Transcript Traumatic Brain Injury

Exceptional Children
An Introduction to Special Education
Tenth Edition
William L. Heward
© 2013, 2009, 2006, 2003, 2000
Pearson Education, Inc. All rights reserved.
Chapter 12
Low-Incidence Disabilities:
Severe/Multiple Disabilities, Deaf-Blindness, and
Traumatic Brain Injury
Focus Questions
Why
is a curriculum based on typical developmental stages
and milestones inappropriate for students with severe and
multiple disabilities?
How
can a teacher assist a child who has been hospitalized
with a traumatic brain injury return to school?
Why
are functional and age-appropriate curriculum so critical
for students with severe and multiple disabilities?
How
does access to the general academic curriculum benefit
students with severe disabilities?
What
are the most important skills for a teacher of students
with severe and multiple disabilities? Why?
How
much time should a student with severe and multiple
disabilities spend in the general education classroom?
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12-2
Severe, Profound, and Multiple
Disabilities
Severe disability
•Significant
functioning
•IQ
impairments in intellectual, motor, and/or social
scores of 35 to 40 or 40 to 55
Profound disability
•Profound
developmental disabilities in all five of the following
areas: cognition, communication, social skills, motor-mobility,
and activities of daily living
•IQ
scores of 20 to 25 and below
Multiple disabilities
•Multiple
disabilities means concomitant impairments, the
combination of which causes such severe educational needs
that they cannot be accommodated in special education
programs solely for one of the impairments
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Deaf-Blindness
Deaf-blindness means concomitant hearing and visual
impairments, the combination of which causes such severe
communication and other developmental and educational
needs that they cannot be accommodated in special education
programs solely for children with deafness or children with
blindness
The majority have some functional hearing and/or vision
 More than 90% have one or more additional disabilities
 57% also have physical disabilities
 66% have cognitive impairments
 38% have complex health care needs
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Characteristics
Most students with severe disabilities
• Exhibit
significant deficits in intellectual functioning
• Possess
more than one disability
• Need
special services and supports because of
motor impediments; communication, visual and
auditory impairments; and seizure disorders
• Treatment
of medical conditions and health
problems results in frequent and often extended
absences from school
• Exhibit
significant and obvious deficits in multiple
life-skill or developmental areas
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Characteristics and Prevalence
• Slow
acquisition rates for learning new skills
• Poor
generalization and maintenance of newly
learned skills
• Limited
communication skills
• Impaired
• Deficits
physical and motor development
in self-help skills
• Infrequent
constructive behavior and interaction
• Stereotypic
and challenging behavior
Prevalence
• Estimates
range from 0.1% to 1% of the
population
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Causes
Severe intellectual disabilities can be caused by
biological conditions, that may occur before birth
(prenatal), during (perinatal),or after birth
(postnatal)
In almost every case, a brain disorder is involved
Brain disorders are the result of either
•
Brain dysgenesis (abnormal brain development)
•
Brain damage (caused by influences that alter the structure or
function of a brain that had been developing normally up to
that point)
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Causes (cont.)
•A
significant percentage of children with severe disabilities
are born with chromosomal disorders
• Genetic
or metabolic disorders can cause serious
problems in physical or intellectual development
• Complications
• Severe
of pregnancy can cause severe disabilities
disabilities may develop later in life from head
trauma
• Factors
such as malnutrition, neglect, ingestion of
poisonous substances, and certain diseases that affect the
brain also can cause severe disabilities
• In
many cases, the cause cannot be clearly determined
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Traumatic Brain Injury (TBI)
Definition
•An
acquired injury to the brain caused by an external force,
resulting in total or partial functional disability or
psychosocial impairment, or both that adversely affects a
child’s educational performance
• Applies to open or closed head injuries
•
TBI is the most common acquired disability in childhood and
the leading cause of death in children
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Types and Causes of TBI
Head injuries are classified by the type of injury, by the kind of
damage sustained by the brain, and by the location of the
injury
• Open head injury-the result of penetration of the skull
• Closed head injury-occurs when the head hits a stationary
object with such force that the brain slams against the inside
of the cranium
• Concussion, a mild brain injury, is a brief loss of
consciousness
• Contusions usually accompany a moderate brain injury and
consists of bruising, swelling, and bleeding
• Hematoma occurs when blood vessels in the brain rupture
• Coma is a severe head trauma
• Anoxia is the loss of oxygen to the brain for a period of
time during a severe brain injury
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Effects and Educational
Implications of TBI
TBI is complex with symptoms varying depending
on severity, extent and site, age of the child at the
time of the injury, and time passed since the injury
Three categories of impairments from brain injuries
• Physical and sensory changes
• Cognitive impairment
• Social, behavioral, and emotional problems
Recovery is a long and unpredictable process
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Educational Approaches
Curriculum: What Should be Taught
Functional
skills - activities of daily living skills (ADLs)
Age-appropriate
skills-activities that are appropriate for same
age peers with disabilities
Communication
Literacy
skills -an essential quality of human life
-provides access to information and further learning
Recreation
and leisure skills-the ability to play and later to
occupy themselves constructively and pleasurably during free
time
Making
choices-opportunities to make choices and the ability
to make choices
Access
to general education curriculum-integrating academic
standards into lessons on functional skills
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Educational Approaches (cont.)
Instructional Methods: How Should Students Be
Taught?
•
•
Select and prioritize instructional targets that are meaningful
for students and their families
Instruction must be carefully planned, systematically executed,
continuously monitored for effectiveness
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The student’s current level of performance must be assessed
The skill must be defined clearly and actively engage the student
The skill may need to be broken down into smaller component steps
The teacher must determine how the student can actively
participate, provide a clear prompt, and gradually withdraw the
prompt
The student must receive feedback and reinforcement
The teacher must use strategies that promote generalization and
maintenance
The student’s performance must be directly and frequently assessed
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Educational Approaches (cont.)
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 and guide the development of positive behavior support
plans
Small group instruction: Advantages
•
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
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Educational Approaches (cont.)
Where Should Students with Severe Disabilities be
Taught?
Benefits of the neighborhood school and inclusion
•
Peers without disabilities are more likely to function
responsibly as adults in a pluralistic society
•
Integrated schools are more meaningful instructional
environments
•
Parents and families have greater access to school activities
when children are attending their home schools
•
Helps develop range of relationships with peers without
disabilities
•
Benefits of inclusion on social skills and relationships have the
most extensive empirical support
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12-15
Teaching Students with Severe and
Multiple Disabilities
Teaching students with severe disabilities is difficult and
demanding. It requires teachers to:
be well organized, firm, and consistent
be knowledgeable about one-to-one and small group
instructional formats
be able to work cooperatively with other teachers and
related service professionals
maintain accurate records and constant planning for
future needs of students
be sensitive to small changes in behavior
be 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 to teachers
Heward
Exceptional Children, 10e
© 2013 Pearson Education, Inc. All rights reserved.
12-16