Severe and Multiple Disabilities: Characteristics, Interventions, and Support

1. Severe and Multiple Disabilities Stephanie Skurski & Emily Subers

2. Introduction • Severe and multiple disabilities • disabilities that involve significant physical, sensory, intellectual, and/or social-interpersonal performance deficits (Hardman, Egan, & Drew, 2015) • Definition according to IDEA: • “Multiple disabilities refers to concomitant [simultaneous] impairments (such as intellectual disability-blindness, intellectual disability-orthopedic impairment, etc.), the combination of which causes such severe educational needs that they can not be accommodated in a special education program solely for one of the impairments. The term does not include deaf-blindness.” (Understanding “Multiple Disabilities”, 2016) • Video

3. Characteristics (National Dissemination Center for Children with Disabilities [NICHCY], 2015) • People 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 • Most common characteristics include: • 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 • a variety of medical issues may accompany severe disabilities

4. Prevalence (Center for Parent Information and Resources, 2016) • An equal number of girls and boys are affected. • According to the U.S. Department of Education, 140,209 students living with multiple disabilities received services in 2002.

5. Causes (NICHY, 2015) • In most cases, the cause of severe and multiple disabilities is unknown • Most common causes may include: • abnormal chromosomes • developmental problems in the brain • environmental issues • disorder in genetic metabolism • complications during or after birth • head trauma and disease later on in life

6. Assessments Used to Identify the Disability (Hardman et al., 2015) • Common for a pediatrician to make the diagnosis right after birth or within the first year of a child’s life, as they miss certain developmental milestones • When a concern is identified, formal assessments are given by an interdisciplinary team: • Pediatrician, speech and language pathologists, physical/occupational therapists, and early intervention specialists • Assessments include evaluation of: • Fine and gross motor skills • Reflexes • Vision / Hearing • Breathing control • Sucking and swallowing • Seizure Activity • Most common assessments include individual intelligence tests and tests of adaptive behavior

7. Interventions for Multiple Disabilities (Hardman et al., 2015) • Early diagnosis and early intervention is key to treating children and youth with multiple disabilities • Early Childhood Years • Services and supports are both child- and family-centered and holistic • Include infant stimulation programs to provoke sensory, cognitive, and physical responses that help newborns connect with their environment • Preschool Aged Children • Continued emphasis on family involvement • Goal is to maximize social communication, motor skills, cognitive skills, self-care, play, etc. for child • Develop child’s social interaction and classroom participation skills and prepare the child for a transition into inclusive school placements

8. Interventions Cont’d (Hardman et al., 2015) • Elementary School Years • Self-determination- to enhance a child’s independence level both in the community and at home • Positive relationships with parents and family members show support for the child and more collaboration when working with school programs • Effective educational programs focus on function skills- skills that will be meaningful to the child in multiple environments • Assistive technology can be used to increase, maintain or improve functional capabilities of students with multiple disabilities (includes communication aids) • Adolescent Years • Important goals for transitioning to adult life: • Establish a network of friends/allies • Develop ability to use community resources on a regular basis • Secure a paid job that supports use of community resources and interactions with peers • Establish independence in making lifestyle decisions

9. Article 1 A Survey on Literacy Instruction for Students with Multiple Disabilities • Purpose of study: • Investigated the attitudes and instructional practices of teachers of students with visual impairments and multiple disabilities • For the purposes of this study literacy is defined as the ability to use words • Methods & Procedures: • Survey consisting of short-answer and forced-choice questions about teacher demographics, training, caseload, and type of literacy instruction • A total of 82 surveys with an average of 16 years experience and 15 students per caseload • Results: • More than 70% of the teachers reported they felt well prepared to teach students with multiple disabilities • Highest rated educational priority- communication skills • Lowest rated educational priority- access to the general education classroom • 45% disagreed that reading skills were a priority and less than half considered writing skills a priority • Access to literacy instruction has often resulted in unexpected grade-level achievement in persons with severe and multiple disabilities. (Durando, 2008)

10. A Survey on Literacy Instruction for Students with Multiple Disabilities (Durando, 2008)

11. Article 2 Engaging Preschool Children With Severe and Multiple Disabilities Using Books and iPad Apps • Purpose of Study: • Child engagement is an important goal for early childhood intervention • Use of technology with preschool aged children with severe and multiple disabilities is limited • Researchers wanted to investigate the potential of books and iPad apps to engage children attending inclusive early childhood settings • Methods: • 3 children with severe and multiple disabilities, all attending a childcare center, had been observed to have severe limitations in engagement with people and materials • None of the children could communicate verbally (Two of the three were diagnosed with Autism Spectrum Disorder) • Parent’s responded to a survey to give researchers more information about devices used at home with children • Procedures: • 4 phases, 2 times per week during outdoor play period • Each child was removed from outside and brought inside to the playroom • Each phase of intervention was implemented for 5 sessions lasting about 6 minutes each (2 for books, 2 for iPad) • Book and iPad sessions were facilitated by the same person for each child (Kemp, Stephenson, Cooper & Hodge, 2016)

12. Engaging Preschool Children With Severe and Multiple Disabilities Using Books and iPad Apps • Results: • Future Research: • Use multiple participants and different treatment designs to compare engagement with a larger group of students • An extension of the research to include a generalization phase, taking it to the inclusive setting rather than one on one to see if their levels of engagement in a distracting environment stays high over an extended period of time (Kemp, Stephenson, Cooper & Hodge, 2016)

13. References Center for Parent Information and Resources, Multiple Disabilities (2016). Retrieved from http://www.parentcenterhub.org/repository/multiple/# Durando, J. (2008). A survey on literacy instruction for students with multiple disabilities. Journal of Visual Impairment & Blindness, 102(1), 40-45. Retrieved from http://rose.scranton.edu/login?url=http://search.proquest.com/docview/222041423?accountid=28588 Hardman, M., Egan, M., & Drew, C., (2015). Severe and multiple disabilities, Human exceptionality: School, community, and family (pp. 292-311). Boston, MA: Cengage Learning. Kemp, C., Stephenson, J., Cooper, M., & Hodge, K. (2016). Engaging preschool children with severe and multiple disabilities using books and iPad apps. Infants and Young Children, 29 (4), 249-266. National Dissemination Center for Children with Disabilities [NICHCY], Severe and/or Multiple Disabilities NICHCY Fact Sheet 10 (2015). Retrieved from https://eclkc.ohs.acf.hhs.gov/hslc/tta-system/teaching/Disabilities/Services%20to%20Children%20with%20Disabilities/Disabilities/disabl_fts_00016_061105.html Understanding "Multiple Disabilities" | A Guide to the IDEA. (2016). Retrieved from http://www.specialeducationguide.com/disability-profiles/multiple-disabilities/