Is asking educational psychologists to assess every child with epilepsy in school ‘a bridge too far’?
by Dr Gillian Parkinson, senior lecturer in neuropsychology and complex learning difficulties. Educational Support and Inclusion Research Group School of Education, University of Manchester
As with other medical problems, epilepsy can present schools with a number of challenges and opportunities. In 1996, 80 per cent of children with epilepsy were receiving education in mainstream schools (DfEE/DoH, 1996), and I would surmise that the number has risen since these statistics were first published, particularly in the light of the Special Educational Needs and Disability Act (2001) and more recent legislation in connection with the Five Principles stated in Every Child Matters: Changes for Children in Schools (2004).
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Medical issues relating to seizure management, risk assessment and management of medication/rescue medication in schools have tended to take centre stage when discussing the inclusion of children with epilepsy at multi-agency admission and review panels. Because of the emphasis on epilepsy being viewed as a ‘chronic medical condition’, educational psychologists (sometimes referred to as child psychologists), have only really been brought in if the child has overt learning or psychosocial problems, a sudden unexplained loss of skills or downturn in academic performance.
Talking to teachers and educational psychologists, I have found that their views of each other’s roles and what each wants from the other, do not always coincide. Mukherjee, Lightfoot and Sloper (2002) found similar confusions and misperceptions in their study of health professionals’ perspectives on the difficulties and possibilities in information exchange between school and healthcare staffs when supporting pupils with SEN in mainstream schools. Are we looking at a similar problem here between educational psychologists on the one hand, and school staff, parents and allied services on the other? Are educational psychologists providing the support that parents, children and school staff need or are they placing the responsibility for the learning, progression and achievement of these children back in the hands of the health professionals – without having addressed the needs of the whole child? The educational psychology Report of the Working Group (DfEE, 2000), examined the role and future direction of educational psychology services and stated, 'The educational psychologist will help to support successful inclusion of children within local mainstream settings.' (p. 8); with a particular contribution being, 'to apply psychology to promote the attainment and healthy emotional development of children and young people 0-19 years.' (DfEE, 2000; 5).
Teachers I talked to said they wanted educational psychologists not only to define what strengths and difficulties a child with epilepsy has (or might potentially) have with learning, knowledge acquisition and understanding of the world. Teachers also need to know how they can make access to the world easier and more feasible for everyone involved – most of all, the child. To enable this to happen we need to consider whether all children with epilepsy should be referred to an educational psychologist – or more probably a child neuropsychologist (now becoming more of a feature in Children’s Services). We know from the literature that many children with epilepsy have periods in their lives, e.g. when seizures become troublesome, when drug treatments are changed or modified, or when the underlying condition that provoked the epilepsy shifts or changes as the child develops. I would argue that, for this reason alone, we should be looking at the way children with epilepsy learn, make adjustments in their lives and how they cope with increasing workloads in school.
Schools should, therefore, actively seek the expertise of child psychology services. They need to be pro-active in ensuring that regular profiling of academic skills is undertaken as a matter of routine in order that, (a) the child and the school know how best the child can access the curriculum (including risk assessment), (b) systems are in place so we can detect any loss or plateauing of abilities.
Finally, as parents and professionals, we should all ensure that we are well informed about epilepsy and how we can all best support the child with this (often under-acknowledged) long term condition in educational settings. Is calling on Children’s Psychology Services and EPs in particular to assess all children with epilepsy, therefore ‘a bridge too far’ in striving to meet their complex and often subtle support and learning needs?
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- DfEE (2000) Educational/Psychology Services (England): Current role, good practice and future direction – Report of the Working Group. London, HMSO.
- DfES/DH (2004) Every Child Matters.
- Mukherjee, S., Lightfoot, J. & Sloper, P. (2002) Communicating about pupils in mainstream school with special health needs: the health perspective. Child Care Health and Development, 28, 21-27.