FINAL

PLEASE READ AND FOLLOW EVERYTHING. I HAVE ATTACHED CHAPTERS FROM THE BOOK

Preschool Plan

For this Final Project, you will be given the opportunity to pull together everything you have learned these past five weeks into a cohesive classroom plan for a three- to five- year-old preschool program. The following is the make-up of your classroom.

You have 12 students total:

1. Eight students are typically developing.

2. One student has an Autism Spectrum Disorder.

3. One student exhibits the following behaviors but has not been diagnosed with any particular learning need or disability.

a. Limited language

b. Jumps from activity to activity

c. Engages only in parallel play

4. One student who has a Sensory Processing Disorder (e.g. she is sensitive to light, sound, smells, and textures such as paint, sand, glue, and clothing and she avoids physical proximity to people).

5. One student who is both cognitively and linguistically advanced.

For this classroom plan, you must show your administration or director that you have the necessary strategies in place to effectively instruct each of your 12 students based on their individual needs. You will present this in the form of a PowerPoint presentation. The presentation will be 14 to 16 slides (not including title and reference slides), one slide for each of the following elements:

1. A title slide

2. Create a mission statement regarding developmentally appropriate practices with three- to five-year-olds (i.e. what is DAP and how does it apply to your teaching of these children?)

3. An outline of the laws governing exceptional children that impact your instruction

4. A description of the classroom environment you will provide for these 12 children

5. A discussion of how you will communicate with the families of your students in order to meet the individual needs of each child

6. A description of two to three specific instructional approaches you will utilize in your instruction, as well as why you feel your chosen approaches will be effective

7. An explanation of your instructional techniques/plans for the eight typically developing students

8. A description of your instructional plan, including accommodations, modifications, and services available to your student who has an Autism Spectrum Disorder

9. A discussion of your instructional plan, including accommodations, modifications and services available to your student who exhibits certain behaviors but has not been diagnosed

10. An explanation of your instructional plan, including accommodations, modifications and services available to your student who has a Sensory Processing Disorder

11. A description of your instructional plan, including modifications/extensions for your student who is cognitively and linguistically advanced.

12. Create a sample lesson plan using the required

Lesson Plan Template

, showing how you will meet the needs of all learners for your chosen lesson (remember, the lesson you choose must be developmentally appropriate). It is required that you use the Lesson Plan Template to complete this portion of your assignment. It is suggested that you utilize the

Early Childhood and Child Development: Lesson Plan Handbook

as a guide for how to more effectively plan this lesson.

13. An explanation of why you feel you have a comprehensive plan for meeting the needs of all of your students

14. A reference slide

· You are encouraged to creatively address the material by including graphics, charts, and/or graphs.

· This presentation must be formatted according to APA style, including the title and reference slides and citing within slides when applicable.

· The notes section of the PowerPoint should be utilized in order to effectively elaborate on each necessary component.

· Lastly, you must use at least five scholarly resources (e.g. peer-reviewed journal article, book, website for a special education organization, etc.) as well as the course text. Remember to cite your sources throughout the presentation in order to support your ideas.

6.1 What Are Speech and

Language Impairments

Students receive services for SLI more than any other disability except for SLD. This section discusses the difference between a speech impairment and a language impairment. It presents the definition for SLI as outlined by IDEA and discusses the prevalence of SLI in schools in the United States.

Defining SLI

Speech and language impairment (SLI) refers to a group of disorders that affect a student’s speech or language skill and development. Language refers to the systems that people use to communicate with each other; it also refers to the meanings of words, and how words are assembled into meaningful thoughts. It can be oral (spoken), written, or even gestural. For example, in the United States, the gestural language of a “high five” usually signals “Congratulations!” Speech, which refers to the oral aspect of language, is how people express ideas or thoughts through sounds. Speech is the main form of communication for people around the world.

A language impairment is a disorder that affects how people understand or use words. This can mean that they have difficulty understanding what people say (receptive language) or that they have difficulty constructing thoughts or ideas (expressive language), or both. Receptive language refers to how people organize and understand information provided through oral, written, or visual means. Expressive language refers to how people construct the words, symbols, or gestures they want to communicate to others. A speech impairment is a disorder that affects the production of sounds and words.

The category of SLI incorporates a wide variety of difficulties, including difficulties related to articulation (pronunciation), fluency (flow of speech), voice, and language (which includes putting words and sentences into meaningful forms). Students with SLI may experience difficulties with speech or language, with approximately half of diagnosed students experiencing both (Seeff-Gabriel, Chiat, & Pring, 2012).

In the field of medicine, SLI often falls under an umbrella category called communication disorders or communicative disorders (as do hearing difficulties; Chapter 10 discusses hearing impairments in detail, as they have their own IDEA 2004 category.) Evaluations or diagnoses from medical professionals may use the term communication disorder, but schools will use the term SLI.

Students with SLI may have academic skills that are below average, average, or above average, but researchers have demonstrated that they often perform below students without SLI on assessments of intelligence, language, and literacy (Ferguson, Hall, Riley, & Moore, 2011). The effects of an SLI on educational outcomes vary and are dependent upon the student’s specific difficulties. For some students, the impairments do not hinder learning new material or participating in classroom activities. Other students with SLI, however, have difficulty with working memory, which influences how they process information and store knowledge. Evidence of a strong association between SLI and problems with working memory continues to grow (Montgomery, Magimairaj, & Finney, 2010).

Other students may have difficulty understanding new material or participating in class. Reading difficulties are common because of the connection between language and reading (Pennington & Bishop, 2009). If students struggle with understanding spoken language (i.e., what words mean) then it can be difficult to understand the meaning of words read on the page. Students may also have difficulty with speech and with communicating through language, and speech difficulties can contribute to reading difficulties (Gosse, Hoffman, & Invernizzi, 2012). The need for support depends on the degree to which the impairment affects the ability to succeed in the general education curriculum setting.

SLI and IDEA 2004

Speech and language impairment is one of the 13 disability categories under IDEA 2004. The passage of PL 94-142 in 1975 mandated that to be eligible for special education services related to SLI, students had to be “speech impaired” (Triano, 2000). Because of the 1997 reauthorization, however, IDEA 2004 considers SLI to be a communication disorder: “Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.”

Note that for students to receive special education services for SLI under IDEA 2004, the impairments must adversely affect educational outcomes, such as reading or mathematics performance. If a student’s academic performance is not adversely affected by the SLI (e.g., the student’s only difficulty is with speech), it is possible for the student to receive special education accommodations under Section 504.

Once students are identified with SLI, the school assigns a speech-language pathologist (SLP) or other certified specialist to provide instructional services. Most school districts employ SLPs to help students diagnosed with SLI because they are trained to work specifically with these impairments. Additionally, some families send their children to work with an SLP outside the school day.

If SLI is the student’s only disability, the SLP is considered to be their primary service provider and is responsible for ensuring that annual IEP goals are achieved. If a student has multiple disabilities that affect educational performance, a special educator may be considered the primary service provider and work in collaboration with both the general education teacher and the speech-language pathologist.

Regardless of the IEP arrangement, all educators must collaborate and communicate regularly about student strengths, needs, and academic progress. Instructional services provided by the SLP should be reinforced both in the classroom and at home. For example, if a student has difficulty pronouncing the /r/ sound, the parents and the teacher should employ the same techniques as the SLP to remind the student about the /r/ sound and provide opportunities to practice it.

Prevalence of SLI

SLIs affect approximately 3% of, or more than one million, school-age students. Boys tend to have slightly higher rates of SLI than girls (Viding et al., 2004).

About 6% of students with an SLI experience a reading SLD, as shown in Figure 6.1 (Gosse et al., 2012). In fact, students with SLI share many characteristics of students with dyslexia (Robertson, Joanisse, Desroches, & Ng, 2009). A small percentage of students with SLI may be diagnosed with other disabilities, such as autism, intellectual disabilities, ADHD, EBD, or SLD (Cleland, Wood, Hardcastle, Wishart, & Timmins, 2010; Pinborough-Zimmerman et al., 2007).

Figure 6.1: Comparison of SLI and SLD

The percentage of school students with SLI has remained relatively constant since 1977. The percentage of students with SLD rose dramatically until 2001 and has begun to decline with new methods of identification of SLD, such as RTI.

6.2 How Has the SLI Field Evolved?

Speech and language difficulties have been reported almost since the beginning of recorded history. Thousands of years ago, young men in Greece and Rome were taught oratory skills to improve public speaking, and tongue exercises were developed to help those with speech difficulties. In medieval times, physicians suggested treating the throat or removing excess saliva from the mouth. In the 16th century, Hieronymus Mercurialis noted that speech impediments could be influenced by anxiety about speaking, and suggested methods for overcoming the problem.

By the 18th century, physicians had learned more about how the human body produces speech, which led to medical treatments for those with speech and language difficulties. In the 19th century, therapists like Alexander Graham Bell—the inventor of the telephone and also a speech therapist—offered lessons to help people with speech and language difficulties.

In the late 19th century, Samuel Potter, a stutterer, wrote about and suggested treatments for different types of speech disorders. Some of his treatments included repeating the alphabet, placing vocal organs in proper positions, and regulating oxygen flow. Edward Wheeler Scripture followed a few years later with a book on stuttering and lisping.

To help students with speech difficulties, Margaret and Smiley Blanton published a book on speech for parents and teachers in 1920. This book recommended speech training for all students during the school day, regardless of whether they had a speech difficulty. As more therapists began providing treatment in the United States for people with SLI, Edward Lee Travis and his colleagues formed the American Speech Society in 1925; this is now the American Speech-Language-Hearing Association.

Throughout the 20th century, more research about speech and language difficulties was carried out (Duchan, 2010). Therapists began recognizing a larger number of specific types of speech and language difficulties, and they suggested many different therapies to help.

Over the last 50 years, standardized assessments and diagnostic routines relating to speech and language have been developed to assist with the diagnosis of SLI. Degree programs for certified and professionally trained speech-language pathologists (SLPs) have also become more prevalent.

The certification of more SLPs, along with the passing of special education laws, has meant that more students can receive the speech and language services they need (Katz, Maag, Fallon, Blenkarn, & Smith, 2010). In fact, because so many students require the services of SLPs and there are not enough SLPs to provide the services, speech-language pathology assistants (SLPAs) have become more prevalent in schools. An SLPA implements interventions with students while supervised by an SLP.

In the last few years, medical technologies have provided greater insight into speech and language production, and researchers have developed and tested therapies and interventions for people with SLI (Baker & McLeod, 2011; Cirrin et al., 2010). For example, a medical professional might use different instruments (e.g., nasometry or electromyography) to understand bodily functions related to speech. An SLP might use evidence-based practices to improve the speech patterns or language skills of a student with an SLI. The SLP might use nonspeech movements, such as massage, cheek puffing, or icing to improve the speech of students (Lass & Pannbacker, 2008).

6.3 What Are the Characteristics of Students With SLI?

The term SLI covers a wide range of disorders related to speech and language; therefore, students with SLI may display many different characteristics. In general terms, students with SLI may experience difficulty following directions or understanding and participating in a conversation. They may struggle with the pronunciation of words and the production of language, and may experience difficulty at school, where communication and learning traditionally rely mainly on the expression of ideas through speech and language.

The National Dissemination Center for Children with Disabilities describes four major areas of difficulty for students with SLI. The first three areas deal with speech difficulties:

Articulation difficulties, which involve problems with the pronunciation of sounds. One type of articulation difficulty is a lisp, which means /s/ and /z/ sounds are pronounced incorrectly. Many toddlers and young children have difficulty with /l/ and /r/ sounds as they are learning to speak. When the difficulty persists past the age of 5, a student has an articulation difficulty.

Fluency difficulties, which involve a student’s flow of speech. A struggle with fluency involves the disruption of the speech pattern because specific sounds and words are difficult to say. Students may repeat or slowly pronounce words, or they may skip difficult sounds or words entirely. Stuttering is an example of a disorder that affects speech fluency. When a student stutters, they repeat or “get caught on” certain sounds (e.g., “I l-l-l-like ice cream”).

Voice difficulties, which involve pitches of sound when speaking. Students may speak too loudly or too softly. They may sound hoarse, breathy, or nasal.

The final area deals with language difficulties:

Language impairments, which involve difficulty with communication. Students with language impairments have trouble expressing their wants and ideas, understanding new information, following directions, and understanding the written or spoken word. Students may pause when speaking to find the “right” word (Smith, Hall, Tan, & Farrell, 2011).

So, speech impairments affect how students make sounds and words. Language impairments affect how students understand language and communicate their thoughts and ideas.

Speech Impairments

Speech sound disorders involve the faulty production of sounds and sound patterns. Motor speech disorders usually involve how the face, mouth, and brain work together to create speech. Speech sound and motor speech disorders can cause articulation, fluency, or voice difficulties. Students with speech impairments may have difficulty imitating the speech of others, and their own speech may be difficult to understand or interpret. They may be anxious when speaking because it is difficult for them. Students with speech impairments often experience language impairments because of disruptions with speech (Finneran, Leonard, & Miller, 2009).

Speech sound disorders are more common than motor speech disorders. Here are a few of the most prevalent types:

Articulation disorder. Students with articulation disorder have difficulty making sounds. When saying syllables or words, students may substitute one sound for another (easier-to-produce) sound, add a sound, or take out a sound. For example, a student may say “the rabbit ran” as “the wabbit wan.” As young children develop speech, almost all have difficulty with articulation. When that difficulty continues past the time students start kindergarten, they may require support to improve their articulation. Teachers, however, need to ensure that the student actually has an articulation disorder rather than speaking a regional dialect or English as a second language. English language learners are often over-identified as having an SLI (Kapantzoglou, Restrepo, & Thompson, 2012). A trained professional, such as an SLP, can help determine the difference between an articulation disorder and a dialect or accent. Often, as students improve their knowledge of English, it becomes clear whether the student has a disorder.

Phonological process disorder. Students with a phonological process disorder make patterns of errors when producing sounds. This disorder is related to how the brain communicates. Often, the student’s tongue produces sounds incorrectly, but in a way that other sounds are produced. For example, say the sound /g/ as in the word “gut.” Your tongue touches the inside of your mouth, all the way in the back. Now, say the /d/ sound. Where did your tongue touch the top of your mouth for /d/? Now, say the /g/ sound again, but touch your tongue to the top of your mouth a little further forward than you did for /g/ before. What you said probably sounded more like /d/ than /g/. Students with phonological process disorder may switch the sounds for /k/ and /t/ as well. They may also have difficulty with blends of two consonants. They often say the first of the two consonants and drop the sound of the second consonant. “Trick” becomes “tick,” and “drip” becomes “dip,” for example.

Stuttering (also called dysfluency). When students stutter, they get “stuck” on a syllable or word, and they repeat it several times. Stuttering falls under speech sound disorders, but it also may classify as a dysfluency disorder. Some stutterers say “um” or “uh” frequently while they are preparing to say a word. For some students, stuttering has little to no effect on speech. For others it can be a major stumbling block for participation in school and life activities. Some examples of stuttering include, “P. . .p. . .p. . .please,” “The. . .the. . .the dog,” or “I want. . .uh. . .uh. . .uh chocolate ice cream.”

The following are a few of the most common motor speech disorders:

Childhood apraxia of speech (CAS). Apraxia is the inability to perform a movement (in this case, speech) even when the brain and body understand what needs to be performed. Students with CAS struggle with saying sounds, syllables, or words. Usually, they want to say something, but their brain and their body parts (e.g., mouth or tongue) have difficulty with the coordination of the speech. Students with CAS typically understand language (i.e., what is being said), but they have trouble speaking as they respond to the language. CAS is different from stuttering in that stuttering is a difficulty with creating speech and CAS is a difficulty with the language that goes into speaking. In other words, students with CAS can articulate words; they just have a hard time finding the “right” words to say.

Dysarthria. Students with dysarthria typically have a neurological impairment that causes difficulty moving the muscles of the face and mouth. The muscles may be too weak or slow to produce speech. These students may also have difficulty breathing, which contributes to difficulty with speech. Students may speak at a slow rate or appear to whisper or mumble. Voice quality may be hoarse, nasal, or breathy. Some students may have experienced a traumatic brain injury (TBI), while others have a disease (such as Cerebral Palsy or Muscular Dystrophy) that contributes to the dysarthria.

Orofacial myofunctional disorders (OMD). Students with an OMD have difficulty with the control of their tongue, which may cause difficulty with speaking. The tongue may move forward in the mouth too much while the student is speaking, which causes difficulty in the production of speech. For example, try to say the word “sink” with your tongue sticking out of your mouth. Did you say “think” instead?

When a student struggles with a speech impairment, whether it is a speech sound disorder or motor speech disorder, the student often demonstrates atypical classroom behavior. For example, the student may not participate in classroom discussions or volunteer to answer questions because they do not want to speak aloud. If teachers are not aware of the speech impairment, they may perceive the student’s lack of classroom participation as disinterest or a lack of knowledge.

Language Impairments

Unlike a speech impairment, which may affect just one part of an individual’s speech, a language impairment typically affects all aspects of an individual’s language (Archibald, Joanisse, & Edmunds, 2011). Language impairments can be divided into two categories: expressive and receptive.

Expressive language disorder. An expressive language disorder affects how students produce verbal and written language. Students typically have difficulty communicating thoughts and feelings in a coherent manner. They may find it hard to put words in the right order to form grammatical sentences, or they may use words in inappropriate contexts. They may have difficulty with verb agreement and using proper tenses (Leonard, Miller, & Owen, 2000). For example, a student might say “The cat lick his paw” or “Last week, Marta bring a frog to class.”

Receptive language disorder. A receptive language disorder affects how students understand what other people are trying to say. Students may struggle with understanding directions or participating in conversations.

Mixed expressive-receptive language disorder. Often, students struggle with both expressive and receptive language (Nickisch & von Kries, 2009). Students have difficulty understanding language and communicating with language.

In discussions of language impairment, you may hear or read the term aphasia, which refers to difficulty remembering words or remembering how to read and speak. Aphasia often occurs after an older person has experienced a stroke or some other type of brain or neurological injury, but young students can experience it as well, especially after an accident. With aphasia, a student may not be able to find the “right” word to say. For example, she might say, “I want to play that game with the red and black pieces—you know, that game. What’s it called?”

Voice disorders affect the sound of a student’s voice. Usually, the unusual qualities in a student’s voice indicate a condition affecting the student’s vocal chords (larynx) or trachea (wind pipe).

6.4 What Are the Causes of SLI?

Different types of SLI have differing causes. One common cause for an SLI is a hearing impairment, because of the role hearing plays in understanding language and speech. Other contributing factors include a variety of diseases, disorders, and deficits within the brain. Sometimes, the causes remain unknown.

The Role of Hearing Impairments

Hearing impairments are the most common causes of speech and language difficulties (Keilmann, Kluesener, Freude, & Schramm, 2011). When a student has a hearing impairment, he or she has difficulty hearing and discriminating between sounds. Students may have mild or moderate hearing loss, such that sounds sound softer. They may have severe or profound hearing loss, such that sounds can only be heard with technologies or not at all.

Hearing impairments affect SLI because hearing others speak influences much of our early speech development. Children learn to speak by mimicking sounds their parents and others make. If the child doesn’t hear these sounds properly, it can cause a delay in speech and language.

The Role of the Brain

In the 19th century, a French physician named Paul Broca conducted an autopsy on a patient who could understand language but had severely limited speech; he found damage to the man’s left frontal cortex (see Figure 6.2). After seeing similar patterns of damage in other patients, Broca concluded that this area of the brain helped produce language. This part of the brain is now referred to as Broca’s area. Several years later, Carl Wernicke, a German physician, discovered another part of the brain related to language understanding. Wernicke’s area, as it is now called, is located in the back of the left temporal lobe.

Figure 6.2: Broca’s Area and Wernicke’s Area

Information comes into the brain and travels to Wernicke’s area, one of the areas involved in how the brain makes sense of the language. Information then travels to Broca’s area, which is involved in the process of responding. When students have damage to either Wernicke’s area or Broca’s area, the student may experience difficulties with speech or language.

Today’s research reveals more about how specific areas of the brain control the comprehension and output of language (Badcock, Bishop, Hardiman, Barry, & Watkins, 2012). An individual’s brain may be involved in difficulties in the production of speech and language or in the motor skills required for speech. For example, parts of the brain may be damaged or connections in the brain may not be working in a typical manner. The brain may be misfiring and sending incorrect signals to the student (Preston et al., 2012).

The Role of Genetics

Genetics may play a role in SLI (Pruitt, Garrity, & Oetting, 2010). Studies of twins have found that when one twin has a speech or language impairment, there is a 40–75% chance that the other twin will have an SLI (Viding et al., 2004). Students with a parent with an SLI have an increased risk of also having an SLI (Pruitt et al., 2010).

Research indicates that the development of language and speech, as it is tied to the brain, is directly related to genetics. That is, brain development and function tends to be similar from parent to child. If a parent has a difficulty with speech and language that is related to brain function, then his or her children are more likely to, as well.

Other Factors

Some students experience SLI because of another disease or disorder. For example, students with Muscular Dystrophy lose muscle control, including control of the tongue, which contributes to difficulty producing sounds and words. Students born with a cleft palate, even if it has been repaired, may still have a difficult time producing sounds and words.

Voice disorders may be caused by excessive or inappropriate use of the vocal chords. For example, students who scream or yell excessively can damage their vocal chords. The inhalation of toxins, such as cigarette smoke, may contribute to vocal difficulties as well.

Other environmental factors, such as allergies or ear infections, can contribute to hearing difficulties, that can, in turn, contribute to an SLI. Additional environmental factors linked to SLI include abuse, neglect, or malnourishment. These factors may contribute to abnormalities in brain development or function, which may cause an SLI.

6.5 How Are Students Diagnosed With SLI?

If a teacher suspects that a student may have an SLI, the teacher should refer the student for evaluation with a trained professional, such as an SLP. The SLP and other medical professionals can conduct appropriate assessments and provide an appropriate diagnosis. Teachers do not diagnose SLI.

When Are Students Diagnosed?

Many teachers recognize SLI during preschool or elementary school, but students can be diagnosed at any time during their school career. Many delays in speech and language development can be identified within the first few years of a child’s life. Other difficulties in understanding and expressing language do not become evident until students begin to learn to read and write.

Once students exhibit persistent difficulties with speech or language, the evaluation process should be initiated. The longer children go without services, the less likely they will be to improve their abilities to understand and produce language.

Parents and teachers can sometimes have difficulty deciding when a child’s speech and language issues are something he or she will “grow out of,” and when the difficulty is something that needs to be brought to the attention of an SLP. Parents may attribute speech difficulties to “baby talk” long after the child should have outgrown the speech patterns. The rule of thumb is that most students should outgrow speech and language difficulties before they enter kindergarten.

The Diagnostic Process

The official evaluation for, and diagnosis of, SLI comes from a certified SLP or other certified therapist or professional, typically early in a child’s education. Family members or teachers who notice difficulties indicative of an SLI may refer the student to the school or district’s SLP (Lindsay, Dockrell, Desforges, Law, & Peacey, 2010). If a school or district does not employ an SLP, the district must pay for an evaluation from an outside center or SLP. Medical professionals, such as doctors, may diagnose SLI as well.

The diagnostic process for SLI may be inconsistent from school to school or clinic to clinic (Dollaghan, 2011). Each SLP may employ their favorite diagnostic measures and processes. However, there are some commonalities in the steps for evaluation and diagnosis used with most students. For example, three sources are typically used in an evaluation: a parent report, a teacher report, and observation by a trained professional (McLeod & Harrison, 2009).

Before an SLI assessment occurs however, an audiologist (i.e., hearing specialist) or an Ear-Nose-Throat physician or specialist should conduct a hearing evaluation to help rule out or clarify the role that hearing loss may have in the student’s speech or language difficulties.

Informal and Formal Observations

Once a hearing assessment has been conducted, the next step is for an SLP to gather more detailed information from parents and teachers about the speech or language difficulties of the student. The SLP may also conduct informal and formal observations of a student’s speech and language skills. In a formal observation, the SLP may conduct a set of activities with the student to elicit specific responses related to speech and language. For example, “This is a ball. Say ball. This is a rabbit. Say rabbit.” The SLP may ask students to follow specific directions; name colors, numbers, letters, or common objects; or sing songs and rhymes. In an informal observation, the SLP may observe the student playing with a parent or peers to determine how the student speaks and whether the student understands language. Informal observations are often used with younger students, while formal observations are often used with older students.

The information obtained helps the SLP determine which diagnostic tests may be appropriate to administer to the student.

Assessment Activities

The SLP then administers a battery of assessments and has students engage in activities to determine the source of difficulty. The assessor first may administer an oral mechanism examination to check for weakness of the lips, jaw, tongue, or teeth. He or she may also evaluate how well the student’s mouth moves in different directions. To evaluate sound production, the SLP may ask the student to say specific sounds or mimic sounds and sound patterns.

The SLP may ask the student to speak and will then count the number and types of dysfluency in the student’s speech—that is, how many breaks or pauses occur in a student’s speech. Additionally, the SLP may examine the student’s rate of speech. To determine difficulties with language, the SLP may administer assessments of oral language comprehension and production.

A medical professional may conduct an anatomical evaluation of the mouth and face to determine whether the larynx or tongue may be contributing to speech or language difficulties. Dentists or orthodontists may notice or assist in the detection of anatomical abnormalities in the student’s mouth.

6.6 How Does SLI Differ Across Grade Levels?

Instructional support for students with SLI, like support for all students with disabilities, varies depending on grade level. Regardless of age or ability, however, instruction at every grade level should promote stronger language skills and strengthen specific areas of weakness, according to the individual child’s needs.

Early Childhood

SLI may first become evident as infants begin to respond to adult communication. Early childhood language includes babbling speech sounds (e.g., “ba” and “ga”) and exhibiting clear responses to direct communication from adults (e.g., a baby turning to look at his mother when she calls his name). As young children progress, they begin mimicking the speech patterns of their parents and repeating basic words (e.g., “bye” and “ball”). Children then begin to speak words to communicate meaning, and eventually combine words to form simple sentences (e.g., “I want cookie”).

At any point during this speech and language development process, delays can be observed. Some delay in speaking and responding to communication may be within normal range, but when significant difficulty is observed past recommended developmental benchmarks, the child may have an SLI

Like all students with disabilities, students with SLI benefit from early intervention. Interventions for SLI can either be child-focused or environment-focused. Child-focused intervention targets a specific behavior within the child, while environment-focused intervention seeks to alter the setting or behaviors of others who interact with the child on a regular basis (Pickstone, Goldbart, Marshall, Rees, & Roulstone, 2009). The earlier that parents or teachers can identify the need for early intervention, the better the outcomes may be for the student. Some students may be referred for early special education services. For many students, speech and language services may be provided by an SLP during pre-school or pre-kindergarten. Some students may receive services in a clinic setting even earlier, if necessary. The earlier that speech or language services can be delivered to the student, the quicker any impairments can be improved or remedied. Students can be identified under IDEA 2004 with an SLI, or students may be identified under the category of developmental delay and receive appropriate services in this manner.

Interestingly, many young students with speech difficulties do not believe they have a speech difficulty (McCormack, McLeod, McAllister, & Harrison, 2010), so if these students can receive speech services before they catch on to their difficulty, they may avoid developing negative feelings about speaking.

Elementary School

Early intervention for SLI is particularly important as students begin learning to read and write in early elementary school. Students with SLI can benefit from small-group, explicit instruction that focuses on recognizing and memorizing patterns in speech sounds, word parts, and sentence structures. With explicit instruction, the teacher or another trained therapist or specialist provides focused instruction on specific topics necessary for the student’s speech or language development. Students may need meaningful repetition and practice with the elements of speech and language. Additional practice and frequent feedback on language assignments may help students with SLI improve their word recognition and processing speed.

Promoting social communication is key at this stage of a child’s education. In elementary school, students with SLI will become aware of their impairment and the difficulties they face understanding and communicating with others. Teachers can plan positive interactions and opportunities for students to share their ideas with others. Structuring activities for students to demonstrate their strengths can build their confidence in their ability to interact with peers and adults. Allowing, or even requiring, multiple modes of communication, such as pictures or storyboards, can increase student interactions.

For elementary students with speech impairments, work with an SLP or other certified specialist is imperative. The general teacher should collaborate with the SLP to coordinate reinforcement and support in the general classroom that is complementary to and builds off speech services. For example, if the SLP is working on phonological awareness (PA) with a student, it is important for the general education teacher to reinforce PA skills in a similar manner.

Secondary School

Most progression of language ability occurs early in a student’s education, and by the time students enter late middle or high school, many of their language habits and abilities are solidified. In fact, the percentage of students receiving SLI services in high school is often drastically lower than students receiving services in elementary school. If adolescent students with SLI do receive services, it is often in shorter increments than elementary age students. However, significant academic gains are still possible for secondary students. A focus on building speech and language confidence and skills should continue into secondary education for students with SLI.

An in-depth understanding of student strengths and weaknesses can help teachers design specific interventions for targeted skills. Secondary school students should have an understanding of their progress to date and future goals for improving expressive and receptive language ability. Continued emphasis on building confidence is important to help students realize their potential.

Adolescent students with SLI may perceive their academic and social abilities to be lower than students without any language impairment. Hughes, Turkstra, and Wulfeck (2009) studied perceptions of executive function in students with SLI; executive function is associated with goal-oriented behavior, including memory, control, and self-monitoring, and it is essential for language-based academic and social tasks for secondary students. Hughes et al. (2009) found that both adolescents with SLI and their parents tended to rate their executive function (i.e., attention, planning, flexibility, etc.) more negatively than students and parents of students without SLI.

Transition

Secondary students with SLI will have a transition plan as a part of their IEP. Post-secondary transition plans vary among students with SLI and are created by the IEP team, including the student, family members, special education teacher, SLP, general education teachers, school counselor, and other service providers, as appropriate. Students who plan to transition to higher education and most careers must be able to effectively read, comprehend, and express their ideas in oral and written form. Post-secondary students with SLI need be able to advocate for their individual needs so that their speech or language impairment does not impede academic and social performance. Additionally, students need to be well aware of the accommodations and resources necessary for their continued success.

For students with multiple or severe disabilities, IEP and transition goals may include functional life skills. This will likely include learning to communicate basic needs, such as using the bathroom, through speech or assistive technology. Such skills are critical to future quality of life, and should be addressed in secondary IEP goals and transition plans.

Once they exit the K–12 school system, it is unlikely that adults with SLI will receive targeted intervention in speech or language. Adults with SLI may show poorer communication, academic, educational attainment, and occupational outcomes than adult peers without speech or language impairments (Johnson, Beitchman, & Brownlie, 2010). However, adults with SLI can be successful in college and career, especially with the appropriate support systems in place.

6.7 How Do I Teach Students With SLI?

Students with SLI should receive speech and language services from trained professionals. The role of the classroom teacher is supportive and collaborative.

Collaboration With an SLP

An SLP often provides appropriate services for students with an SLI, although other certified staff members (e.g., SLPAs, audiologists, vocational specialists, occupational therapists, or physical therapists) may contribute to providing speech and language services (Richburg & Knickelbein, 2011). Depending upon the student’s IEP, the student may receive intensive therapy (e.g., four or five times a week) or periodic therapy (e.g., once a week; Bellon-Harn, 2012). SLPs may conduct a wide range of therapies and activities tailored to the student’s disability. Most often, SLPs work individually with students because each student requires an individualized speech or language program.

Consultation between the SLP and the student’s family is important so that the family is aware of instructional methods used with the student. The discussion should cover improving and practicing speech or language in the home environment (Roberts & Kaiser, 2011).

Special Education Perspectives: Working with Speech Impairments

Students With Speech Disorders

SLPs may lead students with motor difficulties in exercises to strengthen the tongue or mouth. Students may watch themselves in the mirror or watch a videotape that the SLP has made of the student speaking. Students with speech sound difficulties may require different methods; SLPs may teach them how to correctly pronounce letters or words by demonstrating and explaining the actions. For example, the SLP may practice helping a student say the /r/ sound in “rake” by discussing the tongue’s movement in the mouth.

SLPs may teach students who are working on speech or language skills other ways to communicate in the interim. A student may learn to use signs or gestures to indicate wants and needs. In some cases, students may use picture boards or augmentative and alternative communication (AAC) devices. Chapter 9 discusses AAC and picture boards, as they are commonly used for students with autism.

From My Perspective: Being an SLP

I’m Marta, and I’ve worked as an SLP for over 20 years. SLPs work in a variety of settings and with a variety of communication disorders. A child has to have an educational deficit to be found eligible for the speech-language program under IDEA 2004, regardless of the disorder. Most SLPs see a caseload of 35 to 65 students, depending on the school system, and each student’s needs are identified on his IEP. Many SLPs work directly in the classroom to integrate the speech-language goals and successes into the daily routine, so that the teacher can observe and carry over the techniques. Some students require individual or group therapy, which can be conducted in the SLP’s room.

Articulation problems (difficulty pronouncing certain sounds) require the SLP to determine the cause and then assist the student with correct production—starting with single syllables and building up to longer utterances. Visual modeling, auditory discrimination training of the correct production, and tactile cueing are all tools used to achieve success. Reinforcement and repetition are key aspects of treatment.

Language reception and expression are a large part of the caseload, often best treated in the natural environment of the classroom. These areas are often seen in conjunction with other learning challenges, so a collaborative approach provides the best context for the child to improve her skills. Auditory processing of information, syntax (sentence structure), semantics (word meaning), and pragmatics (the non-verbal aspects of expressing oneself) are all areas that are assessed through standardized tests and language samples, and each can be improved through targeted instruction.

Students With Language Impairments

Teachers can do a variety of activities with students with language impairments. Vocabulary instruction should be explicit and focused on vocabulary that is most important for reading comprehension or communication (Taylor, Mraz, Nichols, Rickelman, & Wood, 2009). Typically, a few vocabulary words should be chosen and practiced to build fluency (Bryant, Goodwin, Bryant, & Higgins, 2003). It is helpful to provide pictorial representations, when possible, so students can visualize the meaning of the vocabulary word (Figure 6.3).

Figure 6.3: Teaching Vocabulary

Graphic illustrations may help a student who is learning the word swoop. A square with four sections. The top left section reads, “The eagle swoops down from the sky to catch a mouse.” The top right section reads, “Swoop means to fly down quickly.” The bottom left section shows an illustration of an eagle swooping down to get a mouse. The bottom right section reads, “Let’s practice a swoop with our hand. Put your hand high in the air. Now, quickly move your hand down and touch the ground.” This section shows and illustrations of an arm held high in the air and an arrow moving from the palm of the hand down.

Students can also learn strategies for “finding” the right word (Bragard, Schelstraete, Snyers, & James, 2012). Students can learn how to connect a vocabulary word to other known words using definitions or pictures. For example, a student may not be able to remember the word “carriage.” But the student could learn how to provide cues for the word: “It was used before cars, it has four wheels, and a horse would lead it.” The student might even use the word “wagon” or a picture of a horse-drawn cart to describe “carriage.”

Another helpful strategy to improve language is to expose students to a variety of books or situations that involve reading. Teachers read alongside students and encourage them to synthesize what has been read and guess what they will read next. Teachers should choose reading materials that are appropriate for the student. This may mean choosing books with a predictable structure or easy sentence patterns that enable the student to focus on the ideas or the story.

General Strategies

Teachers may want to place the student with SLI in a seat that is close to the focal point of the classroom (e.g., the whiteboard, the teacher, or the activity). This allows the student easy access to classroom instruction, and it allows the teacher to quickly recognize when the student requires additional help. It might be helpful for the teacher to speak in shorter sentences and paraphrase or highlight main ideas. Teachers should ask students to repeat directions or ask them questions to check for comprehension. Speaking a little bit slower and taking audible pauses may provide all students with time to digest and understand directives.

Strategies like an advance organizer (e.g., “Today we’re learning about plant life cycles”) or graphic organizers (e.g., “Let’s use pictures to show the life cycle of a plant”) can also help students with SLI. Students may especially benefit from advance organizers that include a preview of important vocabulary words.

Teachers may also employ response cards in a classroom with a student with SLI. To use response cards, the teacher asks a question, and each student responds by holding up an appropriate card. Response cards may be general. For example, students may have cards that say, “Yes” and “No.” Students can have cards with a happy face and a sad face. Students can hold up a card to answer a teacher’s question or show the teacher that they answered a problem correctly or incorrectly. Response cards may also be content-specific. For example, the students may have pictures of an ear, a nose, and eyes. For a lesson on the senses, the teacher may ask the student to hold up a response card to designate the best way to investigate an item: by listening, smelling, or seeing.

The teacher may need to educate the rest of the class on how to interact or include a student with SLI into regular classroom activities (McCormack et al., 2010). Young students may find it hard to understand what a student with a lisp or a stutter wants to say. The teacher should give other students guidelines—for example, “Look directly at your classmates when they speak”—to facilitate communication between peers. The entire class should learn to not snicker or laugh when a student has a speech, language, or vocal impairment. Negative peer reactions may cause a student with an SLI to exercise their speech skills less frequently, or it could exaggerate the student’s difficulty.

It may also be helpful to work on a student’s listening skills. Much of language involves listening and comprehending information from other voices, so it is important that students have opportunities to practice and improve their listening skills. Teachers should connect listening to speaking, reading, and writing. To help with listening, teachers can encourage a quieter classroom with fewer noisy distractions (e.g., music from a radio or chairs that scrape noisily on the floor).
Another helpful strategy to improve language is to expose students to a variety of books or situations that involve reading. Teachers read alongside students and encourage them to synthesize what has been read and guess what they will read next. Teachers should choose reading materials that are appropriate for the student. This may mean choosing books with a predictable structure or easy sentence patterns that enable the student to focus on the ideas or the story.

Tips for the General Classroom

The National Dissemination Center for Children with Disabilities (NICHCY) provides tips for general classroom teachers who work with students with SLI. Their suggestions include the following:

Learn about the student’s speech impairment or language impairment. Do not assume that all students with an SLI have the same difficulties.

Ask for a copy of the student’s IEP and learn about the student’s accommodations for the classroom and during testing situations.

Meet with the SLP or the special education teacher. Discuss how you can support the student in your classroom.

Talk with the student’s parent or guardian. Discuss how they can help support the student at home.

Be positive about including the student in your classroom!

General Strategies
Teachers may want to place the student with SLI in a seat that is close to the focal point of the classroom (e.g., the whiteboard, the teacher, or the activity). This allows the student easy access to classroom instruction, and it allows the teacher to quickly recognize when the student requires additional help. It might be helpful for the teacher to speak in shorter sentences and paraphrase or highlight main ideas. Teachers should ask students to repeat directions or ask them questions to check for comprehension. Speaking a little bit slower and taking audible pauses may provide all students with time to digest and understand directives.

Students use response cards or hand signals to participate in answering questions and indicating understanding. A common response is a thumbs-up or thumbs-down gesture. This teacher may have requested, “Give a thumbs up if you can think of a reason why cheating on a test is wrong.”

Teachers need to provide ample “wait time” for students who have difficulty creating speech or generating language. Even though teachers may think it is reassuring, saying things like, “It’s okay, take your time,” or “Relax and breathe” may be more counterproductive than helpful. Phrases like these may draw attention to the student and add to the student’s anxiety about speaking even more!
Strategies like an advance organizer (e.g., “Today we’re learning about plant life cycles”) or graphic organizers (e.g., “Let’s use pictures to show the life cycle of a plant”) can also help students with SLI. Students may especially benefit from advance organizers that include a preview of important vocabulary words.
Teachers may also employ response cards in a classroom with a student with SLI. To use response cards, the teacher asks a question, and each student responds by holding up an appropriate card. Response cards may be general. For example, students may have cards that say, “Yes” and “No.” Students can have cards with a happy face and a sad face. Students can hold up a card to answer a teacher’s question or show the teacher that they answered a problem correctly or incorrectly. Response cards may also be content-specific. For example, the students may have pictures of an ear, a nose, and eyes. For a lesson on the senses, the teacher may ask the student to hold up a response card to designate the best way to investigate an item: by listening, smelling, or seeing.
The teacher may need to educate the rest of the class on how to interact or include a student with SLI into regular classroom activities (McCormack et al., 2010). Young students may find it hard to understand what a student with a lisp or a stutter wants to say. The teacher should give other students guidelines—for example, “Look directly at your classmates when they speak”—to facilitate communication between peers. The entire class should learn to not snicker or laugh when a student has a speech, language, or vocal impairment. Negative peer reactions may cause a student with an SLI to exercise their speech skills less frequently, or it could exaggerate the student’s difficulty.

References

Powell, S. R., & Driver, M. K. (2013). Working with exceptional students: An introduction to special education [Electronic version]. Retrieved from https://content.ashford.edu/

7.1 What Is Gifted and Talented?

This section provides definitions of gifted and talented. These definitions do not come from IDEA 2004 because this legislation does not cover students who are gifted. The section continues with a discussion of the prevalence of gifted and talented students in schools.

Defining Gifted and Talented

Gifted is often used as an umbrella term that describes individuals who are gifted or talented. Students who are gifted demonstrate innate abilities that are exceptional. Students who are talented demonstrate exceptional performance related to their ability. Most people use the terms gifted and talented interchangeably.

While there are no universal definitions of gifted or talented, the primary organization that represents gifted students, the National Association for Gifted Children (NAGC), provides the following guideline:

Gifted individuals are those who demonstrate outstanding levels of aptitude (defined as an exceptional ability to reason and learn) or competence (documented performance or achievement in top 10% or rarer) in one or more domains. Domains include any structured area of activity with its own symbol system (e.g., mathematics, music, language) and/or set of sensorimotor skills (e.g., painting, dance, sports). (2008)

According to the NAGC definition, gifted and talented students demonstrate or have the potential for exceptional abilities in one or more areas.

Another definition, this one from a federal statute, explains that gifted and talented students demonstrate higher performance or are capable of higher performance in intellectual, creative, or leadership domains. According to these definitions, which also vary from state to state, gifted and talented students need specialized instruction, activities, or services in order to develop their exceptional abilities above and beyond general classroom instruction (Stephens & Karnes, 2000).

Gifted and Talented and IDEA 2004

Giftedness is not a category under IDEA 2004, but many school districts serve gifted students through special education offices or programs. The thinking is that students with disabilities require individualized instruction to meet their learning needs, and the same should be true for gifted students. The wide variability in definitions of gifted by both states and districts, though, means that many gifted students are not identified and are underserved (Robertson, Pfeiffer, & Taylor, 2011).

Furthermore, money to provide specialized programs to gifted students does not come from funds provided to school districts under IDEA 2004. Districts provide services through their district budgets; some schools apply for grant funding or work with private organizations to provide programs for gifted students.

Prevalence of Gifted and Talented

According to state-reported data from the National Center for Educational Statistics (2008), more than 3 million American students qualified as gifted in 2006. Each school or district, however, determines its own criteria and process for determining giftedness in both academic and nonacademic areas. Thus, the statistical prevalence of giftedness is difficult to determine and compare between schools, districts, and state populations (Callahan, 2011). As with students with disabilities, giftedness persists into adulthood (Fiedler, 2012).

Minorities tend to be underrepresented in gifted programs (Ford, 2013), as opposed to overrepresented in disability categories (Bollmer, Bethel, Garrison-Mogren, & Brauen, 2007). Reasons for the underrepresentation of minorities include fewer referrals from teachers and bias of assessments for eligibility (Ford, 2013; Hargrove & Seay, 2011). Also, some minority students may choose to not participate in programs because of the negative comments they could get from peers about being in the gifted program (Henfield, Washington, & Owens, 2010). While this is more often reported for minority students, many gifted students may experience some bullying or ostracism because of being gifted (Peters & Bain, 2011).

7.2 How Has the Gifted and Talented Field Evolved?

Like students with disabilities, students with giftedness have not always received special services. Toward the end of the 19th century, some schools started to provide appropriate educational services to gifted students.

One such effort was put forth by William Torrey Harris, the superintendent of schools in St. Louis, Missouri. Harris ensured that the school curriculum was enhanced to meet the needs of gifted students and incorporated art and music into the school day. By the turn of that century, school districts in large cities, such as San Diego and Chicago, started creating classes or schools for students who could handle an advanced curriculum (VanTassel-Baska, 2010). The first school devoted exclusively to the education of gifted students opened in Worcester, Massachusetts, in 1901 (Henry, 1917).

The Debut of the Intelligence Quotient Test

With the development of the first intelligence quotient (IQ) test in France in 1905, people began the attempt to quantify intelligence. The Binet-Simon Intelligence Test was originally designed to identify students with intellectual disabilities.

Lewis Madison Terman, an educational psychologist at Stanford University, revamped the Binet-Simon test in 1916 as the Stanford-Binet IQ test. This test allowed schools to identify students of below-average or above-average intelligence according to their scores. Schools could use the scores to identify gifted students and provide additional or different programs for them.

After the introduction of the Stanford-Binet IQ test, schools began placing students into tracks (i.e., educational programs based on intelligence) in an attempt to provide appropriate educational services. At the heart of this movement was Leta Stetter Hollingworth, who started a “Special Opportunity Class” in New York City for students with above-average intelligence. Hollingworth went on to open the Speyer School in New York (VanTassel-Baska, 2010), which was devoted to educating gifted students. She studied her students over a number of years and wrote the first textbook on gifted students.

The Push for Educating Gifted Students

In 1954, the National Association of Gifted Children was founded to advocate for specialized programs on behalf of gifted individuals. A few years later in 1957, when the Soviet Union launched Sputnik, the first artificial Earth satellite, a movement to identify and provide advanced instruction to gifted individuals took on new life. The United States, fearing that the Soviet Union was getting ahead in terms of technology and science exploration, began pouring money into educational programs that promoted science, technology, and mathematics education. Legislation, such as the National Science Foundation Act and the National Defense Education Act, began providing funds for the education of gifted students in grades K–12.

In 1972, the U.S. Commissioner of Education, Sidney P. Marland, Jr., published a report on the education of gifted students. The Marland report defined gifted as children capable of high performance including those with demonstrated achievement and/or potential ability (Marland, 1972).The Marland report emphasized that students with outstanding abilities need differentiated instruction and services above and beyond the typical educational programs (Kaplan, 2011). In differentiated instruction, students participate in classroom activities and assignments that are tailored (i.e., differentiated) to the strengths of the individual student.

To be gifted, according to Marland, students needed to demonstrate achievement or potential ability in at least one of the following areas: general intellectual ability, specific academic aptitude, creative or productive thinking, leadership ability, visual or performing arts, or psychomotor ability (Jolly, 2009b). (Psychomotor ability was later removed from the definition.) To assist in delivering a proper education to gifted students, the Office of the Gifted and Talented in the U.S. Department of Education was recognized in 1974.

The Jacob K. Javits Gifted and Talented Students Education Act

A 1983 report called A Nation at Risk announced that students in the United States were not performing as well as students in comparable countries around the world. The report suggested that gifted students should receive a curriculum that supports their needs. To affirm this idea, the U.S. Congress passed the Jacob K. Javits Gifted and Talented Students Education Act in 1988. This Act provided funds for national centers and programs for the education of the gifted and talented. The Javits Act was included in the authorization of No Child Left Behind in 2001 but has not been reauthorized since 2011. Without reauthorization, funds to conduct research and outreach in the area of gifted education are unavailable to research centers and state departments of education.

Even though state and federal standards for students are rising with efforts like the Common Core and No Child Left Behind, gifted students still require individualized and differentiated instruction (Johnsen, 2012). In fact, some people feel that such initiatives focus only on raising the performance levels of lower-performing students (Siemer, 2006). Therefore, gifted students may not be receiving the educational services that are warranted (Hargrove, 2012). Without proper avenues for research and dissemination (with the Javits Act) and funding opportunities for gifted programming, it is difficult for many school districts to afford gifted programs.

7.3 What Are the Characteristics of Students Who Are Gifted and Talented?

The exceptional abilities that gifted students display tend to fall into the categories of creative thinking, general intellectual ability, leadership ability, psychomotor ability, specific academic ability, and visual and performing arts ability (Amend, Schuler, Beaver-Gavin, & Beights, 2009; Song & Porath, 2011). Many (if not all) students exhibit one or more characteristics of giftedness at some time during their school careers. When these characteristics are exhibited consistently, a student warrants additional or different instruction at school.

The following section discusses the characteristics of gifted students related to their exceptional abilities and moves on to discuss students who are “twice exceptional.”

Characteristics Related to Gifted and Talented

Gifted students often demonstrate a gift or talent in one or more of the following areas. These areas are similar to those found in the Marland (1972) report and those outlined by the National Society for the Gifted and Talented (NSGT). Students may exhibit some of these characteristics in one or more of the following areas (Carroll, 2008; Cukierkorn, Karnes, Manning, Houston, & Besnoy, 2008; Glass, 2004; Neumeister, Adams, Pierce, Cassady, & Dixon, 2007; Renzulli, Siegle, Reis, Gavin, & Reed, 2009):

General intellectual ability

Displays advanced vocabulary

Engages in tasks independently

Gets excited about new ideas and information; curious

Picks up new material quickly

Remembers information easily

Asks engaging questions

Processes information in complex ways

Specific academic aptitude

Eagerly participates in readings

Reads widely in an area

Comprehends difficult material

Reads advanced material

Accurately recalls facts

Discovers patterns in mathematics

Solves problems abstractly or creatively

Uses a variety of representations

Creative or productive thinking

Pursues opportunities to work and create with technology

Enjoys working with hands-on materials

Invents and creates

Writes and speaks in creative ways

Provides several solutions to problems

Challenged by creative tasks

Displays mature sense of humor; understands sarcasm

Grasps metaphors and analogies

Leadership ability

Sought out by peers as a leader

Works well with others

Expresses ideas fluently

Acts confidently

Makes sound judgments and thinks through consequences of decisions

Is organized

Likes structure

Visual or performing arts

Creates

Observes

Has a visual memory

Displays exceptional ability in art, dance, drama, or music

Reasons well spatially

Solves puzzles and mazes easily

Twice-Exceptional Students

Twice-exceptional students—that is, those who are gifted and also have a disability—have been recognized since the 1970s (Leggett, Shea, & Wilson, 2010). These students have above-average intelligence, but their disability prohibits them from reaching their full potential.

Twice-exceptional students can experience giftedness concurrent with a specific learning disability (Barber & Mueller, 2011), an emotional or behavioral disorder (Bianco & Leech, 2010), attention-deficit/hyperactivity disorder (Foley-Nicpon, Rickels, Assouline, & Richards, 2012), and autism spectrum disorder (Amend et al., 2009; Assouline, Nicpon, & Dockery, 2012). Twice-exceptional students represent a small percentage of students with disabilities. For example, approximately 3–4% of students with SLD also experience giftedness (Leggett et al., 2010).

It is often difficult to identify twice-exceptional students, because their disabilities may mask their giftedness or their giftedness may be more obvious than their disabilities (Morrison & Rizza, 2007). Schools need to use a variety of identification methods rather than relying on one assessment or observation (Rizza & Morrison, 2007). Because of difficulties with identification, twice-exceptional students are underrepresented across the United States (Bianco & Leech, 2010). That is, many students who are twice exceptional remain unidentified and only receive services or accommodations related to their disability and not their giftedness.

Determining best educational practices for twice-exceptional students can be difficult (Amend et al., 2009). These students require specialized instruction and appropriate accommodations and modifications for both their disability and their giftedness (Jeweler, Barnes-Robinson, Shevitz, & Weinfeld, 2008). For example, a gifted student with SLD related to reading may need disability services and accommodations related to reading comprehension and test anxiety (King, 2005). This student, who excels with verbal communication, may need gifted services or accommodations to promote her excellent verbal storytelling skills and creative problem-solving skills. If the teacher only focuses on the disability, the student’s full potential for academic success may be ignored.

In addition, twice-exceptional students may require emotional or social support from teachers (Foley-Nicpon et al., 2012; King, 2005). For example, both gifted and twice-exceptional students may be bullied and need help dealing with this abuse (Peters & Bain, 2011). Also, many twice-exceptional children feel high expectations based on their giftedness, but they have difficulty meeting expectations because of their disability (Barber & Mueller, 2011). These high expectations may come from the students themselves or from adults or peers close to them.

7.4 What Are the Causes of Giftedness?

Like many disabilities, giftedness has no single cause. The main factors, though, are thought to be genetics and the environment (Simonton, 2005). Some people may claim that this is a debate between nature (i.e., genetics) and nurture (i.e., environment of student), but most in gifted education believe giftedness is a blend of the two (Winkler & Jolly, 2012).

A genetic influence can be seen in research showing that parents who exhibit exceptional abilities may have children who are also gifted, just as parents with disabilities may have children with disabilities (Simonton, 2005; Thompson & Oehlert, 2010). Students with gifted siblings are also more likely to be gifted themselves (Ronald, Spinath, & Plomin, 2002). In research related to the brain, researchers have discovered that gifted students demonstrate brain activation patterns different from those of students with below-average or average intelligence (Haier & Jung, 2008; Hoppe & Stojanovic, 2009; Prescott, Gavrilescu, Cunnington, O’Boyle, & Egan, 2010).

The possible influence of the environment can be seen in students who are exposed, especially at an early age, to opportunities that permit them to develop or enhance their gifts and talents (Seeley, 2004). Typically, students from lower-income families and schools or students with minority backgrounds may not have as many gift-enhancing opportunities (Gagné, 2011; Seeley, 2004), so these students may be at a disadvantage for being identified as gifted. School criteria and processes may also influence whether students are identified as gifted.

7.5 How Are Students Identified as Gifted and Talented?

No one process or assessment exists for identifying students as gifted and talented (Callahan, Tomlinson, Hunsaker, Bland, & Moon, 1995). Teacher perception plays a significant role in the recommendation of students for gifted evaluation. Interpretations of giftedness, however, vary by district and state. The identification problem is compounded by the fact that giftedness itself is manifested differently from individual to individual, and differently in the same individual at various ages. Regardless of the identification method, most researchers agree that early identification and early intervention are best for gifted students so students have many opportunities to enhance their gifts or talents (Wellisch & Brown, 2012).

Assessments

In the identification of giftedness, students need multiple opportunities to exhibit special gifts or talents through a range of instruments and performance tasks that align with the areas of giftedness being evaluated. For instance, a standardized assessment may be more appropriate to diagnose giftedness in mathematics than in art, where a portfolio of the student’s work would give a more accurate assessment of exceptional ability.

Schools may use scores on intelligence tests or achievement tests to determine whether students are significantly above average, range in the top 1–5% percent, and/or meet their school’s designated criteria for intellectual ability. An intelligence test (i.e., an IQ test) provides a score related to a student’s potential in terms of intellectual capability; it emphasizes potential instead of showing how much a student knows. An achievement test, on the other hand, provides a score related to what a student knows. Achievement tests usually provide scores in the areas of reading, writing, and mathematics.

To most accurately identify special gifts and talents, a variety of assessments is recommended, including standardized intelligence and achievement tests, performance tasks, observation checklists, and portfolios (Callahan, 2011).

In a performance task, students complete an open-ended task that offers multiple solution possibilities. Student responses are scored via a rubric that helps determine where performance falls on a spectrum from novice to expert (VanTassel-Baska, Johnson, & Avery, 2002). On an observation checklist, teachers identify gifted characteristics that students typically display. Many times, a parent fills out an observation checklist (Figure 7.1) about behaviors exhibited in the student’s home environment. A portfolio is a collection of student work that is collected to demonstrate a student’s exceptional ability in one or more areas (e.g., art and music).

Figure 7.1: Observation Checklist

This teacher checklist from the State of Tennessee is filled out by a student’s classroom teacher when the student is being screened for gifted identification. Information gathered from the checklists helps schools determine whether students are eligible for gifted programs. A checklist of 42 characters titled, TN Teacher Observation Checklist.

Source: Resource Packet: Assessment of Intellectual Disability and Functional Delay, p. 7, Tennessee Department of Education.

Table 7.1 shows a sampling of some commonly used assessments of achievement, performance, creativity, and problem-solving (Callahan et al., 1995):

Table 7.1: Sampling of Commonly Used Assessments

Assessment What it measures

California Achievement Test (CAT) Vocabulary, reading comprehension,

mathematics, science, social studies

Comprehensive Test of Basic Skills (CTBS) Reading, language, mathematics

Developing Cognitive Abilities Test (DCAT) Verbal ability, quantitative ability, spatial ability

Iowa Test of Basic Skills (ITBS) Vocabulary, listening comprehension, reading comprehension, mathematics, science, social studies

Peabody Picture Vocabulary Test (PPVT) Verbal ability

Scholastic Aptitude Test (SAT) Writing, reading, mathematics

Stanford Achievement Test Reading, spelling, mathematics, science, social studies

Torrance Tests of Creative Thinking (TTCT) Creativity with pictures and words

Wallach-Kogan Creativity Instrument Creativity

Watson-Glaser Critical Thinking Appraisal Critical thinking, decision making

Trained specialists (e.g., school psychologists, gifted teachers), administrators, and guidance counselors may administer assessments and interpret the scores, depending on school and district guidelines. If observations or portfolios will be used to determine giftedness, a team should be formed. Members of the team may include the student’s general education teacher, a gifted teacher or program coordinator, a school psychologist or guidance counselor, and any other staff members with experience with gifted and talented students.

The student’s family should be interviewed or involved in the decision-making process for eligibility for gifted programs. For students with gifts that might not be apparent in the general classroom, it is especially important that family members and other people close to the student help show school personnel all aspects of the student’s exceptional abilities. For example, students with exceptional musical abilities may not be able to demonstrate their skill if the school does not have an active music program.

Limitations of Assessments

The cultural and linguistic bias in some standardized assessment instruments can influence students’ performance scores. For example, some assessments require the student to read and respond to questions. If English is not the student’s first language, the student may have difficulty with the reading. If the assessment were administered in the student’s first language, the student’s score might be a better indicator of performance. Additionally, some assessments ask questions related to activities that could be considered culturally biased because a student may be unfamiliar with the content—for example, Halloween trick-or-treating (if not celebrated), remodeling of a house (when living in an apartment high-rise in the city), playing racquetball (if it has never been played or seen). Teachers have no control over the bias of instruments, of course, but they can use instruments that demonstrate minimal bias as much as possible.

Two young boys measure the growth of a plant in their school classroom.

Teachers may not realize students who are English Language Learners (ELL) are gifted if students do not demonstrate proficiency in English. Some researchers have suggested that assessments without a verbal component might be helpful in identifying gifted ELL students, but research in this area is still under investigation (Lohman, Korb, & Lakin, 2008).

Teachers may have difficulty spotting giftedness in students who are English Language Learners (Harris, Plucker, Rapp, & Martinez, 2009). First, because of difficulties with the English language, teachers may not readily identify students and refer them for a gifted evaluation (Harris et al., 2009). Also, because many students may be working on their English skills, students may not participate in activities (e.g., a problem-solving activity in science class) that would help get them noticed for demonstrating gifted characteristics (Harris, Rapp, Martinez, & Plucker, 2007).

Unintended evaluation bias can also occur for populations living in low-income communities, rural communities, or attending low-performing schools (Howley, Rhodes, & Beall, 2009). These students may be considered for evaluation less frequently and may have fewer opportunities to develop and refine their talents than if they attended a more affluent school. Ethnic and racial minorities are disproportionately affected because these students tend live in low-income communities more often than non-minority students, which may be a reason that fewer minority students are identified as gifted (Callahan, 2011).

Evaluation bias can also occur for students who have been previously diagnosed with a disability and are twice exceptional. Teachers or evaluators may let the student’s disability cloud their judgment about the student’s potential for giftedness. Indeed, every student has a multitude of strengths and weaknesses, and all of them must be considered when making educational decisions.

Response to Intervention

RTI, as you learned in an earlier chapter, is a framework that schools use to provide tiers of services for the diagnosis or instruction of students with disabilities or giftedness. It is especially useful in identifying twice-exceptional students because RTI can assist teachers in determining how well students respond (or do not respond) in specific content areas (Crepeau-Hobson & Bianco, 2011; Hughes et al., 2009; Pereles, Omdal, & Baldwin, 2007). Using RTI alone, however, may not be the most viable approach for identifying twice-exceptional students because disability often masks giftedness (and vice versa), so a comprehensive evaluation might be better for identifying giftedness in twice-exceptional students.

When Are Students Identified?

Students may be referred for gifted and talented programs at any time. A parent or teacher may request a gifted screening. When students show exceptional ability in general intelligence, a specific subject (e.g., reading or mathematics), or a nonacademic area (e.g., art or music), the evaluation process can be initiated.

7.6 How Does Being Gifted and Talented Differ Across Grade Levels?

Gifted and talented students may receive services in several different ways. They may be “pulled out” of the general education classroom to receive instruction by a teacher qualified in gifted instruction. Middle and high school students may be placed in honors and advanced placement courses.

Acceleration

is common for gifted students, either across grade levels or within their grade level curriculum. Gifted students may be promoted to the next grade, or work through classroom content at a faster pace than their peers. (See the discussion of pullout programs and acceleration in Section 7.7.) Students who are gifted in nonacademic areas, such as arts or music, may enroll in magnet schools, if the local school district provides them.

Magnet schools are public institutions that organize instruction around a particular skill or interest (e.g., arts and theater, engineering, technology) or academic excellence (e.g., International Baccalaureate program). Courses and curricula at magnet schools include coverage of state standards as well as instruction specific to the magnet’s area of specialty. Magnet schools often require students to apply, and the selection process can be competitive. Magnet schools are most prevalent at the secondary level, since they focus on developing skills to prepare students for careers in specific fields. However, some districts have magnet programs or schools at the elementary level, which prepare students to apply for magnet schools in middle and high school.

Early Childhood

A child showing early evidence of giftedness might reach developmental benchmarks (language, counting skills, classifying/organizing objects, etc.) significantly earlier than normal. However, since children develop at varying rates during their early years, it can be difficult to accurately diagnose giftedness at young ages.

There is debate on whether giftedness can or should be identified in early childhood, as well as whether recognizing giftedness before Kindergarten is necessary for students to realize their full potential (Callahan, 2011). Some talents may not be evident until children enter elementary school, and students may not demonstrate giftedness at an early age. Additionally, putting too much pressure on developing a gift or talent at very early ages can be detrimental to young children’s development. However, once a young child demonstrates a particular gift or talent, adults can encourage development in a supportive manner. Special education services are typically not available for young gifted students, but early education teachers and parents can provide opportunities to develop gifts and talents.

Early childhood teachers can provide activities that are enjoyable and engaging for young children. If a child shows talent in art or science, creative activities, such as art projects and experiments, can encourage this interest. Additionally, providing praise and practice for students who show academic excellence in areas of early literacy and mathematics can be beneficial. In any case, early identification of exceptional talent can help parents and pre-school teachers encourage ability and facilitate access to opportunities.

Elementary School

Once in elementary school, gifted students are more likely to be diagnosed. Schools provide services for elementary students with giftedness in several ways. Often the responsibility falls on the general education teacher, who may accommodate gifted students by differentiating instructional activities, grouping students by ability, or allowing acceleration within the curriculum (all of which will be described in detail in “How Do I Teach Students with Giftedness?”). Teachers must be careful that their instructional decisions and student groupings are not rigid and that they allow all children opportunities to move forward.

Gifted services that are offered outside the general education classroom are typically led by a gifted education teacher and may or may not be grade- or subject-specific. Schools may offer special classes for the whole day for students who are gifted in all academic subjects. More often, though, students are pulled out for content-specific enrichment in addition to their general classroom instruction. Academic enrichment typically takes the form of projects and activities that encourage higher-order thinking about the classroom content (e.g., project-based learning in which students recreate westward expansion). Arts or music enrichment may include additional instruction and practice on different types of art genres.

Secondary School

Once students who are gifted move on to middle school, they are more likely to be placed in honors and high school level classes. Gifted high school students are commonly placed in honors, Advanced Placement (AP), and/or International Baccalaureate (IB) classes. Honors classes typically incorporate more rigorous assignments than the general class curriculum. AP classes offer students the opportunity to earn college credit by passing an intensive exam at the end of the course. Students must apply to the IB program, which is highly competitive and rigorous. IB students are also prepared to take AP exams at the end of each year to earn college credit while still in high school. Gifted high school students also may elect or be selected to attend magnet schools to develop their talents in specific areas, such as creative arts or engineering.

Ensuring that students who are gifted find the appropriate level of challenge and rigor is especially important in middle and secondary school. Increased peer pressure to fit in socially, coupled with high academic expectations, can influence students’ desire to achieve. Depending on a student’s interests and social group, achievement in school may not be widely accepted. Additionally, gifted students often face high expectations from parents and teachers because of their recognized talent. Encouraging student motivations and interests can help keep them focused on realizing their full potential. Summer and afterschool programs can encourage talent and skill, while also providing students with opportunities to build a social network with peers who share their interests. Ensuring students see the connections between their gift or talent and future career opportunities is also important to keep students motivated.

Transition

Gifted students’ transition to post-secondary outcomes and opportunities is different from those of students with disabilities. Since giftedness is not an exceptionality classification under IDEA, teachers and parents may elect whether to create a transition plan for students. Students who are twice exceptional will likely have a transition plan that incorporates goals for both giftedness and disability. Please refer to the Chapter 3 section on transition for more information on transition plans for students with disabilities.

Gifted students may or may not be interested in pursing their gift or talent as a career. Students who are motivated to do so can benefit from summer or afterschool programs that develop particular skills and interests. These programs can enable students to make contacts in their field of interest that lead to future opportunities. Acceleration (and its potential pitfalls) is also something to consider for a gifted student’s transition from high school. Students who have accelerated through school may be able to take college coursework at a much earlier age than class peers, but social and psychological support may be helpful or even necessary for gifted students to adjust (Cross, 2011). Mentoring, goal setting, and career planning can also be beneficial for gifted and talented students in post-secondary environments.

7.7 How Do I Teach Students With Giftedness?

Teachers can choose from among teaching strategies used for all students to improve the instruction and outcomes for gifted students, and no one teaching model or strategy is considered best. These students should receive instruction that enhances their individual abilities (Tomlinson, 2005). A team of school staff (e.g., general education teachers, gifted teachers or specialists, school psychologists) should consider student strengths and weaknesses and develop an individualized program for each gifted student.

Some schools put together a Gifted Individualized Education Program (GIEP) that functions similar to an IEP for students with disabilities. Please note that a GIEP has no connection with IDEA 2004 or special education funding. However, a GIEP helps the school staff (and the student’s family) understand what specialized programs or accommodations are available to provide enriched experiences for a gifted student. For example, a student’s GIEP may highlight how a student’s academic program will be accelerated (i.e., covering more academic material in a shorter amount of time) or gifted programs in which the student may participate.

General classroom teachers can enhance the education of gifted students by employing various strategies related to accelerating or enriching the learning of gifted students. Often, gifted students can be grouped together for such instructional purposes. Two common approaches to providing gifted students learning opportunities within the general classroom include differentiation and

Universal Design for Learning

(UDL).

Student Grouping Strategies

Schools may group any students for social, political, or instructional reasons (Kettler, 2012). Social grouping includes keeping siblings with the same classroom teacher or distributing males and females across classrooms. Political grouping deals with fairness. For example, a school may feel it fair to distribute gifted students among classroom teachers instead of placing all the gifted students with one teacher. Instructional grouping allows teachers to tailor instruction for a group or classroom of students. Often, the way students are distributed into classrooms (i.e., grouped) is determined at the school or district level.

Regardless of the grouping strategy (i.e., social, political, instructional), students may receive gifted services in a variety of ways:

Self-contained classrooms or programs. In a self-contained classroom, all students have similar needs (e.g., they are all gifted). A teacher who is familiar with specializing instruction for gifted students provides accelerated and differentiated instruction for the classroom. Elementary schools that group students by ability create self-contained classrooms within each grade level. In secondary schools, self-contained classrooms are created when students are placed into tracks by ability. For example, an Advanced Placement (AP) or honors class might be considered a self-contained gifted placement. (These classes, however, might include students who are bright or hard-working but who do not qualify as gifted. Often, these students also benefit from the accelerated curriculum of the self-contained classroom.)

Pull-out programs. Pull-out programs group similar students together and provide them with instruction outside the general classroom (McAllister & Plourde, 2008). In many school districts, the gifted program may take place one afternoon each week. At that time, all gifted students are pulled from their general classroom to participate in gifted programs for the time period. Pull-out programs allow gifted students to explore topics in more depth than in the general classroom, or allow them to participate in problem-solving activities, such as Odyssey of the Mind.

Cluster groups. In a cluster group, several gifted students are placed together within a general classroom. This strategy works well for both elementary and secondary students because schools do not always have the resources for self-contained classrooms or pull-out programs. Typically, students are in groups of four to eight students (Pierce et al., 2011). The clustering enables the classroom teacher to tailor the content, products, and learning environment to meet the needs of the gifted students while the rest of the classroom participates in the general curriculum.

Traditional Teaching Strategies

Quite a few traditional teaching strategies can be employed to improve the educational programs of gifted students in any grouping situation (Brulles & Winebrenner, 2011). These methods include acceleration, compacting, enrichment, and independent studies.

As with all effective instruction, proper teacher training is vital (Brulles, Saunders, & Cohn, 2010). Teachers cannot implement strategies or programs without an in-depth knowledge of how to apply them with gifted students. Teachers also need to gather observational and academic data to understand whether gifted students are benefitting from the evidence-based strategies that teachers are using (Eyre, 2007). If students are not demonstrating appropriate performance gains, then teachers need to re-evaluate their instructional strategies and try another strategy.

Acceleration

Acceleration is a process in which students work through materials at a quicker pace or earlier than other students. For example, a student may learn about cell mitosis in one week instead of three. Acceleration may also mean that a student skips a grade in school. Some high school students accelerate their instruction by taking college courses while still in high school.

Acceleration has been shown to be a viable strategy for providing a challenging curriculum to gifted students and for setting gifted students up for later success in life (Gross, 2006; Vialle, Ashton, & Carlton, 2001). To effectively implement an accelerated program, however, teachers need to work with students to prepare them academically and emotionally. Many gifted students experience a drop in self-esteem once they start an accelerated program because the work is challenging and not as easy as they are used to. With proper support, however, students will learn to succeed in their accelerated curriculum (Chapman, 2009).

Whether acceleration that involves skipping grades in school is the best choice for gifted students is controversial. Some experts express concern about the emotional and social needs of the students, while others have demonstrated that gifted students who skipped grades or entered college early seem to be happy and content with their acceleration (Boazman & Sayler, 2011; Steenbergen-Hu & Moon, 2011).

Compacting

To use the strategy of compacting, the teacher assesses (either formally or informally) what a student already knows about a topic and then allows the student to skip known material and move to learning new material (Sutton, 2001; Winebrenner, 2003). Compacting can be used at the elementary and secondary levels (Lewis, Cruzeiro, & Hall, 2007). For example, if a middle school teacher is planning a two-week unit on the core of the Earth, the teacher could administer a pre-test. If a student already knows most, if not all, of the material, the teacher could compact the unknown material into two or three days and then move on to another science unit with this student. Without compacting, many gifted students are bored because they are reviewing material they already have learned.

Enrichment

To provide enrichment, teachers provide extension activities for gifted students. Typically, enrichment activities go into more depth than typical classroom activities (Miller & Gentry, 2010). An effective enrichment activity gives students a choice about what or how they will learn and then provides challenging activities or assignments accordingly (Pereira, Peters, & Gentry, 2010). Enrichment might involve assigning alternative readings that cover a specific topic in greater depth (Halls, 2011). For example, in a classroom unit on Egypt, the student may read books about writing in hieroglyphics and the process of mummifying bodies. In mathematics, students might be presented with open-ended problems that require a variety of upper-level mathematics skills to solve (McAllister & Plourde, 2008). In a history class, student learning might be enriched by research into local history and participation in hands-on activities as well as field trips (Morris, 2005). Students can conduct interviews with people who have lived in the community for years and then write and act in a play about the history of the community.

Enrichment can occur during the school day in a general classroom or a gifted program. It can also occur in Saturday programs or summer programs for gifted students (Pereira, et al., 2010). Some gifted programs are connected with local colleges and universities, rather than a school district; other gifted programs may be connected with private organizations (e.g., an engineering lab, a medical school, or a creative writing center). Typically, these organizations reach out to local schools to help with recruitment of gifted students.

Independent Studies

Students engaged in independent studies investigate a topic in depth with monitoring and guidance from a teacher or mentor. Mentors are often community members (e.g., architects, musicians, journalists) who work in the student’s area of interest. Independent studies work well when students decide (or have a choice) about what they would like to learn and investigate (Delisle, 2012; Powers, 2008). Students can also be provided with open-ended tasks that allow them to decide which approach to use to solve a problem (Gadanidis, Hughes, & Cordy, 2011). For example, a student may decide to investigate the effect of recycling on their community. This task does not have a “yes” or “no” answer, and the student makes choices about how to do the research and measure the effect of recycling. Students should also be presented with authentic reading experiences to pursue their independent learning (Moore, 2005). A student can read books, magazines, plays, newspaper articles, or diaries to learn about a topic.

Technology

Technology can be used to provide instruction to gifted students (Thomson, 2010), especially in schools with limited resources, a small number of gifted students, or a rural location without access to gifted services and programs. At internet portals, students can work with other gifted students in other locations to solve problem-based scenarios (Eckstein, 2009). Online learning portals can connect students with appropriate mentors to engage in meaningful learning opportunities. Of course, teachers need to ensure that the technology sources are appropriate (i.e., age-appropriate, content-appropriate, and with credible information) for their students to use (Johnson, 2008).

Differentiated Instruction

Differentiation of instruction is probably the most mentioned approach for teaching reading and mathematics, as well as content-area subjects, such as science and history, to gifted students (Chval & Davis, 2008; Park & Oliver, 2009). In differentiation, the content (i.e., what the student learns), process (i.e., how the student learns), and product (i.e., how the student shows what she has learned) are differentiated by student (Tomlinson, 1999). Differentiation works well for gifted students because the curriculum is adapted based on the student’s readiness, interest, and learning profile. For twice-exceptional students, differentiation can be used for both remediation and extension or advancement (Manning, Stanford, & Reeves, 2010; Rock, Gregg, Ellis, & Gable, 2008).

Differentiation is not a specific program, but an approach to designing instruction for students. The proper differentiation of instruction for students requires quite a bit of training and preparation on the part of teachers (Dee, 2011). Teachers determine their students’ interests and abilities (Manning et al., 2010). They then individualize the content, process, and product for students based on each student’s readiness, interest, and learning profile (Tomlinson, 1999).

Differentiating the Content, Process, and Product

Teachers can differentiate the content, the process, and the product. Content refers to the material covered during instruction. Process refers to how students will access and interact with material. Product refers to the ways that students demonstrate their knowledge or understanding of the material.

To differentiate by content, teachers can adapt current instructional materials or change the ways that students interact and work with those materials (Tomlinson, 2001). Some ways to differentiate by content include teaching concepts (rather than procedures), compacting, developing learning contracts, conducting mini-lessons, and using a variety of materials and resources.

Learning contracts are an agreement between the teacher and student about what and how the student will learn. The student is held accountable for ensuring that he or she is making adequate progress toward meeting goals. Mini-lessons, which work well in general classrooms, involve teaching students in small groups, in which teachers can extend or remediate work.

To differentiate by process, teachers develop meaningful ways for students to learn the materials. Strategies that help differentiate by process include having students in interest groups, providing students with different types of graphic organizers, providing complex and varied instruction, allowing students to work independently, and accessing the multiple strengths of students.

Differentiating by product entails creating assignments or outcomes that truly show what a student has learned. These products should be interactive and engaging; traditional end-of-chapter tests often are not effective products. See Table 7.2 for some examples.

Table 7.2: Differentiation by Products

Sample products
Design a game	Make a documentary	Conduct an interview
Conduct an experiment	Write a biography	Circulate a petition
Write letters to an editor	Design a costume	Write a song
Present a news report	Create a recipe	Write a new law
Write a musical	Design political cartoons	Conduct a training session
Be a mentor	Write a book	Plan a journey
Write a poem	Lead a symposium	Present a radio program
Put on a puppet show	Design a web page	Develop an exhibit

Differentiation by Readiness, Interest, and Learning Profile

Teachers determine a student’s readiness, interest, and learning profile and use this information to differentiate by content, process, and product. Readiness refers to how well a student understands underlying or prerequisite material before the teacher begins presenting new material. Once a teacher has assessed what students already know (determined their readiness), he or she should provide learning opportunities that push students to learn new material or that which is an extension of previously learned material.

To formulate an approach to differentiating instruction, Tomlinson (2001) encourages teachers to think about the following:

Should representations be more concrete (i.e., hands-on, easy-to-understand) or abstract (i.e., less easy to picture)?

Should resources and materials be simple or more complex?

Should problems have a single approach or many approaches?

Should transfer to novel problems be a small leap or giant leap?

Should solutions and approaches be more or less structured?

Should students have less or greater independence?

Should the pace of learning be slow or quick?

In addition to readiness, teachers need to gauge their students’ interest, or engagement, in learning. Teachers need to understand the interests of their students, play into them, and help students develop new ones (Tomlinson, 2001). For example, a student who loves dinosaurs might be encouraged to learn about other prehistoric animals and plants. Table 7.3 lists ways teachers can differentiate based on a student’s interests.

Table 7.3: Differentiation by Interest

Strategy	Description
Design-a-day	Students choose a topic to work on. Students set goals about their learning, work towards their goals, and assess how well they met their goals.
Group investigation	A group of students work together to investigate a topic of the group’s choice. Collaboration is key.
I-search	Students work independently to answer their own questions.
Jigsaw	A group of students all learn about different parts of a similar topic and thenshare their ideas.
Literature circles	Students read up on topics of interest and share their readings with otherclassmates who read the same or similar material.
Negotiated criteria	A teacher gives the students an outcome (e.g., develop a movie), and the students use their personal interests to help with the outcome.
Orbitals	Students create their own questions and find ways to answer their questions. Students then share their information with peers.

Another way teachers can differentiate learning is according to a student’s learning profile, which describes how an individual student learns (Tomlinson, 2001). The student’s learning profile is how, where, and with whom the student learns best. There are many aspects that can go into preferences based on learning style (Figure 7.2).

Figure 7.2: Differentiation by Learning Profile

All students learn in different ways. What ways do you like to learn?

Teachers who consider all the strengths of a student who is gifted, then, can differentiate instruction for that student. Differentiation does take a lot of planning and teacher education, but it can be a good approach for students who require individualized instruction either because of giftedness, a disability, or both.

Universal Design for Learning

Universal Design for Learning (UDL), discussed in Chapter 2, is also useful to gifted students. The principles of UDL encourage teachers to present content in different ways, allow students to present what they have learned in different ways, and engage in the content in different ways, which is fairly similar to differentiation. UDL and differentiation do share many of the same ideas. UDL, however, was developed with special education students in mind (whereas differentiation was a general education initiative), and UDL emphasizes the use of technology more than differentiation. Of course, gifted students can clearly benefit from instruction in which the content and interaction with the content are individualized to fit their needs.

Motivating Gifted Students

Many gifted students do well in school and need little motivation to keep up their enthusiasm for learning. Some gifted students, however, may underachieve rather than excel in school. This underachievement is often attributable to boredom, lack of challenge, or social pressure to perform at or below average. It also may be a reaction to family members’ extremely high expectations (Callahan, 2011). These factors can compound over time and lead to an increased risk of dropping out of school.

Minimizing this risk and helping underachievers can be difficult for general educators who are faced with the need to simultaneously challenge and support students who are below, on, and above grade level. Teachers must find a balance between engaging disinterested gifted students and fostering habits and mindsets to help students participate even when they find the material boring.

References

Powell, S. R., & Driver, M. K. (2013). Working with exceptional students: An introduction to special education [Electronic version]. Retrieved from https://content.ashford.edu/

5.1 What Is ADHD?

This chapter discusses a disability that is not a separate category under IDEA 2004: ADHD. It is one of the more prevalent disabilities in schools today (Stolzer, 2007). This section presents the formal definition of ADHD and discusses the difference between the terms ADHD and ADD. It highlights how IDEA 2004 defines ADHD and how prevalent it is in students.

Defining ADHD

Students with Attention-Deficit/Hyperactivity Disorder (ADHD) typically exhibit some combination of inattention, hyperactivity, and impulsivity. A student displaying inattention might have trouble focusing on a task for an extended period of time, be easily distracted, or struggle with paying attention to details. Hyperactivity might be seen in class as a tendency to fidget and have difficulty staying seated for reasonable amounts of time. A student who exhibits impulsivity may speak at inappropriate times or have difficulty waiting for his or her turn.

Displaying inattention, hyperactivity, or impulsivity does not necessarily indicate that a student has ADHD. In fact, most students occasionally show one or even all of these behaviors. Any student may daydream or jump out of their seat and run to the window to see something outside. Any student may grab a marker from another student or talk fast and appear jittery. However, when these difficulties are severe and persistent enough to interfere with regular activities, the student who exhibits them may be diagnosed with ADHD.

ADHD and IDEA 2004

ADHD falls under the IDEA 2004 category of Other Health Impairment (OHI). For a student to qualify for special education services under IDEA 2004 in the OHI category, the student must exhibit an academic deficit related to ADHD and exhibit characteristics of ADHD.

ADHD is one of the more commonly identified disabilities that falls under OHI. Other disabilities that may fall under the OHI umbrella include diabetes, epilepsy, and Tourette syndrome (although some schools categorize Tourette syndrome under EBD). Students with ADHD spend most, if not all, of their time in general education classrooms. Thus, a typical general education teacher will likely teach many of these students in his or her classroom (Ambalavanan & Holten, 2005).

Students with ADHD may have either an IEP under IDEA 2004 or be covered by the Americans with Disabilities Act and have a 504 plan. Each school forms its own criteria and uses them to decide whether a student with ADHD receives services under IDEA 2004 or Section 504. Teachers use these plans as a guideline to determine appropriate accommodations or modifications. Most students with ADHD, however, do not have many accommodations or modifications listed in their IEP. Instead, accommodations or modifications are most often in the form of a Functional Behavior Assessment (FBA) and Behavior Intervention Plan (BIP).

DSM-IV and ADHD

Medical professionals often use the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to diagnose; it provides another definition of ADHD (American Psychiatric Association, 2000). The DSM-IV outlines the three subtypes: ADHD predominantly inattentive type, ADHD predominantly hyperactive-impulsive type, and ADHD combined type (Larsson, Dilshad, Lichtenstein, & Barker, 2011). Students with the predominantly inattentive type struggle with inattention without major difficulties with hyperactivity and impulsivity. Students with the predominantly hyperactive-impulsive type struggle with hyperactivity and impulsivity without major difficulties with inattention. Students identified with ADHD combined type exhibit both inattentive and hyperactive-impulsive characteristics. See Table 5.1 for some examples of each type of characteristic as described by the DSM-IV.

Prevalence of ADHD

ADHD affects approximately 3–10% of school-age students (Ambalavanan & Holten, 2005). Because the criteria for diagnosing and delivering services to students with ADHD vary considerably by state, there is a wide variability in the percentage of students diagnosed with ADHD in school classrooms from state to state (anywhere from 3–15%).

Boys are more often identified with ADHD—in fact, up to three times as often—than are girls (Bruchmüller, Margraf, & Schneider, 2012; Barkley, 2006). However, boys generally exhibit more hyperactive characteristics of ADHD, while girls exhibit more inattentive characteristics (Abikoff et al., 2002). This difference may be one reason why males are diagnosed more often: Hyperactivity is usually more apparent and distracting to adults, whereas inattention is not as obvious or bothersome.

Interestingly, African-American students tend to be diagnosed less with ADHD than Caucasian students (Mandell, David, Bevans, & Guevara, 2008). However, African-American students tend to be over-diagnosed with EBD, which probably indicates that schools tend to categorize students (with the same behavioral characteristics) differently based on racial category. Researchers have also discovered that the younger students (by age) in a classroom may be identified more often than older students in the same classroom (Zoëga, Valdimarsdóttir, & Hernández-Diaz, 2012). Perhaps younger students take longer to learn behavior patterns in a typical classroom.

5.2 How Has the ADHD Field Evolved?

Behaviors that educators and medical professionals now associate with ADHD have been highlighted in medical literature for at least the last 200 years. While “bad parenting” was sometimes blamed, some early physicians did believe that the difficulties their patients had in performing certain tasks stemmed from brain anomalies.

An early description of ADHD may be found in a children’s poem, “The Story of Fidgety Philip,” published in 1845, by German psychiatrist and author Heinrich Hoffman. The boy in the poem cannot sit still at the dinner table, and fidgets despite his parents’ requests to stop. At the beginning of the 20th century, an English doctor, George Frederic Still, described young boys with behavioral difficulties that he believed were due to differences in their biological makeup—specifically, in the brain. Still’s work, along with that of others, such as the physician William James, was vital in explaining that the behavior of some children was not a moral failing on the part of parents.

In 1934, Eugene Kahn and Louis Cohen published a study in the New England Journal of Medicine that described patients with impaired attention, impulse control, and self-regulation. Soon after, in 1937, Charles Bradley produced evidence that linked a stimulant drug to the reduction of symptoms for children with behavior difficulties. As more and more researchers worked with these children and tried to find medications to assist with their daily functioning, the term minimal brain dysfunction began to be used to describe their condition. Another term, hyperkinetic syndrome, emerged in the 1950s to describe brain function that is overactive or overwhelmed.

As previous chapters have explained, the 1960s and 1970s were a time of tremendous growth in understanding disabilities, including ADHD. In 1968, the DSM-II recognized ADHD as an actual disorder, hyperkinetic reaction of childhood. The terms Attention Deficit Disorder and, later, ADHD were coined in the 1980s (Brown, 2006).

Attention Deficit Disorder (ADD) is an outdated term. When people use the term ADD, they are usually referring to ADHD predominantly inattentive type. Some adults prefer the term ADD, since they do not experience hyperactivity as much as children and adolescents do, but this chapter will refer to the disorder as ADHD.

In the last few decades, much of the research on ADHD has focused on learning more about the chemicals in the brain that receive and transmit signals (neurotransmitters), understanding the role of medication in helping to control ADHD, determining how to better assess students with behavioral difficulties, and learning how to best teach students with ADHD. These topics will all be covered in the remainder of this chapter.

5.3 What Are the Characteristics of Students With ADHD?

The inattention, hyperactivity, and impulsivity of people with ADHD can emerge in a variety of ways. Table 5.2 lists the common characteristics of ADHD identified by the Centers for Disease Control and Prevention (CDC).

Table 5.2: Common Characteristics of ADHD

Inattentive characteristics	Hyperactive characteristics	Impulsive characteristics
Has difficulty paying attention	Is in constant motion	Frequently loses necessary items
Makes careless mistakes	Is unable to stay seated	Is unable to play quietly
Daydreams	Squirms or fidgets	Acts and speaks without thinking
Doesn’t seem to listen	Has difficulty following through	Has difficulty taking turns
Is easily distracted	Talks out of turn or too much	Interrupts others
Is forgetful
Has difficulty organizing information

Of course, not all children (or adults) who exhibit these qualities have ADHD. In fact, for a diagnosis, students must exhibit inattentive or hyperactive-impulsive characteristics more frequently than is observed in other students of the same age.

How do educators differentiate ADHD? There are three governing principles outlined by the DSM-IV that all must be in place for a student to receive a diagnosis of ADHD:

A student must exhibit characteristics (i.e., inattentive and/or hyperactive-impulsive) for a sustained period of time (six months or more) and in multiple settings (e.g., at home and in school).

The behaviors must be disruptive to the classroom or home environment.

Some of the inattentive, hyperactive, or impulsive behaviors must have been manifested before the student was 7 years of age.

When students exhibit the behaviors that are characteristic of ADHD, it is important to rule out extenuating factors. For example, a student who has recently experienced a sudden death in the family or who is coming to terms with his parents’ divorce might act in atypical ways. It is also important to rule out other medical reasons (such as seizures or depression) that may cause students to appear to have ADHD.

Many students with ADHD are also diagnosed with other disabilities, such as SLD (see Figure 5.1). In fact, the rate for comorbidity (i.e., the likelihood that a student has two or more disabilities rather than just one) with ADHD is as high as 50–60% (Jensen et al., 2001). ADHD can occur alongside behavioral disorders, such as Oppositional Defiant Disorder (ODD), conduct disorder, bipolar disorder, anxiety disorder, depression, or Tourette syndrome (Takeda, Ambrosini, deBerardinis, & Elia, 2012). Some students with ADHD may also have Autism Spectrum Disorder (Grzadzinski et al., 2011), or be considered gifted (Foley-Nicpon, Rickels, Assouline, & Richards, 2012).

Figure 5.1: Comparison of Students With ADHD and SLD

The number of students with ADHD, with SLD, and with both is compared with the total number of school-age students. Note that the number of boys diagnosed with ADHD, SLD, or both is higher than the number of girls diagnosed with either disability.

5.4 What Are the Causes of ADHD?

Researchers have not identified a primary cause of ADHD. They believe that it is probably related to a combination of biology, genetics, and the student’s environment (Larsson et al., 2011; Thapar, Cooper, Eyre, & Langley, 2013). As technology improves over the next few decades, researchers will be better equipped to understand how these causes work and combine to affect students with ADHD.

The Role of Biology

Many researchers hypothesize that students with ADHD are either missing specific neurotransmitters or that the actions of these neurotransmitters are faulty. When neurotransmitters are not working as normal, the information processing system of a student’s brain has difficulty handling new information. In other words, the “hardware” in the brain has trouble organizing new information, so the brain becomes overloaded and shuts down.

Indeed, brain scans of students presented with a difficult or distracting task show marked differences between students with and without ADHD. Students with ADHD often show a decrease in brain activity compared with students without ADHD. Before the difficult or distracting task, all students demonstrated similar patterns in brain activity.

It is well-established that the brain is involved in the intake and processing of information; what may be less obvious is that the rest of the body is also involved. Many students with ADHD experience sensory overload (i.e., too many noises or too much visual activity in the classroom). They may focus on the music playing in the background or the busy collage on the wall instead of focusing on the task at hand.

Genes also appear to play a role in the likelihood of a student developing ADHD (Thapar et al., 2013). While no single gene has been identified as responsible, approximately one-third of students with ADHD have a sibling with ADHD, and approximately half of students with ADHD have a parent with ADHD (Freitag, Rohde, Lempp, & Romanos, 2010; Polderman et al., 2007). The role of genetics in ADHD is further complicated by the fact that about half of students diagnosed with ADHD in school will outgrow their ADHD characteristics by adulthood (Garnier-Dykstra, Pinchezsky, Caldeira, Vincent, & Arria, 2010; Martel, von Eye, & Nigg, 2012).

The Role of the Environment

Quite a few environmental factors have been linked to ADHD (Thapar et al., 2013). Several causal factors may occur during gestation. For example, mothers who smoke or engage in substance abuse may have babies with an elevated risk of ADHD (Graham et al., 2013). Babies born premature or at a low birth weight may also have a higher risk of ADHD. After birth, malnutrition or other dietary factors—such as too much sugar or fatty acids—could possibly be risk factors for ADHD. In addition, researchers hypothesize that some students with ADHD may have had exposure to pesticides or lead (Thapar et al., 2013).

Some researchers believe that family dynamics may contribute to students developing ADHD. For example, if parents and students experience hostility or anger toward one another on a constant basis, or if students are abandoned or feel unsafe in their environment, this may put them at a higher risk for ADHD.

5.5 How Are Students Diagnosed With ADHD?

Like some other disabilities, ADHD is diagnosed by medical professionals or clinicians using DSM-IV criteria or using parent and teacher rating scales along with observations of the student (Rushton, Fant, & Clark, 2004). No test exists for diagnosing ADHD. The professionals may gather checklists, rating scales, and observations from teachers and other school staff members to aid in the diagnosis.

Teachers and school staff can talk with parents about the possibility of their child needing to undergo an evaluation for ADHD, but the official diagnosis must come from a medical professional or clinician (i.e., medical doctor, psychiatrist, or psychologist). Often, parents discuss their concerns with a pediatrician or family physician, who then refers the family to a clinic for professional screening for, and diagnosis of, ADHD.

Checklists

Medical professionals use a checklist of characteristics, along with information in the form of anecdotal evidence and behavioral observations from parents, caregivers, teachers, or other school professionals, to thoroughly evaluate a student. This evaluation usually takes weeks or months to complete because data about the student’s behaviors have to be gathered over time and from a variety of sources. If the screening is conducted properly, it is not possible for a student to walk into a clinic or doctor’s office for the first time and receive an ADHD diagnosis.

As you learned, ADHD is divided into three categories: ADHD predominantly inattentive type, ADHD predominantly hyperactive-impulsive type, or ADHD combined type. Refer to Table 5.2 for a checklist of characteristics divided into inattentive, hyperactive, and impulsivity categories.

Rating Scales and Behavioral Observations

Rating scales, such as the widely-used Conners test or the Barkley Scale, provide one of the more common ways to gather information from teachers, parents, or even individual students when they exhibit characteristics of ADHD.

There are three versions of the Conners test: one for parents or guardians, one for teachers, and one for students who are old enough to rate themselves (i.e., middle- or high-school students).

Parents

, teachers, or students fill out the form and rate the student’s behavior by answering multiple-choice questions. The Barkley Rating Scale also involves parents and teachers filling out different versions of a questionnaire about the frequency of difficult behaviors of the student. The information from these tests and scales, if gathered properly, can aid doctors or clinicians in a diagnosis of ADHD. They should never depend on just one rating scale or source, however, to determine whether a student has ADHD; a proper diagnosis should have documentation from multiple sources.

Behavioral observation is also useful in information gathering for a diagnosis of ADHD. Teachers, parents, or other trained professionals may observe students in different settings (e.g., in the classroom and at after-school workshops). In a behavioral observation, the observer notes whether and how often certain behaviors occur. This information can be used to aid medical professionals in their diagnosis.

A boy at a desk looks off to the side, away from a teacher writing on a blackboard.

Wolfgang Flamisch/Corbis

Diagnosing ADHD before school age can be difficult; it may be hard to determine whether the student’s inattention or hyperactivity and impulsivity is due to ADHD or to being young and inexperienced in social cues and norms. However, ADHD students can be identified earlier than the age of 5 if they exhibit very severe symptoms of ADHD.

When Are Students Diagnosed?

ADHD is often diagnosed near the end of the early childhood period, during preschool or kindergarten. Around age 5, many students begin to exhibit characteristics common to ADHD as they start school and learn the new routines associated with the structured setting of the classroom. Starting school involves learning how to follow directions and how to act in group settings, and if students are not used to school expectations, they may display some of the inattentive, hyperactive, or impulsive characteristics of ADHD (Anderson, Watt, Noble, & Shanley, 2012).

However, this does not mean they have ADHD. If a student comes from a home where lots of physical activity is encouraged, it may take the student a while to learn how to not run around the classroom all the time or jump out of her seat when an adult enters the room. Once students become familiar with the classroom rules and expectations, their classroom attention and behavior should improve. Those students who do not show improvement may have ADHD.

Most students with ADHD are diagnosed around second or third grade, or between the ages of 8 and 10. At that time, they are expected to work more independently and are held more accountable for their schoolwork. When these expectations are placed upon those students whose brains find it difficult to process new information readily, they may begin exhibiting characteristics of ADHD. Students may have displayed ADHD characteristics for a few years, but they were not as noticeable during their participation in the larger-group activities of preschool or kindergarten as they are in a more “academic” setting.

5.6 How Does ADHD Differ Across Grade Levels?

Teaching strategies for students with ADHD show some similarities across grade levels, as well as some differences. For example, all students may benefit from classroom management and organization techniques, but these techniques may have to be amended based on the student’s grade level.

Early Childhood

ADHD is often diagnosed near the end of the early childhood period, during preschool or kindergarten, when students are first asked to participate in and finish tasks, follow directions and rules, sit quietly, and control their movements. Students who have a harder than average time sitting still or transitioning from one activity to another may be showing symptoms of ADHD. For instance, teachers may ask students to move from an art center to the carpet area for story time, and students with ADHD may act out or refuse to follow directions because they find it difficult to leave one task to do another. Many of the teaching strategies highlighted later in this chapter are appropriate for very young students with ADHD.

Elementary School

Most students diagnosed with ADHD will be identified in the elementary grades. Students in this age group may experience difficulties related to spending hours in a classroom during the school day. Students may struggle with inattention to classroom material and hyperactive or impulsive behavior in groups.

When teaching elementary school students with ADHD, it is helpful to present lessons in smaller groups. This allows the classroom teacher to better differentiate instruction and monitor on-task behavior. To differentiate, teachers tailor assignments or materials to the individual student to ensure that the student is getting the most out of the lesson. Peer tutoring, delivering lessons in an explicit manner and at a brisk pace, and using a variety of instructional tools for conceptual understanding are all methods that are known to be helpful in teaching elementary-aged ADHD students (Harlacher, Roberts, & Merrell, 2006). When teaching in an explicit manner, teachers provide direct and focused instruction on a topic area. The teacher helps the student by guiding the student through material and providing many opportunities for feedback and discussion.

Keep in mind that many students with ADHD are hypersensitive to sights and sounds. Think hard about whether to show a presentation with many graphics or a movie with lots of music and noise. Allowing students to have some choice of topics to study (or how to study certain topics) can also be helpful, and tends to help motivate a broad range of students. Activities that are “hands-on” are also more compelling for these students. These kinds of activities include conducting a science experiment with bacteria samples in petri dishes and learning fraction concepts through dividing pizzas.

Teachers need to remember that in-class and homework assignments may take students with ADHD much longer to complete accurately than the typical student. The practice of sending home unfinished classroom activities or work to be completed as homework is not usually effective for students with ADHD. If these students demonstrated difficulty completing an assignment in the classroom with teacher monitoring and feedback, they will probably also struggle with completing this assignment at home. This will only add to their frustration—and that of their parents.

Secondary School

The transition from middle to high school can be difficult for any student, and particularly so for someone with ADHD. First and foremost, expectations from teachers at the secondary level are different than those at the elementary level. Students are expected to be much more responsible for themselves and their learning. They must show up to the correct classroom at the right time, keep track of their academic materials and assignments, and take notes on class material in a way that will help them score well on assessments. Second, secondary students are experiencing numerous physical and emotional changes that can lead to changes in the manifestation of their ADHD. For example, students may become less hyperactive but more impulsive.

Many of the teaching approaches highlighted in Chapter 2 are helpful for secondary school students with ADHD—for example, using explicit instruction, involving students in peer tutoring, and using differentiation. It also may also be helpful to collaborate with the students themselves to find solutions to their educational problems. High school students frequently complain that they are not treated or respected like adults are, so teachers may want to involve them in decisions about what, how, or when they study for a certain topic.

A teacher with high expectations for students, who does not treat them like elementary students but instead provides opportunities for them to take on new responsibilities and exercise autonomy, will contribute to their self-confidence, which in turn can improve behavior. Teachers should assume students can handle certain tasks until they prove otherwise.

Transition

Secondary students with ADHD will also have transition plans to ensure that high school courses and support services align to postsecondary goals. In addition to specifying the effective instructional practices listed in this chapter, transition planning can help students, family members, and educators prepare for ongoing success. These plans can help set up support that continues after graduation from high school. Transition plans should include appropriate service providers, including social services and mental health counselors. Strategic planning increases the likelihood that students with ADHD will complete high school and successfully transition to college or career opportunities.

Individuals with ADHD can absolutely be successful in colleges and careers with the appropriate resources and support. Gaining insight about ADHD, managing behaviors, and utilizing sources of support can all help students achieve (Meaux, Green, & Broussard, 2009). Meaux et al. (2009) outline the following recommendations for postsecondary students with ADHD:

Gain insight about ADHD

Learn from experience

Seek information

Acknowledge difficulties

Open up for support

Manage life and behavior

Be accountable

Learn from consequences

Set alarms and reminders

Take prescribed medication

Engage in self-talk

Stay busy and schedule activities

Utilize sources of support

Parents

Friends

Teachers/Tutors

Academic support and disability services

5.7 How Do I Teach Students With ADHD?

Effective teachers at all grade levels make their classroom environments and practices more conducive to students who struggle with inattention, hyperactivity, or impulsivity.

As mentioned, many of the teaching techniques (such as explicit instruction and peer tutoring) that are effective for students with SLD and emotional and/or behavioral difficulties have also been proven to be effective for students with ADHD. In addition, the use of strategies related to classroom organization and delivery of instruction can provide an optimal learning environment for all the students in the general education classroom.

Teachers should keep in mind that the biggest challenge that students with ADHD face in the classroom is their tendency to be easily overwhelmed or frustrated, either by their environment or by the tasks they are being asked to perform. The characteristics of students with ADHD may lead to classroom behaviors like the following:

Making careless mistakes on assignments

Daydreaming during lectures

Keeping materials and desks unorganized

Only paying attention during “fun” activities

Not following directions and rules

Turning in assignments unfinished

Causing disruptions in class

Classroom Organization

Appropriate organization of the classroom is crucial in reducing the stress an ADHD student feels in the typical, busy classroom (Carbone, 2001). The teacher should make sure that all aspects of instruction are well organized, from the way the classroom functions to the arrangement of furniture and the materials within it. Good classroom organization also extends to helping students bring order to their assignments and providing schedules to follow.

An organized classroom will help students focus on classroom tasks (e.g., taking notes from a lecture, participating in group instruction, completing a book report), minimizing distractions that could lead students astray. An organized classroom also enables the teacher to focus on quality academic instruction without having to spend time on redirecting student attention or correcting off-task behavior.

Functional Organization: Routines, Procedures, and Classroom Rules

Effective functional organization of a classroom involves the establishment of routines and procedures. These provide structure to the classroom and the school day. They help students understand expectations for behavior. A routine might be as basic as one that involves students walking into the classroom at the beginning of the school day and turning in their homework:

Walk into the classroom quietly.

Walk to your locker.

Take your homework assignments out of your backpack.

Place your homework assignments in the green bucket.

Place your backpack into your locker.

Walk to your assigned desk.

Sit at your desk and begin your morning work.

This routine provides a framework for students in terms of classroom behavior. Teachers could have a procedure for getting materials from the art center for a painting project, breaking into partners to proofread a narrative, or returning library books to the school library.

Teachers should provide explicit instruction and modeling for routines and procedures (Jacobson & Reid, 2010), and students should have opportunities to practice them while the teacher provides feedback. They are important ways to guide students throughout the day. With established routines and procedures, students know how things in the classroom operate and thus are less likely to be distracted from the main focus of the academic task by the logistical details of getting it done.

Functional classroom organization also includes the creation of classroom rules that apply to all students. These rules should be positive and brief, with clearly stated consequences for not following them. Ideally, there is a set of rules for the entire school, as this consistency helps ADHD students understand the expectations in every classroom, not just their homeroom. Rules for elementary and secondary students may differ slightly, but the underlying concepts are the same (Figure 5.2). Rules are stated positively, are applicable across various school situations, and help students understand school expectations.

Figure 5.2: Classroom Rules

Rules for a second-grade classroom (left) and for a tenth-grade classroom (right) reflect similar expectations for student behavior. Both sets of rules are positive and age-appropriate.

Organization of Space

Appropriate organization of the classroom space is also important for students with ADHD (Carbone, 2001). Cluttered walls or bulletin boards, for example, can easily be distracting. Classrooms should have meaningful posters and wall hangings, but teachers should keep them to a minimum. Meaningful posters and hangings include things that are important to current classroom instruction or that outline classroom rules and expectations. Content that has not yet been introduced in class, on the other hand, is likely to pull students away from lessons in progress.

Both elementary and secondary teachers should also pay attention to the placement of student desks and work areas. All students should be able to see the teacher at all times without having to turn around in their seats. If there are tables in the classroom, teachers will have to arrange them in such a way that all students can focus on the teacher without strain.

Carbone (2001) suggests placing desks in rows because rows help students avoid the distractions of being seated at a table. If students can focus on the teacher (and the teacher can focus on each student), there is less opportunity for distraction and off-task behavior (see Figure 5.3 to consider seating options). Many secondary classroom teachers do place student desks in rows, and elementary teachers may also find it helpful.

Figure 5.3: Elementary Classroom Seating Options for a Student with ADHD

In this floor plan for a kindergarten classroom, the star indicates the seat for a student with ADHD. What do you think about this choice of seat? What would you do to change this as a classroom teacher?

Regardless of whether student desks or tables are in rows, groups, or some other arrangement, teachers should always assign all students, not just those with ADHD, to work spaces. A student with ADHD will benefit from having an organized work area. Teachers can suggest the use of different colored folders for each class period for secondary students. They can encourage elementary students to place plastic boxes or tubs in their desk to hold small items like pens, pencils, and erasers.

To help elementary students who fidget with writing utensils or scissors, the teacher should store these items in an accessible area that is not within the student’s immediate reach. Teachers should also keep the student’s workspace as clean and free of distraction as possible, avoiding extraneous and overly decorated items (as shown in Figure 5.4).

Figure 5.4: Overly Colorful Nameplate

This nameplate is less than ideal for a student with ADHD. It begs for student distraction, with its U.S. map, colorful patterns, and busy charts. A student may spend time tracing the states when all she really needs to see is how to write the letter J. Would this distract you if it were on your desk?

Organization of Assignments

Many strategies to help students organize their assignments may help students with ADHD in writing, reading, or mathematics. For example, students may have difficulty solving multi-digit computation problems in mathematics (e.g., 5,462 x 23) because they cannot keep their work organized on the page. Students may have trouble keeping the numbers in columns or writing their numbers small enough for their workspace. Teachers can show them how to use graph paper to keep the place value of numbers intact and organized (see Figure 5.5). Turning lined notebooks sideways helps with organization, as well, because the (now) vertical lines of the notebook paper can help students organize their columns by place value (i.e., ones, tens, hundreds, thousands, etc.).

Figure 5.5: Computation Examples

By using graph paper, students can keep each number in the right place. This strategy enables students to organize their work and make fewer mistakes.

Teachers can encourage students to use plain bookmarks as they read to help them focus on the text line by line. For writing assignments where handwriting is not the focus of the lesson, students with ADHD may find it easier and less frustrating to type their assignment.

In assigning work, teachers should consider whether it is reasonable to ask students to complete 10, 20, or 50 problems. Often, students with ADHD can demonstrate mastery of a skill by completing just 10 problems of 30 on a worksheet. Students with ADHD may need longer assignments to be broken into smaller, manageable pieces. This may also be true for other students, as well. For example, when middle school students in an American government class are asked to write an essay on interest groups that influence politics, a teacher could break the assignment into the following parts:

Investigate different types of interest groups. List the types of interest groups. Provide three examples of each group.

Investigate different ways in which these interest groups can influence political policy. Use a graphic organizer to explain five ways political policy is influenced by these interest groups.

Choose three specific interest groups for your research report. Make sure they have enough in common that you can develop a thesis statement about the methods they use to influence American political policy.

Develop an outline or graphic organizer that includes a thesis statement for the introduction, supporting details about how the groups influence policy in each body paragraph, and a concluding paragraph.

Write a five-paragraph essay as the first draft of your report.

Further details and examples can be provided in class discussions about the assignment, as needed. The student turns in each part of the assignment before proceeding to the following step. The teacher provides timely feedback and guidance to the student to ensure success on each part of the assignment. By breaking an assignment into parts, the individual tasks may not appear as daunting as an assignment that states, “Write a five-paragraph essay on how interest groups influence American politics.” Students also feel a sense of accomplishment with the completion of each step.

The Importance of a Schedule

Like other students with disabilities, students with ADHD may function better in the classroom when they are aware of the daily schedule. A visual or written schedule placed in a prominent place in the classroom, in the student’s daily planner, or on the student’s desk can be tremendously helpful (Figure 5.6). If the student works with a specialist at certain times during the school day, these appointments should be listed on the student’s schedule.

Some elementary grade teachers use pictures of clock faces with the hands pointing to the appropriate times for each different activity during the school day. This strategy is especially helpful for students who have difficulty reading the analog classroom clock.

Figure 5.6: Sample Schedules

A schedule for a first-grade classroom hangs in the classroom (left), and a smaller copy could be taped to a student’s desk. A schedule for an eighth-grade student (right) will be unique to the student, so it is taped into the student’s daily planner.

Delivery of Instruction

As discussed in Chapter 2, instruction for students with disabilities should be explicit. In other words, the instruction should be clear and concise, with many opportunities to check for student progress and understanding (Gremillion & Martel, 2012). This is important for students with ADHD because students may have fewer opportunities for inattention or hyperactivity/impulsivity if they are actively engaged in the academic lesson. Effective instructional delivery techniques include prioritizing subjects, making sure students participate in the lesson, modeling, providing adequate breaks, and encouraging self-monitoring (Jacobson & Reid, 2010).

Prioritizing Subjects

Teachers of students with ADHD should prioritize the subjects according to the best times to teach them. For example, reading instruction is usually best in the morning, when students are fresh and ready to learn, rather than, say, the last 45 minutes of the school day after students have just returned from a physical education activity. The end of the day might be better suited for review activities or checking homework because these activities require less concentration and focus than learning new academic content.

Students at the middle or secondary school level who switch classrooms multiple times per day usually have their longest attention span at the beginning of any given period. Teachers, then, should use the beginning of a period to deliver new and important content. Tasks for which full attention is less crucial, or that offer a social element that can refocus attention—such as reviewing homework or completing a group assignment—are better left until the end of the class period, when student attention begins to wane. Teachers should be mindful that students with ADHD may need to switch between tasks at frequent intervals.

Ensuring Participation and Modeling

Teachers should provide frequent opportunities for students to actively participate in a lesson to engage them and monitor understanding and involvement. This participation may be in the form of signaling a thumbs up, raising a hand to answer a question, completing a problem on a white board, discussing an idea with a partner, or echo reading. Echo reading involves a teacher or student reading a sentence or passage and then another person (or the class) repeating the same sentence or passage. The more opportunities students have to interact with and respond to the teacher, the less likely they are to lose focus.

Teachers should also model a concept or skill and practice it multiple times with the student before asking the student to complete an assignment independently. When modeling, the teacher works through a problem or shows students how to complete a task. This helps alleviate student frustration and decrease behaviors that are reactions to frustration. For example, if the teacher asks the students to use a graphic organizer to write a persuasive essay, the teacher can model how to fill in the graphic organizer—with the students—before asking students to fill in their own graphic organizer with a partner or on their own.

Providing Breaks and Releases

Even with organized and effective delivery of instruction, students with ADHD may need brief breaks from the classroom to release their hyperactive or inattentive tendencies (i.e., have some “down time”). Some students may need a quick stretch break at the completion of each academic task. This stretch break may be established as a classroom routine so that it is not distracting to other students, or teachers may find that all students benefit from taking these breaks.

Students with ADHD may find it helpful to draw or doodle as an outlet for their energy. If this drawing is not distracting to the rest of the class, teachers should allow it to occur. Some students may find it helpful to have a squeeze ball to squeeze and release multiple times during tasks. This technique can help eliminate hyperactive behavior and help the student focus.

Teachers and students should become aware of triggers that lead to hyperactive or impulsive behavior and develop signals and routines to use when the student needs a break from the current activity or assignment. For example, if a student is feeling antsy and needs to get out of his seat and stretch, he can raise his hand. The teacher can then nod to signal that the student can move to the back of the classroom to stand for a few minutes. While this might be distracting to some teachers, developing a routine for stretching or standing is better than having a student jump out of his seat and disrupt the entire class.

Many students with ADHD, in fact, may find it difficult to sit for long periods of time. Some elementary schools allow students to sit on exercise balls, which require the student to focus on balance rather than squirm around (Harlacher, Roberts, & Merrell, 2006). This practice is less frequently used at the secondary level, when students switch classrooms throughout the day.

Encouraging Self-Monitoring

As discussed in Chapter 2, encouraging students with disabilities to self-monitor their behavior is an important step in fostering autonomy and ownership of their learning and success (Johnson, Reid, & Mason, 2011). Having students use checklists is one way teachers can help students monitor their own progress in completing tasks or following classroom rules. In addition, a student may stay more focused on an academic or behavioral task if she has a written checklist or set of directions that accompanies verbal directions. Students with ADHD may have difficulty focusing on a long set of verbal prompts, and a visual or written reminder will help them.

Checklists for academic tasks can help students with ADHD break down assignments into manageable parts (Figure 5.7). Checklists for behavior (Figure 5.8) can also be helpful. At the secondary level, students may use more complex checklists.

Students with ADHD may also benefit from learning problem-solving strategies as discussed in Chapter 4 (Jacobson & Reid, 2010). The strategy D.I.R.T. (Define the problem, Identify choices, Reflect on choices, Try it out) helps students with EBD and students with ADHD (Cook, 2005). Problem-solving strategies can help students monitor their own behavior and improve student attention to academic tasks (Iseman & Naglieri, 2011).

Figure 5.7: Sample Checklist in a Writing Classroom

A checklist can help keep students focused in a sixth-grade writing classroom. The student answers questions that lead to the completion of a written assignment with an introduction, body, and conclusion. The color coding in the checklist corresponds to the original instruction provided by the classroom teacher on writing different types of paragraphs and serves as a reminder to the student.

Figure 5.8: Behavior Checklist

A student-generated checklist reminds the student to listen and raise his hand. The student has indicated that he canearn stickers for sitting at his desk, reading independently, raising his hand to use the bathroom, participating in whole-class instruction, and cleaning up after snack time. At the bottom the student has shown the reward he will earn forfour stickers—computer time.

Another way to help students monitor their behavior is through the use of a timer that beeps at set, intermittent points. When the timer beeps, students check their behavior and ask themselves questions targeted to their own goals, such as “Am I in my seat?” or “Am I paying attention?” The questions differ based on the student and the situation.

References

Powell, S. R., & Driver, M. K. (2013). Working with exceptional students: An introduction to special education [Electronic version]. Retrieved from https://content.ashford.edu/

8.1 What Are Intellectual Disabilities?

Until 2012, intellectual disability was referred to, in the IDEA and elsewhere, as mental retardation. (See the feature box titled “Phasing Out the ‘R’ Word” for a discussion of the change in terminology.) Intellectual disability is one of the 13 IDEA 2004 categories.

Defining Intellectual Disabilities

People with ID generally struggle with learning, problem solving, and thinking. They also have difficulty with adaptive behaviors, which are those conceptual, social, and life skills that enable people to participate in everyday life activities. These include using money, engaging in conversations, and taking care of personal hygiene and safety (see Figure 8.1 for more examples). Adaptive behaviors enable people to be self-sufficient and live independently. When people do not initiate such behaviors, it limits their participation in school and society.

Students with ID typically develop at a slower rate than students without ID; they may learn to speak and walk later than normal and may have difficulty learning in school.

ID is sometimes grouped with developmental disabilities. This category, not recognized by IDEA 2004, includes all disorders and disabilities that occur during an individual’s development, typically defined as the period from birth until adulthood (i.e., 22 years old). Autism is considered a developmental disability, as is cerebral palsy, epilepsy, and fetal alcohol spectrum disorder (FASD). Although ID may sometimes fall under the umbrella term of developmental disabilities, a student with a developmental disability does not necessarily have problems with intellectual functioning or adaptive behaviors.

Figure 8.1: Adaptive Behaviors

Adaptive behaviors include conceptual, social, and life skills. Typically, students with ID exhibit deficits in all three areas.

ID is different from mental illness. A mental illness affects how a person thinks and feels and has no connection to intellectual functioning. A mental illness can be positively influenced by treatment; examples include schizophrenia, bipolar disorder, anxiety disorder, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (see Chapter 6). An ID, in contrast, is not an illness. ID is a condition that affects a student for life. Treatment can improve student outcomes, but it cannot change the condition of ID. Although institutions (which you will read about shortly) often housed both populations together, people with mental illness are distinctly different from those with ID in terms of the symptoms, treatments, and responses to treatments they experience.

Intellectual Disabilities and IDEA 2004

PL 94-142 included mental retardation as one of its original disability categories. IDEA 2004, because it was written before Rosa’s Law took effect, still uses that term, but it will change to intellectual disability when IDEA 2004 is reauthorized. The IDEA 2004 definition is as follows: “significantly sub-average general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child’s educational performance.”

Typically, intellectual functioning is defined using an intelligence quotient (IQ). Students scoring below 70–75 often qualify as having an ID. They must exhibit deficits in one of the three areas of adaptive behavior (conceptual, social, or life skills). As with all the other disability definitions under the IDEA 2004, students can qualify as having an ID only if their disability affects their educational performance.

Prevalence of Intellectual Disabilities

Approximately 1% of U.S. students have an ID, and approximately 1–3% of the world population has an ID (Topper, Ober, & Das, 2011). Under the IDEA 2004, however, there is variability in identification by state. As happens in some of the other disability categories, minority students (especially African-American students) and students who are English language learners are identified with ID at a higher rate than students from other racial or ethnic backgrounds (Ford, 2012; Sullivan, 2011). Additionally, boys tend to be identified with ID more than girls (Ford, 2012). The rate of identification of students with ID has decreased over the last several years, especially since autism became its own IDEA category in 1990. Section 8.4 of this chapter discusses some of the syndromes and disorders that can cause ID.

8.2 How Has the ID Field Evolved?

In 7000 B.C.E., people with ID had holes drilled in their skulls to let their “diseases” escape (Manion & Bersani, 1987). More than two thousand years ago, the Greeks and Romans believed that evil spirits allowed children to be born with ID, and many of these children were left to die or were even killed. If their parents were wealthy, children with ID were sometimes permitted to live, but only if a guardian could take care of them.

Over the next two thousand years, some societies continued to exclude children with ID. In some places, they were sold as slaves or used for the amusement of others. People with ID lived in poorhouses, monasteries, or prisons. In other societies, though, children with ID were cherished as being blessed by a higher power and were treated as deities (Manion & Bersani, 1987).

The First Advocates for Individuals With ID

As discussed in Chapter 1, during the 19th century, people began to advocate for individuals with ID and built institutions to house and help them. One of the first researchers was Jean-Marc Gaspard Itard, who worked with Victor, the wild boy of Aveyron, who had characteristics of ID along with other disabilities (Feudtner & Brosco, 2011). His efforts were not entirely successful, but his mentee, Eduoard Seguin, brought Itard’s teaching practices to the United States and published a book titled The Moral Treatment, Hygiene, and Education of Idiots and Other Backward Children.

Seguin, along with others, such as Dorothea Dix, helped spread a movement in the United States advocating that students and adults with ID should be treated humanely and be educated and trained to participate in society. As the 19th century progressed, institutions for the care of people with ID opened in cities across the United States. Many states, though, still preferred to place people with ID in state-controlled institutions so the state could prohibit their marriage or procreation.

Associations With Poverty and Crime

Many societal problems of the 19th century, such as crime and poverty, were blamed on people with ID, who were called “idiots,” “dumb,” or “feeble-minded.” In 1869, Sir Francis Galton published a book called Hereditary Genius, in which he promoted the idea that an ID was inherited. This idea fueled the eugenics movement, which advocated that people with intellectual disabilities should be sterilized to prevent future generations of people with these disabilities.

The eugenics movement was spurred on by Richard Louis Dugdale’s The Jukes: A Study in Crime, Pauperism, Disease, and Heredity and Henry Goddard’s The Kallikak Family: A Study in the Heredity of Feeble-Mindedness. Both authors described “families” who had tendencies toward poverty, criminality, or feeble-mindedness, and eugenicists used these family histories to promote sterilization laws (Smith & Wehmeyer, 2012). (Modern scholars, of course, have debunked many of the claims put forth in Dugdale’s and Goddard’s books.)

By 1944, 30 states had sterilization laws. States could sterilize people who were “imbeciles” or were “unimproveable.” States ultimately sterilized thousands of people, many of whom did not have an ID. After World War II, attitudes toward sterilization shifted, and by the 1960s all states had abandoned this practice.

The First Efforts at Schooling for Individuals With ID

Meanwhile, the use of standardized assessments began to help doctors and educators identify students with disabilities, and states slowly started to provide for the schooling of these students. In 1911—well before PL 94-142 in 1975—New Jersey was the first state to mandate education for students with ID.

Another major milestone for people with ID occurred in 1950 with the formation of the National Association of Parents and Friends of Mentally Retarded Children. This organization, now called ARC, helped advocate on behalf of students with ID. In 1962, President John F. Kennedy formed the President’s Panel on Mental Retardation to provide funds for research and education of students with ID.

With the passing of PL 94-142 in 1975, students with ID received the right to a free, appropriate public education. While many public schools were providing an education to students with ID before 1975, the law made it mandatory.

The Shift From Home to Group Care Environments

As students with ID began to participate in schools more widely, educators and legislators began to reconsider how to best prepare them to be members of society and provide services as they became adults. Advocates believed that institutions were dehumanizing, and they started a movement to integrate adults with ID into local communities.

One such advocate was a professor of special education named Wolf Wolfensberger. Wolfensberger promoted the concept of “normalization,” which involved providing the same opportunities and environment to people with disabilities as were available to people without disabilities (Mann & van Kraayenoord, 2011). Starting in the 1980s, states closed many of their mental institutions, where people with ID had usually been placed, and adults from these institutions went back to living with family members or in group and community homes with other adults with disabilities.

8.3 What Are the Characteristics of Students With ID?

By definition, all students with ID have lower intellectual functioning and have difficulty with adaptive behaviors. (See Figure 8.1 for examples of those.) In addition, they may exhibit certain physical characteristics or mobility issues as part of their disability. For example, students with ID may sit up, crawl, or walk later than other students; weigh less than students of the same age; be shorter than students of the same age; have difficulty with balance; or move around excessively or awkwardly.

Comorbidity With Other Disabilities

The most common type of comorbidity with ID is emotional and behavioral disorders, with comorbidity rates as high as 30–50% (Einfeld, Ellis, & Emerson, 2011). ADHD is another common disorder that often occurs in conjunction with ID (Neece, Baker, Blacher, & Crnic, 2011), although ADHD is sometimes difficult to diagnose in students with ID because the symptoms are manifested differently than in typical students with ADHD (Reilly & Holland, 2011).

Until autism became its own disability category with IDEA, students with autism were often categorized as having ID. With the creation of a separate autism category, the percentage of students with ID identified in school decreased. This decrease did not signal that fewer students had deficits in intellectual functioning and adaptive behavior, but only that the categories had changed (i.e., some students previously identified as ID were now identified with autism spectrum disorder [ASD]).

8.4 What Are the Causes of ID?

As with other disabilities, there is no single cause of ID. Genetics (i.e., the actions of genes in the body) and heredity (i.e., the passing of genetic traits from parent to offspring) commonly play a role. In addition, many causes of ID arise during pregnancy, childbirth, and childhood.

Genetic Causes

When a child inherits abnormal genes from one or both of their parents, or a gene mutates spontaneously, genetic abnormalities can cause disorders, such as Down syndrome, fragile X syndrome, Williams syndrome, Prader-Willi syndrome, and phenylketonuria (PKU).

Children with Down syndrome, or trisomy 21, have an extra copy of chromosome 21. They have a characteristic appearance that may include a small head, broad or flat face, slanting eyes, and a short nose. They also typically have health issues, including heart problems and vulnerability to infectious diseases, as well as intellectual impairments, which can range across a spectrum but are most often mild to moderate (Couzens, Haynes, & Cuskelly, 2011).

Fragile X syndrome is a disorder resulting from changes to the genetic code on a fragile area of the X chromosome. Both girls and boys can have fragile X syndrome, but because girls have two X chromosomes and the unaffected X chromosome helps mask the affected chromosome, boys usually have more severe symptoms. In this syndrome, the gene that makes a certain protein that the brain requires in order to grow has a defect, which leads to abnormal brain development. The syndrome is characterized by delays in speech or intellectual functioning. Some students with fragile X exhibit characteristic physical attributes, such as a long face with a wide forehead.

Children with Williams syndrome are born without approximately 25 genes. This causes atypical brain development. Unlike some other students with ID, students with Williams syndrome are very social and relate well to other students and adults. They often experience medical difficulties related to the heart and require medical care throughout their lifetime.

In Prader-Willi syndrome, children are born with part of chromosome 15 missing. Babies born with this syndrome often have difficulty eating and gaining weight and experience delays with motor development—for example, sitting, crawling, or walking (Yearwood, McCulloch, Tucker, & Riley, 2011). As toddlers, children with Prader-Willi may experience rapid weight gain. Physical characteristics include almond-shaped eyes, a narrow skull, and small hands and feet. Students with Prader-Willi almost always have delays in intellectual functioning.

PKU is a metabolic genetic disorder in which the child’s body lacks the enzyme needed to break down the amino acid phenylalanine. A buildup of this amino acid can lead to brain damage that may affect intellectual functioning. As opposed to Down syndrome, Williams syndrome, and fragile X syndrome, PKU can be treated with a strict diet. Thus, newborns are routinely tested for PKU so that a diet can be started immediately, before damage has occurred.

Prenatal and Perinatal Causes

In addition to its genetic causes, ID can also result from factors, complications, or difficulties during pregnancy or childbirth. For example, excessive alcohol consumption during pregnancy, especially during the first trimester, can result in fetal alcohol spectrum disorder (FASD). One of the most common difficulties associated with FASD is deficits in intellectual functioning. Individuals with FASD often have noticeable physical characteristics, such as a smaller head with atypical facial features such as smaller eyes and thinner lips.

Exposure of a fetus to certain infectious agents can also result in ID. If a mother contracts rubella (also known as the German measles) while pregnant, her child may be born with birth defects, such as hearing or visual impairments. With the advent of the rubella vaccine, the number of babies born with complications due to a mother’s rubella has dwindled to near zero in the United States, but babies with unvaccinated mothers, who may come from other countries or have visited other countries, are still at risk. Toxoplasmosis is another disease that can affect a fetus. It is caused by a parasite that can be present in contaminated or undercooked meats. If a mother contracts toxoplasmosis while pregnant, the infection can affect the fetus. Babies may experience deficits related to the brain and neurological system, which can lead to ID. They may also be born with visual impairments.

Complications during labor and delivery can sometimes lead to intellectual disability in a newborn, particularly if the child’s brain experiences a lack of oxygen (when, for example, the umbilical cord accidentally wraps around the neck). The incorrect use of medical instruments, such as forceps, may also cause injury to the brain.

Childhood Causes

Infectious agents can also lead to development of ID during childhood, as can exposure to certain toxins. They are now rare, but childhood illnesses like measles, whooping cough (pertussis), polio, meningitis, or chicken pox can contribute to changes to the brain or central nervous system, which in turn can lead to ID. Often, these illnesses cause encephalitis, a swelling of the brain that can damage brain cells or cause bleeding in the brain.

Environmental toxins like mercury (which can be found in fish) or lead (which is sometimes still found in paint in older homes), can also lead to brain damage and ID, particularly if the exposure occurs over a long period of time and the toxins build up in the child’s body.

8.5 How Are Students Diagnosed With ID?

As you will remember, students must demonstrate deficiencies in both adaptive ability and intelligence to qualify for special education under the ID category in IDEA 2004—and these deficiencies must adversely affect their academic performance. Schools administer measures of intelligence and adaptive ability to diagnose students with ID.

Each district or school chooses the exact assessment and cut-off scores to consider students for ID. This results in discrepancies from state to state in the classification of students, and state prevalence rates range from 0.4% to 2% (Polloway, Patton, & Nelson, 2011).

Assessing IQ

An intelligence quotient (IQ) test is the primary measure used to diagnose ID. “Intellectual age” or “mental age” are terms used to describe the level at which a student performs on an IQ test. An intelligence quotient (IQ) is determined by comparing “intellectual age” or “mental age” to the student’s actual age. A student’s IQ score falls somewhere along a normal distribution, or “bell curve,” (shown in Figure 8.2) in the general population, with a mean (or average) score of 100 (Simonoff, 2006). As mentioned, most students scoring lower than 70–75 are considered to have ID, though cut-off scores vary, and there are additional criteria (Polloway et al., 2011).

Figure 8.2: The Bell Curve

The shape formed on a line graph of IQ test scores is called a “bell curve” because it looks like a bell. Most students fall in the middle, or average, range. As the bell curves down, fewer students fall into the categories. Typically, students who qualify for difficulties in intellectual functioning score below 70–75 on an IQ test. IQ test scores vary, which is why a range is used for identifying students with ID.

There are many examples of IQ tests. Some of the most common include:

Cognitive Assessment System (CAS)

Kaufman Brief Intelligence Test (K-BIT)

Raven’s Progressive Matrices

Reynolds Intellectual Assessment Scales (RIAS)

Stanford-Binet Intelligence Scale

Wechsler Abbreviated Scale of Intelligence (WASI)

Wechsler Adult Intelligence Scale (WAIS)

Wechsler Intelligence Scale for Children (WISC)

Woodcock-Johnson Tests of Cognitive Abilities

Classroom teachers will never have to decide which IQ test to administer to a student. The choice of assessment and the administration of it is the role of a school psychologist or other trained assessment professional.

The use of IQ tests to diagnose any disability has a controversial history (Gallagher, 2008). Some of this is related to test bias, as earlier chapters have discussed. Educators also argue about whether an IQ score really captures a student’s intelligence—and to a further degree, what is intelligence? If intelligence is an elusive quality that is hard to define, then how can we administer a test for it? Also, does an IQ score correlate with achievement in the classroom? Researchers have improved existing IQ tests and created new ones, but the questions related to IQ scores (and similar instruments) still remain (Kaufman, Reynolds, Liu, Kaufman, & McGrew, 2012). Until recently, IQ was also used as a determining factor for identifying students with specific learning disabilities (SLD).

Assessing Adaptive Behavior

Adaptive behavior assessment also plays a role in identifying students with ID. Social and behavioral ability is typically assessed with an adaptive behavior scale, instrument, or checklist (for an example, see Figure 8.3). The assessment measures students’ use of skills that are conceptual (e.g., literacy, understanding of time, use of money), social (e.g., working with or relating to others), and practical (e.g., care of self, safety, transportation) in the context of everyday life (Polloway et al., 2011). Data from adaptive behavior assessment informs individualized education program (IEP) goals and classroom instruction centered on learning social and life skills.

Three of the most popular ways to assess adaptive behavior include:

Adaptive Behavior Assessment System (ABAS)

Diagnostic Adaptive Behavior Scale (DABS)

Vineland Adaptive Behavior Scales

Adaptive behavior checklists or scales are similar to IQ tests in that they should be chosen and administered by a trained professional who is familiar with adaptive behavior. In many schools, this is a special education teacher or school psychologist.

Figure 8.3: Adaptive Behavior Checklist

These questions are from checklists used to assess adaptive behavior in Tennessee schools. In answering the questions, the teacher compares the student’s behavior with that of other students who are the same age.

Assessing Degree of ID

After assessment, some schools may go a step further and describe the degree of ID for a student. This practice is not universally applied, but you may see a descriptor, such as mild, moderate, or severe, in front of the ID label for some students at some schools.

Students with a mild ID typically have an IQ between 50 and 70. These students may struggle with learning in school, but they will probably learn the basics of reading, writing, and mathematics. Many of these students will go on to live on their own and may have a job to support themselves. Students with a moderate ID usually have an IQ ranging from 35 to 50. These students may learn to recognize certain words or phrases. They will need assistance with learning to care for themselves and will likely require lifelong care. Students with a severe ID (IQ between 20 and 35) or a profound ID (IQ below 20) will struggle with speech and communication throughout life. These students will have limited skills in all areas and will require lifelong care and assistance.

When Are Students Diagnosed?

Children can exhibit characteristics of ID at a very young age, particularly if they have a condition with visible characteristics, such as Down syndrome or Williams syndrome. Genetically caused conditions such as these also may be identifiable before birth, and doctors may classify a fetus as having a high risk for ID. Events during and after birth, such as oxygen deprivation, may also cause an ID that can be identified soon after birth.

In young children, an ID may first be detected as the child develops language, social habits, and early academic skills. The majority of students with ID are identified early in their education, once academic learning starts to accelerate. A child will not be officially diagnosed, however, until his IQ and functional ability are measured. For this reason, many children are not officially classified until they enter preschool or elementary school. Prior to the diagnosis, very young students are often categorized as having a developmental delay. Definitions of ID all include the criterion that it be manifested before the ages of 18–22 (Polloway et al., 2011).

8.6 How Does ID Differ Across Grade Levels?

Depending upon the severity of their ID, some students at all grade levels participate in the general classroom for some, if not all, of the school day. Other students with ID spend most of their time in self-contained classrooms or schools.

Instructional services should be based on IEP goals and post-secondary life plans. Students with ID typically receive instruction in adaptive behavior and academics. Students with more severe ID may receive instruction that is less focused on academics and more focused on social and life skills, such as communication and self-care. Such skills include eating and drinking, expressing a physical or emotional need, managing money and household responsibilities, and staying safe in a variety of settings (Aldridge, 2010). Skills related to self-awareness, self-sufficiency, and self-care, however, should be integrated into the education of all students with ID. This section provides an overview of educational programming for students with ID, from early childhood to post-secondary options.

Early Childhood

Part B of IDEA 2004 mandates a free and appropriate public education (FAPE) for all eligible children aged 3–5 years. Young students with ID are eligible to receive early childhood special education services under IDEA. Early childhood services focus heavily on developmental skills, such as language and social interaction. Social skills include cooperation with adults and peers on everyday tasks, appropriately expressing feelings, and self-control (McIntyre, Blacher, & Baker, 2006). Early childhood teachers can explicitly model the appropriate behavior, create structured environments for students to practice the behavior, and provide positive reinforcement when students perform the social behavior appropriately.

Early special education services can prepare students with ID for later future instruction and social interactions (Yoder & Warren, 2002). Part C of IDEA 2004 allots state funding to provide programming for infants and toddlers at risk for ID before the age of 3 (Polloway et al., 2011). Young children who show developmental delays in language, communication of needs (i.e., hunger, comfort), and motor skills may be considered “at risk” (Tomasello, Manning, & Dulmus, 2010). Early special education services often focus on increasing child communication, motor skills, and social skills.

Not all students with ID are classified as such by age 3, however, since ID manifests in different ways and at different times for each individual. As a result, many students who fall into the “at risk” category before the age of 3 years are not identified and thus do not receive services. This situation has created concern for children 3 to 5 years old who are considered “at risk” for, but not yet identified with, ID. Such children may have been eligible for services as an infant or toddler under Part C, but may not be eligible for pre-school special education services under Part B if they have not been officially identified as having an ID.

Elementary School

As mentioned in Chapter 2, schools are increasingly moving toward inclusion of students with disabilities in general education. Over the last decade, this trend has brought many students with ID into the elementary general education classroom, but more are still placed in separate special education classrooms (Polloway et al., 2011). Depending on their individual needs and the support given, some elementary students with ID can be successful in the general education classroom.

Inclusion in general academic content classes can be beneficial for students with ID to ensure they are receiving instruction on grade-level content. In this setting, a special education teacher pushes into the general education classroom with the student to provide academic and behavioral support. Support may include accommodations (i.e., text read aloud, use of a calculator) or modifications (i.e., length of assignment, scribe) for instructional delivery, class assignments, and assessments.

For some students with ID, receiving the majority of instruction in the general education classroom may not be appropriate. A child’s specific needs and IEP goals can vary significantly from what is covered by the general education curriculum. In these cases, students may receive most of their instruction in a special education classroom. These classes are typically small and can service multiple grade levels. Special education teachers and teaching assistants work to ensure that all students are making progress toward their academic and adaptive behavior goals as stated in their IEPs.

The most appropriate school placement for elementary students with ID continues to be debated among researchers, policy-makers, administrators, and teachers. However, most agree that some inclusion throughout the school day with general education peers is beneficial for developing social and behavioral skills and preparing students for secondary school and adult interactions. Evidence-based research has shown that while inclusion can be effective for students with severe disabilities in increasing academic, social, and communication skills, further work is needed to improve overall instructional effectiveness for students with ID in the general education setting (Alquraini & Gut, 2012).

Secondary School

Most students with ID will have been identified and will have begun receiving services by the time they enter middle or high school. As at elementary levels, secondary students with ID receive instruction either in the general education class with support, in a separate special education class, or some combination of the two. Curriculum for secondary students with ID will vary depending on their IEP goals and learning environment.

Academic IEP goals for students with ID often include a modified version of state standards. These modified state standards often focus on academic skills critical for independent living, such as word recognition, reading and listening comprehension, addition and subtraction, understanding time, and using money. Additionally, students with ID often have behavior goals and social skills built into their curriculum. Adaptive behavior instruction should be explicitly connected to independent living and outside interests to keep secondary students engaged in learning social skills.

Behavior and social skill instruction should be aimed at empowering students to pursue a variety of post-secondary options. This is often referred to as self-determination, or the ability to make decisions and set goals. High self-determination is associated with higher quality of life for individuals with ID, and self-determination can increase through supportive environments that promote choice (Nota, Ferrari, Soresi, & Wehmeyer, 2007).

Teaching self-determination to students with ID is especially important in middle and high school. After graduation, it is less likely that students will have the opportunity to practice decision-making and receive feedback in safe, supportive environments. Facilitating student self-determination while students are receiving school services may improve their quality of life post-graduation.

Goals, curriculum, and instruction for students with ID are highly tailored to each individual’s strengths, interests, and needs. Since instruction can differ drastically from the general education curriculum, it is important to consider where students with ID receive instruction. Secondary placement decisions are based on several factors, including severity of disability, school and district inclusion policies, and post-secondary plans.

Transition

Transition goals and post-secondary school plans are critical for secondary students with ID and are included in the IEP to ensure that students are prepared for their next stage of life. For students with ID, post-secondary school options can range from continuing their education at a community college or university, entering the work force, moving to a residential home, or a combination. This decision is made by the IEP team and should include input from the student, family members, teachers, administrators, and any other health or service providers. Within all of these options, skills in communication and self-care are vital for success.

Post-secondary opportunities are influenced by a student’s education, which is often measured by a high school diploma. There is a great deal of controversy regarding the awarding of high school diplomas to students with ID (see the feature box titled “The High School Diploma Debate” for a discussion of this). Students receiving instruction in secondary special education classrooms may not take all classes typically required for high school graduation. As a result, states have differing policies on whether or not completion of a modified high school curriculum warrants a traditional high school diploma. Some states choose to provide an alternative certificate, while other states make course allowances for students with ID and award them the traditional diploma. This issue continues to be debated, particularly since it is linked to the topics of school accountability and school performance.

Some students with ID take advantage of an option called Comprehensive Transition and Postsecondary Programs (CTPS), in which they take classes at the college or vocational school level (Kleinert, Jones, Sheppard-Jones, Harp, & Harrison, 2012). Students may take these classes while they are still in high school or after graduating or completing high school.

Special grants and work-study monies are available for students with ID to take classes that will help them in a future career. For example, a student with an interest in working at a print shop might take graphic design classes at a community college (Kleinert et al., 2012). Students may take the college or vocational courses for credit, or they may audit the courses. To help students with ID gain access to coursework, colleges and schools sometimes have different entrance requirements (e.g., not requiring a graduation diploma and not requiring the student to take a college entrance exam). Some students graduate with a college degree, while many others take only a few classes to help them with a career.

8.7 How Do I Teach Students With ID?

As you have seen, students with ID vary tremendously in their strengths and abilities. The optimal classroom placement also varies from student to student. In the era of inclusion, some students participate in the general classroom, so teachers must use appropriate teaching strategies in reading, writing, mathematics, and the content areas, while emphasizing social skills.

Classroom Settings

As you learned in Chapter 1, a student’s least restrictive environment must be considered when the IEP team determines the student’s school placement. Since the reauthorization of IDEA in 1997, all students have been required to have meaningful access to the general curriculum (Cooper-Duffy, Szedia, & Hyer, 2010). The IEP team needs to place students in settings that allow the most access to the curriculum of the school or district.

When students spend most or all of their day in the general classroom, they may have a special education teacher who comes into the general classroom to provide extra support. The general and special education teachers work together to develop appropriate modifications for the student with ID. Other students spend time in a resource room receiving individualized or small-group instruction in reading or math, as well as time in the general classroom for instruction related to science, art, music, or physical education (Bouck, 2011).

Students with moderate or severe ID may be placed in one of two settings. The first is a self-contained classroom where the teacher concentrates on adaptive behavior skills and academic skills that are appropriate for the student. The student might participate in extracurricular activities with peers without disabilities (i.e., recess, art, field trips), but most of the student’s time is spent in a classroom devoted to the education of students with severe disabilities.

The second setting is a specialized school operated by the school district or a private school for students with disabilities that the district chooses for the student. At these schools, the staff members are highly trained to provide appropriate training and services to students with severe disabilities. Fewer than 20% of students with ID are placed in self-contained classrooms or specialized schools. If the district makes the decision to place a student in a setting other than the student’s local school, the cost is covered by the district.

Teaching Academic Skills

Many of the accommodations and modifications discussed in Chapter 2 are appropriate for teaching academic skills, such as reading, writing, and mathematics, to students with ID, but it is important for teachers to receive appropriate training in designing this instruction (Lee, Soukup, Little, & Wehmeyer, 2008). In the general classroom or resource room, students with ID may benefit from working in small groups or in pairs (Carter, Sisco, Chung, & Stanton-Chapman, 2010). When pairing a student with ID and a typical student, the teacher needs to ensure proper training and appropriate activities for the pair; the teacher must train the students to work together in a positive way and to provide appropriate feedback.

Students with ID may benefit from extended time to take tests or complete assignments. Additionally, these students may need assignments or assessments broken into smaller sections. The IEP team makes many of these decisions, but the general and special education teachers may recognize a further need to break instruction into smaller segments.

Reading

Until recently, many students with ID did not receive reading and literacy instruction (Allor, Champlin, Gifford, & Mathes, 2010). Many people thought that these students could not learn to read, but recent evidence supports the idea that many students with ID can and should learn basic reading skills (Lemons, Mrachko, Kostewicz, & Paterra, 2012). Even students with severe ID can potentially identify letters and read sight words (Agran, 2011). Reading and literacy skills not only improve the academic outcomes of students with ID but also can improve their social skills by enabling the student with ID to be more of a participant in the classroom and with peers (Forts & Luckasson, 2011).

Some suggestions for reading instruction include the following:

Teach print concepts (Allor, Mathes, Roberts, Cheatham, & Champlin, 2010). Teach students where to find the title and author of a book and how to read a book by turning the pages one by one.

Teach phonological awareness and phonics (Lemons et al., 2012). Students should learn letter names and letter sounds. They should also practice blending sounds into words.

Teach decoding skills (Lemons et al., 2012). Students should learn how to “sound out” a word. For example, “cat” can be broken into three sounds: /c/ /a/ /t/. By decoding, students use their phonics skills to read a word.

Teach sight words (Allor, Champlin, et al., 2010). Students should learn important words that they recognize when they see them. Sight words include high-frequency words that are difficult to “sound out” using phonics skills (e.g., “the,” “about,” and “and”). Students can practice sight words via flash cards, games, reading, or puzzles (Allor, Mathes, Jones, Champlin, & Cheatham, 2010; Ruwe, McLaughlin, Derby, & Johnson, 2011).

Conduct read-alouds (Knight, Browder, Agnello, & Lee, 2010). The teacher and student can read together or the teacher can read aloud while the student follows along. The teacher pauses frequently during the reading to ask comprehension or prediction questions.

Teach vocabulary (Allor, Mathes, Roberts, et al., 2010). Explicit instruction in vocabulary, where teachers teach vocabulary words and their meaning (e.g., “This word is allow. Allow means to let someone do something.”) is important. Providing cards with pictures that go along with key vocabulary words (as shown in Figure 8.4) is a very helpful strategy for students with ID (Cooper-Duffy et al., 2010).

Figure 8.4: Vocabulary Picture Cards

To help students understand vocabulary, teachers can create cards with pictures to represent specific words. Students can use the picture cards to understand the word, write the word, or communicate the idea.

Focus on comprehension (Evmenova, Behrmann, Mastropieri, Baker, & Graff, 2011). Teachers can help students understand the main concepts in a text by highlighting important words or phrases and using pictures to accompany the text. Teachers can conduct read-alouds and sprinkle comprehension questions throughout the reading.

Use graphic organizers (Morgan, Moni, & Jobling, 2006). Graphic organizers (i.e., visuals that help organize information) help students organize the main idea of a story, remember vocabulary, or understand other types of information.

Use technology (Machalicek et al., 2010). Augmentative and alternative communication (AAC) devices can be used to read text to students, allow students to respond to questions, or help students understand and use vocabulary (Ruppar, Dymond, & Gaffney, 2011). These devices—for example, an electronic reader—can highlight sentences or words for students or provide illustrations of stories or concepts.

Read, read, read (Schnorr, 2011). Teachers should read as much as possible with their students, especially students with ID. Many students like knowing a story and reading it again and again, and they can begin making connections with the known story and the printed text. Teachers can also echo read with students. In echo reading, the teacher reads a phrase or sentence and then the student reads the same phrase or sentence.

Instruction on reading and literacy should be intensive and explicit (Taylor, Ahlgrim-Delzell, & Flowers, 2010). That is, teachers model and demonstrate activities and skills and provide students with multiple practice opportunities. Students need daily, intensive teaching sessions that occur over an entire school year or several school years (Allor, Champlin, et al., 2010). Instructional sessions should last 30–60 minutes. They should be fast-paced and include brief activities that are repeated each day (Allor, Mathes, et al., 2010). Student progress must be monitored so that instruction is provided at the appropriate level, and teachers should use progress monitoring data to determine whether current instruction is adequate. Teachers should explicitly connect instruction with the student’s vocabulary and speech (i.e., teach using words the student knows and understands). Teachers should use a motivational system, such as a token economy, to keep students engaged and on task (Allor, Champlin, et al., 2010).

Coyne, Pisha, Dalton, Zeph, and Smith (2010) suggest incorporating the principles of Universal Design for Learning (UDL) into reading instruction. For example, students with ID can use multiple representations by having text highlighted, having hyperlinks embedded within text, and having illustrations that accompany written text. Multiple modes of action and expression can be provided through the use of prompts, questions, and think-alouds, as well as by allowing students to use different response options (e.g., multiple choice, open ended, true or false). Teachers can employ multiple modes of engagement by using popular books or by having students listen to recordings of text.

Writing

Many students with ID can learn to write. Writing has two major aspects: (1) the action of writing letters to make words and (2) the putting together of ideas into sentences and paragraphs.

Some students with ID, especially severe ID, may not possess the fine motor skills required to grasp a marker or pen in a way that allows them to form letters on paper. AAC devices can help these students communicate. Speech-to-text applications and software are readily available, and students can speak while a technology translates their speech into a written form. Other students can learn to write letters with practice. Using a variety of mediums (e.g., sand and rice), students can learn the action of writing the letter “p” or the word “car.”

Strategy instruction has emerged as one of the better approaches for teaching students with ID how to put ideas together into sentences and paragraphs (Joseph & Konrad, 2009). Teachers provide explicit instruction on a specific writing strategy and allow ample practice opportunities for students to apply the formula. One example is POW: Pick my idea, Organize my notes, Write and say more (Sandmel et al., 2009). Figure 8.5 illustrates some of these writing strategies. If students struggle with the physical action of writing as they use any of the strategies, they may use scribes (i.e., a teacher or adult who does the writing for the student) or the speech-to-text applications mentioned above.

Figure 8.5: Writing Strategies

These two posters highlight common writing strategies for students. When teaching students with ID, it can be helpful to further simplify the strategies and provide picture prompts for each step.

Mathematics

Teaching mathematics to students with ID can involve many of the teaching strategies employed for students with LD. Students should learn to recognize numbers and understand what they represent. Students can use the concrete-representational-abstract sequence to learn many different mathematics concepts. By using manipulatives at the concrete stage, students have the opportunity to understand how math works both conceptually and in practical terms.

One popular method for helping students understand the concept of small amounts is TouchMath (Fletcher, Boon, & Cihak, 2010), shown in Figure 8.6. Each number is “drawn” with the appropriate number of dots on the printed number to show the students the quantity. For example, “3” has 3 dots; the student can count and touch “1, 2, 3” dots to understand what “3” represents.

Figure 8.6: TouchMath Numbers

In TouchMath, dots represent the quantity indicated by each written numeral. Students use these aids to understand quantity and to add and subtract single-digit amounts.

Students can also use TouchMath to learn the steps in solving addition, subtraction, multiplication, and division problems. Solving specific problem types can be taught by using task analysis, which describes each step necessary for solving a problem. (See Figure 8.7 for an addition example.)

Figure 8.7: Task Analysis of Addition without Regrouping

This task analysis breaks a double-digit plus double-digit problem (without regrouping) into manageable steps. By breaking down and teaching each step, students can learn to successfully solve this type of problem.

Pegword mnemonics have proven to help students memorize answers to basic facts, such as math tables (Zisimopoulos, 2010). In using pegwords for math, students first use rhymes that are similar to numbers; for example, 6 times 7 is “six sticks and seven heaven.” Then, the students create a picture that puts sticks and heaven with the rhyming answer, “forty-two warty-shoe.” The student might draw sticks in a warty shoe in heaven. It may sound complicated, but students who are familiar with pegwords find it very easy to use this system to remember facts.

Many students with ID need explicit instruction on identifying and using money, as well as on telling and managing time. It is best to let students practice with real money or manipulative coins. They should also practice using money in real-life situations (e.g., grocery shopping, eating at a restaurant).

Time management can be learned using tools—for example, an elapsed time calculator or a vibrating watch (Green, Hughes, & Ryan, 2011). To use an elapsed time calculator, the student types in two dates or times, and the calculator computes the time between the two events. A vibrating watch can keep students on task by vibrating at set intervals to remind students to complete a task or pay attention.

To solve word problems in math, students should use cognitive strategies (Chung & Tam, 2005). Cognitive strategies help students break down an otherwise overwhelming task into manageable parts. For example, students might use the following strategy when solving a word problem:

Read the problem.

Find key words.

Draw a picture.

Write an equation and compute.

Check your work.

See Figure 8.8 for an example of student work that uses this cognitive strategy.

Figure 8.8: Solving a Word Problem Using Cognitive Strategies

A student used the strategy Read, Find key words, Draw a picture, Write an equation and compute, and Check your work to solve this word problem.

Just as when they are learning to read and write, students learning math can use AAC to understand mathematical concepts and solve problems (Knight et al., 2010). They may use AAC to practice basic facts or computation problems or to learn to manage money.

Content Areas

Many of the strategies discussed here to teach reading, writing, and math are also helpful in teaching students with ID in the content areas, such as science and history. For example, it is important to highlight important vocabulary and allow students to practice concepts with hands-on materials.

One approach commonly used for science instruction in the general classroom—the use of inquiry-based activities, in which students explore topics with teacher facilitation—is not typically the most effective teaching strategy for students with ID (Stavroussi, Paplexopouloes, & Vavougios, 2010), who require explicit instruction and hands-on modeling. For example, when learning about the life cycle of plants, a teacher should model with videos or hands-on materials how a seed turns into a plant. The teacher explains what happens to the seed by explaining each stage of the plant’s life cycle. Students should have opportunities to plant seeds, document the life cycle of the plant, and engage in discussion with the teacher and class.

Peer tutoring may also be useful in the content areas. Jimenez, Browder, Spooner, and Dibiase (2012) put students with ID in pairs with general education students. The pairs learned how to use the KWHL strategy to work through problems:

K: What do you know?

W: What do you want to know?

H: How will you find out?

L: What did you learn?

For example, when learning about Pearl Harbor, the pair might say:

K: We know that Pearl Harbor is in Hawaii. We know that Japanese bombed Pearl Harbor.

W: We want to know why Pearl Harbor was bombed. We want to know about the damage of the bombing. We want to know when this happened.

H: We will read our history book section about Pearl Harbor. We will research Pearl Harbor online. We will look at newspaper articles from the time of the bombing.

L: We learned that Pearl Harbor was bombed in 1941. The Japanese bombed Pearl Harbor because the United States had sided with China (and China and Japan were at war). At least 18 ships sank and over 2300 people died.

The KWHL strategy is helpful because it can be applied across subject areas and across grade levels.

Teaching Adaptive Skills

Instruction to help improve adaptive skills is crucial for students with ID to function as members of society (Bouck, 2010). The IEP team will decide which adaptive behaviors should be included in the student’s instructional program. Adaptive skills may be taught alone or in conjunction with conceptual (academic) skills (Miller, 2012).

Social Skills

Teachers should provide instruction on communication, such as engaging in a conversation, taking turns when talking, and interacting in social situations (Boden, Ennis, & Jolivette, 2012; Solish, Perry, & Minnes, 2010). Students with ID may participate in lunch or some classes with general classroom students, but neither the general education students nor students with ID may always understand how to engage in appropriate conversations. Students without disabilities are sometimes afraid to talk to students with ID or unsure of how to respond to students who have different speech patterns (Hughes et al., 2011). Teachers can help bridge the gap between these groups of students with meaningful instruction and practice.

It can be helpful to teach students with ID how to solve problems that arise with friends, at work, or at home (Cote et al., 2010). A general problem-solving approach may be the most helpful, because students can use it in a variety of situations. The following example shows how a general approach can help students think through their choices when presented with a challenging situation:

What’s the problem?

How can you fix it?

Why would it work?

Life Skills

Teachers may need to teach students how to take care of their personal needs (Bouck & Flanagan, 2010). They may guide students in practicing how to pick out clothes and get dressed. They may teach students how to brush their teeth, take a shower, or go to the bathroom. If preparing to live on their own, students may need to learn how to shop for groceries, do their laundry, and cook simple meals. Some students need to learn how to navigate a bus system in the city where they will live. Many of the skills that other students pick up indirectly by observing adults need to be explicitly taught to students with ID.

Task analysis, which was introduced in the discussion of teaching math, is a good way to teach many life skills. Figure 8.9 illustrates a task analysis related to brushing teeth.

Figure 8.9: Brushing Teeth Task Analysis

In task analysis, each part of a process is described as a separate step. A student who learns all the steps in the process—here, brushing teeth—will learn to be successful at the task!

Another way to teach life skills is through video modeling (Hammond, Whatley, Ayres, & Gast, 2010). With video modeling, a student watches a video instructing how to do something. By watching the visual presentation multiple times, the student learns how to do a task. This method has proven successful for teaching students with ID how to cook a meal and get around the community via bus (Mechling & O’Brien, 2010; Stock, Davies, Wehmeyer, & Lachapelle, 2011; Taber-Doughty et al., 2011).

Task analysis and video modeling might be used to teach students and adults with ID to perform tasks, such as watering a plant, delivering the mail, or changing paper towels (Mechling & Ortega-Hurndon, 2007). Checklists generated from a task analysis can provide reminders of how to do tasks, such as preparing food. It is often helpful for these checklists to be accompanied by pictures showing each step (Lancioni & O’Reilly, 2002; Minarovic & Bambara, 2007).

Students with ID also need to receive training on safety skills (Agran, Krupp, Spooner, & Zakas, 2012), which can be provided via explicit instruction or, when feasible, with video modeling. Students should learn how to change batteries in a smoke detector and what to do in case of a fire or crime. Working adults with ID must be trained on appropriate work safety skills (e.g., not walking through an area with a “wet floor” sign).

People with ID should also receive education on relationships that could involve sex. They are at greater risk of sexual abuse (Swango-Wilson, 2011), and appropriate education and training can decrease this risk. For example, teachers may teach students about inappropriate touching and what to do when someone makes you feel uncomfortable.

Students and adults with ID also need to learn of the dangers of drug and alcohol abuse and how to avoid improper use of medication (Agran et al., 2012). While many safety topics may be more useful for adults, students should also receive training and education at appropriate times during their school career. This is especially important with teenage students, who may be influenced by the actions of their peers.

References

Powell, S. R., & Driver, M. K. (2013). Working with exceptional students: An introduction to special education [Electronic version]. Retrieved from https://content.ashford.edu/

11.1 Students With Orthopedic Impairments

Students with orthopedic impairments have mobility difficulties related to a disability. Impairments have a wide range of causes, and students can vary widely in terms of their movement and mobility. This is true even of students with the same disorder. Students with orthopedic impairments often require classroom accommodations to allow them access to physical materials.

What Are Orthopedic Impairments?

Orthopedic impairments limit an individual’s body movements and mobility. Some students have limited mobility in their arms or legs, and some may use wheelchairs or braces to move around (Johnson, Dudgeon, Kuehn, & Walker, 2007). Orthopedic impairments are often referred to as physical disabilities because the student’s physical body is affected (Shapiro & Martin, 2010).

The IDEA 2004 definition of orthopedic impairment includes “impairments caused by a congenital anomaly, impairments caused by disease (e.g., poliomyelitis, bone tuberculosis), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures),” and it requires that the student’s academic performance be affected. Of the student population, 0.08% is identified with orthopedic impairments.

Each student with an orthopedic impairment has different characteristics. Some students have limited mobility in one arm, whereas other students may have difficulty controlling their entire body. Orthopedic impairments are not temporary; for example, a broken leg is not considered an orthopedic impairment. Most schools consider orthopedic impairments as such only if they last more than 60 days and if the impairment appears to have a semi-permanent or permanent effect on the student’s movement and mobility.

Typically, orthopedic impairments are divided into three categories: impairments caused by degenerative disorders, impairments caused by musculoskeletal disorders, and impairments caused by neuromotor impairments.

Orthopedic Impairments Caused by Degenerative Disorders

Degenerative disorders cause the body to weaken as it ages, resulting in a reduction in mobility and movement. At this time, there is no cure for any of the degenerative disorders. The most common group of degenerative disorders falls under the umbrella term of muscular dystrophy (MD), of which there are over 40 types. With most types, the muscles of the body weaken, and mobility becomes severely limited. Some of the more common kinds are Duchenne Muscular Dystrophy, Spinal Muscular Atrophy, and Amyotrophic Lateral Sclerosis (ALS). You may know ALS as Lou Gehrig’s disease. Another degenerative disorder is multiple sclerosis.

Duchenne Muscular Dystrophy affects boys because the gene affected by Duchenne is on an X chromosome. (Because girls have two X chromosomes, a girl with the Duchenne gene does not develop the condition; her other X chromosome overrides it.) Boys with Duchenne often show symptoms between 2 and 6 years of age. The muscles of the body weaken over time, eventually causing paralysis of the arms and legs. Boys start out walking, but as their muscles weaken, they require wheelchairs. Most boys with Duchenne only live to 20–30 years of age.

Spinal Muscular Atrophy (SMA) is also related to a defective gene, but both boys and girls can have SMA. There are several types of SMA. One type affects babies, and the babies typically only live weeks or months because their muscles (including heart and respiratory muscles) are very weak. SMA type II affects children. Young children might be able to sit up, but their weak muscles never allow for walking. As the child ages, muscles become weaker and weaker, leading to paralysis. Many adults with SMA type II have respiratory issues and may have a shortened life expectancy. SMA types III and IV affect the muscle functions of adults, but life expectancy is not shortened.

Amyotrophic Lateral Sclerosis (ALS) is another degenerative muscle disease that causes weakness in movement, speaking, and breathing. ALS is caused by a defective gene that affects how neurons communicate with the brain and muscles of the body. ALS causes death in all patients, but some people can live with ALS for a number of years. Though rare, ALS can affect children.

Another type of degenerative disease is multiple sclerosis (MS). With MS, scar tissue develops around nerves, and the person can experience a wide range of difficulties, including loss of vision, difficulty with speech, and paralysis. The cause of MS is unknown, but it may be related to the body’s immune system. Mostly, MS affects adults, but children can have the disease. Children and adults with MS can learn to live with the symptoms of their MS, and most people live a normal life span.

Orthopedic Impairments Caused by Musculoskeletal Disorders

Orthopedic impairments may be caused by musculoskeletal disorders. These are disorders related to the skeleton and muscles of the body, and they cause mobility limitations. Two of the most common musculoskeletal disorders are juvenile rheumatoid arthritis and limb deficiency. (While degenerative disorders, such as MD, also affect the muscles, their degenerative nature causes them to be classified under degenerative disorder instead of musculoskeletal disorder.)

Juvenile rheumatoid arthritis (JRA) causes swelling or stiffness of the joints and limitations in mobility. Some children with JRA may experience difficulties related to bone growth (i.e., shorter height) and deformity. There is no known cause for JRA, although the disorder might be related to the immune system. Although there is no cure, students with JRA have typical life expectancy.

Another musculoskeletal disorder is limb deficiency. Limb deficiency can be caused by genetic mutations, as when children are born missing part or all of an arm, hand, finger, leg, foot, or toe. It can also be caused by illness or accident. For example, a child may have an amputation after an infection (e.g., gangrene) or amputation in an accident.

Orthopedic Impairments Caused by Neuromotor Impairments

A third cause for orthopedic impairments are neuromotor impairments. Neuromotor impairments are caused by damage to the spinal cord or other parts of the nervous system that lead to difficulty with mobility and movement. Students who experience traumatic brain injury may have physical mobility issues related to neuromotor impairments. The two most common types of neuromotor impairments are cerebral palsy and spina bifida.

Cerebral palsy (CP) is a condition in which students experience tight muscles that cause stiff mobility, abnormal movement, and poor balance. CP may affect one side or both sides of the body. Some students with CP can walk unassisted, while others need braces, canes, walkers, or wheelchairs. Students with CP may also experience seizures, hearing impairment, or visual impairment. Cerebral palsy is often caused by a prenatal or perinatal experience in which brain development is interrupted. Some causes may include asphyxia during delivery, an infection in the brain, or a traumatic brain injury. There is no cure for CP.

Spina bifida is a disorder where babies are born without full formation of the spinal column. This often causes paralysis in some parts of their bodies. Students are born with spina bifida, and there is no cure. They may use wheelchairs, braces, or other walking aids (Thomson & Segal, 2010). Most students with spina bifida also have bowel and bladder difficulties.

How Has the Field of Orthopedic Impairments Evolved?

For millennia, children have experienced orthopedic impairments. Wheelchairs (in a crude form) have been documented as early as 3500 BCE (Woods & Watson, 2004). Early wheelchairs had two large wheels with one small wheel in front, which then changed to two large wheels with two small casters in front (Cooper & Cooper, 2010). With advances in technology, wheelchairs have become less bulky, as they are made with stronger, yet lighter, materials (Cooper & Cooper, 2010). Now wheelchairs are available in manual or motorized versions. For students with limited hand control, wheelchairs can even be directed by movements of the tongue. Wheelchairs are expensive, and many families use insurance to cover the cost or rely on donations from charities and organizations.

Early versions of leg braces were crude and difficult to wear. People used wood and metal to restrict or improve the movement of the legs. They became widely used during the polio epidemic in the middle of the 20th century, and leg braces today have become strong, lightweight, and relatively easy to put on and take off.

Canes, which help people keep steady while standing or walking, have also been around for centuries. Crude canes carved from wood have been replaced with today’s lightweight and strong models, as well.

People with orthopedic impairments received access rights with the Americans with Disabilities Act (ADA) of 1990. Not only did they gain the right for non-discrimination in employment, but the ADA also stated that public buildings, buildings that received federal funding (e.g., libraries, airports, schools), and public transportation (e.g., buses, trains) needed to be accessible. The ADA Accessibility Guidelines and Buildings and Facilities outlines criteria for access in terms of ramps, restrooms, elevators, parking spaces, and other facilities.

What Are the Characteristics of Students With Orthopedic Impairments?

Students with orthopedic impairments experience a wide range of difficulties. Most struggle with physical motor skills because the brain and body have problems working together to perform a motion. Students with orthopedic impairments may use braces, canes, walkers, and wheelchairs for mobility. They may struggle with gross motor skills, fine motor skills, or both. Gross motor skills, which include walking, running and hopping, are skills related to big movements of the arms, legs, or trunk of the body. Fine motor skills are skills that require small movements, usually of the hand, and include writing with a pencil or using a spoon and fork.

Some students struggle with communication skills (Waring & Woodyatt, 2011). For example, some students with MD develop speech difficulties because of problems with the muscles that control how their tongue and mouth move. Students with CP may have difficulty controlling the head and mouth, as well. Many students with orthopedic impairments have difficulty with written communication because of the fine motor skills necessary to hold and control a writing utensil. In some cases, students may use assistive technologies, such as speech-to-text software or picture communication devices, to communicate.

Many students with orthopedic impairments experience average to above-average intelligence. Accommodations for such students will focus on how the student accesses classroom material and participates in activities. For example, students may require use of a scribe for writing essays or extra time to complete assignments. People unfamiliar with orthopedic impairments sometimes see a child in a wheelchair and assume the child has deficits in intellectual functioning. It is important to not allow a student’s physical limitations to cloud a teacher’s judgment about the student’s academic skills.

Students with orthopedic impairments may have medical issues related to their disability. Many students with CP experience seizures. Students who are non-ambulatory (i.e., use a wheelchair) may use diapers or need assistance with self-care related to the bathroom. Students may have bladder or incontinence issues related to their physical disability. Some students may have to undergo surgeries or procedures related to their impairment, causing them to miss chunks of time during the school year.

What Are the Causes of Orthopedic Impairments?

More than 50 types of disorders and diseases can cause orthopedic impairments. The previous discussion covered the most common: degenerative disorders (MD and MS), musculoskeletal disorders (JRA and limb deficiency), and neuromotor impairments (CP and spina bifida). Orthopedic impairments may also be caused by the following:

Bone tuberculosis. Tuberculosis is a bacterial infection that is often respiratory, but the infection can spread to bones. Symptoms may include weakened joints or bones that cause difficulty with movement.

Clubfoot. Clubfoot is a birth defect where one or both feet of the baby are turned in at the ankle. Many children with clubfoot can wear shoes to help correct the problem. Children with clubfoot may experience difficulty with walking.

Epilepsy

. Students with the neurological disorder epilepsy experience seizures. Some seizures can be severe enough to cause twitching of muscles and limbs. Students can fall unexpectedly during a seizure and injure themselves.

Polio. Poliomyelitis is a disease caused by infection that spreads to the spinal cord. While rare, the infection can cause muscle weakness or paralysis. A vaccine can prevent polio.

Scoliosis. A child with scoliosis has spine curvatures that can lead to orthopedic impairments. Students may wear braces to help straighten the spine or undergo surgery to straighten the spine.

Accidents, such as car accidents or burns. Any accident may cause damage to a student’s arms, legs, or trunk. This damage may cause an orthopedic impairment.

How Are Students Diagnosed With Orthopedic Impairments?

Most children with orthopedic impairments—whether caused by disorders, diseases, accidents, or illness—receive a diagnosis from a medical professional before they enter school. When students develop orthopedic impairments after they begin their schooling, teachers may notice changes, such as frequent falling or not being able to grip a pencil. In these cases, the family should have the child undergo a formal evaluation by a licensed physician.

The physician will do a thorough evaluation of the student. An evaluation may include brain scans, body scans, genetic testing, or blood sampling. The doctor should also gather observational data and information about how the student’s impairment may affect learning in the educational environment. For example, the doctor may test a student’s range of motion or ability to walk or skip. The doctor may check a student’s reflexes and dexterity.

Once a diagnosis has been obtained, the IEP team then works with the family and student to determine if the student qualifies for services under IDEA 2004—that is, whether the student’s educational outcomes are adversely affected. Many times, the student will undergo an academic evaluation (e.g., an intelligence test or achievement test) to understand if the student has any academic needs that need to be addressed. An evaluation by a speech-language pathologist or speech therapist may determine if the student has any speech or language needs. A physical therapist, an occupational therapist, or both may be members of the IEP team, because they will provide services to the student (see the feature, “What Do Physical and Occupational Therapists Do?”). The IEP team addresses deficits in gross and fine motor skills and puts together a plan to address the student’s needs.

The team will also address how the student will get around the school in terms of access to classrooms, cafeterias, libraries, and other spaces. Some schools will need to make changes to the physical space of the building to ensure that the student has the same degree of access as students without disabilities. For example, a ramp may need to be constructed so all students can access the stage in the auditorium or an elevator may need to be installed so all classrooms are accessible.

How Do I Teach Students With Orthopedic Impairments?

Teachers focus on access for students with orthopedic impairments—access not only to places, but also to information and activities. Many students with orthopedic impairments have difficulty accessing information and activities in the same way as nondisabled peers. For example, a student may have trouble writing a five-paragraph essay because of difficulty with fine motor skills, or a student may not have the hand strength to pour liquids from beaker to beaker during a science experiment. Teachers need to come up with ways to include the student in classroom activities. In the examples above, the student may choose to type the essay rather than handwrite it, and the student may work with a lab partner. It is important, however, that teachers think of novel ways to have students with orthopedic impairments participate actively, instead of always letting another student do the hands-on work. For example, in a math class, instead of manipulating rubber bands on a geoboard (which requires quite a bit of dexterity), the teacher may use a computer program so that all students in the classroom interface with an electronic version of a geoboard.

Teachers need to think about the arrangement and organization of the classroom space. If the class includes a student using a wheelchair, the classroom floor must be free of rises or impediments. The student should be able to maneuver down rows of desks. No part of the classroom should be off limits. Students in a wheelchair may not be able to reach books on a high shelf, but they should be able to get to the bookshelf. Students may also need accessible desks or tables, as most school desks do not accommodate a wheelchair.

The physical education teacher may need to adapt gym activities. In fact, there are Adapted Physical Education National Standards (APENS). Adaptations may involve playing in a smaller area (when running is difficult) or larger area (when wheelchairs are involved). Students may use a larger ball that is easier to grab, or gloves with Velcro that can easily catch Velcro balls. Recess activities, school plays, and field trips may also need to be made more accessible for students. For example, a trip to a waterpark may not be accessible to a student in a motorized wheelchair. The class could visit a zoo, movie theatre, or bowling alley instead. (Many bowling alleys have a device that can be moved up to a student’s wheelchair that allows the student to roll the ball down a ramp onto the bowling alley.)

Schools must address the accessibility of the school building and grounds. The teacher should develop a routine to help the student get around the school. If the school has an elevator, a pair of students may accompany a student in a wheelchair to help push buttons or keep the elevator doors from shutting too quickly. The playground should be made accessible, and lunchrooms may need to be organized more efficiently (Pinter, Filipcic, Solar, & Smrdu, 2005). For example, lunch tables may need to be placed in rows that allow easy access to and from the food line, trash can, and all exits.

To accommodate students that have difficulty with fine motor skills, especially handwriting and drawing, teachers may need to create ways for these students to use classroom materials. For example, worksheets may be printed with a larger font (Avant & Heller, 2011). This strategy might be particularly useful when, say, the student is asked to underline certain clauses, fill in a missing word, create a graph, or solve a computation problem.

Some students may experience hand trembling or hand paralysis (Avant & Heller, 2011). Teachers need to be creative in devising ways in which these students can play board games, write in a journal, read a book, or do any number of other classroom activities. Students can use technologies (e.g., computer keyboard, speech-to-text software, electronic page turner) to help with fine motor skills. Teachers may want to use bigger game pieces (e.g., a 3-D rectangle that is easy to grab) rather than flat pieces for games or other classroom activities.

Teachers need to provide assistive technologies when appropriate. Students who have difficulty with writing may use recorders to record class lectures. Speech-to-text or text-to-speech programs (that transcribe the spoken word into written text or vice versa), scribes (a person who transcribes a student’s spoken word), or large-print paper (with writing lines further apart to accommodate larger handwritten letters) may be helpful. Teachers may use clipboards or tape to secure student work to a writing space. Students may use markers or larger pens to write instead of pencils. Slip pads may be placed on laptops, calculators, or manipulatives to secure the materials needed for work.

When a classroom includes students with orthopedic impairment, the entire classroom will require social skills education (Donders & Taneja, 2009). Teachers need to work with all students to create a positive classroom environment that is welcoming and built on acceptance. They also need to educate the students about individual differences and how to interact with someone with a physical disability. Teachers may need to establish rules to help with safety. For example, “No riding on the back of a wheelchair,” or “The only person who uses the walker or cane is Margarita.”

Some students may have to miss a day of school for a doctor’s appointment, or they might miss weeks of school due to surgery or illness. In such cases, teachers must help students keep up with their work. Teachers may allow the student to do some work at home during recuperation if the student is healthy enough to do so. Teachers may also record lessons using video or audio so the student can watch or listen via the internet or at a later date. Teachers could also have the student participate in class remotely with a live video feed.

In addition to academic needs, some students may need physical care during the school day. This may involve changing a student’s stoma (i.e., colostomy) bag or refitting a student’s leg braces after nap time. The school and IEP team must decide who is responsible for any physical needs during the school day. Often, a specialist, school nurse, or special education paraprofessional may help out with such activities, but the general classroom teacher may be involved. Regardless of who helps with the care of the student, all personnel should receive proper training from an agency, medical professional, or the student’s family.

11.2 Students With Traumatic Brain Injury

Students who experience an injury or accident that causes difficulty with brain function may have traumatic brain injury. Causes can be related to any accident or injury, and the head does not have to be directly involved in the accident. Students can experience academic difficulties similar to students with SLD or SLI and behavioral difficulties similar to students with EBD.

What Is Traumatic Brain Injury?

A traumatic brain injury (TBI) is an injury to the brain that causes brain function to be impaired. This injury may be caused by being shaken violently or being hit in the head. Most TBI are caused by car accidents, falls, sports injuries, or physical abuse. Injuries can be closed (i.e., within the skull) or open (i.e., the skull cracks or breaks). Congenital or birth trauma brain injuries are excluded, and are often related to cerebral palsy or classified under intellectual disability instead.

According to IDEA 2004, TBI is:

an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child’s educational performance. Traumatic brain injury applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. Traumatic brain injury does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.

Approximately 0.04% of school-age students are categorized as having TBI. TBI is the leading cause of child disability (i.e., disability caused by an accident) and death in the United States. Boys experience TBI approximately 1.5 times more than girls (Arroyos-Jurado & Savage, 2008).

A TBI can affect the academic performance and behavior of the student. The student may experience deficits in intellectual functioning, and some students experience anxiety, anger, restlessness, and emotional outbursts. Some students may also experience physical difficulties, such as orthopedic impairments, because of their TBI. Students may also have physical scars or deformities related to their accident.

The severity of TBI can vary widely, and it depends upon the accident and the healing of the brain afterwards. Students with mild TBI, such as caused by a concussion, demonstrate no significant academic or behavioral deficits (Vu, Babikian, & Asarnow, 2011). Students with moderate TBI demonstrate some impairment of academic and behavioral skills, and students with severe TBI demonstrate significant deficits with academics and behavior (Walz, Yeates, Taylor, Stancin, & Wade, 2009). The brain function of many students with TBI may improve over time, but some individuals experience permanent damage that does not improve, even with therapy and instruction.

What Are the Characteristics of Students With TBI?

Students with TBI may have physical, academic, or behavioral difficulties. Because students with TBI have difficulty with academics, they may experience difficulties similar to students with SLD or ID. Students may experience behavioral and emotional difficulties similar to students with EBD. This section will cover a few common characteristics, but keep in mind that every student with TBI is different.

In terms of physical difficulties, students may experience slurred or delayed speech, visual impairments, and hearing impairments. Some may experience paralysis on one or both sides of their body, may appear clumsy, and may have difficulty with balance. Students might struggle with gross or fine motor skills, or seizures. After a long school day, they may experience fatigue. Some students may use a wheelchair, cane, or braces for mobility.

Students with TBI may experience difficulty in academics related to thinking and reasoning. They may appear distracted or have difficulty paying attention for long periods of time. Students may be slow to respond to teacher questions or class discussions. It may take students longer to complete assignments or tests. Their short- and long-term memory skills may be compromised. Students may have difficulty remembering steps to solving problems or organizing a written essay. They may have difficulty with vocabulary and learning of new information.

Students may have difficulty relating to peers in social situations (Levin, Hanten, & Li, 2009). Other behavioral difficulties may include mood swings, anxiety, and depression. Often after TBI, students have to come to accept their “new normal,” and many need to relearn things that they were able to do before their accident. Some students with TBI may appear restless and have difficulty controlling emotional outbursts.

What Are the Causes of TBI?

TBI is caused by an accident that contributes to brain injury. Falls, sports injuries, car accidents, and firearm accidents can cause TBI.

Falls can cause TBI. Children slip in the bathtub, or fall out of bed, down the stairs, over a balcony or ledge, or from a ladder. Sports injuries are also a fairly common culprit. Bicycling, boxing, diving, football, horseback riding, lacrosse, skateboarding, skiing, and soccer have all been known to lead to head injuries and TBI (Bullock, Gable, & Mohr, 2005). TBI can also be caused by car accidents or accidents involving other moving vehicles, such as personal watercraft or off-road vehicles. Firearm accidents or blasts (perhaps from fireworks) can also lead to TBI. Finally, physical abuse can lead to TBI. Shaken Baby Syndrome (SBS) occurs when an infant or toddler is shaken violently and bleeding and bruising occurs in the brain.

When the TBI is severe, children often are taken to emergency rooms or doctor’s offices for evaluation. Sometimes, however, the TBI may not be apparent until days or weeks after the initial injury (Bullock et al., 2005). Often, when there has been an accident, the student may be recovering from physical injuries and the TBI goes unnoticed as the student recuperates. Medical professionals may be so concerned about healing a student’s more obvious physical wounds that the brain injury is unintentionally ignored. In other cases, the brain actually goes into a state of over-working in reaction to the traumatic injury. When the brain is ready to resume its normal routine, that routine may not be as it was before.

How Are Students Diagnosed With TBI?

All cases of TBI are diagnosed by medical professionals. The doctor may image the brain via Computed Tomography (CT), Magnetic Resonance Imaging (MRI), or functional Magnetic Resonance Imaging (fMRI) to determine if an injury has occurred (Karunanayaka et al., 2007). A neurologist or neuropsychologist will conduct a neuropsychological assessment to better understand brain functions (Stavinoha, 2005). Part of the assessment includes an interview with the patient’s family to understand what the child was like before the injury. The assessment may include tests of a student’s attention, memory, concentration, orientation, language, mathematical reasoning, and spatial ability. The student’s performance is compared with that of students without TBI to better understand differences and deficits.

How Do I Teach Students With TBI?

Students with TBI may display characteristics of SLD, ED, or ID. Thus, some of the teaching strategies for these disability categories may be appropriate for students with TBI because the academic and behavioral difficulties may be similar.

The most difficult part for many students with TBI is adjusting to their “new normal” (Arroyos-Jurado & Savage, 2008). They probably were “typical” students before their accident; they now have different physical, academic, and behavioral needs. Some students with TBI may physically appear the same but have different behaviors and academic needs (Schutz & McNamara, 2011). Ensuring that the emotional well-being of the student is addressed is as important as addressing the educational needs of the student.

Teachers should use explicit instruction in academics (Arroyos-Jurado & Savage, 2008). To provide explicit instruction, teachers demonstrate and model concepts with the students and lead the students with guided practice activities. Task analysis will help them better understand which steps of assignments or tasks students can and cannot do. In a task analysis, teachers break down a skill or task into each individual step necessary to complete it. Students may also need help with self-regulation or self-monitoring. Teachers may teach students to use checklists to help monitor their progress as they work through an assignment or through the school day.

Teachers may also want to emphasize problem-solving skills, as some students become overwhelmed with assignments that have too many steps (Catroppa & Anderson, 2006). Many students will require the use of accommodations and modifications that were outlined in Chapter 2. Examples of accommodations that might be most appropriate for students with TBI include breaking large assignments into smaller ones, providing more time to complete assignments, or giving students various options for completing an assignment (Arroyos-Jurado & Savage, 2008).

Teachers should use behavior supports with motivational tools that are positive and meaningful to the students (McCauley et al., 2011). The staff of the school should work together to ensure that the student is expected to follow the same rules (and receive positive feedback on following rules) across classrooms and settings. Students may have to relearn basic social skills, so teachers need to provide opportunities for students to practice these skills. Teachers may also need to spend time educating the peers of a student with TBI. Many may be frightened or unsure of how to interact with a friend who seems “different” after an accident.

Often, the student and family will have experienced a traumatic event (e.g., a car accident) in conjunction with the student’s injury, so the school needs to be tactful in working with the student’s family (Gfroerer, Wade, & Wu, 2008; Wade et al., 2011). Schools should provide appropriate counseling services to the student (and the student’s school-age siblings) if necessary. In some cases, a student with TBI may have been involved in an accident in which another family member was severely injured or killed. Counseling services can be provided by a guidance counselor or school psychologist. Schools should also provide allowances for student absences, especially if the student’s parent or sibling was also injured. Some students may not return to school for weeks or months after their accident due to hospitalization and rehabilitation (Bullock et al., 2005). The school can prepare for the student’s reentry by developing the student’s IEP and putting in place proper services.

11.3 Students With Other Health Impairment

The IDEA 2004 category of other health impairment encompasses many disabilities not covered by the other 12 disability categories. OHI causes are as wide and varied as the disabilities that qualify under OHI. Teachers can use strategies learned in other chapters to help the academic and behavioral needs of students with OHI.

What Is Other Health Impairment?

Other health impairment (OHI) is a catch-all category for disorders, diseases, and conditions that do not fall under the other 12 IDEA 2004 disability categories and for disabilities that are very rare (Bishop, McLaughlin, & Derby, 2011). As discussed in Chapter 5, Attention Deficit/ Hyperactivity Disorder (

ADHD

) falls under OHI because ADHD is not a separate disability category at this time (Wodrich & Spencer, 2007). There are not many similarities among the disabilities that qualify as OHI.

The official definition of OHI under IDEA 2004 states:

OHI means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that (i) is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and

Tourette syndrome

; and (ii) adversely affects a child’s educational performance.

Approximately 1.07% of the student population is identified with OHI. Here are some common OHI conditions (DePaepe, Garrison-Kane, & Doelling, 2002; Wodrich & Spencer, 2007):

Table 11.1: Common OHI Conditions

Condition	Description
Allergies	Students have allergies (ranging from mild to life-threatening) that can make participating in some activities difficult or dangerous.
Asthma	Students have issues related to the respiratory system that can make participating in some activities difficult.
ADHD	Students experience inattentive or hyperactive-impulsive behavior.
Cancer	The treatment for cancer can cause students to miss school days, which may contribute to adverse educational outcomes.
Cystic fibrosis	Students with cystic fibrosis have a disease that causes lung infections. The lung infections can make participation in some activities difficult.
Diabetes	The bodies of students with diabetes have difficulty regulating insulin levels. At school, students may requireassistance with measuring blood glucose levels or administering insulin shots.
Epilepsy	Students with epilepsy may experience mild to severe seizures. Teachers and other staff may need to be trained torespond to a student experiencing a seizure.
Fetal Alcohol Syndrome Disorder(FASD)	When a mother drinks excessive amounts of alcohol during pregnancy, a baby may be born with birth defects. Thesebirth defects can contribute to academic and behavioral difficulties.
Hemophilia	The blood of a student with hemophelia does not clot as expected. If involved in an accident or fall, a student can require medical attention.
HIV/AIDS	The Human Immunodeficiency Virus (HIV)—and the later stage of Acquired Immunodeficiency Syndrome (AIDS)—cause students to have a weakened immune system. HIV is transmitted through blood. Schools must provide trainingfor all staff about the exposure to the blood of a student with HIV or AIDS.
Lead poisoning	Lead poisoning occurs when a student is exposed to dangerous levels of lead through lead paint or other lead-basedcontaminants. Students with lead poisoning may experience deficits in intellectual functioning.
Leukemia	The treatment for leukemia can cause students to miss school days, which may contribute to adverse educational outcomes.
Nephritis	Students may experience kidney or bladder infections related to nephritis, an infection of the kidney. Students mayrequire assistance with issues related to going to the bathroom.
Rheumatic fever	If students do not have a strep infection (e.g., infection in the throat) treated, the infection may lead to rheumaticfever. Students can experience joint pain or damage, and some students experience heart damage.
Sickle-cell anemia	Students with sickle-cell anemia have blood cells that contribute to a wide range of medical difficulties includingulcers, stroke, visual impairment, bone and joint difficulty, and loss of bladder control.
Tourette syndrome	A student with Tourette syndrome has tics (i.e., repetitive physical movements or voiced sounds/sayings) that occurspontaneously.

Not every student who has one of these conditions—for example, allergies or asthma—needs to be identified as having an OHI. It is only when these conditions are so severe that the child’s educational programming requires alteration that they are considered OHI. For some students with food allergies, for example, policies and emergency procedures need to be established so the student does not come in contact with the allergen and the school knows what to do if this happens (DePaepe et al., 2002). Section 504 plans are especially helpful in situations where the student needs school support or accommodations, yet the student does not qualify under IDEA 2004. Members of a 504 team can outline treatment, accommodations, modifications, or emergency treatment plans for students requiring school support.

You may have noticed that a few of the OHI conditions can be categorized under other disability categories (Adams, Smith, Bolt, & Nolten, 2007). For example, some schools may place epilepsy under an orthopedic impairment if the condition affects the student’s mobility and academic outcomes. If other students’ epilepsy adversely affects their academic outcomes, but not their mobility, those students may qualify for special education accommodations under OHI. Some schools may categorize a student with Tourette syndrome as having an ED when behavioral outcomes are affected, while others might categorize the disability under OHI if the ED definition is not appropriate. Categorization of disability category is determined by the school. The school often favors a specific category over the category of OHI, unless the student does not meet criteria in the specific disability category.

What Are the Causes of OHI?

Disabilities, disorders, and diseases that fall under OHI have any number of causes. Some causes might be related to genetics (e.g., cystic fibrosis, sickle-cell anemia), exposure to blood pathogens (e.g., HIV), infection (e.g., rheumatic fever), or complications during pregnancy (e.g., FASD). Many may not have an exact cause (e.g., leukemia, Tourette syndrome).

How Are Students Diagnosed With OHI?

Often, the conditions that qualify under OHI are diagnosed by medical professionals. Parents may refer their child for evaluation or a medical professional may suspect a disability, disorder, or disease. Students can be diagnosed at birth or at any point in their childhood, depending upon the condition.

How Do I Teach Students With OHI?

Because many of the conditions that cause students’ OHI are uncommon, teachers may need to consult medical professionals or other specialists to understand the student’s needs. The team writing the IEP of students with OHI should obtain as much information as possible from any medical professionals who have diagnosed or treated the student. Schools may involve physical therapists, occupational therapists, behavioral therapists, or speech-language pathologists as members of the IEP team, because these professionals will provide services to the student.

Physical therapists and teachers should aim for optimal physical mobility for the student. Teachers and occupational therapists should ensure that students have all the skills necessary to participate in the school day. Academic or behavioral accommodations may be required when students have difficulty with classroom content or with behavior during the school day. Many of the teachinge suggestions mentioned in Chapters 3 and 4 can be useful for students. Some students may need help with speech and communication, so the teaching suggestions from Chapter 7 would be appropriate. As with most of the disability categories, assistive technologies should be used when appropriate (e.g., a timer that beeps at intervals to increase the attention of a student with ADHD), and schools should keep abreast of new and emerging technologies.

Students with OHI may need medical or health assistance during the school day (DePaepe et al., 2002). For example, some students may wear diapers and need these changed during school or require cleaning of a catheter (Obringer & Coffey, 2010). General education teachers often do not help with such tasks, but teachers must be aware of the student’s needs. Other students may need to take medicine or have shots administered. Schools without full-time school nurses must determine which adult is responsible for helping the student attend to these needs.

11.4 Students With Multiple Disabilities

The category of multiple disabilities is reserved for students who experience two or more severe disabilities. Causes are related to the distinct disabilities of the student. Many students receive services in special education classrooms, but some students may participate in part of the general education curriculum.

What Is Multiple Disabilities?

The category of multiple disabilities is for students who have two or more disabilities that are significant enough that the student cannot be serviced appropriately under one disability category. A student might have an intellectual disability plus a visual or hearing impairment, or both. Other combinations might be orthopedic impairment plus intellectual disability, orthopedic impairment plus speech-language impairment, or autism spectrum disorder plus visual or hearing impairment (Cross, Traub, Hutter-Pishgahi, & Shelton, 2004; Snell, Chen, Allaire, &Park, 2008; Wodrich, Kaplan, & Deering, 2006). Students with multiple disabilities often have severe disabilities that significantly affect their lives.

According to IDEA 2004, “Multiple disabilities means concomitant (accompanying) 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. Multiple disabilities does not include deaf-blindness.” (You’ll remember from Chapter 10 that deaf-blindness is its own disability category.) Approximately 0.18% of the student population is identified as having multiple disabilities.

What Are the Characteristics of Students With Multiple Disabilities?

Students with multiple disabilities exhibit the characteristics of their two or more disabilities. For example, if a student has ID and a visual impairment, the student would experience the characteristics associated with ID and the characteristics associated with visual impairments.

What Are the Causes of Multiple Disabilities?

The causes related to multiple disabilities stem from the two (or more) disabilities of the student. For example, if a student has ID and a visual impairment, the causes related to ID would be those found with other students with ID. The causes for the visual impairment may be related to those of other students with a visual impairment.

How Are Students Diagnosed With Multiple Disabilities?

Typically, the diagnosis of individual disabilities occurs, and then the IEP team decides whether the student qualifies for special education services under the category of multiple disabilities. As explained in IDEA 2004, a student qualifies for the category multiple disabilities when the student’s needs for disability-related services or accommodations do not fit into only one disability category.

How Do I Teach Students With Multiple Disabilities?

The teaching strategies for the individual disabilities apply to students with multiple disabilities. See Chapters 3–11 for teaching suggestions by disability category.

References

Powell, S. R., & Driver, M. K. (2013). Working with exceptional students: An introduction to special education [Electronic version]. Retrieved from https://content.ashford.edu/

9.1 What Is Autism Spectrum Disorder?

Students with autism spectrum disorder (ASD) experience difficulty with communication, social skills, and repetitive behavior (Goldstein, Naglieri, Rzepa, & Williams, 2012). These students often struggle with changes to their routines or environment. They may have unusual sensory responses, such as sensitivity to loud noises, picky eating, or a dislike of getting dressed or grooming (Tomcheck & Dunn, 2007). Many students with ASD have difficulty making eye contact, recognizing faces, and understanding emotions (Kirchner, Hatri, Heekeren, & Dziobek, 2011). Over half of students with ASD exhibit average to above-average intelligence (Whitby, Travers, & Harnik, 2009).

ASD is another term for pervasive developmental disorder (PDD). A student with PDD exhibits delays in communication and social skills, and these delays are often first recognizable during the developmental period from ages 2 to 4. Several disorders have been included in ASD, including autistic disorder (i.e., autism), Asperger’s disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), Rett’s disorder, and childhood disintegrative disorder (CDD). The next section of this chapter describes these in detail; the recent changes to the names of the disorders and how they are categorized will also be outlined.

Students with ASD are often described as high-functioning or low-functioning. High-functioning students with ASD exhibit the hallmark characteristics of ASD, but these characteristics do not prohibit the student from participating in regular activities. Students are typically verbal, and their ASD is less severe than low-functioning students. Low-functioning students with ASD often have below-average intellectual functioning, and they exhibit severe difficulties due to ASD. Many low-functioning students may be nonverbal.

Defining ASD

The Diagnostic and Statistical Manual (DSM) defines disorders and disabilities to help professionals diagnose their patients. The fifth version, DSM-5, published in 2013 by the American Psychiatric Association, places the diagnostic labels of autistic disorder, Asperger’s disorder, PDD-NOS, and CDD under the umbrella term ASD. Individuals with ASD are categorized into levels—Level 1, Level 2, or Level 3—based on their challenges with communication, social skills, and repetitive behaviors. Because this categorization system is new and the old labels will still be used for a while, this discussion begins with a description of the older labels for these disorders so you can understand some of the differences between those and the newly described levels of ASD.

Figure 9.1 shows the categories under the previous edition of the DSM-IV, which you will probably encounter for several years to come. Note that in the past, Rett’s disorder was classified under ASD; however, it is now not mentioned in conjunction with ASD. In DSM-5, Rett’s is considered a separate disorder from ASD (although some students with Rett’s will still qualify for services if their behavioral characteristics indicate an autism diagnosis, as well).

Figure 9.1: ASD Under DSM-IV

Under the DSM-IV, five disorders fall under the umbrella category of ASD. The disorders are listed from the more severe (on the left) to the less severe (on the right). Many in the ASD community describe students with ASD on a spectrum like the one here, sometimes adding the descriptors “low-functioning” or “high-functioning.” The proposed three levels of the DSM-5 will describe low-functioning as “Level 3,” high-functioning as “Level 1,” and a middle range as “Level 2.”

Autistic disorder, also called autism, is a category that describes students who have severe difficulty with communication and social skills. Most individuals with autism avoid eye contact and have difficulty recognizing faces and reading emotions. They often have below-average intellectual skills, which may appear similar to an intellectual disability. Some students have limited or nonexistent verbal skills.

Students with autism may be preoccupied with one or two topics (Willis, 2012). They may also exhibit rituals or behavioral routines (e.g., placing toys in order) that border on compulsive. Most students with autism display repetitive, stereotypic behaviors, such as hand flapping or finger popping (Willis, 2012). Many have or will develop seizures during their lifetime.

Students with Asperger’s disorder typically have average to above-average intelligence. They exhibit typical characteristics of autism (i.e., lack of eye contact, not responding to the calling of their name) when they are toddlers and in preschool, but they gain social and communication skills as they age (Willis, 2012). Students with Asperger’s, however, still continue to exhibit some atypical communication and social skills throughout life. One of the hallmarks of Asperger’s is an exceptional or obsessive interest in one area. For example, a student may have an unusual fascination with trains or outer space. Students typically have difficulty with social skills, and they can be clumsy and uncoordinated. Many people describe Asperger’s as a high-functioning version of autism.

Pervasive developmental disorder not otherwise specified (PDD-NOS) falls between Asperger’s and autistic disorder in severity and is typically diagnosed later than either one. Students exhibit characteristics of autistic disorder (e.g., atypical communication and social skills), but they do not qualify as autistic because they do not exhibit repetitive behaviors as severe as students with autistic disorder (Willis, 2012). Because PDD-NOS is a gray area, professionals use this catch-all category to categorize students who do not qualify under Asperger’s disorder or autistic disorder (Chlebowski, Green, Barton, & Fein, 2010). Rett’s disorder is a very rare degenerative syndrome that affects girls exclusively (Willis, 2012). They usually exhibit typical development until 6–18 months of age. At that time, communication and social skills decrease, and the girls have problems with coordination. Many experience seizures. Therapy can help them recover some of their communication and motor skills.

Childhood disintegrative disorder (CDD), or Heller’s syndrome, is very uncommon (Willis, 2012). Like girls with Rett’s, children with CDD develop normally at first. When they are 2–4 years old, their communication and social skills decrease, as does intellectual functioning. Students become severely impaired, and therapy cannot help them recover. CDD develops more often in boys than in girls.

ASD and IDEA

Autism became an IDEA disability category with the reauthorization of IDEA in 1990. IDEA 2004 defines autism as a developmental disability in which a child has problems communicating, verbally and nonverbally, to a degree that affects academic performance. It states that these communicative and social difficulties usually arise before the age of 3 years, and are often accompanied by repetitive movements or behaviors, resistance to change, and atypical responses to sensory experiences. The IDEA definition specifically excludes those children whose performance in school is hindered primarily by an emotional disorder, though it does allow for an autism diagnosis to be made in children older than 3 years.

Thus, the IDEA 2004 definition uses the term autism to describe the full spectrum of autism disorders, which the DSM-IV and DSM-5 (and this chapter) refer to as ASD. It remains to be seen to what degree girls with Rett’s disorder will be eligible for IDEA 2004 services, and how their disability will be categorized, once the DSM-5 becomes the predominant diagnostic guideline.

Prevalence of ASD

Approximately 1% of school-age students are diagnosed with ASD; approximately 45% of those have autistic disorder, 45% have PDD-NOS, and 10% have Asperger’s disorder. CDD and Rett’s are extremely rare (Autism and Developmental Disabilities Monitoring Network, 2012). Boys are identified about five times more often than girls, but identification of ASD occurs equally in all racial and socioeconomic groups (Goldstein et al., 2012). Currently, about 1 in every 54 boys is diagnosed with ASD; for girls, it is 1 in 252 (Autism and Developmental Disabilities Monitoring Network, 2012).

The rate of students identified with ASD has increased over the last few decades (Kopetz & Endowed, 2012). One reason is that with the reauthorization of IDEA in 1990, autism gained its own disability category. Before then, many students with ASD were categorized as having an intellectual disability (ID). Medical and school professionals, as well as parents and guardians, are also more aware of ASD and may be better equipped to refer students for evaluation. Assessments have also been refined to better identify students with ASD.

9.2 How Has the ASD Field Evolved?

Paul Eugen Bleuler first coined the term autism in 1910, from the Greek word for “self,” to describe a disorder exhibited by his patients, who had been diagnosed with schizophrenia, who had atypical social and communication skills (Crespi, 2010). His patients with autism isolated themselves from others and had interests that bordered on obsessive. Bleuler himself felt he had many characteristics of his autistic patients.

Over the new few decades, other professionals used autism to describe the disorder of students with atypical social and communication skills. Hans Asperger, a doctor in Austria, wrote about his patients who had “autistic psychopathy.” These boys lacked feelings for others, had difficulty forming friendships, and exhibited intense interests in one topic area—characteristics of what is now called Asperger’s disorder. Dr. Asperger described these boys as “little professors” because they could talk forever and in great detail about their special topic area.

Another Austrian doctor, Leo Kanner, studied children who exhibited characteristics related to autism at Johns Hopkins Hospital in Baltimore, Maryland. He described children who wanted things in their lives to be consistent and unchanging and who had difficulty fitting in with other children. His 1943 Autistic Disturbances of Affective Contact laid the groundwork for the modern study of ASD. In this paper, Kanner described 11 students who demonstrated repetitive behaviors and atypical social skills. The condition that Kanner described was different from that of students with ID.

Autism was not recognized as a distinct condition until the middle of the 20th century, when researchers recognized autism was distinct from other disabilities. Until then, it was typically described as an intellectual disability or as schizophrenia. Largely because of the writings of Kanner and psychologist Bruno Bettelheim, autism was blamed on parents—especially mothers—who were distant and cold. That idea, which has been proven incorrect, persisted through the 1960s and 1970s in the public view about autism.

Students with autism have undergone some controversial techniques to “fix” their autism over the years. In the 1960s and 1970s, some professionals used shock treatments or LSD to try to alter behavior. During the 1980s and 1990s, applied behavioral analysis became the standard method for treating and working with students with autism. Section 9.7 of this chapter discusses this behavior therapy.

As researchers gained understanding of how autism manifested differently from child to child, the “spectrum” of autism was developed in the 1990s to describe students with a range of difficulties in communication, social skills, and repetitive behaviors—what is now called ASD.

9.3 What Are the Characteristics of Students With ASD?

No two students with ASD exhibit the exact same characteristics. In addition to the hallmark symptoms that determine their diagnosis, students may also exhibit characteristics related to academic skill in the classroom, physical appearance, or actions. And as with almost all disabilities, students with ASD may experience comorbid disabilities that cause additional issues.

Hallmark Characteristics

Although the characteristics of ASD vary from individual to individual, there are three hallmarks—necessary characteristics—of ASD: (1) difficulties with communication, (2) difficulties with social skills, and (3) repetitive or obsessive behaviors. Many of these characteristics appear at a very early age. For example, parents may say that their babies avoided eye contact or focused on one object for an extraordinary amount of time. Keep in mind that no child exhibits every one of the following characteristics, however (Arora, 2012; Kirchner et al., 2011; Moruzzi, Ogliari, Ronald, Happé, & Battaglia, 2011).

Difficulties With Communication

Students with ASD must exhibit some characteristics related to communication, as outlined in Table 9.1. Often, students understand what they want to communicate, but the means of communication are atypical. Many of the communication difficulties are typical for young children learning to speak and communicate, but when these difficulties persist past 3–4 years of age, parents or teachers may want to refer the student for a formal evaluation.

Table 9.1 Difficulties with Communication
		Behavior	Example
Makes verbal sounds when listening.	“um”
Misuses Pronouns.	“me like dogs” instead of “I like dogs”
Repeats words or phrases.	“Red balloon! Red balloon! Red balloon!”
Speaks in short sentences.	“Want pizza.”
Speaks with unusual pitch or rhythm to voice.	Speaks in a robot voice.
Struggles to whisper.	Speaks loudly into someone’s ear.
Struggles with understanding directional items.	Mistakes “top” for “bottom.”
Talks too loudly or quietly.	Uses normal voice when in movie theatre.
Uses a person’s name excessively.	“Ms. Ellis, I need a pencil. Ms. Ellis. Ms. Ellis.”

Difficulties With Social Skills

Students must also demonstrate difficulty with social skills to be diagnosed with ASD. Many of the characteristics related to social skills as highlighted in Table 9.2 cause the student to appear aloof or immature for their age, while some (e.g., intense interest in one topic) make the student appear well.

Behavior

Example

Table 9.2: Social Skills Characteristics
Avoids answering questions about themselves.	Parent: “Rob, do you like your new shirt?” Student: “When do we get to play outside?”
Blurts out.	“I want that!”
Cannot understand the feelings of others/lacks empathy.	Hits girl and doesn’t understand why she is crying.
Displays a lack of personal space.	Gets very close to person’s face when talking.
Does not start social interaction.	Plays alone, without engaging other students.
Failure to respond when name is called.	Parent: “Maya, will you come brush your teeth? Maya? Maya?” Student: Does not look in the parent’s direction.
Maintains little or no eye contact.	Looks down or around when talking to someone.
Makes honest observations that are inappropriate.	“Your hair looks messy.” “You smell.”
Resistance to holding or touching.	Does not like hugs.
Struggles with interpreting facial expressions.	Does not understand that a frown means unhappy.
Struggles with understanding jokes or sarcasm.	“This story will have you rolling on the floor with laughter!”
Talks a lot about one topic.	“Tornadoes are dangerous and can kill people. I just read a bookabout tornadoes. There was an EF-4 in Oklahoma last spring.Have you seen a tornado before?”
Trusts others too much.	Interacts with strangers when inappropriate.
Sources: DeMatteo, Arter, Sworen-Parise, Faseiana, & Paulhamus, 2012; Lyons; Cappadocia, Weiss, 2011.

Repetitive or Stereotypic Behaviors

Students with ASD must also exhibit some characteristics related to repetitive or stereotypic behaviors (Table 9.3). Stereotypic behaviors are those behaviors that are repetitive and interfere with normal activity (Cunningham & Schreibman, 2008; Ghanizadeh, 2010; Goldman et al., 2008; Lanovaz & Sladeczek, 2012). Students may constantly rock back and forth or repeat a word or phrase. Some behaviors are harmless, but others can be dangerous to the student. A few of these characteristics may be similar to characteristics of ID (e.g., difficulty with motor skills) or EBD (e.g., obsessive behavior), but the characteristics may be due to ASD when the student also has difficulty with communication and social skills.

Table 9.3: Repetitive or Stereotypic Behaviors

Behavior

Example

Clumsy.	Trips. Walks into things.
Collects things.	Picks up every orange leaf on the playground and at the park.
Difficulty with gross- and fine-motor skills.	Struggles to catch ball. Has hard time gripping pencil.
Forms strange attachments to things.	“I can’t go to school without my rabbit foot!”
Has a ritual or compulsive behavior (stereotypy).	Opens and closes mouth. Licks. Hums. Flaps arms. Rocks back and forth. Sucks. Rubs. Sniffs. Twirls. Jumps.
Covers ears. Arches back.	Injures self. Bites arm. Cuts skin. Bangs head against wall.
Quotes movies, games, or books.	“You shall not pass! You shall not pass!”
Participates in repetitive play.	Rolls a car around on the floor hundreds of times.
Sources: Cunningham & Schreibman, 2008; Ghanizadeh, 2010; Goldman et al., 2008; Lanovaz & Sladeczek, 2012.

Academic Characteristics

Some students with ASD perform well in academic subjects, whereas others struggle in school (Oliveras-Rentas, Kenworthy, Roberson, Martin, & Wallace, 2012). Typically, students with high-functioning ASD perform better with academic tasks than students with low-functioning ASD, but almost all students with ASD require accommodations or modifications in the classroom (Estes, Rivera, Bryan, Cali, & Dawson, 2011).

Researchers believe students with ASD may experience difficulty because they have weak theory of mind, weak central coherence, or impaired executive function (Constable, Grossi, Moniz, & Ryan, 2013; Harris et al., 2008). Students who have weak theory of mind have difficulty understanding the feelings and thoughts of others. When central coherence is weak, students process information in small pieces instead of understanding the bigger picture. If students have impaired executive functioning, then planning and paying attention, as well as accessing information from working memory, may be difficult. All three of these types of difficulties may contribute to obstacles with learning in the classroom.

Some students demonstrate exceptional ability in music or art, and others need help with fine-motor skills, such as coloring a picture and cutting with scissors (Vital, Ronald, Wallace, & Happe, 2009). Some students with ASD demonstrate exceptional skill with remembering dates or being able to compute large numbers (Iavarone, Patruno, Galeone, Chieffi, & Carlomagno, 2007). This exceptional talent, however, is very rare in students with ASD, even though this skill has been highlighted in popular media.

Most students with ASD have trouble dealing with changes in the school routine. For example, if a student knows that Wednesday is the day for physical education and suddenly the class is attending an assembly instead, the student may struggle with the change by refusing to participate or throwing a tantrum. Similarly, students with ASD tend to have difficulty with transitions from one activity or class to another.

Physical Characteristics

Many students with ASD exhibit atypical physical movement. They may have unusual posture, walk on their toes, or experience clumsiness. They may not swing their arms normally when walking; they may often walk or run into stationary objects or other people.

Students with ASD often have bowel and bladder difficulties. They may have abnormal amounts of burping and passing gas, and they may also have food allergies or sensitivities. In addition, they may have difficulty sleeping.

Comorbidity With Other Disabilities

Students with ASD may also have other conditions, such as Fragile X syndrome, ID, ADHD, bipolar disorder, OCD, or Tourette syndrome (Grzadzinski et al., 2011; Leyfer et al., 2006). They may have seizures; approximately 30% of students with ASD develop epilepsy by adulthood. Students may have visual impairments as well.

9.4 What Are the Causes of ASD?

There is no one cause for ASD. Researchers believe heredity and environmental factors contribute (Dietert, Dietert, & Dewitt, 2011), but many risk factors remain unidentified.

The Role of Heredity

Researchers have discovered specific genes associated with ASD (Walsh, Elsabbagh, Bolton, & Singh, 2011). No one gene can be said to cause ASD, but there are studies that support the role of heredity. In sets of identical twins, up to 90% of twins both struggle with ASD if one twin does (Rutter, 2011). If a non-twin sibling has ASD, there is a 5–7% chance that another sibling will have ASD (Dodds et al., 2011).

The Role of the Brain

Students with ASD also demonstrate characteristic brain differences compared to students without ASD (Gotts et al., 2012; Mak-Fan, Taylor, Roberts, & Lerch, 2012). Often, students with ASD have larger heads and larger brains than average (Zielinski et al., 2012), and their brains are different in other ways, as well. For example, Jou et al. (2011) determined that students with ASD may have neural passages that do not connect in a typical manner. McAlonan et al., (2008) demonstrated that students with ASD have atypical grey matter areas compared to students without ASD. Grey matter is the area in the brain where neurons that control information are located. The thickness of the brain’s cortex also differs, with students with ASD having a thicker cortex than students without ASD (Frazier, Keshavan, Minshew, & Hardan, 2012).

The Role of the Environment

A wide variety of environmental factors have been suggested as possible causes of ASD, but none of them has been verified (Dodds et al., 2011). A mother’s infection or complications before or during birth may contribute to ASD. Some medications taken by pregnant women may also contribute. Siblings who are born less than a year apart have a greater chance of having ASD. Some researchers have pointed out that both mothers and fathers who have children at a later age tend to have more children with ASD (Eriksson, Westerlund, Anderlid, Gillberg, & Fernell, 2012).

Mothers who take prenatal vitamins, specifically vitamins with folic acid, before getting pregnant have a lower chance of having a child with ASD (Surén et al., 2013). In addition, students with ASD typically show different vitamin levels (especially vitamin D) than students without ASD (Adams et al., 2011), and the severity of ASD is related to these vitamin levels in the body (Mostafa & Al-Ayadhi, 2012). Other environmental factors may include exposure to pesticides, other chemicals, and some plastics (Shelton, Hertz-Picciotto, & Pessah, 2012).

Over the last decade or so, various other environmental causes of ASD, including diets and vaccinations, have garnered extensive media attention. Some parents believe food allergies to gluten or casein trigger or enhance some of the behaviors associated with ASD. Thus, they may put their children on gluten-free and/or casein-free diets. (Gluten is found in wheat and barley products, and casein is found in dairy products.) While parents may claim that they see improvement when their children are on these diets, research has not determined whether the diets are effective (Mulloy et al., 2010).

Many parents of children with ASD believe that their children were developing normally until they received vaccinations at about 2 years of age. The argument that vaccines, specifically the measles-mumps-rubella (MMR) vaccine, were a cause of ASD gained international attention in 1998 when Dr. Andrew Wakefield and colleagues published a paper claiming a link between the MMR vaccine and ASD (Wakefield et al., 1998). This paper has now been discredited because of Wakefield’s falsification of study results. Parents tried to use the court system to sue vaccine makers for causing ASD, but no lawsuits were successful (Keelan & Wilson, 2011; Kirkland, 2012). By 2001, vaccine makers had removed thimerosal, a preservative containing mercury, from all vaccines, but thimerosal has never been proven as a cause for ASD either (Miller & Reynolds, 2009). Research has shown no direct link between vaccinations and ASD (DeStefano, Bhasin, Thompson, Yeargin-Allsopp, & Boyle, 2004; Hornig et al., 2008; Price et al., 2010).

9.5 How Are Students Diagnosed With ASD?

The diagnosis of ASD is typically made when a child is between 2 and 4 years of age, before beginning school (Chlebowski, Green, Barton, & Fein, 2010). Often parents notice unusual behaviors or developmental patterns in their child and talk to their medical doctor. Physicians, psychiatrists, or other trained medical personnel make the diagnosis for ASD, but schools will evaluate students to determine whether they qualify for services under IDEA 2004.

Some early indicators of ASD are listed in Table 9.4.

Table 9.4: Early Indicators of ASD

Early Indicators of ASD (ages 1–3)	Later Indicators of ASD (ages 4–8)
No babbling or pointing by age 1.	Inability to make friends.
No single words by 16 months.	Impaired ability to start or sustain a conversation.
No two-word phrases by age 2.	Absence of, or impairment in, play.
No response to name.	Stereotyped or repetitive use of language.
Loss of language or social skills.	Restricted patterns of interest.
Poor eye contact.	Preoccupation with certain objects or subjects.
Excessive lining up of toys or objects.	Inflexibility with routines and rituals.
No smiling.
Source: National Institute of Neurological Disorders and Stroke, 2009.

If parents, caregivers, or teachers notice some of these characteristics on a consistent basis, the student should be referred for an initial evaluation to a professional, such as a pediatrician or family physician. Many places also have clinics specializing in the identification and treatment of students with ASD. Parents may be referred to these clinics for evaluation.

It is important to note that a medical diagnosis of ASD may differ from a school diagnosis of ASD. Although uncommon, it is possible for a school to not recognize a student as ASD if the student does not fulfill the criteria for autism under IDEA 2004 guidelines. If a student’s educational performance is not affected by ASD, then a school may not be able to diagnose the student as such.

A survey or screening instrument is used to evaluate the child (Bölte et al., 2011; Chlebowski et al., 2010; Flose, Plotts, Kozeneski, & Skinner-Foster, 2011; Mayes et al., 2009). Some examples of instruments include:

Ages and Stages Questionnaire (ASQ)

Childhood Autism Rating Scale (CARS)

Autism Diagnostic Observation Schedule (ADOS)

Communication and Symbolic Behavior Scales (CSBS) (shown in Figure 9.2)

Gilliam Autism Rating Scale (GARS)

Parents’ Evaluation of Developmental Status (PEDS)

Modified Checklist for Autism in Toddlers (MCHAT)

Social and Communication Disorders Checklist (SCDC)

Social Responsiveness Scale (SRS)

Screening Tool for Autism in Toddlers and Young Children (STAT)

A comprehensive evaluation should include information from parents, teachers (if possible), and a medical professional (Bölte et al., 2011). Others who might help with the evaluation include a psychiatrist, psychologist, speech therapist, occupational therapist, ASD specialist, or neurologist.

Figure 9.2: ASD Checklist

The Communication and Symbolic Behavior Scales (CSBS) checklist is used to assess communication skills and social skills of young students (ages 2–4) who are suspected of having ASD. If the parent answers “not yet” to many of the questions, the child should undergo a formal evaluation for ASD.

9.6 How Does ASD Differ Across Grade Levels?

When students with ASD receive early and intensive intervention, outcomes are greatly improved. To keep up the positive gains, schools should work on developing programs and appropriate teacher training at all levels for students with ASD. In this section, you will learn how students with ASD receive services throughout early childhood, elementary, and secondary school settings.

Early Childhood

Once an ASD diagnosis is made, it is important that a plan be put in place so the student can receive important services. This will be an Individualized Family Service Plan (IFSP) if the child is younger than 3 years and covered under Part C of IDEA 2004. If the student has turned 3 (and is not yet 22 years old), an Individualized Education Plan (IEP) is created under Part B. Because students with ASD struggle with communication and language, early special education services and academic/social interventions should be employed to help improve these skills as soon as possible.

Early childhood services focus heavily on developmental skills, such as language and social interactions. Students may receive services either from certified behavior analysts or speech therapists, or from general school-ready providers, such as Head Start. Involving families and parents in interventions improves outcomes for the students (Wong & Kwan, 2010). Sometimes early intervention takes place in a school setting. Families who do not live in an area with a school option, however, may have to take their children to clinics or hospitals to meet with speech therapists or ASD specialists.

Preschool and early intervention programs focus on teaching communication and social skills. Teachers provide a good deal of instruction and practice on relating to, and working with, other students and adults. Teachers also work with young students to help them understand what schedules are and how to follow them. Classrooms should be structured and organized, and students with ASD should learn to work within the classroom schedule.

Working on basic academic skills, such as writing letters and learning numbers, should be a goal of preschool programs if it is appropriate for the student. Behavior therapy led by certified behavior analysts might also be appropriate for young students with ASD (see the feature box in Section 9.7 for a discussion of this type of therapy). Above all, teachers should create an inviting classroom environment where the student feels like a classroom member.

As will be discussed later in the chapter, technology can help young students with ASD communicate. Some students with ASD do not talk, but they can share their wants and needs with technology that “speaks” for them. In one computer application, the student can press a picture and the computer voices the desire. For example, when students need a drink of water, they can press a picture of a water fountain to let the teacher know their need. Such communication can make meltdowns or tantrums less frequent. Students, teachers, and parents need to receive appropriate training with these, as with all, technologies.

Elementary School

Many of the preschool skills (i.e., taking turns, asking for help, talking to peers) taught to students with ASD should continue into elementary school. When schools know that a student with ASD is starting kindergarten, they should ensure that school staff and parents work together to develop an IEP for the student before the school year begins to ensure that the student receives appropriate services from the start of formal schooling.

Many of the accommodations and modifications listed in Chapter 2 are common for students with ASD. Districts should ensure that teachers and others who work with students with ASD receive proper training on teaching academics and behavior to students with ASD. If a student has not attended school before kindergarten, teachers will have to work more on social skills, especially skills in relating to other students and adults. In fact, schools may evaluate all students in terms of behavior and social skills to develop the best individualized program for each student.

A good elementary classroom for students with ASD is organized and structured. Depending on the students’ IEPs and school settings, students with ASD may receive instruction in a self-contained special education classroom, the general education classroom, or a combination of both. Regardless of setting, teachers should create a meaningful curriculum for the entire class and tailor activities for students with ASD.

Teachers must develop cohesive behavior management plans for the classroom. Many teachers consult with behavior specialists or special education teachers to work on eliminating or reducing problem behaviors in the classroom. An important part of any behavior plan involves communication. Young students with ASD need to have a system of communication with their teachers, so that they can express themselves and understand teacher instructions at all times—including when they are upset. Picture cards and sign language are two good communication options, as are technologies like a DynaVox or an iPad. These tools can also be helpful in teaching academics and social skills, in addition to behavior.

Secondary School

Secondary school students with ASD often spend much of their time in a general education classroom, as other placement options may not exist. Explicit instruction in academic and social skills, as mentioned in the elementary section, is appropriate for secondary students. Specific teaching strategies are covered in Section 9.7. Many secondary students have difficulty making and maintaining friendships, so working on communication between peers can benefit students with ASD.

For secondary students, it is vital that the IEP team and the student begin to think about transition and post-secondary options (Schall & McDonough, 2010).

Transition

Some students with ASD plan to go to college or into the workplace after secondary school. Others may move to a community/group home for individuals with disabilities or live with relatives who can provide necessary care. Regardless of the post-secondary choice, transition plans need to be in place by age 15. Continued work on social skills will help students develop appropriate competencies in college or the work environment (DeMatteo et al., 2012). Social skills instruction and practice should occur in the projected setting whenever possible (i.e., on the college campus, at a workplace). For example, students with ASD may need help in learning how to live with roommates or how to call a supervisor if they are too sick to report to work.

9.7 How Do I Teach Students With ASD?

Based on the severity of their disability, students with ASD spend varying amounts of time in the general classroom (Figure 9.3). Approximately half of students with Asperger’s disorder spend their entire school day in the general classroom. They may have appropriate accommodations (e.g., use of picture schedule, breaking activities and assignments into smaller chunks) and modifications (e.g., allowing student to write an essay about their favorite topic instead of an assigned topic), but their school day is spent with peers without disabilities. A small percentage of students with Asperger’s spend their entire school day in a self-contained setting. About one-quarter of students with PDD-NOS and only 15% of students with autism spend their entire school day in the general classroom.

One of the major reasons the DSM-5 renames the ASD categories is to describe student needs in terms of levels (i.e., Level 1, Level 2, and Level 3) that can help teachers and schools provide appropriate placements for students. Schools are not using this level system yet, but they may be switching over in the next few years. Level 1 students with ASD require support but will likely spend most of the school day in the general classroom. Level 2 students need substantial support, and these students may spend some time in the general classroom. Level 3 students require extensive support, which means these students will likely spend most of their time in specialized classrooms or schools. As with all disability decisions, the IEP team will make placement decisions based on the individual student’s needs and not based on a disability category or level number.

Figure 9.3: Placement Decisions for Students With ASD

Students with high-functioning ASD are more likely to be placed in the general classroom than students with more severe ASD. High-functioning students possess better communication skills and social skills that enable these students to participate in activities alongside peers without ASD.

According to LRE policy, students with ASD should receive the majority of their academic and behavioral instruction in naturalistic settings as close to the general classroom setting as possible (Wolery & Hemmeter, 2011). In fact, most of the court cases involving schools, students, and families with ASD, as well as disagreements about IDEA, have involved disagreements about the placements of students (Hill, Martin, & Nelson-Head, 2011).

Some school districts have developed separate ASD classrooms or schools that specialize in helping those students. These specialized programs, however, may not be inclusive because only students with ASD attend (Marks, 2007). In addition, the programs are less common for older than younger children (Figure 9.4). Many schools do not have the resources to best provide services to students with ASD, and many families and students experience challenges in accessing appropriate educational and behavioral services (Tincani, 2007). This is especially the case in more rural areas of the United States (Murphy & Ruble, 2012).

Figure 9.4: Inclusion of Students With ASD at Various Grade Levels

Students with ASD spend differing amounts of time in various settings based on grade level. Many schools have put preschool programs in place for young students with ASD. It is less likely that elementary and secondary schools have ASD programs, so students spend more time in the general classroom at those grade levels.

All students with ASD should have highly qualified teachers who use evidence-based practices (Lerman, Vorndan, Addison, & Kuhn, 2004).

Many of the teaching suggestions presented in previous chapters may benefit students with ASD. For students with high-functioning ASD, many of the strategies for students with SLD may prove helpful (Donaldson & Zager, 2010). For students with more severe ASD, teachers may want to adopt the teaching strategies for students with ID and EBD. Educators need to individualize instruction for all students with ASD, as for any disability, and detailed plans about instruction and the learning environment need to be written into the student’s IFSP or IEP (Guldberg, 2010).

The following discussion covers both general teaching strategies for students with ASD and strategies for teaching academics and behavior in particular.

General Teaching Strategies

Teachers need to carefully choose the language and vocabulary they use in talking to students with ASD. They should communicate directions and expectations in language that is simple, unambiguous, and easy to understand, and avoid sarcasm, metaphors, and idioms, as these kinds of indirect expressions can confuse students with ASD. For example, the command “Zip your lips! Pretzel time!” is often used to get students to close their mouths, not talk, and sit cross-legged on the floor. Such word choice can be confusing to students with ASD, who often take the meanings of words literally. A teacher would be much better off saying, “Time to listen. No talking. Sit with your legs crossed.”

As much as possible, the teacher should tightly organize and structure the classroom environment and schedule, which benefits not only students with ASD, but all students. Written or visual prompts (Figure 9.5) and reminders are important to help students understand the steps required to complete an assignment or the daily schedule of activities (Cuhadar & Diken, 2011). The teacher should try to provide as much warning as possible about an upcoming schedule change. For example, most schools participate in fire drills periodically. Teachers usually know when these drills are going to take place and can prepare students for the interruption.

Figure 9.5: Clean Desk Reminder

Students with ASD may benefit from visual representations of concepts—in this case, a picture of a clean desk and workspace accompanied by written reminders help students understand the expectations for an organized desk. Some students with ASD would do fine with the written reminders, while others need the ideas presented with pictures.

Many students—especially students with ASD—have problems with the concept of time. A teacher’s request to “finish up your work in the next2 minutes” can be confusing because a student may not understand whether 2 minutes is about the length of a snap, a commercial, or a movie.Setting a timer and placing it where the student can track the amount of time left before the teacher moves on to the next activity can help prepare the student and help with the transition to the next activity.

Teachers should verify that students with ASD understand directions and assignments. Instead of asking, “Do you understand?” teachers shouldask a student to repeat directions back to them to make sure the student understands.

When students are working in the classroom, the teacher should frequently monitor student progress and provide appropriate feedback. Many students need help understanding what it means to finish or complete an activity or assignment. For example, students may wonder what a “finished” art project looks like: Is it only creating a dragon or does the background of the paper need to be colored in, too? Teachers can provide a picture of a finished project or a cleaned workspace so the student can use the picture for comparison.

Teachers often allow students to make choices about what they will read or how they will go about completing an assignment. For students with ASD, it is often best to whittle down choices to one or two viable options. For example, instead of asking a student to pick a book from the reading corner, the teacher could provide the student with two books and ask them to choose one.

Choices for students with ASD may also extend to nonparticipation in activities. Within reason, teachers should decide when it is appropriate for a student to opt out of a certain activity. For example, a student with ASD may not enjoy playing a game in physical education that involves throwing balls. The teacher may create an alternative activity for that student.

Music can help students understand mathematical concepts (such as fractions) and learn letters and states (e.g., “The ABC Song” and “The State Song”). For example, students can learn concepts of numerator and denominator by clapping to the first beat (out of 4) to demonstrate 1/4. Music can also improve the communication and speech skills of students with ASD by helping students become more comfortable with talking/singing with others (Reschke-Hernández, 2011). Students who have difficulty with speaking may find music an easier outlet for communicating ideas.

Teaching Academics

Many strategies can help students with ASD excel in the classroom. Often, activities need to be broken into smaller, more manageable steps for learning and practicing.

Technology

can be used to teach students new skills, and one use of it, video modeling, shows great potential in helping students with ASD.

Task Analysis

Breaking down tasks into steps, or task analysis, was discussed in Chapter 8 in the context of teaching students with ID. This strategy is useful in teaching both behaviors and academic tasks to students with ASD. A task analysis can be used to teach students how to add suffixes to words, how to water a plant, how to prepare their materials for the school day, or how to walk to the lunchroom.

After completing a task analysis by writing out the task step by step, the teacher needs to explicitly teach the student how to follow the steps to complete a task. For students with ASD, teachers may want to break a project into smaller chunks (e.g., complete the first three steps on Monday and the last three steps on Tuesday) to ensure that the student achieves success with the project. Teachers may provide students with a written or pictorial list of steps when appropriate.

Technology

Technology can greatly enhance the classroom experience and participation of students with ASD. If they have difficulty with handwriting because they have problems with fine motor skills, the use of computers or voice-activation software can help them with written responses. Students with ASD who are nonverbal or have limited verbal communication can use Augmentative and alternative communication (AAC) that provide answer choices or help students put together sentences using pictures.

Using Interest Areas

Many students with ASD have an exceptional interest in one or two topic areas. The teacher can use this characteristic to advantage in teaching. For example, the teacher might present choices related to a student’s area of interest for activities like writing a persuasive essay or reading a book. A student who is fascinated by trains might write an essay about establishing a train museum or read a book about train engines. The teacher could include a few problems about train cargo when that student is solving multiplication word problems.

While it is important that students with ASD not focus all of their time learning about their primary area of interest in school, teachers can play into these interest areas to engage these individuals and make academic work meaningful.

Teaching Reading

Many students with ASD struggle with the reading skills of decoding (i.e., understanding the connections between letter sounds and words), vocabulary, and comprehension (i.e., understanding the meaning of text) (Huemer & Mann, 2010; Saunders, Page, & Wood, 2011). Explicit instruction is the key to helping students improve reading skills (Chiang & Lin, 2007; Ganz & Flores, 2009). To provide explicit instruction, teachers model and provide many opportunities for practicing a skill. It is also important to use different types of media (e.g., computers, books, songs) to help students understand the connections between letters, sounds, words, and text.

Students should be taught sight words as well (Spector, 2011). Sight words are words that appear frequently within text that students should know without decoding (e.g., the, because, always, and). To improve comprehension, teachers can use graphic organizers and instruction about the structure of text and stories. Teachers can show students how to find important information within the text and how to reread for understanding (Randi, Newman, & Grigorenko, 2010). For example, teachers may teach students how to identify the topic sentence in a paragraph and how to answer who, what, when, and where questions as the student reads or rereads.

Computer programs can help improve speed of letter and sight-word recognition (Coleman-Martin, Heller, Cihak, & Irvine, 2005; Travers et al., 2011) and help with understanding of vocabulary (Moore & Calvert, 2000). One computer program to improve vocabulary is called an E-word wall (Narkon, Wells, & Segal, 2011). Using this program, students can read and hear a word, see a picture, and then read and hear a sentence using the vocabulary word that relates to the picture (Figure 9.6). The multiple ways of hearing and seeing the word help students with ASD ascribe meaning to the vocabulary and text.

Figure 9.6: E-word Wall

In an e-word wall program, students learn words beginning with the letter C. Students can listen to the word, see a picture of the word, and see and hear the word used within a sentence. All these examples help provide concrete examples of the word and its meaning.

Explicit instruction in higher-order skills of reading comprehension is also effective. For example, the teacher can break down the steps for how to sequence a story, providing sentence starters for students to use when retelling—”in the beginning,” “then,” “at the end,”—and explaining how to use them. Then the teacher models the steps to read and retell a story the students find interesting. Throughout the story, the teacher gradually asks students for more input on the beginning, middle, and end, so that students will be ready to practice this skill on their own. The teacher provides appropriate and immediate feedback as students respond, and provides opportunities for students to practice the skill with gradually increasing independence.

Teaching Writing

Many students with ASD have difficulty with handwriting because they have problems with coordination. Additionally, some students have sensory difficulties that make the student resistant to touching or gripping objects like a pencil. Teachers can practice writing words, such as a student’s name, with the teacher’s hand guiding the student’s hand. Teachers can also prepare tracing activities for students to practice writing letters and words (as shown in Figure 9.7).

Figure 9.7: Tracing Letters

A student can practice writing letters by tracing the dots. Often, it is best to have students work on tracing one or two letters instead of the entire alphabet.

For some students, teachers may not want to push handwriting with a traditional writing instrument. Instead, teachers can be creative and offer students writing instruction in a variety of mediums. Teachers may let students paint on an easel, use chalk on the sidewalk or chalkboard, or write with fat or skinny markers. Teachers may let students roll play dough into letters, write letters with shaving cream or pudding, or pick out magnetic letters.

To improve higher order writing skills, such as writing a sentence or a paragraph, teachers should also use explicit instruction. To do this, teachers can demonstrate how to write a sentence with a subject and verb that agree or model learn how to write a paragraph with a topic sentence, three supporting sentences, and a concluding sentence. Self-regulation, which was discussed in Chapter 3, is a good strategy to use with students with ASD (and most other students). To self-regulate, students learn a strategy for writing, and they also learn how to monitor their progress when working through the strategy. Students with ASD can also practice writing by using computer programs. One such program provides key words that students are to use to write their sentences or paragraphs (Pennington, Stenhoff, Gibson, & Ballou, 2012).

Teaching Mathematics

Teachers should use explicit instruction to teach important mathematics concepts and procedures (Donaldson & Zager, 2010). Teachers can provide multiple demonstrations for solving a mathematics problem, give the student multiple opportunities to practice with the teacher, and then allow the student to practice problems independently with teacher support. Using the concrete-representational-abstract (CRA) sequence can help students with ASD see the connections between concepts and procedures (Donaldson & Zager, 2010). At the concrete stage, students use manipulatives, such as Base-10 blocks, fraction tiles, or bear counters, to practice mathematical concepts (Cihak & Foust, 2008). At the representational stage, students solve problems with pictures of manipulatives or objects drawn on their paper. At the abstract stage, students solve a problem with numbers and symbols. The following is an example of CRA in action:

C: Student starts with 3 red bears. Student adds 4 blue bears. Student counts all bears: “1, 2, 3, 4, 5, 6, 7. 7 bears. 3 plus 4 equals 7.”

R: Student works on a worksheet with 3 bear pictures on one side of the paper and 4 bear pictures on the other side. Student is able to touch and count each bear: “1, 2, 3, 4, 5, 6, 7. 7 bears. 3 plus 4 equals 7.”

A: Student solves an equation written on paper: “3 + 4 = __.”

Music can be used to help students remember number sequences or answers to basic facts. For example, students can learn a song to help them remember how to count from 1 to 20. Songs make remembering numbers and facts easier, just as the alphabet song does for letters. Mnemonics can help students remember how to regroup a multi-digit addition problem or how to divide fractions. For example, when dividing fractions, students learn to “copy, change, change”: copy the first fraction, change the sign from division to multiplication, change the original fraction to its inverse. Some teachers teach students to use numbers with dots that represent their amounts. (See TouchMath in Chapter 8.) By using the dots on each number, students can quickly add and subtract (Cihak & Foust, 2008).

Teaching Behavioral Skills

Many of the hallmark characteristics of ASD contribute to behavioral problems in the classroom. To address these, teachers can create lessons on relating to peers that are designed for all students in a class, including those with ASD; use video modeling to teach adaptive behavior; train all students, including those with ASD, to pair up for effective peer tutoring; or use computer-assisted instruction programs to help students learn to recognize faces and emotional cues that they do not usually notice, which can ease social strain and improve behavior. General and special education classrooms can also incorporate the assistance of applied behavior analysis specialists or occupational therapists to facilitate behavioral change and to avoid situations that trigger problem behaviors.

Relating to Peers and Others

Many students with ASD have difficulty relating to peers; they have trouble understanding social cues and how to act in social situations (Whitby, Ogilvie, & Mancil, 2012). General education students, in turn, may need some help learning to understand and work with students with ASD in their classrooms. Teachers may work with both the student with ASD and the entire class on certain types of social skills (Campbell & Barger, 2011).

For example, if a student with ASD has trouble playing a game in which the students take turns or compete, the general education or physical education teacher may engage the class in a lesson focused on taking turns and cooperation (Obrusnikova & Dillon, 2011). It is important that these lessons be aimed at the entire class rather than the student with ASD so that all students learn how to work with each other.

Video modeling can help improve conversational skills, playing, and other social skills of students with ASD (Biederman & Freedman, 2007; Kagohara, 2010; Ganz, Earles-Vollrath, & Cook, 2011). Students watch a video of a task to learn how to act in a specific situation or how to do something. Students often watch videos multiple times, and teachers use scaffolding to remove the video from use. For example, students may watch a video of students playing a board game to better understand taking turns and moving game pieces. Students then play a game and practice the strategies outlined in the video. Students can view the video multiple times and then practice the skills repeatedly (Ganz et al., 2011).

Teachers can create their own videos for students after identifying a target skill, gathering materials, and filming the video.

Peer tutoring can be an effective strategy for students with ASD to improve communication and social skills (Sperry, Neitzel, & Engelhardt-Wells, 2010; Su, Lai, & Rivera, 2012; Trottier, Kamp, & Mirenda, 2011). Teachers, however, must provide proper training and structure the activities. Merely letting students choose partners and begin working together is not effective for either student in the pair. Teachers should assign roles in the pair (i.e., coach and player; leader and doer) and make sure that students understand those roles.

Teachers also need to teach strategies for getting along with partners. For example, some students need to learn a little patience and understanding, while other students need to learn how to praise their partner and help if the partner makes a mistake. Video modeling can help students with ASD and their partners see how to work together (Silton & Fogel, 2012).

Some students with ASD have difficulty recognizing and discriminating among people’s faces, as well as interpreting others’ emotions visually (Hopkins et al., 2011). Computer-assisted instruction (CAI) programs can increase students’ recognition of faces and understanding of emotion cues (Tanaka et al., 2010). These programs show different faces and emotions, and students learn how to recognize and interpret them.

Making Decisions

Students may need instruction on how to make decisions in and outside of the classroom. Providing students with pictures as options is helpful for students with ASD. For example, to help a student decide what to eat at lunch, the teacher could display pictures of chicken, salad, and a sandwich. Students could also choose a picture to decide which task to complete first: read a story or finish math homework.

Students can also learn to use Social Stories to make decisions (Kokina & Kern, 2010). Students can read a Social Story or an adult can read it for them, and the story helps the student think through a situation. Stories can be in words or pictures. For example, students may use Social Stories to work through how to cross the street at a stoplight, raise their hand to go to the bathroom, or ride the school bus. To teach street crossing, the story might be: “When I’m walking down the street and I see a stoplight, I need to stop at the street corner. If I don’t stop, I could get hurt. After I stop, I push the button and wait. When the walking man flashes on, I start to cross the street. I keep walking until I’m all the way across the street.”

References

Powell, S. R., & Driver, M. K. (2013). Working with exceptional students: An introduction to special education [Electronic version]. Retrieved from https://content.ashford.edu/

10.1 What Are Hearing Impairment, Deafness, Visual Impairment, Blindness, and Deaf-Blindness?

This section will outline the differences between hearing impairment and deafness, and between visual impairment and blindness. Students who experience comorbid difficulties with hearing and sight may be described as having deaf-blindness. Regardless of disability category, to be eligible for services under IDEA 2004, students must demonstrate adverse effects to their educational outcomes.

Defining Hearing Impairment and Deafness

An individual who has a decreased ability to hear sounds is said to have a hearing impairment. People born with this impairment are said to have a congenital hearing impairment, but individuals can develop a hearing impairment at any point in their life. They may experience hearing loss in one or both ears.

Noise levels are measured in units called decibels, which are electric signals that indicate the intensity of sound. The lower the decibel level, the quieter the sound. Individuals with typical hearing can hear sounds in the range of 0–25 decibels. Those with mild hearing impairment can hear 26–40 decibels; with moderate impairment, 41–70 decibels; with severe impairment, 71–90 decibels; and with profound impairment, only higher than 90 decibels. Someone who can hear only in the 71–90 decibel level needs sound to be much louder than the person with typical hearing requires. Students with mild and moderate impairments may have trouble hearing distant sounds or typical conversational voices. Students with severe or profound hearing impairment require assistive devices to hear any ordinary sounds.

Deafness is different from hearing impairment; it describes the condition of not hearing sounds even with assistive devices. Some people are profoundly deaf, which means that they cannot hear any sound at all. Others can hear some sound, but the sounds come through so quietly as to be indistinguishable.

The Deaf community differs from the deaf community, and people typically associate with one community or the other. Members of the deaf community see themselves as members of the hearing world, and do not identify primarily as deaf. These students usually attend regular schools. Members of the Deaf community, in contrast, relate strongly to Deaf culture and primarily associate with other Deaf individuals (Hamill & Stein, 2011). Students who are members of the Deaf community usually attend special schools for Deaf students. There is debate between the two parties and their advocates, especially since the advent of cochlear implants, about whether young children will be part of the deaf community or the Deaf community (Gale, 2011).

You may have noticed the term Deaf individuals in the previous paragraph, which clearly violates the person-first language discussed in Chapter 1 and used throughout this book. The Deaf community has rejected person-first language because members feel that it trivializes a person’s Deaf identity. So, when referring to a person, a school, or a community of Deaf persons, it is more common to not use people-first language. A student in the deaf community, meanwhile, is typically referred to as “a student with a hearing impairment.”

Hearing Impairment, Deafness, and IDEA

Hearing impairment and deafness have been two separate categories under IDEA since PL 94-142 in 1975. IDEA 2004 defines hearing impairment as: “an impairment in hearing, whether permanent or fluctuating, that adversely affects a child’s education performance but that is not included under the definition of deafness.” Deafness, conversely, is defined in IDEA 2004 as a “hearing impairment so severe that the child is impaired in processing linguistic information through hearing, with or without amplification, such that his educational performance is adversely affected.”

Students qualify under hearing impairment when they do not qualify under deafness. Most of the time, diagnosis of a hearing impairment or deafness is conducted outside of the school, and the school accepts the diagnosis. An IEP team then decides the best placement for the student.

Most students with hearing impairment participate in the general classroom with or without assistive devices (e.g., hearing aid or sound amplification system). Students may receive services from a specialist related to speech and language; they may also use a sign language interpreter. Other Deaf students may attend special programs or schools.

Defining Visual Impairment and Blindness

Visual impairment refers to a decreased ability to see that interferes with performance of daily activities. Students with visual impairment have some sight, but their sight difficulties may make it difficult to walk around, read, drive, or learn. Visual impairment can occur in one or both eyes. Individuals can be born with a visual impairment, or their vision can decrease because of injury, disease, or other conditions.

Blindness refers to a complete or almost complete lack of vision. However, if an individual is blind, it does not mean that he or she sees nothing. Many people who are blind may be able to see different colors, objects, and shapes.

Vision involves both visual acuity and the visual field. Visual acuity is the clarity and sharpness with which a person sees an object. In the United States, visual acuity is represented by two numbers (e.g., 20/20). People who have 20/20 vision can see the level of detail when they are 20 feet away from an eye chart (Figure 10.1) that others with normal vision can see at that distance. This “normal” vision has been determined over many years of examining human eyes. People who have 20/100 vision must be 20 feet away to see what a person with normal vision can see at 100 feet away. Visual field refers to an individual’s line of sight above, below, to the left and right, and straight in front, when not moving the head. A person with normal vision usually has a visual field of about 190 degrees.

Figure 10.1: Snellen Eye Charts

The Snellen chart on the left is often used to test visual acuity. The chart on the right is used with younger students and others who cannot read letters but who can demonstrate which way the “fingers” of the E point with their own fingers.

Individuals with a visual impairment may have lower than normal visual acuity, a smaller visual field, or both. Their visual acuity is 20/70 or less in their better eye with corrective lenses. The visual field may be less than 20 degrees. To break down visual impairment further, the following terms are typically used. Low vision refers to vision from 20/70 to 20/160 with corrective lenses. People with low vision can usually see enough, often with technologic assistance, to participate in daily activities. Severe visual impairment includes people with vision from 20/200 to 20/400 when using corrective lenses.

Because a visual acuity of 20/200 or less refers to legal blindness, many people with a severe visual impairment may be diagnosed as legally blind. Legal blindness can also refer to a visual field of less than 20 degrees.

The National Federation for the Blind, the primary advocacy group in the United States for blind persons, prefers not to use person-first language. Thus, it is acceptable to say “the blind person.” However, person-first language for students with visual impairment should be used (e.g., “a student with visual impairment”).

Visual Impairment, Blindness, and IDEA

IDEA 2004 addresses both visual impairment and blindness under the single category of visual impairment. After the passage of PL 94-142, many students with visual impairment were placed in classrooms with sighted peers and teachers who did not have the proper training or resources to provide an effective education. Schools are getting better at providing appropriate educational services to these students, and schools and families may choose from a variety of placement options (Suvak, 2004).

Some students spend most of their time in the general classroom, with special education teachers or specialists pushing in to assist the student. Others may be placed in a self-contained classroom that supports the needs of students with visual impairment. Students with severe impairments may attend specialized schools, some of which are residential, that can provide specialized instruction.

Defining Deaf-Blindness

Deaf-blindness refers to difficulties related to both hearing and vision. Very few people with deaf-blindness cannot hear or see at all; most have varying degrees of hearing impairment and visual impairment.

Deaf-Blindness and IDEA

Deaf-blindness is its own disability category under IDEA 2004. Individuals in this category have “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.”

For babies and toddlers with deaf-blindness, early intervention services are vital, especially in communication and speech (Dammeyer, 2010; McKenzie & Davidson, 2007). The IFSP guides the education of individuals with deaf-blindness until age 3. Once they enter school, most students with deaf-blindness receive most or all of their education in self-contained classrooms, special schools, or residential programs.

Prevalence of Hearing Impairment, Deafness, Visual Impairment, Blindness, and Deaf-Blindness

The prevalence of students with difficulties related to hearing and sight is quite low, making them “low incidence” disabilities. The percentage of students who are categorized as having hearing impairment or deafness under IDEA is approximately 0.1%, while approximately 0.04% of schoolage students are categorized as having a visual impairment. With less than 0.01% of school-age students having deaf-blindness, it is the least common of all disability categories.

10.2 How Have the Fields Related to Hearing and Sight Disabilities Evolved?

The history of disabilities related to hearing and sight is rich and varied. Because it was often easy to identify people as “blind” or “deaf,” stories of people with hearing and sight difficulties appeared in writings, and people reached out to help those with difficulties communicate with the hearing and sighted world by developing their communication in different ways than the spoken or written word.

Evolution of the Hearing Impairment and Deafness Field

Deafness and hearing impairment have been recognized for centuries, if not millennia. Centuries ago, most people believed that deaf people could not learn because they could not hear, and people who were deaf were described as “dumb” or “mad.” Some even said that children were born deaf because “God was angry” (Anglin-Jaffe, 2013).

The Greek philosopher Plato mentioned people using signs to communicate with the deaf around 400 BCE (Ruben, 2005). The first record of an attempt to teach a deaf child to speak was in 685 CE in England, where a teacher was able to teach the “Dumb Boy of Hexham” how to speak some sounds and a few words (Laes, 2011).

In the 16th century, a monk named Pedro Ponce de Leon (not the explorer), who became known as the “first teacher for the deaf,” created a school for deaf students in Spain (Ruben, 2005). Among the first to believe that deaf students were capable of learning, Ponce de Leon taught children how to speak and write. He also taught students to use hand signs to represent letters of the alphabet. This practice was also used by monks who had taken a vow of silence.

A contemporary of Ponce de Leon in Italy was Giralamo (a.k.a. Geronimo) Cardano. He had a son who was deaf, and Cardano worked to teach his son how to read and write. He also taught his son how to use different gestures and signs to communicate with hearing people. Some of Cardono’s ideas were published in 1620 in a book about teaching speech to the deaf by Juan Pablo Bonet. Bonet also included pictures on alphabetic hand signals that later influenced Spanish, French, and

American Sign Language

(ASL) (see the feature, “American Sign Language”).

Thomas Hopkins Gallaudet opened the first school for the deaf in the United States with Laurent Clerc and Mason Cogswell in Hartford, Connecticut, in 1817 (Sayers & Gates, 2008). Mason’s daughter, Alice, became deaf as a toddler, and Gallaudet wanted to create a school for children like her. The school is still open and is today called the American School for the Deaf. It focused on instruction in sign language, and Alice Cogswell was the school’s first graduate.

In 1864, the first college for the deaf opened in Washington, DC (van Drenth, 2003). Edward Miner Gallaudet, Thomas’ son, was the first president of the National College for the Deaf and Dumb. To recognize the Gallaudet family, this college was renamed Gallaudet College (and later Gallaudet University), and the university remains a leader in Deaf education.

In 1880, the National Association for the Deaf was founded as an advocacy group for people with hearing loss. During the late 1800s, there was quite a bit of controversy as to whether people should use sign language or learn to speak. While sign language would be easier than learning to speak a language that is difficult or impossible to hear, advocates for speech felt that learning to speak would allow people with hearing impairment to participate more easily in society. As the 20th century progressed, the choice to learn to speak or use sign language became the choice of the student or family. Today, ASL is the dominant form of communication for the Deaf.

Special Education: Your Profession

American Sign Language

American Sign Language (ASL) was developed from Old French Sign Language (OFSL), with homegrown signs that were developed in America (Figure 10.2). (OFSL was the sign language refined by Charles Michele l’Épée and brought to the United States by Laurent Clerc.) Many students who did not live near schools where they could receive formal sign language instruction created their own signs to communicate. This creation of signs also occurred in communities where a significant number of people in the population were deaf.

To use sign language, people use one or two hands to sign (or show) different letters, words, or phrases. Sometimes people touch or point to places on the face or head, or use facial expressions to show words or phrases. Some people who are deaf use their voices when they sign, while Deaf people will typically not use their voices at all.

Figure 10.2: American Sign Language Alphabet Chart

Each letter of the American alphabet has a unique hand gesture in ASL. People use these gestures to spell words. There are many additional gestures that signify commonly used words and phrases.

Because ASL is its own language, it has its own grammatical rules and word order. For example, to sign in ASL, “I have one brother,” a person would make signs to represent “me, one brother.” You may hear of Pidgin Signed English (PSE) or Signed English (SE). This uses ASL signs, but uses the word order of standardized English. Less important words (e.g., am, to, the) are not signed. A person would use PSE to sign, “I one brother.” If students can speak, they may switch between ASL and spoken English (Andrews & Rusher, 2010), making them bilingual.

You may also hear of Signed Exact English (SEE). This is quite different from ASL. With SEE, a person signs using some components of ASL to represent English as it is spoken. It is the closest sign language to spoken English, and many speaking parents with children who are deaf may find it the easiest to use. In SEE, a person would make signs that say, “I have one brother.”

ASL is used in the United States, most of Canada, and parts of Mexico. Many other countries have their own sign languages; for example, Italy and Spain each have sign languages much older than ASL. British Sign Language (BSL) is also very different from ASL. In fact, ASL and BSL only have about one-third of signs in common.

Students can learn ASL from a very early age. Many babies and toddlers use signs before they learn to speak (Brereton, 2010). The sooner students learn to use their hands to sign, the earlier they can communicate (Snoddon, 2008). Most students exposed to ASL learn to write in written English after they learn ASL (Enns, Hall, Isaac, & MacDonald, 2007).

Evolution of the Visual Impairment, Blindness, and Deaf-Blindness Field

Like those with hearing impairment, people with visual impairment or those who were blind were historically excluded from society. Some people who were blind were killed or abandoned. Blind men might be sold into slavery, whereas blind women might be sold as prostitutes. In the middle ages, societies began to feel more compassion for people with disabilities. “Poor houses” were set up to care for disadvantaged people, including the blind.

During the middle ages, magnifying glasses were created to help people with visual impairment see written text (Maldonado, 2001). Soon, two glass lenses were riveted together and worn on the bridge of the nose. In the 14th century, glasses were so fashionable that everyone wanted to wear them, whether they needed the corrective lenses or not. Johannes Gutenberg’s invention of the printing press in 1440 and the proliferation of books created much more of a need for reading glasses.

In 1784, Valentin Haüy opened the first school for the blind in Paris, France (Lowenfeld, 1956). Haüy had seen a blind beggar named Francois Leseuer who could tell the value of coins by the raised markings on the coins. He decided to teach Leseuer to read, so Haüy created wooden blocks with raised letters and numbers. Because of his success educating Leseuer, Haüy decided to create books with raised letters. He opened his school, the Royal Institution for the Young Blind, and Leseuer was a teacher at the school (Oliphant, 2008). After the French Revolution, Haüy left France and moved to Russia. He opened a similar school in St. Petersburg, and other schools in England, Denmark, Austria, and Germany.

Following in Haüy’s footsteps, Louis Braille invented a method for reading and writing that involved a series of raised dots. Blind from the age of 3, Braille attended the Royal Institution for Blind Youth in Paris, but had difficulty reading the raised letters. When he was 12, a soldier came to the Royal Institution with an invention called “night writing,” which consisted of 12 raised dots that soldiers could use to share secret information during battle and at night without having to speak.

Around 1825, Braille took the idea of using dots and created his own system involving six dots to represent letters and numbers (Figure 10.3). He published his first book about his dot system when he was 20 years old. It took a while to catch on, and the Braille system of writing did not fully develop until the 20th century, but now it is used around the world to help people with visual impairment and blindness read (D’Andrea, 2009). With the invention of newer technologies, such as text-to-voice, Braille use has declined slightly, but it is still important in the blind community (Wall & Corn, 2004).

Figure 10.3: Braille

Braille printing arranges raised dots in a two-by-three grid to denote different letters, abbreviations, and punctuation. A person “reads” by moving a finger from left to right.

The first school for the blind in the United States opened in 1832 in Boston, Massachusetts. Originally named the New England Asylum for the Blind, the school is now called the Perkins School for the Blind, and it is a prominent school for blind education. Perkins is named after Thomas Handasyd Perkins, a visually impaired donor who gave money to begin the school. Samuel Gridley Howe became the director and raised funds to educate the blind. Howe brought Laura Bridgman, the first student with deaf-blindness to be educated in the United States, to the school. The Perkins Brailler, a Braille typewriter, was developed at the Perkins School (Bickford & Falco, 2012).

Anne Sullivan attended Perkins, and, upon graduation, was sent to Alabama to begin working with 7-year-old Helen Keller. Sullivan met Keller, who had become deaf-blind as a toddler, in 1887. Sullivan taught Keller how to communicate by drawing letters on Keller’s hand. The next year, Keller traveled with Sullivan to Boston to attend Perkins. Sullivan and Keller worked together until Sullivan’s death.

After Perkins was founded, other organizations for the blind arose in cities across the United States in the 19th century. The American Printing House for the Blind began in 1858 and printed books in Braille for blind students. In 1921, the American Foundation for the Blind (AFB) formed as an advocacy group for blind people. A similar organization, the National Federation for the Blind (NFB), started in 1940. The NFB worked to help the American public understand blind people as normal people who cannot see, instead of helpless beings.

One of the more important efforts of the NFB was the nationalization of the White Cane Law. The NFB wrote a model of the White Cane Law that states could adopt, and all 50 states have a version. Many people with visual impairment use a cane (usually white with a red tip, but it can be different colors) to help them navigate their environment. The White Cane Law basically states that blind people with canes or guide dogs have the same access rights as people without visual impairment. This allows blind people to take their canes and dogs into public buildings, restaurants, airports (and airplanes), buses and trains, and other public places. The White Cane Law also states that cars must stop when a person with a white cane is walking in a crosswalk.

10.3 What Are the Characteristics of Students With Hearing Impairment, Deafness, Visual Impairment, Blindness, and Deaf-Blindness?

Many babies and children have hearing or visual impairments that are not immediately apparent. This section discusses the characteristics of students with hearing and vision difficulties. Parents and guardians should be aware of these warning signs in order to refer children for early evaluation.

Hearing Impairment and Deafness Characteristics

Students with hearing impairments may experience hearing loss that is mild (i.e., student can hear sounds in the 26–40 decibel range), moderate (41–70 decibels), or severe (71–90 decibels). Students with deafness can only hear sounds above 90 decibels. Most students with hearing impairments fall within the mild and moderate categories, and it may not be obvious to parents or caregivers that the child is experiencing hearing difficulty.

Often signs of hearing impairment or deafness become apparent between birth and 12 months of age. Babies may not respond to voices. For example, if two adults are speaking, the baby may not turn his or her head in the direction of the voices. (Babies with typical hearing often look in the direction of noise.) Babies may not smile when someone is speaking to them, and babies may not respond to their own name.

Additionally, babies may not respond to loud noises in typical ways (turning in the direction of a loud noise or showing displeasure at it). For example, when a fire truck drives past with blaring sirens, most babies will start crying because the noise bothers their ears. If a baby is not frightened or does not seem to notice a very loud siren, the parent or guardian should bring the baby to a hearing assessment.

Because babies with hearing impairment are not hearing sounds well or at all, they are not picking up on some of the basics of language and communication. Often, babies and toddlers with a hearing impairment will not babble or make first sounds like “ba” and “ma.” The single biggest indicator of hearing loss is delayed speech development.

Parents should have their child’s hearing evaluated by a medical professional if they suspect hearing difficulties. As with many other disabilities, early intervention is vital because hearing is the foundation for developing speech and language skills.

Hearing loss may also occur at later ages. Toddlers and children may display delays in speech and language or they may have atypical speech patterns (e.g., speaking without inflection). Children may have difficulty engaging in conversation with other children or adults, and may seem to have difficulty understanding what others say. They may not respond when someone calls their name, or consistently turn the volume up high on televisions or audio systems. Some children experience earaches or ear pain; children may touch or cover their ears to indicate hearing difficulty. If a parent or teacher suspects that a student has a hearing impairment, the child should undergo an evaluation as soon as possible.

Visual Impairment and Blindness Characteristics

Students experience a range of vision difficulties, ranging from visual impairment, to low vision, to severe low vision, to blindness. Most students have sight difficulties, but not complete blindness: therefore, it may be difficult for parents and teachers to recognize a vision problem.

Several signs can indicate that a student has a visual impairment. Sometimes, the eyes themselves may be the first clue. Students may cross their eyes or not be able to focus on an object. They may squint or blink often, demonstrate sensitivity to bright lights, or close one eye often.

Other indicators can include clumsiness, as when a student regularly trips or runs into things or has trouble judging the distance to an object. For example, a student might swing a bat (to hit a ball) well before the ball crosses the plate. Students may choose to sit very close to a television or hold a toy or book very close to their eyes. The writing of students may be affected because they may experience poor hand-eye coordination.

Deaf-Blindness Characteristics

Students with deaf-blindness exhibit a combination of hearing and visual impairment characteristics. As noted earlier, it is important to remember that students with deaf-blindness usually have some sight and some hearing ability; it is extraordinarily rare that a student with deaf-blindness is completely deaf and completely blind.

10.4 What Are the Causes of Hearing Impairment, Deafness, Visual Impairment, Blindness, and Deaf-Blindness?

Hearing and visual impairments can come from a variety of causes. Congenital impairments are present at the time of a baby’s birth. The impairment may be related to genetics or may stem from prenatal or perinatal causes. Acquired impairments occur after birth and are related to a disease, disorder, infection, or accident that happens to the student.

Causes of Hearing Impairment and Deafness

Hearing occurs when sound waves enter the auditory canal and hit the eardrum (Figure 10.4). The eardrum vibrates, and these vibrations travel through three small bones in the middle ear called the malleus (hammer), incus (anvil), and stapes (stirrups). These bones amplify the vibrations, and the amplification is picked up by very tiny hair-like cells in the cavity known as the cochlea. The hair-like cells move around, and the movements travel through auditory nerves to the brain. The brain interprets the messages as sound.

People can experience conductive hearing loss, which occurs when sound waves travel inefficiently to the eardrum and middle ear. Conductive hearing loss can often be improved with hearing aids. When a person has sensorineural hearing loss, the person has damage to the cochlea or the auditory nerves that send messages to the brain. Cochlear implants may help improve the hearing capability of a person with sensorineural hearing loss. When a person has damage to the eardrum and middle ear as well as the cochlea and inner ear, it is described as mixed hearing loss. People may experience hearing loss in one ear (unilateral) or both ears (bilateral).

Figure 10.4: The Ear

Some individuals experience hearing difficulty because of a breakdown in the process of sound waves traveling from the eardrum to the cochlea. Other individuals may have a disorder with the hair-like cells in the cochlea.

There are many causes for hearing impairment or deafness. A brief list includes the following:

Allergies. Many children suffer from allergies—and often, fluid can build up in the child’s middle ear. Long-term build-up of fluid can contribute to hearing difficulty.

Chicken pox. The chicken pox virus can, in rare cases, cause an ear infection that leads to hearing loss.

Diabetes. Complications related to diabetes can cause infections that may lead to hearing difficulty.

Ear development. Students can be born with malformations of any of the parts of the ear that contribute to hearing impairment.

Ear infections. Eardrums can become infected, and without treatment, the infection can cause permanent hearing loss.

Earwax. If earwax collects in the ear canal, the wax can block sound waves from entering the inner ear. Earwax is typically related to temporary hearing difficulty.

Encephalitis. With encephalitis, parts of the brain may experience swelling. This swelling, if close to regions related to hearing, can cause hearing loss.

Genetics. Students may inherit a gene or genes that cause hearing loss. Interestingly, more than 90% of children with a congenital hearing impairment, or deafness, are born to hearing parents.

Head injury. Any injury that causes damage to the ear canal or the auditory nerves that carry messages to the brain may cause hearing loss.

Hypothyroidism. People with an underactive thyroid may experience hearing loss.

Lyme disease. The Lyme disease infection may affect the ear canal and cause hearing loss.

Meniere’s disease. This disorder in the inner ear causes vertigo and can also cause fluctuating hearing loss.

Meningitis. With meningitis, especially bacterial or fungal meningitis, parts of the brain and spinal cord may swell. This swelling may affect the parts of the brain related to hearing.

Mumps. The mumps virus can cause an ear infection that leads to hearing loss.

Otosclerosis. In this hereditary disorder, the student has growths around the bones in the middle ear, which contribute to sound waves not travelling through the ear canal properly.

Ruptured eardrum. If a student is exposed to very loud noises, gets an ear infection, or has an accident where the eardrum is punctured, hearing loss can occur.

Sickle-cell anemia. Students with sickle-cell disease can also experience sensorineural hearing loss.

Syphilis. An infection related to syphilis may contribute to hearing loss (even years after the initial infection).

Tuberculosis (or the medicine used to treat it). While tuberculosis may not cause hearing loss, the medications used to treat it (e.g., streptomycin) may cause hearing loss.

Tumors. Tumors that grow in the ear or in locations of the brain related to auditory nerves can cause temporary or permanent hearing loss.

Causes of Visual Impairment and Blindness

The process of sight is complex, and abnormalities at any step can cause visual impairment (Figure 10.5). Light enters the eye through the cornea, a clear cover at the front of the eye, and then passes through the pupil, a hole in the center of the eye (surrounded by the iris) to the lens, which focuses the light rays onto one point on the retina. The retina is the back part of the eye that has cells that sense light. The visual information is then transmitted from the retina to the brain via the optic nerve, where it’s interpreted as a visual image.

Figure 10.5: The Process of Vision

Light passes through the cornea, pupil, and lens to the retina, which helps interpret the light and then sends messages to the brain through the optic nerve. The brain interprets the messages as images. At any point, a defect in one of these parts of the eye or the optic nerve can contribute to difficulty with vision.

Visual impairment or blindness can be present at birth or develop during childhood. Disease, eye disorders, injury, or degenerative conditions can all lead to visual impairment. Examples of factors that can lead to visual impairment include:

Amblyopia (lazy eye). The eyes do not align properly, and one eye becomes weaker than the other. In a small child, the brain will shut down the vision in the weaker eye.

Cataracts. The lens of the eye becomes clouded, and light is prevented from passing through.

Coloboma. Part of the iris has a hole or a defect. Most coloboma is congenital.

Cortical visual impairment. When the part of the brain that carries messages about vision is defective, students can experience vision loss.

Diabetic retinopathy. The retina blood vessels become damaged, which leads to vision difficulty.

Genetics. Students inherit a gene or genes that cause vision loss.

Glaucoma. Pressure inside the eye damages the optic nerve. While glaucoma is typically thought of as affecting older people, glaucoma can affect children.

Infectious diseases. Diseases, such as measles, rubella, and scarlet fever, can cause infections that may contribute to visual impairment.

Macular degeneration. When part of the retina deteriorates, vision is impaired. Macular degeneration is one of the most common causes for visual impairment in older adults.

Nystagmus. An involuntary movement of the eyes that often develops between birth and 6 months of age. The movement causes vision difficulty.

Optic nerve hypoplasia (ONH). If the fibers in the optic nerve are underdeveloped in the womb, a baby may experience visual impairment related to this underdevelopment. Students with ONH often experience developmental delays.

Retinitis pigmentosa. A disease that slowly destroys the retina.

Retinopathy of prematurity. When babies are born premature, the retina does not have time to develop properly, which can lead to blindness.

Strabismus. When a person has difficulty aligning both eyes at the same time. Children with strabismus may appear cross-eyed.

Trachoma. This contagious bacteria causes an eye infection. Trachoma is the most common cause of blindness in the world, but it is extremely rare in the United States.

Vitamin A deficiency. When children do not receive enough Vitamin A in their diet, the deficiency can cause damage to the retina. Vitamin A deficiency is one of the most common causes for visual impairments in third-world countries.

Causes of Deaf-Blindness

Deaf-blindness, although extremely rare, can be caused by a number of reasons. Some of the most common include:

Asphyxia. When a person experiences a lack of oxygen, damage to the brain can occur, leading to hearing and vision loss. Babies can experiences asphyxia during birth if the mother experiences a drop in blood pressure or if the umbilical cord gets caught or wrapped around the baby.

CHARGE syndrome. CHARGE stands for coloboma, heart defect, atresia choanae, retarded growth and development, genital abnormality, and ear abnormality. Students with CHARGE syndrome experience a range of difficulties, and CHARGE syndrome is one of the leading causes for deaf-blindness.

Complications due to premature birth. Babies born prematurely may experience atypical development of the ear and eyes that leads to to hearing and vision loss.

Cytomegalovirus (CMV). CMV is a common herpes virus that can cause a delay in brain development to a baby in the womb.

Genetics. Children can inherit genes related to hearing and vision loss.

Hydrocephalus. When a child’s brain collects excess fluid, the functions of the brain can be affected, leading to hearing and vision loss.

Infection or injury. Children can experience infections (e.g., measles, rubella, fevers) or injury to the head and brain that can contribute to hearing and vision difficulties.

Microcephaly. When a student’s brain does not develop in a typical way, the brain is smaller than a typical brain. The brain function of a small brain is reduced, and this can cause difficulties with hearing and sight.

10.5 How Are Students Diagnosed With Hearing Impairment, Deafness, Visual Impairment, Blindness, and Deaf-Blindness?

Most often, parents recognize symptoms of hearing loss or vision loss and seek evaluation. Medical professionals may also identify children for evaluation at birth or during normal check-ups. Teachers may watch for signs of hearing or vision loss, especially after a student has experienced an illness or accident. Regardless of who notices warning signs, medical professionals conduct the evaluations and confirm a diagnosis. The school IEP team decides whether the student’s hearing or visual impairment requires special education services because academic performance has been affected.

Diagnosis of Hearing Impairment and Deafness

Hospitals often administer a hearing test to babies before they leave the hospital. This usually begins with an otoacoustic emissions (OAE) test, which is administered when the baby is sleeping. A tiny device that makes clicking sounds is placed in a baby’s ear. The device records the baby’s echo response to the sounds—that is, whether sound waves come back out of the ear canal. If an echo is produced, then the baby’s ear function is probably normal.

When a baby’s OAE test results are abnormal, the automated auditory brainstem response (AABR) test is administered. Electrodes placed on the baby’s head record brainwave activity in response to clicking sounds emitted from headphones. If the brain responds to the clicking sounds (i.e., the brain shows activation from hearing the sounds), then the baby’s hearing is most likely normal. If brainwaves are not activated by clicking, then the baby might have a hearing impairment.

Parents and teachers who suspect hearing difficulties may refer toddlers and older children for a hearing screening. Many types of tests may be administered. A medical professional, such as an audiologist, may insert probes into the ear to determine how sound waves bounce off the eardrum (see the feature, “What Does an Audiologist Do?”). Another test, called an audiogram, determines the quietest sounds a child can hear. Children may also be tested for ear infections. Speech and language assessments may be administered to determine delays in basic skills.

Once a hearing impairment or deafness is identified, a team of professionals works with the family to determine the best treatment plan for the child. For many children, a hearing aid can help amplify sounds enough to improve the child’s hearing substantially (Rekkedal, 2012). For other students with severe or profound hearing loss, a cochlear implant may be an option

Diagnosis of Visual Impairment and Blindness

Usually, a visual impairment is diagnosed by an ophthalmologist or optometrist. An ophthalmologist is a medical doctor (MD) specializing in eyes, and an optometrist is a doctor of optometry (OD) without a degree from a medical school. An optometrist understands and works with eyes, whereas an ophthalmologist can treat the entire body.

The first step in an examination is typically a vision test using a Snellen chart, shown earlier in this chapter. Doctors will also administer a visual field test. A set of goggles is placed on the patient, and lights flash on and off in the periphery of the visual field. The patient presses a button any time he or she sees a light.

Tests of the eye itself are also typically included in a vision evaluation. Doctors examine the cornea, pupil, iris, and lens to look for deterioration or damage. They may test to see if fluid pressure has built up in the eye. Doctors may also test how well signals in the optic nerve travel to the brain.

Beyond the basic evaluation, professionals (e.g., a visual impairments teacher or a certified orientation and mobility specialist) may conduct a functional vision assessment (FVA) for students with low vision. In an FVA, the student participates in near tasks (closer than 16 inches), intermediate tasks (16 inches to 3 feet), and distance tasks (over 3 feet). Tasks may include looking at pictures for specific objects or manipulating objects. The FVA helps teachers understand which accommodations (e.g., use of bold print, use of magnifying lens) may be necessary for the student in the classroom.

Diagnosis of Deaf-Blindness

To diagnose deaf-blindness, medical professionals use the same procedures as used to identify hearing impairment and visual impairment. Often deaf-blindness accompanies other medical conditions, so medical professionals conduct the evaluation for hearing and vision loss.

10.6 How Do I Teach Students With Hearing Impairment, Deafness, Visual Impairment, Blindness, and Deaf-Blindness?

An IEP team decides the most appropriate placement for each student, and the parents’ wishes should be considered, along with the requirement of LRE. For example, some parents of Deaf children may opt for a classroom that uses ASL as the main form of communication instead of spoken English. For those students who spend some or all of their time in a general classroom, there are a number of accommodations, modifications, technologies, and organizational and instructional strategies that can make all the difference in educational outcomes. The effective introduction of specialists—such as a speech and language pathologist or an orientation and mobility specialist—can also improve academic performance.

Teaching Students With Hearing Impairment and Deafness

If students are placed in the general classroom, teachers can use a variety of accommodations and modifications to enable participation in the general classroom. Students may use interpreters if ASL is their primary form of communication and they attend their local schools. Other students attend schools where instruction is provided in ASL.

Many students with hearing impairment who use spoken English as their main communication method attend local schools. The inclusion of students with hearing impairment benefits all students, as students learn to be accepting of individual differences and communicate in unique ways (Bowen, 2008). No matter what the placement situation, students need qualified teachers who understand the needs of students with hearing impairment (Ausbrooks, Baker, & Daugaard, 2012).

Accommodations

For students with mild or moderate hearing loss, the classroom may have a sound-field amplification system (DiSarno, Schowalker, & Grassa, 2002). To use this system, the teacher wears a microphone, and wireless technology transmits the teacher’s voice to an amplifier that typically is installed on a wall, on the ceiling, or in the front of the classroom. The entire classroom of students hears the teacher’s voice through the amplifier.

All students seem to benefit from the amplification system, in terms of improving listening skills (DiSarno et al., 2002). Alternatively, the teacher may wear a microphone that wirelessly transmits the teacher’s voice to the student’s own hearing aid.

Students with hearing impairment often receive test accommodations in the form of extended time, small-group or individual administration, test directions interpreted, and test items interpreted (Cawthon, 2009). These accommodations may be in place for classroom assessments and standardized assessment programs implemented by the school or district. Some students may have tests translated into ASL. Depending upon the severity of disability, some students may take an alternate assessment (i.e., the modified assessment program for up to 2% of the school population).

General Teaching Strategies

Teachers of students who are deaf or hearing impaired should eliminate unnecessary directions and words to provide students with concise, clear information. For example, instead of saying, “For your art project, you’ll gather a paintbrush and three colors. Choose blue, red, and yellow paints. Then, go to your easel and place your paint in the tray,” a teacher might say, “Get a paintbrush and the colors blue, red, and yellow. Put the paint in the tray.” Teachers should also check for understanding by asking students to repeat directions or explain a task that they are to perform.

It is helpful to allow “wait time” after asking a question before expecting a response. Often, students with hearing impairment need a little extra time to process information and produce an answer. Teachers may provide advance organizers (e.g., “Today we’re learning about the difference between rectangles and squares”) to help students prepare for the types of questions or activities that may be asked or covered in class.

Students with hearing impairment often fall behind their peers in terms of academics, so teachers may need to provide remediation to help catch students up to grade-level material. Students have often fallen behind because of inadequate language and speech skills. If students cannot understand the speech of the teacher, then they miss out on much of the instruction during the school day. Once a student’s speech and language improves, teachers need to fill in any academic knowledge the student missed out on. Strategies for students with SLD can be beneficial to students with hearing impairment or deafness who need help in the academic areas.

Teaching Speech and Language Skills

Instruction on speech and language skills is based on the student’s IEP. One challenging area for students with hearing impairment is vocabulary and new concepts. Often, students with hearing impairment learn concrete concepts well (e.g., car, truck, sun) but struggle with more abstract concepts (e.g., around, before, after). Pictures and videos are very helpful for demonstrating concepts that are language-based. If students are familiar with ASL, sign language pictures that accompany text may be used (Figure 10.6) (Hoffman & Wang, 2010).

Figure 10.6: ASL and Vocabulary

To help students who are comfortable with ASL learn important words or phrases, teachers can provide pictures of signs along with written text. In this example, the words to the Pledge of Allegiance are placed under the ASL signs.

Teachers also need to provide explicit instruction on homophones—words that sound the same but have different meanings (e.g., their, they’re, there) and words that have multiple meanings (e.g., bark, can, play). Homophones, because they sound the same, can be very confusing to students who have limited language and vocabulary skills. Teachers may work on a pair of homophones with the student, providing examples of each one and when it can be used.

Students with hearing impairment often speak in shorter, more succinct sentences than other students. Thus, teachers may need to work with them on writing skills, such as developing and writing complex sentences (Massone & Baez, 2009). Teachers also need to help students learn to pay attention to word endings and plurals, as students with hearing impairment often have difficulty hearing these sounds. For example, a student may write, “I look for the cat,” instead of “I looked for the cats.”

Depending on how much sight and hearing students have, they may use Cued Speech, gestures, or lipreading. When using Cued Speech (Figure 10.7), students use their hands to signal different phonemes of English. Eight handshapes demonstrate consonant phonemes, and cues near the mouth demonstrate vowel phonemes. Cued Speech presents students with visuals of the spoken word. To use gestures, students communicate using informal signs. For example, a student may touch the mouth to indicate hunger. In order to lipread, students learn to understand speech by interpreting the movement and formation of the lips.

Figure 10.7: Cued Speech

To use Cued Speech, a person makes a handshape and then places the handshape in a specific location around the face to indicate a specific consonant, vowel, or consonant-vowel combination.

The Speech-Language Pathologist

Students with hearing impairment often miss out on critical communication and speech development. A speech-language pathologist (SLP) can help these students improve their communication skills. Students may receive these services at their school, travel to a clinic, or have the SLP come to their home.

The SLP helps students learn how to form and say sounds and words, speak, and listen. Many students with hearing impairment struggle with hearing quiet sounds, such as “s,” “f,” “k,” and “t.” SLPs may work with students on picking up on these sounds and using them in words. SLPs may also help students modulate the pitch of their voice and learn to speak at an acceptable volume rather than too loudly or too softly. Sometimes SLPs help students understand the connection between sign language and spoken English because sign language is not a direct interpretation of spoken English.

Teaching Students With Visual Impairment and Blindness

Some students with visual impairment or blindness—often those who have additional disabilities— attend specialized or residential schools. Specialized programs offer very specific resources for students (e.g., tactile maps, Braille readers, hallways with guide rails), and the teachers are specially trained to work with students with visual impairment. Many students, however, attend their neighborhood schools and participate in general classrooms for some or all of their day.

Classroom Organization

Teachers in a general education classroom can help visually impaired students navigate the classroom by following some basic rules. First, make sure the classroom is well organized and free of obstructions. Avoid clutter. Provide wide, clear aisles. Make sure no items hang from the ceiling or protrude from a wall in a place that a person could bump into. Once the classroom is set up, minimize changes. A blind student will learn quickly the pattern of desks and tables in the classroom. If they are rearranged, it can be very confusing.

Teachers should also think about the lighting in their classroom. For students with some sight, it is important for the space to be well lit. Schools can install better overhead lighting or teachers can use lamps placed around the classroom. Students may even have a desk lamp placed on their desk or work area.

Consider the placement of the student’s work area in the classroom. Students with mild visual impairment might benefit from sitting in the front of the classroom, near the teacher, or close to the board area. Students who rely mostly on the spoken voice should be able to sit where they can easily hear the teacher and contribute to conversations. Teachers should stand facing the students as much as possible so that the students can use cues (such as hand gestures and facial expressions) as well as lip reading to understand the teacher.

General Teaching Strategies

Teachers need to provide explicit instruction for all the academic subjects. They should give thorough and concise directions and make sure that students understand expectations for each activity or assignment. By using explicit instruction and concise directions, teachers allow the student to focus on learning rather than be distracted by unnecessary information. Teachers may want to give out assignments or reading lists well before a due date, as students with visual impairment may need more time to read and digest information than a typical student.

Teachers should work on helping students with visual impairment improve their listening skills, since they rely heavily on listening to gather information and communicate (Durando, 2008). Listening skills can be improved with listening activities. A teacher may give students a list of things to do (e.g., items to gather from a locker) or tell a story and ask questions about the story. Teachers may also want to develop a verbal cue (e.g., “Time to listen”) or a physical cue (e.g., hand raised in air) to signal students when it is very important to pay attention.

In the general classroom, placing students into cooperative learning groups benefits students with and without visual impairment (Najafi, Rostamy-Malkhalifeh, Pezeshki, & Amiripour, 2011). Students without visual impairment may act as helpers or guides, and the interactions may teach students acceptance of individual differences. Teachers should use assistive technologies when it would be beneficial for the student, as described later on (Zhou, Smith, Parker, & Griffin-Shirley, 2011).

For assignments and testing situations, some students with visual impairment may use a scribe, who writes out the work that the student dictates. The student can also use technologies, such as a computer or speech-to-text program, to type or transcribe work. Students may be provided with extra time for tests or untimed testing situations. As with all disabilities, accommodations on state assessments must be included in the student’s IEP.

Teaching Reading and Writing Skills

Some students with visual impairment learn to read Braille—and sometimes sighted peers like learning it as well (Swenson & Cozart, 2010). Often, if students will use Braille as their main way to read, they learn it in a specialized school or program with a teacher experienced in teaching it. There are different grades of Braille, which are unrelated to school grades. At grade one, students read the letters of the alphabet using uncontracted Braille. At grade two, students read the letters of the alphabet and contractions (Barclay, Herlich, & Sacks, 2010). Most Braille used in public signs involves Contracted Braille. At grade three, Braille becomes a shorthand that is not standard English, in which dots represent words and phrases.

There is some debate as to whether students should learn uncontracted Braille before learning contracted Braille, or whether contracted can be learned first (Emerson, Holbrook, & D’Andrea, 2009). Whatever the orders of learning grades of Braille, however, students should learn Braille as they are learning to read (Holbrook, 2008; Swenson, 2008).

Students can also learn how to write in Braille, with a machine or by hand (Clark-Bischke & Stoner, 2009). Writing in Braille by hand involves using a device called a slate. A piece of paper is placed between two metal plates of the slate. The writer uses a stylus to form pits (that represent Braille) from right to left on the page. When the paper is taken out of the slate and turned over, the Braille can be read from left to right.

A focus on meaningful and important words in vocabulary instruction can lead to large gains in reading performance (Dimling, 2010; Campbell, 2011). For example, teachers can teach the meanings of the key words “journey” and “explore” to prepare students for a reading on the exploration of the Louisiana Purchase. Students with visual impairment often demonstrate difficulty with the basic parts of words, such as phonemes (i.e., smallest unit of sound), graphemes (i.e., the letters that represent phonemes), and onset rimes (i.e., in a one-syllable word, the initial consonant—onset—and the vowel and final consonants—rime), so teachers need to provide explicit instruction specific to these concepts (Crawford & Elliott, 2007).

Teachers should provide as many books as possible to students (Day, McDonnell, & O’Neill, 2008). Parental support of reading at home—whether in Braille or aloud—helps them learn to read unfamiliar words and greatly benefits their reading development (Kamei-Hannan & Sacks, 2012). Students may also use large-print books, which are available at many libraries.

Using Technology

Students may require that lectures or class discussions be audiorecorded. With technology—for instance, a digital recorder—this is quite easy to do. Students then may listen to the recording later to review or prepare for an exam.

Students may also listen to books or stories read aloud. Text-to-speech programs are readily available to translate written text to audible speech. Students can also speak and have their words translated to text with speech-to-text programs. There are many Braille translation programs available, and there is even a Braille tablet that students can use.

Some students may benefit from the use of large print. Using a computer, it is easy to change the font from a regular 12-point font to a 16- or 18-point font. With many e-readers, it is easy to enlarge the font to an appropriate size for individual students. Keep in mind, though, that for some students the large print may be distracting. The color contrast on most screens can also be improved (Figure 10.8).

Figure 10.8: Color Contrast

Many books, pictures, and websites on the computer do not present colored items in a way that is helpful for students with visual impairment. The color contrast at the top of the screen makes the text much easier to read than that on the bottom of the screen. Teachers may need to alter materials, using technology, to provide better contrast for students.

Tactile Learning

Whenever possible, teachers should provide students with tactile learning experiences so students can experience (with their hands) something that is difficult to see (with their vision). In teaching mathematics, technology can be used to create tactile images of important concepts, such as grids, geometric shapes, charts, and graphs (Bouck & Meyer, 2012; McDonnall, Cavenaugh, & Giesen, 2010).

In teaching social studies, a teacher may provide a raised map that the student can touch and feel to better understand geographical boundaries or characteristics, such as mountains and rivers. Teachers may provide 3-D models of objects, such as a space shuttle or a giraffe, so students can understand what these items look like (Smothers, 2011).

Arts and Physical Education

Students with visual impairment can learn to read music (via a Braille system) and play instruments (Coates, 2010). Music, whether played by the students or provided via recordings, is a great way to teach students new skills and concepts (Villasenor & Vargas-Colon, 2012). For example, students can learn the U.S. presidents by song. Students can also use music to help them focus and eliminate other background distractions. Students with visual impairment have to rely on listening, so nature sounds or classical music can help eliminate aural distractions and create a calm work environment.

Art experiences are an important component of education for these students, especially because of the tactile and expressive experiences art can provide. Students, even if they cannot see their art well, can use art to express themselves or answer questions. Students can use art to practice writing letters or words in print or Braille.

Students with visual impairment often have difficulty understanding spatial concepts. For example, when learning about the solar system, it may be difficult to understand the Earth’s relation to the sun without seeing it. Using textured paint, a teacher can paint the different planets on a long piece of paper, and then the student can compare the distance between the sun and Earth or the Earth and Jupiter.

Students can also work on developing positive peer interactions and social skills in physical education classes (Conroy, 2012). By playing games or participating in activities with other peers, all students can learn acceptance of individual differences and how to not be afraid of students with disabilities. Physical education teachers can include students with visual impairments by providing verbal descriptions of activities alongside their physical demonstrations. Instead of saying, “Throw the ball through here,” teachers might say, “Throw the ball through the hoop on the wall.” Physical education teachers may also use devices that produce beeps or other sounds to make the basketball hoop, or other items, easier for students with visual impairments to locate.

Orientation and Mobility Training

Students with visual impairment benefit greatly from instruction on tasks that develop mobility and orientation. An orientation and mobility (O&M) specialist works with students in special schools or in general classrooms. In fact, over half of all students with visual impairment in any setting work with an O&M specialist (Wolffe & Kelly, 2011).

An O&M specialist helps students with visual impairment learn to independently navigate their environment in a safe way (Correa-Torres & Durando, 2011). O&M specialists usually work one-on-one with students. They might teach students how to navigate with a cane, or they might help a student learn how to travel with a guide dog. An O&M specialist teaches students how to ride the train or bus, how to cross the street, and how to enter or exit buildings. They might also help students with developing gross- and fine-motor skills, such as cutting with a knife and fork.

Teaching Students With Deaf-Blindness

All the teaching strategies for students with hearing impairment and students with visual impairment are applicable to students with deaf-blindness. Some students require highly specialized instruction (Correa-Torres, 2008), whereas others can attend their local schools and participate in inclusion programs (Kamenopoulou, 2012). General education teachers, if teaching a student with deaf-blindness, should receive proper training from their school district for working with these students (Hartmann, 2012). This training may include learning about evidence-based techniques for hearing and visual impairments, as well as any specialized care the student may require (e.g., wheelchair access).

People with deaf-blindness communicate in many ways. To use the hand-over-hand method of tactile sign language, the person receiving the signs lightly places his or her hands over the signer’s hands. The signer then uses some version of sign language, such as ASL, sometimes modifying the signs so that they can be felt rather than seen. Other people use fingerspelling, in which one person spells letters on the other’s palm. (This is the method Anne Sullivan used with Helen Keller.) Another method is Braille signing; one person points to places on the other’s palm that represent the dots of Braille.

Helping Students With Visual and Hearing Impairments Transition

Transition plans to independent living must begin as early as possible for students with visual impairment. Students who are going to live on their own need to learn how to navigate their community with public transportation, how to grocery shop and prepare meals, how to interview for jobs or apply to college, and how to take care of their finances and personal care. Students may also require instruction on sexual relationships (Krupa & Esmail, 2010). They may need to continue to work on their communication and literacy skills, and teachers will want to keep them updated on recent technologies.

Secondary students with deaf-blindness should have transition plans developed early. Some students may need to learn a vocational skill to succeed after school (Parker, Davidson, & Banda, 2007). For example, students may work bagging groceries or cleaning stores. Other students may work in greenhouses watering plants. Students need to learn the skills related to their vocations in addition to daily living skills.

References

Powell, S. R., & Driver, M. K. (2013). Working with exceptional students: An introduction to special education [Electronic version]. Retrieved from https://content.ashford.edu/

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