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Children with profound and multiple learning disability (PMLD) have difficulties in more than one area, including severe learning disability, combined with other significant problems and complex needs. Many are lifelong wheelchair users.

The problems and complex needs experienced by children with PMLD may include physical disabilities, sensory impairment (sight and hearing), autism, social-emotional and mental health needs and severe medical issues such as epilepsy. These children have considerable difficulty communicating, very limited understanding, and many show challenging behaviours. They require a high level of adult support for both learning needs and personal care throughout their lifetime.

But it’s important to remember that people with PMLD are a diverse group of individuals with their own personalities, preferences and ways of communicating. The abilities of these children vary considerably.

Finding a school

Children with PMLD 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, or assistive technology. Their attainments are likely to remain low and as they are working below the standard of the National Curriculum assessments, and not able to engage in subject-specific study; their progress is measured differently. P scales 1-4 are currently used as descriptors of the emergence of skills, knowledge and understanding appropriate to the nature of the child’s special need. From late 2021 these will be replaced by an Engagement Model covering five areas:

  • exploration
  • realisation
  • anticipation
  • persistence
  • initiation.

A child with PMLD is unlikely to continue to further education and may need supported living arrangements at 25.

Social isolation

People with PMLD remain one of the most marginalised groups in society. Due to the multiplicity of their disabilities and because our communities have not historically been inclusive, they are often excluded from playing a full role in society.

But things are changing, largely thanks to organisations such as Mencap. Their Involve Me project, for example, aims to increase the involvement of people with PMLD in decision making and consultation. The Involve Me summary booklet and practical guide is a result of this three-year project supported by the Renton Foundation and run by Mencap in partnership with the British Institute of Learning Disability (BILD). People with PMLD and staff took part by learning about using different approaches to communication: sharing stories, creative communication, peer advocacy and multimedia advocacy.

How we can help

The Good Schools Guide website features reviews of recommended schools for PMLD or consult our SEN team for one-to-one help.

Further information

Find out more about how to get the right support and communication for a child with PMLD by visiting

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