Chapter 13: Low Incidence Disabilities: Multiple- Severe Disabilities, Deaf-Blindness, and Traumatic Brain Injury

Opportunities for a Better Future

Very low incidence disabilities include those with prevalence rates of less than ½ of one percent
Three very low incidence categories are:
- Multiple-severe disabilities
- Deaf-Blindness
- Traumatic brain injury (TBI)
The 1990 authorization of IDEA made TBI a separate category
Deaf-Blindness has been considered a separate category by the federal government since 1969

The emphasis for these students is on developing skills that promote independence and community presence
The challenge these students present require an individualized, intensive, and creative education
There has been a shift from the deficit to what individuals can accomplish through supports
People with multiple and severe disabilities require on-going and intensive support throughout their lives
The needs of the individual are unique and require different specialists.
Before IDEA many students were excluded from school and spent their lives in institutions

Only 0.18% of students in the U.S. have multiple-severe disabilities
Requirements for each state are different
- Some states do no include learning disabilities or hearing problems in this category
- All students are served to meet their unique needs

Multiple factors cause disabilities
- Heredity
- Problems during pregnancy
- Problems at birth
- Incidents after birth
- Low birth weight
- Unknown factors
Prevention should include:
- Pre-pregnancy determination of risk factors
- Good prenatal care
- Access to health care
- Public awareness of prevention strategies

Students may have trouble:
- Generalizing information
- Communicating
- With memory
- Participating in the community without supports
Students may have medical problems such as:
- Seizure disorders
- Vision or hearing
- Heart disease
- Cerebral palsy

Deaf-Blindness has been a separate special education category since 1969
Many of these youngsters have other disabilities besides their visual and hearing problems
To be included in this category, students must
- Have visual acuity of 20/70 or worse in the better eye
- An auditory deficit of 30 dB in the better ear
Many Deaf-Blind individuals can:
- Move around independently
- Read enlarged print
- Recognize familiar faces
- Read sign language
- Understand some sounds
- Recognize familiar voices

Prevalence
- The Deafblind Census reports 9,344 students identified in 1999
- The U.S. Department of Education reported 1,840
- Discrepancy is due to the fact states only need to report student's disabilities in one area
Causes
- Associated with the following factors:
  - Pre-maturity
  - Heredity causes
  - Risk factors including poverty and access to health care
Prevention
- Risk factors can be reduced with systematic national prevention programs

Students have restricted vision and hearing
The degree and amount is not uniform
Each individual is affected differently
At least 60% of students have other disabilities in addition
Cognitive disabilities is a common problem
Common problem areas include:
- Feelings of isolation
- Communication
- Mobility

Before 1975 these students were served under the learning disabilities category
It is estimated that every teacher will come in contact with a student with TBI
Medical advances since 1960s are saving more children, but some end up needing special education
One million children annually experience head injury - 15,000 to 16,000 have lasting effects
TBI
- Is an acquired injury to the brain
- Adversely affects educational performance
- Refers to either open or closed head injuries
- Does not include brain injuries at birth
- Ranges from mild to severe
- Can result in lifelong problems
- Is not immediately recognized or diagnosed

Families need coping with the differences of their infants and young children
Most preschools are fully inclusive and help with:
- Motor development
- Language skills
- Academics
Common goals are:
- Communication skills
- Participation in the community
Foundation for these students should include:
- Functional assessments
- Educational decisions made on an individual basis
- Instruction directly applied to the target behavior

Collaboration includes all members of the multidisciplinary team
Accommodations are made for the unique learning styles of each student
Evaluations are frequent and direct
Procedures applied are verified through research
IDEA and Leave No Child Behind laws require that students with disabilities be part of statewide testing. Three options are available:
- Partial participation
- Out-of-level testing
- Alternative assessment (usually in the form of portfolios)

Students with low incidence disabilities leave school at 21 instead of 18
After school, many receive supported living arrangements and employment services
As students get older, they receive more community-based instruction to foster learning from one setting to another
A transition plan must be in place for students by the age of 14

Educators must focus on the family's concerns, needs, capacity, and potential for providing support
Key concepts in creating family support include having the family:
- Be the primary unit of concern
- Remain active in the community
- Be assisted in gaining access to support systems
- Empowered to deal with the complexity of social service agencies
- Receive services which are sensitive to their cultural diversity

Technology helps students:
- Communicate more effectively
- Increase levels of independence
- Control their environments
- Gain access to information
Distance education offers the possibility to:
- Communicate across great distances

What comprised an appropriate education and the least restrictive environment for students with low incidence disabilities?
- There is no single answer because of students' complex, unique, and severe problems
- Supports required tend to be pervasive and intense
Goals and instructional methods must be individualized to achieve independence, community presence, and quality of life