Chapter 12
Severe/Multiple Disabilities,
Traumatic Brain Injury
Low Incidence Disabilities
• Low Incidence disability – Disabilities that do not occur very
often. Together Multiple Disabilities, TBI, and deaf-blindness
represent less than 3% of all children who receive special
education.
• Many of these individuals cannot perform the most basic,
everyday tasks such as:
– Eating
– Toileting
– Communicating basic needs
Severe and Multiple Disabilities
Severe disability
• Significant disabilities in intellectual, physical, and/or social
functioning
• No single definition (perceptions of what is severe may
vary and are based on a multitude of intellectual
assessments
Multiple disabilities
• Multiple disabilities means concomitant impairments, that
causes such severe educational problems that they
cannot be accommodated in special education programs
solely for one impairment
Characteristics and Prevalence
• Characteristics
– 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
– Stereotypic and challenging behavior
• Prevalence
– Estimates range from 0.1% to 1% of the population
Causes
• In almost every case of severe disabilities, a brain disorder
is involved
– Chromosomal disorders
– Genetic or metabolic disorders that can cause serious
problems in physical or intellectual development
• Complications in pregnancy – prematurity, Rh
incompatibility, infectious diseases, alcohol/drug intake
• Severe disabilities may develop later in life from head
trauma
• In about one-sixth of all cases, the cause cannot be clearly
determined
Syndromes that may result in severe
disabilities
• Hurler Syndrome (lack of an enzyme) – severe MR, physical
disabilities, early death
• Lesch-Nyan Syndrome (genetic) – SIB, aggression,
neurological problems, MR
• Rett Syndrom (genetic) – Regression to 6-18 months, loss of
speech, motor and social functions, MR
• Cornelia de Lange Syndrome (chromosomal) – Physical
disabilities, health impairing conditions, Severe MR, SIB
• Angelman Syndrome (chromosomal) – Speech and language
deficits, balance and gait, seizures, microcephaly, severe MR
Traumatic Brain Injury (TBI)
Definition
• an acquired injury to the brain
Resulting in total or partial functional disability
Adversely affects a child’s educational performance
• TBI is the most common acquired disability in
childhood
• 1 in 500 school-age children will be hospitalized with
TBI
• Leading cause of death in children (1/3 of all
accidental deaths in children)
Traumatic Brain Injury (TBI)
• Open Head Injury – Penetration of the skull – bullet or forceful
blow to the head caused by a sharp object
– Usually result in specific deficits sensory or motor functions
• Closed Head Injury – Head hits a stationary object with such
force that the brain slams inside the cranium. Stress pulls apart
and tears nerve fibers or axons
–
–
–
–
Car accidents
Shaken baby syndrome
Severity depends on the part of the brain that was injured
Mild injury (contusions) - recovery
Traumatic Brain Injury (TBI)
• Temporary or lasting impairments
– Physical and sensory changes
• Lack of coordination, spasticity of muscles
– Cognitive impairments
• Short and long term memory deficits, difficulty maintaining attention
and concentration
– Social and behavioral problems
• Mood swings, lack of motivation
What Should Be Taught?
1.
2.
3.
4.
5.
Functional skills - activities of daily living skills (ADLs)
Age-appropriate skills
Making choices skills
Communication skills (PECS /AAC)
Recreation and leisure skills
Instructional Methods: How Should
Students Be Taught?
• Instruction must be carefully planned, systematically executed,
continuously monitored
– The student’s current level of performance must be assessed
– The skill to be taught must be defined clearly
– The skill may need to be broken down into smaller component
steps
– The teacher must provide a clear prompt to cue the child
– The student must receive feedback and reinforcement
– Strategies that promote generalization and maintenance must
be used
– The student’s performance must be directly and frequently
assessed
Partial Participation, Positive Behavioral
Support, and Small Group Instruction
• Partial participation
– Students can be taught to perform selected components
or an adapted version of the task
• Positive behavioral support
– Use of functional assessment methodologies to support
student’s placement
• Advantages of small group instruction
– Skills learned in small groups may be more likely to
generalize
– Provides opportunities for social interaction
– Provides opportunities for incidental or observation
learning from other students
– May be a more cost-effective use of teacher’s time
The Challenge and Rewards
of Teaching Students with
Severe and Multiple Disabilities
• Must be sensitive to small changes in behavior
• The effective teacher is consistent and persistent in
evaluating and changing instruction to improve learning
and behavior
• Working with students who require instruction at its very
best can be highly rewarding
Fyffe et al
• Participant – Matt, 9 year old boy with TBI
• Target Behavior – touching or attempting to touch others in the
area of the groin, buttocks or breasts.
• Functional Analysis – 20 min sessions 1) Demand, 2) attention,
3) play.
– Results suggested attention function
• Treatment – FCT + EXT - use of graduated guidance to hand
the experimenter an attention card.
• Results?