Education and Landau Kleffner Syndrome

Landau Kleffner Syndrome (LKS) may be associated with complex language, and additional learning and behaviour difficulties. Children and young people with LKS will benefit from a school placement that can support their individual pattern of abilities and needs.

Children with LKS benefit from a variety of education settings depending on their needs and abilities, though most will inevitably need support by speech and language therapy wherever they are. Educational psychologists and school Special Educational Needs and Disabilities Coordinators (SENDCos) can give advice and recommendations about current and future school placements within local areas to help parents assess a school’s suitability for their child. Children should have an assessment so that an Education Health and Care Plan (EHCP) is put in place as soon as possible. Many parents will find it helpful to have a copy of the current SEN Code of Practice to understand and monitor the process.

Education setting options may include:

Mainstream schools: For children with LKS who show a good recovery, mainstream education may be the most appropriate placement. For other children who show a moderate degree of recovery, mainstream schooling may be possible with help from a learning support assistant (LSA) who will provide classroom support and help to adapt the curriculum to suit the child’s language and learning levels.

Special schools: Children with LKS who have more general learning difficulties may benefit from being taught in a school for children with special educational needs where they will have access to a differentiated curriculum and therapy support within the school.

Language units: Language units are usually attached to mainstream schools. They offer specific expertise for children with language and communication disorders, and may be appropriate for some children with LKS.

Schools for children with hearing impairment: Children with LKS who rely on sign language as their main form of communication may benefit from a placement in a school or unit for children with hearing impairment which uses a signed approach to learning.

The active seizure phase of LKS tends to stop before or around the start of puberty and many young people recover and achieve well with support. For some young people, the transition to secondary school requires careful planning. In this new setting, a young person might lose previously established support and friendships and needs to rebuild these in an environment that will have no memory of their earlier profound illness. It is also a time when children progress to being young adults and want to be more independent. Increased demands are placed on them during the school day in terms of academic studies, social relationships and organisation of work tasks. A review of a child’s educational progress is therefore recommended in Year 5 to ensure a smooth transition to secondary provision and ongoing provision of therapy and educational support as needed.

LKS can change rapidly over time, making progress at school erratic and unpredictable. Regular monitoring and updating of therapeutic and educational plans is necessary to respond to this. When a child’s disease is active, performance can vary even within a day. Children can become tired and find it hard to concentrate. Teachers should be made aware of this so they can organise timetables in ways that may help to minimise the impact.

Despite having significant language difficulties, many children with LKS retain average or above average nonverbal abilities. However, most classroom teaching requires a child to understand and use spoken language. This means that a specialist teaching approach must be devised. It is vital that these good skills are recognised and that it is not assumed that the child has general learning difficulties because of their language difficulties. Using a visual approach to teaching can enable a child to follow lessons and continue learning new concepts.A speech and language therapist and class teacher should work with the child to formulate appropriate strategies.

Further information regarding supporting a child’s language skills through visual resources (signing, pictures) is detailed in the Language and Communication information sheet in this series.

LKS is associated with a number of behavioural difficulties that may be disruptive to learning and school life, for example, poor attention and concentration, social communication problems or aggressive outbursts. It will be important for staff to recognise and understand this so that these areas can be supported during the school day. For example, children who find social interaction difficult may need additional help in unstructured situations such as break time in the playground. Other children would benefit from help to tackle behavioural problems that impact on their ability to engage in and access learning activities.

Further information regarding supporting a child’s behaviour is detailed in the Abilities and behaviour information sheet in this series.

Children with LKS who have retained or recovered their spoken language, may continue to have difficulties processing language around them, particularly in noisy environments. This can sometimes be due to slow auditory processing, which means that a child will take longer to process and respond to words and sentences they hear. Slow processing can also affect their ability to make sense of conversation or follow spoken instructions and explanations given in class, impacting on friendships and schoolwork.

Sometimes it is hard to identify that a child needs support in this area as their expressive language skills may be very good. Children may also be aware of their difficulties but reluctant to ask for help or repetition and they will need support and encouragement to do so. The noisy environment of school classrooms can be challenging places to learn in, without assistance and environmental adaptations. Improving the acoustic conditions of the classroom can be very helpful in improving the understanding of classroom teaching and instructions. The following adaptations may be considered:

• Windows and doors should be closed whenever possible.
• Pupils could be encouraged to move through the school corridors quietly during lesson times.
• The young person with LKS should be seated away from any potential noise sources, such as the window, heating or ventilation systems.
• Equipment such as computers and overhead projectors should be turned off when not being used.
• There should be as many carpet areas as possible to lessen noise from chairs. Where there are not carpets, soft pads could be stuck to the bottom of chair and table legs to reduce noise.
• A quiet area should be provided.

In secondary school, when a child is no longer in the active phases of LKS, they will no longer experience extreme fluctuations in abilities. Many young people show a graded improvement over years, however residual difficulties can become apparent and they may continue to have some special educational needs. For example, a young person may make a good recovery but lack the early skills and concept knowledge that would normally have been acquired around the time that the LKS was active. They often need explicit teaching of these early concepts and skills (including grammar, maths, vocabulary, and two-way conversation skills).

Due to the nature of difficulties associated with LKS, children will benefit from an integrated program of care at home and school. They may receive input from services such as speech and language therapy, psychology, neuropsychology, psychiatry, occupational therapy and social work, working alongside parents and education.

Often young people will need support to develop their emotional literacy (ability to recognise, understand and appropriately express emotions) as their experiences in these areas may have been limited during the active phase of their illness. For teenagers, in the recovery phase of the condition, there can still be significant emotional needs and we recommend that pastoral support (such as having a supportive relationship with an identified member of school staff who checks in with the young person regularly) is available in secondary school.

• Background noise or other distractions should be kept to a minimum. Students may benefit from sitting close to the teacher.
• Verbal communication needs to be short, clear and simple.
• Students must be given plenty of time to process verbal information.
• Check a student has understood instructions or explanation and use repetition, rephrasing or visual supports to help consolidate their understanding when needed.
• Students will also benefit from being given plenty of time to put their thoughts into words.
• Vocabulary and concept words needed for particular subjects are best taught in advance so that the young person can effectively access these lessons.
• It is essential that visual cues and supports are provided alongside spoken language in all subjects (such as pictures, timetables, diagrams, checklists, flow charts).
• Where children rely on lip-reading to support their understanding, it is important for them to be seated so that they can see the speaker’s face.
• Encourage students to recognise any difficulty with understanding and seek repetition or clarification. They should also be encouraged to ask speakers to slow down if they are speaking too quickly.

Young people with LKS typically have an uneven profile of abilities and they may struggle to demonstrate their full range of abilities when sitting exams if support is not in place to help compensate for areas of weakness. Many young people with LKS will be eligible for adaptations during examinations at school or college, due to their Cognition and Learning Needs and/or their Communication and Interaction Needs, in accordance with the Joint Council for Qualifications guidelines for the current year.

• In order for a child to access this support, they would need to be able to provide evidence of their ‘learning difficulty’ in order to provide evidence of special educational needs. The school Special Educational Needs and Disabilities Coordinator (SENDCo) should be able to provide support with this.
• Where an educational psychologist has been involved in assessing and supporting a child, they will also be able to advise on any examination adaptations required.
• Evidence of special educational needs can also be gained from cognitive and speech and language assessments that may be carried out by a specialist multidisciplinary team or professionals within a local NHS service.

Children with cognitive and learning needs and/or communication and interaction needs may require:

• extra time
• supervised rest breaks
• a word processor (should be established as their ‘normal way of working’ prior to sitting the exam)
• a computer reader or a reader
• an Oral Language Modifier or a Sign Language Interpreter
• a scribe
• a prompter
• a practical assistant
• papers with modified language and/or modified print
• coloured overlays
• coloured/enlarged papers

In order to award extra time of up to 25 per cent for examinations, the school or college needs to have in place for your child either:

• statutory assessment relating to secondary education which confirms the child’s disability (for example, an Education Health Care Plan or EHCP), or;
• an assessment carried out from the start of Year 9 by a specialist assessor usually within school confirming a learning difficulty relating to secondary/further education.

• Many students experience some nervousness or apprehension before, during, or even after an exam, and it is perfectly natural to feel some anxiety when preparing for and taking a test. However, some children with LKS may become very anxious about examinations, particularly if they do not have special circumstances in place, but also due to the learning and psychological needs associated with their condition.
• Too much anxiety about a test is commonly referred to as test anxiety. Test anxiety can interfere with revision and the young person’s performance during the test so that they may have difficulty demonstrating what they know.
• Providing students with tools and strategies that build both emotional skills and healthy physical habits when preparing for a test can help them overcome test anxiety and the associated symptoms. For further information please see the online resource available.