Unit 1
Introduction to Multiple Disabilities
• When a child has several different disabilities we say, that
he/she has multiple disabilities.
• Eg: A child may have difficulties in learning, along with
controlling her movements and/or with hearing and vision.
• These disabilities could be a combination of both motor and
sensory nature.
• Multiple Disabilities could be two different types of physical
disabilities, two different mental disabilities, or a combination of
physical and mental disabilities
Some Examples of Multiple Disabilities
• Visual Impairment + Hearing Impairment + Mental Retardation
• Visual Impairment + Mental Retardation
• Cerebral Palsy + Mental Retardation/ Hearing/ Speech/ Visual
problems
• Intellectual Disability and Blindness
• Mental Retardation and Orthopedic Impairment
• Locomotor Disability and Speech Impairment.
Reason for separation of Deaf Blindness
Category
• Dual sensory impairment, or deaf- blindness is defined as a
separate disability group
• In countries like USA, deaf-blindness is not included in the category
of Multiple Disabilities because there is a separate classification for
deaf-blindness in laws like Individuals with Disabilities Education
Act’s (IDEA).
• In the Rights of Persons with Disabilities Act (RPWD) — there in
no separate classification for deaf-blindness. So, in India deaf-
blindness would be part of the category Multiple Disabilities.
Definition of Multiple disabilities
"Multiple disabilities" means concomitant impairments (such as
mental retardation blindness, mental retardation-orthopedic
impairment, etc.), the combination of which causes such
severe educational needs that they cannot be accommodated
in special education programs solely for one of the
impairments. The term does not include deaf blindness. - U.S
Federal government
Characteristics of Multiple Disabilities
These physical and medical
• 1996, Fred Orelove and Dick
problems result in the presence
Sobsey defined this group as of two or more of the following
individuals with mental characteristics:
• Restriction of movement
retardation who require
• Skeletal deformities
extensive or pervasive • Sensory disorders
supports and who also • Seizure disorders
possess one or more • Lung and breathing control
significant motor or sensory
impairments and /or special
health care needs. Continued…
• Most significant characteristic of many people with
multiple disabilities is
• deficits in the area of communication, making it difficult
for them to communicate their wants, needs and pains to
those around them
Deficit Areas of Multiple Disabilities
• Children ages 3 to 5 are considered to have multiple disabilities
when they demonstrate concomitant cognitive, physical, and /or
sensory impairments which result in severe delays in
development.
• Children with multiple disabilities will typically share deficits in
five distinct areas of development
Intellectual functioning
Adaptive skills
Motor skills
Sensory functioning
Communication skills
Motor skills
• Students with multiple disabilities usually have
significant motor and physical challenges.
• Students with multiple disabilities usually have
sensorimotor impairments that produce abnormal
muscle tone.
• Some have underdeveloped muscle tone; they often
have difficulty sitting and moving from a sitting to a
standing position.
• Others have increased muscle tension and
extremely tight muscles, causing spasticity.
Intellectual functioning
• Most students with multiple disabilities have significant
impairments in intellectual functioning, their IQ scores
are approximately 35 points or more below the norm-
that is, IQ 65 or lower.
• However, students with a higher IQ still can be classified
as having multiple disabilities because of their adaptive,
motor, sensory, or communication impairments.
• Students with the most profound intellectual
impairments can still learn.
• Their IEP team should focus on what they can do and not
just on their limitations.
Sensory Functioning
• Hearing and vision impairments are common
among individuals with multiple disabilities.
• Although for our purposes we include deaf-
blindness in the category of multiple
disabilities.
Adaptive skills
• Adaptive skills include conceptual, social, and practical
competencies for functioning in typical community settings in
an age-consistent way.
• Self-care skills are especially important for students with
multiple disabilities because these students are increasingly
included in schools and community activities.
• Most students and adults with multiple disabilities can attain
some level of independence in caring for their own needs.
• School programs typically include instruction in self-care skills
such as dressing, personal hygiene, toileting, feeding, and
simple household chores as part of the focus on students'
other educational needs.
Communication Skills
• Almost all students with multiple disabilities,
not just those who are deaf-blind, have
communication impairments.
• Typically, these students have limited or no
functional speech.
• Their teachers will instruct the student to use
expressions, informal gestures, and basic
vocalizations to communicate
Prevalence
• Definitions of this highly variable group with both severe
and multiple disabilities are less precise than some
other disability groups, making an estimate of their
prevalence difficult. Prevalence ranges from less than
0.25 % to 0.5 % of the population, and is considered
relatively uniform across socioeconomic classes.
Points to remember
• A child who is multiple disabled should receive help as early as
possible so that she can be helped to achieve her potential, and
so that her disabilities will not become worse.
• The child will be slow to make progress and will have difficulty in
generalizing.
• It is important that we are patient and that we set realistic goals
that are small and achievable, as the child can learn only in small
steps with a lot of practice and repetition.
Continued…..
• Because children with multiple disabilities have problems with all
muscle movement, with understanding and often with seeing and
hearing as well, communication is very difficult for them.
• Often we may not know how much a multiple disabled child is
understanding, and her attempts to communicate may be unfamiliar to
us and may pass unnoticed.
• For these reasons we may wrongly label a child as being mentally
handicapped when she is not.
• We must try our best to assess a child's understanding and expression
to ensure that she is not wrongly labeled.
Causes and Types of
multiple Disabilities
Causes
There are several factors that cause severe and multiple
disabilities and can be divided as follows:
Prenatal causes:
It includes chromosomal abnormalities, viral infections, drug and
alcohol use during pregnancy, mother’s malnutrition, and physical
trauma to the mother.
Perinatal causes:
It includes lack of oxygen supply to the baby’s brain, physical
injury to the baby’s brain at birth and contracted infections during
birth.
Postnatal causes:
It includes childhood infections such as meningitis and
encephalitis, traumatic brain injury from an accident or
abuse, lead poisoning, reactions to medication and
exposure to toxins or other environmental conditions.
As with other disabilities, the severity and complexity
of the disability depends on the genetic abnormality,
the amount of damage to the brain and the
environment in which the child is raised.
Types of Multiple Disabilities
• Children with multiple disabilities will have a combination
of various disabilities that may include:
speech, physical mobility, learning, mental
retardation, visual, hearing, brain injury and possibly
others.
• Along with multiple disabilities, they can also exhibit
sensory losses and behaviour and or social problems.
Cerebral Palsy (CP)
• “Cerebral” means brain. “Palsy” means a disorder of movement. CP refers to a
group of nonprogressive neuromuscular problems of varyi
• CP is damage to the brain, primarily to the part of the brain that controls motor
functions.
• However other parts of the brain may also be affected.
• In such cases the person affected has more than one disability.
• The extent of the damage varies from person to person.
• Mild disability might mean fine motor skills, like using scissors or writing, are
difficult.
• Severe disability can mean poor movement of all four limbs, the trunk and neck.
The child may even have difficulty in swallowing severity.
Autism
• All children with ASD demonstrate deficits in
1) social interaction,
2) verbal and nonverbal communication, and
3) repetitive behaviours or interests.
• In addition, they will often have unusual responses to sensory
experiences, such as certain sounds or the way objects look.
• Each of these symptoms runs the gamut from mild to severe.
• They will present differently in each individual child.
• For instance, a child may have little trouble learning to read but
exhibit extremely poor social interaction.
• Each child will display communication, social and behavioural
patterns that are individual but fit into the overall diagnosis of ASD.
Intellectual Disability
• Intellectual disability is characterized both by a significantly below-average
score on a test of mental ability or intelligence and by limitations in the
ability to function in areas of daily life, such as communication, self-care and
getting along in social situations and school activities.
• Intellectual disability is sometimes referred to as a cognitive disability or
mental retardation.
• Children with intellectual disability can and do learn new skills, but they
develop more slowly than children with average intelligence and adaptive
skills.
• There are different degrees of Intellectual disability, ranging from mild to
profound. A person’s level of Intellectual disability can be defined by their
intelligence quotient (IQ), or by the types and amount of support they need.
Locomotor Disability
Locomotor disability means disability of the
bones, joints or muscles leading to substantial
restriction of the movement of the limbs or
any form of cerebral palsy.
Spinal cord injuries:
• It is usually the result of a traumatic blow to
the spine. Some spinal cord injuries can
completely heal and others will cause
paralysis.
Polio
• It is a highly contagious infectious disease
caused by polioviruses. It is destructive to the
nervous system and can cause paralysis.
Muscular Dystrophy
• It is an inherited group of diseases that affect
the muscles, causing them to weaken and
break down over time.
Contractions
• It is permanent tightening of muscles and
joints
Club Foot (talipes equinovarus):
• There are 3 components of deformity namely
equinus, hindfoot varus and forefoot
adductus. Club foot is more common in boys.
Hearing impairment
• Hearing Impairment: “Hearing impairment” means loss of
sixty decibels or more in the better ear in the
conversational range of frequencies.
• Deafness: A hearing loss greater than 90 dB. Individuals
who are deaf have vision as their primary input and
cannot understand speech through the ear. Deafness
means a hearing impairment so severe that the child is
impaired in processing linguistic information through
hearing, which adversely affects educational performance.
(Turnbull, et. al., 2004).
• .
Different types of Hearing loss
• 1. Sensorineural Hearing Loss:
Permanent hearing loss that is a result of damage to the
cochlea or auditory nerve. The treatment for sensorin eural
hearing loss is often the use of hearing aids or cochlear implants.
• 2. Conductive Hearing Loss: Conductive hearing loss results from
defects in the outer or middle ear. The sound is not conducted
efficiently to the inner ear. All sounds heard thus become weak
and or muffled. Usually such individuals speak softly irrespective
of the surrounding environmental noise. It can generally be
offset by amplification or medical intervention. Sometime
surgery can restore hearing in a conductive hearing loss.
• Mixed Hearing Loss: A hearing loss resulting from a
combination of a conductive hearing loss and a
sensorineural hearing loss.
• Central Auditory Disorder: Central hearing loss is
due to damage, malformation or infections of the
neural pathways and the hearing centers in the
brain. The child may hear but has difficulty in
understanding what he hears. Some of the children
classified as learning disabled or slow learners may
have this type of hearing loss
Visual Impairment
• Blindness: refers to a condition where a person
suffers from any of the following conditions,
namely: Total absence of sight or Visual acuity
not exceeding 6/60 or 20/200 (Snellen) in the
better eye even with correction lenses or
limitation of the field of vision subtending an
angle of 20 degree or worse. For deciding
about blindness, the visual acuity as well as
field of vision has been considered.
Low Vision
• “Person with low vision” means a person with
impairment of visual functioning even after
treatment or standard refractive correction
but who uses or is potentially capable of using
vision for the planning or execution of a task
with appropriate assistive device
Mental Illness
• Anxiety Disorders: Children with anxiety disorders
respond to certain things or situations with fear and
dread, as well as with physical signs of anxiety
(nervousness), such as a rapid heartbeat and sweating.
Separation anxiety disorder, overanxious disorder and
posttraumatic stress disorder are the common types of
anxiety disorder seen in children.
• Disruptive Behaviour disorder: Children with these
disorders tend to defy rules and often are disruptive in
structured environments, such as school. Common types
seen in children are conduct disorder, oppositional
defiant disorder and attention deficit hyperactivity
disorder (ADHD).
• Eating Disorder: Eating disorders involve
intense emotions and attitudes, as well as
unusual behaviors, associated with weight and
or food. Anorexia nervosa and bulimia nervosa
are the two types of eating disorders seen in
children
• Affective disorders: These disorders involve
persistent feelings of sadness and/or rapidly
changing moods. Most common types seen in
children is major depressive disorder
• Pervasive Developmental Disorders or Autistic
Spectrum Disorders: These children have
difficulties and abnormalities in their abilities
to form reciprocal social interaction and to
verbally and nonverbally communicate.
