CHILDREN'S SPEECH AND LANGUAGE DISORDERS

HL Deb 20 December 1972 vol 337 cc1122-65

4.38 p.m.

BARONESS BROOKE OF YSTRADFELLTE rose to draw attention to the problems of children suffering from specific speech and language disorders and the difficulties faced by their parents; and to move for Papers. The noble Baroness said: My Lords, from the very important matters that we have been discussing this afternoon I should now like to draw your Lordships' attention back to the more human things that are happening at home. I am particularly glad that I drew a place in the ballot for one of our short debates—particularly glad because the debate is to-day, the last Wednesday before Christmas. This is a time when the minds of many of us are full of children—normal, happy, carefree children bursting with excitement that there are only four more days left before they can hang up their stockings. It is right that we should pause for a moment and think of those other children, and their parents, who are caught up in the difficulties and distresses of non-communication or only partial communication.

There are several factors which have culminated in my putting this Motion down for debate. This year has seen the publication of three remarkable contributions. The first is a paper published by the Invalid Children's Aid Association entitled Developmental Aphasia—an Introduction, written by Miss Pauline Griffiths, who has worked as a teacher at the John Horniman School at Worthing educating aphasic children. This is a fascinating study. It helps those who were wholly ignorant, like me, to grasp some of the technical problems and manifestations of this comparatively obscure disability. The second contribution is the report of a committee set up in 1969 under the chairmanship of Professor Quirk—and I quote: to consider the need for and the role of speech therapy in the field of education and medicine, the assessment and treatment of those suffering from speech and language disorders, and the training appropriate for those specially concerned in this work." The third comes in the form of a book by Elizabeth Browning called, I Can't See What You Are Saying. This concerns the medical and educational history of her son—a story that reveals only too disconcertingly the present inadequacy of our authorities when called upon to deal with problems of the kind which this" intelligent and attractive" little boy presented, to quote what Professor Zangwill said in his foreword to the book.

By chance, I read these works in the right order: that is, the reverse of the order which I have just given. I read Elizabeth Browning's hook in proof last summer, and it absorbed my attention from the start so that I was caught up in her emotions as the mother of a severely handicapped boy whom she refused to have written off as hopeless, and in the white-hot determination which she and her husband maintained in the face of countless disappointments and endless irritating frustrations. The nub of their problem lay in their inability to obtain the intelligent assessment of their little boy that was required to place him in his own right niche. When you have had two perfectly normal little girls and then your longed-for little son arrives, premature and very small, your immediate hopes are fixed on him and you watch every step of his development. When at the age of three and a half this boy was neither talking nor understanding speech, his parents began their long and often fruitless search for a diagnosis of his trouble and for educational help for him. Because he was described as" highly intelligent and not deaf" by a famous professor at a research unit for deafness, and because they were told by another highly-thought-of pædiatrician that if he was not speaking by the time he was three and a half they must accept that it was most unlikely he ever would, his parents did not know whether they were coming or going. But they both agreed that they did not believe he would never speak, and they realised the fight was on for their son's future. Their G.P. helped them to elucidate things when he explained that their son's symptoms indicated mental deficiency, but that as he obviously was not defective everybody was completely" foxed".

He was next taken to another highly recommended pædiatrician who watched the child at play and said that he seemed bright enough to him and he could not see much wrong with him. They did, however, emerge from this interview with the address of a special school for children with speech difficulties. Here the first seemingly accurate assessment was made, when the school doctor at the interview said." This is a straightforward case of aphasia and he must come to us when he is five". The parents could not believe their ears. Someone knew what was wrong and had a place where it could be put right. They were told that aphasia was a condition still not recognised by a number of doctors—hence their dilemma up till now. The failure of children to develop speech may he due to deafness, mental subnormality, severe emotional or personality disturbance. very bad home or environmental conditions, or a combination of any of these. However, it may also be due to a specific language disorder caused by some defect in the central nervous system, resulting in an inability to express oneself and sometimes an inability to understand language symbols. This condition has been termed" developmental aphasia".

When this little boy was five he was taken to the special school that had been advised—the John Horniman School, administered by the Invalid Children's Aid Association and recognised by the Department of Education and Science as a boarding school for children suffering from speech and language disorders. Here he stayed and showed signs of increasing development until the age of nine. During this time things technically were good and bad. At six and a half his vocabulary was steadily increasing. However, it was suspected that to some degree he was deaf, and tests undertaken at a clinic ascertained a marked high-frequency hearing loss. It did not seem possible that a mistake had been made earlier when he had been described as" highly intelligent and not deaf"—but it turned out to have been a good mistake, because if the child had been diagnosed as deaf he would have been sent to a school for the deaf, where the teaching methods would not have been effective in view of his aphasic condition.

He was given a hearing aid, which it became a struggle to make him use. When friends asked his mother what was wrong with him she would reply that he was suffering from aphasia and that this seemed to be an appreciation of some situations but a non-comprehension of the meaning of words which, with the added complication of hearing loss, made communication difficult and complicated. Scattered fragments of information were accumulated, but although fine in themselves they seemed to exist in isolated irrelevance in his mind. Grammar and phrasing were unique and illogical. Numerous phrases were understood by the little boy's family, but made no sense to other people. One phrase took four years to straighten out. It was:" Have we went before here we been". This would he said on a journey—sometimes as a question, sometimes as an answer. It expressed recognition of a route previously taken.

At the age of nine the moment arrived for the assessment; and after all the cases had been gone through from every angle it had to be decided by the teachers, speech therapists and doctors whether the children should move on to another special school or take their chance in normal schools. In the case of the little boy it was decided that he needed further special school education, so he was to move the next term to a senior school run on somewhat similar lines.

Some time after his move, a Trust called the Sembal Trust asked Miss Pauline Griffiths (the speech therapist at the John Horniman School) to do a research project into the situation of those children who, after assessment at nine, had not been considered bad enough or" suitable" to move on to the special senior school. These children then had to take" pot luck" in ordinary state schools. As a result of visits all over the country to the children who had been at the John Horniman School and then gone on to ordinary education, it was revealed that in nearly every case the results had been disastrous. The large classes and the complete and inevitable ignorance of the teachers about aphasia had made" mincemeat" of the children; it was felt that all that had been done for them at their special school had been virtually lost. Many of the children had turned in on themselves in self-defence or from despair.

The special senior school the little boy went to was a non-maintained but Minitry-recognised special school for children suffering from speech and language disorders. He stayed at this school until he was 11, when his parents were informed by post that he was now fit for normal education and should leave at the end of the term. They visited the school without delay to find out what was intended and to ask how a child of 11, unable to read or write, could be ready for normal education, and why he could not stay where he was, since lessons were going so well. There was virtually no explanation or reply—only repetition of the phrase that he was now considered to be ready for normal education.

What was to happen next? The consultant psychiatrist at the child guidance clinic run by the local education authority suggested a special school for children suffering from various defects. It promised to be ideal and all arrangements were made—and the boy had actually been there for two days—when the news broke that he had no right to be at this school. The consultant's recommendation had not been accepted by the education authority. When the father called on the education officer and the medical officer of health and begged them to see the boy for themselves, they said there was no need for this as they had his case on paper, where it was clearly stated that he was now fit for normal education. The father pointed out that whatever was written on the paper the fact remained that at 11 the boy could neither read nor write and that this could not be regarded as normal. However, he he was up against a stone wall, and the only reply he got from the Education Officer was that there was a place for him at the local secondary school and that he should start there the next Monday. This was followed subsequently by a telephone message to the boy's mother that the head of the junior school was prepared to take the boy into his class of eight-year-olds as a favour.The parents were completely nonplussed, but felt that there was nothing they could do except to let the boy go. He sat in the front row of a class of 44 eight-year-olds and learnt nothing.

And so the story continues: effort after effort to achieve educational help, to be met with frustration and disappointment at the end of the day. And if I might be allowed to" plug a commercial" at this stage, if any of your Lordships have book tokens and do not know what to do with them, do put them into this book called I Can't See What You're Saying; it is fascinating. And yet, thanks to the determination of the parents, the boy won through to a remarkable degree. Their son, now nearly 20, is working today as an apprentice to a farrier and doing a real job with real pay. Aphasia still lurks said an expert teacher who had known him in his John Horniman days— but his disability is masked by social `know-how'. He can get the finer points of a film because it is visual and appeals to the emotions and is intuitive, but he cannot see patterns of words in his mind.

My Lords, I have sketched the problem as it affected one family where the parents were determined to help their child who was suffering from a specific speech difficulty, no matter what frustrations or difficulties they met on the way. But what of the thousands of other children suffering from disordered language ability and in need of special schools and speech therapy, whose parents have neither the intelligence nor the drive to help them to obtain what they so badly need? The Quirk Report suggests that some 180,000 children in ordinary schools need speech therapy. It estimates that for children alone some 3,400 speech therapists are needed. And what have we got'?—822 in terms of full-time equivalents. The number would need to be quadrupled to match up to current needs. Why is there this tremendous discrepancy in the numbers available and the numbers needed? The limitation of the speech therapy service in this country since the 1944 Education Act has not been due to failure on the part of the College of Speech Therapists. The College has repeatedly stressed the lack of financial resources required to provide an adequate career structure, to recognise special qualifications or special responsibilities, and to pay salaries which will permit the profession to develop to its full potential. At present, to the best of my knowledge, there are 11 training centres, and one degree course at Newcastle University. I understand that the Inner London Education Authority is opening in January a class for severely language-impaired children and a class for children with perceptual difficulties, and that a pre-school day unit also is projected.

Men have rarely entered the profession. At present, there are only nine male therapists in practice, and the number of women who train is seriously depleted through marriage. There is evidence that a larger number of qualified married women would return to work if employers were ready to help them to combine professional and domestic life, and if there were more opportunities to refresh their skills and to catch up with developments in the profession—and if there were more incentives in terms of working conditions, professional status and pay. To meet the essential needs of all children with delayed development or a disorder of speech, it should be possible to refer them to a speech therapist, who should see each child. The speech therapist is the only person trained to diagnose and assess disorders of speech, though recently a one-year course to study speech disorders has become available at London University for doctors, psychologists and others with suitable qualifications.

Could the Minister, when he comes to speak at the end of this debate, tell us whether money is likely to be made available to help provide financial assistance for teachers who wish to undertake in- service training at one of the existing special schools for speech and language disordered children? The speech therapists can arrange for any medical, surgical or other hospital consultant to assess any underlying conditions. Those likely to be involved are the paediatricians, neurologists, audiologists, psychologists and, in cases of cleft palate, the plastic surgeon. The Quirk Report also recommends that in the future development of the speech therapy services one of the first priorities should be the provision of facilities for the early detection and assessment of delayed or abnormal speech and language. Though at present such facilities in the form of assessment centres or panels do exist, they are far too few in number. My Lords, it is this lack of assessment facilities which causes so much distress to parents of speech and language disordered children.

Some parts of the country are relatively well served, for instance London and some of the larger cities. But there are vast areas—Wales, for example—where assessment facilities are sparse or nonexistent. In these areas children in need of assessment have to travel long distances and often spend days and nights in strange surroundings with people unknown to them. In such circumstances a true picture of their difficulties is unlikely to emerge, particularly in the case of younger, more handicapped children. Not only does the number of assessment centres need to be increased, but the expertise, at present confined to a comparatively few centres, is in need of dissemination. It is by no means uncommon for the parents of a language disordered child to be given a different diagnosis at each of several assessment centres, particularly where assessment is complicated by the question of a possible hearing loss.

Children whose condition dates from birth may not be correctly diagnosed until they reach secondary school age. Think what it must be like, my Lords, to have a child thus afflicted, especially during those vitally formative years from three to eight when emerging from the nursery into the world. It involves a colossal strain for the parents, the family, and the child. Patience and imagination are desperately and constantly needed. The child cannot ask questions. He will wish to tell his family what he wants and, be cause he cannot express himself, he will suffer unbelievable extremes of frustration, and this may express itself in fits of crying and in trying to draw attention to himself by lashing out at his family or by hitting himself on whatever is nearest at hand. Early misdiagnosis leads to unsuitable educational placing and under-achievement on the part of the child, and consequential frustration for the parents. The best years for language learning are missed, and the child never reaches his potential. Facilities for early and accurate assessment are an urgent necessity—not as a long-term project, but now.

A generous estimate of the number of assessment centres and panels operating in the British Isles at this time would appear to be 20. For the many children desperately in need of the services they offer this is a totally inadequate number. Knowledge of the whereabouts and the availability of centres and panels should be easily available to parents of speech and language disordered children, but at present this is not so. Would the Minister tell us how many specialist diagnostic centres are known by the Department of Health and Social Security to exist for the assessment of children whose language development is retarded? And what percentage of the Department's budget on the health side is allocated for specialist diagnostic centres for speech and language disordered children? Would the Minister be good enough to give us the number of places provided in schools for children suffering from specific speech and language disorders? Could he tell us what happens to children who qualify for entry to Moor House School but who are turned away for lack of places there? To me, it would seem that there are altogether about 390 places currently available in special schools, of which three are in existence; and as there are 6,400 children of school age with specific developmental language disorder this would seem to leave a deficit of roughly 6,000 places. The Department of Education and Science has co-operated most admirably with the Manchester Education Authority to provide a special school for speech and language disordered children there. Is it likely to extend similar encouragement and support to local' education authorities in other parts of the country?

My Lords, because speech therapists and caring members of the medical profession came across so many of these children who had been sent from one expert to another non-expert, losing so much valuable time which could have been used in starting treatment, the Association for All Speech Impaired Children, known as AFASIC, came into being. This Association wants a more positive attitude towards the problem, and better trained personnel. If medical students, midwives, health visitors, social workers and teachers, as well as speech therapists, received adequate training in normal speech and language development in infants, the speech and language impaired child would be recognised earlier and the difficulties of many children could be prevented or alleviated. The Association would like all children who fail to speak at the age of two years to be examined by a competent team. They would like every parent of a speech impaired child to be given positive support, by explanation of the problem and advice about how to help the child—and how I agree with them!

My Lords, one may say that this is a relatively narrow subject which I have been given the opportunity to raise, but to the parents of these children it means all the world, and it occupies their minds ceaselessly. I am grateful to your Lordships for listening, and my best hope is that this debate will bring advances which may lift a load off the parents who have this problem on their hands, day in day out, and cannot escape from it. I beg to move for Papers.

5.1 p.m.

BARONESS PHILLIPS

My Lords, I am very glad to have the opportunity of taking part in this debate, which has been opened so splendidly by the noble Baroness, Lady Brooke. One of the great advantages of having such an efficient speech to introduce a debate is that one does not need to repeat many of the arguments that she has put forward so splendidly. I congratulate her. Also it is delightful to see such a star-studded list of speakers wishing to take part in the debate. I am sure the noble Baroness is delighted about it, and particularly about the two maiden speakers, whom we all await with great interest. Both are very distinguished. As we always try to work to time in these debates I will not attempt to cover some of the areas which have already been outlined, but I would remind your Lordships that we are to-day using the opportunity not only to speak of the problem of the children but of the findings of this splendid Report of Professor Quirk—the inquiry into speech therapy services.

Human beings must communicate with one another. Language can be either a bridge or a barrier. I once heard the noble Lord, Lord Hill of Luton, eloquently describe this barrier beyond which, he said, was a stranger, who could be either a friend or an enemy. Although we recognise that language is not the only means of communication, we live in a linguistic community, and a child who is unable to communicate is in a peculiarly difficult, and indeed in many cases a hopeless, position. He is at a disadvantage from the word" Go". With each report that we have had on the educational institutions, whether they be related to the younger child or to the secondary child, emphasis has been laid on the importance of communication and of language. In the Plowden Report we read again The development of language is essential to the educational process. Our educational system is basically geared to the acquisition of academic skills. For the normal child this is a hard process; for the child who does not hear or comprehend with the same speed as his fellows it is a cruel and often useless operation, as the noble Baroness has indicated.

Like the noble Baroness, I had the pleasure of studying The Story of Freddy, written so brilliantly by his mother, and I was delighted that she used the opportunity to mention a way in which book tokens would be utilised. I believe that if the powers-that-be would sit down and read that story they would be much more quickly moved to action than possibly any words of mine could make them do. It describes the battle with authority but it is written by people who did not, and were not prepared to, recognise that their child could be" written off". Authority did not appear to understand, nor in many ways even assist the child to receive education. The fact that this boy has emerged as an adult, able to earn his own living and to enjoy life, has been achieved only because he had loving, dedicated and educated parents who persisted in their demands. One puts down the book and asks," How many children are there like this who have just been left because their parents, while being loving and dedicated, were not sufficiently persistent, or sufficiently understanding, or sufficiently educated to pursue the way through the jungle of officialdom?"

The Association to which the noble Baroness has referred has received many letters which highlight the fact that this is not an isolated case. Indeed, any of us who have been in the field of education know only too well that this is merely the tip of the iceberg. We read in one letter from a desperate parent; It has been a constant struggle with doctors, clinics, institutions, who have all said there is nothing wrong and that he would grow out of it. It has been a struggle with education authorities to get him properly educated. I could read many of these very moving letters, written by the parents who have been able themselves to put down their case. But what of the other parents who are unable, though they try, to understand what this is all about?

As the noble Baroness has emphasised, the first need is for diagnosis. The Quirk Report outlines the various causes of speech disorder—the voicing, rhythm, articulation, mixed disorders. There are some very telling comments on the medical profession. One doctor, giving evidence to the Committee, said—and I quote: Medicine, with certain notable exceptions, has neglected disorders of speech and language during the last half century. No medical student is taught the elements of language development or linguistic theory. In the fullest development of mutual understanding and liaison between the speech therapist and medicine the knowledge of the doctor must be increased. The G.P. is the first one that a child of this kind will meet. The role of the speech therapist is underlined very clearly, both in the story which we have heard referred to and in many papers that I have read on the subject, and in the Report itself.

I have the highest admiration for speech therapists. This goes back 12 years, when my own husband, after a stroke, was, at a blow, unable to speak or write. Can your Lordships imagine yourselves suddenly denied all communi cation with the outside world? Then began the search for the speech therapist. This was in the Metropolis. On paper there were speech therapists, but in fact they did not exist. When we were able to find two, I well remember the harrowing experience of going from hospital to hospital where no room was ever available for the speech therapist. I remember once we were in the optical clinic; once we were in an old chapel; but never was there any feeling that this vital service was really accepted as being part of the whole set-up. That was twelve years ago and I hoped that situation had changed. When we read in the Report that, Providing treatment virtually unknown in Great Britain 60 years ago, speech therapy is now acknowledged as vitally important in a large range of conditions it might be expected that a specialisation of this kind would by now have obtained a strong professional position, but this is not so- Again the Report says: We are in no doubt of the inadequacy of the services. So it seems that little has changed in the last 12 years.

Here is a description which indeed underlines my own experience. This was a speech therapist reporting on her field of action: My accommodation at the health centre was in one room just large enough for a desk, two chairs and a cupboard. The floor space was just enough for one adult and one child to use for seated accommodation. Group work was out of the question. There was no soundproofing and in this one room one had to interview parents who were often accompanied by other children, assess children, treat children up to 18 years old, talk to head teachers, psychologists, doctors, etc., and do all one's paper work". That is obviously still by no means uncommon. What a comment in this day and age that even in the Metropolis we are unable to produce a vital service of this kind! As to the numbers needing treatment, so far as present figures can be assessed—and these are the children and adults who are known—we have in the school population 212,000 children needing some sort of speech assistance, and when we add the number of preschool children needing speech assistance the figure is about 275,000. If we take a case load of 100 for a 31-hour week, we still have far fewer than half the number of speech therapists needed for the immediate number of patients who are in need of this great care.

The recommendations in this Report are many and it is not my intention to go over them all. There is great need to re-structure the service in relation to education, training and, of course, research. There is great need for the speech therapist to be regarded as an integral member of an assessment team for any patient with a disorder of speech or language. There is need for provision and facilities for early detection and assessment, and I hope that the Minister will be able to give the noble Baroness the reply to the question she asked in this context.

In the Foreword to the Report by two Secretaries of State we read: We are in no doubt that the Report, with its far-ranging proposals for the future organisation and development of the speech therapy services, will provide a stimulus and focus for thought and discussion which will be of lasting benefit to the speech therapy services. It seems to me that one word is missing. Thought and discussion, yes; but"action" is the word I want included. If to-day, as a result of this debate initiated by the noble Baroness and as a result of the eloquent words of those who are to follow me we can jerk some action into this matter, this discussion will have been well worth while. If we do not get action then we shall have to return to the subject.

5.13 p.m.

LORD SEEBOHM

My Lords, I am most fortunate to-day that my first speech in this House should be on a subject about which I feel very deeply indeed. The noble Baroness, Lady Brooke of Ystradfellte, covered the subject extremely widely but there is one aspect of it which I should like to stress. I refer to certain facts that are clearly displayed in the Quirk Report. It is not for me to discuss the merits or demerits of the recommendations but there are certain facts which should be cried from the housetops.

There is one reference to the first inquiry since the war made into speech therapy. It was in 1945, when the Senior Medical Officer of the then Ministry of Education looked into the need for speech therapists. He calculated that the necessity was at least one for every 10,000 children in the education system. This meant a number of approximately 920. I remind the House that the population has increased considerably since 1945. I also remind your Lordships that a great number of handicapped children now survive who previously would have died. Thus, that figure of 920 must be looked upon not as a minimum but as being way below probably what is required to-day. We should therefore be ashamed that at the time of this Report the total number of speech therapists employed in the education system was still only 613.

I have heard it said that there are no such things as children—that there are some people who just have not been around very long. When I go to schools nowadays I sometimes think, considering our bright youngsters, that there is some truth in that. However, it is absolutely inapplicable to the under-fives and it is this particular age group which worries me more than any other. We are all aware of the vulnerability of this age group. The damage done for the under-fives cannot necessarily be healed throughout the whole life of the individual. But we also know that it is a period which is highly responsive, not only to love and care but also to teaching, and this is the point I want to make to-day as strongly as I can.

We welcome wholeheartedly the new initiatives that have been announced for nursery schools, the steps that are being taken to increase the number of play groups throughout the country and, I hope, for the greater care and attention which is being paid by local authorities to such things as day nurseries and child minders. However, what use are any of these things to the children who cannot communicate or to whom one cannot communicate, whether through physical, social or psychological reasons or just through reasons of language?

I wish to make one very strong recommendation. It is that as a start there should be formed or appointed a central council for training and development in speech therapy. I do not wish to infer that the College of Speech Therapists or the other training institutions are not doing a good job. They are, but the whole thing wants pulling together. There wants to be conformity. Standards must be set and as a start I should have thought that such a body, probably under the Department of Health and Social Security, should be formed as a matter of great urgency. Whether it could be done under existing legislation I do not know.

It is only fair that one should say that the shortage of speech therapists applies not only in education but in hospitals. The latest figures shown in this Report are that only 70 per cent. of hospital establishments are filled. This again seems to be a disgrace. But we are concerned in this debate with children, so I make my special plea to-day for improved services for children.

5.18 p.m.

BARONESS ELLIOT OF HARWOOD

My Lords, I am sure that I am voicing the view of all your Lordships in congratulating the noble Lord, Lord Seebohm, on his maiden speech. I have known the noble Lord for many years and it is fair to say that the whole nation is indebted to him, certainly for the activities for which I know him best—namely, the Seebohm Report, which has completely revolutionised the social work of local authorities, and the Institute of Social Work Training, of which since its inception he has been chairman. I understand that he has only just retired from that position. That body has done more for the training of social workers than anything that has occurred in this field for a long time. The suggestion which the noble Lord made about a central advisory council for speech therapists follows what he has done by starting the Institute for the Training of Social Workers, and I hope very much that the Department of Education will consider his proposition as one which I am sure would be exceedingly valuable in the work which we all hope will come as a result of this debate. I hope that on other occasions the noble Lord, Lord Seebohm, will give us the benefit of his advice and long experience in a very wide range of work.

I do not intend to delay your Lordships because already we have had two first-class speeches, one from the noble Baroness, Lady Brooke of Ystradfellte, and the other from the noble Baroness, Lady Phillips. Both have covered the ground very well indeed and I simply want to back up in every way I can what they have said.

I should like to add my congratulations to the Government on the Quirk Report, which is excellent and I was delighted to see in the introduction that no fewer than four important Ministers all set their names to it: Mrs. Thatcher, Sir Keith Joseph, Mr. Gordon Campbell (Secretary of State for Scotland), and Mr. Peter Thomas (Secretary of State for Wales). So it is a Report covering the whole country, and that is definitely what we want to-day. What the noble Lord, Lord Seebohm, has said about children under five is of absolutely vital importance. My association, the National Association of Autistic Children, has found that to discover any deficiency in speech or understanding at that early age is absolutely vital. I hope very much that the policy of Her Majesty's Government, which we know is to concentrate in some degree on the under fives, will bear that in mind as well.

In reading the Quirk Report, I was astonished at how very late, in a way, the development of speech therapy has come into the social services. The treatment of the deaf and blind and the mentally deficient all date from a much earlier period. Speech therapy work dates from post-First World War, from 1918 onwards. Now—and here I should like to say that I stand in a white sheet although it is not that exactly; it is not, so to speak, my fault—when people referred in their speeches to the shortage of speech therapists and the lack of facilities given by education authorities, I well remembered my own experience, for six or seven years, as chairman of an educational authority, of the difficulty we had to get any speech therapist or enough speech therapists to deal with the small number of children within our area. We were only a small area, and a rural area at that. I felt at the time—some years ago now—what a great lack there was in our social work services or education services—however you like to put it—in the fact that we could not do what was asked of us for speech therapy. I have not read the book that has been referred to, but I can say from my own experience that often one used to feel terribly hampered, knowing that certain children needed a particular type of treatment which simply was not available. One then tried to make do with the next best; but on occasions like that the next best is not good enough, because a very particular and very difficult type of training is required to help children suffering from speech defects of any kind at all.

What arises out of the Report more than anything, I believe, is the fact that there are not a sufficient number of people undertaking this training. In my opinion, therefore, it cannot be sufficiently well-paid. The conditions under which people train are not sufficiently good and the facilities which are given to people to practise their skills, as Lady Phillips has just said, even now in the centre of London, leave a great deal to be desired. I hope very much, as she has said, that out of our deliberations to-day will come a great urge for action on the part of Her Majesty's Government.

I hope also that in the finding and in the training of speech therapists there will be consideration for the families of the children who suffer from these defects: because although one may go to the speech therapist perhaps once, twice or three times a week (I do not know how often this should be arranged but certainly in the ordinary education in schools it was nothing like so often as that that one was able to make that provision, but supposing one could make that provision), help is still needed for the parents at home, there are still the dedicated and wonderful people who carry on in their homes with the training of the children. I should like to see those parents also helped by the therapists. I should like to sec not only encouragement but actual technical skill being passed on to the parents in order to keep the children up to the standard which the therapist reaches when he or she—and it is"she" in most cases—is dealing with the children. It is a very exacting profession, there is no doubt about that at all. Dissatisfaction has been expressed in the report, in Chapter 5, paragraph 4, I will not quote it because it takes too long, but there are given some of the reasons for the dissatisfaction of the profession.

We on local authorities—and I speak as someone who is an active member of a local authority—should give a greater priority to this than we do at the present time. I have no feeling that we shall not get from the noble Lord. Lord Belstead, and from the present Minister, Mrs. Thatcher, a very sympathetic approach to this matter. I had reason a little while ago to take a deputation to see Mrs. Thatcher about autistic children and we had the most sympathetic reception. Immediately after that a circular was sent to all local authorities drawing their attention to the problems of autistic children (many speech problems, as well as other problems) and action was taken at once. I feel confident that out of this debate we shall have action from the Minister. I am quite sure that he will find a response, certainly in your Lordships' House but also far and wide, because this is something which a great many people know about, are deeply concerned about, and only bitterly regret that they cannot do all they should for these children.

5.26 p.m.

LORD ANNALY

My Lords, I would ask for the courtesy of the House. We have heard the problems of aphasia described by my noble friend Lady Brooke of Ystradfellte and by the noble Baroness, Lady Phillips. My approach to this problem is from a different direction—I am the father of an aphasic child. Not long ago, a child labelled as deaf and dumb"was all too often an embarrassment to the family and, without hope of treatment or cure, sentenced to live a life in a silent world of loneliness and frustration. Although to-day this situation has changed, and the problem is openly discussed and accepted by a more enlightened world, what has changed very little is the possibility of finding a system whereby such children can be assessed as suffering from aphasia in the early and formative years of their lives. Nor are the known techniques for dealing with the condition sufficiently available.

I suggest, my Lords, that action in dealing with this problem is long overdue. Lack of communication is not immediately recognisable in the newborn child: it may be many months before it is observed that reflexes and reactions to speech and sound are distorted, or even totally absent. Once this disability has been discovered, the problem of diagnosis arises. At this stage, the parents will almost certainly be faced with a mass of well-intentioned advice on where next to turn. My experiences with my own daughter completely con firm those of Elizabeth Browning, the authoress of the book that has been referred to, who describes the endless visits and fruitless attempts to obtain the right information from specialists and so on. There must be very many other bewildered parents in the same situation. A child specialist who had seen my daughter on two previous occasions, when she was very small, considered that she was perfectly normal but he told me on the third visit, when she was just three, that he had come to a different conclusion."There is something very wrong with your daughter", he said," and in my view there is no hope. You are wasting your time trying to get anything clone for her and she should go to a home. She will never be more than a cabbage."

A short time ago, I took my daughter out from her special school and was intrigued by her description of the part which she was taking in the Christmas play. This was made possible only by gestures she had evolved herself, as no word she utters is recognisable. I understood practically all of her story. My Lords, my daughter is now nine and it is estimated that her IQ is in the 90/95 range. I am sure that I speak for many parents who, like myself, have followed numerous false trails and long for guidance. The first seven years in a child's life are vitally important in mind development, and every moment lost in the early stages, in assessment and remedial training is irretrievable.

There are thousands of children in this country who, due to aphasia, or lack of communication, cannot share their world with their parents or enjoy normal family life and all that goes with it, though many of them have average, or even high, intelligence. The facilities for help are appallingly few and far between. The strain on parents trying to find guidance for a speech-disordered child can be intolerable, as Mrs. Browning so clearly shows in her book. In addition to the difficulties of adapting family life to the handicapped child, there is the need to consider the education of someone who is not, technically,"disabled". The State requires that every child over the age of five must be educated, but the parents of an aphasic can be placed in an impossible situation when no suitable establishment is available, and the local authority may, through lack of appreciation of this specific problem, recommend totally unsuitable schooling.

Last week I visited the John Horniman School, which my noble friend Lady Brooke has mentioned; it has only 25 places for children between the ages of five and nine. I was taken to a classroom where a young teacher was training six children. They were all suffering from multiple handicaps, including partial deafness and dyslexia, but overall the handicaps were in the aphasic field. The teacher had been trained in a relatively new form of sign language known as the Paget-Gorman system. She was communicating freely with each of the children. Considering the problem involved, I was astonished at the high degree of mutual understanding. Two of the children could speak; it was not well enough to be easily followed, but each one had sufficient knowledge of the sign language to ensure that almost full comprehension was possible between teacher and child. I was able to see exactly what can be achieved if the means are available. The young teacher told me that when she had completed her course there were, to the best of her knowledge, only 40 teachers of this particular sign language in the country, but that the numbers were now, fortunately, increasing rapidly. Through the different media, I believe, people are now being made aware of the fact that problems of speech and language disorders in otherwise normal children do exist, and, hopefully, this will encourage more students and potential teachers to take up this branch of therapy.

In spite of the improved facilities and general awareness of this problem, it is still possible for a parent to be met with the response like that of the consultant psychiatrist I visited last month about my child. Having produced an encouraging report, which happened to be quite different from the previous one, he ended by saying that he knew of nowhere suitable to send a child in her predicament, and that as she is happy where she is perhaps she should stay there, even though the staff (for whom I have the highest regard for their kindness and attention) are not trained in her type of problem.

My Lords, it is exactly this type of frustrating situation which parents are facing at the present time. As a parent who has now lived with this problem for eight or more years, I sincerely believe that action must be taken as soon as possible; and the action required, as stated by previous speakers, is surely to set up a system of centres manned by teams of experts to diagnose and assess children in whom speech and language disorders are suspected. I have discovered by pure chance that two such centres do exist, and there may well be more; but their whereabouts were not known to me when I was searching for a school some years ago, and no information was forthcoming from any source. Once a diagnosis has confirmed the suspicion, the relief to the parent of some certain knowledge cannot be overestimated. But unless the provision of the right type of education, so exclusive to these specific needs, is available, then the parent is thrown back into a further state of anxiety and bewilderment. I believe there lies with us all the responsibility and duty to assist these aphasic children as much as is humanly possible.

My Lords, in the words that I have spoken I have on several occasions introduced a personal note concerning my daughter. I ask for your indulgence since, while the problem is a national one, my experience is derived from my own particular case. I thank your Lordships for your courtesy.

5.35 p.m.

THE LORD BISHOP OF BRISTOL

My Lords, I am grateful that it falls to me not only, by the courteous custom of this House, to express our congratulations to Lord Annaly, but even more to be able to thank him for having brought this discussion so immediately into the reality, the humanity, of the topic which we are discussing. We have been deeply moved to hear his personal testimony, and everything else that will be said in this debate will be said with an extra dimension of caring in consequence of what we have heard, and for which we thank him. We should like also, I am certain, to thank the noble Baroness, Lady Brooke, for having introduced this human topic, in a speech which was not only comprehensive but compassionate.

I must confess that I knew little enough about aphasia until I noticed that this was to be the topic of to-day's debate, which sent me to the report of Professor Quirk to which references have been made. But as soon as I saw the reference to parents in the topic of this debate there immediately came to my mind the experience which I shall once more undergo in a few day's time, as President of the Bristol branch of the Society of Mentally Handicapped Children. We shall be having our Christmas party, and year by year I always find that a most moving occasion, not only because of the children—though, as many of your Lordships will yourselves have experienced, there is a quality of unaffected affection about the mentally handicapped children which is very heart warming—but also because it is an occasion when I see an association of parents who are deriving regular comfort from their association with each other. It is that aspect of this topic introduced by Lady Brooke that I should like to emphasise.

I came across a short article in a report of our association, by a doctor writing on present and future trends in the education of children with severe learning difficulties, which struck me as highly relevant to what we are discussing. He writes that Public opinion about any handicap progresses through three distinct stages. First, the handicap is either ignored or there is poor provision made. The second stage is protective and sentimental, with too low an expectation of achievement in relation to actual capability, and the third stage (which we are just entering) with regard to most children's disabilities, is developed through professional study of the precise nature of the handicap, leading to action designed to minimise its effect. It seems to me that it is at this third stage, where medical expertise and research and the careful work of such experts as the speech therapists of whom we have been hearing has reached a degree 'of complexity at which the ordinary layman finds it difficult to grasp what is going on, that this kind of association between the parents of those who are afflicted has its greatest benefit. It is of enormous comfort to the parents of afflicted children to realise that their children are not unique, that they are not peculiar, that they are part of a fellowship of suffering into which the parents can enter to their mutual support, not only with sympathy but with the hope that they may grow in knowledge.

My right reverend friend the Bishop of London has drawn my attention to the fact that there was recently published for the Board of Education of the Church of England a small book by E. H. Denny, published by the Church of England Information Office, which is intended to assist the parents of children suffering from disability to learn from each other and to carry less'heavily the burden which rests on them. The point that I am chiefly trying to emphasise is the great benefit that comes when hope dawns on such parents that, through this association with each other, they may have access, of which they would otherwise be unaware, to various kinds of specialised help.

We have heard reference made to the difficulties that are often encountered in discovering where, in a complex field, or, as in this case, in a seriously understaffed field, one can begin to look. One of the great values of the parents' associations is the way in which they pool resources of knowledge and enable those with less education, less initiative, less resources, to discover things which, left to their own devices, they might never have learned.

The doctor, in a final paragraph in the article from which I have just quoted, lays emphasis on the point which the noble Lord, Lord Seebohm, made, and which I should like to re-emphasise. He writes of the way in which research is progressing, and that knowledge in various forms of child disability is steadily growing. He says: All this provides real hope for the future, but still there remains a gap which must be filled. The years from birth to five years are crucial in the development of any child, and the family into which a handicapped child is born has a special need for all the expert advice, guidance and help that is available, … Then he goes on to point out how extremely rare it is to find, under the auspices of local authorities, persons to whom one can turn, and— a suitably trained person to be responsible for real parent education and the active involvement of parents in the education and training of their handicapped children during the preschool period. This is a matter of vital importance"— as the noble Lord, Lord Seebohm, has emphasised.

I would only conclude by saying that if this debate does anything to enable diagnosis and recognition of the condition, and the support of parents in finding the means to deal with it as early as possible, it will indeed have been a very worthwhile debate.

5.43 p.m.

LORD GRENFELL

My Lords, when looking into the problem of children without speech or with speech difficulties, there is one real truism; that is, that in years gone by they were all lumped together as backward, sat at the back of the class, said nothing and did nothing. In our present age medical science has advanced to such a degree that we are able to put these children into categories and help them according to their different disabilities, but as we progress in this way we run into difficulties in the fact that the different categories need different treatment, and hence we cannot lump them all together. For instance, we are not talking specifically to-night about those children with mental handicaps as that comes under a different form of teaching, but we are talking, with the initiative of my noble friend, about those children lacking in speech who are perfectly normal in other ways, but for many reasons need expert tuition in the language of their birth.

In discussing these children, I have come to some definite conclusions: First, that these children will not in any way benefit from ordinary schooling; secondly, that with special education they will, in many cases, be able to lead normal and happy lives. If we accept these conclusions—and I think we must—we must also accept the fact that the schooling of these children is difficult in the fact that they are spread over a wide area, which in rural areas makes it imperative that the schools should be residential. Owing to the difficulty of boundaries, I am convinced that these schools, together with schools for the autistic, dyslexic, and other types, dealing with disabilities other than mental handicap, should be on a national basis, strategically placed with very large catchment areas. The local authorities would then pay a fee for children from their area. This must make sense if these children are going to be properly catered for.

My main knowledge of this particular disability stems from long association with the Invalid Children's Aid Association who have a primary school called the John Horniman School at Worthing. Here may I say how deeply we were moved to hear the speech of my noble friend Lord Annaly. I hope that if I can help in any way at any time he will call on me. This school accommodates 24 intelligent children between the ages of five to nine with varying degrees of speech difficulties upwards from nil. As I have already said, the aphasic child cannot respond to normal educational methods, but with very specialised treatment, by both speech therapists and teachers, of which we have heard so much to-day, teachers can develop enough of his potential to enable him to take his place in society and lead an independent and happy life.

The teaching can take place only in small groups with qualified and experienced personnel working in the right environment. As the noble Baroness, Lady Phillips, stated, it must be the right environment, and not just one small room at the back of a very poor building. Within the next two years the Association which I have mentioned will open a new school near Nottingham, made possible by a grant from the Dawn Trust, to bring secondary education to the children of the John Horniman School and also care for the local requirements in the area.

This brings me to my next point, that although there are small classes in many schools for this form of disability, it is estimated that there is a deficiency in the region of 6,000 places, and the places which are available are almost entirely for primary education. My Lords, it is vital that there should be a follow up of secondary education for those who have not reached a high enough standard in the primary field. If this is not provided, the child will slip back and all the teaching will be lost.

In summing up, may I say this: first, that these children must be diagnosed early, not only for the benefit of themselves, but also of their parents—and I think we all understand that; secondly, that they can, in very many cases, be helped with really good teaching, as so much of their trouble is psychological; thirdly, there is the old factor in life which my Nanny used to teach me," If at first you don't succeed, try, try and try again". Therefore, secondary education must be catered for. Fourthly, in rural areas residential schools must be strategically situated with wide catchment areas; and fifthly, and lastly: that we can succeed, that we must succeed, in giving these children a useful and a happy life.

5.50 p.m.

BARONESS NORTHCHURCH

My Lords, may I first be allowed to congratulate the noble Lord, Lord Seebohm, and the noble Lord, Lord Annaly, on their maiden speeches and to thank them, first, for the expert speech from Lord Seebohm and, secondly, for the personal speech that Lord Annaly made which we all appreciated very much.

My Lords, I do not often speak in your Lordships' House, but this debate initiated by my noble friend Lady Brooke is one of enormous importance and I want to congratulate her and thank her. She covered so much of the subject and gave us so much information that will be helpful. I have no intention of offering any expert experience or advice, but I am intervening from the angle of a grandmother. I am fortunate enough to have had four children, all normal—I was going to say"fairly normal". They, in turn, have produced 13 grandchildren—so far, also all normal. One of them has produced one great-grandchild. She has just arrived in a foreign country so that I cannot tell your Lordships very much about her, but I am told that she is all right.

When my children were born, we knew very much less about the various disabilities, physical and mental, of which we hear so constantly to-day: the spastic children, the autistic children and the aphasic children, to quote a few that were not widely recognised. The tendency was to relegate any abnormal child under an umbrella labelled"mentally deficient" or"crippled"—with no details. If a child belonging to some friend or acquaintance"wasn't quite right", the fact was not discussed except behind closed doors or in carefully controlled whispers. If a little mongol boy or girl was seen walking beside their mother in the street, one tended to look the other way. If a child could not speak or articulate properly he would be lucky if he received any help at all to assist him attain even a small degree of normality.

My Lords, two world wars, with their consequent legacies of shock to so many nervous systems, have awakened in us a determination to do something to help alleviate the distress caused by an inability to find expression in coherent words. But we have not yet advanced very far in either the knowledge of what exactly is wrong or how to set about righting it. This afternoon we have been given a great deal more information; and from the books referred to (which I have also been privileged to see) I know that I have learned a great deal myself.

My Lords, I can so easily put myself in the place of any one of those deeply-distressed parents who know that their child is lacking in something and yet meet with so much frustration and disappointment. As we have heard to-day, when they seek help from someone they deem to be an expert, they are often sent away with false encouragement which leads to bitter disappointment. They find that contrary to what they had so often been led to believe would be the case,"it is not going to be alright". It seems to me that far more trained re-assessment of pre-school age children who fail to develop speech and language is absolutely necessary and we are much encouraged by what we have heard from the Minister of Education.

If a child is found to be deaf while failing to develop speech and language, immediate and adequate provision can be made for treatment; but if a pre-school age child fails to develop speech and language and is found to have a language disorder, then, as we have heard to-day, no such provision is made. I want to put the question that has already been put to the Minister. Does he intend to provide treatment for language disordered pre-school age children in the same way as for deaf children? Furthermore, in the most welcome extension of nursery school education recently announced by the Minister, how many places are being made available for speech and language-disordered children?

As one of the lucky ones who has not had to suffer in the knowledge that"all is not right with the child", I would urge the Minister, who is well known for his sympathy and understanding approach to these problems, to continue ceaselessly to bring pressure to bear on those who have responsibility in this field. Every day, every week, every month, every year, parents are suffering anguish and acute anxiety because they feel that so often (as we have heard to-day and as I repeat) they look in vain for help. The few who are fortunate in discovering the right school or therapeutic assistance for their deprived child are in a minority. We have this afternoon heard some of the figures. There is so much to be done and the reward in terms of relief and hope and actual achievement is immeasurable.

5.55 p.m.

LORD PLATT

My Lords, time is getting on and I shall be brief. I should like to add my thanks to the noble Baroness who opened this debate because I believe that it has been valuable, and I am quite sure it will have some benefits in the future. I should like also to say how much I enjoyed the contributions of the two maiden speakers.

Like most medical men, I am extraordinarily ignorant on this subject. I would only say, as a sort of mitigation of how ignorant the doctors are, that a great deal of this knowledge, the grasping of the importance of the proper examination of children who are seen to be backward in their learning in one way or the other, is comparatively new. I would also say that you cannot teach everything to every doctor and that if you tried to spread the knowledge so thin they would become even more dangerous than if they had no knowledge at all. What we must do is to see that there are ready means of informing doctors who are likely to come into contact with these children—the general practitioners, the paediatricians and so on—where centres of special knowledge are to be found and how to go about it when they are presented with the problem.

It is easy to say that more money must be devoted to this; and I should be the first to agree that money is essential for the setting up of centres for further training of special remedial teaching of various kinds (not only speech therapists), and for better salaries, and conditions, and career prospects. But one thing I think has been insufficiently mentioned—and perhaps this is the only excuse for me to talk at all on this subject. I believe that research has been insufficiently stressed. It seems to me that there is a great deal of ignorance even among those who have studied these subjects very closely, and I think they will be the first to admit that there are still very big areas of ignorance which really do need first-class research. It seems to me that if more really first-class research centres were to be established, we should then have centres of knowledge which would help in the training of these people and we should gradually bring up a generation (shall I say?) of people who saw in this a worthwhile career whatever their background may originally have been, whether medical or in education or psychology or sociology.

My Lords, that, I think, is the only contribution I should like to make, except that I would carry it a little further and say that I am afraid I am speaking without having done the homework that I should have done to see how much is going on. I hope that the Minister, in his reply, will say,"A great deal of what you advocate is already being done." I suggest that, if it is not being done sufficiently, there should be first of all a conference of experts to define the fields in which further research is necessary and the way that centres of experts could be developed. And then, if it is not already being done, it would be an ideal subject for the kind of practical, directional research which was an important feature of Lord Rothchild's controversial Report: not only ideal from the point of view of being a very well worthwhile research project of that kind, but also ideal in being one in which two Departments could corroborate, Health and Social Security, on the one hand, and Education and Science, on the other. Even if a a great deal of this is being done, I imagine that a bit more effort could probably be put into it.

6.2 p.m.

LORD GAINFORD

My Lords, it gives me great pleasure, in fact double pleasure, to add my congratulations to the noble Lord, Lord Seebohm, and to my noble friend Lord Annaly on their splendid maiden speeches. Their contributions to this debate and their first-hand information were of particular value. This is an important day for each of them and I hope that both noble Lords will have many opportunities to address your Lord ships' House in the future. This is also the first opportunity I have ever had to congratulate any Member of your Lordships' House on his maiden speech. Not long ago I made my own maiden speech, and I am very grateful for all the encouragement I received on that occasion and for the encouraging reception given to the few speeches that I have made since. I am even more grateful for the fact that I am able to speak.

The reason why I am speaking in this debate to express my support for the Motion is because once I was afflicted with a speech defect. Mine was not nearly as bad as some, but I could well have done without it, and I am more than glad that eventually it was overcome. Occasionally, sometimes in quite simple little situations, my mouth and tongue seem to get tied up with each other and I wonder what has upset me enough to bring it on. So any scheme put forward to help other people who are suffering, particularly children, arouses my interest and my desire to do something to show support.

The recent report by Pauline Griffiths on the development of aphasia, quoted by my noble friend, has an important sentence at the very end, which was referred to by the noble Baroness, Lady Phillips; that speech defects could be likened to the tip of an iceberg; in each case there are other symptoms and there is hardly any case of a speech impairment which is completely identical with another. But in the treatment of a defect, just as with anyone who suffers from a serious injury in any other part of their body, the morale of that person is vital. He or she may know that they may be different from other people for the rest of their lives. The concentration must be made on what that person can do well. In making use of my own experience I well recall the inferiority complex at my boarding schools until, as a new boy at the last one I went to, I found there a boy (I will refer to him as"Billy") who had been able to turn his speech trouble to his complete advantage. Billy could get away with almost anything—outrageous"cheek" to anyone in authority—and he could get himself out of awkward situations. Each time he opened his mouth and spoke there came roars of laughter from the people who heard him; but the laughter was with him, it was never against him. Unfortunately people with defects often do not have such spirit as Billy had; but where they do show any sign of it, it must be channelled in the right direction.

In the speech therapy that I underwent music was often used. It seems to me—and I wonder whether anyone in your Lordships' House can support this—that Nature rewards many people who have vocal hitches with a talent for singing and music. In my case there was a definite talent. My first boarding school encouraged music and acting, and by the time I left I could sing well, sight read and had ability with both piano and violin. People were kind enough to say that it was above average for someone of my age. Perhaps I could have made a career in music but I wrecked my chances—whether it was the result of another defect that accompanied my stammer or just a childish trait in me at the time I do not know—by suffering from such a degree of shyness that it made me terrified at any prospect of being watched, listened to or performing in front of other people. With acting I had the same fear with regard to my voice. I was scared that it might cause me to make a fool of myself. Later, an actor friend said the best therapy would have been to give me a good part in a play and force me into doing it. I have heard of persons in show business who have had speech defects in private life and yet never gave any indication of it when performing, simply because of the completely different action required in projecting the voice.

The matter of education for such children as we are discussing to-day is of vital importance. Only this afternoon I have been given a piece of information that was new to me, and I should like to hear whether there is any truth in it. We have heard stressed the need for more speech centres, but I was told that there are still a great number of qualified speech therapists who are unable to find a place in a school or college. If there is any truth in that statement it shows that there are available an ample number of persons who could fill the extra centres for which the need has been stressed.

With a child that has such a defect, education usually has to continue after the normal age when he would be considered old enough to earn a living. The problem of aphasia is relatively new, because those who may have been sufferers were classed with other children who were hard of hearing or had difficulty in speaking. A new problem is often upsetting regardless of how many advances have been made in the educational system, but it is a matter of fact: it is there and it cannot be ignored. I have no doubt that a solution to this problem will be found. Whether it is found by doctors or by teachers, or both, it will be a great triumph and honour to those finally responsible for the discovery. The essential thing for us to ensure is that all hindrances to reaching this solution are quickly removed.

6.10 p.m.

THE COUNTESS OF LOUDON

My Lords, mental handicap is very common. We recognise it best in developed countries where education and techniques are at high levels. It seems likely that with appropriate measures, especially those designed to remedy poverty, malnutrition and a poor environment, fewer mentally handicapped children will be born. But what of the problems and difficulties faced to-day by the parents of children suffering from speech and language disorders? Speech is built up very gradually, beginning at a very early age. Most mothers start to talk to their babies almost as soon as they are born, and words become linked to feelings and expressions and acquire an emotional content. A minority of retarded children, those labelled profoundly retarded, may never learn any speech. The moderately and severely retarded will be slow, but should develop a useful vocabulary given sufficient help and encouragement. The secret of success in the development of young retarded children is patience, and this most mothers have a great deal of (although of course there are exceptions), which is why most children do better at home than in institutions.

But what of the isolation and loneliness of the parents? They desperately need help and advice as to treatment and help in overcoming specific behavioural difficulties such as temper, tantrums, disturbed behaviour destructiveness and so on. Much psychiatric and social worker help may be necessary with the family, as well as material assistance, to enable it to hold together under the stress imposed by the handicapped child. Sometimes the stress is physical, such as loss of income because the mother is unable to go out to work, reduced standard of living and greater expenditure if the child is destructive. Some times the stress is social and psychological—reduced contact with friends and relations, even a hidden sense of guilt. But parents do need advice, and especially advice on management. Some may expect too much of their child, while others are over-indulgent, giving way to every whim and allowing quite unacceptable patterns of behaviour to develop.

Most backward children are more behind in speech than in other ways; but most do learn to speak, even if late. Many children who are quite markedly retarded none the less have a good memory. But to achieve this, the child must have stimulation and plenty of experience. One way is by playing games with the child—acting out situations which occur within his experience, such as the postman coming to the door, a tea party, or buying a new pair of shoes. This play is imitative of adult behaviour and is normal in children. Also, it helps a mentally handicapped child to relate a sequence of events in his mind and helps to stimulate his imagination. There are many games which can be used, such as simple wooden jigsaws, glove puppets or toy telephones, to mention just a few. But to reap the full benefit from these games it is essential that the child is talked to while being played with.

Television advertisements are another useful source of language stimulus. Although programmes in general do not necessarily make children more verbally proficient, in that there is no demand on the child to reply, nevertheless the advertisements have been found to encourage mentally retarded children to learn new words because of the constant repetition of a phrase or a jingle. Thus the child is given both auditory and visual stimulus, which is probably reinforced a number of times over a period of weeks. Added to this, he needs plenty of experience: perhaps to be taken to the park, the rail way station, the bus station, the zoo or the seaside. New experiences linked to new words help to expand his understanding of his environment in verbal terms.

All the family can help the speech of their retarded member, but inevitably most of the responsibility will fall upon the mother. If she is tied 24 hours a day she may become disheartened and give up trying. She must have help from relatives, friends, social workers or even a day nursery. This will permit her to relax and perhaps see her friends or relations, and she may then be ready to try again with renewed enthusiasm. The years teach much which the days do not show.

6.15 p.m.

LADY RUTHVEN OF FREELAND

My Lords, may I intervene for a few moments before the Minister answers this interesting debate. I have some experience of autistic children because I am a friend of Dr. John Corby, who runs the Hilda Lewis Institute at the Bethlehem Hospital where quite a number of retarded children are sent, particularly those who can neither speak nor hear—in other words, they are autistic. I have seen two or three cases and he has very kindly allowed me to sit in on his conferences. I am not so worried about the children, because I think a lot is being done for them and a great deal of research is going on, but I am worried about a particular case within my knowledge—a boy who went to a Rudolf Steiner School until, I think, the age of 18, when he had to leave. His family naturally took him home and looked after him, but being very strong and tall, he got beyond them, and he is now in a psychiatric hospital. Those are the sort of people of whom we have to think as well.

We need a great deal more research into both retarded children and all children who cannot speak or hear. but we must think of what will happen later. Their fathers and mothers may die and they may be left. In the particular case of this boy of 22 or 23, his father and mother are there, but they simply cannot do anything. They cannot look after him because he is too strong for them, and, as I say, he has had to go into a psychiatric hospital. I hope that the Minister will have this situation in mind.

6.18 p.m.

THE PARLIAMENTARY UNDER-SECRETARY OF STATE, DEPARTMENT OF EDUCATION AND SCIENCE (LORD BELSTEAD)

My Lords, it is perhaps salutary that Lady Brooke's Motion directs the attention of those of us who have spent a good deal of our time making use of the gift of speech to the vitality of language and the tragedy of its loss. I think it is fair to say that a child's first words obviously bring joy to parents, but speech defects cause utter dismay, and subsequently they will strike at the very roots of education and development.

It is for this very human reason that Lady Brooke's debate has attracted this full list of speakers this afternoon. I am sure that it would be the wish of your Lordships if I repeated the appreciation, which has I think comes from all sides of your Lordships' House, of the two maiden speeches that have been made in this debate. Together with other noble Lords I listened with interest to the views of my noble friend Lord Annaly on this subject. I think we all listened with particular care, as the right reverend Prelate said, to what my noble friend was saying because he was talking at first hand. I have particularly taken note of what he said about assessment and the need for more strategic regional assessment provision. What some of your Lordships may not be aware of is that my noble friend Lord Annaly has been, and probably still is, a very fine cricketer, and, as such, I am sure he will know how satisfying it is to get successfully off the mark. I hope it is clear to him that this is precisely what he has done this afternoon, and we all hope that he will return and speak to us again when the House reassembles.

To the noble Lord, Lord Seebohm, I hope it is clear that Members interested in the work of the social services departments of local authorities offer to him the warmest welcome to this House. The noble Lord's interests, as I realise, go a great deal wider than that. But again and again the fact of the matter is that we refer in our business in this House to the work of those committees which are the product of the noble Lord's really remarkable Report. Again and again in this afternoon's debate we have referred, either directly or by implica tion, to the social services committees of local authorities. We are all very glad that instead of constantly having to refer to the work of the noble Lord's"offspring", in future it may be that we shall be able to refer to the noble Lord himself. I hope that he, like the noble Lord, Lord Annaly, will find the work of this House of interest and will perhaps find time to return and take part in further debates.

Diagnosis and assessment have been referred to by many of your Lordships, and not least by the noble Baroness, Lady Brooke, herself and the noble Lord, Lord Annaly. May I just say a word or two on these, Obviously parents should be the first link in the chain which leads a child who is not developing normally to the doctor; but it is obvious from this debate today that it is parents themselves who want and call for—just as did the author of the book to which my noble friend has referred—an effective diagnostic and assessment process. It is true to say that clinical experience supports this wish. It is true that during the past ten to twenty years there has been some improvement in techniques, and to-day the great majority of local health authorities make arrangements to screen the hearing of babies between 6 and 12 months old. I should like to add that because of the increasing awareness of the importance of this kind of service, careful testing of hearing is now an important part of the examination of children when first they go to school.

The noble Baroness, Lady Brooke, referred to Mrs. Browning's remarkable book, I Can't See What You're Saying. It is perfectly true that because there are so many causes of speech delay it can sometimes seem to the anxious parents that help is really agonisingly slow in either coming or being able to be obtained, but as your Lordships will know and as several noble Lords have said, a number of different disciplines are often involved in assessment. In addition, there may be the need for help from a social worker—someone who may in the middle of a case have to be called in or someone who has possibly been involved in a case from the outset. The need for a multi-disciplinary approach is now generally accepted, and not least because of people like Mrs. Browning, who have brought facts to the notice of the general public. Steps are being taken to see that there should be a sufficient stock of suitable premises to serve as the base for diagnostic and assessment work. The noble Baroness, Lady Brooke, asked about this and she will know that there was in fact no capital programme before the special capital allocation of £1 million (which is now running at £1½ million) initiated in 1971 and designed to help in the establishment of some forty new centres in England, of which I think 14 have so far been completed. The aim eventually is to have as assessment centre in every district general hospital, and every new district hospital will have assessment facilities built in.

As the causes of speech delay are multiple, so are the methods of management and treatment. As the noble Baroness's Motion recognises, at the centre of any course of treatment must inevitably stand the parents. I think we are all agreed that it is difficult to over-emphasise the strain imposed upon a mother and father by a child who is unable to communicate. Samuel Johnson said that"language is the dress of thought", and of course speech and language are crucial, not only for intellectual but also for social and emotional growth. Parents need the earliest possible help in coming to terms with their child's disability and with obtaining practical advice on how to bring up their son or daughter.

Health visitors are given training to help them to identify these children. Social workers can be a vital link in the chain of diagnosis, assessment and treatment. Day nurseries and playgroups provide a means whereby a mother can meet and learn from others as well as from the staff—although I realise that one would not be talking about the majority of the children under discussion here this afternoon. Perhaps your Lordships might like to know, in passing, that the capital building programme for day nurseries will have risen from £737,000 in 1970–71 to £1,300,000 this year, and I hope that your Lordships may have approved the paragraphs in my right honourable friend's recent White Paper, Education: A Framework for Expansion, which refers to the role of voluntary playgroups which have involved thousands of mothers as well as children. In this general connection, may I just pay a tribute to the work of the voluntary organisations of all kinds? I listened carefully to what the noble Countess, Lady Loudoun, was saying—and here I am also referring to the National Society for Mentally Handicapped Children with which the Lord Bishop of Bristol is associated.

Early educational provision alongside speech therapy is, of course, crucial for children with communication difficulties. Some local education authorities have visiting advisory teachers and I think it is fair to say that this work is very valuable. But where there may now be entirely new opportunities is within the extra programme for nursery education which my right honourable friend has just announced in her White Paper. I think it is fair to claim that nursery education enables immediate measures to be taken to offset the disadvantages of any handicapping condition—and of course it is a valuable source of support and advice for parents.

I have listened carefully to what my noble friends Lady Brooke and Lord Grenfell have said—and they were quite definite about this—about aphasic children not being removed to ordinary schools. What I am submitting to your Lordships—and I am not dogmatic about this, because I always listen carefully to advice which is given in this House, and not least to that which is given by my noble friend, Lord Grenfell—is that provided a suitable balance is maintained and provided that staffing and other arrangements are appropriate, less severely handicapped children can sometimes be educated with others in nursery schools and classes.

I was grateful to the noble Baroness, Lady Northchurch, and to the noble Lord, Lord Seebohm, for drawing attention to the importance of the early years for these children. The noble Baroness asked me a specific question about the percentage of handicapped children who would now receive nursery education in the future. We shall look carefully at the need for nursery education in the light of what she has said to this House. Perhaps my noble friend would like to know that we have hived off for the replacement or improvement of old special schools in this year, next year and the year after, some of the money from the primary improvement programme. We have done this quite deliberately. I say this because I hope that it shows where our heart lies. We shall look carefully at the programme. But I think I should also say to the noble Baroness that if she cares to turn to my right honourable friend's White Paper she will see that the special school building programme is to be increased from £11 million this year to £19 million in 1976–77.

BARONESS PHILLIPS

My Lords, before the Minister leaves the question of the pre-school group, I am not quite sure what he meant when he said that playgroups will assist in this, because in many playgroups there are not even professional teachers; so how they would be able to recognise the aphasic child, or indeed any child suffering from a speech I disorder, I am not quite clear.

LORD BELSTEAD

My Lords, if the noble Baroness will look at the White Paper, she will find paragraphs where we try to spell out carefully how we at the Department of Education and Science see play groups may be closely allied with education or how, if it is the wish of those voluntary bodies or local education departments, they may even become part of the education service.

My Lords, may I now turn to speech therapy. In 1971 of the 90,000 pupils in England and 4,000 in Wales who received speech therapy, the vast majority attended an ordinary school. When a pupil has speech therapy away from school I think it is fair to say that the mother usually goes along too; and your Lordships will know that a mother is generally invited to be present during the first few sessions to see how the therapist works, and at the end of each session the therapist will tell the mother what to practise with the child during the following weeks. Of course if one has this process there is an opportunity for a discussion to arise. But what the noble Lord, Lord Seebohm, said is perfectly true: there is a grave shortage of speech therapists. In October the Quirk Report was published and I am interested to find out how your Lordships have so obviously all read it with care. I cannot comment on the outcome of the current consultations which are going on at the moment about this Report, but it recommends the unification of services under the new Area Health Authorities; it recommends a trebling of the number of speech therapists to a total of 2,500, and that they should be supported by a new class of people who are called"aides"; and it recommends broad-base courses at degree level as the future pattern of training. I will certainly draw my right honourable friend's attention to the support of the noble Lord, Lord Seebohm, for the recommendation for a central council for speech therapy. I will also pass on the views of my noble friend Lady Elliot of Harwood on the need for therapy links with children's homes; and I will also have the apprehensions of my noble friend Lord Gainford, about the employment prospects of some therapists, looked into.

The noble Baroness, Lady Brooke of Ystradfellte, before this debate kindly gave me notice that she would certainly be touching on the matter of buildings. She has asked this afternoon whether accommodation for children will be extended by an extension of special schools. I had the good fortune to visit the Ewing School at Manchester, which my noble friend has referred to, before this debate; and I hope I profited from the time I spent there. In addition to the Ewing School there is Moor House in Surrey; and there is John Horniman, run by the Invalid Children's Aid Association, of whose finance committee my noble friend Lord Grenfell is chairman. That is in Sussex. Moor House is currently being rebuilt and a new department of the John Horniman School, as my noble friend told us, Dawn House, in Nottinghamshire, is due to start building next year. This year, out of the total of 457 children suffering from speech defects who were in special schools in England and Wales, 103 were in these three English schools, and the new buildings to which I have referred will add a further 80 places.

I should like to see that my right honourable friend's Department, in conjunction with local education authorities, assesses the need again in the light of the extra places coming into use. I think it is fair to say that we shall have to consider with the authorities and with the voluntary bodies whether we need a school or schools for children from several regions, which would obviously mean boarding; or whether it would be better to have more small special units on a day attendance basis. I must apologise to your Lordships that I have not got for to-day's debate the number of these children who are in day special units. In doing all this, we will certainly bear in mind the view of my noble friend Lord Grenfell that we need boarding provision on a regional basis; and I also noted his views about secondary education. What I can undertake this evening is that decisions will be taken only after consultations with authorities and the voluntary bodies. If a need is established for additional schools for this or other categories of handicap—and your Lordships have made pretty clear this afternoon what your view is—the rapid acceleration of the special school building programme which we have announced in the White Paper will make it at least more possible to find room quickly for the provision which would be required.

The noble Baroness asked about provision for people who are over statutory school age. This, I know, is something about which some of your Lordships feel strongly. I think my noble friend Lord Grenfell, although he did not mention it in his speech, feels deeply about it. I thought your Lordships might like to know that a recent follow-up of a small group of 10 very severely handicapped young people who had been diagnosed as having receptive aphasia showed that, so long as employers and fellow workers were aware of the problem, these young people had no great difficulty in obtaining employment, though the report stressed the importance of suitable work and an understanding employer. Their social lives were of course severely restricted, and they remained a source of considerable anxiety to their parents, not least because of the continuing help which they would need when their parents would no longer be able to provide it.

Although the lion's share of the new special school building programme must go to the most prevalent handicaps, I very much hope that a programme which nearly doubles itself in a period of five to six years will offer a better chance for more provision where it is most needed. But I admit that this will not deal directly with the very real problems of the young man or young woman who has left school. I assure the noble Baroness that we have this matter very much in mind. We dealt with it specifically in paragraph 20 of Circular No. 671 on Autism. And, as I think some of your Lordships may know, we now have co-operation on a single committee among the Department of Education and Science, the Department of Health and Social Security and the Department of Employment—which the noble Lord, Lord Platt, may approve of. None the less, I know that there are no grounds for complacency over what we do now to help these children. Difficulty of communication—auditory, visual, emotional or social—is the thread which runs through all types of handicap, and nowhere is it seen more poignantly than in children who cannot understand what is said to them or cannot express what they wish to say.

My Lords, I should like, if I may, to write to the noble Lord, Lord Platt, about research in this field. Time is beginning to overtake me. I should have liked to say a word or two about this aspect because people who are interested in this field, and people who have been personally affected in this field, have every right to know about research; and if any other noble Lord cares to write to me of course I will furnish him with details. I hope your Lordships may feel that the noble Baroness has given us an opportunity to hear of some ways in which provision is being made rather better, perhaps, than it has been before, but also, I know, to identify the gaps. For the Government, it has been an opportunity to listen and to learn; and through experiment, research and greater concentration of resources I promise your Lordships that we will do our best to improve the prospects for the children who have been the subject of this debate to-day.

6.38 p.m.

BARONESS BROOKE OF YSTRADFELLTE

My Lords, I should like to take this opportunity of thanking not only those noble Lords who have taken part in this debate but those who have been present. I must confess that when I put down the Motion for one of these mini-debates I wondered very much whether I should have any names to support me at all. I have been delighted by the response which has come; and, as so often happens in your Lordships' House whenever a really human problem is being discussed, your Lordships' contribution reaches heights which sometimes on other occasions it does not. I should like to thank all noble Lords who have taken part. Particularly I should like to congratulate and to thank our two maiden speakers. They made completely different contributions. They both quite clearly had the ear of the House for their contributions, and it was transparently clear that all of us who had the privilege of hearing them want to hear them again.

Finally, my Lords, I want to thank the Minister. We all know that the Minister takes immense care and trouble and has a heart; and that cannot always be said of those in high places. We immensely appreciate the trouble he has given and the sympathetic hearing we have had from him to-night. I promise him one thing, and that is that his undertakings will be watched with the greatest of care, and an occasional penetrating Question may find its way on to the Order Paper in future in order to see that what he has from his heart undertaken to see will be done is in fact being done. I thank all your Lordships, and beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.