§ 4.57 p.m.
§ LORD BEAUMONT OF WHITLEY rose to ask Her Majesty's Government: What steps they propose to take to ensure that autistic children receive an education suited to their needs. The noble Lord said: My Lords, I do not propose to detain your Lordships long in asking this Question. The first reason for this is that, although the Answer may be complicated and detailed, I do not think the Question is. The second reason is that I am delighted that a number of noble Lords are joining me in asking this Question tonight, and I am sure that all noble Lords interested in this subject will be delighted that the noble Baroness, Lady Elliot of Harwood, who is President of the National Society for Autistic Children, has her name down among those who are to speak.
§ Autism is not a new condition. It is, however, a fairly modern diagnosis. In my extremely brief account of this condition, I shall be relying to a large degree 1115 on the extremely useful pamphlet, Children Apart, by Dr. Lorna Wing, published by the British Medical Association; as, indeed, for the rest of my speech I shall depend upon the equally important Report, Misplaced Children, published in November last year by the National Society for Autistic Children. These children—and, indeed, adolescents and adults—have a very severe learning problem. This arises, apparently, at some stage in the interpretation that goes on between their perfectly normal eyes and ears and their brains. They are, in the words of Dr. Wing,"tone deaf to any kind of language ". They are also unable to entertain concepts and to work out causal connections.
§ Very little indeed is known about the causes of this condition, but it is quite obvious that not only is it a vast and tremendous handicap to the child affected, but it places a particular strain on the family which has a child in that condition. This is the more so because at the moment there is no medical treatment for autism. Nevertheless, very considerable progress has been made in teaching children to find a way round their difficulties, so that at the very least they can become acceptable members of society, live with their own families and, indeed, learn basic skills which enable them to earn their own living. For this reason it is particularly important that the right kind of education should be given to the autistic children in this country.
§ My Lords, it is calculated that in England and Wales there are about 3,000 autistic children of school age and 2,000-odd below school age. A survey reported in Misplaced Children deduces that there are well over 700 young children in this condition in mentally subnormality hospitals who should not be there at all. They are autistic children who should be receiving proper education, and they are there in these hospitals only because there is nowhere else for them to go. For the 3,000 autistic children in this country there are only 21 educational centres; and all of them, incidentally, are in the South-East.
§ One of the ways of overcoming this problem, of course, would be to provide more autistic centres in different parts of the country and/or more residential schools. For various reasons, which have been dealt with in the Report, mental subnormality 1116 hospitals are particularly bad for autistic children, apart from cheating them of the possibility to learn to cope with their situation. The children are there, as I have said, because there are not enough special schools. Quite often they are there because the education authorities are not as aware of this problem as they ought to be; and although some authorities are extremely good, and have a very good record in this matter, others are obviously still behind the times and ignorant about it.
§ The necessary framework within which these children can be treated, within which the local education authority can work, is laid down in Section 33 of the 1944 Education Act—and, if I may say so, extremely good machinery it is. The Secretary of State is empowered to lay down special categories of children which, when they are diagnosed, can be treated —indeed, must be treated, according to the regulations; and there is a duty on the local education authority to see that they are so educated.
§ Under this section a number of conditions (I think ten in all) have been laid down by regulation as demanding a special treatment. They range from blindness and deafness to such rather indeterminate categories as "delicate" children. Autism has not been included so far, partly because it is a fairly new diagnosis, partly because it is difficult to diagnose, and partly, I believe, because the Department of Education and Science has certain doubts about the whole future and rightness of categorisation. I do not think there can be very much doubt that if autism were categorised, and special regulations made, this would have a tremendous effect on seeing that autistic children received the right kind of education, and that the right kind of schools were provided for them in the right place and at the right time.
§ In a letter to the National Society for Autistic Children, dated February 4 of this year, Miss Alice Bacon intimated that one of the subjects that would be dealt with by the forthcoming major Education Bill, and therefore in the White Paper—or, as some of us hope, the Green Paper—which we may expect this year, is the whole question of categorisation, and that the present view of the Department of Education and Science is that there should be less rather than 1117 more categorisation. I understand that categorisation can give rise to difficulties in cases where children suffer from multiple handicaps, but I would maintain that no better machinery could be found for dealing with small and relatively obscure categories of children than Section 33 of the 1944 Act.
§ It may well be that there should be less categorisation. It may well be that there is no longer a need to categorise such groups as the blind or the deaf, simply because their education is now recognised by all local education authorities as a duty, and there is no danger that such people will not be educated, even if not necessarily completely, at any rate as adequately as possible with the money available. Nevertheless, I would urge that in the case of autistic children there is still need for categorisation. The idea put forward by the Department, as I understand it—that is to say, that, instead of categorisation, there should be tailor-made treatment, education, for each individual child, not straitjacketed by categorisation—is a very attractive and appealing one. But it appears to me to be idealistic and a little naive to think that we have reached this stage, even if after Maud, say, we have only the number of local education authorities which is envisaged in that Report.
§ It has been suggested that we do not at the moment know the best way to educate autistic children, and that therefore it is difficult to lay down the regulations or to know what the result of them would be. There is of course some truth in this statement; and I think all noble Lords will be delighted that there is a project, supported by the Department of Education and Science, to compare and evaluate the education and training being given to these children. Nevertheless, there is enough first-class educational treatment of autistic children now going on, as some of your Lordships will have seen, to make it quite clear that progress can be made.
§ The idea has been put forward that autistic children are better educated when mixed with non-autistic children, and receiving stimulus from them, than when in special units. I am not an expert on the subject, but it does not seem to me that the stimulus they get from their 1118 fellow children can be any substitute for the stimulus that one sees they get from teachers who are particularly trained in and concentrating on giving this stimulus; and, however good the teachers are in a mixed unit, they will undoubtedly respond more to the lively children than they will to the children who have this problem of almost total non-communication. However that may be, there is no dispute over the need to make sure that autism is diagnosed early and that sufferers are given the best possible treatment.
§ If categorisation is to continue, surely it is to the benefit of these children that they should be categorised. If it is not to continue, may we not have categorisation until the new Bill comes in, which must at any rate be a couple of years off, if not more? It would help reassure a large number of parents and children, and it would give us some experience of what the results of categorisation are, which in any case surely cannot be harmful. Nothing will be lost; and even if categorisation is not continued, experience will have been gained. If the whole future of categorisation is still in doubt, these arguments surely still remain. It would be a fairly simple and easy thing to apply categorisation by way of a regulation under Section 33 of the Education Act, whatever is going to happen in the Education Bill two or three years ahead, which may depend upon what Government are in power and may be longer ahead anyway than any of us anticipate.
§ But whether or not we get a favourable reply from the Government to this particular point that I am urging, I am sure that all noble Lords will agree that we must have—and I know that the Department will be only too delighted to give— some really definite assurance that the kind of tragic cases which have been reported of the misplacement of autistic children will not occur in the future. There must be something more than pious hopes that local education authorities will be able to see that these children are diagnosed and that treatment is given. Now that a considerable scandal has been exposed, there must be some plans to see that these things do not occur again. A civilisation and education system is surely judged by the treatment that it gives to its most unfortunate members. The autistic children, and to a certain extent their parents, are indeed among some of 1119 the most unfortunate members of our community, and we must do everything we possibly can for them. My Lords, I beg leave to ask the Question standing in my name on the Order Paper.
§ LORD ABERDARE
My Lords, we are all very grateful to the noble Lord, Lord Beaumont of Whitley, for having drawn our attention to the difficulties and needs of autistic children. I make no secret of the fact that I am very ignorant on the subject and, in fact, before the noble Lord put down his Question I really did not know what autistic children were. I should like also to express my gratitude to the National Society for Autistic Children whose secretary, Mrs. Everard, was very helpful and also Mrs. Elgar of their school at Ealing where I have seen something of what is done for them. This is a school well known to my noble friend Lady Elliot of Harwood who founded it and has had a great deal to do with encouraging it. I feel very humble in the presence of so many great experts on this subject who are speaking in this debate to-day and I hope that my remarks will be accepted for what they arc worth, as the first impressions of an ignorant observer.
I know that there is some controversy about the causes of autism in children, and I know that there are different views on the best method of treating them. But one thing seems clear: and that is expressed better than I could by Dr. Michael Rutter in his book Schooling and the Autistic Child from which I will briefly quote:In our present state of knowledge education probably constitutes the most important aspect of treatment and it is to the school in one form or another that we must look for the greatest hope of bringing about improvement in the child.This is certainly the overwhelming experience of those working at the school in Ealing which I visited. Some of the children benefit to the stage that they graduate into the ordinary world and can take a place working in the normal world; others will need care and help all through their lives; but all of them will have benefited to some degree or another from their years at the school and, at the very least, they will have learned socially acceptable behaviour. 1120 The one thing that struck me personally at this school, where many children had been severely disturbed, was their immensely good behaviour. They are all of ages between five and eighteen and, although they found speech difficult and although they were undoubtedly very backward at reading and writing, they obviously enjoyed themselves doing all the usual school activities. Some were painting, some were doing pottery, some were enjoying music. All seemed happy; yet among them were children with an I.Q. lower than thirty—well below the normal standard of fifty which usually determines whether a local education authority considers a child educable. Some of them in the school had been too disturbed even to take a test. Yet here they were happy and in pleasant surroundings doing elementary lessons and joining in many of the usual school activities.
We speak so often of education as the bringing up of a child in the whole sense; not just encouraging his mental ability but caring for his or her physical, moral and psychological development. How shocking then, my Lords, to categorise any child as ineducable. So much depends on the local education authority where the child lives. A so-called "ineducable" child or an untestable child may be lucky enough to live in an area where there is some provision for autistic children. If not, he or she is likely to be sent to a Junior Training Centre and here, among a mass of children suffering from other mental handicaps, the autistic child, unable to communicate, often becomes utterly withdrawn or violent. In either case he is difficult to deal with and in the end is probably sent home or ends up in a mental hospital—and as the noble Lord, Lord Beaumont of Whitley, said, already there are well over 700 autistic children in mental subnormality hospitals. With the best will in the world the overworked understaffed hospital cannot possibly care for the needs of these unfortunate children who, above all, require individual attention.
As the noble Lord has said, we are fortunate in the South East of England in having increasingly good provision for autistic children. Many voluntary bodies are doing an excellent job: the National Society for Autistic; Children, the 1121 National Society for Mentally Handicapped Children, the Invalid Children Aid Association, the Rudolf Steiner Homes, and I have no doubt that there are others. Many local education authorities can also be included; and personally I think particularly of the Inner London Education Authority. They have been particularly generous. For example, at the Ealing school they are paying the fees for one young man who is 18 years of age whereas they need not have paid beyond the school-leaving age. But in other parts of the country the pattern is not nearly so satisfactory; there are far too few special schools for autistic children and the result is that far too many of them are in the mental hospitals.
My Lords, one way to assist this problem is the way that the noble Lord, Lord Beaumont of Whitley, suggested. He made the case admirably in favour of adding autism to the statutory categories, and I would not say any more on that beyond saying how much I sympathise with his views. But I should like to add that in making provision for these children, it is not necessary to undertake any new building at all. It is much better to adapt existing buildings. The school at Ealing is particularly successful because it exists in four small, separate houses where the atmosphere is very much more homely and pleasant than any kind of institution would be. So far as money is concerned, I think that we should bear in mind that these children, even in such units, may eventually have to go into mental hospitals where I understand each child may cost upwards of £1,000 per annum to maintain. How much better to keep them in special units where they can benefit.
I should like to make one other point. Perhaps it goes slightly beyond the Question but, on the other hand, the Question asks that autistic children "receive an education suited to their needs", and the needs of autistic children go rather further on in life than those of normal children because their progress is that much slower. There is an urgent need for hostels for these children after they leave school. Many of them may find places in industrial rehabilitation centres or in sheltered workshops but most will continue to need help in their 1122 normal home life. The more willing and self-sacrificing the parents are—and they so often are—the greater the worry is that when they are not there the child will be left on its own and may well fail to cope and finally will end up in a mental hospital. Knowing that these autistic children can benefit from suitable education, it surely is a tragedy when, after all the devoted care that has been put into their education, they should be allowed to slip back. At the age of 18, they are still mentally years younger. Ideally, their education should go on far longer. But in any case I would hope that some provision could be made for them, after they leave the special schools and units, where they could find pleasant hostel accommodation and be sure of a home base for the rest of their lives. This surely would enable them to play a useful role in society which would not only be in the interests of society financially but is morally our duty to help them achieve. I hope that the noble Baroness can give us some encouragement.
My Lords, to sum up, I feel that there are especially two needs: first, more schools and more special units throughout the country to cope with the education of these children; and secondly, the need after they leave school for hostels where they can continue their education and where they may be looked after permanently.
THE LORD BISHOP OF CHICHESTER
My Lords, the noble Lord, Lord Beaumont of Whitley, has posed a question to Her Majesty's Government for which we must all, I think, accept some responsibility. Like the last speaker, I must confess with some shame that until this matter was brought to my notice recently, I was quite ignorant, as I imagine is the bulk of the public, of the nature and situation of this particular group of children. It could be accepted as axiomatic throughout the country that there is within limits a right of education for all children; and the limits, presumably, would be either what they are able to take or what the country is able to provide. Although there may be areas of concern for other handicapped children, the problems of education do not leave them out of it. What has been said and stated elsewhere seems to put these children, so far as they can be diagnosed, 1123 in a very peculiar category of their own. They are not within the realm of the usual subnormal group. Therefore it is a tragedy that there are so many of them at present in larger hospitals for the subnormal, where they cannot profit and where, probably, the nature of the environment is likely to do them damage to a greater degree than to other patients in the same place.
On the other hand they are not like some groups with rather particular handicaps which can be analysed and met. There is a larger number of deaf children in the country; I understand that there are not so many blind children. We can perhaps understand their needs. But these autistic children are, if I may say so, not so fortunate as blind or deaf children. If I might use the phrase of the Psalmist:… eyes have they, but they see not;They have ear, but they hear not;They have the ordinary organs for receiving through their senses the experiences of the world out of which we build our personalities; but, somehow or other, they lack entirely a capacity to co-ordinate, assess and build these up into a framework of life which can be theirs. They are therefore in a rather particular situation in which they are cut off as others cannot be cut off; condemned, so it seems, to be alone and remain alone in increasing isolation as time goes on.
The first question that must be posed is whether there is an educational case to be made out for dealing with this particular group. I think we ought to have sympathy for them, when we reflect that those children are deprived of just the normal processes which education takes into account and by which we build up our life through simply receiving them through the senses. It seems to be partly a question of unlocking some doors somewhere so that they can come to terms with the normal world and, indeed, with themselves. The first question that is put to us is: Is there a real educational problem to be looked at on its own? In a sense, that is another way of saying, is there a particular category? In spite of what the noble Lord said, I think that the aim in many of these special categories should be not merely to bring them up to such a standard of enlightenment as they can receive but to bring them into the normal community. If there are special units, 1124 it is desirable to try to make them as closely linked as possible with the normal school and educational world in which other children will be.
My Lords, we do not want to assume wholly that they must always remain separated from normal school life— indeed some of them do not so remain. But it is clear that normal school methods cannot be used to deal with them. The Department published a pamphlet two years ago called Slow Learners at School. It was posited there that learning is not primarily acquiring knowledge; it is coming to know yourself and entering into relationships in the world around you, particularly with other people round you. That is far more important to the building up of a human personality than what actual knowledge one acquires, and it is here that the slow learner can best be met. It is at this very point, because of an inability to know themselves and an inability to face relationships with other people, that these particular children are so sorely handicapped. Yet there is evidence that, after immense care and research, at least some of these children have responded in a way which has brought them back almost to a normal life. I think we must build on the evidence of those who have tried. We recognise the difficulties of diagnosis; we recognise that in some autistic children there are other complications at work. But if there is this educational case, ought we not, as society, to take it up?
If we ask that question we must go on, as indeed the noble Lord's Question implies, to ask one other question. If there is an educational case particularly for these children, what practical provision would it be possible for society to give to meet that need? None of us perhaps—certainly not I—would presume to answer that question here. I suggest that the first thing needed would be a much closer and wider examination of the total situation of these children and what would be involved, either in strengthening the units that are there, encouraging research or enlarging the field. Admittedly it would be in buildings, in other units; and some of it, surely, might be in remembering that there is another element in the scene, and that is the parents and those related to these children so much more intimately in their own homes.
1125 We ought to spare a moment of understanding for the parents of such children. Here are children who apparently in many cases look normal. They are physically normal yet they do not proceed to become normal. They are much more difficult, therefore, to understand. It may be that parents are trying their best to offer them the kindness, the love and the care which a child needs, and yet that is being rejected by the child—which is something that the parents cannot understand, nor perhaps can their neighbours. It is a very great strain on the parents, and I understand that there is pressure from many parents of such children for further steps to be taken to meet their particular need. Perhaps it could be done in practical ways; partly by having more day centres for such children and providing further domiciliary help for parents so that they may be free to do their part. I am sure that they ought not to be left out of account, any more than should the particular need for teachers of remarkable capacity and patience who can be equipped and, I hope, remunerated adequately for doing this kind of work. But if, in the end, it is a question, apart from that, of funds, I think that is something we should want to pose specifically to any Government.
I spoke to a representative of one local authority on the work in his county area. It was clearly an area where there was great sympathy for this work. There was no particular unit in the area, but there was no problem about it, inasmuch as, if there was a special case that could be identified, they were prepared to spend money on it. Indeed, there was a case where they provided one full-time teacher for one child in order that that child might be at school. Not all authorities would be in a position to do this as things stand at present; therefore it might mean some further undertaking on the part of the Government themselves. But my friend echoed the point that in present circumstances there is a great shortage of places where such children can go. It is a sorry tale, of children being taken from one centre to another, almost month after month, because nobody can find the right place to put them in. In such cases, the last state would be worse than the first.
1126 More provision for places or units will be required and for people to man them, but I take it that in the end more public sympathy will be required. This may seem almost irrelevant, but if it is a question of the further provision of money it is ironic that we have given a lead to the country over other questions of life, we have had debates about the abolition of hanging, about moral rights and about the protection of society and I never recall the question of money coming in, though it may be a consideration in those fields, too. Therefore, I hope that in the case of these children we shall not make money the consideration there, either.
My Lords, in a book called The Special Child, written by Mrs. Furneaux, head of "The Lindens", a school for autistic children in St. Ebbas Hospital, Epsom, under the Surrey County Council, a chapter on autism begins with the following words:There are some stories common to the folk-lore of many countries. Among these is the legend of the changeling child. In these old stories a beautiful human child was stolen soon after birth by the fairies, who left in its place a child of their own.This child was sometimes described as being ugly, but more frequently as a dainty fairy-like creature, who yet was totally cold and unresponsive, to the despair of its parents, for it brought nothing but grief and anxiety to them.Sometimes it cried ceaselessly and unconsolably, at other times it lay quietly for hours totally self-engrossed, again sometimes it was a voracious eater, at other times it required the utmost patience to induce it to take enough food to keep it alive. It seemed indifferent to pain and pleasure, heat and cold, and never responded lovingly in any way to anybody.One is tempted to speculate whether these old stories are not the first accounts of children suffering from early infantile autism, for there is a great similarity between them and the behaviour which is now beginning to be regarded as typical of these children.In the days of these stories, the children were hidden away or placed in asylums, where they were, sad to say, treated as dangerous beasts, but now efforts are being made by eminent men and women not only to try to discover the reason for this state in a child but also to do everything possible to bring the child to a normal life and to alleviate the suffering of the parents.
Autism in modern language is very hard to define and many opinions differ, but I believe a description which would not be 1127 challenged is "a totally withdrawn child". This may occur from birth or may be caused by a shock of some kind, by ill treatment, lack of love, broken marriage or some terrifying experience, which makes the child, so to speak, renounce the world and all its works.
The I.Q. of the child, if it is possible to test it, is highly varied, and a large proportion would be assessed as educable and hence not mentally handicapped. The education and rehabilitation of this child is expensive, as individual care of the most intensive sort must be given to each child, if any results are to be attained. At the Edith Edwards Home, a residential school at Banstead run by the Invalid Children's Aid Association for autistic and highly disturbed children, the staff consists of a headmistress, three teachers, six child care workers and one permanent volunteer, teaching 21 children. The annual fee paid by the local authority concerned is £1,320 per child; and this is by no means the highest.
The greatest problem which must be faced by the teacher is gaining the confidence and co-operation of the child, as little can be attained until this is done, and the greatest degree of skill and patience is required at this stage. I know that we are deeply grateful to the teachers who look after these children, but I fear that in spite of ail the efforts being made by the teachers, the necessary education of these children is far from satisfactory.
As the noble Lord, Lord Beaumont of Whitley, said, the National Society for Autistic Children state that there are 700 autistic children in hospitals for the mentally handicapped. This is not because they are mentally handicapped but because there is simply nowhere else for them to go. There are far too few small units for these children near their homes. We at Edith Edwards have one child from Cardiff and one from Cheshire. "The Lindens" is almost completely a day school, so that the family ties so essential are maintained and I understand that some families have moved to be near their children. At Banstead, which is residential, except for holidays, the family have little chance of frequent visits, which are so important to the whole future of the child.
The fact that there are 700, as reported, in mental hospitals is very disturbing. 1128 The teaching of the mentally handicapped is quite different from the teaching of the autistic, who will gain little from that type of education. It is also a fact that these children are taking up beds which are so badly needed for those mentally handicaped children who urgently need hospital care.
Finally, perhaps the most important matter is the lack of any homes or hospitals for the adolescents, who either have to return home or go into mental hospitals. The small number of schools which exist cannot keep them into adolescence, and certainly in the case of Edith Edwards School it is exceedingly difficult to place them if for some reason they cannot return to the family. It is indeed a sad story if, after all the money spent and improvement achieved, the child must be abandoned, maybe to return to its worst state.
I have made a number of speeches in your Lordships' House on the various handicaps to children and adults, and in preparing these speeches I invariably find that I come to the same conclusion; that is, that no reorganisation of hospitals, no Green Papers or White Papers will be of any use until successive Governments will understand that it is of vital importance for all handicapped people who need special education to have half-way houses outside the hospitals or schools which will carry out the final task of conditioning them to live happily in the community.
In thanking the noble Lord, Lord Beaumont, for asking this Question, I would again ask the noble Braoness to consider with the local authorities the great need for hostels and the further requirement of more small units for autistic children who need our help so urgently.
§ BARONESS ELLIOT OF HARWOOD
My Lords, I should like to thank the noble Lord, Lord Beaumont, for putting this Question on the Order Paper. I am sure that we shall hear from the noble Baroness, Lady Phillips, an extremely sympathetic reply, since nobody on the Government Front Bench knows more about children and leaching than she does, having spent a good deal of her life in that profession.
This debate is to me of great significance, since it is now some ten years 1129 since I first came into contact with an autistic child. This child, whom I loved very dearly, and who in himself was the most beautiful and lovely child, was yet completely cut off from us by this condition, which in those early days was hard to diagnose and very baffling to know how to deal with. It was because I had this compassionate interest in this one child that I found myself linked up with a number of other families all of whom had the same tragic and difficult conditions in their families, with perhaps only one child out of several suffering from this condition.
As a result, we got together and formed a small Society which we called the National Society for Autistic Children. It is only about fifteen years' or possibly a few more, since autism was diagnosed. Before that time there was no mention of it in the categories; and even to-day I know, from my experience of talking to doctors and to other people, that many still do not realise what an autistic child or a condition of autism really is. Therefore I think it is important not only to draw the attention of the Government to this matter—because they know something about it—but that the publicity we receive from the noble Baroness's Answer should help in bringing this information to those people who are, or should be, anxious to know and understand the problem created by this condition.
The National Society, small as it is, and voluntarily supported, has had the help of many distinguished doctors and psychiatrists, both from the Maudesley Institution and from other hospitals, and our efforts have led to a considerable amount of success. We can now say (and nobody, I think, will dispute this) that any child diagnosed as an austistic child is educable; that is to say, that some education will help, and in some cases help to a great degree, to bring the child into a fairly normal state: in most cases one cannot say entirely normal, although this does sometimes happen. This is a big step forward. Of course we need special methods of treatment in special schools, but we can say that all children can benefit by education. In the early days this was not known and not thought possible, and that I believe is why so many children are today to be found in subnormal hospitals and mental hospitals. 1130 This, as other speakers have said, is the worst way of treating them, since they become more and more withdrawn, and are less able to understand their surroundings; because, as we know, mental hospitals to-day are extremely overcrowded and understaffed. It is not their fault that they cannot deal with a category of child that should never be there.
So it is in order to ask that this category shall be both recognised and helped that this Question has been put down to-day. There are some schools which have been set up to deal with these children, and the noble Lord, Lord Grenfell, has mentioned two which are very successful. The National Society has three schools. One, at Ealing (and I must thank the noble Lords, Lord Aberdare and Lord Beaumont, for going to see it), is very well run by a remarkable person, and has had great success. It caters for some 40 children. It was not more than three or four years ago that I had the honour to be asked to open this school which now makes such a valuable contribution. There is another school at Gravesend, Kent, and another at Dedisham, near Horsham. In addition, there are seven other private schools in and around London, and 11 special schools which are run by the Inner London Education Authority. All deal with this area. Outside this area there is a school in Birmingham; one at Eccles, in Lancashire; two in Cheshire—one in the Wirral and the other at Upton—and one at Bath. All these schools are doing a remarkable job. But, as your Lordships will understand, they deal with only a small number of children.
Dr. Lorna Wing, one of the medical doctors who has made a great study of autistic children, has estimated that in a population of 250,000 at least twenty children will be autistic, as well as sixty adults—that is to say, persons over fifteen years of age and into adulthood. A medical study made by the Medical Research Council and the Middlesex County Council showed that four in 10,000 children in that area are affected. This adds up to the large figure that has been mentioned, of 3,049 autistic children in the country to-day.
If this is compared with blind children, where the United Kingdom figure is 1,427, or with deaf children, totalling 3,356, it shows that autistic children are, alas! 1131 in a very high category indeed. The special provision for them nowhere compares with the special provision for deaf or blind children. In fact, if one looks at the problem as individually as possible —and, after all, that is the way that one should look at it, because these children must have a large amount of individual attention—we want 800 units now to deal with autistic children. This is a large number, but when one compares it with the children who are being catered for who are deaf or blind it is something that I think is well within the capacity of the local authorities to deal with. As my noble friend has said, the importance of keeping these autistic children outside mental hospitals is vital, because in a mental hospital they will never get the kind of treatment and encouragement which will bring them up to the standdard of the ordinary child, or even of the child who can manage in an ordinary society.
I agree with the noble Lord, Lord Beaumont, about the question of categories. I have in my hand the categories which are mentioned in the Education Act; there are ten of them, but autism is not mentioned. It has been suggested that it is better not to have too many categories, and that they should be ended. That is one point of view; and if we could be sure that in doing away with categories the services—whether by doctors, psychiatrists or local education authorities—would include all these varieties, then I should not object to the ending of categorisation. But if the categories are there and autistic children are not mentioned, then I think it is a great mistake; because it is true (and the right reverend Prelate said himself he had not heard of autistic children until quite a short time ago) that people do not know anything about autism as a category. I meet this all the time from many people. This is because autism is not on the list, and they have not heard of it in any other way. I hope the noble Baroness will urge the Minister of Education to consider this point, because it is a pity that autism should not be brought to the attention of the local education authorities, in the same way as the other categories are brought to their attention.
One of the things that has brought autistic children to the public eye has 1132 been the publication of one of the Reports put out by the National Society. This one, Misplaced Children, has been referred to by the noble Lord, Lord Beaumont, and many other people, and it drew a great deal of publicity because it is simple and brilliantly produced. It states the problems very clearly. It is because of the publicity received for that particular Report—and there are two others —that the whole subject reached the minds of the public; and I imagine that this is one of the reasons why the noble Lord, Lord Beaumont of Whitley, put down his Question. So I would back up the noble Lord in asking that if we are going to have any categories, then autism should be mentioned.
I should like to stress a point which has been made by other noble Lords, and it concerns what we can do for these children when they leave school and go out into the world to earn their living, or to live in a special place, because their parents cannot manage to keep them in their homes or, perhaps, because their parents have died. Hostels should be provided for these children in such cases. We want hostels for many other reasons —for instance, for children on probation, and that sort of thing. I think that a hostel for autistic people would be of enormous help. I would also ask that they should be included in the sheltered workshops activities, which deal with many other handicaps and I believe are handled by the Department of Employment and Productivity. If they could participate in this type of work it would be of enormous help to many of these boys and girls leaving school.
My Lords, I have sat, as I expect many noble Lords in this House have sat, on education committees, and I have been a chairman of an education committee. I know that it is sometimes very difficult to secure recognition for children as between one diagnosis and another. If a child is diagnosed as ineducable, and is sent to a day centre, it is very difficult, if that child can be educated through to another category, to get that child moved from the day centre into the educable category. This is one of the reasons why it is extremely important that these children should not be put into the in-educable grade without a great test of education. Local authorities are very reluctant to move children from one 1133 category to another, yet it is often very important that they should be able to graduate from the less educable into the higher grade, if they can make it.
I know that there are children in these special centres such as the one which the noble Lord, Lord Aberdare, saw at Ealing. I have just learned that of the children there one boy has attained G.C.E. standard in art; one boy has a certificate in art and arithmetic up to the G.C.E. level. Two children have gone to normal schools from the Ealing school; two, it is hoped, will make the grade for a normal school quite shortly, and another has been accepted for industrial training under the Department of Employment and Productivity. That shows that these children can graduate into these other categories if the possibilities are there, and I would therefore plead for a very careful assessment before any child is put into the ineducable grade.
I know that the problem is extremely difficult. I have had years of experience on local authorities, and I know that almost all local authorities are anxious to do everything they can for the children in their care. But the fact remains that they are often short-staffed, and it is difficult for them to deal with these individual difficulties. These difficulties, however, should be dealt with because, at the end of the day, not only will it save children and their futures, but, to put it at its lowest, it will save the State a great deal of money and trouble because in all probability the people will be able to look after themselves, even if at the end they find themselves in mental institutions, which we know happens with many people.
So I would ask the Minister, through the noble Baroness, to look at the problem. In years gone by, schools for the deaf and blind were unusual, and had to be started; but they have now spread all over the country. I hope that some treatment for autistic children will be included in the demands which we make on local education authorities. This is a subject which should be regarded as of great importance, and it will in the long run be of enormous importance to the country. If we can also spread the interest beyond the schoolchildren to the young adults, those who, having begun in their handicapped world, have reached 1134 a stage where they are almost able to look after themselves, it will be of even greater value. We should see that those who suffer from this condition do not slip back for lack of special provision after they leave school. If the noble Baroness will draw the attention of the Department of Education to what we have been saying here this afternoon, I am sure that this will achieve a tremendous amount of good, and she will earn the gratitude of a great many people in this country.
§ BARONESS PHILLIPS
My Lords, I should like to say at once to the noble Baroness, who has just been listened to with great pleasure, that she is probably quite correct in saying that I am as sympathetic in this particular matter as any other member of the Front Bench. I have been interested in this problem for many years, since I taught at one stage a group known, rather curiously, as "dull and backward". I grew very fond of that group; I realised that they were all very individual. All children are individual and all adults are individual, but this group particularly were very individual and their needs were very different. I like to feel that I was able to help some of them back into the main stream of life. From that point I have become very interested in just the kind of child the noble Baroness has herself been working for—we know that she is President of the Society.
I should like to say straight away that I found the particular papers to which she has referred extraordinarily easy to read. As she said so rightly, they are in simple, straightforward English; they are factual and very useful. I have to-day also had a Paper from the Parents' and Professional Workers' Association for Psychiatric Provision for Adolescents, and again it is a splendid Paper which I hope I shall be able to study and follow through.
Her Majesty's Government are extremely grateful to the noble Lord, Lord Beaumont of Whitley, for providing an opportunity to debate the plight of these children and their parents. As the noble Baroness so rightly said, the debate not only is a sounding board in this House, but we hope will be a means of establishing a wider interest. Knowing the noble Lord as I do, I feel certain that if he does not like my reply 1135 on this occasion he will return to the question, in this form or another, at a later date. I can assure your Lordships that Her Majesty's Government share the concern that has been expressed this evening. The disturbed behaviour of the children, their lack of meaningful speech and the fact that, as so many noble Lords have described, they have the inability to communicate, cast a dreadful, heartrending emotional strain on their parents and on those who have to care for them. To the parents I believe it also brings a feeling of desperation; it is something they have to cope with which has no apparent remedy.
I should like to sound at once a note of hope and of inspiration. I would remind your Lordships that the Prime Minister announced that in future no child was going to be written off as incapable of education. I tremble to use that horrible word "ineducable", which I have always disliked because it is very difficult to say in any event; it is jargon of the worst kind. It seems to typify exactly some of the points that have been referred to this evening. Nobody is incapable of education. Teaching the group that I did, I became convinced that every human being has a talent, but unfortunately many people go through life and their talent is never discovered This is one of the inspirations one draws from teaching these children. One knows they are capable of something, which has to be discovered.
I would remind your Lordships that the direct responsibility for providing education, including the special education to meet the particular needs of all handicapped children, lies (I am sure your Lordships are well aware of this, but I have to remind you) with the local education authorities. My right honourable friend does not directly provide this education, although, as we have been reminded this evening by several of your Lordships, he is responsible under the Education Act for defining various categories of handicapped children for whom special education is provided.
Perhaps at this point I may refer to the suggestion that autistic children are at a disadavantage because they are not specifically mentioned in the statutory list of categories. Under the Education Acts local education authorities have a duty to provide such a variety of instruction 1136 and training as may be desirable in view of the different ages, abilities and aptitudes of the children, and in fulfilling their duties they are required to have regard to the need for providing, either in special schools or otherwise, appropriate education for pupils who suffer from disability of mind or body. There is no question, therefore, of the authorities lacking the powers to provide whatever education autistic children may need, and in fact they have the duty to do so. The fact that autism is not a separately listed category of handicap in the Secretary of State's Regulations has not, to the best of my knowledge, deterred local authorities from providing special educational treatment appropriate to the age, the abilities and the aptitudes of the autistic child.
The value of the present arrangements whereby children who need special educational treatment are classified by handicap and placed in special schools will be one of the subjects for consideration in the planning of new legislation to replace the present Education Acts. My right honourable friend the Secretary of State for Education and Science has announced his intention to issue shortly a Green Paper on his proposals for future legislation, and this will provide an opportunity for a public expression of views. I am quite sure that the views of your Lordships will not be lacking in this respect As advances in surgery and medicine enable more children to survive to school age with complex and multiple disabilities, the task of classifying them by handicap becomes more difficult and its relevance becomes more questionable. I think we should agree that what is needed is that local education authorities should make whatever provision is best suited to the needs of each child, and this seems to point to fewer rather than to more categories. In any case, it would be unwise to add to the list of categories at the present juncture, and noble Lords can be assured that the difficulties in educating autistic children cannot be ascribed to the lack of a specific statutory label.
I would here make a personal note. I would suggest to your Lordships that in present society we label people far too much. I think we should hesitate very much before we add to the categories. Whether my medical friends would agree 1137 with me is another point, but as an educationist I would say that the fewer categories we have, the better. The particular class I looked after was known euphemistically as "the Remove", but the children called it "the daft class". So whatever categories we devise, I think children will devise their own names. I would, however, seriously suggest that this is not a limitation on attending to the needs of the autistic child. The powers are there.
Autistic children, as various noble Lords have mentioned, are not an homogeneous group and their educational needs and capacities are widely varied. I am not certain that enough emphasis has been laid on this point. Autism is frequently associated with other handicaps, and I am sure that the noble Lord, Lord Aberdare, will have noticed this when visiting the school referred to. Also, I am certain that the noble Baroness, Lady Elliot of Harwood, will appreciate this. This point has to be borne in mind in deciding the educational programme for the child. It has been claimed that all autistic children should be educated in units specially set aside for them. In some cases this may indeed be the right course. Even there, however, this causes a great difficulty to all but the heavily populated areas of the country in organising viable units; and this is probably the reason why we have found this type of situation only in the South-East. This is especially so with younger children whose parents are unwilling to let them go away from home.
In the present state of knowledge it would be wrong to suppose that a separate unit is needed in every instance, or indeed in even a large proportion of instances. There is still a great deal to be found out about this condition. The more one discovers about it, the more one realises how little one knows about it. The best methods of educating children who suffer from it have yet to be discovered, but where one of the principal difficulties lies in the failure on the part of the child to communicate with others there would seem to be grave objections to a uniform type of education which involves separating the autistic children from those with better powers of communication, thus depriving them of stimulation to progress. I got the feeling 1138 that the noble Lord, Lord Beaumont of Whitley, does not quite take this point. I think he felt they were not necessarily stimulated by other children. I would say that, again in my own small experience, children do stimulate one another—sometimes to do the wrong things, but certainly in communication.
§ LORD ABERDARE
My Lords, is not one of the troubles that these children appear to be so normal and yet they are not quite normal, and therefore they suffer rather badly in company with other normal children who cannot see their disability? If a child is blind or maimed other children can see that he is disabled, but if he looks normal another child cannot understand why he is not the same as a normal child, and very often the autistic child suffers.
§ BARONESS PHILLIPS
Yes, my Lords, I take that point, but that is true of only certain groups and does not apply to all autistic children. We must be very careful not to generalise. I think the noble Lord will agree with me that these children can look normal, and indeed they can look attractive and be bright, but the expert quickly recognises that there is this difference. The inability to communicate is something which is quickly recognised within a group. Nevertheless, I have seen people stimulated to communicate by others, although not of course if they were in certain stages of this condition. I think we are up against the difficulty of definition. It seemed to me that there were nine symptoms, many of which could be symptoms of other medical conditions, and not all the children show many of the characteristic symptoms.
As to the treatment, again this varies and not all children require the same educational treatment. We must bear this in mind. We need much more experience and knowledge of the effect of the different forms of education for these children, and a research project financed jointly by the Department and the Gulbenkian Foundation is being conducted to make a comparative study of the progress in three units in London which provide various forms of education for autistic children. But research of this kind is complex and difficult and therefore it must of necessity be slow. It takes time to get firm results, and I am afraid 1139 that the results of the investigation are not expected earlier than 1972. In the meantime, discussion continues among professional staff as to the type of education and the type of environment in which the children will flourish. My right honourable friend the Secretary of State for Education and Science is giving the whole of this complex problem his careful attention and he has under consideration the guidance he can give to local authorities in the light of what is already known, and what further information must be sought on the numbers of children in various parts of the country and the provision which is at present being made for them.
As I have said, the range of abilities of the children varies greatly, and about half of them function mentally at severely subnormal levels. Under the present law they may be treated as being unsuitable for education in schools and placed in the junior training centres run by the local health authorities or the mental subnormality hospitals. In view of what I felt was a slight air of criticism, I think we must pay tribute to the devoted staff both in the training centres and in this kind of hospital.
I noticed that the noble Lord, Lord Beaumont of Whitley, suggested that the teacher is drawn instinctively to the lively child. I would almost put the emphasis the other way: that the good teacher— and, let us face it, like the people who work in hospitals teachers are generally very dedicated; they certainly do not take on this work for the salary—is drawn instinctively to those who seem to be in need of extra care and attention. If I had any criticism of teachers I would say that they tend to give more attention to that group than to some of the highly intelligent. So I can reassure the noble Lord, Lord Beaumont, on that point.
Noble Lords will know—and again I think this is a great note of hope— that legislation is being introduced in the current Session of Parliament to transfer from the Health to the Education Services the responsibility for the education and training of all mentally handicapped children. I feel certain that the noble Lord, Lord Grenfell—although I thought that in some ways he seemed to be a little despondent—will appreciate the enormous change which is to take place there and which will bring about many 1140 of the things for which your Lordships have been asking. It is fair to say that our present information indicates that many of the children have a limited capacity for education. Of course, this does not mean that they have none, and I should like to emphasise that point.
May I now reply to the suggestions which have been made that because these children are slow to acquire education they need extra attention when they are adolescents. The view of Her Majesty's Government is that the powers and duties of the local education authority are already sufficient. Unlike other children, the children in special schools already have to remain at school until the age of 16, and where the parents wish the child to continue to remain at school the local education authority has the duty to provide full-time education, not to the age of 18, but to the age of 19. In addition, they have a duty to provide facilities for further education for young people over compulsory school age. Any autistic boy or girl who has made reasonable educational progress in school and who has some degree of attainment can be helped to make use of these facilities.
I noticed that the noble Lord, Lord Aberdare, and I think the noble Baroness, Lady Elliot of Harwood, referred to the fact that the young autistic adult might benefit from a sheltered workshop; and I believe that the noble Lord, Lord Aberdare, suggested a protected environment. Unhappily, this is not peculiar to this group in the community. The provision for these needs, the shelter, or the hostel, is the duty of the local health authority and it would be difficult at this point of time to single out a particular group. This does not mean, of course, that it has not been looked at.
§ BARONESS ELLIOT OF HARWOOD
My Lords, may I ask the noble Baroness whether it is not the fact that the Ministry of Employment and Productivity is responsible for the sheltered workshops? Would it then be the duty of the local health authority to provide the hostel? I should have thought the hostel would be part and parcel of the sheltered workshop.
§ BARONESS PHILLIPS
My Lords, as I understand the position the hostel is the responsibility of the health authority, whereas the sheltered workshop is the 1141 responsibility of the Department of Employment and Productivity. I would say to the noble Baroness that a great deal of research is being carried out, and in that connection my right honourable friend is also looking at the various provisions for the different types of people within the community who are not necessarily getting the best type of employment. This, again, I feel is a matter which we can usefully raise. I would assure your Lordships that I am quite happy to follow all these points through to the various Departments because I feel so strongly on this matter. I give your Lordships that solemn assurance.
The Secretary of State for Education and Science proposes shortly to lay before Parliament a Bill which will give effect to the acceptance by the Government of the proposal that the responsibility for the education of mentally handicapped children shall be transferred. I have mentioned this before, but I am repeating it because the appointed day on which that will take effect is to be announced shortly, and I feel that this is heartening in the context of this debate. My Lords, I would express deep gratitude to the noble Lord, Lord Beaumont of Whitley, and to all noble Lords who have taken part in this discussion. It has given us the opportunity to bring to the notice and the sympathy of the general public, as well as to the Department, this subject of great complexity and concern to us all. Autism is a difficult and discouraging condition and there is a great deal yet to be found out about the methods of dealing with it educationally, and I hope that from this debate this evening some great good will flow.
My Lords, before the noble Baroness sits down, may I ask one question? Does she really believe that in the case of an autistic and a thoroughly withdrawn child in a class of about 14 or 15 mentally handicapped children, the teacher will have the time or the possibility to give all the attention which is essential to that child?
§ BARONESS PHILLIPS
My Lords, the noble Lord has touched on the most delicate point in this type of work. Obviously the group should be smaller, but equally I can say to the noble Lord that within that group of 15 there will 1142 be other conditions which will also call for special and individual treatment. In my small experience I have found that the teachers genuinely try to give it. Just how well they succeed we have yet to discover. This is something we always work towards—the smaller group—but I should be raising false hopes if I were to say from this Box this evening that we may expect those smaller groups immediately. What we can expect, and what we are going to get, is a new look at this problem—and not only at the autistic child but at all the children for whom I know the noble Lord has great feeling: the mentally handicapped.