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Children with MLD may appear immature and find it difficult to mix with their peer group; many are vulnerable and may experience bullying as a result. Often they are needy, with an over-reliance on adult help and support.

Children described as having moderate learning difficulties experience great difficulty in acquiring basic literacy and numeracy skills, despite receiving suitable help. They have general developmental delay, which means that they reach developmental milestones much more slowly than their peers do, and learn much more slowly. They are likely to have reached below level 2 of the national curriculum at the start of senior school. They may also have speech and language delay, difficulty in concentrating and underdeveloped social and emotional skills.

Generally children with MLD will have some or all of: 

  • Difficulty understanding basic concepts.
  • Problems acquiring basic skills in reading, writing and numeracy, resulting in a lack of confidence in using and developing the skills they do have.
  • A lack of logic.
  • Poor problem-solving skills.
  • An inability to generalise learning and apply it to new situations.
  • Limited communication skills, coupled with immature social and emotional understanding.
  • Poor fine and gross motor skills.
  • Difficulty with personal organisation.
  • Poor auditory/visual memory.
  • Poor long and short term memory; difficulty remembering what has been taught.
  • Speech and language delay.
  • Emotional and behavioural difficulties.
  • Sensory impairment.
  • A lack of social skills.

What helps children with MLD?

  • Routine and structure.
  • Giving the child responsibilities.
  • The potential for success. Encourage, praise, reward - not just for work and achievements but for positive behaviour too.
  • Building on the child’s knowledge and understanding.
  • Ensuring learning objectives are realistic for every lesson, and that success is achievable.
  • Giving clear instructions. Careful questioning to ensure a child knows what is expected of them and of the task.
  • Checking understanding at every stage.
  • Carefully planned and differentiated work, broken down into small, manageable tasks.
  • Regular reinforcement of tasks to be mastered and the opportunity to practise and apply skills in everyday situations.
  • Showing how things are done rather than just explaining. Providing plenty of opportunities for multi-sensory, practical learning.
  • Tasks, such as handling money and telling the time, presented in short, frequent bursts.
  • Writing frames to help structure work.
  • Use of ICT including, where applicable, modified hardware.
  • Monitoring, recording and reporting of progress and the strategies that are successful.
  • Ensuring support is a tool, not a crutch.
  • Facilitating friendship groups.
  • Having positive role models.
  • Opportunities to participate and be fully included.

Children with MLD may be assisted not just by trained teachers, but also by learning support assistants (LSAs), who work under the direction of the classroom teacher and special educational needs coordinator (SENCo) or equivalent. Many schools issue individual education plans (IEPs) detailing a child’s needs and targets. Targets set should be closely monitored and regularly reviewed.

Pupils with MLD do not find learning easy and may display challenging behaviours if their needs are not fully recognised and understood.

Choosing a school for a child with MLD

Many children with MLD cope in mainstream nursery and primary schools, but often, by secondary school age, the gaps between them and other learners have widened to such an extent that the demands of secondary education are too stressful: different teachers; a wide range of subjects; the need to move around the school; to be organised; to change for PE. At this stage intellectual gaps tend to widen too.

Choosing a school for a child with MLD depends not only on the wishes of the family and the child’s individual needs, but also the local authority’s policy. 

MLD is perhaps the group that provokes the most controversy about the best methods of schooling.

Some special schools cater for MLDs, but many people feel these children should be fully integrated into mainstream schooling with help and adaptations. Increasingly, mainstream schools incorporate units for children with MLD, and alternatively some children are registered at both a mainstream and special school and spend part of the time in each.

Different education authorities use different approaches. Where you live and the type and nature of your child's needs will have considerable bearing on their education. What matters is getting the best education, in the right educational setting. You should hope for flexibility within choices too - so that education, including the school, if appropriate, changes as your child does. 

‘My daughter has blossomed,’ said a parent whose child had joined Swiss Cottage special school. ‘In mainstream school she was always the least able in the class and she had very low self-esteem. She’s completely changed since coming here: she feels able, she’s got confidence and she’s happy.’

Severe learning difficulties (SLD)

Children with severe learning difficulties have acute development delay, with an intellectual or cognitive impairment, coupled with possible sensory, physical, emotional and social difficulties, that make it difficult for them to follow the curriculum without substantial help and support.

They may use basic words and gestures to communicate (using symbols and sign language may help), but are likely to find it difficult to understand, learn and remember new skills. They are likely to need a high level of support with activities such as cooking, cleaning and shopping, but may be able to look after some personal care needs. Their difficulties may be compounded by poor co-ordination and additional special needs.

School options

Severe learning difficulties are generally diagnosed early on, and children with SLD should have an Education Health and Social Care (EHC) plan (or equivalent).  Most will attend a special school, (possibly a residential one), though some are supported in attending mainstream schools or have dual placements, spending time in mainstream and special schools.

The curriculum

The attainments of children with SLD are likely to remain below level 1 of the national curriculum (in the upper P scale range, P4-P8) for much of their school careers. They follow a curriculum which is carefully broken down into small steps with plenty of repetition, reinforcement and encouragement.

The curriculum should encourage independence, life skills and communication, as well as learning, at a level appropriate both for their intellect and their age. They are likely to benefit from a multi-sensory approach, adapted to take account of issues such as visual difficulties and other sensory needs.


Therapy is likely to be included in the EHC plan and built into the child's learning programme. This may include music therapy, play therapy, physiotherapy and sensory stimulation as well as speech and language therapy. In some cases the child’s behaviour may need to be managed through specialist approaches.

Teaching aids

Technology and learning aids can be used to enhance learning, encourage interaction and communication and help provide a multi-sensory learning environment.

Switch-operated equipment and specialised toys and communication aids can make a real difference to the child's learning experiences and progress. Overlay keyboards (computers with a special grid overlay) take a variety of forms, including a simplified and/or enlarged keyboard, or pictures grids replacing standard keys. Children who are visually impaired may use special high-visibility or tactile overlays. The keyboards are usually combined with specially designed or adapted hardware and software. Speech output and symbols may also be used. Switches may help the child to access software and rollerballs or mousers may replace the standard computer mouse.

Measuring success

Generally, the school will keep detailed assessments of a child's progress.

Wherever possible the child should be involved in the process; many children are encouraged to use target boards to measure and record their successes - we have seen some wonderful examples of these on our school visits. 

In line with independent education plans, targets should be Specific, Measurable, Attainable, Relevant and Time-Bound, or SMART for short. 

Profound and multiple learning difficulties

Children with profound and multiple difficulties have a very severe intellectual disability, often combined with other significant problems, and complex needs. These may include physical disabilities, sensory impairment, autism and severe medical needs such as epilepsy. They have considerable difficulty communicating, very limited understanding, and many show challenging behaviour. They require a high level of adult support for both learning needs and personal care, and are educated in special schools.

They are likely to need sensory stimulation and a curriculum broken down into very small steps. Some pupils communicate by gesture, eye pointing or symbols, others by very simple language. Their attainments are likely to remain below level 1 of the national curriculum in the P1-P4 range.

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