Children with multiple disabilities present complex management problems, bo
th for their families and for the professionals involved in their care. For
any one child, the list of functional and medical problems that need to be
addressed is frequently reflected in an even longer list of involved profe
ssionals, leading to conflicting advice and problems in cc-ordination of ca
re. A hierarchical model for assessment and management is proposed, which h
ighlights the interdependency of apparently different areas of functioning.
The model aims to assist both parents and professionals in determining pri
orities, to improve interdisciplinary working, and to underpin staff traini
ng. Illustrative case studies indicate the importance of resolving issues i
n areas such as visual functioning, positioning and nutrition before integr
ated functions such as communication skills can be addressed successfully.