Transcript
Page 1: (c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Chapter Ten Teaching Students with Autism, Traumatic Brain Injury, and Other Low- Incidence Disabilities

(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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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

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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 child’s

educational performance.”

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IDEA Definition

Orthopedic impairment is defined as “a severe orthopedic impairment that adversely affects a child’s educational performance.”

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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

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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

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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”).

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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.

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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 child’s educational performance.”

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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

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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

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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.

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Causes of AutismThere 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

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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

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Positive Autism Characteristics

Some children with autism present some positive characteristics including:

Hyperplexia Splinter Skills

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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.

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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

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Important Principles

for Program Development

Use of Functional Activities Design of a Program Appropriate for the

Student’s 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 student’s

daily environment? Will learning certain skills make it less likely that

someone will have to do the task for the student in the future?

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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

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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.

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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

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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

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Basic Concepts AboutTraumatic 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.

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IDEA Definition of TBITraumatic 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.

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Causes of TBI

Falls Vehicle Accidents Abuse Lack of Oxygen to the Brain Infections Tumors Strokes

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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

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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

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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.

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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

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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

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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

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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 student’s 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 student’s self-image.

Know the signs and symptoms of respiratory distress.

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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

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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

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Suggestions for Meeting the Needs of Children with Cancer

Express your concern about a student’s condition to parents and family.

Learn about a student’s 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 student’s terminal illness and possible death.

Encourage discussion and consideration of future events.

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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 student’s condition and status with teachers and student’s siblings.

Be prepared to deal with issues concerning death and dying with students.

Provide information to school staff and parents, as needed.

Facilitate the student’s reentry into school after an extended absence.

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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.

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Methods for Classifying CP

By Type Physiological

By Distribution Topological

By Degree of Severity

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Intervention Approach for CP

Primary focus is on meeting physical needs.

Intervention may include: Physical Therapy Occupational Therapy Surgery

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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.

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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 student’s physical conditions.

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Suggestions

Prepare students for the eventual outcomes of the disease by raising the topic of death and dying.

Consider restricting certain physical activities.

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 student’s 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)

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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.

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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.

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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.

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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

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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.

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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.

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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.

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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

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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.

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Basic Concepts About HIV and AIDS

Human immunodeficiency virus (HIV) infection occurs when the virus attacks the body’s 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.

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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 student’s 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 student’s skills and abilities will change over time if he or she is infected with HIV/AIDS.

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Guidelines Prepare for the fact that the

student may die, especially if AIDS is present.

Be sensitive to the stress that the student’s family is undergoing.

Ensure that the student with HIV/AIDS is included in all aspects of classroom activities.

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Basic ConceptsAbout 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.

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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.

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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.

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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

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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.

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(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.

Page 61: (c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Chapter Ten Teaching Students with Autism, Traumatic Brain Injury, and Other Low- Incidence Disabilities

(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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