Chapter 12 Severe/Multiple Disabilities, Traumatic Brain Injury

Low Incidence Disabilities Low Incidence disability – Disabilities that do not occur very often. Together Multiple Disabilities, TBI, and deaf-blindness represent less than 3% of all children who receive special education. Many of these individuals cannot perform the most basic, everyday tasks such as: Eating Toileting Communicating basic needs

Severe and Multiple Disabilities Severe disability Significant disabilities in intellectual, physical, and/or social functioning No single definition (perceptions of what is severe may vary and are based on a multitude of intellectual assessments Multiple disabilities Multiple disabilities means concomitant impairments, that causes such severe educational problems that they cannot be accommodated in special education programs solely for one impairment

Characteristics and Prevalence 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 Stereotypic and challenging behavior Prevalence Estimates range from 0.1% to 1% of the population

Causes In almost every case of severe disabilities, a brain disorder is involved Chromosomal disorders Genetic or metabolic disorders that can cause serious problems in physical or intellectual development Complications in pregnancy – prematurity, Rh incompatibility, infectious diseases, alcohol/drug intake Severe disabilities may develop later in life from head trauma In about one-sixth of all cases, the cause cannot be clearly determined

Syndromes that may result in severe disabilities Hurler Syndrome (lack of an enzyme) – severe MR, physical disabilities, early death Lesch-Nyan Syndrome (genetic) – SIB, aggression, neurological problems, MR Rett Syndrom (genetic) – Regression to 6-18 months, loss of speech, motor and social functions, MR Cornelia de Lange Syndrome (chromosomal) – Physical disabilities, health impairing conditions, Severe MR, SIB Angelman Syndrome (chromosomal) – Speech and language deficits, balance and gait, seizures, microcephaly, severe MR

Traumatic Brain Injury (TBI) Definition an acquired injury to the brain Resulting in total or partial functional disability Adversely affects a child’s educational performance TBI is the most common acquired disability in childhood 1 in 500 school-age children will be hospitalized with TBI Leading cause of death in children (1/3 of all accidental deaths in children)

Traumatic Brain Injury (TBI) Open Head Injury – Penetration of the skull – bullet or forceful blow to the head caused by a sharp object Usually result in specific deficits sensory or motor functions Closed Head Injury – Head hits a stationary object with such force that the brain slams inside the cranium. Stress pulls apart and tears nerve fibers or axons Car accidents Shaken baby syndrome Severity depends on the part of the brain that was injured Mild injury (contusions) - recovery

Traumatic Brain Injury (TBI) Temporary or lasting impairments Physical and sensory changes Lack of coordination, spasticity of muscles Cognitive impairments Short and long term memory deficits, difficulty maintaining attention and concentration Social and behavioral problems Mood swings, lack of motivation

What Should Be Taught? 1. Functional skills - activities of daily living skills (ADLs) 2. Age-appropriate skills 3. Making choices skills 4. Communication skills (PECS /AAC) 5. Recreation and leisure skills

Instructional Methods: How Should Students Be Taught? Instruction must be carefully planned, systematically executed, continuously monitored The student’s current level of performance must be assessed The skill to be taught must be defined clearly The skill may need to be broken down into smaller component steps The teacher must provide a clear prompt to cue the child The student must receive feedback and reinforcement Strategies that promote generalization and maintenance must be used The student’s performance must be directly and frequently assessed

Partial Participation, Positive Behavioral Support, and Small Group Instruction 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 Advantages of 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

The Challenge and Rewards of Teaching Students with Severe and Multiple Disabilities Must be sensitive to small changes in behavior The effective teacher is 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

Fyffe et al Participant – Matt, 9 year old boy with TBI Target Behavior – touching or attempting to touch others in the area of the groin, buttocks or breasts. Functional Analysis – 20 min sessions 1) Demand, 2) attention, 3) play. Results suggested attention function Treatment – FCT + EXT - use of graduated guidance to hand the experimenter an attention card. Results?