MULTIPLE DISABILITIES 101 SIGNS SYMPTOMS AND ELIGIBILITY PRESENTED

MULTIPLE DISABILITIES 101: SIGNS, SYMPTOMS, AND ELIGIBILITY PRESENTED BY: DAVID BRIGGS, ED. S. , NCSP

GOALS FOR TODAY By the end of this presentation, you should be more familiar with and better able to identify: What does it mean to have Multiple Disabilities (MD). How eligibility is determined in the State of Wyoming. Common Comorbid Disorders Intervention and accommodation ideas.

WHAT DOES IT MEAN TO HAVE MULTIPLE DISABILITIES According to the Individuals with Disabilities Education Act’s (IDEA): Multiple disabilities refers to “concomitant [simultaneous] impairments (such as intellectual disability-blindness, intellectual disability-orthopedic impairment, etc. ), the combination of which causes such severe educational needs that they cannot be accommodated in a special education program solely for one of the impairments. The term does not include deafblindness. ” In other words, a student whose special needs are categorized under multiple disabilities requires coinciding adaptions for more than one disability. The exception is the combination deafness and blindness, as this pair of impairments has its own classification under IDEA.

MULTIPLE DISABILITY DIAGNOSTIC CRITERIA Wyoming’s definition is the same as IDEA’s, and requires a comprehensive evaluation. The Colorado Department of Education’s definition is somewhat more descriptive: A child with Multiple Disabilities shall have two or more areas of significant impairment, one of which shall be an intellectual disability. The other areas of impairment include: Orthopedic Impairment, Visual Impairment including Blindness, Hearing Impairment including Deafness, Speech or Language Impairment, Serious Emotional Disability, Autism Spectrum Disorders, Traumatic Brain Injury, or Other Health Impaired. The combination of such impairments creates a unique condition that is evidenced through a multiplicity of severe educational needs which prevent the child from receiving reasonable educational benefit from general education.

MULTIPLE DISABILITY DIAGNOSTIC CRITERIA In order to identify and be determined as eligible for special education services as a student with Multiple Disabilities, the IEP Committee shall document that the following standards have been met. The IEP Committee must determine that the student shall have the following characteristics: meet the standards for two or more identified disabilities and be unable to benefit from services and supports designed for only one of the disabilities, as determined to be primary or secondary disabilities by the IEP Committee. the nature of the combination of disabilities require significant developmental and educational programming that cannot be accommodated with special education services that primarily serve one area of the disability.

MULTIPLE DISABILITY DIAGNOSTIC CRITERIA- CONT’D

RATES OF OCCURRENCE A recent study by Cooper, S. A. , et al. (2015) indicated that… • Only 31. 8 % of individuals with intellectual disabilities had no other conditions, just a diagnosis of ID. • The intellectual disabilities group were significantly more likely to have more of all the specified number of conditions (physical and mental health conditions) where 27. 5% of the group studied had only one condition and 10. 9% of the group had three diagnosed conditions. • For the intellectual disabilities group, 14 out of 32 physical conditions were significantly more prevalent relative to control groups, 11 were significantly less prevalent, with 7 conditions showing no significant differences. • Individuals with intellectual disabilities had significantly higher prevalence for five of the six mental health conditions with no significant difference found for anorexia/bulimia.

RATES OF OCCURRENCE

RATES OF OCCURRENCE • The U. S. Department of Education reports that in the 2003 -2004 school year, roughly 2. 2% students receiving special education services had a classification of multiple disabilities. • Intellectual Disorders: The prevalence of children diagnosed (2014 -2016) with intellectual disability was 1. 48% among boys and 0. 90% among girls. • Autism: About 1 in 59 children has been identified with autism spectrum disorder. ASD is reported to occur in all racial, ethnic, and socioeconomic groups. ASD is about 4 times more common among boys than among girls. • As of the most recent prevalence study conducted by the Centers for Disease Control (CDC), which studied records from 2008, 38% of children with ASD had an Intellectual Disability.

RATE OF OCCURRENCE- INTELLECTUAL DISORDER & COMORBID CONDITIONS- PHYSICAL Common physical disorders that co-occur with intellectual disabilities. Co-Occuring Disorder Individuals diagnosed with ID General Population Cancer 2% 1% Diabetes 6% 2% Respiratory disorder 1% Obese 42% 26% Polypharmacy 8% 4% Epilepsy 2% 1% Multiple morbidity 8% 4%

COMORBID CONDITIONS- MENTAL HEALTH Attention-Deficit Hyperactivity Disorder (ADHD), 6. 5%; Autism, 4. 2%; Anxiety, 2. 7%; Bipolar Disorder, 1. 1%; Delusional Disorder, 0. 8%; Depression, 2. 3%; Obsessive-Compulsive Disorder, 0. 8%; Schizophrenia, 1. 9%; Enuresis, 10. 3%; Epilepsy, 23. 7%; Behavioral Problems, 80. 9%. The prevalence of psychiatric disorders was statistically higher in severely intellectually disabled children (IQ ≤ 49) than mildly intellectually disabled children (IQ≥ 50).

COMORBID CONDITIONS- HEARING IMPAIRMENT • The attached graph illustrates the trend for increased prevalence of hearing loss with each advancing age decade. • People with ID show losses 3 to 9 times greater depending upon age decade. • These findings strongly support the need for annual hearing evaluations for people with ID starting at age 18 and each year thereafter.

COMORBID CONDITIONS- ORTHOPEDIC IMPAIRMENT • According to the U. S. Department of Education, Orthopedic Impairments represent approximately 1% of all students having a classification in special education.

COMORBID CONDITIONS- VISUAL IMPAIRMENT • Each year States must report to the U. S. Department of Education how many children with visual impairments received special education and related services in our schools under the Individuals with Disabilities Education Act (IDEA), the nation’s special education law. Data for the school year 2015 -16 indicate that the following numbers of children were served in the U. S. and its outlying areas: • 2, 799 children or less than 0. 0004% (ages 3 -5) with visual impairment • 24, 944 children or less than 0. 005% (ages 6 -21) with visual impairment

ACCOMMODATION NEEDS Limited level of awareness- may have a limited level of knowledge of what is happening in the environment and may not be able to respond effectively to prompts or instruction. Medical complications- may have medical complications such as seizures, a shunt, a feeding tube, a tracheotomy, severe contractures, or eating and swallowing issues, just to name a few. Limited speech or communication; Difficulty in basic physical mobility; Sensory losses; Behavior problems; Presence of primitive reflexes; Possibly non-ambulatory; Tendency to forget skills through disuse; Trouble generalizing skills from one situation to another; A need for support in major life activities (domestic, leisure, community use, vocational).

ACCOMMODATION NEEDS Scheduling. For example, • • giving the student extra time to complete assignments or tests breaking up testing over several days Setting. For example, • working in a small group • working one-on-one with the teacher Materials. For example, • providing audiotaped lectures or books • giving copies of teacher’s lecture notes • using large print books, Braille, or books on CD (digital text) Instruction. For example, • reducing the difficulty of assignments • reducing the reading level • using a student/peer tutor Student Response. For example, • allowing answers to be given orally or dictated • using a word processor for written work • using sign language, a communication device, Braille, or native language if it is not English.

ACCOMMODATION NEEDS Assistive Technology- • Self-help devices (e. g. , bath chairs and feeding tools), • Special toys and switches, • Assistive listening devices (e. g. , hearing aides), • Augmentative communication devices (e. g. , picture communication boards or computer driven voice output devices), • Mobility (e. g. , power wheel chair, walkers, lifts) • Positioning devices (e. g. , standers)

ACCOMMODATION NEEDS • Consider the physical arrangement of the classroom- special equipment and assistive • • technology is often needed. Integration among their peers is important to assist these students with social development. A safety plan may need to be developed and included in the IEP. Adapted equipment—such as a special seat or a cut-out cup for drinking; Training for staff, student, and/or parents; Peer tutors; A one-on-one aide; Adapted materials—such as books on tape, large print, or highlighted notes; and Collaboration/consultation among staff, parents, and/or other professionals.

SERVICES THAT MAY BE NEEDED • Early identification and assessment of disabilities in children • The use of Alternative Standards and Curriculum • Speech-language pathology and audiology services • Interpreting services • Psychological services • Physical and occupational therapy • Recreation, including therapeutic recreation • Counseling services, including rehabilitation counseling • Orientation and mobility services • Medical services for diagnostic or evaluation purposes • School health services and school nurse services • Social work services in schools • Transition Services

PRACTICAL TIPS FOR TEACHER Tap into the student’s strengths. Each student with multiple disabilities has his or her own set of skills, strengths, and learning needs, which are documented in the IEP (always start with the IEP!). So, it’s a good idea to find out more about the student’s strengths and interests. Be ready to make modifications. The right Partial participation can make the difference. Partial participation means making modifications to the task so that a student with multiple disabilities isn’t excluded from activities. Even if the student isn’t able to complete a task fully or independently, he or she can still participate and benefit from the learning taking place. modifications and accommodations in the Learn about assistive technology (AT). AT is classroom can help a student with multiple often the key to inclusion for many students with disabilities access the general education curriculum multiple disabilities. at a grade-appropriate level. Learn about accessible textbooks. The law Ask for the program supports or modifications requires that schools provide students with print you need to be included in the IEP. The student’s disabilities with accessible instructional materials. If IEP can include Program Modifications for School your student has difficulties using print materials, Personnel. visit the National AIM Center to learn where and how to get textbooks and workbooks that your student will be able to use: http: //aim. cast. org/

PRACTICAL TIPS FOR TEACHER Don’t give up on a goal; practice and reinforce. Make the most of paraprofessionals. Some If your student’s disabilities affect his or her students with multiple disabilities will require the intellectual functioning, he or she will be slower to support of an aide or paraprofessional. Learn learn new things and will have difficulty applying effective strategies for working with that learning in new situations. Do not, however, paraprofessionals. assume that a student who is having difficulty Be involved in the student’s transition planning. cannot achieve a goal. Plan more hands-on IDEA requires that IEP teams and students plan opportunities for learning and practice, give ahead for the student’s transition from school to the feedback immediately, and repeat the learning task adult world. This is especially crucial for a student in different settings. who has multiple disabilities. Deal with behavior issues. Disabilities often affect a student’s behavior, and a combination of disabilities can be especially disruptive. If the student’s behavior is affecting his or her learning or the learning of others, find effective strategies in our Behavior Suite

SOURCES Cooper, S. A. , Mc. Lean, G. , Guthrie, B. , Mc. Connachie, A. , Mercer, S. , Sullivan, F. , & Morrison, J. (2015). Multiple physical and mental health comorbidity in adults with intellectual disabilities: population-based cross-sectional analysis. BMC family practice, 16, 110. doi: 10. 1186/s 12875 -015 -0329 -3. http: //nichcy. org/schoolage/accommodations http: //nichcy. org/schoolage/iepcontents/modifications-personnel http: //nichcy. org/schoolage/behavior http: //nichcy. org/schools-administrators/paras http: //aim. cast. org/ https: //fl- pda. org/independent/courses/TSWD/content/unit 02/docs/Multiple_Disabilities_in_Your_Classroom_10_ Tips_for_Teachers. pdf https: //www. parentcenterhub. org/multiple/ https: //vkc. mc. vanderbilt. edu/assets/files/tipsheets/inclusionsevclasstips. pdf https: //nces. ed. gov/fastfacts/display. asp? id=64

ANY QUESTION? If so, contact me: davidbriggs@boces 5. org