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Disability Definitions

The Ohio Coalition for the Education of Children with Disabilities has put together an extensive list of definitions and their descriptions. To start your research, click on a disability from the options below: 

AD/HD

The essential feature of Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development. (DSMIV-TR) 

Autism

Autism means a developmental disability significantly affecting verbal and non-verbal communication and social interactions, generally evident before age three that adversely affects a child's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in routine, and unusual responses to sensory experiences. The term does not apply if a child's educational performance is adversely affected primarily because the child has a serious emotional disturbance, as defined in paragraph (b) (9) of Federal Regulation 34 CFR 300.7.

What Causes Autism?

There is no known single cause for autism, but it is generally accepted that it is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brains of children with and without autism. Researchers are investigating a number of theories, including the link between heredity, genetics and medical problems. In many families, there appears to be a pattern of autism or related disabilities, further supporting a genetic basis to the disorder. While no one gene has been identified as causing autism, researchers are searching for irregular segments of genetic code that children with autism may have inherited. It also appears that some children are born with a susceptibility to autism, but researchers have not yet identified a single "trigger" that causes autism to develop. Other researchers are investigating the possibility that under certain conditions, a cluster of unstable genes may interfere with brain development resulting in autism. Still other researchers are investigating problems during pregnancy or delivery as well as environmental factors such as viral infections, metabolic imbalances, and exposure to environmental chemicals.

How is Autism Diagnosed?

There is no test for diagnosing autism. A child can be identified for educational purposes by the local school districts Multifactored Evaluation Team (MFE) for the provision of special education services under the IDEA. Doctors can diagnose children with autism according to the definition in the DSM IV that lists characteristics that must be present for the diagnosis. Many school districts require a diagnosis from outside professionals (doctors, psychologists, psychiatrists, pediatricians. etc..) to support their educational identification, but IDEA does not require it.

Sometimes identifiable symptoms are present in children early as 18 months of age and research indicates that early intervention improves outcomes so that early diagnosis is encouraged. As with many medical conditions, many symptoms can be shared with other conditions and disabilities so that continued assessment and observation is warranted.

How Common is Autism?

Autism is the most common of the Pervasive Developmental Disorders, affecting an estimated 1 in 250 births (Centers for Disease Control and Prevention, 2003). This means that as many as 1.5 million Americans today are believed to have some form of autism. And that number is on the rise. Based on statistics from the U.S. Department of Education and other governmental agencies, autism is growing at a rate of 10-17 percent per year. The overall incidence of autism is consistent around the globe, but is four times more prevalent in boys than girls. Autism knows no racial, ethnic, or social boundaries, and family income, lifestyle, and educational levels do not affect the chance of autism's occurrence.

What are the Characteristics of Autism?

Autism is a spectrum disorder. The symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe. Although autism is defined by a certain set of characteristics, children and adults can exhibit any combination in any degree of severity. Two children, both with the same diagnosis, can act very differently from one another and have varying skills and needs. Every person with autism is an individual, and like all individuals, has a unique personality and combination of characteristics. Some individuals mildly affected may exhibit only slight delays in language and greater challenges with social interactions. The person may have difficulty initiating and/or maintaining a conversation. Communication is often described as talking at others (for example, monologue on a favorite subject that continues despite attempts by others to interject comments). Children with autism process and respond to information in unique ways. In some cases, aggressive and/or self-injurious behavior may be present. Children with autism may also exhibit some of the following traits.

  • Insistence on sameness; resistance to change
  • Difficulty in expressing needs; uses gestures or pointing instead of words
  • Repeating words or phrases in place of normal, responsive language
  • Tantrums
  • Little or no eye contact
  • Sustained odd play
  • Spins objects
  • Inappropriate attachments to objects
  • Apparent over-sensitivity or under-sensitivity to pain
  • No real fears of danger
  • Noticeable physical over-activity or extreme under-activity
  • Uneven gross/fine motor skills
  • Not responsive to verbal cues; acts as if deaf although hearing tests in normal range.

Deaf-blindness

Deaf-blindness is defined by the Individuals with Disabilities Education Act as a "concomitant hearing and visual impairments, the combination of which causes such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness."

The term deafblindness does NOT mean a child must be completely unable to see or hear. The term refers to the combination of visual and hearing impairments that serve to impair a child's ability to communicate and to learn to the extent that specialized instruction is required to support the child's education.

The range of vision and hearing that children with the designation deafblind have is great. Some with have more vision that hearing and others more hearing than vision. Most will have sufficient vision to move about in their environment and to recognize faces. Most will have enough hearing to recognize familiar sounds and develop speech themselves.

There are a number of syndromes that are rare that have combined visual and hearing impairment as aspects of the disorder. They include: Alport Syndrome, Congenital Rubella Syndrome, Cytomegalovirus (CMV), CHARGE Association, Down Syndrome, Marshall Syndrome, Rubella Syndrome, Stickler Syndrome.

Emotional Disturbances

Adapted from NICHCY

Under IDEA

an emotional disability refers to a mental illness that interferes with a child's learning and can't be explained by other factors. Some state have referred to this condition as a "behavior disorder."

For the purpose of the Individuals with Disabilities Education Act, an emotional disturbance is defined as "a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance:

  • An inability to learn that cannot be explained by intellectual, sensory, or health factors.
  • An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.
  • Inappropriate types of behavior or feelings under normal circumstances.
  • A general pervasive mood of unhappiness or depression.
  • A tendency to develop physical symptoms or fears associated with personal or school problems.

The term includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance."

What are the Characteristics of Emotional Disturbance?

The causes of emotional disturbance have not been adequately determined. Although various factors such as heredity, brain disorder, diet, stress, and family functioning have been suggested as possible causes, research has not shown any of these factors to be the direct cause of behavior or emotional problems. Some of the characteristics and behaviors seen in children who have emotional disturbances include:

  • Hyperactivity (short attention span, impulsiveness);
  • Aggression/self-injurious behavior (acting out, fighting);
  • Withdrawal (failure to initiate interaction with others; retreat from exchanges of social interaction, excessive fear or anxiety);
  • Immaturity (inappropriate crying, temper tantrums, poor coping skills);
  • Learning difficulties (academically performing below grade level).

Children with the most serious emotional disturbances may exhibit distorted thinking, excessive anxiety, bizarre motor acts, and abnormal mood swings. Some are identified as children who have a severe psychosis or schizophrenia.

Many children who do not have emotional disturbances may display some of these same behaviors at various times during their development. However, when children have an emotional disturbance, these behaviors continue over long periods of time. Their behavior thus signals that they are not coping with their environment or peers.

How Common Is Emotional Disturbance?

In the 2000-2001 school year, 473,663 children and youth with an emotional disturbance were provided special education and related services in the public schools (Twenty-fourth Annual Report to Congress, U.S. Department of Education, 2002).


What are the Educational Implications?

The educational programs for children with an emotional disturbance need to include attention to providing emotional and behavioral support as well as helping them to master academics, develop social skills, and increase self-awareness, self-control, and self-esteem. A large body of research exists regarding methods of providing students with positive behavioral support (PBS) in the school environment, so that problem behaviors are minimized and positive, appropriate behaviors are fostered. (See the resource list at the end of this publication for more information on PBS.) It is also important to know that, within the school setting:

  • For a child whose behavior impedes learning (including the learning of others), the team developing the child's Individualized Education Program (IEP) needs to consider, if appropriate, strategies to address that behavior, including positive behavioral interventions, strategies, and supports.
  • Students eligible for special education services under the category of emotional disturbance may have IEPs that include psychological or counseling services. These are important related services which are available under law and are to be provided by a qualified social worker, psychologist, guidance counselor, or other qualified personnel.
  • Career education (both vocational and academic) is also a major part of secondary education and should be a part of the transition plan included in every adolescent's IEP.

There is growing recognition that families, as well as their children, need support, respite care, intensive case management, and a collaborative, multi-agency approach to services. Many communities are working toward providing these wrap-around services. There are a growing number of agencies and organizations actively involved in establishing support services in the community.


Gifted

Children who are gifted can also have a disability that hinders their success unless proper interventions are provided. These twice-exceptional children may receive special-education services, but gifted services are often not even considered. (Ohio Gifted Task Force, 2002). 

Hearing Impairment

A hearing impairment is defined by the Individuals with Disabilities Education Act (IDEA) as "an impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance but that is not included under the definition of deafness. Deafness is defined as: a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification, that adversely affects a child's educational performance

Types of Hearing Loss

There are four basic types of hearing loss:

  1. Conductive hearing loss

    Conductive hearing loss occurs when sound waves are not transmitted effectively to the inner ear because of some interference in:

    • The external ear canal;
    • The mobility of the eardrum which can be caused by the accumulation of fluid in the eustachian tube which connects the middle ear to the back of the throat;
    • The three tiny bones inside the middle ear;
    • The middle-ear cavity;
    • The openings into the inner ear;
    • The eustachian tube;
  2. Modern techniques make it possible to cure or to improve many cases involving problems with the outer or middle ear. Individuals with conductive hearing loss can often benefit greatly from medical intervention and/or the use of a hearing aid.

  3. Sensorineural hearing loss

    With the sensorineural hearing loss, the damage lies in the inner ear, the auditory nerve, or both.

    The cochlear, which is the innermost portion of the ear, has approximately 30,000 hearing nerve endings (hair cells). The hair cells in the large end of the cochlea respond to very high-pitched sounds, and those in the small end (and throughout much of the rest of the cochlea) respond to low-pitched sounds. These hair cells, and the nerve that connects them to the brain, are susceptible to damage from a variety of causes.

    • When there is damage to any part of the cochlea, the term "sensory" hearing loss is used.
    • "Neural" hearing loss is the correct term to use when the damage is to the auditory nerve, anywhere between its fibers at the base of the hair cells and the relay stations in the brain.
  4. Central hearing loss

    In central hearing loss, the problem lies in the central nervous system, at some point within the brain. Comprehending speech is a complex task. Some people can hear volume perfectly well, but have trouble understanding what is being said. Although information about central hearing loss is accumulating, it remains somewhat a mystery in otology (the medical specialty of ear medicine and surgery).

    A condition called central auditory processing disorder frequently leads people to think they have hearing loss when their hearing sensitivity is actually normal. Despite the fact that this problem is extremely common and present in many highly successful people, it can present challenges in a classroom environment.

  5. Mixed hearing loss

    A mixed hearing loss occurs when an individual has both a conductive and sensorineural hearing loss in the same ear.

Functional Deafness

This type of hearing loss is a result of perceptual deficits rather than a physiological cause, and can be the result of an emotional trauma. Hearing Loss in One Ear (Unilateral Hearing Loss)

A unilateral hearing loss refers to hearing loss in one ear only which can range from mild to total hearing loss in that ear. In the case of a unilateral hearing loss, a child can hear well in most situations. Problems may be experienced in the following instances, however:

  • Hearing sounds directed at the affected ear
  • Localizing the source of sounds that are hear
  • Understanding speech in a noisy background (this is more problematic if the good ear is close to the noise.

A unilateral hearing loss can impact a child's school performance. There is research that shows that 25%-35% of children with unilateral hearing loss are a risk for failing a grade in school. They may show a limited attention span, be distractible or experience fatigue as the school day progresses. A child's teacher should always be made aware of a unilateral hearing loss so that necessary accommodations can be made and the child's performance can be monitored.


Modes of Communication

Communication access is the foundation for learning. Students with hearing impairment will develop their mode of communication within their family unit. This may be a manual form of communication such as American Sign Language or a variant of oral communication. Both require training and support for the parents and child. According to the Operating Standards for Ohio's Schools Serving Students with Disabilities, parents of students with hearing impairments can choose their child's mode of communication for educational purposes. This decision is included in the child's Individual Education Program and becomes the language of instruction for that student.

There are two main communication modes and the decision regarding the use of each is based on a number of factors including degree of hearing loss, age of the onset of the hearing loss, parental choices, and learning styles.

Strategies available to Deaf/hard of hearing students can be broken down into two general categories.

  • Sign Language
  • Speech/Oral Communication

Signed speech can include:

ASL (American Sign Language)
is a communication system that incorporates the use of the hands, arms, body and face to produce a language with its own grammar and linguistic rules.

MCE (Manually Coded English)
is a mixed language system used in communication between Deaf and hearing individuals where some signs may be compromised when there is no ASL equivalent to the spoken word or vice versa. It was developed to code English word order, syntax and grammar. While it was developed to ease the transition from written English to speech, it does not keep up with spoke English as ASL does.

Cued Speech
A system of phonemically-based handshapes used to supplement speechreading. It uses eight handshapes to represent consonants and four positions on the face to signify vowels to aid speechreaders in distinguishing between words that look the same on the lips such as pat and mat.
Speech/Oral Communication

This refers to the use of speechreading and auditory cues for English communication. For Deaf individuals who have very little auditory ability, oral communication requires extensive training and speech therapy. Only 30-40% of all speech sounds can be read on the lips and a number of common conditions impede the process of speechreading, including: poor lighting, use of unfamiliar names or words, rapid speech, overlapping speakers, etc.

Every student has his/her own unique needs. Many hard of hearing students will rely on speech/oral and text communication with the assistance of a hearing aid and/or other assistive technology and through the use of speechreading. These individuals may or may not choose sign language as their mode of communication. Students with moderate hearing loss (65-95 decibels) or a profound loss (over 95 decibels) are more likely to use sign language, although some individuals with moderate and profound loss will choose oral communication. There are schools for the Deaf that focus on oral communication. Two such schools in Ohio are Ohio Valley Voices and St. Rita's School for the Deaf.


Hearing Aids

Hearing aids: Proper functioning of hearing aids is addressed in Title 34, Code of Federal Regulations: Sec. 300.303 Proper functioning of hearing aids which reads: "Each public agency shall ensure that the hearing aids worn in school by children with hearing impairments, including deafness, are functioning properly. (Authority: 20 U.S.C. 1412(a)(1))" Local school district do not usually provide hearing aids for students, however, they bear the responsibility of ensuring that a child's hearing aids are in proper functioning order.


Classroom Supports For Students With Hearing Impairments
  1. Interpreter Services

    Ohio's deaf and hard of hearing students often require the services of a qualified educational interpreter to gain access to and benefit from participation in the general education curriculum. Under IDEA, parents have the right to choose a child's mode of communication and the school has a responsibility to address that need. Parents may request American Sign Language, Manually Coded English or an oral program for their child. If interpreter services are required to support a student in classes or in extracurricular activities sponsored by the school district, the district is responsible for providing the services.

    "Interpreter services includes assisting learners with hearing impairments and deaf learners by providing interpretation in English and American Sign Language, transliteration in a manual form of coded English or other coded forms of English." [Sec. 3301-51-01(JJ)(h) Operating Standard for Ohio's Schools Serving Student To find out about interpreter services and requirements for interpreters, parents may contact the Interpreter and Sign Language Resource Center, Ohio School for the Deaf at 614-995-1566.

  2. Assistive Technologies in the Classroom

    A range of assistive technologies can be used in the classroom to support the education of students with hearing impairments.

Other technologies used in the classroom would be identified by the IEP team and can include:

Captioned Media
Captioned Media is a free service funded by the U.S. Department of Education that loans captioned videos and DVD's to deaf and hard of hearing individuals, their families and teachers, interpreters and anyone who works with deaf or hard of hearing persons. There are no charges for postage. A catalog of available items is available on the internet of by catalog. The user must register and request an account to participate.

The Sound Field System
A sound field system consists of a microphone that the teacher uses that is connected to speakers mounted in the room to help students hear the teacher above the ambient classroom noise. They can be important for some students with mild hearing impairments and in improving the achievement of other children in the classroom. Some research has been done regarding sound field systems. Following is the introduction to Sound Field Systems by two researchers.

Rehabilitation Engineering Research on Hearing Enhancement
Classroom sound-field systems are basically Public Address (PA) systems with the inclusion of a wireless microphone. As the teacher talks into the microphone his/her voice is transmitted to a specialized receiver/amplifier that is connected to, or physically a component of, a loudspeaker assembly. The loudspeakers may be located in the ceiling, on the walls around the room, or at the room corners. Whatever arrangement is used, the purpose of the system is to ensure that the teacher's voice is clearly audible above the background sounds at all instructional locations within the room. Research has shown that in the average classroom, the teacher's voice usually arrives at the children at a level only 6 dB or so above the background sounds. (Mark Ross, Ph.D. and Harry Levitt, Ph.D., retrieved, February 4, 2005)

FM System
FM or frequency modulated systems, also called auditory trainers, consist of a microphone that the teacher uses to transmit his/her voice directly to a student who is using a receiver. The receiver can be a small amplifier at the student's desk, or to headphones or transmitted directly to the student's hearing aid. Wherever the teacher stands or the direction the teacher faces, the student is able to hear the teacher's voice at the same level above ambient room noise.

CART
Communication Access Realtime Translation (CART) is a transcription system that provides a word-for-word translation of everything that is said is settings such as courtroom, classrooms, churches, meetings or conferences. CART captions can be displayed on a computer for one person to read, or it can be projected to a large screen or broadcast via satellite or the internet. A trained transcriber must be used to provide this service.

TypeWell
TypeWell is a transcription system that is used as a realtime communication access or notetaking service provided by a TypeWell-trained transcriber. The transcriber does not Type word-for-word, but is trained to capture the meaing of what is said as weel as how it is said. Students read on a computer the notes as the transcriber writes. Students can also type questions and comments to the transcriber for clarification. Transcriber notes can be used as notes after the class.

Voice-to Text-to-Sign Language Technologies
Voice-to and Text-to-Sign Language technologies offer the promise of real time sign language interpretation using technology, however, the accuracy of the interpretation is not high enough for consistent use at this time. All of these products, whether voice-to-text or voice-to-sign language depend upon voice recognition and the software programs must be trained for a specific speaker. Accuracy rates are higher in a quiet environment limiting practical application classroom.
Cochlear Implants

A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard of hearing. The implant is surgically placed under the skin behind the ear.

An implant has four basic parts: microphone, which picks up sound from the environment; a speech processor, which selects and arranges sounds picked up by the microphone; a transmitter and receiver/stimulator, which receive signals from the speech processor and convert them into electric impulses; and electrodes, which collect the impulses from the stimulator and send them to the brain.

More children with hearing losses are getting cochlear implants at early ages each year. A student's IEP team must consider the special needs of a child with a hearing loss who has a cochlear implant, whether they be continued interpreter services, auditory training support, and/or tutoring services for academic subjects. Each child's needs will be different.

An implant does not restore or create normal hearing. Instead, under the appropriate conditions, it can give a deaf person a useful auditory understanding of the environment and help him or her to understand speech.

Cognitive Disability

Intellectual disability (used to be Cognitive Disability) is a term used when a person has certain limitations in mental functioning and in skills such as communicating, taking care of themselves-, and social skills. These limitations will cause a child to learn and develop more slowly than a typical child. Children with intellectual disabilities may take longer to learn to speak, walk, and take care of their personal needs such as dressing or eating. They are likely to have trouble learning in school. They will learn, but it will take them longer. There may be some things they cannot learn.

What Causes Intellectual Disability?

Doctors have found many causes of intellectual disabilities. The most common are:

  • Genetic conditions. Sometimes an intellectual disability is caused by abnormal genes inherited from parents, errors when genes combine, or other reasons. Examples of genetic conditions are Down syndrome, fragile X syndrome, and phenylketonuria (PKU).
  • Problems during pregnancy. Intellectual disabilities can result when the baby does not develop inside the mother properly. For example, there may be a problem with the way the baby's cells divide as it grows. A woman who drinks alcohol or gets an infection like rubella during pregnancy may also have a baby with intellectual disabilities.
  • Problems at birth. If a baby has problems during labor and birth, such as not getting enough oxygen, they may have an intellectual disability.
  • Health problems. Diseases like whooping cough, the measles, or meningitis can cause intellectual disabilities.  This can also be caused by extreme malnutrition (not eating right), not getting enough medical care, or by being exposed to poisons like lead or mercury.

An intellectual disability is not a disease. You can't catch an intellectual disability from anyone.  It is also not a type of mental illness, like depression. There is no cure for an intellectual disability. However, most children with this disability can learn to do many things. It just takes them more time and effort than other children.

How is an Intellectual Disability Diagnosed?

Intellectual Disabilities are diagnosed by looking at two main things. These are:

  • the ability of a person's brain to learn, think, solve problems, and make sense of the world (called IQ or intellectual functioning); and
  • whether the person has the skills they need to live independently (called adaptive behavior, or adaptive functioning).

Intellectual functioning, or IQ, is usually measured by a test called an IQ test. The average score is 100. People scoring below 70 to 75 are thought to have an intellectual disability. To measure adaptive behavior, professionals look at what a child can do in comparison to other children of their age. Certain skills are important to adaptive behavior. These are:

  • daily living skills, such as getting dressed, going to the bathroom, and feeding one's self;
  • communication skills, such as understanding what is said and being able to answer;
  • social skills with peers, family members, adults, and others.

To diagnose an intellectual disability, professionals look at the person's mental abilities (IQ) and their adaptive skills. Both of these are highlighted in the definition of intellectual disability provided between the lines below. This definition comes from the Individuals with Disabilities Education Act (IDEA). The IDEA is the federal law that guides how schools provide early intervention and special education and related services to children with disabilities.

Providing services to help individuals with intellectual disabilities has led to a new understanding of how we define this disability. After the initial diagnosis is made, we look at a person's strengths and weaknesses. We also look at how much support or help the person needs to get along at home, in school, and in the community. This approach gives a realistic picture of each individual. It also recognizes that the "picture" can change. As the person grows and learns, their ability to get along in the world grows as well.

IDEA's Definition of "Intellectual Disability"

Our nation's special education law, the IDEA, defines a intellectual disability as "significantly subaverage general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child's educational performance." [34 Code of Federal Regulations §300.7(c)(6)]

How Common is an Intellectual Disability?

As many as 3 out of every 100 people in the country have an intellectual disability (The Arc, 2001). Nearly 613,000 children ages 6 to 21 have some level of a intellectual disability and need special education in school (Twenty-fourth Annual Report to Congress, U.S. Department of Education, 2002). In fact, 1 out of every 10 children who need special education has some form of intellectual disability.

What Are the Signs of Intellectual Disability)?

There are many signs of intellectual disability. For example, children with this disability may:

  • sit up, crawl, or walk later than other children;
  • learn to talk later, or have trouble speaking,
  • find it hard to remember things,
  • not understand how to pay for things,
  • have trouble understanding social rules,
  • have trouble seeing the consequences of their actions,
  • have trouble solving problems, and/or
  • have trouble thinking logically.

About 87% of people with intellectual disabilities will only be a little slower than average in learning new information and skills. When they are children, their limitations may not be obvious. They may not even be diagnosed as having an intellectual disability until they get to school. As they become adults, many people with this disability can live independently. Other people may not even consider them as having a disability. The remaining 13% of people with an intellectual disability score below 50 on IQ tests. These people will have more difficulty in school, at home, and in the community. A person with more severe intellectual disability will need more intensive support their entire life. Every child with this disability is able to learn, develop, and grow. With help, all children with an intellectual disability can live a satisfying life.

Multiple Disabilities

Adapted from NICHCY

The Individual with Disabilities Education Act defines multiple disabilities as: 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.

People with severe disabilities are those who traditionally have been labeled as having severe to profound mental retardation. These people require ongoing, extensive support in more than one major life activity in order to participate in integrated community settings and enjoy the quality of life available to people with fewer or no disabilities. They frequently have additional disabilities, including movement difficulties, sensory losses, and behavior problems.

What is the Incidence of Multiple Disabilities?

In the 2000-2001 school year, the states reported to the U.S. Department of Education that they were providing services to 112,559 students with multiple disabilities (U.S. Department of Education, Twenty-fourth Annual Report to Congress, 2002).


What are the Characteristics?

People with severe or multiple disabilities may exhibit a wide range of characteristics, depending on the combination and severity of disabilities, and the person's age. There are, however, some traits they may share, including:

  • Limited speech or communication;
  • Difficulty in basic physical mobility;
  • Tendency to forget skills through disuse;
  • Trouble generalizing skills from one situation to another; and/or
  • A need for support in major life activities (e.g., domestic, leisure, community use, vocational).

Medical Implications of Multiple Disabilities

A variety of medical problems may accompany severe disabilities. Examples include seizures, sensory loss, hydrocephalus, and scoliosis. These conditions should be considered when establishing school services. A multi-disciplinary team consisting of the student's parents, educational specialists, and medical specialists in the areas in which the individual demonstrates problems should work together to plan and coordinate necessary services.


Educational Implications of Multiple Disabilities

In the past, students with severe and/or multiple disabilities were routinely excluded from public schools. Since the implementation of Public Law 94-142 (the Education of the Handicapped Act, now called the Individuals with Disabilities Education Act, or IDEA), public schools now serve large numbers of students with severe and/or multiple disabilities. Educational programming is likely to begin as early as infancy. At that time, as well as later on, the primary focus is upon increasing the child's independence.

In order to be effective, educational programs need to incorporate a variety of components to meet the considerable needs of individuals with severe and/or multiple disabilities. Programs should assess needs in four major areas: domestic, leisure/recreational, community, and vocational. These assessments enable the identification of functional objectives (objectives which will result in the learner's increased skill and independence in dealing with the routine activities of his/her life). Instruction should include: Expression of choice; communication; functional skill development; and age-appropriate social skills training.

Related services are of great importance, and the multidisciplinary approach is crucial. Appropriate people such as speech and language therapists, physical and occupational therapists, and medical specialists need to work closely with classroom teachers and parents. Because of problems with skill generalization, related services are best offered during the natural routine in the school and community rather than removing a student from class for isolated therapy.

Frequently, classroom arrangements must take into consideration students' needs for medications, special diets, or special equipment. Adaptive aids and equipment enable students to increase their range of functioning. For example, in recent years computers have become effective communication devices. Other aids include: wheelchairs, typewriters, headsticks (head gear), clamps, modified handles on cups and silverware, and communication boards. Computerized communication equipment and specially built vocational equipment also play important roles in adapting working environments for people with serious movement limitations.

Integration with nondisabled peers is another important component of the educational setting. Attending the same school and participating in the same activities as their nondisabled peers are crucial to the development of social skills and friendships for people with severe disabilities. Integration also benefits nondisabled peers and professionals through positive attitude change. People with severe disabilities are those who traditionally have been labeled as having severe to profound mental retardation. These people require ongoing, extensive support in more than one major life activity in order to participate in integrated community settings and enjoy the quality of life available to people with fewer or no disabilities. They frequently have additional disabilities, including movement difficulties, sensory losses, and behavior problems.

Orthopedic Impairment

The following information was retrieved from the United Cerebral Palsy of Cleveland, Ohio.

Orthopedical disabilities affect body movement and muscle coordination. These conditions can be caused by damage to specific areas of the brain or other conditions or diseases affecting muscles, nerves or tissues. Orthopedic conditions may or may not be present with other disabilities. Cerebral palsy is an umbrella term for those conditions caused as a result of damage to the brain.

Cerebral palsy describes a group of chronic conditions affecting body movement and muscle coordination. It is caused by damage to one or more specific areas of the brain, usually occurring during fetal development; before, during, or shortly after birth; or during infancy. Thus, these disorders are not caused by problems in the muscles or nerves. Instead, faulty development or damage to motor areas in the brain disrupt the brain's ability to adequately control movement and posture.

"Cerebral" refers to the brain and "palsy" to muscle weakness/poor control. Cerebral palsy itself is not progressive (i.e. brain damage does not get worse); however, secondary conditions, such as muscle spasticity, can develop which may get better over time, get worse, or remain the same. Cerebral palsy is not communicable. It is not a disease and should not be referred to as such. Although cerebral palsy is not "curable" in the accepted sense, training and therapy can help improve function.

History

In the 1860s, an English surgeon named William Little wrote the first medical descriptions of a puzzling disorder that affected children in the first years of life, causing stiff, spastic muscles in their legs and to a lesser degree, their arms. These children had difficulty grasping objects, crawling, and walking. They did not get better as they grew up nor did they become worse. Their condition, which was called Little's disease for many years, is now known as spastic diplegia. It is one of several disorders that affect control of movement due to developmental brain injury and are grouped together under the term cerebral palsy.

Because it seemed that many of these children were born following premature or complicated deliveries, Little suggested their condition resulted from a lack of oxygen during birth. He proposed this oxygen shortage damaged sensitive brain tissues controlling movement. But in 1897, the famous psychiatrist Sigmund Freud disagreed. Noting that children with cerebral palsy often had other problems such as mental retardation, visual disturbances, and seizures, Freud suggested that the disorder might sometimes have roots earlier in life, during the brain's development in the womb. "Difficult birth, in certain cases," he wrote, "is merely a symptom of deeper effects that influence the development of the fetus."

Despite Freud's observation, the belief that birth complications cause most cases of cerebral palsy was widespread among physicians, families, and even medical researchers until very recently. In the 1980s, however, scientists analyzed extensive data from a government study of more than 35,000 births and were surprised to discover that such complications account for only a fraction of cases--probably less than 10 percent. In most cases of cerebral palsy, no cause of the factors explored could be found. These findings from the National Institute of Neurological Disorders and Stroke (NINDS) perinatal study have profoundly altered medical theories about cerebral palsy and have spurred researchers to explore alternative causes.

What are the effects?

Cerebral palsy is characterized by an inability to fully control motor function, particularly muscle control and coordination. Depending on which areas of the brain have been damaged, one or more of the following may occur: muscle tightness or spasticity; involuntary movement; disturbance in gait or mobility, difficulty in swallowing and problems with speech. In addition, the following may occur: abnormal sensation and perception; impairment of sight, hearing or speech; seizures; and/or mental retardation. Other problems that may arise are difficulties in feeding, bladder and bowel control, problems with breathing because of postural difficulties, skin disorders because of pressure sores, and learning disabilities.

What are the causes?

Cerebral palsy is not a disorder with a single cause, like chicken pox or measles. It is a group of disorders with similar problems in control of movement, but probably with a variety of causes.


Congenital cerebral palsy results from brain injury during intra-uterine life. It is present at birth, although it may not be detected for months. It is responsible for about 70% of children who have cerebral palsy. An additional 20 % are diagnosed with congenital cerebral palsy due to a brain injury during the birthing process. In most cases, the cause of congenital cerebral palsy is unknown.

On the other hand, in the United States, about 10 percent of children who have cerebral palsy acquire the disorder after birth. (The figures are higher in underdeveloped countries.) Acquired cerebral palsy results from brain damage in the first few months or years of life and can follow brain infections, such as bacterial meningitis or viral encephalitis, or the results of head injury -- most often from a motor vehicle accident, a fall, or child abuse.

A large number of factors, which can injure the developing brain, may produce cerebral palsy. A risk factor is not a cause; it is a variable which, when present, increases the chance of something occurring -- in this case, cerebral palsy. Just because a risk factor is present does not mean cerebral palsy WILL occur; nor does the absence of a risk factor mean that cerebral palsy will NOT occur. If a risk factor is present, it serves to alert parents and physicians to be even more observant to the infant's development.

Risk factors for cerebral palsy include the following: premature birth; low birth weight; inability of the placenta to provide the developing fetus with oxygen and nutrients; lack of growth factors during intra-uterine life; RH or A-B-O blood type incompatibility between mother and infant; infection of the mother with German measles or other viral diseases in early pregnancy; bacterial infection of the mother, fetus or infant that directly or indirectly attack the infant's central nervous system; prolonged loss of oxygen during the birthing process and severe jaundice shortly after birth.

Are there different types of cerebral palsy?

Yes. Spastic diplegia, the disorder first described by Dr. Little in the 1860s, is only one of several disorders called cerebral palsy. Today doctors classify cerebral palsy into three principal categories-spastic, athetoid, and ataxic,-according to the type of movement disturbance. A fourth category can be a mixture of these types for any individual.


Spastic cerebral palsy. In this form of cerebral palsy, which affects 70 to 80 percent of patients, the muscles are stiffly and permanently contracted. Doctors will often describe which type of spastic cerebral palsy a patient has based on which limbs are affected, i.e spastic diplegia (both legs) or left hemi-paresis (the left side of the body). The names given to these types combine a Latin description of affected limbs with the term plegia or paresis, meaning paralyzed or weak. In some cases, spastic cerebral palsy follows a period of poor muscle tone (hypotonia) in the young infant.


Athetoid, or dyskinetic cerebral palsy. This form of cerebral palsy is characterized by uncontrolled, slow, writhing movements. These abnormal movements usually affect the hands, feet, arms, or legs and, in some cases, the muscles of the face and tongue, causing grimacing or drooling. The movements often increase during periods of emotional stress and disappear during sleep. Patients may also have problems coordinating the muscle movements needed for speech, a condition known as dysarthria. Athetoid cerebral palsy affects about 10 to 20 percent of patients.


Ataxic cerebral palsy. This rare form affects the sense of balance and depth perception. Affected persons often have poor coordination; walk unsteadily with a wide-based gait, placing their feet unusually far apart; and experience difficulty when attempting quick or precise movements, such as writing or buttoning a shirt. They may also have intention tremor. In this form of tremor, beginning a voluntary movement, such as reaching for a book, causes a trembling that affects the body part being used and that worsens as the individual gets nearer to the desired object. The ataxic form affects an estimated 5 to 10 percent of cerebral palsy patients.


Mixed forms. It is not unusual for patients to have symptoms of more than one of the previous three forms. The most common mixed form includes spasticity and athetoid movements but other combinations are also possible.


What are the early signs?

Early signs of cerebral palsy usually appear before 18 months of age, and parents are often the first to suspect that their infant is not developing motor skills normally. Infants with cerebral palsy are frequently slow to reach developmental milestones, such as learning to roll over, sit, crawl, smile, or walk. This is sometimes called developmental delay.

Some affected children have abnormal muscle tone. Decreased muscle tone is called hypotonia; the baby may seem flaccid and relaxed, even floppy. Increased muscle tone is called hypertonia, and the baby may seem stiff or rigid. In some cases, the baby has an early period of hypotonia that progresses to hypertonia after the first 2 to 3 months of life. Affected children may also have unusual posture or favor one side of their body. Parents who are concerned about their baby's development for any reason should contact their physician, who can help distinguish normal variation in development from a developmental disorder.


How is cerebral palsy diagnosed?

Doctors diagnose cerebral palsy by testing an infant's motor skills and looking carefully at the mother's and infant's medical history. In addition to checking for those symptoms described above -- slow development, abnormal muscle tone, and unusual posture -- a physician also tests the infant's reflexes and looks for early development of hand preference.

Reflexes are movements that the body makes automatically in response to a specific cue. For example, if a newborn baby is held on its back and tilted so the legs are above its head, the baby will automatically extend its arms in a gesture, called the Moro reflex, that looks like an embrace. Babies normally lose this reflex after they reach 6 months, but those with cerebral palsy may retain it for abnormally long periods. This is just one of several reflexes that a physician can check.

Doctors can also look for hand preference-a tendency to use either the right or left hand more often. When the doctor holds an object in front and to the side of the infant, an infant with hand preference will use the favored hand to reach for the object, even when it is held closer to the opposite hand. During the first 12 months of life, babies do not usually show hand preference. But infants with spastic hemiplegia, in particular, may develop a preference much earlier, since the hand on the unaffected side of their body is stronger and more useful.

The next step in diagnosing cerebral palsy is to rule out other disorders that can cause movement problems. Most important, doctors must determine that the child's condition is not getting worse. Although its symptoms may change over time, cerebral palsy by definition is not progressive. If a child is continuously losing additional motor skills, the problem more likely springs from elsewhere-including genetic diseases, muscle diseases, disorders of metabolism, or tumors in the nervous system. The child's medical history, special diagnostic tests, and, in some cases, repeated check-ups can help confirm that other disorders are not at fault.

The doctor may also order specialized tests to learn more about the possible cause of cerebral palsy. One such test is computed tomography, or CT, a sophisticated imaging technique that uses X rays and a computer to create an anatomical picture of the brain's tissues and structures. A CT scan may reveal brain areas that are underdeveloped, abnormal cysts (sacs that are often filled with liquid) in the brain, or other physical problems. With the information from CT scans, doctors may be better equipped to judge the long-term outlook for an affected child.

Magnetic resonance imaging, or MRI, is a more recent brain imaging technique that is rapidly gaining widespread use for identifying brain disorders. This technique uses a magnetic field and radio waves, rather than X rays. MRI gives better pictures of structures or abnormal areas located near bone than CT.

A third test that can expose problems in brain tissues is ultrasonography. This technique bounces sound waves off the brain and uses the pattern of echoes to form a picture, or sonogram, of its structures. Ultrasonography can be used in infants before the bones of the skull harden and close. Although it is less precise than CT and MRI scanning, this technique can detect cysts and structures in the brain, is less expensive, and does not require long periods of immobility.

Finally, physicians may want to look for other conditions that are linked to cerebral palsy, including seizure disorders, mental impairment, and vision or hearing problems.

When the doctor suspects a seizure disorder, an electroencephalogram, or EEG, may be ordered. An EEG uses special patches called electrodes placed on the scalp to record the electrical currents inside the brain. This recording can help the doctor see telltale patterns in the brain's electrical activity that suggest a seizure disorder.


How many people have cerebral palsy?

It is estimated that some 764,000 children and adults in the United States manifest one or more of the symptoms of cerebral palsy. Currently, about 8,000 babies and infants are diagnosed with the condition each year. In addition, some 1,200 - 1,500 preschool age children are recognized each year to have cerebral palsy.

Other Health Impairments Disabilities

http://www.parentcenterhub.org/repository/categories/#ohi

…means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that—

(a) is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and

(b) adversely affects a child’s educational performance.


Specific Learning Disabilities

Specific learning disability means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations. The term includes such conditions as perceptual handicaps, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. The term does not include children who have problems that are primarily the result of visual, hearing, or motor disabilities, or mental retardation, emotional disturbance, or of environmental, cultural, or economic disadvantage.

The types of LD are identified by the specific processing problem. They might relate to getting information into the brain (Input), making sense of this information (Organization), storing and later retrieving this information (Memory), or getting this information back out (Output). Thus, the specific types of processing problems that result in LD might be in one or more of these four areas.

Input

Information is primarily brought into the brain through the eyes (visual perception) and ears (auditory perception). An individual might have difficulty in one or both areas.

Auditory Perception. (Also called Receptive Language) The individual might have difficulty distinguishing subtle differences in sound (called phonemes) or might have difficulty distinguishing individual phonemes as quickly as normal. Either problem can result in difficulty processing and understanding what is said. Individuals might have difficulty with what is called auditory figure-ground. They have difficulty identifying what sound(s) to listen to when there is more than one sound.

Visual Perception. One might have difficulty distinguishing subtle differences in shapes (called graphemes). They might rotate or reverse letters or numbers (d, b, p, q, 6, 9); thus misreading the symbol. Some might have a figure-ground problem, confusing what figure(s) to focus on from the page covered with many words and lines. They might skip words, skip lines, or read the same line twice. Others might have difficulty blending information from both eyes to have depth perception. They might misjudge depth or distance, bumping into things or having difficulty with tasks where this information is needed to tell the hands or body what to do. If there is difficulty with visual perception, there could be problems with tasks that require eye-hand coordination (visual motor skills) such as catching a ball, doing a puzzle, or picking up a glass.

Integration

Once information is recorded in the brain (input), three tasks must be carried out in order to make sense or integrate this information. First, the information must be placed in the right order or sequenced. Then, the information must be understood beyond the literal meaning, abstraction. Finally, each unit of information must be integrated into complete thoughts or concepts, organization.

Sequencing. The individual might have difficulty learning information in the proper sequence. Thus, he might get math sequences wrong, have difficulty remembering sequences such as the months of the year, the alphabet, or the times table. Or, she might write a report with all of the important facts but not in the proper order.

Abstraction. A person might have difficulty inferring the meaning of individual words or concepts. Jokes, idioms, or puns are often not understood. He might have problems with words that might have different meanings depending on how they are used. For example, "the dog" refers to a pet. "You dog" is an insult.

Organization. An individual might have difficulty organizing materials, losing, forgetting, or misplacing papers, notebooks, or homework assignments. She might have difficulty organizing her environment, such as her bedroom. Some might have problems organizing time. They have difficulty with projects due at a certain time or with being on time. (Organization over time is referred to as Executive Function.)

Memory

Three types of memory are important to learning. "Working memory" refers to the ability to hold on to pieces of information until the pieces blend into a full thought or concept. For example, reading each word until the end of a sentence or paragraph and then understanding the full content. "Short-term memory" is the active process of storing and retaining information for a limited period of time. The information is temporarily available but not yet stored for long-term retention. "Long-term memory" refers to information that has been stored and that is available over a long period of time. Individuals might have difficulty with auditory memory or visual memory.

One reads a sentence and hold on to it. Then the next and the next. By the end of the paragraph, he pulls together the meaning of the full paragraph. This is working memory. He continues to read the full chapter and study it. Information is retained long enough to take a test and do well. This is short-term memory. But, unless the information is reviewed and studied over a longer period of time, it is not retained. With more effort over time, the information might become part of a general body of knowledge. It is long-term memory.

Output

Information is communicated by means of words (language output) or though muscle activity such as writing, drawing, gesturing (motor output). An individual might have a language disability (also called expressive language disability) or a motor disability.

Language Disability. It is possible to think of language output as being spontaneous or on demand. Spontaneous means that the person initiates the conversation. Thoughts have been organized and words found before speaking. Demand language means that one is asked a question or asked to explain something. Now, she must organize his thoughts, find the right words, and speak at the same time. Most people with a language disability have little difficulty with spontaneous language. However, in a demand situation, the same person might struggle to organize her thoughts or to find the right words.

Motor Disability. One might have difficulty coordinating teams of small muscles, called a fine motor disability. He might have problems with coloring, cutting, writing, buttoning, or tying shoes. Others might have difficulty coordinating teams of large muscles, called a gross motor disability. She is awkward when running or jumping.

Each individual will have his or her unique pattern of LD. This pattern might cluster around specific common difficulties. For example, the pattern might primarily reflect a problem with language processing: auditory perception, auditory sequencing/abstraction/organization, auditory memory, and a language disability. Or the problem might be more in the visual input to motor output areas. Some people with LD will have a mixture of both.

Symptoms of Learning Disabilities

The symptoms of learning disabilities are a diverse set of characteristics which affect development and achievement. Some of these symptoms can be found in all children at some time during their development. However, a person with learning disabilities has a cluster of these symptoms which do not disappear as s/he grows older.

Most frequently displayed symptoms:

  • Short attention span
  • Poor memory
  • Difficulty following directions
  • Inability to discriminate between/among letters, numerals, or sounds
  • Poor reading and/or writing ability
  • Eye-hand coordination problems; poorly coordinated
  • Difficulties with sequencing
  • Disorganization and other sensory difficulties

Other characteristics that may be present:

  • Performs differently from day to day
  • Responds inappropriately in many instances· Distractible, restless, impulsive
  • Says one thing, means another
  • Difficult to discipline
  • Doesn't adjust well to change
  • Difficulty listening and remembering
  • Difficulty telling time and knowing right from left
  • Difficulty sounding out words
  • Reverses letters
  • Places letters in incorrect sequence
  • Difficulty understanding words or concepts
  • Delayed speech development; immature speech

Speech/Language Impairment

Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child's educational performance. 

Traumatic Brain Injury

Adapted from NICHCY

Under IDEA, traumatic brain injury refers to an acquired brain injury that Traumatic brain injury means an acquired injury to the brain.

The Individuals with Disabilities Education Act (IDEA) defines traumatic brain injury as "being caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance. 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.

The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma."

This injury can change how the person acts, moves, and thinks. A traumatic brain injury can also change how a student learns and acts in school. The term TBI is used for head injuries that can cause changes in one or more areas, such as:

  • thinking and reasoning,
  • understanding words,
  • remembering things,
  • paying attention,
  • solving problems,
  • thinking abstractly,
  • talking,
  • behaving,
  • walking and other physical activities,
  • seeing and/or hearing, and
  • learning.

The term TBI is not used for a person who is born with a brain injury. It also is not used for brain injuries that happen during birth.

The definition of TBI below comes from the Individuals with Disabilities Education Act (IDEA). The IDEA is the federal law that guides how schools provide special education and related services to children and youth with disabilities.

How Common is Traumatic Brain Injury?

More than one million children receive brain injuries each year. More than 30,000 of these children have lifelong disabilities as a result of the brain injury.

Many call this TBI the silent epidemic because often individuals don't think to report incidents that may have resulted in an injury to the brain. Children are particularly susceptible because of falls, car accidents and sport injuries. Any time a concussion is sustained, there is the possibility of traumatic brain injury.

What Are the Signs of Traumatic Brain Injury?

The signs of brain injury can be very different depending on where the brain is injured and how severely. Children with TBI may have one or more difficulties, including:

Physical disabilities:
Individuals with TBI may have problems speaking, seeing, hearing, and using their other senses. They may have headaches and feel tired a lot. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten (this is called spasticity). They may also have seizures. Their balance and walking may also be affected. They may be partly or completely paralyzed on one side of the body, or both sides.
Difficulties with thinking:
Because the brain has been injured, it is common that the person's ability to use the brain changes. For example, children with TBI may have trouble with short-term memory (being able to remember something from one minute to the next, like what the teacher just said). They may also have trouble with their long-term memory (being able to remember information from a while ago, like facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a short time. They may think slowly. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding the order in which events happen (called sequencing), and judgment.
Social, behavioral, or emotional problems:
These difficulties may include sudden changes in mood, anxiety, and depression. Children with TBI may have trouble relating to others. They may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.

A child with TBI may not have all of the above difficulties. Brain injuries can range from mild to severe, and so can the changes that result from the injury. This means that it's hard to predict how an individual will recover from the injury. Early and ongoing help can make a big difference in how the child recovers. This help can include physical or occupational therapy, counseling, and special education.

It's also important to know that, as the child grows and develops, parents and teachers may notice new problems. This is because, as students grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for the student to learn new skills that come with getting older. Sometimes parents and educators may not even realize that the student's difficulty comes from the earlier injury.

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