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Brittinie & Tricia
October 16, 2012 Multiple Disabilities
“It should be noted however,
that these students can also
have average or even above-average intelligence”
Resources:
United Cerebral Palsy
Association –
www.ucp.org
Utah Center for
Assistive Technology –
www.ucat.usor.utah.gov
Assistiveware –
www.assistiveware.com
Project Ideal -
http://projectidealonline.
org/multipleDisabilities.
php
National Dissemination
Center for Children
with Disabilities
http://nichcy.org/disabili
ty/specific/multiple
Encompasses a combination of conditions that may impact a student’s ability to learn
and achieve success in an academic setting. o Students with severe disabilities are typically included under this terminology.
o This disability category includes those students with the most severe physical,
cognitive, and communicative impairments.
o The common connection isn’t that they have two or more co-existing impairments,
but that they generally need extensive support across any number of skill areas.
Intellectual functioning-
Most have severe
impairments
Adaptive skills-
Especially self-care and
social skills
Programs should include
self-care and self-
advocacy components
(essential for their
inclusion in the
community)
Characteristics - Six Categories that impact their learning:
Teaching Strategies: Planning process: a
multidisciplinary process
(parents, teachers, physical
therapist, assistive
technology teachers, and
any additional support
staff).
Determining the students
strengths and desires
Determine what Resources
and support will be needed
Develop an IEP
Integrate students with
multiple disabilities with
other peers. Part of the
learning process is social
development.
Motor development-
Significant delays in fine
and gross motor skills
Physical Therapy w/
orthopedic supports to
improve deficits in motor
Sensory impairments-
Hearing and visual
impairments are common
Having a clear
understanding of their
sensory impairments will
help develop appropriate
instructional programs.
Health care needs-
Medical procedures,
medical aids, medications
Communication skills-
Challenges requiring
augmentative and
alternative communication
Peer tutoring – Must be
reciprocal. Student with
MD should be able to
provide something to the
tutoring process, even if it
is simply social behavior.
Assistive technology – is
an effective tool for
students with MD in
overcoming functional
and communicative
limitations.
Augmentative and
Alternative
Communication –is any
instructional device,
technique, or system that
serves to support and
bolster communication
GOAL: AAC devices
allow students with MD to
share countless emotional
and social benefits that
can come from a
reciprocal interaction with
another person.
Tangible and tactile
symbol systems:
Choice boards
Object prompts &
symbols
Physical modeling &
prompting
Computer or microswitch
technology
Autism defined by IDEA
Autism means a developmental disability significantly affecting verbal and nonverbal
communication and social interaction, generally evident before age three, that adversely
affects a child's educational performance. Other characteristics often associated with
autism are engagement in repetitive activities and stereotyped movements, resistance to
environmental change or change in daily routines, and unusual responses to sensory
experiences.
IDEA Regulations: Part 300 / A / 300.8 / c / 1 / i
Statistics CDC Report 2012 from www.austim-society.org
1 in 88 are diagnosed
1 in 54 boys
Austim Spectrum includes:
Autistic Disorder Rett syndrome
Childhood disintegrative disorder
Pervasive developmental disorder-not otherwise specified (PDD-NOS)
Asperger syndrome
Characteristics
Social Relationships:
o Difficulty establishing relationships
o Resist human contact
o Issues with social interaction
o Lack of eye contact
o Uninterested in others
Communication
o Delayed language
o Struggle to maintain communication (conversations)
Poor communication leads to inappropriate behaviors (screaming,
hitting, biting, running)
o Echolalic speech – repeat what others say
Repetitive Behaviors
Interests
o Narrow range of interests
o Can spend hours alone exploring 1 thing obessesively
Student Stress
o Tend to get stressed easily
o Difficultly dealing with stress
o Get stressed or “set off” by little things
o Often need rituals to complete tasks
Non Profit Organizations
www.autismspeaks.org
www.autism-socitey.org
Teacher Tips
Create structured/predictable environments
Establish and display clear procedure for tasks
Establish and display rules
Establish consistent pattern for instruction
Use visuals (pictures) for displaying rules and procedures
Foster social interactions
o Teach children with autism to take turns, wait, complete tasks, be flexible, be
quiet…
Communication
o Variety of strategies depending on level of ASD
Language
Sign Language
Communication boards
Other tips:
o Social Stories: Brief stories of when certain behaviors are acceptable and not
acceptable
o Picture Exchange Communication System: display picture of desired item or
task…student responds…no words used
o Visual Schedules: Pictures that depict daily routines displayed in classroom
and in student notebook
o Special Education Department: work with SPED to develop a plan that
works with each individual student.
Resources from http://www.autismspeaks.org/family-services/resource-library/tools-professionals
Autism Speaks School Community Tool Kit This tool kit is intended to be a support for the general education and administrative school staff
who interact with students with autism in various capacities.
www.autismspeaks.org/school
Eden Autism Services Free Webinars: Teaching Students with Autism This program provides free monthly webinars and "live chats," free lesson plans, and online
discussion forums to help teachers connect and collaborate on the best practices for supporting
students with autism.
Effective Strategies for Students in Grades PreK-5
Effective Strategies for Students Grades 6-12
http://www.autismspeaks.org/what-autism/symptoms
How to Set Up A Classroom for Students with Autism
A Manual for Teachers, Para-Professionals and Administrators
www.autismclassroom.com
Skills®: The Online Autism Solution Skills® is an online tool for educators of children with autism that provides comprehensive
assessment and curriculum, positive behavior support planning for challenging behavior,
progress tracking and treatment evaluation all in one place.
www.skillsforautism.com
Intellectual Disability Definition in IDEA: “…significantly subaverage general intellectual functioning, existing
concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child’s educational performance.” [34 CFR §300.8(c)(6)] In 2010, President Obama signed Rosa’s Law, which replaced the stigmatizing label “Mental Retardation” with the more acceptable term “Intellectual Disability”
IDs are the most common form of developmental disability1-3% of America’s general population and 10% of students requiring SPED have an ID
Causes: Genetic conditions (e.g. Down syndrome, Fragile X syndrome, Williams syndrome),
problems during pregnancy (e.g. mother who used alcohol during pregnancy, improper cell division), problems at birth (e.g. lack of oxygen), and health problems (e.g. malnutrition, lack of appropriate medical care, contact with poisons, and diseases like whooping cough, meningitis, or the measles)
Characteristics:
Variety of physical markers depending on cause of the disability
Below average intelligence ranging in incidence rate and severity o For a mild diagnosis, students’ IQ scores will be between 70-75 or below o For a moderate to severe diagnosis, students’ IQ scores will be approximately 55 or below
Slower learning rate and greater difficulty retaining information
May reach a point where learning levels off
Difficulty generalizing skills learned in one context to another
Trouble solving problems/thinking logically
Difficulty with social and daily living skills
Developmental delays
Suggested Teaching Strategies: Treat students appropriately according to their chronological age
Carefully follow the strategies outlined in the student’s IEP
Break large concepts down into smaller steps and include breaks
Teach one subject or idea at a time
Supply manipulatives to concretely represent concepts
Provide opportunities for continued practice in a variety of settings
Teach social and daily living skills
Match expectations to instruction (i.e. accommodations and modifications)
Use peer-tutoring, inclusive methods, and family involvement
Additional Resources: The Arc http://www.thearc.org/page.aspx?pid+2335 The Arc is a community-based organization that advocates and serves those with intellectual and developmental disabilities and their families. The site includes various fact sheets on intellectual disabilities detailing everything from the causes of these disabilities to criminal justice issues regarding these disabilities. The Utah Association for Intellectual Disabilities (UIAD) http://www.uaidutah.org/home The UIAD is a relatively new non-profit organization that formed in 2008 after The Arc of Utah closed due to financial reasons. UIAD took over some of the services the local Arc chapter provided, including the “Holiday Gift Box Program, Bridge to the Future, Connections to Computers, and socialization projects.” The Bridge to the Future is a particularly beneficial resource for parents and educators alike, outlining the services a person with an intellectual disability may require throughout stages of his or her life. People interested in supporting UIAD’s mission are welcome to volunteer. Project Ideal http://www.projectidealonline.org/index.php Project Ideal is part of a teacher preparation program meant to prepare teachers to work with students with disabilities. It provides helpful resources such as tips for classroom management and managing student behavior along with descriptions of disability categories and disability law. The U.S. Equal Employment Opportunity Commission http://www.eeoc.gov/facts/intellectual_disabilities.html The EEOC provides information on employment opportunities and the rights of workers with intellectual disabilities. EEOC is an important resource for educators to gain knowledge on how to prepare students with disabilities for future jobs and opportunities. This resource would be especially applicable for secondary teachers. American Association on Intellectual and Developmental Disabilities (AAIDD) http://www.aamr.org/index.cfm The AAIDD offers links to national disability organizations focusing on specific disabilities.
Orthopedic Impairment
Definition: Orthopedic impairment is defined as a severe orthopedic impairment that adversely affects a child's educational performance. The term includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).
Characteristics of Students who have Orthopedic Impairment: Learning, perceptual, or sensory problems
May impede speech production
Impede expressive language of the child
Characteristics based on 3 Categories of Orthopedic Impairments: Neuromotor Impairments: an abnormality of, or damage to, the brain, spinal cord, or nervous system that sends impulses to
the muscles of the body. These impairments are acquired at or before birth, and often result in complex motor problems that can affect several body systems.
Limited limb movement
Loss of urinary control
Loss of proper alignment of spine
Two most common are Spina Bifida and Cerebral Palsy 1. Spina Bifida: is a developmental defect of the spinal column. It may or may not affect intellectual functioning. Spina bifida
occulta is a mild condition while spina bifida cystica is more serious. Involves some paralysis
2. Cerebral Palsy : refers to several nonprogressive disorders of voluntary movement or posture that are caused by
malfunction of or damage to the developing brain that occurs before or during birth or within the first few years of life.
Individuals with cerebral palsy have abnormal, involuntary, and/or uncoordinated motor movements.
The four most common types of cerebral palsy include: Spastic (very tight muscles occurring in one or more muscle groups that result in stiff, uncoordinated
movements)
Athetoid (movements are contorted, abnormal, and purposeless)
Ataxic (poor balance and equilibrium in addition to uncoordinated voluntary movement)
Mixed (any combination of the types)
Degenerative Diseases: are composed of various diseases that affect motor development. The most common is muscular
dystrophy. Muscular dystrophy: group of inherited diseases characterized by progressive muscle weakness
Musculoskeletal Disorders: are composed of various conditions that can result in various levels of physical limitations juvenile rheumatoid arthritis
limb deficiency
Teaching Tips
Special seating arrangements to develop useful posture and movements Instruction focused on development of gross and fine motor skills Securing suitable augmentative communication and other assistive devices Awareness of medical condition and its effect on the student (such as getting tired quickly) Educate everyone in the school community on a student’s disability Have parent/student/resource staff conferences to ensure classroom is accommodating for each
child’s IEP
Due to the various levels of severity of orthopedic impairment, multiple types of assistive technology may be used
speech recognition software screen reading software augmentative and alternative communication devices (such as communication boards) academic software packages for students with disabilities
Learning Tools
Physical Therapists who work on gross motor skills (focusing on the legs, back, neck and torso) Occupational Therapists who work on fine motor skills (focusing on the arms and hands as well as
daily living activities such as dressing and bathing) Speech-Language Pathologists who work with the student on problems with speech and language Adapted Physical Education Teachers, who are specially trained PE teachers who work along with
the OT and PT to develop an exercise program to help students with disabilities Other Therapists (Massage Therapists, Music Therapists, etc.)
Additional Resources
Project Ideal: http://www.projectidealonline.org/orthopedicImpairments.php Bright Hub Education: http://www.brighthubeducation.com National Center on Accessible Instructional Materials
http://aim.cast.org/learn/disabilityspecific/physical United Cerebral Palsy: http://www.ucp.org/
Deafness
Legal Definition of Deafness:
Deafness is defined as “a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification.”
*Important to understand the distinction between Deafness and Hearing Impaired.
Hearing impairment is defined by IDEA as “an impairment in hearing, whether permanent or fluctuating, that adversely affects a child’s educational performance.”
Characteristics of Students Who Are Deaf:
1. Typically no visible indicators, but students who are deaf often use hearing aides or cochlear implants to amplify sound.
2. Students have difficulty learning vocabulary, grammar, word order, and idiomatic expressions. 3. Frequent requests for repetition or clarification. 4. Tendency to bluff when not hearing someone due to the fear of asking them to repeat
themselves. 5. Students can lack maturity for the following reasons:
a. Rules of etiquette are acquired through listening and imitating, which is not possible for individuals who are deaf.
b. Students fail to develop group social skills because interactions involving multiple conversations are confusing.
Types of Hearing Loss: 1. Conductive: Disease or obstruction in the outer or middle ear. Students can derive benefit from
hearing aids and cochlear implants. 2. Sensorineural: Occurs in the cranial nerve, inner ear, or central processing center of the brain.
Sensorineural deafness is very difficult to treat. 3. Mixed hearing loss: Occurs in the outer, middle, and inner ear. Hearing aides may help but have
limited effect. 4. Central hearing loss: Damage or impairment to the nerves or nuclei of the central nervous system,
either in the pathways to the brain or the brain itself. Central hearing loss is very rare and very hard to treat.
Suggested Learning Strategies: -Teacher Tips:
1. Reduce ambient noise in the classroom. 2. Face the class while presenting information. 3. Use appropriate body language, facial features, and signals while speaking. 4. Stand in one location, rather than moving around the room. Make sure the student is sitting
near the teacher to facilitate lip-reading. 5. Use visual aids as often as possible. 6. Speak clearly, but do not exaggerate sounds while speaking. 7. Enroll in a sign language course, or at least learn some useful signs. 8. Create peer support 9. Help students learn to use their residual hearing to the maximum extent possible.
-Learning Tools:
1. Assigned services- including interpreters, note takers, teachers’ aides or integration assistants. 2. Amplification devices for students with some residual hearing
a. Hearing aids b. FM system (student has a small speaker, teacher uses a small microphone) c. Cochlear implants (sophisticated electronic hearing device that transmit electric signals to
the brain). 3. American Sign Language (ASL) 4. Manually Coded English (MCE) such as: Signed Exact English (SEE) 5. C-Print (a typist is present in class using standard abbreviation to capture what is being said.
Students read information on a computer screen). 6. Teachers should include closed captioning when showing videos.
Additional Resources:
• Hands and Voices (non-profit): http://www.handsandvoices.org/
• National Dissemination Center For Children with Disabilities:
http://nichcy.org/tags/deafness-or-hearing-impairment
• National Association of the Deaf: http://www.nad.org/
• Utah Deaf Services: http://deafservices.utah.gov/
• Council for Exceptional Children: http://www.cec.sped.org/
• Bright Hub Education- http://www.brighthubeducation.com/
American Society for Deaf Children: http://www.deafchildren.org
What is Emotional Disturbance? A condition exhibiting one or more of the following characteristics over a long period of time:
An inability to learn that cannot be explained by intellectual, sensory, or health
factors
An inability to build or maintain satisfactory interpersonal relationships with
peers and teachers
Inappropriate types of behavior or feelings under normal circumstances
A general pervasive mood of unhappiness or depression
A tendency to develop physical symptoms or fears associated with personal or
school problems
Definition from IDEA
Resources & Support Positive Behavioral Interventions & Supports (www.pbis.org)
o Provides school assistance for identifying, adapting, and sustaining disciplinary
practices
Anxiety & Depression Association of America (www.adaa.org
o Provides information and helpful services available.
o Information separated into categories (military, women, college, teens, children)
National Eating Disorders Association (www.nationaleastingdisorders.org)
o Supports individuals and families affected by eating disorders
o Serves for prevention, cures, and access to quality care
National Alliance on Mental Illness (www.nami.org)
o Information available, provides programs and services, online support groups,
and advocacy
Emotional Disturbance
By Mikayla and Michelle
Examples of ED
Eating Disorder
Psychotic Disorder
Bipolar Disorder Anxiety Disorder
Characteristics
When a person’s physical, social, or cognitive skills are
affected Hyperactivity (short attention span, impulsiveness)
Aggression/self-injury (acting out, fighting)
Withdrawal (not socially interacting, excessive fear/anxiety)
Immaturity (inappropriate crying, temper tantrums)
Learning difficulties (academically below grade level)
Learning Strategies: Family therapy
Training strategies for parents
Training in problem-solving for child
Community-based services
Psychotherapy or counseling
Diet
Medication
Positive behavioral support in the school environment
Obsessive-Compulsive Disorder
Conduct Disorder
Reward appropriate behaviors
IDEA Category of Disability (Developmental Delay) Description & Definition of developmental delay:
(1) Who is experiencing developmental delays as defined by the State and as measured by
appropriate diagnostic instruments and procedures in one or more of the following areas:
Physical development, cognitive development, communication development, social or emotional
development, or adaptive development; and
(2) Who, by reason thereof, needs special education and related services. [34 CFR §300.8(b)]
a) Children aged three through nine experiencing developmental delays. Child with a
disability for children aged three through nine (or any subset of that age range, including
ages three through five), may, subject to the conditions described in §300.111(b).
It’s a good idea to find out if your state has added details to this definition of developmental
delay. States are allowed to do so, if they choose. They also decide on the age range of children
with whom the term may be used (3-5, 3-9, or any subset between 3-9).
It may be helpful to know that, under IDEA:
Your state may not require that your local school district also adopt and use the term
developmental delay in working with children.
If your local school district decides to use the term, it must use the same definition and
age range as the state does.
Characteristics:
Skills such as taking a first step, smiling for the first time, and waving “bye bye” are called
developmental milestones. Children reach milestones in playing, learning, speaking, behaving,
and moving (crawling, walking, etc.). A developmental delay is when your child does not reach
these milestones at the same time as other children the same age.
What are developmental milestones? Developmental milestones are a set of functional skills or age-specific tasks that most children
can do at a certain age range. Your pediatrician uses milestones to help check how your child is
developing. Although each milestone has an age level, the actual age when a normally
developing child reaches that milestone can very quite a bit. Every child is unique!
Examples of Developmental Milestones:
Gross motor: using large groups of muscles to sit, stand, walk, run, etc., keeping
balance, and changing positions.
Fine motor: using hands to be able to eat, draw, dress, play, write, and do many other
things.
Language: speaking, using body language and gestures, communicating, and
understanding what others say.
Comment [c1]:
34 CFR §300.8(b)] is an Electronic Code of Federal
Regulations. Current as of September 13, 2012.
Copy & paste code (CFR §300.8(b) into
browser or click on the link below.
http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&rgn=div8&view=text&node=34:2.1.1.1.1.1.36.7&idno=34
Comment [c2]: Utah’s Definition of Developmental Delay
Utah’s Baby Watch Early Intervention program
serving children birth to three years of age defines a developmental delay as:
“Children birth to three years of age who meet or exceed the definition of developmental delays in one
or more of the following areas:
Physical development
Vision and hearing
Feeding and dressing skills
Social and emotional development
Communication and language
Learning, problem solving and play skills
The delay must adversely affect a student’s educational performance.
Comment [c3]: Refer to additional group handout listing
characteristics and signs to watch for starting at an early age.
Cognitive: Thinking skills: including learning, understanding, problem-solving,
reasoning, and remembering.
Social: Interacting with others, having relationships with family, friends, and teachers,
cooperating, and responding to the feelings of others.
If a developmental delay is not recognized early, children must wait to get the help they need.
This can make it hard for them to learn when they start school. In the United States, 17 percent
of children have a developmental or behavioral disability. But, less than half of children with
problems are identified before starting school.
Additional Resources:
NICHCY Developmental Delay Resources: The National Dissemination Center for Children with Disabilities (NICHCY) offers brief, but
detailed fact sheets on Developmental Delays. Each fact sheet defines the disability, describes its
characteristics, offers tips for parents and teachers, and connects you with related information
and organizations with special expertise. Also, lists early intervention services by state.
Center for Disease Control and Provention (CDC), Local Health Department & Make-A-Difference Information Network: An alternative to questions about children development is
the local health department or finding testing locations near your community contact the Make-
A-Difference Information Network at 1-800-332-6262
Developmental Delay Resources (DDR): A nonprofit organization dedicated to meeting the needs of those working with children who
have developmental delays in sensory motor, language, social, and emotional areas. DDR
publicizes research into determining identifiable factors that would put a child at risk and
maintains a registry, tracking possible trends. DDR also provides a network for parents and
professionals and current information after the diagnosis to support children with special need.
What is Developmental Delay? This website answers many of the frequently asked questions about Developmental Delays, the
causes of them, what to do if you suspect DD, early intervention strategies and techniques,
special education, and transition.
Comment [CC4]:
Teaching Strategies for students with
developmental delay
Motor Skills
Hands on activities such as rolling a ball
Sensory and Thinking Skills
Repetition such as playing "I Spy" multiple times
using the same object
Language and Social Skills
Group activities such as playing rhyming games
Comment [c5]: References & additional resources:
http://ecfr.gpoaccess.gov/cgi/t/text/text-
idx?c=ecfr&rgn=div8&view=text&node=34:2.1.1.1.1.1.36.7&idno=34
http://www.med.umich.edu/yourchild/topics/devdel.htm
http://www.zerotothree.org/
www.cdc.gov/actearly
http://nichcy.org/state-organization-search-by-state
http://www.utahparentcenter.org/disabilities/dd/
http://www.devdelay.org/
http://www.utahbabywatch.org
http://www.ddivantage.com
