Tuesday, 4 November 2008

A developmental disorder – not a diagnosis

Back to Budapest

You may have seen the latest posting on Norman Perrin’s blog. If you have not, then I do highly recommend it.

He republishes his own article (Perrin, 2008) from the current issue of SEN: the Journal for Special Needs. It opens thus:

The problem, Norman,’ said the Education Officer (SEN), ‘is that we do not agree with your view of cerebral palsy, so we do not see that Conductive Education has anything to offer us.”.

She added that in making placements at schools, her LEA relied on assessments by paediatricians and therapists.

Talk about synchronicity! I’m making a presentation around just this problem in Budapest on Friday.

When I stumbled willy-nilly into Conductive Education nearly thirty years ago, I knew nothing about cerebral palsy or any other of the physical disabilities to which it may be applied. Rather than learning a little I decided to continue in this state of bliss, and remain a psychologist.

As a psychologist I was and remain horrified at how extraordinarily removed people in this sector are from what I have understood as fundamental positions and insights into the nature of human development, ones long since absorbed, sine quâ non, into the development, upbringing and pedagogy of, say, the deaf and the blind.

I still know very little about movement disabilities, but their developmental (and therefore their educational) implications do seem rather obvious – to me, anyway!

The developmental view is very easy to share at an intellectual level with most lay people, as long as they have no investment in maintaining things as they are. And of course I have met many, many parents over the years, who have come to just such a formulation, intuitively, through the harsh school of experience.

The common view

The implications of a developmental view appear to escape, however, the attention or even the comprehension of most teachers and educational bureaucrats, most relevant health professionals (medical and paramedical), most politicians resonsible for existing services, and much of the population at large. My direct experience of this lack of understanding is restricted largely to my own country but I hear enough from elsewhere to believe that the situation is worldwide – and in some countries even worse.

This lapse is not of course the personal fault of the people involved, they are part of a system that does not know, and may indeed include powerful sectional interests that would prefer things to stay as they are.

How to typify the presently dominant paradigm without producing a stark, black and white caricature?

Here goes. If, say, children have cerebral palsy, then this condition is explanation enough for almost everything that is happening and what should happen in their lives, in the lives of their families, and on into adulthood.

As Norman’s education official said, so honestly and so accurately, even such patently social actions as school placements have 'relied on assessments by paediatricians and therapists’. I remember when this deplorable and archaic situation was triumphantly confronted and then abolished for the whole of the rest of special education (as it was then called) back in the late sixties and the early seventies. The same laws have since applied to what were then in the United Kingdom referred to as ‘physical handicap’ – now equally unspecifically as ‘physical disability’, but the bleak hegemony of diagnosis-centred definition of these children’s (and their families’) lives has been and remains powerful enough to smother the effects of mere legislation.

‘Motor disorder’ is a disorder of development and should be construed and provided for like any other developmental disorder. To do otherwise is an act of discrimination (even if an unwitting one) and systems of educational systems that do so are being institutionally discriminatory.

What instead?

No objection is offered here to medical diagnosis. as such. It is right and proper in its place and indeed the diagnosis of cerebral palsy has just received a thorough polish. Anyway, as I have said, such matters lie quite outside such expertise as I have.

My experience of Conductive Education – trying to figure out what is happening in conductive pedagogy and upbringing and then trying to justifying this theoretically to student-conductors – has cried out, however, for explanation in terms of human mental development, with matters to do with the physical base serving as a necessary but far from sufficient explanation of what is happening to people’s lives and what might be done about this.

Nothing that I shall say on Friday is in any way new or original. It is implicit in the everyday practice of conductive pedagogy and upbringing. The developmental psychologies that serve as the basis for stating this in the way that I do go back at least to the nineteen twenties.

Maybe, of course, I am just hopelessly off track in my views and maybe I am hopelessly wrong in my belief that Conductive Education will get nowhere in this world till people, particularly those in authority, have a clear idea in their heads that, say, children do not ‘have cerebral palsy’. Instead they are experiencing systemic developmental effects arising at the social and psychological levels, stemming from how their condition affects interaction with their world, the cardinal mechanism in this being learning. In other words, such children have a developmental disorder as arises from deafness and blindness for which appropriate social and pedagogic measures should be regarded as a simple human right.

Of course, it will not be easy to change social attitudes clear vested interests out of the way but only a professional generation ago the worlds of education, rehabilitation and social care managed a major theoretical and practical paradigm shift over inclusion – so why not here? As long as the old hegemony, the old way of thinking, remains in charge, however, it seems unlikely that Conductive Education – or any analogous approach – will make much headway.

Towards a developmental model

My first primitive attempt to state this model was published twenty years ago (McGee and Sutton, 1988). It roused no interest that I know of, within Conductive Education or without. After all these years my understanding of this matter may be a little more refined but has not fundamentally changed. A year or so ago I offered to present it at Tsad Kadima’s conference in Tel Aviv but this was declined. Ditto for the Chicago CE conference this autumn.

On Friday in Budapest I have an opportunity to present the model for critical examination by an audience with considerable and varied experience of Conductive Education. It will be interesting to see how the model holds up in that ‘internal’ context before trailing it, again, across the external world. The audience will include a spectrum of conductors (from students all the way up), and the present Rektor of the Pető Institute and his immediate predecessor, plus a few people from outside Hungary. Perhaps in response to what they say I shall modify and revise my views. I do not think that I shall recant them altogether.

This is a developmental model – and as such it is dynamic, systemic, developmental, transactional, mediated, ecological... I will published it in full as knoll when I return.

Notes and references

Do please note that what is being proposed in this present article is nothing whatsoever to do with the ‘medical versus social models’ of disability. No sociological reductionism is being advocated here in place of a medical one. This is a potential cause of confusion here.

McGee, A. and Sutton, A. (1988) Conductive Education and developmental psychology, Educational Psychology, vol. 9, no 4, pp. 339-345

Perrin, N. (2008) Talking about the education of children with cerebral palsy, SEN: Journal of Special Educational Needs, no 37, November/December
Republished on the Internet:

I wonder whether Norman and his Education Officer (SEN) recognise how evocative are his opening lines of the once well-known opening scene of A. S. Makarenko's Road to life: an epic of education.
They are to me, anyway!

1 comment:

  1. Andrew,
    I loved this blog entry, for a very selfish reason, your thoughts contribute greatly to my own current investigation around definitions of physical disability or to be more precise cerebral palsy. I came across lots of medical and therapeutic discussion regarding the aetiology and impact of this childhood disorder; mainly in therapeutic and medical publications; unfortunately SEN discourse is seriously lacking of detailed and critical examination of this particular disability.
    Is it because CP is still considered to be a medical condition and educationalist still believe that ‘meeting the needs’ more of a responsibility for therapists and less of an educational issue? Is it because this particular disorder is so diverse and there is no single path how it can be described in terms of developmental/educational needs as it is with other impairments such as Dyspraxia, ADHD, Asperger’s syndrome? Is it because it would be hard to develop a discourse of educating children with CP without ‘stigmatising’ or ‘labelling’? Or it is because educationalists still getting familiar with issues of development and the complexity of learning?
    Your potential model of ‘developmental disorder’ is great. I would love to refer to it because it reflects my own viewpoint on CP, and articulates the viewpoint of CE so well. Unfortunately I have to say that the discourse of CE is not critical yet to strengthen this further.

    In the mean time I would recommend a book which I came across recently, a publication which raises issues about educating children with disabilities:

    Norwich, B (2007) Dilemmas of Difference, Inclusion and Disability. International Perspectives and Future Directions. London: Routledge.



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