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Severe & Complex Support Needs

The term 'severe and complex support needs' can be used to describe children and adults with multiple barriers to learning such as communication, cognition, sensory (vision & hearing) and physical.

The population of individuals with Profound and Multiple Learning Difficulties (PMLD) are often also included within the 'Complex Needs' description.

Some individuals with Autism Spectrum Conditions (ASC) may also be described as having complex support needs due to the complexity of their communication, cognitive and sensory difficulties.


Technology has the potential to reduce or eliminate barriers to learning for this population, offering solutions for communication and access across all areas of life.

Some Ways Technology Can Help

In a school setting, learners with complex needs require a specialised environment and access to the curriculum, which may (should?) include some or all of the following low, medium and high assistive technology supports.

Low Tech

  • Objects Cues - e.g. 'Objects of Reference' can help individuals anticipate what will happen next.
  • Multi-sensory referencing - uses touch, sound & smell in a way that supports a learner to make sense of their environment.
  • Pictures or Symbols - visual supports to help learners understand what is happening and make choices.

Medium Tech

  • Single Message Devices - a one message communication device, which enables learners to press the device and play the message.
  • Multi-Message devices - a multi-message device to enable learners to use a series of pre-recorded messages. There are many other multi-message devices which use symbol and photo overlays and dynamic screen interfaces.

You can find out more about 'Multi-Message' devices on the CALL Scotland Communication Aids pages.

High Tech

  • Large Touch Screens - interactive screens such as SMARTboards or the Inclusive Interactive Screen enables learners to access and manipulate images and text on the screen using specialist software.
  • Mobile Touch Screens - devices such as iPads or Android tablets enable learners to use touch to interact with the screen.
  • Switches & Switch Boxes (CALL link to switch page) - enable learners with physical difficulties to access & control computers and tablets.
  • Switches & Powerlink Boxes (CALL quick guides link) - enable learners with physical difficulties to access & control electrical items.
  • Eye Gaze - an access method which uses an infra red camera in place of a mouse to control a communication device, control the environment or play games.

How can we use Assistive Technology?

Individuals with Complex Needs require opportunities to experience and learn communication, cognition and social interaction skills. For individuals with PMLD, who are at the very earliest stages of development, a responsive environment focusing on responding, interacting and communicating is essential.

When working with learners who are at a very early developmental level, it is almost impossible to separate out the learning of communicative skills from the actual process of living and, to this degree, communication can be seen to be perhaps more than any other area of development an almost entirely processed-based activity.

Imray & Hinchliffe 2014

Whilst Assistive Technology can support individuals to learn these skills and gain a degree of control over their environments, it is important to note the need for careful consideration and assessment. When using Assistive Technology, we should always be carefully observing and reflecting, asking the question 'Why am I doing this?' so that the use of Technology does not become an end in itself, but rather a means of learning new skills.

For example:

  • Angus is learning that he can have an effect on his environment i.e. learning to understand cause & effect.
    Angus has some movement in his left hand and can reach out with his fingers to explore sensory items which are placed on his wheelchair tray. Angus has shown he loves bubbles, by smiling and giggling when he feels them land on his head and arms. Angus is given frequent opportunities to control a bubble machine which has been adapted for use with a switch. Now, whenever Angus presses the switch, the bubble machine (which has been carefully placed on his wheelchair tray so that it can't fall over, and won't blow bubbles straight into Angus' face) whizzes and produces bubbles, much to his delight. As soon as Angus removes his hand from the switch the production of bubbles stops. By using the switch in this way Angus is able to learn that it is the action of him pressing the switch that is controlling the bubbles.
  • Sarah loves being with people, particularly when there is music & singing involved.
    Sarah's family have noticed there are particular songs & rhymes she responds to more than others, by becoming very excited and vocalising when they are sung. In order to help Sarah learn about exerting her autonomy (i.e. initiating an action to achieve a desired result) her Mum records herself singing the first few words of one of her favourite songs onto a BIGmack. She labels the BIGmack with a 'sing' symbol and offers the BIGmack to Sarah, asking her if she wants to sing. When Sarah presses the BIGmack her family join in with the rest of song, much to her delight. When the singing is finished, her Mum puts the BIGMack beside Sarah and waits expectantly observing her closely and asking her if she wants 'more singing' by looking and pointing at the BIGmack.
  • Andrew has a good understanding of cause and effect.
    Andrew has used a switch to play with many switch adapted toys, and is now able to use photographs to eye point to choose toys he would like to play with. He is now showing clear favourites. Andrew's teacher wants him to use his skill in understanding cause & effect in one setting and help him to generalise it another. The class have enjoyed experiencing a sensory story, getting used to the various sensory props with which they have been learning to anticipate and respond. The teacher had created an animated PowerPoint to support the telling of the story, with characters flying in on screen and various sound effects. Andrew is given the role of 'Page Turner', to give him the opportunity to learn that when he presses the switch, he can 'turn the page' of the slideshow, moving the story on.

Assisstive Technology in Schools

Staff working in schools may have a number of Assistive Technologies at their disposal, and it is important that everyone supporting learners with complex needs in school settings not only feel comfortable and skilled enough to use the technology, but have a clear understanding of why it is being used and how it links to the curriculum. At CALL Scotland, we have a programme of Professional Learning including 1 day courses, half day seminars and free webinars. You can find details of all our courses on the Learning page. We encourage you to sign up for our newsletter which will alert you to relevant upcoming Professional Learning.

There are a number of excellent frameworks and guidance materials created by colleagues in England, Wales and Northern Ireland, which provide ideas for assessment, implementation and curricular contexts for using Assistive Technology with learners who have complex needs.

Ian Bean's Switch Progression Roadmap.

The Routes for Learning Assessment Tool from the Welsh Government.

Quest for Learning and the Q Skills
a guidance and assessment resource from Northern Ireland, based on Routes for Learning and includes materials for assessment, guidance and pathways for learning.