1. Low-Incidence Disabilities
People with severe disabilities:
require extensive ongoing support
typically have more than one disability
represent a relatively small percentage
None of the disabilities listed under low-incidence disabilities generally exceed 1% of the school-aged population at any given time. The relative rarity of students with these disabilities in public schools often poses significant challenges for local schools struggling to meet their needs. Since they encounter these students so infrequently, most local schools have little if any knowledge of how to best educate these students, of what technologies are available to assist them, and of how to obtain needed and appropriate support services from outside agencies. All students with low-incidence disabilities thus experience a commonality: they are difficult to serve in current local public school programs.
Severe/Multiple Disabilities, Deaf-Blindness, and Traumatic Brain Injury

2. 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

3. 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
Students need extensive ongoing support
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

4. 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
Infrequent constructive behavior and interaction
Stereotypic and challenging behavior
Prevalence
Estimates range from 0.1% to 1% of the population

5. 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)
A significant percentage of children with severe disabilities are born with chromosomal disorders
Genetic or metabolic disorders can cause serious problems in physical or intellectual development
Complications of pregnancy can cause severe disabilities
Severe disabilities may develop later in life from head trauma
Factors such as malnutrition, neglect, ingestion of poisonous substances, and certain diseases that affect the brain also can cause severe disabilities
In many cases, the cause cannot be clearly determined

6. 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

7. 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

8. 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

9. 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

10. Watch the Severe Disabilities Inclusion video
Watch the video of the educational approach in use with the student with severe, multiple disabilities
What are some advantages you see to the educational approach seen in the video?
What are some potential disadvantages?
Why do you think the school system and parents chose the approach they did?

11. Benefits of the neighborhood school and inclusion
Educational Approaches Where Should Students with Severe Disabilities be Taught?
Benefits of the neighborhood school and inclusion
Peers 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

12. 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

13. 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
TBI is brain damage acquired by trauma

14. Types and Causes of TBI Under age 5, accidental falls
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
Under age 5, accidental falls
After age 5, vehicular accidents
Shaken Baby syndrome

15. Traumatic Brain Injury
Prevalence
250:100,000 children
A “silent epidemic”
Males more prone than females
Shaken Baby

16. Effects and Educational Implications of TBI
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
EDUCATIONAL CONSIDERATIONS NEED TO BE A TEAM APPROACH
IEPs need to be reviewed more often – should not go longer than 6 months
remembering learning new information
speech/language difficulty sequencing
making sense of things uneven ability performance
uneven progress inappropriate manners
understanding humor easily tired, frustrated
unreasonable anxiety irritability
mood swings depression
aggression perseveration

17. Watch video on Traumatic Brain Injury
Share thoughts about the recovery of students with TBI.

18. 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 Deaf-Blindness
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
CHARGE syndrome is a disorder that affects many areas of the body. CHARGE stands for coloboma, heart defect, atresia choanae (also known as choanal atresia), retarded growth and development, genital abnormality, and ear abnormality. The pattern of malformations varies among individuals with this disorder, and infants often have multiple life-threatening medical conditions. The diagnosis of CHARGE syndrome is based on a combination of major and minor characteristics.
The major characteristics of CHARGE syndrome are more specific to this disorder than are the minor characteristics. Many individuals with CHARGE syndrome have a hole in one of the structures of the eye (coloboma), which forms during early development. A coloboma may be present in one or both eyes and can affect a person's vision, depending on its size and location. Some people also have small eyes (microphthalmia). One or both nasal passages may be narrowed (choanal stenosis) or completely blocked (choanal atresia). Individuals with CHARGE syndrome frequently have cranial nerve abnormalities. The cranial nerves emerge directly from the brain and extend to various areas of the head and neck, controlling muscle movement and transmitting sensory information. Abnormal function of certain cranial nerves can cause swallowing problems, facial paralysis, a sense of smell that is diminished (hyposmia) or completely absent (anosmia), and mild to profound hearing loss. People with CHARGE syndrome also typically have middle and inner ear abnormalities and unusually shaped ears.
The minor characteristics of CHARGE syndrome are not specific to this disorder; they are frequently present in people without CHARGE syndrome. The minor characteristics include heart defects, slow growth starting in late infancy, developmental delay, and an opening in the lip (cleft lip) with or without an opening in the roof of the mouth (cleft palate). Individuals frequently have hypogonadotropic hypogonadism, which affects the production of hormones that direct sexual development. Males are often born with an unusually small penis (micropenis) and undescended testes (cryptorchidism). External genitalia abnormalities are seen less often in females with CHARGE syndrome. Puberty can be incomplete or delayed. Individuals may have a tracheoesophageal fistula, which is an abnormal connection (fistula) between the esophagus and the trachea. People with CHARGE syndrome also have distinctive facial features, including a square-shaped face and difference in the appearance between the right and left sides of the face (facial asymmetry). Individuals have a wide range of cognitive function, from normal intelligence to major learning disabilities with absent speech and poor communication.
How common is CHARGE syndrome?
CHARGE syndrome occurs in approximately 1 in 8,500 to 10,000 individuals.
Usher syndrome, often referred to as retinitis pigmentosa, is the most common condition that involves both vision and hearing, and the condition worsens over time. Early intervention appears to be critical for children who are deafblind and their families. See Table 12.1 and 12.2 for more details and definitions.

21. Educational Considerations for Deaf-Blindness
Direct teaching
Structure and predictability
Communication
Orientation and mobility
Behavior
Factors affecting outcomes
Quality and intensity of instruction received
Degree and type of visual and auditory impairment varies dramatically
Vast majority have other disabilities and medical conditions
Communication
Braille
Adapted signs
Touch cues
Problems accessing information
Problems communicating
Pattern of isolation
Importance of language-rich environment
Problems navigating the environment

22. Early Intervention for Children with Low-Incidence, 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. Person-centered plans Natural supports Vocational programming
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.