Disability Population Receiving Transition Services

Definition, characteristics, and educational implications for all individuals entitled to Transition Services

The completion of high school is the beginning of adult life. Entitlement to public education ends, and young people and their families are faced with many options and decisions about the future. The most common choices for the future are pursuing vocational training or further academic education, getting a job, and living independently.

For students with disabilities, these choices may be more complex and may require a great deal of planning. Planning the transition from school to adult life begins, at the latest, during high school. In fact, transition planning is required, by law, to start once a student reaches 14 years of age, or younger, if appropriate. This transition planning becomes formalized as part of the student’s Individualized Education Program (IEP).

Transition services are provided for students with disabilities to help make the transition from the world of school to the world of adulthood. The population that is eligible under IDEA to receive such services includes students classified as disabled under 13 separate categories. This chapter will focus on those 13 categories and provide the reader with an overview of each specific disability. After reading this section you should be familiar with the following areas:

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Eligibility for Transition Services

The Education of the Handicapped Act, Public Law (P.L.) 94-142, was passed by Congress in 1975 and amended by P.L. 99-457 in 1986 to ensure that all children with disabilities would have a free, appropriate public education available to them which would meet their unique needs. It was again amended in 1990 and the name was changed to IDEA.

IDEA defines “children with disabilities” as having any of the following types of disabilities: autism, deaf, deaf-blindness, hearing impairments (including deafness), mental retardation, multiple disabilities, orthopedic impairments, other health impairments, serious emotional disturbance, specific learning disabilities, speech or language impairments, traumatic brain injury, and visual impairments (including blindness). These terms are defined in the regulations for IDEA, as described below.

1. AUTISM

Definition

Autism and Pervasive Developmental Disorder-NOS (not otherwise specified) are developmental disabilities that share many of the same characteristics. Usually evident by age three, autism and PDD-NOS are neurological disorders that affect a child’s ability to communicate, understand language, play, and relate to others.

In the diagnostic manual used to classify disabilities, the DSM-IV (American Psychiatric Association, 1994), “autistic disorder” is listed as a category under the heading of “Pervasive Developmental Disorders.” A diagnosis of autistic disorder is made when an individual displays 6 or more of 12 symptoms listed across three major areas: social interaction, communication, and behavior. When children display similar behaviors but do not meet the criteria for autistic disorder, they may receive a diagnosis of Pervasive Developmental Disorder-NOS (PDD not otherwise specified). Although the diagnosis is referred to as PDD-NOS, throughout the remainder of this fact sheet, we will refer to the diagnosis as PDD, as it is more commonly known.

Autistic disorder is one of the disabilities specifically defined in the Individuals with Disabilities Education Act (IDEA), the federal legislation under which children and youth with disabilities receive special education and related services. IDEA, which uses the term “autism,” defines the disorder as “a developmental disability significantly affecting verbal and nonverbal communication and social interaction, usually evident before age 3, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.”

Due to the similarity of behaviors associated with autism and PDD, use of the term pervasive developmental disorder has caused some confusion among parents and professionals. However, the treatment and educational needs are similar for both diagnoses.

Incidence

Autism and PDD occur in approximately 5 to 15 per 10,000 births. These disorders are four times more common in boys than girls. The causes of autism and PDD are unknown. Currently, researchers are investigating areas such as neurological damage and biochemical imbalance in the brain. These disorders are not caused by psychological factors.

Characteristics

Some or all of the following characteristics may be observed in mind to severe forms

• Communication problems (e.g., using and understanding language) Difficulty in relating to people, objects, and events Unusual play with toys and other objects Difficulty with changes in routine or familiar surroundings Repetitive body movements or behavior patterns

Children with autism or PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak; others have limited language that often includes repeated phrases or conversations. People with more advanced language skills tend to use a small range of topics and have difficulty with abstract concepts. Repetitive play skills, a limited range of interests, and impaired social skills are generally evident as well. Unusual responses to sensory information — for example, loud noises, lights, certain textures of food or fabrics — are also common.

Educational Implications

Early diagnosis and appropriate educational programs are very important to children with autism or PDD. Public Law 105-17, the Individuals with Disabilities Education Act (IDEA), formerly the Education of the Handicapped Children’s Act, includes autism as a disability category. From the age of three, children with autism and PDD are eligible for an educational program appropriate to their individual needs. Educational programs for students with autism or PDD focus on improving communication, social, academic, behavioral, and daily living skills. Behavior and communication problems that interfere with learning sometimes require the assistance of a knowledgeable professional in the autism field who develops and helps to implement a plan which can be carried out at home and school.

The classroom environment should be structured so that the program is consistent and predictable. Students with autism or PDD learn better and are less confused when information is presented visually as well as verbally. Interaction with peers without disabilities is also important, for these students provide models of appropriate language, social, and behavior skills. To overcome frequent problems in generalizing skills learned at school, it is very important to develop programs with parents, so that learning activities, experiences, and approaches can be carried over into the home and community.

With educational programs designed to meet a student’s individual needs and specialized adult support services in employment and living arrangements, children and adults with autism or PDD can live and work in the community.

2. DEAFNESS

Definition

The Individuals with Disabilities Education Act (IDEA) includes “hearing impairment” and “deafness” as two of the categories under which children with disabilities may be eligible for special education and related service programming. While the term “hearing impairment” is often used generically to describe a wide range of hearing losses, including deafness, the regulations for IDEA define hearing loss and deafness separately.

Hearing impairment is defined by IDEA as “an impairment in hearing, whether permanent or fluctuating, that adversely affects a child’s educational performance.”

Deafness is defined as “a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification.”

Thus, deafness may be viewed as a condition that prevents an individual from receiving sound in all or most of its forms. In contrast, a child with a hearing loss can generally respond to auditory stimuli, including speech.

Incidence

Hearing loss and deafness affect individuals of all ages and may occur at any time from infancy through old age. The U.S. Department of Education (2000) reports that, during the 1998-99 school year, 70,813 students aged 6 to 21 (or 1.3% of all students with disabilities) received special education services under the category of “hearing impairment.” However, the number of children with hearing loss and deafness is undoubtedly higher, since many of these students may have other disabilities as well and may be served under other categories.

Characteristics

It is useful to know that sound is measured by its loudness or intensity (measured in units called decibels, dB) and its frequency or pitch (measured in units called hertz, Hz). Impairments in hearing can occur in either or both areas, and may exist in only one ear or in both ears. Hearing loss is generally described as slight, mild, moderate, severe, or profound, depending upon how well a person can hear the intensities or frequencies most greatly associated with speech. Generally, only children whose hearing loss is greater than 90 decibels (dB) are considered deaf for the purposes of educational placement.

There are four types of hearing loss:

• Conductive hearing losses are caused by diseases or obstructions in the outer or middle ear (the conduction pathways for sound to reach the inner ear). Conductive hearing losses usually affect all frequencies of hearing evenly and do not result in severe losses. A person with a conductive hearing loss usually is able to use a hearing aid well or can be helped medically or surgically.
• Sensorineural hearing losses result from damage to the delicate sensory hair cells of the inner ear or the nerves which supply it. These hearing losses can range from mild to profound. They often affect the person’s ability to hear certain frequencies more than others. Thus, even with amplification to increase the sound level, a person with a sensorineural hearing loss may perceive distorted sounds, sometimes making the successful use of a hearing aid impossible.
• Mixed hearing loss refers to a combination of conductive and sensorineural loss and means that a problem occurs in both the outer or middle and the inner ear.
• Central hearing loss results from damage or impairment to the nerves or nuclei of the central nervous system, either in the pathways to the brain or in the brain itself.

Educational Implications

Hearing loss or deafness does not affect a person’s intellectual capacity or ability to learn. However, children who are either hard of hearing or deaf generally require some form of special education services in order to receive an adequate education. Such services may include:

• regular speech, language, and auditory training from a specialist amplification systems services of an interpreter for those students who use manual communication favorable seating in the class to facilitate speech reading captioned films/videos assistance of a note taker, who takes notes for the student with a hearing loss, so that the student can fully attend to instruction instruction for the professional and peers in alternate communication methods, such as sign language counseling

Children who are hard of hearing will find it much more difficult than children who have normal hearing to learn vocabulary, grammar, word order, idiomatic expressions, and other aspects of verbal communication. For children who are deaf or have severe hearing losses, early, consistent, and conscious use of visible communication modes (such as sign language, fingerspelling, and Cued Speech) and/or amplification and aural/oral training can help reduce this language delay. By age four or five, most children who are deaf are enrolled in school on a full-day basis and do special work on communication and language development. It is important for professionals and audiologists to work together to teach the child to use his or her residual hearing to the maximum extent possible, even if the preferred means of communication is manual. Since the great majority of deaf children (over 90%) are born to hearing parents, programs should provide instruction for parents on implications of deafness within the family.

People with hearing loss use oral or manual means of communication or a combination of the two. Oral communication includes speech, speechreading and the use of residual hearing. Manual communication involves signs and fingerspelling. Total Communication, as a method of instruction, is a combination of the oral method plus signs and fingerspelling.

Individuals with hearing loss, including those who are deaf, now have many helpful devices available to them. Text telephones (known as TTs, TTYs, or TDDs) enable persons to type phone messages over the telephone network. The Telecommunications Relay Service (TRS), now required by law, makes it possible for TT users to communicate with virtually anyone (and vice versa) via telephone.

3. DEAF-BLINDNESS

Simultaneous hearing and visual impairments, the combination of which causes such severe communication and other developmental and educational problems that a child cannot be accommodated in special education programs solely for children with deafness or children with blindness.

4. HEARING IMPAIRMENT

A hearing impairment, whether permanent or fluctuating, which adversely affects a child’s educational performance but which is not included under the definition of “deafness.”

5. Intellectual Disability

Definition

People with an Intellectual Disability are those who develop at a below average rate and experience difficulty in learning and social adjustment. The regulations for the Individuals with Disabilities Education Act (IDEA) provide the following technical definition for Intellectual Disability:

“Intellectual Disability means significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child’s educational performance.”

“General intellectual functioning” is typically measured by an intelligence test. Persons with an intellectual disability usually score 70 or below on such tests. “Adaptive behavior” refers to a person’s adjustment to everyday life. Difficulties may occur in learning, communication, social, academic, vocational, and independent living skills.

An intellectual disability is not a disease, nor should it be confused with mental illness. Children with an intellectual disability become adults; they do not remain “eternal children.” They do learn, but slowly, and with difficulty.

Probably the greatest number of children with an intellectual disability have chromosome abnormalities. Other biological factors include (but are not limited to): asphyxia (lack of oxygen); blood incompatibilities between the mother and fetus; and maternal infections, such as rubella or herpes. Certain drugs have also been linked to problems in fetal development.

Incidence

Some studies suggest that approximately 1% of the general population has an intellectual disability (when both intelligence and adaptive behavior measures are used). According to data reported to the U.S. Department of Education by the states, in the 1998-99 school year, 610,445 students ages 6-21 were classified as having an intellectual disability and were provided special education and related services by the public schools. This figure does not include students reported as having multiple disabilities or those in non-categorical special education pre-school programs who may also have an intellectual disability.

Characteristics

Many authorities agree that people with an intellectual disability develop in the same way as people without an intellectual disability, but at a slower rate. Others suggest that persons with an intellectual disability have difficulties in particular areas of basic thinking and learning such as attention, perception, or memory. Depending on the extent of the impairment — mild, moderate, severe, or profound — individuals with an intellectual disability will develop differently in academic, social, and vocational skills.

Educational Implications

Persons with an intellectual disability have the capacity to learn, to develop, and to grow. The great majority of these citizens can become productive and full participants in society.

Appropriate educational services that begin in infancy and continue throughout the developmental period and beyond will enable children with an intellectual disability to develop to their fullest potential.

As with all education, modifying instruction to meet individual needs is the starting point for successful learning. Throughout their child’s education, parents should be an integral part of the planning and teaching team.

In teaching persons with an intellectual disability, it is important to:

• Use concrete materials that are interesting, age-appropriate, and relevant to the students Present information and instructions in small, sequential steps and review each step frequently Provide prompt and consistent feedback Teach these children, whenever possible, in the same school they would attend if they did not have an intellectual disability. Teach tasks or skills that students will use frequently in such a way that students can apply the tasks or skills in settings outside of school Remember that tasks that many people learn without instruction may need to be structured, or broken down into small steps or segments, with each step being carefully taught

Children and adults with an intellectual disability need the same basic services that all people need for normal development. These include education, vocational preparation, health services, recreational opportunities, and many more. In addition, many persons with an intellectual disability need specialized services for special needs. Such services include diagnostic and evaluation centers; special early education opportunities, beginning with infant stimulation programs and continuing through preschool; and educational programs that include age-appropriate activities, functional academics, transition training, and opportunities for independent living and competitive employment to the maximum extent possible.

6. MULTIPLE DISABILITIES

Definition

People with severe and/or multiple disabilities are those who traditionally have been labeled as having severe to profound mental retardation. These people require ongoing, extensive support in more than one major life activity in order to participate in integrated community settings and enjoy the quality of life available to people with fewer or no disabilities. They frequently have additional disabilities, including movement difficulties, sensory losses, and behavior problems.

Incidence

In the 1998-99 school year, the states reported to the U.S. Department of Education that they were providing services to 107,591 students with multiple disabilities (Twenty-Second Annual Report to Congress, 2000).

Characteristics

Children and youth with severe or multiple disabilities may exhibit a wide range of characteristics, depending on the combination and severity of disabilities and the person’s age. Some of these characteristics may include:

• Limited speech or communication Difficulty in basic physical mobility Tendency to forget skills through disuse Trouble generalizing skills from one situation to another A need for support in major life activities (e.g., domestic, leisure, community use, vocational)

Medical Implications

A variety of medical problems may accompany severe disabilities. Examples include seizures, sensory loss, hydrocephalus, and scoliosis. These conditions should be considered when establishing school services. A multi-disciplinary team consisting of the student’s parents, educational specialists and medical specialists in the areas in which the individual demonstrates problems should work together to plan and coordinate necessary services.

Educational Implications

Early intervention programs, preschool and educational programs with the appropriate support services are important to children with severe disabilities. Educators, physical therapists, occupational therapists, and speech-language pathologists are all members of the team that may provide services, along with others, as needed for each individual. Assistive technology, such as computers and augmentative/alternative communication devices and techniques, may provide valuable instructional assistance in the educational programs for students with severe/multiple disabilities.

In order to effectively address the considerable needs of individuals with severe and/or multiple disabilities, educational programs need to incorporate a variety of components, including language development, social skill development, functional skill development (i.e., self-help skills), and vocational skill development. Related services are of great importance, and the appropriate therapists (such as speech and language, occupational, physical, behavioral and recreational therapists) need to work closely with classroom professionals and parents. Best practices indicate that related services are best offered during the natural routine of the school and community, rather than by removing the student from class for isolated therapy.

Classroom arrangements must take into consideration students’ needs for medications, special diets, or special equipment. Adaptive aids and equipment enable students to increase their range of functioning. The use of computers, augmentative/alternative communication systems, communication boards, head sticks, and adaptive switches are some of the technological advances that enable students with severe disabilities to participate more fully in integrated settings.

Integration/inclusion with peers without disabilities is another important component of the educational setting. Research is showing that attending the same school and participating in the same activities as their peers without disabilities is crucial to the development of social skills and friendships for children and youth with severe disabilities. Traditionally, children with severe disabilities have been educated in center-based, segregated schools. However, recently many schools are effectively and successfully educating children with severe disabilities in their neighborhood school within the regular classroom, making sure that appropriate support services and curriculum modifications are available. The benefits to inclusion are being seen to benefit not only those with disabilities but also their peers without disabilities and the professionals who work with them.

Schools are addressing the needs of students in several ways, generally involving a team approach. Modifications to the regular curriculum require collaboration on the part of the special educator, the regular educator, and other specialists involved in the student’s program. Community-based instruction is also an important characteristic of educational programming, particularly as students grow older and where increasing time is spent in the community. School to work transition planning and working toward job placement in integrated, competitive settings are important to a student’s success and the long-range quality of his or her life.

In light of the current Vocational Rehabilitation Act and the practice of supported employment, schools are now using school-to-work transition planning and working toward job placement in integrated, competitive settings rather than sheltered employment and day activity centers.

7. ORTHOPEDIC IMPAIRMENT

A severe orthopedic impairment which adversely affects a child’s educational performance. The term includes impairments caused by a congenital anomaly (e.g. clubfoot, absence of some member, etc.), impairments caused by disease (e.g. poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns which cause contractures).

8. OTHER HEALTH IMPAIRMENT

Having limited strength, vitality or alertness, due to chronic or acute health problems such as a heart condition, tuberculosis, rheumatic fever, nephritis, asthma, sickle cell anemia, hemophilia, seizure disorders, lead poisoning, leukemia, or diabetes, which adversely affects a child’s educational performance. According to the Office of Special Education and Rehabilitative Services’ clarification statement of September 16, 1991, eligible children with ADD may also be classified under “other health impairment.”

9. SERIOUS EMOTIONAL DISTURBANCE

Definition

Many terms are used to describe emotional, behavioral or mental disorders. Currently, students with such disorders are categorized as having a serious emotional disturbance, which is defined under the Individuals with Disabilities Education Act as follows:

“…a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects educational performance–

(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors;

(B) An inability to build or maintain satisfactory interpersonal relationships with peers and professionals;

(C) Inappropriate types of behavior or feelings under normal circumstances;

(D) A general pervasive mood of unhappiness or depression; or

(E) A tendency to develop physical symptoms or fears associated with personal or school problems.” [Code of Federal Regulations, Title 34, Section 300.7(b)(9)]

As defined by the IDEA, serious emotional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have a serious emotional disturbance. [Code of Federal Regulation, Title 34, Section 300.7(b)(9)]

It is important to know that the Federal government is currently reviewing the way in which serious emotional disturbance is defined and that the definition may be revised.

Incidence

For the 1998-99 school year, 463,172 children and youth with a serious emotional disturbance were provided services in the public schools (Twenty-Second Annual Report to Congress, U.S. Department of Education, 2000).

Characteristics

The causes of emotional disturbance have not been adequately determined. Although various factors such as heredity, brain disorder, diet, stress, and family functioning have been suggested as possible causes, research has not shown any of these factors to be the direct cause of behavior problems. Some of the characteristics and behaviors seen in children who have emotional disturbances include:

• Hyperactivity (short attention span, impulsiveness) Aggression/self-injurious behavior (acting out, fighting) Withdrawal (failure to initiate interaction with others; retreat from exchanges of social interaction, excessive fear or anxiety) Immaturity (inappropriate crying, temper tantrums, poor coping skills) Learning difficulties (academically performing below grade level)

Children with the most serious emotional disturbances may exhibit distorted thinking, excessive anxiety, bizarre motor acts, and abnormal mood swings and are sometimes identified as children who have a severe psychosis or schizophrenia.

Many children who do not have emotional disturbances may display some of these same behaviors at various times during their development. However, when children have serious emotional disturbances, these behaviors continue over long periods of time. Their behavior thus signals that they are not coping with their environment or peers.

Educational Implications

The educational programs for students with a serious emotional disturbance need to include attention to mastering academics, developing social skills, and increasing self-awareness, self-esteem, and self-control. Career education (both academic and vocational programs) is also a major part of secondary education and should be a part of every adolescent’s transition plan in his or her Individualized Education Program (IEP).

Behavior intervention planning and implementation are the most widely used approaches to helping children with a serious emotional disturbance. However, there are many other techniques that are also successful and may be used in combination with behavior modification.

Students eligible for special education services under the category of serious emotional disturbance may have IEPs that include psychological or counseling services as a related service. This is an important related service that is available under the law and is to be provided by a qualified social worker, psychologist, guidance counselor, or other qualified personnel.

There is growing recognition that families, as well as their children, need support, respite care, intensive case management services, and multi-agency treatment plan. Many communities are working toward providing these wrap-around services, and there are a growing number of agencies and organizations actively involved in establishing support services in the community. Parent support groups are also important, and organizations such as the Federation of Families for Children’s Mental Health and the National Alliance for the Mentally Ill (NAMI) have parent representatives and groups in every state. Both of these organizations are listed under the resource section of this fact sheet.

Other Considerations

Families of children with emotional disturbances may need help in understanding their children’s condition and in learning how to work effectively with them. Help is available from psychiatrists, psychologists or other mental health professionals in public or private mental health settings. Children should be provided services based on their individual needs, and all persons who are involved with these children should be aware of the care they are receiving. It is important to coordinate all services between home, school, and therapeutic community with open communication.

10. SPECIFIC LEARNING DISABILITY

Definition

The regulations for Public Law (P.L.) 101-476, the Individuals with Disabilities Education Act (IDEA), define a learning disability as a “disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or to do mathematical calculations.”

The Federal definition further states that learning disabilities include “such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.” According to the law, learning disabilities do not include learning problems that are primarily the result of visual, hearing, or motor disabilities; mental retardation; or environmental, cultural, or economic disadvantage. Definitions of learning disabilities also vary among states.

Having a single term to describe this category of children with disabilities reduces some of the confusion, but there are many conflicting theories about what causes learning disabilities and how many there are. The label “learning disabilities” is all-embracing; it describes a syndrome, not a specific child with specific problems. The definition assists in classifying children, not teaching them. Parents and professionals need to concentrate on the individual child. They need to observe both how and how well the child performs, to assess strengths and weaknesses, and develop ways to help each child learn. It is important to remember that there is a high degree of interrelationship and overlapping among the areas of learning. Therefore, children with learning disabilities may exhibit a combination of characteristics.

These problems may mildly, moderately, or severely impair the learning process.

Incidence

Many different estimates of the number of children with learning disabilities have appeared in the literature (ranging from 1% to 30% of the general population). Differences in estimates perhaps reflect variations in the definition. In 1987, the Interagency Committee on Learning Disabilities concluded that 5% to 10% is a reasonable estimate of the percentage of persons affected by learning disabilities. The U.S. Department of Education (2000) reported that, in the 1998-99 school year, over 2.8 million children with learning disabilities received special education and related services.

Characteristics

Learning disabilities are characterized by a significant difference in the child’s achievement in some areas, as compared to his or her overall intelligence.

Students who have learning disabilities may exhibit a wide range of traits, including problems with reading comprehension, spoken language, writing, or reasoning ability. Hyperactivity, inattention, and perceptual coordination problems may also be associated with learning disabilities. Other traits that may be present include a variety of symptoms, such as uneven and unpredictable test performance, perceptual impairments, motor disorders, and behaviors such as impulsiveness, low tolerance for frustration, and problems in handling day-to-day social interactions and situations.
Learning disabilities may occur in the following academic areas:

• Spoken language: Delays, disorders, or discrepancies in listening and speaking Written language: Difficulties with reading, writing, and spelling Arithmetic: Difficulty in performing arithmetic functions or in comprehending basic concepts Reasoning: Difficulty in organizing and integrating thoughts Organization skills: Difficulty in organizing all facets of learning

Educational Implications

Because learning disabilities are manifested in a variety of behavior patterns, the Individual Education Program (IEP) must be designed carefully. A team approach is important for educating the child with a learning disability, beginning with the assessment process and continuing through the development of the IEP. Close collaboration among special class professionals, parents, resource room professionals, regular class professionals, and others will facilitate the overall development of a child with learning disabilities.

Some professionals report that the following strategies have been effective with some students who have learning disabilities:

• Capitalize on the student’s strengths Provide high structure and clear expectations Use short sentences and a simple vocabulary Provide opportunities for success in a supportive atmosphere to help build self-esteem Allow flexibility in classroom procedures (e.g., allowing the use of tape recorders for note-taking and test-taking when students have trouble with written language) Make use of self-correcting materials, which provide immediate feedback without embarrassment Use computers for drill and practice and teaching word processing Provide positive reinforcement of appropriate social skills at school and home Recognize that students with learning disabilities can greatly benefit from the gift of time to grow and mature

11. SPEECH OR LANGUAGE IMPAIRMENT

Definition

Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

Incidence

More than one million of the students served in the public schools’ special education programs in the 1998-99 school year were categorized as having a speech or language impairment. This estimate does not include children who have speech/language problems secondary to other conditions such as deafness. Language disorders may be related to other disabilities such as mental retardation, autism, or cerebral palsy. It is estimated that communication disorders (including speech, language, and hearing disorders) affect one of every 10 people in the United States.

Characteristics

A child’s communication is considered delayed when the child is noticeably behind his or her peers in the acquisition of speech and/or language skills. Sometimes a child will have greater receptive (understanding) than expressive (speaking) language skills, but this is not always the case.

Speech disorders refer to difficulties producing speech sounds or problems with voice quality. They might be characterized by an interruption in the flow or rhythm of speech, such as stuttering, which is called dysfluency. Speech disorders may be problems with the way sounds are formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or quality of the voice. There may be a combination of several problems. People with speech disorders have trouble using some speech sounds, which can also be a symptom of a delay. They may say “see” when they mean “ski” or they may have trouble using other sounds like “l” or “r”. Listeners may have trouble understanding what someone with a speech disorder is trying to say. People with voice disorders may have trouble with the way their voices sound.

A language disorder is impairment in the ability to understand and/or use words in context, both verbally and nonverbally. Some characteristics of language disorders include improper use of words and their meanings, inability to express ideas, inappropriate grammatical patterns, reduced vocabulary and inability to follow directions. One or a combination of these characteristics may occur in children who are affected by language learning disabilities or developmental language delay. Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate.

Educational Implications

Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to find appropriate timely intervention. While many speech and language patterns can be called “baby talk” and are part of a young child’s normal development, they can become problems if they are not outgrown as expected. In this way an initial delay in speech and language or an initial speech pattern can become a disorder which can cause difficulties in learning. Because of the way the brain develops, it is easier to learn language and communication skills before the age of 5. When children have muscular disorders, hearing problems or developmental delays, their acquisition of speech, language and related skills is often affected.

Speech-language pathologists assist children who have communication disorders in various ways. They provide individual therapy for the child; consult with the child’s professional about the most effective ways to facilitate the child’s communication in the class setting; and work closely with the family to develop goals and techniques for effective therapy in class and at home. Technology can help children whose physical conditions make communication difficult. The use of electronic communication systems allow nonspeaking people and people with severe physical disabilities to engage in the give and take of shared thought.

Vocabulary and concept growth continues during the years children are in school. Reading and writing are taught and, as students get older, the understanding and use of language becomes more complex. Communication skills are at the heart of the education experience. Speech and/or language therapy may continue throughout a student’s school year either in the form of direct therapy or on a consultant basis. The speech-language pathologist may assist vocational professionals and counselors in establishing communication goals related to the work experiences of students and suggest strategies that are effective for the important transition from school to employment and adult life.

Communication has many components. All serve to increase the way people learn about the world around them, utilize knowledge and skills, and interact with colleagues, family and friends.

12. TRAUMATIC BRAIN INJURY

Definition

(IDEA) defines traumatic brain injury as…

“…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. The term 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; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.” [34 Code of Federal Regulations §300.7(c)(12)]

A traumatic brain injury (TBI) is an injury to the brain caused by the head being hit by something or shaken violently. This injury can change how the person acts, moves, and thinks. A traumatic brain injury can also change how a student learns and acts in school. The term TBI is used for head injuries that can cause changes in one or more areas, such as:

• thinking and reasoning understanding words remembering things paying attention solving problems thinking abstractly talking behaving walking and other physical activities seeing and/or hearing learning

The term TBI is not used for a person who is born with a brain injury. It also is not used for brain injuries that happen during birth.
The definition of TBI below comes from the Individuals with Disabilities Education Act (IDEA). The IDEA is the federal law that guides how schools provide special education and related services to children and youth with disabilities.

How Common is TBI?

More than one million children receive brain injuries each year. More than 30,000 of these children have lifelong disabilities as a result of the brain injury.

What are the Signs of TBI?

The signs of brain injury can be very different depending on where the brain is injured and how extensively. Children with TBI may have one or more difficulties, including:

Physical disabilities: Individuals with TBI may have problems speaking, seeing, hearing, and using their other senses. They may have headaches and feel tired a lot. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten (this is called spasticity). They may also have seizures. Their balance and walking may also be affected. They may be partly or completely paralyzed on one side of the body, or both sides.

Difficulties with thinking: Because the brain has been injured, it is common that the person’s ability to use the brain changes. For example, children with TBI may have trouble with short-term memory (being able to remember something from one minute to the next, like what the professional just said). They may also have trouble with their long-term memory (being able to remember information from a while ago, like facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a short time. They may think slowly. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding the order in which events happen (called sequencing), and judgment.

Social, behavioral, or emotional problems: These difficulties may include sudden changes in mood, anxiety, and depression. Children with TBI may have trouble relating to others. They may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.

A child with TBI may not have all of the above difficulties. Brain injuries can range from mild to severe, and so can the changes that result from the injury. This means that it’s hard to predict how an individual will recover from the injury. Early and ongoing help can make a big difference in how the child recovers. This help can include physical or occupational therapy, counseling, and special education.

It’s also important to know that, as the child grows and develops, parents and professionals may notice new problems. This is because, as students grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for the student to learn new skills that come with getting older. Sometimes parents and educators may not even realize that the student’s difficulty comes from the earlier injury.

Educational Implications

Although TBI is very common, many medical and education professionals may not realize that some difficulties can be caused by a childhood brain injury. Often, students with TBI are thought to have a learning disability, emotional disturbance, or mental retardation. As a result, they don’t receive the type of educational help and support they really need.

When children with TBI return to school, their educational and emotional needs are often very different than before the injury. Their disability has happened suddenly and traumatically. They can often remember how they were before the brain injury. This can bring on many emotional and social changes. The child’s family, friends, and professionals also recall what the child was like before the injury. These other people in the child’s life may have trouble changing or adjusting their expectations of the child.

Therefore, it is extremely important to plan carefully for the child’s return to school. Parents will want to find out ahead of time about special education services at the school. This information is usually available from the school’s principal or special education professional. The school will need to evaluate the child thoroughly. This evaluation will let the school and parents know what the student’s educational needs are. The school and parents will then develop an Individualized Education Program (IEP) that addresses those educational needs.

It’s important to remember that the IEP is a flexible plan. It can be changed as the parents, the school, and the student learn more about what the student needs at school.

Tips for Parents

Learn about TBI. The more you know, the more you can help yourself and your child. See the list of resources and organizations at the end of this publication. Work with the medical team to understand your child’s injury and treatment plan. Don’t be shy about asking questions. Tell them what you know or think. Make suggestions. Keep track of your child’s treatment. A 3-ring binder or a box can help you store this history. As your child recovers, you may meet with many doctors, nurses, and others. Write down what they say. Put any paperwork they give you in the notebook or throw it in the box. You can’t remember all this! Also, if you need to share any of this paperwork with someone else, make a copy. Don’t give away your original! Talk to other parents whose children have TBI. There are parent groups all over the U.S. Parents can share practical advice and emotional support. If your child was in school before the injury, plan for his or her return to school. Get in touch with the school. Ask the principal about special education services. Have the medical team share information with the school. When your child returns to school, ask the school to test your child as soon as possible to identify his or her special education needs. Meet with the school and help develop a plan for your child called an Individualized Education Program (IEP). Keep in touch with your child’s professional. Tell the professional about how your child is doing at home. Ask how your child is doing in school.

Tips for Teachers

Find out as much as you can about the child’s injury and his or her present needs. Find out more about TBI. See the list of resources and organizations at the end of this publication. Give the student more time to finish schoolwork and tests. Give directions one step at a time. For tasks with many steps, it helps to give the student written directions. Show the student how to perform new tasks. Give examples to go with new ideas and concepts. Have consistent routines. This helps the student know what to expect. If the routine is going to change, let the student know ahead of time. Check to make sure that the student has actually learned the new skill. Give the student lots of opportunities to practice the new skill. Show the student how to use an assignment book and a daily schedule. This helps the student get organized. Realize that the student may get tired quickly. Let the student rest as needed. Reduce distractions. Keep in touch with the student’s parents. Share information about how the student is doing at home and at school. Be flexible about expectations. Be patient. Maximize the student’s chances for success.

13. VISUAL IMPAIRMENT, INCLUDING BLINDNESS

Definition

The terms partially sighted, low vision, legally blind, and totally blind are used in the educational context to describe students with visual impairments. They are defined as follows:

“Partially sighted” indicates some type of visual problem has resulted in a need for special education;

“Low vision” generally refers to a severe visual impairment, not necessarily limited to distance vision. Low vision applies to all individuals with sight who are unable to read the newspaper at a normal viewing distance, even with the aid of eyeglasses or contact lenses. They use a combination of vision and other senses to learn, although they may require adaptations in lighting or the size of print, and, sometimes, Braille;

“Legally blind” indicates that a person has less than 20/200 vision in the better eye or a very limited field of vision (20 degrees at its widest point)

Totally blind students learn via Braille or other non-visual media.

Visual impairment is the consequence of a functional loss of vision, rather than the eye disorder itself. Eye disorders that can lead to visual impairments can include retinal degeneration, albinism, cataracts, and glaucoma, muscular problems that result in visual disturbances, corneal disorders, diabetic retinopathy, congenital disorders, and infection.

Incidence

The rate at which visual impairments occur in individuals under the age of 18 is 12.2 per 1,000. Severe visual impairments (legally or totally blind) occur at a rate of .06 per 1,000.

Characteristics

The effect of visual problems on a child’s development depends on the severity, type of loss, age at which the condition appears, and overall functioning level of the child. Many children who have multiple disabilities may also have visual impairments resulting in motor, cognitive, and/or social developmental delays.

A young child with visual impairments has little reason to explore interesting objects in the environment and, thus, may miss opportunities to have experiences and to learn. This lack of exploration may continue until learning becomes motivating or until intervention begins.

Because the child cannot see parents or peers, he or she may be unable to imitate social behavior or understand nonverbal cues. Visual handicaps can create obstacles to a growing child’s independence.

Educational Implications

Children with visual impairments should be assessed early to benefit from early intervention programs, when applicable. Technology in the form of computers and low-vision optical and video aids enable many partially sighted, low vision and blind children to participate in regular class activities. Large print materials, books on tape, and Braille books are available.

Students with visual impairments may need additional help with special equipment and modifications in the regular curriculum to emphasize listening skills, communication, orientation and mobility, vocation/career options, and daily living skills. Students with low vision or those who are legally blind may need help in using their residual vision more efficiently and in working with special aids and materials. Students who have visual impairments combined with other types of disabilities have a greater need for an interdisciplinary approach and may require greater emphasis on self-care and daily living skills.

Conclusion

In order to better understand transition services, it is critical to fully understand the population that will be receiving them. Since there are many factors that must be considered to insure that the each students transition plan is practical, useful and fulfilling, a strong working knowledge and overall sensitivity to the needs of the various of children with exceptionalities is a basic responsibility of all special educators.

From Transition Services in Special Education: A Practical Approach

Roger Pierangelo, Long Island University
George A. Giuliani, Hofstra University

ISBN: 0-205-34569-7
Publisher: Allyn & Bacon
Copyright: 2004
Format: Paper; 272 pp
Published: 09/09/2003

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