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Focus QuestionsWhy 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?
KEY TERMS AND CONCEPTSDefinitions: PECS, Brain Dysgenesis (and causes), Functional Assessment, Functional Analysis, Naturalistic Teaching, Profound disabilities, Multiple Disabllities,Positive Behavioral Support (PBS) – what it is, how used, componentsSevere disabilities:
Definition Characteristics, When identified Curriculum (functional/daily living) Use of AAC Methods. Instructional programs Communication issues Advantages of placement in neighborhood school. Reasons why
they do not attend neighborhood schools. Recreational and leisure skills
Closed/open head injury and examplesTraumatic Brain Injury:
Severe DisabilitiesSevere Disability Significant disabilities/impairments in intellectual,
physical(motor), and/or social functioning Significantly below the norm Below age and grade level expectations Identified shortly after birth Compare how child performs on tests, developmental
functioning/progress compared to others their age IQ scores of 35 to 40 or 40 to 55 Functions as a typical 2 to 6 year old
The organization TASH ( formerly The Association for Persons with Severe Handicaps) describes the people for whom it advocates as “ people with significant disabilities and support needs who are most at risk for being excluded from society; perceived by traditional service systems as most challenging; most likely to have their rights abridged; most likely to be at risk for living, working, playing and learning in segregated environments; least likely to have the tools and opportunities necessary to advocate on their behalf; and are most likely to need ongoing, individualized supports to participate in inclusive communities and enjoy a quality of life similar to that available to all people” ( TASH, 2011).
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
Ex.- intellectual disability and blindness; intellectual disability and orthopedic impairment
NJAC 6A:14 Definition "Multiply disabled" corresponds to "multiply
handicapped" and “multiple disabilities,” and means the presence of two or more disabling conditions, the combination of which causes such severe educational needs that they cannot be accommodated in a program designed solely to address one of the impairments. Multiple disabilities includes cognitively impaired-blindness, cognitively impaired-orthopedic impairment, etc. The existence of two disabling conditions alone shall not serve as a basis for a classification of multiply disabled. Eligibility for speech-language services as defined in this section shall not be one of the disabling conditions for classification based on the definition of "multiply disabled." Multiply disabled does not include deaf-blindness.
Deaf-BlindnessDeaf-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
Ex. A program for children who are deaf would not be appropriate for a child who has vision loss.
Ex. A program for children who are blind, would not be appropriate for a child who has hearing loss.
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 Can include students under the following
CharacteristicsSlow acquisition rates for learning new skills
Compared with students with disabilities, learn at a slower rate, need more instructional trials to learn a given skill, learn fewer number of skills, have extreme difficulty learning abstract concepts.
Poor generalization and maintenance of newly learned skills
Generalization- performance of a skill in settings or under conditions different from those in which the skill was learned initially
Maintenance- continues use of a skill after instruction has been terminated
Instruction must be specifically planned in order for generalization and maintenance to take place
CausesSevere 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)
Brain Dysgenesis & Damage Brain Dysgenesis- abnormal brain development
Prenatal accounts for most cases of severe cognitive limitations
Ex. Mother’s substance abuse (alcohol, drugs, poor nourishment) during pregnancy
Brain Damage- cause by influences that alter the structure or function of the brain that had been developing normally up to that point
Automobile/bike accidents, head trauma, falls, assaults, abuse Malnutrition, neglect, ingestion of poisonous substances Diseases that effect the brain (meningitis, encephalitis)
Causes Continued•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
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
NJAC 6A:14 Definition "Traumatic brain injury" corresponds to
"neurologically impaired" and means an acquired injury to the brain caused by an external physical force or insult to the brain, resulting in total or partial functional disability or psychosocial impairment, or both. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual and motor abilities; psychosocial behavior; physical functions; information processing; and speech.
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 injuryOpen Head Injury- result of penetration of the skull, such as that caused by a bullet or a forceful blow to the head with a hard or sharp object Closed Head Injury- head hits a stationary object with such force that the brain slams against the inside of the cranium
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 injuriesPhysical and sensory changesCognitive impairmentSocial, behavioral, and emotional problems
Curriculum: What Should Be Taught?Students with Severe and Multiple Disabilities
Functional skills - activities of daily living skills (ADLs) needed now and in the future
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 Recreation and leisure skills – must be taught, don’t come naturally. Without being taught, people sit by the television or only
socialize with other people who have disabilities. Making choices-opportunities to make choices and the ability to
make choices Access to general education curriculum-integrating academic
FunctionalityFunctional skills- immediately useful to a student, frequently required in school and non-school environments, results in less dependence on othersAllows student to participate in less restrictive environments Ex. Dressing oneself, prepare a snack, ride a public bus, purchase items from coin-operated vending machine, recognize common sight words in community setting (man, woman, stop, walk)Should employ authentic materials
Communication Skills Communication must “work”; that is be functional
for the child by influencing the behavior or others. Communication Functions:
Name objects, people, activities Tell people what to do Secure help Convey social pleasantries (“Hi”; “Bye”) Convey interest in an activity Protest Convey emotional or physical state Make a choice Request and/or report information
Naturalistic Teaching Strategies: Mand- verbal instruction that cues students to perform a
behavior that they may know how to perform, but do not do Ex. Teacher blocks access to water, teacher obtains
attention then says (mand) “Tell me what you want”, student complies, then gets water and praise
Mand-Prompt- teacher mands, as stated above, but also prompts student
Ex. Teacher blocks water access, teacher obtains students attention and mands, student does not comply teacher provides prompt by saying “Water” or “I want water”, gain attention and repeat man-prompt-wait sequence no more than three times, then give access to water(reinforce) so student is not discouraged from asking for water again (another teachable moment)
Model- student can perform a behavior but hesitates to do so, teacher may dispense with mands and just model the correct behavior for students to imitate (peer buddy)
Make sure all students have prerequisite skills Encourage students to listen and watch other
group members, praise them for doing so Make instruction interesting by keeping individual
turns short, give all members turns Active student response- choral responding,
response cards Teach at a lively pace with brief intertrial intervals Involve all members by using multilevel instruction Use partial participation/material adaptations Keeping waiting time to a minimum Promote cooperation
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 consistentbe knowledgeable about one-to-one and small group instructional formatsbe able to work cooperatively with other teachers and related service professionalsmaintain accurate records and constant planning for future needs of studentsbe sensitive to small changes in behaviorbe consistent and persistent in evaluating and changing instruction to improve learning and behaviorWorking with students who require instruction at its very best can be highly rewarding to teachers:The effective teacher is consistent and persistent in evaluating and changing instruction to improve learning and behaviorWorking with students who require instruction at its very best can be highly rewarding to teachers