University of San Agustin

COLLEGE OF LIBERAL ART, SCIENCES AND EDUCATION

EDUCATION DEPARTMENT
Center of Development and Training in Teacher Education Program
PAASCU/FAAP Accredited
Iloilo City, Philippines
Tel. no. (63-33) 337-4842 loc. 243
E-mail address: [email protected]

Core Professional Education Course

FOUNDATION COURSE/THEORIES AND CONCEPTS

Foundations of Special and Inclusive Education

Prof Ed 4

The Purpose and Promise of Special Education

Who Are Exceptional Children?

• Exceptional children differ from the norm (either below or above) to such an extent that they require
an individualized program of special education
• Four key terms
– Impairment - The loss or reduced function of a body part or organ
– Disability - Exists when an impairment limits the ability to perform certain tasks
– Handicap - A problem encountered when interacting with the environment
• Not all children with a disability are handicapped
– At risk - Children who have a greater-than-usual chance of developing a disability

Who Are Exceptional Children?

• Exceptional children differ from the norm (either below or above) to such an extent that they require
an individualized program of special education
• Four key terms
– Impairment - The loss or reduced function of a body part or organ
– Disability - Exists when an impairment limits the ability to perform certain tasks
– Handicap - A problem encountered when interacting with the environment
• Not all children with a disability are handicapped
– At risk - Children who have a greater-than-usual chance of developing a disability

How Many Exceptional Children Are There?

• It is impossible to state the precise number
– Different criteria used for identification
– Preventive services
– Imprecise nature of assessment
– The child may be eligible at one point in time and not eligible at another
• Children in special education represent about 9% of the school age population
• Approximately 75% of students with disabilities receive at least part of their education in regular
classrooms

As reported by the Department of Education, Bureau of Elementary Education, Special Education Division as of school
year 2004-2005 that there are 156,270 children with special needs enrolled in schools.
Specifically:
77,152 are mentally gifted/fast learners (G/FL)
79,118 are children with disabilities
As to the children with disabilities:
ὢ 40,260 have learning disability (LD);
ὢ 11,597 have hearing impairment (HI);
ὢ 2,670 have visual impairment (VI);
ὢ 12,456 have mental retardation (MR);
ὢ 5,112 have behavior problems (BP);
ὢ have orthopedic impairments/handicap (OH);
ὢ 5,172 have autism (Au);
ὢ 912 have speech defect (SD);
ὢ 142 have chronic illnesses (CI) and

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 ὢ 32 have cerebral palsy (CP)

Why Do We Label and Classify Exceptional Children?

• Possible benefits of labeling
– Recognizing differences in learning and behavior is the first step to responding responsibly
to those differences
– May lead to more acceptance of atypical behavior by peers
– Helps professionals communicate and disseminate research findings
– Funding and resources are often based on categories
– Helps advocacy groups promote more awareness
– Makes special needs more visible

Why Do We Label and Classify Exceptional Children?

• Possible disadvantages of labeling
– Focuses on what students cannot do
– May stigmatize the child and lead to peer rejection
– May negatively affect self-esteem
– May cause others to have low expectations for the student
– Disproportionate number of culturally diverse groups are labeled
– May take the role of fictional explanatory constructs
– Takes away from the child’s individuality
– Suggest that there is something wrong with the child
– Labels have permanence
– Basis for keeping children out of the regular classroom
– Requires great expenditure that might be better spent on planning and delivering instruction

Why Are Laws Governing the Education of Exceptional Children Necessary?

• An Exclusionary Past
– Children who are different have often been denied full and fair access to educational
opportunities
• Separate Is Not Equal
– Special education was strongly influenced by social developments and court decisions in the
1950s and 1960s
• Equal Protection
– All children are entitled to a free, appropriate public education

REPUBLIC ACT NO. 7277

 
AN ACT PROVIDING FOR THE REHABILITATION, SELF-DEVELOPMENT AND SELF-RELIANCE OF DISABLED
PERSONS AND THEIR INTEGRATION INTO THE MAINSTREAM OF SOCIETY AND FOR OTHER PURPOSES.

TITLE I
GENERAL PROVISIONS
CHAPTER I
BASIC PRINCIPLE
Section 1. Title. — This Act shall be known and cited as the "Magna Carta for Disabled Persons."

Sec. 2. Declaration of Policy — The grant of the rights and privileges for disabled persons shall be guided by the
following principles:
 State shall give full support to the improvement of the total well-being of disabled persons and their integration
into the mainstream of society. Toward this end, the State shall adopt policies ensuring the rehabilitation, self-
development and self-reliance of disabled persons. It shall develop their skills and potentials to enable them to
compete favorably for available opportunities. 
 Disabled persons have the same rights as other people to take their proper place in society. They should be
able to live freely and as independently as possible. This must be the concern of everyone — the family,
community and all government and non-government organizations. Disabled persons' rights must never be
perceived as welfare services by the Government.
 The rehabilitation of the disabled persons shall be the concern of the Government in order to foster their
capacity to attain a more meaningful, productive and satisfying life.
 The State also recognizes the role of the private sector in promoting the welfare of disabled persons and shall
encourage partnership in programs that address their needs and concerns. 

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  To facilitate integration of disabled persons into the mainstream of society, the State shall advocate for and
encourage respect for disabled persons. The State shall exert all efforts to remove all social, cultural,
economic, environmental and attitudinal barriers that are prejudicial to disabled persons.
CHAPTER II
EDUCATION
Sec.  12. Access to Quality Education. — The State shall ensure that disabled persons are provided with access to
quality education and ample opportunities to develop their skills.

The State shall take into consideration the special requirements of disabled persons in the formulation of educational
policies and programs. It shall encourage learning institutions to take into account the special needs of disabled persons
with respect to the use of school facilities, class schedules, physical education requirements, and other pertinent
consideration. 
The State shall also promote the provision by learning institutions, especially higher learning institutions of auxiliary
services that will facilitate the learning process for disabled persons. 
Sec.  13. Assistance to Disabled Students. — The State shall provide financial assistance to economically marginalized
but deserving disabled students pursuing post secondary or tertiary education. Such assistance may be in the form of
scholarship grants, student loan programs, subsidies, and other incentives to qualified disabled students in both public
and private schools.
Sec.  14. Special Education. — The State shall establish, maintain and support complete, adequate and integrated
system of special education for the visually impaired, hearing impaired, mentally retarded persons and other types of
exceptional children in all regions of the country. Toward this end, the Department of Education, Culture and Sports shall
establish, special education classes in public schools in cities, or municipalities. It shall also establish, where viable,
Braille and Record Libraries in provinces, cities or municipalities. 
The National Government shall allocate funds necessary for the effective implementation of the special education
program nationwide. Local government units may likewise appropriate counterpart funds to supplement national funds.
Sec.  15. Vocational or Technical and Other Training Programs. — The State shall provide disabled persons with training
in civics, vocational efficiency, sports and physical fitness, and other skills. The Department of Education, Culture and
Sports shall establish in at least one government-owned vocational and technical school in every province a special
vocational and technical training program for disabled persons.
Sec.  16. Non-Formal Education. — The State shall develop non-formal education programs intended for the total human
development of disabled persons. It shall provide adequate resources for non-formal education programs and projects
that cater to the special needs of disabled persons. 
Sec.  17. State Universities and Colleges. — If viable and needed, the State University or State College in each region or
province shall be responsible for (a) the development of material appliances and technical aids for disabled persons; (b)
the development of training materials for vocational rehabilitation and special education instructions; (c) the research on
special problems, particularly of the visually-impaired, hearing-impaired, speech-impaired, and orthopedically-impaired
students, mentally retarded, and multi-handicapped and others, and the elimination of social barriers and discrimination
against disabled persons; and (d) inclusion of the Special Education for Disabled (SPED) course in the curriculum. 
The National Government shall provide these state universities and colleges with necessary special facilities for visually-
impaired, hearing-impaired, speech-impaired, and orthopedically-impaired students. It shall likewise allocate the
necessary funds in support of the above.

Related Legal Mandates in the Philippines

1. Policies and Guidelines of SPED in the Philippines
Includes:
 School admission and organization
 Curriculum content, instructional strategies and materials
 Organizational patterns
 Administration and supervision
 Evaluation of programs and services
 Parent education and community involvement
 Linkages
2. Handbook on Inclusive Education
 Main reference guide to inclusion practices in the Philippines
3. DECS Order No. 26 s. 1997
 Institutionalization of SPED Programs in All Schools.
 States that the role or function of SPED Centers will be expanded as to the support of
children with special needs who are integrated in regular school, assist in the conduct of in-
service training and to conduct continuous assessment of children with special needs
4. Proclamation No. 240

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  In the said order the President instructs clearly all heads of Departments, Chiefs of Bureaus,
Offices, Agencies and Instrumentalities of the National government, including Officials of
Local Governments to implement plans, programs and activities geared towards the
development of persons with disabilities (PWDs) in line with the comprehensive National
Plan of Action fund allocations for these plans and programs shall be sourced out from the
annual appropriation which should not be less than 1% of each agencies total budget for the
year or equivalent to the amount provided for under Sections 29 and 31 of the General
Appropriations Act of 2002

The Individuals with Disabilities Education Act

Six Major Principles of IDEA
• Zero Reject: Schools must educate all children with disabilities
• Nondiscriminatory Identification and Evaluation: Schools must used nonbiased, multifactored
methods of evaluation
• Free, Appropriate Public Education: An IEP must be developed for each child
• Least Restrictive Environment: Must be educated with children without disabilities to the maximum
extent appropriate
• Due Process Safeguards: Parents’ and children’s rights protected
• Shared Decision Making: Schools must collaborate with parents

Related Legislation
• Gifted and Talented Children
– The Gifted and Talented Children’s Education Act of 1978 provides financial incentives for
states to develop programs for students
• Section 504 of the Rehabilitation Act of 1973
– Extends civil rights to people with disabilities
• Americans with Disabilities Act
– Extends civil rights protection to private sector employment, all public services, public
accommodation, and transportation

What Is Special Education?

• Special education as intervention
– Preventive: Designed to keep minor problems from becoming a disability
– Remedial: Attempt to eliminate the effects of a disability
– Compensatory: Enable successful functioning in spite of the disability
• Special education as instruction
– Individually planned
– Specialized
– Intensive
– Goal-directed

Current and Future Challenges

• Bridge the research-to-practice gap
• Increase the availability and intensity of early intervention and prevention programs
• Improve students’ transition from school to adult life
• Improve the special education—general education partnership

Planning and Providing Special Education Services

The Process of Special Education

• Prereferral Intervention
– Provide immediate instructional and/or behavioral assistance
• Evaluation and Identification
– All children suspected of having a disability must receive a nondiscriminatory multifactored
evaluation
• Program Planning
– An individualized education program must be developed for children identified as having a
disability
• Placement
– The IEP team must determine the least restrictive educational environment that meet the
student’s needs

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 • Review and Evaluation
– The IEP must be thoroughly and formally reviewed on an annual basis

Individualized Education Program (IEP)

• IDEA requires that an IEP be developed and implemented for every student with disabilities between
the ages of 3 and 21
• Individualized family service plans are developed for infants and toddlers from birth to age 3.

The IEP team must include the following members:

– Parents
– Regular education teachers
– Special education teachers
– LEA representative
– An individual who can interpret evaluation results
– Others at the discretion of the parent or school
– The student (age 14 or older must be invited)

IEP Components
• The IEP must include:
– A statement of present levels of educational performance
– A statement of annual goals
– A statement of special education and related services
– An explanation of the extent to which the student will not participate with nondisabled
children
– Individual modifications
– The projected date for the beginning and duration of services
– A statement of how the child will be assessed
– Beginning at age 14, a statement of transition service needs must be included
– Beginning at age 16, an individual transition plan must be developed

IEP Functions and Formats

• IEP formats vary widely across school districts
• Properly including all of the mandated components in an IEP is no guarantee that the document will
guide the student’s learning and the teachers’ teaching
• The purpose is to create a document that goes beyond compliance with the law and actually
functions as a meaningful guide

Least Restrictive Environment

• LRE is the setting that is closest to a regular school program that meets the child’s special
educational needs
• The IEP team must determine if the annual goals and short-term objectives can be achieved in the
regular classroom
– Removal from the regular classroom should take place when the severity of the disability is
such that an appropriate education cannot be achieved
– Placement must not be regarded as permanent

A Continuum of Services

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Inclusive Education
• Inclusion means educating students with disabilities in regular classrooms
– Studies have shown that well-planned, carefully conducted inclusion can be generally
effective with students of all ages, types, and degrees of disability
• A few special educators believe that the LRE principle should give way to full inclusion, in which all
students with disabilities are placed full time in regular classrooms

Arguments For and Against Full Inclusion

• Pro
– LRE legitimates restrictive environments
– Confuses segregation and integration with intensity of services
– Is based on a “readiness model”
– Supports the primacy of professional decision making
– Sanctions infringements on people’s rights
– Implies that people must move as they develop and change
– Directs attention to physical settings rather than to the services and supports people need
• Con
– Placing a child in a general education setting is no guarantee he will learn or be accepted
– General education teachers are often not sufficiently trained
– System of supports often not available
– No clear definition of what inclusion means

Where Does Special Education Go from Here?

• The promise of a free, appropriate public education for all children with disabilities is an ambitious
one, but substantial progress has been made toward fulfillment of that promise
• Implementation of IDEA has brought problems of funding, inadequate teacher training, and
opposition by some to inclusion of children with disabilities in regular classrooms

• Regardless of where services are delivered, the most crucial variable is the quality of instruction that
each child receives

Collaborating with Parents and Families in a Culturally and Linguistically Diverse Society

Support for Parent and Family Involvement

• Parents and the family:
– Are the child’s best advocates
– Are the child’s first teachers
– Are with the child everyday throughout his/her educational career
– Have the greatest vested interest in their children and are usually the most knowledgeable
about their needs
– Have to live with the results of educational decisions

Three Factors Responsible for an Increased Emphasis on Parent and Family Involvement
• Parents want to be involved in their child’s education
– Parents were an important catalyst of PL 94-142
• Educational effectiveness is enhanced when parents and families are involved
– Repeated research and practice demonstrates the benefits
• The law requires collaboration
– Each reauthorization of IDEA has strengthened and extended parent and family participation

Benefits of Family Involvement

• Increased likelihood of targeting meaningful IEP goals
• Greater consistency and support in the child’s two most important environments
• Increased opportunities for learning and development
• Greater access to expanded resources

Understanding Families of Children with Disabilities

• Adjustment process includes feelings of:
– Shock, denial, and disbelief
– Anger, guilt, depression, shame, and overprotectiveness

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 – Acceptance, appreciation, and pride
• Educators should refrain from expecting parents to exhibit any kind of typical reaction

The Many Roles of the Exceptional Parent

Caregiver - Additional needs of an exceptional child can cause stress
Provider - Additional needs often create a financial burden
Teacher - Exceptional children often need more teaching to acquire skills
Counselor - Must often help their child cope with the disability
Parent of Siblings Without Disabilities - Meet the needs of their other children too
Behavior Support Specialist - Some have to become skilled behavior managers
Marriage Partner - Having a child with disabilities can put stress on a marriage
Information Specialist/Trainer for Significant Others - Must train others
Advocate - Advocate for effective educational services and opportunities

Principles of Effective Communication

• Accept parents’ statements
– Respect parents’ point of view
• Listen actively
– Respond to the parents with interest and animation
• Question effectively
– Speak plainly and use open ended questions
• Encourage
– Describe and show their child’s improving performance
• Stay focused
– The purpose is the child’s educational program and progress
[Source: From C. L. Wilson, 1995]

Identifying and Breaking Down Barriers to Parent-Teacher Partnerships

• Effective partnerships are characterized by family members and professionals jointly pursuing shared
goals
– Respect cultural differences
– Don’t make faulty assumptions; parents are allies not adversaries
• Regular two-way communication with parents is the key
– Conferences, notes home, telephone calls, and home/school contracts
• Preparation is the key to effective parent-teacher conferences
– Establish specific objectives
– Obtain and review the student’s grades
– Select examples of the student’s work
– Prepare an agenda for the meeting

Other Forms of Parent Involvement

• Parents as Teachers
– Use tutoring to practice and extend skills already learned in school
• Parent Education and Support Groups
– Parents and professionals can plan parent education groups
• Parent to Parent Groups
– Parent to Parent programs help parents become allies for one another
• Parents as Research Partners
– Involving parents in research increases the social validity of research

Current Issues and Future Trends

• Professionals who work with parents should value family needs and support families
• Effective change for the child cannot be achieved without helping the entire family
• Assume that all families have strengths they can build on and use to accomplish their own goals

Intellectual Disability/Mental Retardation

Definitions of Mental Retardation

• AAMR’s 1983 definition in IDEA
– Significantly subaverage intellectual functioning
– Deficits in adaptive behavior

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 – Manifested during the developmental period
• AAMR’s new definition based on needed supports
– Significant limitations in both intellectual functioning and conceptual, social, and practical
adaptive skills; the disability originates before age 18
• Intensity of supports:
– Intermittent - As needed, short-term supports. Supports are provided on an “as needed
basis.” These supports may be Episodic- that is, the person does not always need
assistance; or Short-term, occurring during lifespan transitions (e.g., job loss or acute
medical crisis). Intermittent supports may be of high or low intensity.
– Limited - Consistent support for limited time. Supports are characterized by consistency; the
time required may be limited, but the need is not intermittent. Fewer staff may be required,
and costs may be lower than those associated with more intensive levels of support
(examples include time-limited employment training and supports during transition from
school to adulthood).
– Extensive - Consistent support in some settings. Supports are characterized by regular
involvement (e.g, daily) in at least some environments, such as work or home; supports are
not time-limited (e.g., long-term job and home-living support will be necessary).
– Pervasive - Consistent, high intensity support in most settings. Supports must be constant
and of high intensity. They have to be provided across multiple environments and may be
life-sustaining in nature. Pervasive supports typically involve more staff and are more
intrusive than extensive or time-limited supports.

Name Change
Intellectual disability (intellectual developmental disorder) as a DSM-5 diagnostic term replaces
“mental retardation” used in previous editions of the manuals. In addition, the parenthetical name “(intellectual
developmental disorder)” is included in the text to reflect deficits in cognitive capacity beginning in the
developmental period. Together, these revisions bring DSM into alignment with terminology used by the World
Health Organization’s International Classification of Diseases, other professional disciplines and organizations,
such as the American Association on Intellectual and Developmental Disabilities, and the U.S. Department of
Education.

American Association on Intellectual and Developmental Disabilities(AAIDD, 2010) defined

Intellectual disability as “Significantly sub average general intellectual functioning existing concurrently with
deficit in adaptive behaviour and manifested during the developmental period that adversely affects a child’s
educationl performance.” An individual is considered to have an intellectual disability based on the following
three criteria:
1. Subaverage intellectual functioning: It refers to general mental capacity, such as learning,
reasoning, problem solving, and so on. One way to measure intellectual functioning is an IQ test. Generally,
an IQ test score of around 70 or as high as 75 indicates a limitation in intellectual functioning.
2. Significant limitations exist in two or more adaptive skill areas: It isthe collection of conceptual,
social, and practical skills that are learned and performed by people in their everyday lives.  Conceptual skills
—language and literacy; money, time, and number concepts; and selfdirection.  Social skills—interpersonal
skills, social responsibility, self-esteem, gullibility, naïveté (i.e., wariness), social problem solving, and the
ability to follow rules/obey laws and to avoid being victimized.  Practical skills—activities of daily living
(personal care), occupational skills, healthcare, travel/transportation, schedules/routines, safety, use of
money, use of the telephone.

Standardized tests can also determine limitations in adaptive behavior.

3. The condition manifests itself before the age 18: This condition is one of several developmental
disabilities-that is, there is evidence of the disability during the developmental period, which is operationalized
as before the age of 18. The AAIDD definition has evolved through years of effort to more clearly reflect the
ever-changing perception of intellectual disabilities. Historically, definitions of intellectual disability were based
solely on the measurement of intellect, emphasizing routine care and maintenance rather than treatment and
education. In recent years, the concept of adaptive behaviour has played an incresingly important role in
defining and classifying people with intellectual disabilities.

Identification and Assessment

Assessing Intellectual Functioning
• Standardized tests are used to assess intelligence

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 – A diagnosis of MR requires an IQ score at least 2 standard deviations below the mean (70
or less)
• Important considerations of IQ tests:
– IQ is a hypothetical construct
– IQ tests measure how a child performs at one point in time
– IQ tests can be culturally biased
– IQ scores can change significantly
– IQ testing is not an exact science
– Results are not useful for targeting educational objectives
• Results should never be used as the sole basis for making decisions regarding special education
services

Normal Curve

Assessing Adaptive Behavior

• Adaptive behavior is the effectiveness or degree with which the individual meets the standards of
personal independence and social responsibility expected of his age and social group
– Measurement of adaptive behavior has proven difficult because of the relative nature of
social adjustment and competence

Prevalence and Causes

Prevalence
• During the 2000-2001 school year, approximately 1% of the total school enrollment received special
education services in the MR category
• Mild MR cases make up about 85% of all persons with MR
Causes
• More than 750 causes of MR have been identified
• For approximately 50% of mild MR cases and 30% of severe MR, the cause is unknown

Biological Causes
• Prenatal causes include:
– Chromosomal disorders
– Inborn errors of metabolism
– Developmental disorders
– Toxic exposure through maternal substance abuse
• Perinatal causes include:
– Intrauterine disorders
– Neonatal disorders
• Postnatal causes include:
– Head injuries
– Infections
– Degenerative disorders
– Malnutrition

Environmental Causes

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 • Prevention: The biggest single preventive strike against MR was the development of the rubella
vaccine in 1962
• Toxic exposure through maternal substance abuse and environmental pollutants are two major
causes of preventable MR that can be combated with education and training
• Advances in medical science have enabled doctors to identify certain genetic influences
• Although early identification and intensive educational services to high-risk infants show promise,
there is still no widely used technique to decrease the incidence of MR caused by psychosocial
disadvantage

Classification of Intellectual Disability

A number of ways have been developed to classify children with intellectual disability during the past
few decades. The 1973 and 1983AAIDD definitions of intellectual disability divided severity of disability into
four categories (mild, moderate, severe and profound intellectual disability), a classification system that
continues to have widespread acceptance and use.

Classification of Intellectual Disability According to severity of disability

Level of IQ range Characteristics Approximate mental % of persons with

Intellectual age in adulthood Intellectual Disability
Disability at
this level

Mild 55-69 Usually not identified until school age 8 years, 3months 85
to 10 years, 9
Most students master many academic months
skills

Most able to learn job skills well enough to

support themselves independently or semi-
independently

Moderate 36-51 Most show significant delays in 5 years, 7 10

development during the preschool years months to 8
years, 2 months
As they grow older the discrepancies in
age related adaptive and intellectual skills
widens

Severe 20-35 Usually identified at birth 3 years, 2 3.5

months to 5
Most have significant central nervous years, 6 months
system damage

Likely to have health care problems that

require intensive supports

Profound < 20 Majority have multiple disabilities that < 3years, 2 1.5
affect nearly every aspect of intellectual months
and physical development
Source: Sattler (2002, p. 337)

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Educational Approaches
Curriculum Goals
• Functional curriculum
– A functional curriculum will maximize a student’s independence, self-direction, and
enjoyment in school, home, community, and work environments
• Life skills
– Skills that will help the student transition into adult life in the community
• Self-determination
– Self-determined learners set goals, plan and implement a course of action, evaluate their
performance, and make adjustments in what they are doing to reach their goals

Characteristics of Effective Instruction

• Explicit and systematic instruction
• Task analysis
• Direct and frequent measurement of student performance
• Active student response
• Systematic feedback provided by the teacher
• Transfer of stimulus control from prompts to task
• Generalization and maintenance

Educational Placement Alternatives

• Some children with MR attend special schools
• Most are educated in their neighborhood schools
– Special classes
– Regular class with support
– Resource room
• The extent to which a student with MR should be included in the regular classroom should be
determined by the student’s individual needs

Current Issues and Future Trends

• Some concerns of the current definition of MR include:
– IQ testing will remain the primary means of assessment
– Adaptive skills cannot be reliably measured with current assessment methods
– The levels of need supports are too subjective
– Classification will remain essentially unchanged in practice
• Acceptance and membership
– An especially important and continuing challenge is moving beyond the physical integration
of persons with MR in society to acceptance and membership that comes from holding
valued roles

Learning Disabilities

IDEA Definition of Learning Disabilities (LD)

• A disorder in one or more of the basic psychological processes involved in understanding or using
language
• May manifest itself in an imperfect ability to:
– Listen, think, speak, read, write, spell, or do math
• Does not include learning problems that are the result of other disabilities or environmental, cultural,
or economic disadvantage

The NJCLD Definition of LD

• A general term that refers to a group of disorders manifested by significant difficulties in the
acquisition and use of listening, speaking, reading, writing, reasoning, or math abilities
• Problems with self-regulatory behaviors, social perception, and social interaction may coexist but do
not themselves constitute a learning disability
• Although learning disabilities may occur with other handicapping conditions or with extrinsic
influences they are not the result of those influences

Operationalizing the Definition

Most states require three criteria be met to receive services:

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 • Discrepancy between intelligence and achievement
– An “unexpected” difference between general ability and achievement
• Exclusion criterion
– LD can occur with other disabilities but the learning problems must not be “primarily the
result” of the other disability or other condition (e.g., low SES)
• A need for special education services
– The student shows specific and severe learning problems despite normal educational efforts

Characteristics
• Students with LD experience one or more of the following difficulties:
– Reading problems - 90% of all children identified
– Deficits in written language - Perform lower across most written expression tasks
– Underachievement in math - 50% have math IEP goals
– Poor social skills - 75% have social skills deficits
– Behavioral problems
• Defining Characteristic
– Specific and significant achievement deficits in the presence of adequate overall intelligence

Prevalence
• LD is by far the largest of all special education categories
– 51% of all children with disabilities receive services under the LD category
– 5 out of every 100 students in the U.S. is diagnosed with LD
– Males with LD outnumber females by 3-to-1
– The number of children identified is growing

Causes
• In almost every case the cause is unknown
– Brain damage or dysfunction
• In most cases there is no evidence of brain damage
• Assuming a child’s learning problems are caused by a dysfunctioning brain can
serve as a built-in excuse for ineffective instruction
– Heredity
• There is growing evidence that genetics may account for at least some family
linkage with dyslexia
– Biochemical imbalance
• Most professionals give little credence to biochemical imbalance as a cause
– Environmental factors
• Impoverished living conditions early in a child’s life and poor instruction probably
contribute to achievement deficits
• Many students’ learning problems can be remediated by direct, intensive, and
systematic instruction

Educational Approaches
Explicit instruction
– Provide a sufficient range of examples to illustrate a concept
– Provide models of proficient performance
– Have students explain how and why they make decisions
– Provide frequent, positive feedback for student performance
– Provide adequate practice opportunities
Content enhancements
– Guided notes
– Graphic organizers and visual displays
– Mnemonics
Learning strategies
– Students use task-specific strategies to guide themselves successfully through a learning
task or problem

Educational Placement Alternatives

• Regular classroom
– During the 99-00 school year, 45% of students with LD were educated in regular classrooms
– Some school districts employ a collaborative teaching model to support the full inclusion of
students with LD

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 • Consultant teacher
– Provides support to regular classroom teachers who work directly with students with
learning disabilities
• Resource room
– A resource room is a specially staffed and equipped classroom where students with LD
come for one or several periods during the school day to receive individualized instruction

Current Issues and Future Trends

• The discussion and debate over what constitutes a true learning disability are likely to continue
• Most professionals and advocates for students with LD do not support full inclusion
• Students with LD possess positive attributes and interests that teachers should identify and try to
strengthen

Emotional and Behavioral Disorders

Problems with IDEA Definition

• Definition is vague and subjective
– What are “satisfactory” peer and teacher relationships?
– What does “inappropriate” behavior look like?
• The definition, as written, excludes children on the basis for which they are included
– How does one differentiate between “socially maladjusted” and true “emotional
disturbance”?
• Individual teacher expectations and tolerances make identification a difficult and subjective process

CCBD Definition of Emotional or Behavioral Disorders

• Behavioral or emotional responses so different from appropriate age, cultural, or ethnic norms that
they adversely affect educational performance
– More than temporary, expected responses to stress
– Consistently exhibited in two different settings, at least one of which is school related
– Unresponsive to direct intervention in the general education setting

Common Characteristics
Behavioral deficits
– Academic achievement
• Low GPA
• High absenteeism
• At risk for school failure and early drop out
– Social skills
• Less participation in extracurricular activities
• Lower quality peer relationships
• Juvenile delinquency

Prevalence
– Estimates vary, but about 3% to 5% of school-age population
– Given prevalence data, many students not receiving specialized services
Gender
– The vast majority are boys

Causes
Biological factors
– Brain injury or dysgenesis
– Genetics
– Temperament
Environmental factors
– Home - Inconsistent parenting practices
– Community - Low SES, gangs, high crime rate
– School - Low ASR, coercive pain control

Identification and Assessment

Screening tests
– Used to determine if intervention is warranted

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 – Behavior rating scales or checklists
Projective tests
– Ambiguous stimuli
– Limited usefulness for education planning
Direct observation and measurement
– Directly focuses on the child’s problems
– Useful for educational planning

Functional Behavioral Assessment

Systematic, data-driven process
– Informal assessment
• School records, parent interviews, teacher checklists
– Direct observation and measurement
• In-class observation when behavior is likely to occur
– Hypothesis development
• All informal and observational data used to develop intervention based on probable
cause of the behavior
– Intervention
• Teaching functional replacement behaviors
– Evaluation and modification
• Data are collected to determine success of the intervention

Curriculum Goals
Social skills
– Cooperation skills
– Appropriate ways to express feelings
– Responding to failure
Academic skills
– High ASR
– Direct, explicit instruction
– High rates of teacher praise
Behavior management
– Clear school-wide expectations
– Positive proactive classroom management strategies
Self-management
– Self-monitoring
– Self-evaluation
Peer mediation and support
– Peer tutoring
– Positive peer reporting
Self-Management Card

Fostering Strong Teacher-Student Relationships

Differential acceptance
– Witness or be the victim of acts of anger without responding similarly
Focus on alterable variables

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 – Teachers should focus effort on only those variables that make a difference in student
learning and can be affected by sound teaching practice

Educational Placement Alternatives

• More than 50% of students with EBD receive their education in:
– Separate classrooms
– Special schools
– Residential facilities
• Most students receiving special education because of emotional or behavioral disorders have serious
problems that require intensive intervention

Current Issues and Future Trends

• Revising the federal definition to meet the needs of students
• Prevention efforts in the community
• Clarify regulations for disciplining students
• Improving services for youth in correctional facilities
• Developing “wraparound” services for families
• Putting into practice research validated teaching methods

Autism Spectrum Disorders

DSM-IV Definitions
Autistic Disorder - marked by three defining features, with onset before age: 1) impaired social interaction, 2)
impaired communication, and 3) restricted, repetitive, and stereotyped patterns of behavior, interests, and
activities
Asperger Syndrome - impairments in all social areas, particularly an inability to understand how to interact
socially
Rhett’s Syndrome - a distinct neurological condition that begins between 5 and 30 months of age, marked by a
slowing of head growth, stereotypic hand movements, and severe impairments in language and coognitive
abilities
Childhood disintegrative disorder - shares characteristics with autistic disorder, but doesn’t begin until after the
age of 2 and sometimes not until age 10
Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) - diagnosis given to children who
meet some, but not all, of the criteria for autistic disorder.

Autism Spectrum Disorder  Diagnostic Criteria (DSM-V)       

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by
the following, currently or by history (examples are illustrative, not exhaustive, see text):
1.       Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach
and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to
failure to initiate or respond to social interactions.
2.       Deficits in nonverbal communicative behaviors used for social interaction, ranging, for
example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and
body language or deficits in understanding and use of gestures; to a total lack of facial expressions and
nonverbal communication.
3.       Deficits in developing, maintaining, and understanding relationships, ranging, for example, from
difficulties adjusting behavior to suit various social contexts; to difficulties in  sharing imaginative play or in
making friends; to absence of interest in peers.
Specify current severity: Severity is based on social communication impairments and restricted repetitive
patterns of behavior. (See table below.)

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the
following, currently or by history (examples are illustrative, not exhaustive; see text):
1.       Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor
stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2.       Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal
nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns,
greeting rituals, need to take same route or eat food every day).
3.       Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong
attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).

15
 4.       Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the
environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures,
excessive smelling or touching of objects, visual fascination with lights or movement).
Specify current severity: Severity is based on social communication impairments and restricted, repetitive
patterns of behavior. (See table below.)

C. Symptoms must be present in the early developmental period (but may not become fully manifest until
social demands exceed limited capacities or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current
functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or
global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make
comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be
below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder,

or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum
disorder. Individuals who have marked deficits in social communication, but whose symptoms do not
otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic)
communication disorder.

Specify if:
- With or without accompanying intellectual impairment
- With or without accompanying language impairment
- Associated with a known medical or genetic condition or environmental factor
(Coding note: Use additional code to identify the associated medical or genetic condition.)
- Associated with another neurodevelopmental, mental, or behavioral disorder
(Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral
disorder[s].)
- With catatonia 

Table: Severity levels for autism spectrum disorder

Severity level Social communication Restricted, repetitive behaviors
Severe deficits in verbal and nonverbal social
communication skills cause severe impairments
in functioning, very limited initiation of social
interactions, and minimal response to social Inflexibility of behavior, extreme difficulty
Level 3
overtures from others. For example, a person coping with change, or other
"Requiring very
with few words of intelligible speech who rarely restricted/repetitive behaviors markedly
substantial
initiates interaction and, when he or she does, interfere with functioning in all spheres. Great
support”
makes unusual approaches to meet needs only distress/difficulty changing focus or action.
and responds to only very direct social
approaches

Marked deficits in verbal and nonverbal social

communication skills; social impairments
Inflexibility of behavior, difficulty coping with
apparent even with supports in place; limited
change, or other restricted/repetitive
Level 2 initiation of social interactions; and reduced or 
behaviors appear frequently enough to be
"Requiring abnormal responses to social overtures from
obvious to the casual observer and interfere
substantial others. For example, a person who speaks
with functioning in  a variety of contexts.
support” simple sentences, whose interaction is limited 
Distress and/or difficulty changing focus or
to narrow special interests, and how has
action.
markedly odd nonverbal communication.

Level 1 Without supports in place, deficits in social Inflexibility of behavior causes significant

16
 communication cause noticeable impairments.
Difficulty initiating social interactions, and clear
examples of atypical or unsuccessful response
to social overtures of others. May appear to interference with functioning in one or more
"Requiring have decreased interest in social interactions. contexts. Difficulty switching between
support” For example, a person who is able to speak in activities. Problems of organization and
full sentences and engages in communication planning hamper inde
but whose to- and-fro conversation with others
fails, and whose attempts to make friends are
odd and typically unsuccessful.

IDEA Definition
Autism is a developmental disability affecting verbal and nonverbal communication and social interaction,
generally before age 3, that adversely affects a child’s performance.

Characteristics
• Impaired social relationships
• Many children with autism do not speak. Echolalia is common
among those who do talk
• Varying levels of intellectual functioning, uneven skill development
• Unusual responsiveness to sensory stimuli
• Insistence on sameness
• Ritualistic and stereotypic behavior
• Aggressive or self-injurious behavior

Screening
• Early diagnosis is highly correlated with dramatically better
outcomes
• Autism can be reliably diagnosed at 18 months of age
– Checklist for Autism in Toddlers (CHAT)
– Modified Checklist for Autism in Toddlers (M-CHAT)

Diagnosis
• Childhood Autism Rating Scale (CARS)
• Autism Diagnostic Interview—Revised
• Gilliam Autism Rating Scale (GARS)
• Asperger Syndrome Diagnostic Scale (ASDS)
Prevalence and Causes

Prevalence
• Recent estimates - Autism occurs in as many as 1 in
500 people
• Boys are affected about 4 times more often than girls
• Autism is the fastest-growing category in special
education
Causes
• The cause of autism is unknown
• There is a clear biological origin of autism in the form of
abnormal brain development, structure, and/or
neurochemistry
• No evidence of childhood vaccinations causing autism

Educational Approaches
Applied Behavior Analysis (ABA)
– Discrete Trial Training
– Picture Exchange Communication System (PECS)
– Peer-mediated interventions
– Errorless discrimination learning
– Generalization
– Functional assessment of challenging behavior
– Pivotal response intervention

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 – Naturalistic language strategies

Educational Approaches (continued)

• Social stories
• Picture activity schedules

Educational Placement Alternatives

• Regular Classroom
• Resource Room

Current Issues and Future Trends

• Although some children with autism have progressed so significantly that they no longer carry the
diagnostic label, the opinions of experts differ greatly on the issue of recovery from autism
• A serious problem in the field of autism is the popularity of unproven educational interventions and
therapies
• Parents and professionals should select autism treatments on the basis of careful and systematic
evaluations of the scientific evidence of their effects and benefits

Communication Disorders

Definitions
• Communication involves encoding, transmitting, and decoding messages
– Communication involves
• A message
• A sender who expresses the message
• A receiver who responds to the message
– Functions of communication
• Narrating
• Explaining/informing
• Requesting
• Expressing
• Language is a formalized code that a group of people use to communicate
– The five dimensions of language:
• Phonology-Rules determining how sounds can be sequenced
• Morphology-Rules for the meaning of sounds (e.g., un, pro, con)
• Syntax-Rules for a language’s grammar
• Semantics- Rules for the meaning of words
• Pragmatics-Rules for communication
• Speech is the oral production of language
– Speech sounds are the product of four related processes:
• Respiration-Breathing that provides power
• Phonation-Production of sound by muscle contraction
• Resonation-Sound quality shaped by throat
• Articulation-Formation of recognizable speech by the mouth

Normal Development of Speech and Language

• Most children follow a relatively predictable sequence in their acquisition of speech and language
– Birth to 6 months: Communication by smiling, crying, and babbling
– 7 months to 1 year: Babbling becomes differentiated
– 1 to 1.6 years: Learns to say several words
– 1.6 to 2 years: Word “spurt” begins
– 2 to 3 years: Talks in sentences, vocabulary grows
– 3 years on: Vocabulary grows
• Knowledge of normal language development can help determine whether a child is developing
language at a slower-than-normal rate or whether the child shows an abnormal pattern of language
development

Communication Disorders Defined

• ASHA definition
– An impairment in the ability to receive, send, process, and comprehend concepts of verbal,
nonverbal and graphic symbols systems

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 • IDEA definition
– A communication disorder, such as stuttering, impaired articulation, a language impairment,
or a voice impairment that adversely affects a child’s educational performance

Prevalence
• A little more than 2% of school-age children receive special education for speech and language
impairments
• Over 21% of all children receiving special education services are served in this category
– The second largest disability category under IDEA
• Nearly twice as many boys as girls have speech impairments
• Children with articulation and spoken language problems represent the largest category of speech-
language impairments.

Causes
• Causes of Speech Disorders
– Cleft palate
– Paralysis of the speech muscles
– Absence of teeth
– Craniofacial abnormalities
– Enlarged adenoids
– Traumatic brain injury
– Neuromuscular impairments
• Causes of Language Disorders
– Cognitive limitations or mental retardation
– Hearing impairments
– Behavioral disorders
– Environmental deprivation

Characteristics
• Speech sound errors
– Distortions
– Substitutions
– Omissions
– Additions
• Fluency disorders
– Stuttering and cluttering are examples of fluency disorders
• Voice disorders
– A phonation disorder causes the voice to sound breathy, hoarse, husky, or strained
– Resonance disorders are hypernasality or hyponasality
• Language impairments
– An expressive language impairment interferes with production of language
– A receptive language impairment interferes with understanding of language

Identification and Assessment

• Communication disorders are usually first identified by teacher observations

• The speech-language pathologist is the professional with the primary responsibility for identifying,
evaluating, and providing services
• Evaluation components include a physical examination and testing

Educational Placement Alternatives

• The vast majority of children with speech and language impairments are served in regular
classrooms
• Some examples of service delivery models:
– Monitoring
– Pullout
– Collaborative consultation
– Classroom-based
– Self-contained classroom
– Community-based

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Current Issues and Future Trends
• SLP or LREC
– Controversy as to whether services should take a therapeutic versus educational focus
• Changing populations mean growing caseloads and more children with severe and multiple
disabilities
• The changing role of SLPs means that they will have to develop interventions applicable not only in
the classroom but by teachers and parents

Deafness and Hearing Loss

Definitions of Hearing Loss

Medical perspective
– Continuum of hearing loss from mild to profound
Educational perspective (IDEA definition)
– A hearing loss that adversely affects educational performance
Difference between deafness and hard of hearing
– Deaf: The student is not able to hear even with a hearing aid
– Hard of hearing: Significant hearing loss that makes special adaptations necessary
• Many persons who are deaf do not view hearing loss as a disability

How We Hear
Audition, the sense of hearing, is a complex and not completely understood process
– The auricle funnels sound waves into the auditory canal
– Variations in sound pressure cause the eardrum to move in and out
– The vibrations of the bones of the middle ear transmit energy to the inner ear
– The inner ear is the most critical and complex part of the hearing apparatus

Prevalence
• According to ASHA, 95 of every 1,000 people have a chronic hearing loss
• The large majority of persons with hearing loss are adults
• The U.S. Public Health Service estimates 83 out of 1000 children have an educationally significant
hearing loss
• About 25% of students who are deaf or hard of hearing have another disabling condition

Types and Causes of Hearing Loss

Age of onset is important for determining educational needs
• Congenital hearing loss is present at birth
– Causes of congenital hearing loss
• Genetic Factors
• Maternal Rubella
• Congenital Cytomegalovirus (CMV)
• Premature birth
• Acquired hearing loss appears after birth
– Prelingual hearing loss before speech develops
– Postlingual hearing loss after speech develops
– Causes of acquired hearing loss
• Otitis Media
• Meningitis
• Ménière’s Disease
• Noise Exposure

Characteristics of Students with Hearing Loss

• Students with hearing loss have different characteristics
– Levels of functioning influenced by:
• Degree of hearing loss
• Attitudes of parents and siblings
• Opportunities to acquire a first language
• The presence of other disabilities
• Academic achievement
– Most children with hearing loss have difficulty with all areas of academic achievement

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 – Deafness itself imposes no limitations on the cognitive capabilities of the individual
• Social functioning
– The extent to which a child successfully interacts depends largely on others’ attitudes and
the child’s ability to communicate in some mutually accepted way

Technologies and Supports That Amplify, Provide, Supplement, or Replace Sound

Hearing aids
– Hearing aids make sounds louder but not necessarily clearer
– The earlier in life a child is fitted the more effectively he will learn to use hearing
– Hearing aids offer minimal benefit in noisy and reverberant classrooms
Assistive listening devices
– A radio link established between the teacher and the child can solve problems caused by
distance and noise
Cochlear implants
– A cochlear implant bypasses damaged hair cells and stimulates the auditory nerve directly
– Tremendous controversy surrounds cochlear implants in the deaf community

Supports and Technologies

• Interpreters
– Interpreters have increased the ability of students to perform well in school
• Speech-to-text translation
– Computer devices that translate speech to text
• Television captioning
– Captioning helps students comprehend more
• Text telephones
– Helps teachers communicate with deaf students
• Alerting devices

Educational Approaches
• Oral/Aural Approaches
– Training in producing and understanding speech is incorporated into virtually all aspects of
the child’s education
• Total Communication
– Simultaneous presentation of language by speech and manual communication
• American Sign Language (ASL) and the Bilingual-Bicultural Approach
– ASL is a legitimate language in its own right
– The goal of the bilingual-bicultural approach is to help deaf students become bilingual adults
who can read and write with competence in their second language

Educational Placement Alternatives

• Approximately 84% of children who are deaf or hard of hearing attend local public schools
– All of the professional and parent organizations involved with educating students who are
deaf have issued position statements strongly in favor of maintaining a continuum of
placement options

Current Issues and Future Trends

• The keys to improving the future for people who are deaf or hard of hearing
– Access to the language and communication modality best suited to their individual needs
– Effective instruction with meaningful curriculum
– Self-advocacy

Blindness and Low Vision

Definitions of Visual Impairment

Legal definition of blindness
• The legal definition is based on visual acuity and field of vision
– A person whose visual acuity is 20/200 or less after the best possible correction with
glasses or contact lenses is considered legally blind
– A person whose vision is restricted to an area of 20 degrees or less is considered legally
blind
Educational definitions of visual impairments

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 • The IDEA definition emphasizes the relationship between vision and learning
– Totally blind: Receives no useful information through the sense of vision
– Functionally blind: Learns primarily through the auditory channel
– Low vision: Uses vision as a primary means of learning

Prevalence and Causes

• Fewer than 2 children in 1000 have visual impairments
– Almost half of school age children with visual impairments also have another disability
• Causes of visual impairments
– Refractive errors: Myopia (nearsightedness) and hyperopia (farsightedness)
– Structural impairments: Cataracts, glaucoma, nystagmus, strabismus
– Cortical visual impairments: Suspected damage to parts of brain that interpret visual
information
– Retinitis pigmentosa
– Macular degeneration

Characteristics of Students with Visual Impairments

• Cognition and language
– Impaired or absent vision makes it difficult to see the connections between experiences
• Motor development and mobility
– Visual impairment often leads to delays and deficits in motor development
• Social adjustment and interaction
– Children with visual impairments interact less and are often delayed in social skills
– Many persons who have lost their sight report that the biggest difficulty socially is dealing
with the attitudes and behavior of those around them

Educational Approaches
• The age of onset has implications for how children with low vision should be taught
– Visual impairment can be congenital (present at birth) or adventitious (acquired)
Special adaptations for students who are blind
• Braille
• Tactile aids and manipulatives
• Computer technological aids for reading print
– Hardware/software that magnifies screen images
– Speech recognition software
– Software that converts text files to synthesized speech

Special Adaptations for Students with Low Vision

• Functional vision
– Teaching a child to use the vision that she has
• Optical devices
– Glasses
– Contacts
– Small hand-held telescopes
– Magnifiers
• Print reading
– Approach magnification
– Lenses
– Large print
• Classroom adaptations
– Special lamps
– Desks with tilting tops
– Off-white writing paper
– Chairs with wheels

Expanded Curriculum Priorities

• Orientation and mobility training (O&M)
• Cane skills
• Guide dogs
• Sighted guides
• Electronic travel aids
• Listening skills

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 • Functional life skills
– Cooking
– Personal hygiene
– Shopping
– Financial management
– Transportation
– Recreational activities

Educational Placement Alternatives

86% of children are educated in public schools
• Itinerant teacher model
– Most students who are included in general education classrooms receive support from
itinerant teacher-consultants
– The most important factor to the successful inclusion of students with visual impairments is
the regular classroom teacher’s flexibility
• Other important aspects
– Peer acceptance and interaction
– Availability of support personnel
– Adequate access to special supplies and equipment
• Residential schools
– About 7.5% of school-age children with visual impairments attend residential schools

Current Issues and Future Trends

• Specialization of services
– Children with visual impairments are likely to receive special education services in the future
in both regular and residential schools
– Greater emphasis will be placed on intervention with infants and young children and on
training older students for independence
• Emerging technology and research
– It is hoped that all people with visual impairments will benefit from new technological and
biomedical developments
– Artificial sight may be possible in the future
• Fighting against discrimination and for self-determination
– Career opportunities will likely expand as individuals with visual impairments become more
aware of their legal and human rights

Physical Disabilities, Health Impairments, and ADHD

Components of IDEA Definitions

• Orthopedic Impairment (OI)
– Dysfunction of bones, joints, limbs, and associated muscles
– Dysfunction of central nervous system affecting movement
– Adversely affecting educational performance
• Other Health Impairment (OHI)
– Limited strength, vitality, or alertness due to chronic or acute health problems
– Adversely affecting educational performance
• Many children with OI and OHI receive services under other categories
• Some do not require specialized educational services

Orthopedic Impairments
• Cerebral Palsy
– Permanent disorder of voluntary movement and posture
– Little relation between impairment and intellectual development
– Classified according to muscle tone and motor movement
• Spina Bifida
– Congenital defect in the vertebra that enclose the spinal cord
– Can result in paralysis below affected vertebra
– Hydrocephalic condition common; treated with a shunt

23
 Orthopedic Impairments
• Muscular Dystrophy
– Progressive weakening and degeneration of the muscles
– Little relation between impairment and intellectual development
• Spinal Cord Injuries
– Caused by fracture, stretching, or compression of spinal cord
– Car accidents, sports injuries, and violence most common causes
– Result in paralysis below affected vertebra

Other Health Impairments

• Seizure disorder (epilepsy)
– Caused by abnormal electrical activity in the brain
– Three different categories based on severity
– Seizures can be controlled with medicine
• Diabetes
– Chronic disorder of metabolism
– Body unable to breakdown sugar
– Treated with insulin, diet, and exercise

Other Health Impairments

• Asthma
– Chronic lung disease resulting in a narrowing of airways
– Leading cause of absenteeism in school
• Cystic Fibrosis
– Genetic disorder affecting pulmonary and digestive systems
• Acquired Immunodeficiency Syndrome (AIDS)
– Children afforded legal protection under Section 504

Attention-Deficit/Hyperactivity Disorder (ADHD)

• The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity

• Children with ADHD can be served under the “other health impairments” category
• Estimates of prevalence of ADHD range from 3% to 5% of all school-age children
• Two treatment approaches that are widely used with children with ADHD are drug therapy and
behavioral intervention

ADHD is defined as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development.
• Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is
disorganized; these problems are not due to defiance or lack of comprehension.
• Hyperactivity means a person moves about excessively when it is not appropriate, and/or excessively
fidgets, taps, or talks. In adults, it may appear as extreme restlessness or wearing others out with
their activity.
• Impulsivity means hasty actions that occur in the moment without a person thinking first; or a desire
for immediate rewards or inability to delay gratification. Impulsive actions may have high potential for
harm. An impulsive person may be socially intrusive and interrupt others excessively or make
important decisions without considering the long-term consequences.

DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with
functioning or development:
1. Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for
adolescents age 17 years and older and adults; symptoms of inattention have been present for at
least 6 months, and they are inappropriate for developmental level:
1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at
work, or with other activities.
2. Often has trouble holding attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.

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 4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties
in the workplace (e.g., loses focus, side-tracked).
5. Often has trouble organizing tasks and activities.
6. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period
of time (such as schoolwork or homework).
7. Often loses things necessary for tasks and activities (e.g. school materials, pencils, books,
tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
8. Is often easily distracted
9. Is often forgetful in daily activities.
2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age
16 years, or five or more for adolescents age 17 years and older and adults; symptoms of
hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and
inappropriate for the person’s developmental level:
1. Often fidgets with or taps hands or feet, or squirms in seat.
2. Often leaves seat in situations when remaining seated is expected.
3. Often runs about or climbs in situations where it is not appropriate (adolescents or adults
may be limited to feeling restless).
4. Often unable to play or take part in leisure activities quietly.
5. Is often “on the go” acting as if “driven by a motor”.
6. Often talks excessively.
7. Often blurts out an answer before a question has been completed.
8. Often has trouble waiting their turn.
9. Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

 Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
 Several symptoms are present in two or more setting, (such as at home, school or work; with friends
or relatives; in other activities).
 There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or
work functioning.
 The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety
disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during
the course of schizophrenia or another psychotic disorder.

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
 Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity
were present for the past 6 months
 Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-
impulsivity, were present for the past six months
 Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity,
but not inattention, were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.
Diagnosing  ADHD in Adults
ADHD often lasts into adulthood. To diagnose ADHD in adults and adolescents age 17 years or older, only 5
symptoms are needed instead of the 6 needed for younger children. Symptoms might look different at older
ages. For example, in adults, hyperactivity may appear as extreme restlessness or wearing others out with
their activity.
Characteristics
• Children are more different than alike
– Classification based on symptoms of little use in educational planning
– For no other group of exceptional learner is the continuum of educational services more
relevant
• Three important factors that affect educational needs
– Age of onset - children with congenital or acquired impairments have different needs
– Visibility - the visibility of impairment may cause some to underestimate the child’s abilities
and limit opportunities

25
Educational Approaches
• Often involve the collaboration of an interdisciplinary team
– Teachers
– Physical, occupational, and speech therapists,
– Other health care specialists (e.g., heath care aids)
• Children with physical disabilities may also need environmental modifications
– Examples include, wheelchair accessible classrooms, or other assistive technology
• Inclusive attitude on the part of teaches and non-disabled peers
– Students should be encouraged to develop as much independence as possible

Current Issues and Future Trends

• Related services in the classroom
– Teachers will need to make accommodations for related services in the classroom
• New and emerging technology
– Myoelectric (bionic) limbs
– Robotics
• Animal assistance
– Canine helpers in the classroom
• Employment, life skills, and self-advocacy
– Vocational and professional opportunities must be expanded

Low Incidence Disabilities: Severe/Multiple Disabilities, Deaf-Blindness, and Traumatic Brain Injury

Severe and Multiple Disabilities

Severe disability
• Significant disabilities in intellectual, physical, and/or social functioning
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

• 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
– 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
• Severe disabilities may develop later in life from head trauma
• In about one-sixth of all cases, the cause cannot be clearly determined

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

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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

• 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
• 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

Where Should Students with Severe and Multiple Disabilities Be Taught?

• Benefits of the neighborhood school and inclusion
– More likely to function responsibly as adults in a pluralistic society
– Integrated schools are more meaningful instructional environments
– Parents and families have greater access
– Helps develop range of relationships with nondisabled peers
– Students with severe disabilities are more likely to develop social relationships with students
without disabilities if they are included at least part of the time in the regular classroom

The Challenge and Rewards of Teaching Students with Severe and Multiple Disabilities
• Teachers 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 to teachers

Compiled by:
FRANK S. EMBOLTURA, R.N., M.Ed.-SPED
[email protected]

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