§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Monro.]
§ 11.49 p.m.
§ Mr. Laurence Pavitt (Willesden, West)It is right that the debate which I wish to initiate on the Adjournment should be separated from the debate which we have just concluded, although on the surface it may seem to be allied to it.
I want to draw to the attention of the House the problem of the education and health provisions that we are making for autistic children and make a plea for distinguishing between the autistic child on the one hand and the mentally handicapped child on the other. In this short debate I want to concentrate entirely on the problem of the autistic child.
Although the problem is comparatively small, in proportion, it is indicative of a wider problem relating to new and sophisticated diagnostic techniques. Whereas once upon a time we had very broad categories for the treatment of people who suffered from sickness of the mind or disabilities of the mind, we are now able to define far more accurately what is wrong. We are not dealing with one group. There are more than 100 different cases. In recent years we have been able to isolate and look at the techniques and provisions for teaching and incorporating the autistic child into the community. It is because there is a need for a furtherance of this that I raise this subject.
The first priority is that of diagnosis—to be able to ensure that we are establishing that a child is autistic and not mentally subnormal or suffering from some other disability. The problem of autism is one mainly of communication. The House will know that this is a subject about which I have personal experience. It was Helen Keller, who was blind and deaf, who pointed out that deafness was the most difficult to sustain because it cut off communication from one's fellow human beings.
What happens with autistic children is that the whole of their communication is jumbled and what could be and maybe 1685 is an intelligent brain from the point of view of any other measurement, merely because of jumbled communication, becomes a problem of a special kind. The eyes and ears function normally and the I.Q. may be above average, but the messages from eyes and ears do not link up with the brain and so their picture of the outside world is distorted. Because of this the autistic child is withdrawn and unable to demonstrate any kind of affection. Being unable to express themselves, they often show their disturbed behaviour in a way which leads them to be diagnosed as being other than autistic. Instead, they are diagnosed as being mentally subnormal and find themselves in hospitals for such children where they are not able to compete for attention. They withdraw into themselves, often scratching their arms and faces until they bleed, because they have nothing better to do. Eventually the situation becomes extremely distressing. A recent spot check carried out by the National Society for Autistic Children showed that out of 460 children between the ages of 5 and 14, 60 were wrongly categorised and were in hospitals for the mentally subnormal. On a wider scale this shows that there are something like 667 autistic children in the wrong place.
It is because I hope that we might be able to do something for such children that I have initiated this debate, calling for co-ordination between Departments. This is why I mention the educational and health provisions for such children. I hope that we can do something to diagnose this condition successfully and make the right provisions for these children.
Secondly, there is the problem of how to teach these children. I disagree with the comments made in the previous debate by the Under-Secretary. He talked about meaningful education. I believe that he was thinking in stereotyped and orthodox terms. For autistic and subnormal children the degree of education is a question not just of being able to assimilate certain facts and put them out again but of how one co-ordinates and is incorporated into the community.
The hon. Gentleman gave me an answer on 9th July, when he replied to my Question about training: 1686
There is no generally accepted professional training specifically for teaching autistic children, but a limited number of short courses have been provided including a 5-day course this month at Newcastle University for teachers, psychologists and speech therapists."—[OFFICIAL REPORT, 9th July, 1970; Vol. 803, c. 81.]This is totally inadequate. If we are to tackle this problem of autistic children, there has to be specialised training—to us, highly specialised training—for the body of teachers to be able to deal with it.Even in the present situation, for an estimated 5,000 autistic children there are only 250 school places. In other words, the vast majority have no educational provision whatsoever. It is estimated that there are about 5,000 autistic children between the ages of babies and 17. I pay a tribute to the very few special schools, especially the one in Ealing, which serves my own constituency, the London Borough of Brent, where my local medical officer of health does a tremendous job in association with the local authorities and the centre at Ealing.
I should also like the hon. Gentleman to look at the possibility of adding this category to the 1944 Education Act, if not by some amending legislation, perhaps by circular. We have discussed a number of circulars dealing with education in recent weeks. He will know that the list of categories include the blind, the partially sighted, the deaf, the partially deaf, the educationally subnormal, the paraplegic, the maladjusted, the physically handicapped, those suffering from speech defects, and the delicate. There is a need to designate autistic children, now that there is a clear definition of what such a child is. I hope that the hon. Gentleman will consider the possibility of bringing these into the framework of our provisions.
The Parliamentary Secretary to the Ministry of Housing, who is present, told me, in answer to a Question on 6th July, that no reliable estimate has been made of the number of autistic children resident in subnormality hospitals, and went on:
Special 'autistic units' in hospitals are not generally favoured by psychiatrists."—[OFFICIAL REPORT, 6th July, 1970; Vol. 803, c. 6.]This is a question of where the experts conflict. The psychiatrists, used to mental 1687 subnormality but not necessarily to autistic children, are giving one set of advice, while the specialists with the National Society of Autistic Children and those concerned with education are giving another. I hope that there will be some co-ordination between the two Departments to get their expert advice sorted out.I hope that the Under-Secretary will also look at the continuing provision for health and educational care in hospitals and for sheltered work at the end of the day when the strictly educational task for autistic children is finished. This is a continuing responsibility, which does not end when the child finishes with the particular Department. It remains a community responsibility.
I would make a plea that on both the educational side and on the health and welfare side there should be much greater co-ordination between the Departments. When I asked the Prime Minister if he would designate one Minister for this, he replied that he was not convinced that it would be helpful at this stage but that he would look into it. I hope that the two hon. Gentlemen will probe him to look into it further. It is ridiculous that in the last Government a Minister could move from Department to Department and still retain responsibility for sport when responsibility for things like autistic children and the disabled is just a small sector of one Department running over into at least 10 other Departments in terms of health and welfare. In particular, educational responsibility for the autistic child rests with the Under-Secretary of State for Education and Science, but there will be a continuing responsibility—even partly educational—in the Department of Health and Social Security. It would therefore be helpful to have either one or the other as the overlord, in order to co-ordinate what is happening.
My last point is that although I am laying a charge for the various six priorities not only on the hon. Member but on the Government and the Department, I am afraid that it is a continuing responsibility of all of us. There is a need for a greater understanding of the problem by the community, for greater help for parents of autistic children, and for greater neighbourliness, so that 1688 people can understand not only the problems of the parents of autistic children but what the hon. Member is trying to do, in order to co-operate in a voluntary fashion with what the Government can do on a statutory basis.
It is my hope that by initiating this debate we shall get some continuing action. There is a long time for the Government to think about this matter before we return after the Summer Recess. I shall be returning to the subject again from time to time until some of the things that I am demanding are implemented by the Government.
§ 12.1 a.m.
§ The Under-Secretary of State for Education and Science (Mr. William van Straubenzee)I hope that the hon. Member noticed that there were two junior Ministers on the Government Front Bench to listen to what he had to say. I am deeply obliged to my hon. Friend the Under-Secretary of State for the Department of Health and Social Security for giving me moral support on this occasion. I hope that the hon. Gentleman will understand that both of us take very seriously the question that he has raised.
In preparing my mind for attempting to answer the hon. Gentleman I have been very impressed, when dealing with the officials of both Departments—because it has been necessary for me to do that—with the real sense of personal dedication to the problems of the handicapped that I have found in them. Officials sometimes necessarily sound a little distant, or seem a little distant, to the average person, but they are not when one is fortunate enough to have close contact with them. Being new in office I want to place that fact very firmly on the record. It has impressed me greatly.
I am grateful to the hon. Member for drawing attention to the difficulties of these children and their parents, and of those who care for and teach them. The hon. Member mentioned that my right hon. Friend the Prime Minister has undertaken to look into the hon. Member's suggestion that one Minister should be designated to be responsible for the services at present extended to autistic children by the Department of Health and Social Security and the Department of Education and Science. It is obviously very helpful, when my right hon. Friend the Prime Minister is giving attention to 1689 that suggestion, that the hon. Member should be kind enough to raise the points that he has.
As the hon. Member knows, psychiatric disorders in children have been known for many years, but the use of the term "autistic" to describe a particular group is very much more recent. I understand that the term is now widely used by professional workers, both in health and education, to describe children with a combination of disorders of behaviour, development and learning, whose disabilities cannot be attributed to obvious organic defects.
This group is so identified in terms of symptoms shown and not in terms of underlying causes. I know that the hon. Member understands that I lay claim to no professional knowledge in this subject, but at the same time there are some general aspects of autism in children that it might be helpful for me to state as clearly as I can.
First, there is a wide range of variation between one child and another in the severity of the symptoms and the relation of those symptoms to one another. Sometimes one of these is more conspicuous, and sometimes another. I understand, also, that the condition is thought to be brought about not by a single underlying cause but by a variety of such causes. There is a great range, also, in the tested intelligence of autistic children. They may, on the one hand, be to all intents and purposes normal or, on the other, extend to the lowest limits at which tests can effectively be made. A number of autistic children suffer, as we know, from additional handicaps. In short, the point I am making is that the group is not at all uniform, and individual autistic children have very different needs and a very different capacity for development.
In extreme cases—alas, they are not infrequent—an autistic child is practically unable to communicate with others, either by speaking or in other ways, or to demonstrate, as the hon. Gentleman said, the natural interest and affection which a child normally feels for his parents or his family and others who have earned his confidence and affection. It is this feature of autism which is so particularly distressing to the child's parents and so discouraging to those responsible for its care and education. Wherever a family 1690 contains a handicapped child the child and the family have a need of particular health, educational and social welfare services. This is true whether the handicap is autism or whether it is some other form of handicap, and the questions arise of prevention, of medical treatment, of care, of cure or remediation, of special education, and advice and help for the parents. Tonight, I realise, we are concerned with educational and health problems, and I need only mention in passing—but I do mention—that there are also other problems of social welfare in these cases.
To deal first with the health side, autism, as the hon. Gentleman said, may be due to a variety of causes, among which are sensory defects, brain damage, or emotional disturbance. It follows from this that medical and psychological assessment is of paramount importance, and this is undertaken by the health services, generally in a hospital setting. Medical treatment, where this is appropriate, varies according to the nature of the condition, but in the present state of our knowledge, so I am advised, in many instances what is provided is rather in the nature of skilled care than in the nature of cure. A number of autistic children, in particular those with emotional disturbance, are found to benefit from phychiatric treatment in hospitals. Psychiatrists generally do not favour the provision of separate units in hospitals for autistic children, but there are units doing devoted work, as the hon. Gentleman knows better than I, at High Wick, St. Albans, and in the Smith Hospital at Henley-on-Thames.
As I said, the condition has only comparatively recently been recognised, and because of the variety of forms the syndrome may take and the variety of underlying causes, many of which remain obscure, we still have a great deal to learn about the nature of the condition, its diagnosis, prevalence and treatment, and psychiatrists, by working in the health service, have played, and are still playing, a most important part in a number of research projects.
Turning briefly to the educational side, local education authorities have a general duty to provide education according to a child's age, ability and aptitudes, and to identify, with medical advice, and to 1691 provide for, those children who, as a result of handicap, need special education.
Autistic children, as I have said already, are a very heterogeneous group and local education authorities place them in a great variety of establishments and, I would have thought, rightly so. Some are in special schools for the educationally subnormal or the maladjusted; some are in units attached to special schools or to ordinary schools; and some are sent by the local education authorities, who pay their fees, to independent schools.
A number also are classified by local education authorities as "unsuitable for education", in the sense in which that term is at present used, and are either in the case of local health authorities in junior training centres or are placed in hospitals for the mentally handicapped. The education of autistic children will, we hope, as a result of the Bill to which we have just given a Third Reading, from next April become the responsibility of local education authorities.
Many autistic children are being educated at schools or other establishments under the responsibility of local education authorities. Exclusion from the educational services can take place only after elaborate medical and psychological examination, and parents have a right of appeal to my right hon. Friend the Secretary of State for Education and Science, who gives very careful attention to any representations made to her. Nor would it be correct, as has sometimes been inferred, even when such children are classified as "unsuitable for education" to suggest that they are not receiving any education at all. I should like to make special reference to the devoted and expert work of the teachers of the mentally handicapped who will join the education services in April.
I noted the point made by the hon. Gentleman about the provision for handicapped children beyond the normal school-leaving age, which for children in special schools is 16. Local education authorities already have a duty to provide full-time education in school for any child up to the age of 19 whose parents wish him or her to continue at school, 1692 and this point we dealt with a moment ago in the Bill. In addition, the further education provisions of the Education Acts apply to any handicapped children who are able to go on to take a course of further education using the normal facilities. I take the hon. Gentleman's point on anxiety about those over the age of 19, but he will know that the provision of further training and sheltered employment for handicapped adults is the responsibility of local health authorities and of the Department of Employment and Productivity. and those autistic children who reach adult life and have not achieved a sufficient degree of social and emotional adjustment to take a normal place in the community may be provided for in this way.
It has been borne in on me as I have sought over the years to interest myself in this problem that there is still much difference of opinion among those who are professionally responsible on the most effective form of education, and a research project financed jointly by my Department and the Gulbenkian Foundation has been under way since 1966 to make a comparative study of the progress made by children in three units in the London area catering in different ways for children with autistic symptoms. One unit is a day centre run by the National Society of Autistic Children—a society which has been mentioned by the hon. Gentleman—one is a day unit in a hospital and one is a residential unit. Results are expected in two years' time. Because of the variety in the educational needs of children suffering from autism, it is unlikely that any single educational régime will be shown to be the best for more than a small proportion of these children.
I should now sum up what I have already said, answering for two Departments, and look forward to the future. Autistic children are not a homogeneous group, and, because of the variety and complexity of the problems presented, we are still far from knowing with any certainly what are the best régimes either for the health or for the education of these children. What appears likely is that a wide variety of treatment is needed, and, within the limits of present knowledge, this is being provided.
My right hon. Friends the Secretaries of State for Education and Science and 1693 for Social Services would not think it right to engage in any general development of expensive and highly specialised units. These could well prove less effective than the kind of flexible and varied provision already being developed. There is a great need for research and for the acquiring of practical experience. Research projects are being undertaken, and in due course their findings will be applied in practice.
A large number of autistic children now in the care of local health authorities and in hospitals will have responsibility for their education transferred to the local education authorities, though these will not extend over the medical care and nursing of the children. My right hon. Friends have no doubt that, as the local education authorities gain experience in their fresh responsibilities, these 1694 children will benefit from the integration of the education services given to them within the education service as a whole. I can give the assurance to the hon. Gentleman that it is our intention to press on with these developments, and I can assure the parents of these most grievously afflicted children of the very real concern of the Government for the plight in which they find themselves.
I hope that this setting out of the position as the two Departments see it may be, in the present state of our knowledge, of assistance to the hon. Gentleman and will show the care, thought and sympathy going into these difficulties from two Government Departments.
§ Question put and agreed to.
§ Adjourned accordingly at sixteen minutes past Twelve o'clock.