Severe or Multiple Disabilities

Severe Disabilities

People with severe disabilities are those who traditionally have been labelled 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.

The Individuals with Disabilities Education Act (IDEA) (PL 94-142) defines multiple disabilities to be a combination of impairments (such as mental retardation-blindness, or mental retardation-physical disabilities) that causes such severe educational problems that the child cannot be accommodated in a special education program solely for one of the impairments. The term does not include deaf-blindness.

The same act uses the term children with severe disabilities to refer to children with disabilities, who because of the intensity of their physical, mental, or emotional problems, need highly specialized education, social, psychological and medical services in order to maximize their full potential for useful and meaningful participation in society and for self- fulfillment. The term includes those children with disabilities with severe emotional disturbance (including schizophrenia), autism, severe and profound mental retardation, and those who have two or more serious disabilities such as deaf-blindness, mental retardation and blindness, and cerebral palsy and deafness.

The Association for Persons with Severe Disabilities (TASH) gives multiple disabilities the following definition: "Persons with severe handicaps include individuals of all ages who require extensive ongoing support in more than one life activity in order to participate in integrated community settings and to enjoy a quality of life that is available to citizens with fewer or no disabilities. Support may be required for life activities such as mobility, communication, self-care, and learning as necessary for independent living, employment, and self-sufficiency." Most multiple disabilities are believed to involve sensory deficits, brain malfunctioning, or genetic disorders that disrupt with the normal progression of the development of cognitive, social, and physical skills.

Characteristics

Children and youth 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. Some of these characteristics may include:

Restricted movement: Cerebral Palsy is the most frequent identifiable diagnosis in students with multiple disabilities. Cerebral Palsy is the result of improper development of the brain or damage to the brain. This damage to the brain results in limited movement and control over voluntary movement in the student.
Skeletal deformities: Many students with multiple disabilities are born with or develop physical disabilities as a result of brain damage. Some examples of this include a curve in the spine (scoliosis), permanently shortened muscles and tendons, dislocated hips, foot and ankle abnormalities. Problems with joints, muscles, tendons and bones may cause pain and discomfort. They can also be life threatening as when a severe scoliosis interferes with the student's ability to breathe adequately.
Sensory Disorders: Students with multiple disabilities are more likely to also have a vision and/or hearing loss.
Seizure Disorders: Many students will have seizure disorders. Medications are often be used to control the seizure disorder, but the medications have side effects.
Lung & Breathing Control: The muscle weaknesses and skeletal deformities these students have make it difficult for them to breathe. They may also have trouble swallowing and coughing to clear their airway. As a result they may have a build up of mucus or other secretions in their airway and lungs. Sometimes the student has an underdeveloped respiratory system and needs a mechanical respirator to be able to breathe.
Other Medical Problems: These students will tend to be less healthy that other students. They have more infections due to restricted movement and impaired lung and breathing control. They will be more likely to be on a variety of medications for these infections and for seizure disorders.
Delayed motor development
Limited speech or communication
Difficulty in basic physical mobility
Tendency to forget skills through disuse
Trouble generalizing skills from one situation to another
A need for support in major life activities (e.g., domestic, leisure, community use, vocational).

Causes

The sources of intellectual disabilities are many, complex and varied. Some of these are:

Congenital disorders can lead to severe, profound, multiple disabilities.
Biological factors such as asphyxia (lack of oxygen) or blood incompatibilities between the mother and foetus.
During pregnancy, the brain may be damaged or maternal infections such as rubella could cause damage to the foetus.
Certain drugs have also been linked to problems in foetal development.
Injury during birth is also a possibility but is generally rare nowadays.
The child could contract illnesses such as meningitis, measles or Reye's Syndrome or as a result of an injury, damage could be caused to the brain.

Click here to view a summary of the causes of multiple handicaps.

Identifcation

Medical Evaluation: Infants with severe and multiple disabilities are usually detected at birth during the administration of the screening processes required by physicians in checking for observable disabilities, genetic and metabolic disorders, and potential developmental problems. An example of a screening process for newborns is the Apgar Test. This test is designed to give physicians a snapshot of the newborn's general condition. The scores are recorded at one minute after birth and again at five minutes after birth. There are five assessment categories: appearance, pulse, grimace reflex, activity and respiration. The baby is given a score of 0, 1 or 2 in each category. Those whose overall score is between 7 and 10 are considered to be in good condition. They generally will need only routine postdelivery care. Those scoring between 4 and 6 are in fair condition and may require extra attention. Those with score below 4 are in poor condition and probably will need immediate life-saving efforts.

Educational Implications

Early intervention programs, preschool and educational programs with the appropriate support services are important to children with severe disabilities. Educators, physical therapists, occupational therapists, and speech-language pathologists are all members of the team that may provide services, along with others, as needed for each individual. Assistive technology, such as computers and augmentative/alternative communication devices and techniques, may provide valuable instructional assistance in the educational programs for students with severe/multiple disabilities.

In order to effectively address the considerable needs of individuals with severe and/or multiple disabilities, educational programs need to incorporate a variety of components, including language development, social skill development, functional skill development (i.e., self-help skills), and vocational skill development. Related services are of great importance, and the appropriate therapists (such as speech and language, occupational, physical, behavioral and recreational therapists) need to work closely with classroom teachers and parents. Best practices indicate that related services are best offered during the natural routine of the school and community, rather than by removing the student from class for isolated therapy.

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. The use of computers, augmentative/ alternative communication systems, communication boards, head sticks, and adaptive switches are some of the technological advances which enable students with severe disabilities to participate more fully in integrated settings.

Integration/inclusion with nondisabled peers is another important component of the educational setting. Research is showing that attending the same school and participating in the same activities as their nondisabled peers is crucial to the development of social skills and friendships for children and youth with severe disabilities. Traditionally, children with severe disabilities have been educated in center-based, segregated schools. However, recently many schools are effectively and successfully educating children with severe disabilities in their neighborhood school within the regular classroom, making sure that appropriate support services and curriculum modifications are available. The benefits to inclusion are being seen to benefit not only those with disabilities but also their nondisabled peers and the professionals who work with them.

Schools are addressing the needs of students in several ways, generally involving a team approach. Modifications to the regular curriculum require collaboration on the part of the special educator, the regular educator, and other specialists involved in the student's program. Community-based instruction is also an important characteristic of educational programming, particularly as students grow older and where increasing time is spent in the community. School to work transition planning and working toward job placement in integrated, competitive settings are important to a student's success and the long-range quality of his or her life.

In light of the current Vocational Rehabilitation Act and the practice of supported employment, schools are now using school-to-work transition planning and working toward job placement in integrated, competitive settings rather than sheltered employment and day activity centers.