§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. G. Campbell.]
§ 4.9 p.m.
Mr. Compton Can (Barons Court)After three and a half years in this House I always feel nervous whilst standing up to speak. Today, I feel even more nervous, because I rise to speak on behalf of children and people who have not very often had the opportunity of speaking for themselves. Indeed, the children may never have that opportunity.
I will try to be factual and not be emotional, although it is extremly difficult to do so, because the children of whom I am speaking, and of whose parents I am speaking, are the autistic children, who were known not very many years ago as juvenile schizophrenics and sometimes just referred to as psychotic children and have now been sorted out among the ruck of mentally handicapped children and have been recognised as lying in a separate field. They are mainly withdrawn and apparently aloof from their environment.
An article in the Evening News of 9th November expressed, I think, their position more succinctly than I can. In its headline it referred to them as "Children in Chains", and, indeed, at present they are. Those of us who have some knowledge of these children—I have very little myself—are more and more convinced that the field through which one can help them most directly is that of education rather than that of medical research.
I feel all the more diffidence in speaking about this matter when I realise that it is only recently that work has been started in the true educational field on this problem. If one looks at the names of the people who know most about the problem one finds that they are mainly medical men of great repute in the treatment of the mentally handicapped. They include Dr. Mildred Creak, Dr. O'Gorman, Dr. Tizard and Dr. Vaughan, all people who are dealing with the matter almost purely from a medical point of view.
As I say, it is felt that the majority of these children can, at any rate, respond to some educational stimulus, but before 913 I speak in those terms I wish to mention one or two facts about them, because they are very much an unknown factor to many people. Indeed, many of my hon. Friends and hon. Members opposite have asked me during the past week or so, since my interest in the problem became known, what the word "autistic" means.
It is estimated that there are about 3,000 or 4,000 of these children. This is an absolutely inspired guess, because no one has any idea how many such children may be immured in mental hospitals and regarded as completely subnormal children of the very lowest possible level. Because, unfortunately, they are withdrawn, non-communicating —although there is some discussion about this term—in some cases quiet children, one lacks the opportunity of observing the depths of their mentality. The fact that there are about 3,000 or 4,000 of them means that in one of the new Greater London boroughs, if the London Government Bill becomes an Act, there might be 19 or 20 of these children. This is a very small problem in terms of the nation. But they are, as I say, children for whom there is hope that something may be done for them.
This is not a question of a holding operation or of putting the children somewhere more comfortable, but of redeeming and reclaiming them from, in quite a number of cases, the abyss of the mental hospital and of bringing them to something like normality, at any rate half way to normality, through the E.S.N. school into the community at large.
There is no sense at all in my implying that the treatment, however careful or detailed, will guarantee a cure. That I would not wish to do. Indeed, medical evidence would be very strongly against me if I were to do that. On the other hand, autistic children are particularly vulnerable to a stimulating environment and, vice versa, they are liable to react badly to an unstimulating environment. It is, therefore, felt that if only environment and education can provide them with stimulation they can make some movement towards normality, even though they cannot finally reach that goal.
There are cases where these children have assets which, if used to the full, may make up almost completely for their disabilities. As I have said, this 914 means that the most rewarding approach is likely to be based on a practical assessment of those disabilities, so that educational methods can be applied in assisting them.
As I have said, the term "autism" is a general one, and I would not wish to limit the level at which it should be applied. But one obviously tends to talk more of the pure case even if one speaks in medical terms, although there are a tremendous number of marginal cases where there may be multiple handicaps. I shall try to speak in terms of the pure case, if such exists.
I want to deal very quickly with the case of the juvenile schizophrenic, because the effect of this disease has the appearance of typical schizophrenia equivalent to that found in the adult. I have met many of these children, and their parents. Some parents are still plagued by general practitioners who, not knowing about this condition, tend to label these children as incurable and try to persuade the parents that the child should be completely institutionalised. This is one reason why we think that the matter should be approached through education rather than medicine.
We who have anything to do with autistic children feel sure that once we are given the opportunity of proving our case we can show—and we believe that my hon. Friend, together with the Minister and the Ministry will be able to show —that there is a lot more to do, and, what is more, that out of the work which may be done in respect of these children much more new work may be inspired, both medically and educationally.
It is fair to say that at the moment most children are approached from the medical point of view, and are given such education as appears possible, after treatment. We feel that this is not the way in which this matter should be dealt with. It is true that it is a medical condition, and must be dealt with medically, but we feel that it no more needs to be dealt with medically rather than educationally than any other disease, and any mental handicap. We are moving towards a realisation that education is as important a stimulant mentally as treatment is medically.
I do not want to overrun my time, because I very much want to hear what my hon. Friend has to say, as do many 915 others. I shall, therefore, cut short the other things that I could say. Those things, unfortunately—and I say "unfortunately" because I think that it is the wrong approach—tend to be expressed from an emotional point of view. Once one has seen these children one cannot hold back emotion. What the parents must feel as a result of living with autistic children is unbelievable.
One realises that they are almost completely unpredictable and may be subject to great tantrums, prolonged fits of screaming and head banging, and all kinds of peculiar behaviour. That not only affects the parents and the parents in their relationship with the neighbourhood because, as one says, "people talk", but it may also affect the normal children of those parents because very often autistic children have completely normal brothers and sisters. There is tremendous strain and it is very hard to speak unemotionally about it.
Before reaching the suggestion which I wish to make to my hon. Friend, I should say that I hope he will not think when he deals with the parents of autistic children that they are an "aggressive bunch". Those concerned with them know that they tend to become aggressive. Any parents who have known that their child, almost from birth and certainly from infancy, is different from other children, and have been told that the child should be institutionalised although they know that is not the treatment, or have been told that the child is just slow, are bound to be aggressive in the approach to an authority which, they feel, may have failed the parents.
I do not need to plead with my hon. Friend for sympathy, tact and understanding of these parents. These parents see at long last some possibility of the things which they thought for so long could be done now being opened to them. London County Council, through its special education sub-committee and the officers of that sub-committee, has now opened up possibilities to parents in London which were not provided even as recently as six months ago. One therefore understands the feelings of these parents who have been, so to speak, battering their heads for so long against what seemed to be a brick wall.
The suggestion I make to my hon. Friend is that these children need a special 916 type of research work to be done on their education. They need a unit which should contain nearly all the educational services, if possible under one roof. If they could have a special day nursery, schools, a residential family unit and a hospital unit for the disturbed children combined in one research centre, the advance might be so greatly accelerated that the educative result both for teachers and medical people, apart from that of the children involved in the experiment, would be tremendous.
I have very much in mind that the teacher-child ratio in this case ought never to be more than one to three; it ought more properly to be one to two. When one realises that in junior training centres dealing with mentally handicapped children the ratio is one to nineteen, one understands the tremendous strain which this might entail. But a centre such as this would give training to teachers, housemothers, social workers and nurses as well as to the small number of children with which it might deal. We ask for support for that from my hon. Friend.
We who are connected with this problem—I say "we" and I am proud to be associated with it although I am not so closely associated with it as others, especially parents—believe that there are nine needs which are outstanding. I shall run through them quickly. They include more and earlier diagnosis and more surveys to assess the needs for services. We need more flexible educational special and medical services, including more trained personnel to give those services. We need a more open mind to unorthodox techniques, because this is a problem with which we have not dealt. We need more residential care for all ages in schools and hospitals. Teen-agers and adolescents have very little hope of being treated today. The adolescent autistic has little hope of treatment.
We need more help for the family, community care, and more co-operation between education and health authorities. We need more research and experimentation in all aspects of the problem. There is a need which I cannot ask my hon. Friend to meet directly although I can ask him to try to inspire it—a need for more public understanding; and there is something which I can ask him to put to his right hon. Friend and other right hon. 917 Gentlemen—more money to spend on all these needs.
If he will give us an assurance that he will look at these problems at any rate with sympathy and with understanding, a few hundred people will sleep the more happily in their beds tonight.
§ 4.26 p.m.
§ Mr. Philip Noel-Baker (Derby, South)I wish to speak for only a minute to reinforce the plea which the hon. Member for Barons Court (Mr. Compton Carr) made for more research into cases of subnormality in children and into the methods by which it can be treated.
I especially emphasise what the hon. Member said about the need for an open mind towards unorthodox methods of treatment. I give one example: I have had to deal with a number of subnormal children, some of them severely subnormal, whose troubles were greatly accentuated by dislocations which had resulted from falls when they were very young.
When they were manipulated by people whom the medical profession sometimes do not recognise but who, in fact, are highly skilled and highly qualified osteopaths, some of their troubles disappeared. For example, I have seen children cured of tantrums, excessive screaming and the head banging phenomenon which is so very familiar and so very painful for those who see it.
I only hope that the Ministry will give much more attention to subnormality in general than it has given in the past
§ 4.27 p.m.
§ The Parliamentary Secretary to the Ministry of Education (Mr. Christopher Chataway)Many will be grateful to my hon. Friend the Member for Barons Court (Mr. Compton Carr) both for raising this matter on the Adjournment and for the energetic interest which he has shown for some time in the problem of autistic children. I am aware, too, of the depths of interest in the problem shown by the right hon. Member for Derby, South (Mr. P. Noel-Baker).
My hon. Friend referred to the recent memorandum by the Drs. Wing, a copy of which he kindly gave me and a copy of which is in the possession of my Department. Although the children concerned may not be numerous and their 918 plight is tragic, I find that one reads works such as that of the Wings with a feeling of some excitement, because here is research and discovery which may possibly, as they say, separate a few more children from the numbers of mental defectives and maximise their chance of growing up as normal adults.
One can hardly fail to be encouraged by the growth of expertise and specialisation in the treatment and education of mentally ill children Whatever else can be said about the age in which we live, it is one in which we are learning to avoid the waste and grim frustration in human talent which has hitherto prevailed.
I assure my hon. Friend that there is no lack of sympathy in my Department both for these children and for the real problems of their parents and their teachers, because I recognise that it must make demands on both.
I hope that in the few minutes available to me I may tell my hon. Friend something of the work which is in hand. May I first refer to diagnosis? The first need of psychotic children, among whom these autistic children are to be numbered, is for medical attention. Early diagnosis and treatment, preferably before school age, offer hope of improvement in some cakes, and this was emphasised in the Report of the Department's Chief Medical Officer.
The size of the problem is not yet known, but several attempts are being made to estimate the number of children affected. For example, medical officers of the London County Council have been conducting a survey of the numbers of autistic children in London. The returns of this survey are being analysed and it is expected that the results will be announced in a few weeks' time. We understand that the Society for Autistic Children is considering the paper to which I have already referred.
Uncertainty about the extent of incidence does not mean that individual cases need go undetected. School medical officers are alerted to the condition at the time of the course they are required to complete before assuming responsibility for ascertaining children who are educationally subnormal. Psychiatrists working in children guidance clinics are also trained to recognise autism and other forms of psychosis. Additional safeguards exist in the areas of those local education authorities which have set up 919 diagnostic units where the cause and not merely the degree of a young child's educational retardation can be discovered.
On the subject of treatment, may I give these details? Medical treatment for autistic children is available at hospital units throughout the country for severely maladjusted and psychotic children. At present there are sixteen of these units in England and Wales, with five additional units for adolescents. Two new units, one for children and one for adolescents, are expected to open within the next few weeks. At the request of my right hon. Friend the Minister of Health, the Standing Mental Health Advisory Committee is at the moment reviewing the extent of the need for special facilities for mentally ill children and the lines on which these facilities ought to be developed.
In the past, psychotic children were far too often assumed to be mentally subnormal and unsuitable for education. Now it is recognised that some are capable of great improvement in a suitable educational environment, and we are clear that none should be regarded as unsuitable for education without a prolonged and very careful assessment.
We have not reached a point where we can assess the full extent of the demand for educational facilities for autistic children as yet. It is not simply a question of estimating the incidence of the condition, but of providing further facilities for medical investigation and treatment so that children may be brought to the point where they can respond to education. I must agree entirely with my hon. Friend that medical and educational treatment must be complementary and concurrent.
Until we know the size of the problem, it is necessary to proceed empirically, and this is being done. Teachers provided by local education authorities or in the direct service of regional hospital boards are employed at most of the existing hospital units for severely maladjusted and psychotic children. The provision of educational facilities is essentially a matter for the very closest co-operation between the educational and the health services. The Ministry's medical officers and Her Majesty's Inspectors are at the moment considering with local education authorities and the 920 hospitals concerned the best means of strengthening the educational arrangements at hospital units.
In this very difficult field it is clear that experimental techniques and approaches must continually be worked out, and often they will have to be worked out separately for each child. The Society for Autistic Children has decided to establish one or two nursery/infant units in the London area based on the homes of its members and has obtained the agreement of the London County Council to assist with the payment of fees and, where necessary, transport costs. So far one unit has been established at Hammersmith for two children, the London County Council providing the teacher. However, we understand that shortly after the unit opened one of the children was withdrawn and placed by the parents in a private nursery school. The Society has as yet been unable to find any other London children to attend this unit. This is one piece of evidence which would seem to conflict with other estimates as to the number of autistic children there may be and is an illustration of the lack of certainty about their numbers.
The London County Council, as my hon. Friend knows, itself established a small class for psychotic children at the Province of Natal Centre and works in close co-operation with the hospital authorities at Great Ormond Street in the provision of special educational treatment for these children. At present four children are attending this Centre. The council also hopes to set up in 1965, or soon after, a small observation and assessment unit for young autistic children at one of its day schools for maladjusted pupils.
Similar co-operative efforts by education and hospital authorities are being made in other parts of the country and these are a few of the developments that are at the moment in hand. Clearly this is a sphere in which there is much research still to be done. We may say that we are still in the early stages of discovery. But I share with my hon. Friend his desire that there should be a wider awareness of the sort of problems we have been discussing today. Education is now often spoken of as "an investment". That 921 is the fashionable phrase these days, but the justification for educational expenditure in terms of economic advantage can to my mind be carried too far. We should never forget that there is some education that yields little or no economic return and is yet supremely deserving of the com- 922 munity's interest and support. I would suggest that the education of these children falls into that category.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-three minutes to Five o'clock.