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Children with Severe and Multiple Disabilities

(4-30-15)

IDEA

  • IDEA does not include the category of “severe” disability, but does include “multiple disability” and “deaf-blind”
  • Multiple Disabilities are defined by IDEA as concomitant impairments that may combine to cause such severe educational problems that accommodation cannot be achieved in educational programs solely for one of the impairments
    • use of the term: “dual diagnosis” is problematic because this expression has multiple meanings in the professional literatures:
      • “dual diagnosis” may refer to the occurrence of emotional/behavioral problems in an individual with mental retardation
      • However–in other contexts “dual diagnosis” refers to comorbid substance abuse and psychiatric disorder; or to mental retardation and another mental disorder
  • Deaf-Blindness is a dual sensory impairment, intellectual functioning may range from gifted to severe mental retardation
    • Helen Keller

TASH The Association for Persons with Severe Handicaps

The TASH definition of Severe Disabilities focuses on 3 factors in their definition of severe disabilities:

  1. need to consider adaptive fit: the relationship of the individual with the environment–requiring the individual to cope with the demands of various environments as well as requiring environments to accommodate the need of the individual
  2. the need to include people of all ages
  3. need for “extensive ongoing support” in life activities
  • Prevalence of severe and multiple disabilities
    • Very small percentage of general population: estimates vary from 0.1 to 1%
    • Small percentage of children receiving special education: approximately 2%
  • Etiology: numerous factors may be involved
    • neurological factors are common
  • Characteristics:
    • Life needs often cannot be met without substantial assistance from others.
    • Degree of participation in life may require substantial assistance from others.
    • For some, life long institutional care may be a reality.
    • Mental retardation is often a primary condition.
    • Academic learning may be a reduced priority.
    • Adaptive skills are critical to success in personal independence and social interaction: taking care of oneself and communicating basic needs are essential life skills.
      • direct training efforts focused on adaptive behavior has been very successful
      • enhancing executive functioning has been less successful
      • adaptive communication is useful in overcoming speech problems, less effective with language and/or comorbid profound intellectual deficit
    • Significant deficits in and delays in speech and language skills are common; these tend to positively correlate with severity of mental retardation (but not always–severe cerebral palsy may compromise speech, manual, and electronic communication in individuals with good language ability and intelligence).
    • Significant physical and health needs are common.
    • Sensory and motor deficits are common.
  • Technological advances have made a significant impact on the quality of life of some individuals with severe and multiple disabilities.
    • assistive devices
    • enhanced independence and safe self-sufficiency
    • vocational opportunities
    • opportunities for social communication and interaction
  • Nontechnological supports
    • service animals
    • ADA, the American’s with Disabilities Act
    • Illinois Office of Rehabilitation Services
  • Balancing the good of the individual and the good of society is a major challenge
    • paying for services
    • providing accessible venues
    • dealing with prejudice and stereotypes
    • barriers to employment represent a significant area of continuing struggle and effort

Am I my brother’s keeper?

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