Rethinking learning for pupils with PMLD: challenging assumptions and embracing individuality.

Pupils with profound and multiple learning disabilities (PMLD) have complex needs. In addition to very severe learning disabilities, pupils are likely to have other significant challenges such as physical disabilities, sensory impairment or a severe medical condition. These pupils require a high level of adult support, both for their learning needs and for their personal care.¹

But what does this look like in the classroom? And how can these complex needs be met in a meaningful and educational way?

With 20 years’ experience in special education, and as the mother of a 15-year-old with profound and multiple learning disabilities, I’ve had the privilege of getting to know lots of individuals with PMLD.  I’ve come to understand that while they may share some characteristics, they are far from a homogenous group.

Each individual has a unique combination of needs, preferences, abilities, and ways of engaging with the world. Alongside profound intellectual disabilities, many experience physical and sensory impairments, complex medical conditions, and significant communication challenges. These overlapping needs demand holistic, highly personalised approaches to education.

Basic needs must be met with care and dignity

Often, the intellectual disability becomes secondary to the more pressing physical and sensory challenges learners face. Before any learning can begin, their basic needs must be met with care and dignity. In my classroom, each day starts with individually tailored physiotherapy routines—these may include stretches, splints, arm or leg gaiters, and transferring via a hoist into standing frames or postural seating.

• Further reading: InFocus special on PMLD

Medical needs are a constant consideration. Some learners require enteral feeding, ongoing medication, and regular health monitoring. While we’re fortunate to have an on-site nursing and feeding team, in many schools, this care is the daily responsibility of class staff. Emergencies are not uncommon, and the presence of physiotherapists, nurses, and care staff creates a busy and dynamic environment.

Despite the demands of care, learning remains a central focus. It just doesn’t look traditional. We embed it into every moment of the day, focusing on functional and sensory experiences that are meaningful and empowering. We use multi-sensory approaches to engage all available senses—especially important when learners have visual or hearing impairments.

Bringing education to life for students with PMLD

A story, for example, isn’t just read aloud. It’s brought to life through touch, movement, sound, smell, and taste (where appropriate).  A particular favourite of mine was a short sensory story about a day on a farm. We had the sound of a cockerel recorded on a Big Mack switch for the pupils to press, straw for them to feel, and coconut halves to imitate the clip-clopping sound of horses.

There were trays of water to explore as the duck pond, eggs to hold, and some soil and straw I had collected from a pigsty—stored in a plastic container so that, when opened, the smell of pigs was unmistakable. We also included a vibrating toy and some wool to accompany a line in the story about sheep shearing, as well as a medical glove filled with water that the students could pull to imitate milking a cow. They could harvest carrots from the soil themselves and then taste carrot purée.  The lines of the story were concise and straightforward, but the learning was rich, conveyed through experience rather than just words.

Repetition is a key component in everything we do and plays a vital role in the learning process. We often revisit the same theme or lesson throughout a whole term. This consistency helps learners become familiar with what is happening, which in turn reduces anxiety, builds confidence, and encourages engagement. It supports them in understanding routines and anticipating what comes next.

Sensory cues and learning

Other key teaching strategies include using music cues to signal transitions between activities for routines.  Over time, the pupils begin to associate particular sounds with particular events. The music cue for lunchtime regularly prompts huge, beaming smiles from learners who have anticipated what is happening next.

We use on-body signing (where signs are made on the learner’s body rather than in front of them, like Makaton) to indicate that something is about to start, has finished, or to alert learners that they are about to be moved or hoisted. Just imagine how terrifying it must be to be sitting in a wheelchair and for someone to come behind and start pushing you without warning!

On-body signing enables direct tactile communication, allowing learners with visual impairments or those with a longer processing time to understand what is happening.  We also allow time for rest and recovery – Rest is not a luxury; it’s a necessity. Learners with PMLD often expend significant energy just maintaining posture or coping with sensory input. Planned periods of rest throughout the day ensure they are not overwhelmed and can participate meaningfully in learning.

Misconceptions around learners with PMLD

Despite growing awareness, many misconceptions still surround learners with PMLD. These misunderstandings can significantly impact how we support, teach, and relate to them—often leading to an underestimation of their potential and individuality. It saddens and angers me how dismissive people can sometimes be toward this group of learners, assuming they don’t understand or are unable to communicate.

Everyone has the potential to communicate, and while individuals with PMLD may not use recognisable speech or signing, their communication is still present—whether receptive or expressive.  It is our responsibility, as educators, carers, and members of society, to become more attentive and responsive to these signals—whether they be vocalisations, facial expressions, body language, or more subtle forms of communication such as eye movements or changes in breathing patterns.

Individuals with PMLD are too often viewed through a lens of pity, with bleak assumptions made about their quality of life. That perception is both unfair and deeply inaccurate. With appropriate support and thoughtful adaptations, they can live lives full of joy, connection, and discovery. They can enjoy music, theatre, relationships, exploration, humour, and rich emotional experiences. They can tell you, in their own way, what they like, what they want more of, and what they’d rather avoid.

Giving meaning to learning for pupils with PMLD

Teaching pupils with PMLD is about so much more than delivering lessons. It’s about recognising each person as a full human being—with their own rights, preferences, and capacity to grow. It takes patience, creativity, flexibility, and deep respect. Many of our pupils will face shortened lives due to the complexity of their health needs. That only heightens our duty to fill each day with joy, connection, and moments of meaning.

I feel incredibly lucky to do this work. It is an honour to be part of these young people’s lives. They’ve taught me far more than I’ve taught them—about presence, trust, resilience, humour, and the things that really matter. I carry their lessons with me every day.

When we let go of assumptions, listen carefully, and hold high but realistic expectations, real learning becomes possible. It may not follow a conventional path—but it is every bit as valuable. These learners deserve nothing less than the opportunity to thrive.

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Emma Murphy is a SEND teacher and mother to a 15-year-old young adult with PMLD