1. © 2013, 2009, 2006, 2003, 2000 Pearson Education, Inc. All rights reserved. William L. Heward Exceptional Children An Introduction to Special Education Tenth Edition

2. Chapter 12 Low-Incidence Disabilities: Severe/Multiple Disabilities, Deaf-Blindness, and Traumatic Brain Injury

3. Focus Questions  Why is a curriculum based on typical developmental stages and milestones inappropriate for students with severe and multiple disabilities?  How can a teacher assist a child who has been hospitalized with a traumatic brain injury return to school?  Why are functional and age-appropriate curriculum so critical for students with severe and multiple disabilities?  How does access to the general academic curriculum benefit students with severe disabilities?  What are the most important skills for a teacher of students with severe and multiple disabilities? Why?  How much time should a student with severe and multiple disabilities spend in the general education classroom? 12-2 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

4. Severe, Profound, and Multiple 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 12-3 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

5. 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 12-4 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

6. 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 12-5 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

7. 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 12-6 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

8. 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 dysgenesis (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) 12-7 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

9. Causes (cont.) 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 12-8 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

10. 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 12-9 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

11. 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 12-10 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

12. 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 12-11 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

13. 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 12-12 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

14. Educational Approaches (cont.) 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 12-13 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

15. 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: Advantages 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 12-14 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

16. Educational Approaches (cont.) 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 12-15 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

17. 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 12-16 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.