(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Chapter Ten Teaching Students with Autism, Traumatic Brain Injury, and Other Low- Incidence Disabilities.

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Slide 1 Slide 2 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Chapter Ten Teaching Students with Autism, Traumatic Brain Injury, and Other Low- Incidence Disabilities This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or in part, of any images; any rental, lease, or lending of the program. Slide 3 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Introduction In addition to sensory impairments, there are many other conditions that occur relatively rarely in children. These conditions include: Autism Traumatic Brain Injury Many Different Physical and Health Problems Slide 4 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 IDEA Definition Other Health Impairment is defined as having limited strength, vitality, or alertness, due to chronic or acute problems such as a heart condition, tuberculosis, rheumatic fever, nephritis, asthma, sickle cell anemia, hemophilia, epilepsy, lead poisoning, leukemia, or diabetes that adversely affects a childs educational performance. Slide 5 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 IDEA Definition Orthopedic impairment is defined as a severe orthopedic impairment that adversely affects a childs educational performance. Slide 6 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Types of Orthopedic Impairments Congenital Anomalies Examples: clubfoot, absence of some member Impairments Caused by Disease Examples: poliomyelitis, bone tuberculosis Impairments From Other Causes Examples: cerebral palsy, amputations, fractures or burs Slide 7 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Need for a Collaborative Approach General education teachers should have the following personnel to assist them in meeting the needs of these students: Behavioral specialists Psychologists Physical therapists Occupational therapists Nurses Other health personnel Slide 8 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Autism Autism is a pervasive developmental disorder that primarily affects: Social interactions Language Behavior Autism has a significant impact on individuals and their families. The characteristics of autism differ significantly among individuals with this disorder (i.e., autism is a spectrum disorder). Slide 9 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 History of Autism Autism has a confusing and controversial history. This condition was first described 50 years ago by Dr. Leo Kanner. Early controversy surrounded the erroneous belief that autism was caused by poor mother-child bonding. During the 1980s, autism was found to be an organic disorder. Autism was deemed a separate disability category under the IDEA in 1990. Slide 10 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 IDEA Definition of Autism Autism is a developmental disability that primarily results in significant deficits in verbal and non-verbal communication and social interactions, generally evidenced before the age of 3 years and adversely affects the childs educational performance. Slide 11 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Autism typically appears within the first three years of life. Autism is the result of a neurological disorder that affects brain function. Autistic behaviors have been estimated to occur in as many as 1 in 500 individuals. Autism is four times more prevalent in boys than girls. There are no racial, ethic, or social differences among students who have autism. Some Facts About Autism Slide 12 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Students with autism typically have difficulties with: Verbal and Non-Verbal Communication Social Interactions Leisure or Play Activities Repeated Body Movements Unusual Responses to People or Attachments to Objects Resistance in Changes in Routine Common Difficulties Slide 13 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Prevalence of Autism Autism is a relatively rare condition although the number of children identified has increased dramatically over the past few years. The incidence of autism varies widely depending on the definition used. More restrictive definitions suggest that approximately 0.7 to 2.3 individuals per 10,000 persons have autism. Less restrictive definitions indicate that autism may occur in as many as 7 to 14 per 10,000 persons. Approximately 0.10% of the school-age population was identified as having autism during the 1999- 2000 school year. Slide 14 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Causes of Autism There is no single cause of autism. Some causes are: Brain Damage Genetic Links Pregnancy Complications In most cases, a cause cannot be determined. Students who are at higher risk for autism include those: born with rubella who have fragile X syndrome Slide 15 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Behavioral Deficits and Excesses Associated with Autism (Webber, 2002) Behavioral Deficits Inability to relate to others Lack of functional language Sensory processing deficits Cognitive deficits Behavioral Excesses Self-stimulation Resistance to change Bizarre and challenging behaviors Self-injurious behaviors Slide 16 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Positive Autism Characteristics Some children with autism present some positive characteristics including: Hyperplexia Splinter Skills Slide 17 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Classroom Adaptations for Students with Autism Intensive interventions have been somewhat effective for students with autism. No single method is effective with all children with autism. Slide 18 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Inclusion of Students with Autism Growing evidence suggests that placing students with autism with their nondisabled peers in general education settings, with appropriate supports, can make a difference in their behaviors. Gains that may occur include: Increases intellectual and adaptive behavior Improved social skills Slide 19 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Important Principles for Program Development Use of Functional Activities Design of a Program Appropriate for the Students Developmental Level and Chronological Age Questions to be Considered: Does the program teach skills that are immediately useful? Will the materials used be available in the students daily environment? Will learning certain skills make it less likely that someone will have to do the task for the student in the future? Slide 20 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Self-Management Strategies Self-management is a promising intervention strategy for students with autism. This approach incorporates: Self-recording Self-reinforcement Self-management strategies can be used to address: Self-injurious behavior Delayed echolalic speech Stereotypical behavior Slide 21 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Facilitated Communication Facilitated communication is a process in which a facilitator helps the person with autism type or use a keyboard for communication purposes. Recent research has cast doubt on its effectiveness. Slide 22 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Asperger Syndrome This syndrome was first described in 1944 but was ignored for many years. Students with Asperger syndrome share many characteristics with those who have autism. Unique features of Asperger include: Higher cognitive development Better communication skills Slide 23 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Teaching Students with Asperger Syndrome There is not single method to teach student with Asperger syndrome. Areas that should be considered include: Using visual strategies Using structural strategies Providing logical instructional strategies Slide 24 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Traumatic Brain Injury (TBI) TBI was added as a separate disability category under IDEA in 1990. TBI is the most common cause of death and disability among children in the U.S. Each year, more than 1 million children suffer from, and 9% to 38% of these students are referred for special education services. This means that many children with TBI are not served in special education programs. Slide 25 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 IDEA Definition of TBI Traumatic brain injury 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 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, perceptual and motor abilities, psychosocial behavior, physical functions, information processing, and speech. The term does not apply to brain injuries that are congenital, degenerative, or induced by birth trauma. Slide 26 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Causes of TBI Falls Vehicle Accidents Abuse Lack of Oxygen to the Brain Infections Tumors Strokes Slide 27 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Persisting Deficits Associated with TBI Social-emotional and cognitive deficits caused by TBI may persist long after physical capabilities recover. These include: Inability to Concentrate Poor Short-Term Memory Poor Self-Confidence/Self-Esteem Personality Changes Slide 28 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Prognosis for Students with TBI The prognosis for recovery is very variable and depends on many factors such as: Type of injury Rapidity and quality of medical and surgical care Rehabilitation Educational intervention Slide 29 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Classroom Adaptations for Students with TBI The transition of students with TBI from rehabilitation facilities to school settings needs to be coordinated among a number of professionals. Teachers may need to address the significant amount of schooling the student has missed. An appropriate program includes evaluating the impact of the injury on functioning and potential learning. Slide 30 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Effective Instructional Strategies for Students with TBI Retaining Impaired Cognitive Processes Developing New Skills or Procedures to Compensating for Residual Deficits Creating an Environment that Permits Effective Performance Identifying Effective Instructional Procedures Improving Metacognitive Awareness Slide 31 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Types of Health Problems and Physical Disabilities Asthma Childhood Cancer Cystic Fibrosis Deaf-Blind Diabetes (Juvenile Diabetes) HIV and AIDS Muscular Dystrophy Spina Bifida Tourette Syndrome Slide 32 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Asthma is the most common chronic childhood illness in children, affecting about 3 million children under the age of 15. Asthma is characterized by episodes of coughing, shortness of breath, and wheezing, resulting from the narrowing of small air passages,. Asthma is caused by irritation of the bronchial tubes due to allergic reactions to various substances. Asthma attacks can be very dangerous and should be taken seriously by school personnel. Asthma Slide 33 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Suggestions for Teachers Develop an effective system for addressing makeup work issues. Recognize the side effects of prescribed medications. Sensitize other students in the class to the nature of allergic reactions. Determine what types of physical limitations might have to be set. Work on building up the students self-image. Eliminate any known allergens found in the classroom. Introduce a vaporizer or humidifier to the classroom when needed. Allow students to rest when needed, as they often tire easily. Allow the student to participate in nonstressful activity until an episode subsides. Ensure that students have proper medications and take them at appropriate times. Work on building the students self- image. Know the signs and symptoms of respiratory distress. Slide 34 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Is the school free of tobacco all of the time, including during school-sponsored events? Does the school maintain good indoor air quality? Is a school nurse in the school all day, every day? Can students take medicines at school as recommended by the doctors and parents? Does the school have an emergency plan for taking care of a child with a severe asthma attack? Does someone teach school staff about asthma, asthma management plans, and asthma medications? Do students with asthma have good options for fully and safely participating in physical education class and recess? Important Questions School Personnel Need to Ask Slide 35 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Childhood Cancer Childhood cancer occurs in approximately 1 in 330 children prior to the age of 19. Types of childhood cancer include: Leukemia Lymphoma Tumors of the Central Nervous System Bone Tumors Tumors Affecting the Eyes Tumors Affecting Various Organs Slide 36 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Suggestions for Meeting the Needs of Children with Cancer Express your concern about a students condition to parents and family. Learn about a students illness from parents and hospital personnel. Inquire about the type of treatment and anticipated side effects. Refer the student for any needed special education services. Prepare for a students terminal illness and possible death. Encourage discussion and consideration of future events. Slide 37 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Suggestions for Meeting the Needs of Children with Cancer Allow for exceptions to classroom rules and procedures when indicated. Be available to talk with a student when the need arises. Share information about the students condition and status with teachers and students siblings. Be prepared to deal with issues concerning death and dying with students. Provide information to school staff and parents, as needed. Facilitate the students reentry into school after an extended absence. Slide 38 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Cerebral Palsy (CP) CP is a disorder of movement that is caused by brain damage. CP affects the voluntary muscles and often leads to major problems in communication and mobility. CP is neither progressive nor communicable. Education, therapy, and applied technology can help persons with CP lead productive lives. Between 6 and 10 individuals for every 10,000 persons have CP. Slide 39 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Methods for Classifying CP By Type Physiological By Distribution Topological By Degree of Severity Slide 40 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Intervention Approach for CP Primary focus is on meeting physical needs. Intervention may include: Physical Therapy Occupational Therapy Surgery Slide 41 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Suggestions Consult physical and occupational therapists. Understand the functions and components of a wheelchair. Ask students to repeat verbalizations that may be hard to understand. Encourage students to use computers that are equipped with expanded keyboards or other portable writing aids. Learn the correct way to position and handle the student and how to use adaptive equipment. Allow extra time for students to move from one location to another. Consider the use of augmentative communication devices. Provide many real-life activities. Create a supportive classroom environment that encourages participation. Slide 42 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Cystic Fibrosis Cystic fibrosis is an inherited, fatal disease that results in an abnormal amount of mucus throughout the body, most often affecting the lungs and digestive tract. Cystic fibrosis occurs in approximately 1 in every 2,000 live births. Most children with cystic fibrosis live to their mid-teens. As the diseases progresses, it greatly affects stamina and the students physical conditions. Slide 43 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Suggestions Prepare students for the eventual outcomes of the disease by raising the topic of death and dying. Consider restricting certain physical activities. Provide opportunities for students to talk about their concerns, fears, and feelings. Ensure that the student is included in all class activities to whatever extent is possible. Learn how to clear a students lungs and air passages, as such assistance may be needed after certain activities. Support the implementation of special diets, if needed. Know the medications a student must take and be able to administer them. Prepare students in class for the realities of this disease (e.g., coughing, non- contagious sputum, gas) Slide 44 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Students Who Are Deaf-Blind Students who have both visual and hearing impairments present unique challenges for educators. Students who are both deaf and blind have needs that are extremely complex. Dual sensory impairment or multiple sensory impairments are considered more appropriate terms than deaf-blind even though this term is still used in the IDEA. Slide 45 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Students Who Are Deaf-Blind Students who are classified as being deaf- blind may have degrees of visual and auditory impairments that do not classify as blindness or deafness. Estimates are that 94% of these students have residual hearing or sight. During the 1999-2000 school year, only 1,845 students, nationwide, were identified as deaf- blind and were served in special education programs. Slide 46 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Suggestions Use an ecological approach to assessment and skill selection to emphasize functional needs of students. Use time delay prompting, where time between prompts is increased. Use a variety of prompts, cues, and reinforcement strategies in a systematic instructional pattern. Use groups and cooperative learning strategies. Slide 47 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Diabetes (Juvenile Diabetes) Diabetes affects about 8 million people in the U.S. Diabetes is a metabolic disorder in which the pancreas cannot produce sufficient insulin to process food. Teachers should be alert to possible symptoms of diabetes including: Increased thirst, appetite, and urination Weight loss Irritability Slide 48 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Diabetes (Juvenile Diabetes) Children with Type I (insulin-dependent) diabetes must take daily injections of insulin. School personnel must have knowledge about the special dietary needs of children and understand their need for a daily activity regimen. Slide 49 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Suggestions Communicate regularly with the family to determine any special needs the student may have. Schedule snacks and lunch at the same time every day. Help the student deal with the disease. Be prepared for hypoglycemia a situation in which the student needs sugar. Understand the distinction between having too much insulin in the body and not having enough. Slide 50 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Epilepsy Epilepsy is a series of recurrent convulsions, or seizures, that are caused by abnormal electrical discharges in the brain. There are several different types of epilepsy, determined by the impact of abnormal electrical activity. Approximately 1% of the population of the U.S. has epilepsy. No common characteristics are shared by people with epilepsy. Slide 51 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Signs of Epilepsy Staring Spells Tic-Like Movements Rhythmic Movements of the Head Purposeless Sounds and Body Movements Head Drooping Lack of Response Eyes Rolling Upward Chewing and Swallowing Movements Slide 52 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Medication and Epilepsy Medication is the primary intervention for students with epilepsy. Even persons who respond very well to medications have occasional seizures. Teachers and school personnel need to know the steps to be taken in the event of a seizure. Teachers, parents, and others should record behaviors before, during and after the seizure. Slide 53 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About HIV and AIDS Human immunodeficiency virus (HIV) infection occurs when the virus attacks the bodys immune system, leaving an individual vulnerable to infections or cancers. In its later stages, HIV becomes acquired immunodeficiency syndrome (AIDS). HIV/AIDS is transmitted only through the exchange of blood or semen. Two of the fastest-growing groups contracting HIV are infants and teenagers. In 1996, there were 7,472 cases of AIDS in children under the age of 13. Teachers need to take precautions when dealing with HIV/AIDS. Slide 54 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Guidelines Follow the guidelines (universal precautions) developed by the Centers for Disease Control and the Food and Drug Administration for working with individuals affected with HIV/AIDS. Ask the students physician whether there are any special procedures that must be followed. Discuss HIV/AIDS with the entire class, providing accurate information, dispelling myths, and answering questions. Discuss with students in the class that a students skills and abilities will change over time if he or she is infected with HIV/AIDS. Slide 55 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Guidelines Prepare for the fact that the student may die, especially if AIDS is present. Be sensitive to the stress that the students family is undergoing. Ensure that the student with HIV/AIDS is included in all aspects of classroom activities. Slide 56 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Muscular Dystrophy Muscular dystrophy is an umbrella term used to describe several different types of inherited disorders that result in progressive muscular weakness. Duchenne Dystrophy: The most common and serious form of muscular dystrophy In this type of muscular dystrophy, fat cells and connective tissue replace muscle tissue. This form of muscular dystrophy results in an inability to walk, typically by age 12. Individuals with this type of dystrophy typically die during young adulthood. Teachers must adapt their classrooms to accommodate the physical needs of these students. Slide 57 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Suggestions Prepare other students in class for the realities of the disease. Understand the functions and components of wheelchairs. Be familiar with different types of braces. Use assistive techniques that do not hurt the individual. Monitor the amount of time the student is allowed to stand during the day. Involve the student in as many classroom activities as possible. Monitor the administration of required medications. Be prepared to help the student deal with the loss of various functions. Slide 58 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Spina Bifida Spina bifida is a congenital condition characterized by a malformation of the vertebrae and spinal cord. Spina bifida occurs in about 1 in every 2,000 births. School personnel must ensure appropriate use of wheelchairs and make accommodations for limited use of arms and hands. Slide 59 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Three Types of Spina Bifida Spina Bifida Occulta Least serious form Occurs when vertebral column fails to close properly leaving a hole in the bony vertebrae Surgical closure is undertaken Meningocele Similar to spina bifida occulta except that it includes outpouching without nervous tissue Surgical correction is undertaken Myelomeningocele Most common and serious form Similar to meningocele except that outpouching includes nervous tissue Generally results in permanent paralysis Slide 60 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Suggestions Notify parents if there are any unusual physical or behavioral changes. Learn proper positioning and handling techniques. Help the student develop a positive, healthy self-concept. Understand how to use and maintain a wheelchair. Ensure the full participation of students in all classroom activities. Maintain a safe physical environment that minimizes the risk of accidents. Be ready to deal with occasional incontinence of students. Learn about the various type of adaptive equipment the student may use. Understand the process of clean intermittent catheterization. Learn about any medical needs the student may have. Slide 61 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Tourette Syndrome Tourette syndrome is a neuropsychiatric disorder that occurs in males three times as often as in females. The prevalence rate for males is as high as 1 in 1,000. This syndrome is characterized by multiple motor and or more vocal tics. These tics may occur many times a day, nearly every day, or intermittently. Slide 62 (c) Allyn & Bacon 2004Copyright Allyn and Bacon 2004 Basic Concepts About Tourette Syndrome Characteristics of Tourette syndrome include: Motor tics Inappropriate laughing Rapid eye movements Winks and grimaces Aggressive behaviors In some cases: Mental retardation Mild to moderate incoordination Peculiar verbalizations

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