placed on a table surface within his reach, Jon would grasp it, take the cup to his mouth and drink it.  Following the first mouthful of a ‘non-milk’ drink, staff would assist Jon to take the cup from his lips, but as soon as their touch was removed from his hand, Jon again took the cup to his lips and continued drinking until he had consumed the drink.

His accumulated years of experience in the company of concerned staff and carers, may have led him to expect all drinks to taste of milk, as, knowing that Jon preferred milk to any other drink, they would typically provide it for him. But Jon persisted with the drink even though he had tasted it and found it to be disliked.  Seen from a classical conditioning approach, the sight of a cup may have become reliably associated with the taste of milk and had become a conditioning stimulus.  The occasional failure in the protocol ‘drink from any cup’ would occur when the cup contained orange juice, but this might only have served to make the association more resistant to extinction through the mechanism of intermittent reinforcement. While plausible, this explanation just seemed too simple.

There is a long history of accounting for learning using this and other behavioural models [see e.g. Farrell, McBrien & Foxen, 1992], but the accounts often provide what appear to be contradictory and oversimplified explanations.  Indeed competing accounts of the processes underpinning the actions of learners often provide a more confusing range of perspectives than different newspaper accounts do of football matches, where frequently, the only consistent facts across the papers are the opposing teams names and the final score.

The present study provides a new perspective on the processes that underpin the interaction between individuals and the environment.  While not attempting to discount other views, the approach presents a principled explanation of the behaviours of individuals operating in complex environments.  Taken from the analysis of operator behaviours during catastrophic incidents in the power generation industry, the Generic Error Modelling System [Reason, 1987iii, 1990] or ‘GEMS’ views human behaviour from a cognitive perspective where varying degrees of attentional resources are focused on problem configurations using a hierarchy of intellectual processing levels. 

GEMS shares a schematic approach with other perspectives to describe the progression from effortful involvement with novel experiences through to what becomes increasingly skilled interaction with more familiar encounters, and frames this process within a hierarchy of three levels of intellectual involvement. In addition, however, GEMS models the points during interactions at which slips, errors and mistakes typically occur because of the nature of the cognitive system and the biases which influence action.  It presents the reasons for the break down of many interactions in terms of ‘frequency gambling’, itself the result of cognitive underspecification or a compromised resource of intellectual reference points from which to construct an accurate ‘world picture’ so that inferences about ongoing environmental events may be made.

In the present study, a number of school aged individuals with PMLD were involved in a series of scripted encounters to ascertain whether this approach could indeed be used to explain their social and object focused behaviours.  In addition, the logic of the approach would be discussed to suggest an intervention style that might enable profoundly intellectually disabled learners to interact with their environment with more success allowing a more complex and interconnected ‘world picture’ to develop.

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