LOWINCIDENCE DISABILITIES SevereMultiple Disabilities DeafBlindness and Traumatic Brain

LOW-INCIDENCE DISABILITIES Severe/Multiple Disabilities, Deaf-Blindness, and Traumatic Brain Injury

SEVERE AND PROFOUND DISABILITIES Severe disability • Significant impairments in intellectual, motor, and/or social functioning • IQ scores of 35 to 40 or 40 to 55 Profound disability • Profound developmental disabilities in all five of the following areas: cognition, communication, social skills, motor-mobility, and activities of daily living • IQ scores of 20 to 25 and below Multiple disabilities • Multiple disabilities means concomitant impairments, the combination of which causes such severe educational needs that they cannot be accommodated in special education programs solely for one of the impairments

CHARACTERISTICS Most students with severe disabilities �Exhibit significant deficits in intellectual functioning �Possess more than one disability �Need special services and supports because of motor impediments; communication, visual and auditory impairments; and seizure disorders �Treatment of medical conditions and health problems results in frequent and often extended absences from school �Exhibit significant and obvious deficits in multiple life-skill or developmental areas

CHARACTERISTICS AND PREVALENCE Characteristics �Slow acquisition rates for learning new skills �Poor generalization and maintenance of newly learned skills �Limited communication skills �Impaired physical and motor development �Deficits in self-help skills �Infrequent constructive behavior and interaction �Stereotypic and challenging behavior Prevalence �Estimates range from 0. 1% to 1% of the population

CAUSES Severe intellectual disabilities can be caused by biological conditions, that may occur before birth (prenatal), during (perinatal), or after birth (postnatal) In almost every case, a brain disorder is involved Brain disorders are the result of either �Brain dygenesis (abnormal brain development) �Brain damage (caused by influences that alter the structure or function of a brain that had been developing normally up to that point)

TEACHING STUDENTS WITH SEVERE AND MULTIPLE DISABILITIES Teaching students with severe disabilities is difficult and demanding. It requires teachers to: � be well organized, firm, and consistent knowledgeable about one-to-one and small group instructional formats � be able to work cooperatively with other teachers and related service professionals � maintain accurate records and constant planning for future needs of students � be sensitive to small changes in behavior � be consistent and persistent in evaluating and changing instruction to improve learning and behavior Working with students who require instruction at its very best can be highly rewarding to teachers

EDUCATIONAL APPROACHES CURRICULUM: WHAT SHOULD BE TAUGHT • • Functional skills - activities of daily living skills (ADLs) Age-appropriate skills-activities that are appropriate for same age peers with disabilities Communication skills -an essential quality of human life Literacy -provides access to information and further learning Recreation and leisure skills-the ability to play and later to occupy themselves constructively and pleasurably during free time Making Choices -opportunities to make choices and the ability to make choices Access to general education curriculum-integrating academic standards into lessons on functional skills

EDUCATIONAL APPROACHES INSTRUCTIONAL METHODS: HOW SHOULD STUDENTS BE TAUGHT? Select and prioritize instructional targets that are meaningful for students and their families Instruction must be carefully planned, systematically executed, continuously monitored for effectiveness The student’s current level of performance must be assessed The skill must be defined clearly and actively engage the student The skill may need to be broken down into smaller component steps The teacher must determine how the student can actively participate, provide a clear prompt, and gradually withdraw the prompt The student must receive feedback and reinforcement The teacher must use strategies that promote generalization and maintenance The student’s performance must be directly and frequently assessed 12 -8

EDUCATIONAL APPROACHES (CONT. ) Partial participation � Students can be taught to perform selected components or an adapted version of the task Positive Behavioral Support � Use of functional assessment methodologies to support student’s placement and guide the development of positive behavior support plans Small group instruction: � Skills learned in small groups may be more likely to generalize � Provides opportunities for social interaction � Provides opportunities for incidental or observation learning from other students � May be a more cost-effective use of teacher’s time

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EDUCATIONAL APPROACHES WHERE SHOULD STUDENTS WITH SEVERE DISABILITIES BE TAUGHT? Benefits � Peers of the neighborhood school and inclusion without disabilities are more likely to function responsibly as adults in a pluralistic society � Integrated schools are more meaningful instructional environments � Parents and families have greater access to school activities when children are attending their home schools � Helps develop range of relationships with peers without disabilities � Benefits of inclusion on social skills and relationships have the most extensive empirical support

TEACHING STUDENTS WITH SEVERE AND MULTIPLE DISABILITIES Teaching students with severe disabilities is difficult and demanding. It requires teachers to: be well organized, firm, and consistent be knowledgeable about one-to-one and small group instructional formats be able to work cooperatively with other teachers and related service professionals maintain accurate records and constant planning for future needs of students be sensitive to small changes in behavior be consistent and persistent in evaluating and changing instruction to improve learning and behavior Working with students who require instruction at its very best can be highly rewarding to teachers

TRAUMATIC BRAIN INJURY (TBI) Definition: An acquired injury to the brain caused by an external force, resulting in total or partial functional disability or psychosocial impairment, or both that adversely affects a child’s educational performance • Applies to open or closed head injuries • TBI is the most common acquired disability in childhood and the leading cause of death in children

TYPES AND CAUSES OF TBI Head injuries are classified by the type of injury, by the kind of damage sustained by the brain, and by the location of the injury • Open head injury-the result of penetration of the skull • Closed head injury-occurs when the head hits a stationary object with such force that the brain slams against the inside of the cranium • Concussion, a mild brain injury, is a brief loss of consciousness • Contusions usually accompany a moderate brain injury and consists of bruising, swelling, and bleeding • Hematoma occurs when blood vessels in the brain rupture • Coma is a severe head trauma • Anoxia is the loss of oxygen to the brain for a period of time during a severe brain injury

15 TRAUMATIC BRAIN INJURY § Prevalence § 250: 100, 000 children § A “silent epidemic” § Males more prone than females

EFFECTS AND EDUCATIONAL IMPLICATIONS OF TBI is complex with symptoms varying depending on severity, extent and site, age of the child at the time of the injury, and time passed since the injury Three categories of impairments from brain injuries • • • Physical and sensory changes Cognitive impairment Social, behavioral, and emotional problems Recovery is a long and unpredictable process

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DEAF-BLINDNESS Deaf-blindness means concomitant hearing and visual impairments, the combination of which causes such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness The majority have some functional hearing and/or vision • More than 90% have one or more additional disabilities • 57% also have physical disabilities • 66% have cognitive impairments • 38% have complex health care needs

19 CHARACTERISTICS AND PREVALENCE OF DEAFBLINDNESS § Poor central visual acuity or/and a field defect § Hearing, so severe speech cannot be understood without amplification § Combination has extreme affect on daily life activities, psychosocial adjustment, or obtaining vocation § Criteria vary from state-to-state § Rare: 1, 583 students received services in 2011

20 CAUSES OF DEAF-BLINDNESS § Genetic/chromosomal syndrome § CHARGE syndrome: abnormalities of pupil, retina, or optic nerve § Usher syndrome: retinitis pigmentosa (night blindness and tunnel vision) § Down syndrome § Prenatal conditions § Rubella or German measles § Congenital cytomegalovirus § Postnatal conditions § Meningitis § TBI

21 EDUCATIONAL CONSIDERATIONS FOR DEAFBLINDNESS Direct teaching Structure and predictability Communication Orientation and mobility Behavior

22 EARLY INTERVENTION FOR CHILDREN WITH LOWINCIDENCE, MULTIPLE, AND SEVERE DISABILITIES Many begin life in neonatal intensive care units. “Early intervention” may be early in life, or as soon as possible after a disability is detected. §Family-centered practices §Multicultural perspective §Cross-disciplinary collaboration §Developmentally and chronologically age- appropriate practices

23 TRANSITION FOR STUDENTS WITH LOW-INCIDENCE, MULTIPLE, AND SEVERE DISABILITIES § Self-determination § Person-centered plans § Natural supports § Vocational programming § Shift to actual work settings in secondary school § Community and domestic living skills Hallahan, Kauffman, & Pullen. Exceptional Learners: An Introduction to Special Education, Thirteenth Edition. © 2014, 2012, 2009, 2006 by Pearson Education, Inc. All rights reserved.