Severe

1
Severe Multiple Disabilities

• FRIEND CH 14,
• SPED 281
• Dr. Schneider

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Learning Objectives

• Definition of Severe Multiple Disabilities
  (S-MD)
• Historical facts about field of S-MD
• Characteristics of S-MD
• Causes
• Identification procedure
• Prevalence data
• Types of services for students w/ S-MD
• Best teaching strategies
• Perspectives of family members
• Issues affecting the field of S-MD

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Definition of Severe Multiple Disabilities

• IDEA DEFINITION
• No single category exists for M-SD, these
  disabilities are described in several categories
  ( problem to access prevalence data!)
• Individuals has 2 or more disabilities that
  cannot be accommodated in a SPED program that
  addresses 1 of the impairments

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Definition of Severe Multiple Disabilities

• IDEA DEFINITION
• 3 main groups individuals with
• a) severe profound MR other disability/ -ies
• b) Who are both deaf blind ( concomitant
  hearing visual impairments that lead to severe
  communication other developmental and
  educational deficits that cannot be accommodated
  in SPED
• c) Multiple disabilities means concomitant
  impairments that in their combination lead to
  such deficits that they cannot be accommodated in
  SPED programs solely for one of the impairments

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Characteristics of Severe Multiple
Disabilities

• IN MOST CASES low intellectual functioning,
  majority have significant IQ impairments
• IQ skills vary functional skills to basic
  contact skills (e.g., eye contact)

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Characteristics of Severe Multiple
Disabilities

• TASH DEFINITION (2000)
• Includes individuals
• Of all ages, races, genders, creeds, national
  origins, sexual orientations
• That require ongoing support in or more major
  life activities to be able to participate in an
  integrated community
• And to enjoy quality of life similar to those w/o
  a disability
• Support may be required for mobility, community
  living, self-sufficiency, employment, (TASH 2000)

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Historical facts about field of S-MD

• Technology helps children w/ M-SD survive and
  thrive today who would have died in first half of
  20th cent. (until late1960s)
• 1902 Helen Keller first person to attend
  college w/ multiple disability (deaf-blind)
• 1921 National Society for Crippled Children
  established
• Many educated at home or in private schools

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Historical facts about field of S-MD

• Beginning 1970s CHANGE
• 1975 P.L. 94-142 brings children w/ severe
  disabilities into public schools
• AERA OF ADVOCACY TASH Equity, Opportunity,
  Inclusion for people with Disabilities of the
  most challenging kinds

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Characteristics of M-SD

• COGNITIVE CHARACTERISTICS
• On gen. IQ scores, M-SD individuals score in
  range of 25-40 (85-115 average)
• If range is blow 25 gt profound level of
  intellectual impairment
• BUT CONSIDER PHYS. COMMUN. ADAPTIVE
  difficulties that can falsify IQ data
• Motor delay, hearing/vision impairment,
  communication difficulties w/o assistive
  technology, low adaptive skills
• Difficulty understanding abstract concepts of
  more-less, larger-smaller, countable-non-countable

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Characteristics of M-SD

• PARENTS EDUCATORS
• Teach skill in direct, systematic way breaking
  task in small steps providing much repetition
  for overlearning
• Teach within natural contexts -gt functional
  skills are included then
• Teach across disciplines
• Use a variety of prompts assistance techniques,
  demonstrations (hand-over-hand)
• Provide prompt positive feedback

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Characteristics of M-SD

• ACADEMIC CHARACTERISTICS
• LITERACY
• High frequency, function words, favorite words
  BUT ALSO SOME PATTERNS if IQ not too low
• Assistive technology communication boards
• ORAL LANGUAGE NON-VERBAL LANG, RECEPTIVE
  LANGUAGE
• Speech practice for proper pronunciation,
  swallowing techniques
• Must learn explicitly how to make known what is
  needed, feelings w/o hurting self or others
• Must learn to use and read gesture/picture cues
  if oral lang. reception is poor
• MATH

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Characteristics of M-SD

• SOCIAL-EMOTIONAL CHARACTERISTICS
• due to language impairments, behind in
  development of peers
• Hardly friends unless natural charmer
• Very often bullied gt depressed
• Must be taught social skills explicitly
• BEHAVIORAL CHARACTERISTICS
• Poor communication skills can but does not
  automatically lead to disruptive behavior
• Positive behavior support and integration with
  others to experience positive integration helps
  address negative behavior.

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Causes

• BEFORE BIRTH
• Viral infections (rubella, German measles)
• Drug, alcohol abuse
• Malnutrition (e.g., folic acid)
• Physical trauma to mother during pregnancy
• DURING BIRTH
• Lack of oxygen
• Physical injury to brain during delivery
• Contracted infection (syphilis)

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Causes

• AFTER BIRTH
• Infections (meningitis)
• Traumatic brain injury (car accident, fall,
  abuse)
• Lead poisoning
• Reaction to medication
• Exposure to toxins
• CONGENITAL
• abnormalities in parent genes that affect the
  metabolism development of the child
• e.g., PKU phenylketonuria -gt mental retardation
  if not treated w/i first few days and followed up
  with a diet

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Causes

• How can you prevent genetically based
  disabilities?
• gene tests prior to pregnancy
• prenatal testing
• Amniocentisis
• umbilical blood sampling
• fetal therapy, in-utero surgery

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Identification procedures for M-SD

• at new-born level
• observation medical screening of new born
• Apgar test (0-2 points each) below 4 problems
  possible
• heart beat
• gag reflex
• color
• muscle tone
• at non-discriminatory evaluation level
• adaptive behavior scales
• Standardized tests fail tell teacher what and how
  to teach gt authentic assessment
• Person-centered approach-authentic assessment
• Functional ecological assessment-authentic
  assessment
• Parent, caretaker interviews (CAOCH Test)
• individualized IQ tests- if possible

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Identification procedures for M-SD

• Why would normal IQ tests not work with this
  population?
• low adaptive skills (social, conceptual,
  practical competencies) majority can
  successfully acquire some independence in
  adaptive skills, esp. self care
• significant delay in motor development due to
  long positions in same posture many can learn to
  move about with assistance
• frequent hearing /or vision impairments
  sensory impairment
• almost all have communication difficulties mostly
  due to muscular impairments learn to use
  assistive technology

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Prevalence data

• LOW INCIDENCE DISABILITY GROUP
• About 2 of all IDEA served 6-21 year olds
• About 1 of entire school population (2002)
• Data difficult to obtain b/c severe and multiple
  disabilities are not separated categories under
  IDEA
• Multiple disabilities 1999-2000
• In separate schools 22
• Less than 21 outside reg. ed class 11
• Less than 40 in reg. ed class 43
• Deaf-blind students 1999-2000
• In separate schools 17
• Less than 21 outside reg. ed class 15
• Less than 40 in reg ed class 40
• M-SD children in public school classes for most
  of the day
• End 1980s 6
• End 1990s 11

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Types of services for students w/ M-SD

• EARLY CHILDHOOD
• Early intervention is crucial for children with
  M-SD
• Most have limited access to peers w/o
  disabilities
• Many states do not certify Early Childhood-SPED
  specialists in education programs
• HEAD START PROGRAMS provide inclusive experiences
• ELEMENTARY-SECONDARY SCHOOL
• Many in separate settings prepared to handle
  life-functional skills rather than academic tasks
  such as reading, writing, math
• gt CHANGE NOW WITH NCLB because all students are
  to participate in state tests

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Best Teaching strategies

• (1) MAP Process (Make Action Plan) needs,
  strengths, visions
• a) What is your history- story
• b) what are your dreams?
• c) what are your nightmares?
• d) who are you?
• e) what are your strengths, gifts, talents?
• f) What do you need?
• g) what is the plan of action?
• (2) partial participation by using special
  tools/technology/ assistance
• (3) peer support-collaboration

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Best Teaching strategies

• (4) Community-based instruction (CBI)
• Highly individualized to ease transition from
  school to work
• Sample different types of employment
• Financial support for services are available
  throughout life
• (5) Supported Employment
• Assisting individuals with M-SD
• to attain jobs on the competitive market
• To keep jobs with successful results
• 2 ways of support
• Natural support (occasionally)
• Job coach (consistently)

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Best Teaching strategies

• (6) Meaningful individualized curricula
• Developmentally appropriate
• Meaningful with regard to interests, personal
  goals, limitations
• (7) Positive Behavior Support
• Students learn social-emotionally appropriate
  behavior through positive feedback rather than
  negative and punishment
• (8) Collaborative Approaches
• Active family involvement
• Team approach (therapists, teachers,
  paraprofessionals, parents, community)

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Perspectives of family members

• (1) Need to learn from professionals how to help
  child become as independent as possible.
• (2) religious perspective can either help accept
  the child with disabilities or see the challenge
  as a punishment from god. Need to learn how to
  best cope and adapt.
• (3) financial resources can influence the degree
  of acceptance of the child
• (4) Cultural Diversity Issue
• Latino families place less emphasis on
  independence than the American culture gt stress
  in school, educate parents
• Asian families keep them home

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Issues affecting the field of M-SD

• (1) Development in medicine and technology
• INTEGRATING RELATED SERVICES INTO THE NATURAL
  LEARNING ENVIRONMENT ( not removing student from
  reg. classroom for services)
• NEW COMMUNICATION DEVICES
• (2) Accountability for academic performance for
  all students through NCLB
• KENTUCKY ACADEMIC MODEL
• (3) Over-reliance of mostly untrained
  paraprofessionals

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Website references

• www.tash.org Association for Persons with Severe
  Handicaps international advocacy organization
  promotes inclusion in all aspects of life
• www.disabilityisnatural.com contemporary way of
  thinking about individuals w/ significant
  disabilities
• www.isaac.org International Society for
  Augmentative Alternative Communication (ISAAC),
  resources, publications, events
• www.inclusion.org e-mail your questions about
  inclusion

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Website references

• www.enablingdevices.com company making assistive
  technology you can view a variety of AT for
  students w/ severe and multiple disabilities
• www.chimeinstitute.org CHIME Institute fully
  inclusive preschool, elem., middle school in
  California