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WHAT ARE THE FOUNDATIONS OF SEVERE DISABILITIES?

History

• Historically, the history of people with severe disabilities closely follows that of people with intellectual disabilities. (p. 400)
• Until the early- to mid-20th century, many individuals with severe disabilities were institutionalized. (p. 400)
• A rubella outbreak in the 1960's also increased society's awareness of deaf-blindness. (p. 400)
• The last 50 years have seen a focus on advocating for the treatment and education of those with severe disabilities. (p. 400-1)
• The passage of IDEA, in 1975, mandated a public education for students with severe disabilities. (p. 401)

Definition

• There is no universally accepted definition of severe disabilities. Typically, those with severe disabilities are served within the IDEA 04 categories of multiple disabilities or deaf-blindness. (p. 401-2)
• IDEA 04 defines multiple disabilities as the coexistence of impairments that results in severe educational needs that educational programs for the individual impairments cannot support. (p. 402)
• IDEA 04 defines deaf-blindness as the existence of both a hearing and a visual impairment that requires more educational support than programs for either individual impairment could provide. (p. 402)

Classification

• Individuals may be classified by their need for extensive or pervasive supports. (p. 402-3)
• Classification is not precise. (p. 402-3)

Prevalence

• Overall prevalence is estimated to be less than 1%. Both multiple disabilities and deaf-blindness are low incidence disability categories. (p. 403)

WHAT ARE THE CAUSES AND CHARACTERISTICS OF SEVERE DISABILITIES?

Causes

• The causes of severe disabilities are varied and can be caused by genetic, biological, or environmental factors. (p. 403)
• Primary disabilities can lead to secondary disabilities. (p. 403)
• There are a number of rare syndromes and conditions associated with severe disabilities. (p. 404)
• Deaf-blindness can also be caused by a variety of factors that affect vision, hearing, or both senses. (p. 405)

Characteristics

• Students with severe disabilities may or may not have intellectual disabilities. Intellectual disabilities may include difficulties in abstract reasoning/concepts, attention, memory, learning, and the transfer/generalization of skills. (p. 405-8)
• Students with severe disabilities may display problems in communication and in social-personal skills. (p. 408)
• Communication skill development is critical in the development and adjustment of individuals; a lack of communication skills may be one reason for the emergence of challenging behaviors. (p. 408)
• Social–personal skills need direct instruction and support and are important in the inclusion of people in school and society. (p. 408)
• Behavioral characteristics of students with severe disabilities may vary considerably. Students may display stereotypical repetitive, nonpurposeful movements or self-injurious behaviors. (p. 408-9)
• Physical and health impairing disabilities can affect individuals. Students with severe disabilities may be in poor health. (p. 409)
• Students with deaf-blindness may or may not have intellectual disabilities. They will often have communication problems as well as display characteristics related to their sensory needs. Students with deaf-blindness may also have issues with social adjustment and behavior due to deficits in communication and lack of sensory input. Specific characteristics are often influenced by the age of onset of the sensory losses. (p. 409-10)

HOW ARE SEVERE DISABILITIES IDENTIFIED?

• Severe disabilities are frequently identified at birth. (p. 411)
• Individual disabilities that contribute to multiple disabilities are identified by professionals in related fields. (p. 411)
• Identification of severe disabilities in early childhood is often done through neonatal screening, medical evaluations, and developmental assessment batteries and scales to assess family functioning. A transdisciplinary approach is often used. (p. 411)
• Identification of severe disabilities in school-aged students often includes IQ testing, adaptive behavior scales, and dynamic assessments. A focus of assessment for program planning is on how well the individual functions in different environments. (p. 411-12)
• The identification of deaf-blindness is typically done by specialists in each field. The individual needs only to have significant losses, rather than being both legally deaf and blind, in both areas to be considered deaf-blind. (p. 413)

WHAT AND HOW DO I TEACH STUDENTS WITH SEVERE DISABILITIES?

Instructional Content

• Students with severe disabilities may participate in the general curriculum. (p. 413)
• Access to the general education curriculum for pre-school-age students occurs through the use of developmentally appropriate practice. (p. 414-15)
• The general education curriculum for school-aged children with severe disabilities can be made accessible through the adaptation of learning objectives and standards and carefully selecting skills to be developed. (p. 415-16)
• Ecological inventories and functional behavior assessments are useful in determining functional curriculum objectives for students with severe disabilities. (p. 416-18)
• Alternative assessments may be more effective with students with severe disabilities than traditional assessment tools. (p. 418-19)
• Transition planning for students with severe disabilities should start early and heavily involve the student's family. Transition planning may include preparing students for postsecondary education programs, full-time competitive employment, or supported employment. (p. 419-20)

Instructional Procedures

• Some instructional strategies to consider using with students with severe disabilities are teaching specific target behaviors, teaching nontargeted information, using naturalistic teaching strategies, implementing embedded skill instruction, and planning for partial participation. (p. 421-23)
• Useful strategies for teaching specific target behaviors include discrete trial teaching, massed trial teaching, and distributed trial teaching. (p. 421-22)
• Use of naturalistic teaching and behavior chain interruption strategies are especially helpful for communication skill development. (p. 421-22)
• Students with severe disabilities will often be supported by paraprofessionals. Teachers should work closely with paraprofessionals to define and support the services they provide. (p. 424)
• Teachers should plan to work closely with parents of students with severe disabilities and be aware of possible supports they may need to best help their child. Additionally, teachers should recognize that culturally and linguistically diverse families may have different views and needs. (p. 424-25)

WHAT ARE OTHER INSTRUCTIONAL CONSIDERATIONS FOR STUDENTS WITH SEVERE DISABILITIES?

Instructional Environment

• Students with severe disabilities should be educated in natural, inclusive environments when possible. Inclusion can support communication and social skills as well as provide benefits to general classroom peers. (p. 426-28)
• Community-based instruction allows students with severe disabilities to learn skills within the inclusive environment of the community at large. (p. 427-28)
• The classroom environment for students with deaf-blindness must be planned for with both sensory limitations in mind. (p. 428-29)
• Extended school year services should be considered for students with severe disabilities. (p. 429)
• Specific considerations for students with deaf-blindness include an evaluation of the environment with their needs in mind, adjusting materials, using assistive technology, and structuring group activities to provide assistance with social interactions. (p. 428-29)

Instructional Technology

• Assistive technology can enhance communication skills and compensate for disabilities. (p. 429)
• Adaptive equipment helps students adjust to certain instructional/life situations. (p. 429)
• Assistive technology should be chosen based on individual needs and should be understood by the teacher. (p. 429)
• Alternative/augmentative communication aids allow students to communicate in a manner other than through their own oral speech. (p. 429-30)

WHAT ARE SOME SPECIAL CONSIDERATIONS FOR THE GENERAL EDUCATION TEACHER?

• General education teachers are involved in the IEP development and daily instruction of students with severe disabilities. (p. 432)
• Collaboration between general education teachers, special education teachers, paraprofessionals, related services personnel, families, and others is needed for the successful inclusion of students with severe disabilities. (p. 432)
• Research shows that the inclusion of students with severe disabilities does not negatively affect the learning of other students in general education classrooms. (p. 433)