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CATEGORIES OF DISABILITIES
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(A COMPILATION)

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by Diana Rose B. Zamoras

October 2014

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BLINDNESS AND LOW VISION
LEGAL DEFINITION - based on measurement of :

Visual Acuity - is the ability to clearly distinguish forms or discriminate details at a

specific distance.
- measured by reading letters, numbers and other symbols from a chart 20 feet
away.

Field of Vision
- refers to the area that normal eyes cover above, below and on both sides while
looking at an object or when gazing straight ahead.

Peripheral Vision
- covers the outer ranges of the field of vision.

EDUCATIONAL DEFINITION

Total Blindness
- the person is absolutely without sight but may have light and movement
perception
and travel vision.
- use sense of touch to read braille and train in orientation and mobility to move
around and travel independently.

Low Vision
- is a level of vision that with standard correction hinders an individual in the
visual
planning and execution of tasks, but which permits enhancements of the
functional
vision through the use of optical or non-optical aids and environmental
modifications
or techniques.

FIVE PHYSIOLOGICAL OR PHYSICAL SYSTEMS IN VISION

the protective structures

- surround the eye to protect it from harm.
- these are the bony eye socket in the skull and the protruding bones in the
cheeks
and forehead, the lacrimation system or tear ducts, the eyebrows, eyelids and
eyelashes.

the refractive structures

- bend or refract light rays so that the image of the object focuses on the retina.

muscles- function to coordinate and balance the movements of the eyes.

 the retina and the optic nerve
retina - is a multilayered sheet of nerve tissues at the back of the eye.
optic nerve - is connected to the retina and conducts visual images to the
brain.

the brain - where vision takes place.

PARTS OF THE EYE

TYPES AND CAUSES OF PROBLEMS OF VISIONS

Errors of Refraction
- after the light rays enter the cornea, acqueous humour and pupil and the lens
fails to refract and bend the light rays to focus on the central part of the retina,
errors of refraction occur.

Hyperopia or farsightedness - the lens fails to focus the light rays from near
object on the retina.
- convex lenses are prescribed to converge the light rays on the retina.

Myopia or nearsightedness - the eyes are abnormally long from front to back and
the lens fails to refract the light rays from distant objects on the retina.
- concave lenses are prescribed to diverge the light rays from far objects on the
retina.

Astigmatism- the cornea which formally forms a portion of a spherical lens is

deformed, the refraction of light rays becomes faulty and blurred vision results.
- cylindrical lens which corrects the direction of the spherical lens.
 Imbalance of the Eye Muscles
- When the muscles of both eyes do not work together in a coordinated way,
imbalance of the eye muscles occurs.

Amblyopia - occurs when vision is suppressed

in one eye and it becomes weak or useless.

Nystagmus - is a condition in which there are rapid involuntary movements of the

eyeball that can result to nausea and vomiting and dizziness.

Diseases of the Eye

Cataract - caused by the clouding of the lens which results to progressive blurring
of vision and eventually blindness occurs.

Diabetic retinopathy - occurs when diabetes mellitus interferes with the flow of
blood to the retina causing it to degenerate.

Diseases of the Retina - most sensitive part of the visual mechanism, can be
congenitalor present at birth.

Coloboma - is a degenerative diseases in which the central and or peripheral areas

of the retina are not completely formed.

Retinitis pigmentosa - is a hereditary condition that results in the degeneration of

the retina.

Glaucoma - is a condition in which there is excessive pressure in the eye.

Trauma or Accidents

SPECIAL ADAPTATIONS,AIDS AND TECHNOLOGY FOR STUDENTS WHO ARE

BLIND AND WITH LOW VISION:

Braille system of reading and writing in which letters,words,numbers and other

systems are made from arrangements of raised or embossed dots.
Typewriter - to communicate with their teachers, classmates and friends.
Manipulatives and tactile aids - used in learning mathematics, sciences and
social studies.
- cuisenaire rods
- cranner abacus
- speech-plus talking calculator
- braille
- verbal or taped instructions
Technological Aids - The Optacon (optical-to-tactile converter) is a small
electronic device that converts regular print into a readable vibrating form for
blind people.
Assistive Technology- enables blind persons to access to personal computers.
- use speech recognition software to enable the user to tell the computer what to
do.
EDUCATIONAL PLACEMENT

Integration of blind students in regular classes started in 1960s as a

component of the teacher training program for selected public school
teachers.
Schools are operating on the principle of placement in the least restrictive
environment.
SPED centers were established to function as a resource center.
Inclusive Education
blind boys and girls with average or better mental ability were enrolled in
regular classes.
Special Education teacher teaches skills and concepts that most children
learn visually through the remaining senses.
Students were taught and learn to read & write in the braille.

Alternative Models in delivery of Educational Service

Community Based Rehabilitation (CBR) Services

As an alternative delivery system, the approach of CBR has widely been
recognized and accepted as the most suitable and viable way of providing
comprehensive rehabilitation services and equal opportunities to the majority of
persons with disabilities.

Community Based SPED Program

This is an instructional delivery system where the child with special needs is
taught particular skills in a natural setting such as the home or any convenient
place in the community. This serves as an outreach program of the Special
Education Division of the Department of Education addressing the needs of out-of-
school handicapped children and youth ages 8-18 years old.

Vocational Program
The ultimate aim of education is to develop in the learner desirable
knowledge, skills, values and attitudes that can effectively used to alleviate poverty
and improve the quality of life of the individual. Thus, vocational program is an
important component of the curriculum for children with special needs.
Educational opportunities and other services are provided in order to maximize their
potentials and become productive and improve their quality of life, thus ensuring
their integration in the mainstream of society.

GENERAL APPROACHES

For Students who are blind:

Braille is the primary means of literacy . Student learn to read and write in
braille by using a brailler which operates like a typewriter with six keys.

portable laptop computer called VersaBraille II + (Telesensory System Inc.)

 Blind students use regular typewriter to communicate with their teachers,
classmates and friends.

Manipulatives and tactile aids used in learning mathematics, sciences and

social studies.

Technological Aids ex. Optacon (optical-to-tactile converter) system that

scans and reads via a synthetic voice typeset and other printed matter.

Assistive technology enable access to personal computers

For Low Vision:

Uses special optical devices to enlarge or magnify regular print.

ex.: corrective eyeglasses, contact lenses, magnifier stand (for reading smaller
print), monocular (one-eye) telescope, small hand-held telescope, magnifier, field
widening lenses
Books and other materials with large print

Classroom modification desks with adjustable or tilting top, special lamps

or special writing paper with a dull finish and off white color reduces
glare were provided.

Recorded books, magazines and other materials come with the synthetic
speech equipment.

Helpful Guidelines Whenever a Blind or a Low Vision Students are

Mainstreamed in Your Class
Use the words look and see when communicating with a blind person.

Introduce him or her as you would any of your students.

Include him or her in all class activities.

Extend the same opportunity to the blind child.

The same disciplinary rules that apply to the rest of the class should apply as
well to the child with visual impairment.

Encourage the child to move about the classroom to get the materials or to
do certain activities.

Give verbal instructions or oral cues.

Provide space to accommodate his or her special materials.

Motivate the seeing classmates to become interested in topics related to

vision and visual impairment.
 When approaching the blind student, unless he or she knows you, always say
who you are instead of asking him or her to guess who you are.

Consult the special education teacher whenever a need arises.

TOP 10 FAMOUS PEOPLE WHO ARE VISUALLY

IMPAIRED

1. Marla Runyan
Born in 1969 in Santa Maria, California, Runyan has
Stargardts disease, a degenerative eye condition
that caused her to become legally blind.
An avid marathon runner with a masters degree in special education
A three-time national champion in the womens 5000 meter, Runyan
competed in the 1500-meter finals at the 2000 Olympics in Sydney, Australia.

Runyan is a professional motivational speaker.

She said she was inspired to succeed as a young child, after a doctor told her
that her blindness would prevent her from achieving success in life.

Runyan also reaches out to children and families dealing

with vision loss. The future is not written and you have
control about how you respond to the vision loss, she has
said. Your child will show you what he or she wants to
do.
2. Joseph Pulitzer
He was known for his hard stance against
corruption and illegal gain.

Pulitzer used his political clout and investigative

reporting skills to expose illegal lotteries, gambling
rings and tax dodgers. In 1883, he bought New York World and worked to
expose the seedy underbelly of public government waste and fraud.

During these acquisitions, Pulitzers eyes were failing him and he was
completely blind by 1889.

However, he never turned a blind eye to social crimes and continued to be a

watch-dog for injustice.

Pulitzer died in 1911 and left behind more than $2 million to establish a
school of journalism at New Yorks Columbia University.
 In his honor, the Pulitzer Prizes which are considered the top national honor
for music, literature and journalism are awarded every year.

3. Andrea Bocelli
Born in 1958 in Lajatico, Italy, Bocelli went blind at age 12, when a blow to his
head during a soccer game further
complicated his congenital glaucoma.

He worked for years as a lawyer and

practiced his hobby of singing in
piano bars and parties on weekends.

A talent scout happened to hear him

sing at a party he attended and signed
him to a recording deal.

He is best known for his sweet songs, such as Con Te Partir, a duet with
Sarah Brightman and has released several multi-platinum albums throughout
Europe and the United States.

All that counts in life is intention, he is quoted as saying. You have to persevere,
you have to insist.
4. Claude Monet

He was one of arts most important and influential figures and the leader of
the Impressionist movement.

Born in Paris in 1840, Monet was a rebel from an

early age, preferring to spend his time
outside, sketching nature, rather than being
confined to a classroom.

Monets style used complex short brush strokes and dots of contrasting color
that, when viewed up close, looked chaotic. When viewed far away, however,
the large scale painting looked like a beautiful soft-focus image.

His most famous works include Water Lilies and Sunflowers. Many critics
wondered how Monets eyesight severely compromised by severe cataracts
had impacted his work and style.

Monet died in 1926. His paintings, most worth millions each, hang in
prestigious museums throughout the world.

5. Harriet Tubman
 Tubman was born a slave in 1820 in Dorchester County, Maryland.

Sold as a slave as a child, Tubman

escaped the South and became a
leading abolitionist in the Civil War
era.

Tubman helped black slaves

escape slavery by establishing the
Underground Railroad, a network
of safe houses and locations stretching north
where slaves on the run could seek shelter,
food and protection from other abolitionists.

Tubman, who was mostly blind due to a cruel head injury she received as a
teen when a man lobbed a weight at her head, is estimated to have helped
more than 300 fugitive slaves escape their Southern captors and relocate to
Canada, where slavery was illegal.

6. Galileo Galilei

Known as the Father of Modern Science, Italian scientist and scholar Galileo
Galilei was a visionary even though he was visually impaired.

In order to avoid jail, Galileo spent the rest of his

life on house arrest in Florence.

Galileo was the first person to use a telescope to

view the planets and stars.

During his viewings, he noted on important fact: it did

not appear that the sun and planets orbited the
Earth, as it was believed; rather the Earth and
planets orbited the sun. His findings forever
changed the course of astronomy and got him in trouble with the Catholic Church,
which put him on trial for his crimes and forced Galileo to confess that he was
mistaken in his belief that the Earth was not the center of the universe. During this
time, his vision began to worsen to the point of blindness due to cataracts and
glaucoma. Though nearly blind and confined to his house, Galileo continued to
study, invent and write until his death in 1642.

7. Louis Braille
 Born in Coupvray, France in 1809, Braille is the inventor of the modern Braille
system, which uses a series of raised dot
formations to spell letters and words.

Braille was blinded at the age of three, after

he was hit in the eye by a tool in his
fathers barn. An infection of the injury
took his sight completely.

Since few opportunities existed for the

blind, Brailles parents encouraged him to
attend regular school, where he succeeded
by relying on his memory, rather than reading and taking notes.

By age 20, Braille had perfected his six-dot based code and used it to code
letters, common words, numbers and scientific symbols.

He published these codes and debuted them at the Paris Exposition of

Industry in 1834.

It took 20 years for Braille to become accepted by the blind world, two years
after his death in 1852.

8. Ray Charles

Born in 1930 in Albany, Georgia is a great American songwriter who helped

change the face of modern music.

Born with the visual condition glaucoma, Charles went completely blind by
age seven.

Charles is credited with the early

development of soul music, which blends
jazz, gospel and rhythm and blues.

Charles died in 2004, after receiving a

total of 13 Grammy Awards, including the
Lifetime Achievement Award in 1987.

Never one to let his blindness stop him from succeeding, Charles quipped: I
dont know what Id do if I wasnt able to hear.

9. Stevie Wonder
 Born Steveland Judkins in 1950 in Saginaw, Michigan and raised Detroits
inner-city, Wonder was a child prodigy, teaching himself to play piano, organ,
harmonica and drums at the age of eight.

Wonders blindness was caused by an excess of oxygen in the incubator

following his premature birth, but his disability did little to slow him down.

Known for his songs, such as I Just Called to Say I Love You, My Cherie
Amour and For Once in My Life

He was inducted into the Rock and Roll Hall of Fame in 1989 and received the
Grammy Award for Lifetime Achievement in 2005.

10. Helen Keller

Born in 1880 in Tuscumbia, Alabama a childhood illness left Keller deaf and
blind at age 18 months.

Kellers life changed completely at age seven, when she began being tutored
by a young teacher, Annie Sullivan.

Kellers progress astounded family and friends.

Keller continued to amaze as she graduated

from Radcliffe College, married and began
writing the first of numerous published
magazine and journal articles.

Her book, The Story of My Life was a

worldwide bestseller and has been published in
more than 50 languages.

During her lifetime, Keller traveled the world,

met 12 presidents, received several honorary
doctorate degrees and countless awards,
including the being elected to the Womens Hall of Fame.

Keller continued to amaze as she graduated from Radcliffe College, married

and began writing the first of numerous published magazine and journal
articles.

Her book, The Story of My Life was a worldwide bestseller and has been
published in more than 50 languages.
 During her lifetime, Keller traveled the world, met 12 presidents, received
several honorary doctorate degrees and countless awards, including the
being elected to the Womens Hall of Fame.

HEARING IMPAIRMENT
a partial or total inability to hear
 refers to the reduced functions or loss of the normal function of the hearing
mechanism
limits the persons sensitivity to tasks:
* listening
* understanding speech
* speaking in the same way those persons with normal hearing do

DEGREE OF HEARING LOSS

Deaf/Deafness
-refers to a person who has a profound hearing loss and uses sign
language.
Hard of hearing
- refers to a person with a hearing loss who relies on residual hearing
to communicate through speaking and lip-reading.
Hearing impaired
- is a general term used to describe any deviation from normal hearing,
whether permanent or fluctuating, and ranging from mild hearing loss to profound
deafness.
Residual hearing
- refers to the hearing that remains after a person has experienced a
hearing loss. It is suggested that greater the hearing loss, the lesser the residual
hearing.

LEVEL OF SEVERITY OF HEARING LOSS

TYPES OF ONSET:

1. Adventitous (aquired)
- occurred after birth, due to illness or injury
Causes:
* build up of fluid behind the eardrum
* ear infections (known as otitis media)
* childhood diseases (such as mumps, measles or chicken pox)
* head trauma
2. Congenital
- the hearing loss or deafness was present at birth.
Causes:
* family history of hearing loss or deafness
 * infections during pregnancy (such as rubella)
* complications during pregnancy (such as the Rh factor, maternal diabetes,
or toxicity)

TYPES OF HEARING IMPAIRMENT

Conductive hearing loss

Occurs in the outer and middle ear thereby blocking the passage of the
acoustic energy
Can be corrected through surgical and medical treatment.
Hearing aid is usually prescribed
Causes:
* wax in the ear canal, cold and allergies
* perforation(is a small hole in a thin material or web )in the eardrum
* otitis media(fluid in the middle ear)

Sensorineural hearing loss

a problem located in the inner ear or along the nerve pathway between the
inner ear and the brain
Usually permanent and not treatable by medical or surgical intervention.
Causes:
* aging
* infection or other disease
* noise exposure
* related to a genetic disorder

Mixed hearing loss

conductive loss and a sensorineural loss occurring at the same time

conductive component may be treated
sensorineural component is permanent
CAUSES:
1. Age
- a progressive loss of ability to hear high frequencies with increasing
age known as presbycusis.
* noise exposure
*toxins or disease agents
2. Noise
*living near airports or freeways are exposed to levels of noise

3. Significant outdoor or open window conditions

4. Environmental sound at damaging levels

*car stereos * gun use
* hair dryers *power tools
* children's toys
* transportation
* crowds
* lawn and maintenance equipment

5. Genetic
a. Syndromic deafness
- there are other medical problems aside from deafness in an individual.
* Usher syndrome
* Waardenburg syndrome
* Alports syndrome
* Neurofibromatosis type 2
b. Nonsyndromic deafness
- no other problems associated with an individual other than deafness.

6. Illness
a. Measles - may cause auditory nerve
damage
b. Meningitis - may damage the auditory nerve or the cochlea
c. Autoimmune disease
d. Mumps(Epidemic parotitis)
- sesorineural hearing loss
- unilateral(one ear)
- bilateral(both ears)

e. Presbycusis

- a progressive hearing impairment accompanying age, typically affecting

sensitivity to higher frequencies
f. HIV/AIDS
- frequently experience auditory system anomalies.
g. Chlamydia
- cause hearing loss in newborns at whom the disease has been passed at
birth.
h. Fetal Alcohol Syndrome
- infants born to alcoholic mothers
 i. Premature birth
- causes sensorineural hearing loss
j. Syphilis
- transmitted from pregnant women to their fetuses
k. Otosclerosis
- hardening of the stapes (or stirrup) in the middle ear and causes
conductive hearing loss.
l. Medulloblastoma and other types of brain tumors

7. Neurological disorders
* multiple sclerosis
* strokes
8. Medications
*aminoglycosides(main member gentamicin)
* diuretics,
*aspirin
* NSAIDs
* macrolide antibiotics
9. Chemicals
*lead
* solvents
- toluene (found in crude oil, gasoline and automobile exhaust
* asphyxiants
10. Physical trauma
* head injury
* tinnitus
11. Neurobiological factors

ASSESSMENT

1.Behavioral audiometry testing

Determine whether or not a patient has a hearing loss.
Determine the degree, configuration, and type of hearing loss if hearing loss
does exist.
Monitor the patient's hearing over time.
Provide information for the fitting of hearing aids or other sensory devices.
Help determine the functional benefit of hearing aids or other sensory
devices.

2. Behavioral Observation Audiometry (BOA)
-is an unconditioned behavioral response procedure in which an observation
of general awareness of sound (e.g., mother's voice, environmental sounds and
music) is used to determine a general level of auditory responsiveness or function.

3. Visual Reinforcement Audiometry (VRA)

-is a conditioned behavioral response procedure used to determine threshold
sensitivity in infants beginning at approximately six months of age (i.e.,
developmental age). A head-turn response to the presentation of an audiometric
test stimulus is rewarded by the illumination and activation of an attractive
animated toy.

4. Conditioned Play Audiometry (CPA)

- is a conditioned behavioral response procedure used to determine threshold
sensitivity in young children beginning at approximately two years of age
(i.e., developmental age). A play response (block- drop, ring stack) to the
presentation of an audiometric test stimulus is rewarded, usually by giving the child
social praise.

5. Speech Audiometry
- is used to assess the ability to detect, discriminate, identify, and
comprehend speech.
- several test procedures are used for speech audiometry in infants and
young children, including speech sounds (syllables), words, phrases, and sentences.

-The tests can be conducted by using earphones in each ear or through a

loudspeaker.

A. infants
- the conditioned head-turn response can be used to estimate speech
detection thresholds for words or individual syllables.
B. young children
- speech identification ability is determined at a listening level that is
comfortable for the child, well above threshold. Usually, young children are asked
to identify body parts (e.g., "Where's your nose?") or familiar objects (e.g., "ball,"
"spoon") by pointing to or picking up the object.
C. older children
- may be asked to repeat the stimulus words or point to pictures in order to
determine their speech identification ability. The final speech identification score
(percent of words or simple sentences identified correctly) is sometimes
referred to as a "speech discrimination score" or "word recognition score".

EDUCATIONAL PLACEMENT

1. Local Public School Classroom

2. Public School Classroom with source room support
3. Separate Classroom in Public School
4. Separate Non-Residential School Public or Private
5. Separate Residential School, Public or Private
6. Homebound or Hospital Environments

GENERAL APPROACHES

Auditory-oral approaches These use residual hearing to develop listening and

speaking skills.
Sign bilingualism This uses sign language as the childs first language, with
speech learned as a second language.
Total communication This involves using a variety of methods flexibly, such as
signing, speech and hearing, fingerspelling, gesture, facial expressions and
lipreading, in the combination that works best for the deaf child (how total
communication is developed and used varies, but it is based on the principle that
deaf children can learn to communicate by using any ways that they are able to).

FAMOUS PEOPLE WITH HEARING IMPAIRMENT

Pres. Bill Clinton

After years of exposure to loud rock music and noise

from hunting rifles and political rallies, former
President Bill Clinton experienced difficulty hearing
in noisier environments. During an annual physical in
1997, he was formally diagnosed with high
frequency hearing loss and fitted for completely-in-
canal hearing aids. Clinton and Ronald Reagan were
fitted for hearing aids while in office, which provided
a positive spin to the usually negatively-stereotyped
hearing aid.

Helen Keller

Helen Keller - (1880 - 1968) - Helen Adams

Keller (June 27, 1880 - June 1, 1968) was an
American author, activist and lecturer. She was the
first deaf/blind person to graduate from
college. She was not born blind and deaf; it
was not until nineteen months of age that she came
down with an illness described by doctors
as "an acute congestion of the stomach and the
brain", which could have possibly been scarlet
fever or meningitis. The illness did not last for
a particularly long time, but it left her deaf and
blind. Keller went on to become a world-
famous speaker and author. She is remembered as an advocate for people with
disabilities amid numerous other causes.

Thomas Alva Edison

Thomas Alva Edison (February 11, 1847 -

October 18, 1931) was an American inventor of
Dutch origin and businessman who developed
many devices that greatly influenced life around
the world, including the phonograph and a long
lasting light bulb. In school, the young Edison's
mind often wandered. He was noted to be terrible
at mathematics, unable to focus, and had
difficulty with words and speech. This ended Edison's three months of official
schooling. The cause of Edison's deafness has been attributed to a bout of scarlet
fever dur ing childhood and recurring untreated middle ear infections.
Ludwig Van Beethoven
Beethoven was as we know a great source of
confidence for himself and for others, being able
to create music and play music even after being
completely deaf is by itself quite a miracle.
Although it was clear to everyone that beethoven
was but a man, he conquered his disability and
led himself to being one of the greatest
musicians of all time. If there was one thing that
w as affecting his struggle to succeed it was not
only being deaf, but having to fight all the
emotions that he felt inside when he had to turn
around to look at the audience applause because
he could not hear.

BLINDNESS AND LOW VISION

Introduction:
- As human beings, we learn about the world around us through our senses.
Vision and hearing are called our DISTANCE SENSES. We REACH OUT into
space with these two senses to get INFORMATION. We gather a lot of
INCIDENTAL information through them. 80% of what we learn comes through
vision; 90% through a combination of vision and hearing.
- SMELL, TASTE, TOUCH (and Proprioception) are our CONTACT senses. They
are all very important and we still get INFORMATION through them. But
because we need to be in CONTACT with something or someone to get this
information, these are more limited in their scope.

- We are constantly switching between senses - one always being dominant,

with the others in the background. Sometimes the switching is so rapid that it
is almost imperceptible.

What is 'deaf-blindness'?

- is the condition of having little or no useful sight and hearing.

- Although the term "deaf-blind" may at first seem absolute, in reality people
who are deaf-blind experience a broad range of perceptions.

- Deafblindness' combines - in varying degrees - both hearing and visual

impairment.

- Someone may be completely blind but only partially deaf, or have some
vision early in life, no hearing at all, and gradually lose that vision.

- Only a very few people described as "deaf-blind" are profoundly deaf and
totally blind.
- Deafblind people have an experience quite distinct from people who are only
deaf or blind and not both.
- a concomitant vision and hearing impairment causing multi sensory
deprivation, is one of the most serious disabilities known to mankind.
- is a low incidence disability and within this very small group of children there
is great variability.
- An expensive disability according to one of the deaf-blind people.
It indicates that deafblindness is a unique disability. It is not visual
impairment PLUS a disability in hearing, nor is it deafness PLUS some level of
visual impairment
A loss in one area impacts the loss the in the other area - hence the emphasis
on "combination" and "concurrent" in the definition
 The federal (IDEA Federal Register) definition is: Deaf-blindness means
concomitant hearing and visual impairments, the combination of which
causes such severe communication and other developmental and educational
needs that they cannot be accommodated in special education programs
solely for children with deafness or children with blindness.

TYPES OF DEAF-BLINDNESS

Does the word deaf-blind mean a person is fully deaf and fully blind?

There are four very broad categories of deaf-blind people:

1. People who are congenitally deaf-blind (born deaf and blind or became deaf
and blind before age 2-4). The cause is often genetic or rubella. There is a
large group of deaf-blind people now in their 30s and 40s that as a result of
the rubella outbreak in the 1960s. Congenitally deaf-blind people usually live
in a supported home or other supported environment. Most attend a school
for the blind and learn through tactile interpreting, finger spelling, and
signing.

2. People who are born deaf or hard of hearing, lose their sight with age. The
largest cause is Ushers syndrome. Recent research shows that there are
three, possibly four types of Ushers. Those with type 1 lose vision between
age 14-16 and can still see but get tunnel vision. In their 40s to 60s, they
experience a decrease in central vision and become blind. Those with type 2
usually, but not always, have central vision that lasts much longer. Type 3,
which was just identified, causes hearing and vision to drop about the same
time. Most attend schools for the deaf.

3. People who are born blind, lose their hearing with age. There are several
causes. Most go to a school for the blind but interact with the deaf
community.

4. People who have lost both vision and hearing as they age.

CAUSES OF DEAF-BLINDNESS

Deafblindness is not caused by a single medical condition. People can be born

deafblind, possibly as a result of infection, a genetic syndrome or birth trauma. This
is often referred to as congenital deafblindness.
I. Acquired deafblindness refers to occasions where a person becomes deafblind
later in life, for
example as the result of a progressive condition or through infection,
accident or the
process of ageing.
1. Birth trauma as a cause of deafblindness
a. Vision and hearing impairment can arise as a result of problems at
birth or soon after.
Children who are born with such problems usually have additional,
often multiple,
 impairments. They may have severe physical impairment, learning
disabilities and
communication difficulties.
2. Accidents or other trauma as a cause of deafblindness
a. Any accident involving head injury can damage the parts of the brain
that deal with how
we process information through sight and hearing.
b. The injury can have many different effects that are difficult to
understand. Some other
kinds of trauma can result in deafblindness, for instance, a stroke (a
cerebral hemorrhage).
Again parts of the brain that deal with sight and hearing may be
affected.
3. Deafblindness associated with ageing
a. The most common cause of deafblindness is simply age. After the age of
around 50 years
hearing and vision impairments become more common. The prevalence
of sensory impairment
increases with age.

Congenital ( inherited or inborn )

Pertains to a condition present at birth, whether inherited or caused by the en
vironment,especially the uterine environment.
Infections as a cause of deafblindness
a. Rubella caught during pregnancy used to be a major cause of
deafblindness before the introduction of vaccination programmes.
b. Other infections which can affect the developing fetus include
1. cytomegalovirus (CMV) or toxoplasmosis.

2. Meningitis is an example of an infection which can cause

impairments at any time in life, depending on the strain and
severity of the infection. Some particular types of meningitis affect
young babies more than other groups.

Genetic conditions as a cause of deafblindness

a. A number of genetic conditions can give rise to deafblindness, for
example Usher syndrome.

Usher syndrome is due to a gene irregularity which is present from birth

with effects appearing gradually over the course of the years. Hearing impairment is
usually present from birth or soon after and can range from moderate to profound.
Visual impairment is progressive and can occur in late childhood to early
adolescence. It is not possible to predict how much sight will be lost.

Regardless of the causes of this condition, the fact remains that deaf
and blind individuals require a special deaf blind education in order to be able
to communicate with others.

Characteristics of Deaf-Blindness
 deaf-blind implies a complete absence of hearing and sight, in
reality, it refers to children with varying degrees of vision and
hearing losses. The type and severity differ from child to child. The
key feature of deaf-blindness is that the combination of losses limits
access to auditory and visual information.

More than 90% of children who are deaf-blind have one or more
additional disabilities or health problems and some may be identified
as having multiple disabilities rather than deaf-blindness. In these
cases, the impact of combined hearing and vision loss may not be
recognized or addressed.

Deafblind people communicate in many different ways, determined by the

nature of their condition, the age of onset, and what resources are available
to them.

Children who are called deaf-blind are singled out educationally because
impairments of sight and hearing require thoughtful and unique educational
approaches in order to ensure that children with this disability have the
opportunity to reach their full potential.

A person who is deaf-blind has a unique experience of the world. For people
who can see and hear, the world extends outward as far as his or her eyes
and ears can reach. For the young child who is deaf-blind, the world is initially
much narrower. If the child is profoundly deaf and totally blind, his or her
experience of the world extends only as far as the fingertips can reach. Such
children are effectively alone if no one is touching them. Their concepts of the
world depend upon what or whom they have had the opportunity to
physically contact. If a child who is deaf-blind has some usable vision and/or
hearing, as many do, her or his world will be enlarged. Many children called
deaf-blind have enough vision to be able to move about in their
environments, recognize familiar people, see sign language at close
distances, and perhaps read large print. Others have sufficient hearing to
recognize familiar sounds, understand some speech, or develop speech
themselves.

Persons with this combination of sensory losses have different needs than
persons who have single sensory disabilities - such as deafness, or visual
impairment

Characteristics Affecting Learning

There are several characteristics that affect learning in the child who is deafblind.
Depending on the age of onset, deafblindness can affect learning in the following
areas:

Difficulty with communication

 Distorted perceptions: Difficulty in imaging the whole picture or relating one
element to the whole;
Anticipation: Difficulty in knowing what is going to happen next, lacking the
context normally provided through "overseeing" or "overhearing" information
and cues;
Motivation: The motivating factors may be missing from a situation, going
unseen or unheard;
Incidental learning: First hand experiences are much more effective than
incidental observation group experiences.

ASSESSMENT

Children with deafblindness or multiple disabilities tend to experience the

world as it exists within their immediate reach (Miles, 2000). Many of these children
may have some residual vision and/or hearing. However, the combination of this
dual sensory impairment limits the extent of interaction they have with people,
access to information about events and objects at a distance, incidental learning
acquired just by seeing and hearing, and development of meaningful concepts
about home, school, and community. School teams must assess these children
differently from other students to effectively address their unique learning needs.

Successful assessments should include:

#1: FAMILY PARTICIPATION

Incorporate active family involvement throughout the assessment process.

Interview the family regarding their priorities, immediate goals, and long term
dreams.
Include family input in planning assessment activities.
Use family members to facilitate some assessment activities, as they are
familiar and trusted by the child.
Give attention to any family concerns that remain following assessment.

#2: TRANSDISCIPLINARY ASSESSMENT GUIDELINES

Assessment of the child across natural settings (i.e. home, classroom).

Selection of a variety of familiar, everyday activities where different skills can
be assessed.
Use of a transdisciplinary team approach in which educational team members
share knowledge from their areas of expertise for other team members to
incorporate in their practice.
Follow-up team assessment by using information to plan the educational
program.
Focus IEP goals and short-term objectives on behavioral skills to be
developed or expanded.
Conduct ongoing assessment throughout the school year, with changes to the
IEP made as the child masters critical skills (short-term objectives).
#3: ASSESSMENT STRATEGIES

Base interactions on data in most recent vision and hearing reports. Select
toys or other objects that use the child's preferred colors, textures, and
sounds. Present the objects in the positions where the child has the best
vision and hearing. After the child is engaged, move the toys to varying
positions to assess any response.
Use the child's current communication program if one exists. Interpret the
child's changes in behavior as communication, and prolong the exchange to
learn more about how the child communicates.
Select a single team member to act as activity facilitator to decrease the
number of people with whom the child will interact.
Choose activities based on family routines.
Include components that apply to classroom instruction and appropriate age
level activities.
Ask the child to make choices, follow steps in a routine, or indicate what
comes next in an activity.
Embed critical skills within activities to assess the child's level of
understanding and response. Does the child initiate activity? What level of
support or prompts are needed? What is the child's response if the routine is
changed or sabotaged? What kind of choice-making is shown?
Create a report in which team members contribute to one comprehensive
final document based on areas assessed. The report should include ideas for
planning and educational programming.

#4: ESSENTIAL ASSESSMENT DOMAINS

Social/Communication: (Vocalizations, gestures, eye gaze, changes in

movement, alertness, verbalizations, signing.) What methods does the child
use for receptive and/or expressive communication? How does the child use
these? How does the child respond to the assessment facilitator, parent,
peer? i.e. cues, verbal requests, pauses for turn-taking.
Sensory/Motor: What are the child's likes/dislikes? tolerance for different
types of sensory input? willingness to explore new, unfamiliar sensory input?
How does muscle tone affect the child's ability to participate in activities?
(Motor planning? Stamina? Reach and grasp?) What supports and physical
modifications are used and what are the results of each? What positioning
works best for stabilization, comfort and greatest range of motion?
Functional Vision: Does the child appear to have useful remaining vision?
What focusing and tracking patterns are present? How does the child use
near vision? distance vision? What is observed about the visual fielduse of
central or peripheral viewing? Do visual fields appear to be intact? Does the
child look at an object while interacting with it or look away, and then act?
Does the child show color preferences? preference for movement rather than
still objects? Are eyeglasses or low vision aids recommended? tolerated? in
use? What is the child's preferred learning mode: visual, auditory, or tactual?
Functional Hearing: Is the child aware of sound? Does s/he alert to sound,
orient to sound, localize sound, isolate a specific sound in the presence of
other sounds? Does the child respond to a selected sound among other
 sounds? Does the child appear to use hearing to respond during the
assessmentto voice? music? speech? Are hearing aids recommended?
tolerated? in use?

All of these areas need to be assessed because they are interrelated in their
influence on the child's ability to make sense of the world. Accurate functional data
on vision and hearing is particularly critical since it is the combined effect of the
dual sensory impairment that requires instructional approaches differing from either
vision or hearing strategies. Only when the child is assessed in settings where s/he
is familiar with the facilitators, routines, and materials will s/he have the opportunity
to respond in a way that gives a true indication of developmental/cognitive level.
The child will demonstrate competencies and areas where skills are emerging or as
yet undeveloped. The more accurate the assessment of the child, the more effective
will be the next steps toward greater meaning and participation at home, school
and in the community.

EDUCATIONAL PLACEMENT
Deaf-blindness children cannot join the regular classes because they have
special needs.
They have to be part of Special Education to help cater their special needs
accordingly.
In the Philippine Setting, We have the Philippine Schools for the Deaf and
Blind
( Pasay City ) school for the blind and visually impaired, school for the deaf.
"Children and youth having auditory and visual impairments, the combination of
which creates such severe communication and other developmental and learning
needs that they cannot be appropriately educated without special education and
related services, beyond those that would be provided solely for children with
hearing impairments, visual impairments, or severe disabilities, to address their
educational needs due to these concurrent disabilities."

Deaf-blindness combination of which causes such severe communication and

other developmental and educational problems that they cannot be accommodated
in special education programs solely for children with deafness or children with
blindness." 34 CFR 300.7 (c)

Special Education is very broad in the sense that it caters not only the
children with special needs but it allows us to know the cause and effect and the
means to intervene so that we could bring up children who are still able to
communicate to others and to help themselves in the near future.
Special School is a must! that is why parents are encouraged to be open
minded about the curriculum of the special education so that they would be obliged
to understand the reasons of the special children's world.
that is why we need to educate them so that they could live a valuable life in the
family, in the community and to our country.

ALTERNATIVE MODELS

In pursuance of our goals to the cause of inclusive education in the 21st

century some alternative
models in the delivery of educational services for children with special needs are
put in place:
1. Community-Based Rehabilitation (CBR) Services
This program is presently undertaken by the National Council for the Welfare
of Disabled Persons (NCWDP)
2. Home Based Instruction for the Handicapped
This is one model of a community-based rehabilitation service, where
instruction takes place in the home. Resource materials in the form of modules are
provided for the special child to work on.
3. Community-Based SPED Program
This is an instructional delivery system where the child with special needs is
taught particular skills in a natural setting such as the home or any convenient
place in the community. This serves as an outreach program of the Special
Education Division of the Department of Education addressing the needs of out-of-
school handicapped children and youth ages 8-18 years old.
It has a special feature of accrediting the clientele's home study in a regular school
program of the parents as the clientele desire it. This is done by recommending the
child with special educational needs to take the PEPT
(Philippine Educational Placement Test) after giving all the lessons for the CBSPED
program. The result of this test will determine the grade placement of the child in
the school.
4. Vocational Program
The ultimate aim of education is to develop in the learner desirable
knowledge, skills,values and attitudes that can effectively used to alleviate poverty
and improve the quality of life of the individual. Thus, vocational program is an
important component of the curriculum for children with special needs. Educational
opportunities and other services

GENERAL APPROACHES
The approach though differs depending on the particular characteristics.
For instance, a person who experiences blindness after deafness will probably use
sign language, while a tactile mode of spoken and written language is usual if
blindness occurs before deafness.
There are approaches identified to make inclusive education work in regular
schools. These
approaches are as follows:
1. Establishment of a SPED Center which will function as a Resource Center to:
1.1 support children with special needs enrolled in regular schools'
1.2 assist in the conduct of in-service trainings for regular teachers, administrators
and
prospective SPED teachers;
1.3 conduct continuous assessment of children with disabilities and their referral;
and
1.4 produce appropriate teaching materials
2. Information, Dissemination and Education
2.1 Explanation of the concepts of integrated education and inclusive schools to
parents
and family members, administrators, supervisors and the community
2.2 In-Service trainings in special needs education for all Classroom (Receiving)
Teachers
2.3 Continuous orientation of the school personnel and pupils in inclusive schools

3. Strengthening the Support Services which include the following:

3.1 Hiring of trained SPED teachers to serve as Resource Teacher/Itinerant Teacher/
Consulting Teacher
3.2 Continuous in-service training of SPED teachers and administrators
3.3 Provision of specialists like physical therapist, speech therapist and other
specialists
whenever available
3.4 Hiring of teacher-aides from trained parents, community-based rehabilitation
workers,
community volunteers and others with specialized trainings
3.5 Implementation of the "buddy" system where a trained classmate can be paired
with
a pupil who has disability
3.6 Provisions of instructional materials, assistance devices and essential equipment
4. Parent and Community Involvement
4.1 Provision of parent education
4.2 Involving families, people with disabilities and the community in the decision-
making
process
4.3 Linkage with other Gos and NGOs working for children with disabilities
5. Utilization of the Team Approach to Mastery (TAM)
(DedeJohnston, Will Proctor and Susan Corey)
In TAM classrooms, students with disabilities are educated alongside their
nondisabled
peers throughout the entire school day' there is an average ratio of two nondisabled
children to each child with disability

FAMOUS PEOPLE

Helen Keller (1880-1968) - author, activist and lecturer

The best-known deafblind person is the author, activist and lecturer
first deafblind person to receive a Bachelor of Arts degree and perhaps the person
most popularly associated with the condition.

Francisco Goya (1746 1828): Spanish painter, deaf and blind by the time of his
death.Victorine Morriseau (1789 1832): first deafblind person to be educated in
Paris.

James Mitchell (1795 1869): congenitally deafblind son of Scottish minister.

Sanzan Tani (1802 1867): Japanese teacher who became deaf in childhood and
blind later in life,communicating with students by touch.

Hieronymus Lorm (1821 1902): inventor and novelist.

Laura Bridgman (1829 1889): first deafblind child to be successfully educated

in the US.
Mary Bradley (? 1866): first deafblind child to be successfully educated in the
(time and place of birth not known, died in 1866)

Joseph Hague: second deafblind child to be successfully educated in the UK.

Yvonne Pitrois (1880 1937): French biographer.

Marie Heurtin (1885-1921) first deafblind born child to be successfully educated

in Larnay (France).[6]

Alice Betteridge (1901 1966): first deafblind Australian to be educated.

Teacher, traveller, writer.

Jack Clemo (1916 1994): British poet who became deafblind as an adult.

Richard Kenney (1924 1979): educator, lecturer, and poet; third deafblind
person to graduate from an American university; president of the Hadley School for
the Blind from 1975 to 1979.

Robert Smithdas (1925 ): first deafblind person in the US to receive a master's

degree.

Mae Brown (1935 1973): Canadas first deafblind university graduate;

developed services for the deafblind at the Canadian National Institute for the Blind
(CNIB).

Vasile Adamescu (1944 ): Romanian teacher and sculptor.

Theresa Poh Lin Chan (1945? ): Singaporean teacher and writer.

Anindya (Bapin) Bhattacharyya (1970? - ): technology expert living in the US.

Alice Betteridge (1901-1966) - first deafblind Australian to be educated. Teacher,

traveler, writer.

Jack Clemo (1916-1994) - British poet who became deafblind as an adult

Robert Smithdas (1925- ) - the first DeafBlind person in the US to receive a

master's degree.

Richard Kinney (?-?) Educator, lecturer and poet; president of the Hadley
School for the Blind from 1975 to 1979.

LATEST UPDATES OF DEAF-BLINDNESS( CURRENT DEVELOPMENT )

- At present, there are no programs for assistance or service for deafblind

persons in the country.Our efforts are geared towards the intensification of
measures to ensure quality special education. As we realize, the present time
is characterized by enormous development of information technology that
 somehow affects special education in the country. Concerted efforts have
focused on the identification of strategies. These strategies are seen through
some initiatives that are likely to meet the many challenges and ever-
changing demands of the time.
For the past two decades, the trend in the education of children with special
needs is towards the promotion of integration and participation as against
segregation.

- At present there are already 133 SPED Centers throughout the country.One
model of inclusive education in the Philippines is the mainstreaming program.
This can be either partial or total. Its operationalization is best exemplified in
the Special Education Center where the Center is part of the regular
elementary or secondary school. The shifting of disabled children in the
regular class becomes a part of the school program because the children are
already within the school Operating on the principle of placement in the
"least restrictive environment" the mainstreaming program can be the
Philippine commitment to inclusive education.

Communication Device for the Deaf Blind

1. BLOCK LETTER COMMUNICATOR is a communication device

for individuals who are deaf-blind. This small, lightweight device
enables individuals who are deaf-blind and who do not know
Braille to communicate with sighted individuals.

2. BRAILLE SENSE U2 (MODEL H432B) is a Braille notetaker

and word processor designed for use by individuals who are blind or have low
vision. This compact, portable braille notetaker has a 9-key
Perkins-style Braille keyboard, a 32-cell braille display and an
LCD display. It provides the functionality of a laptop computer,
including WiFi, chat, document processing, DAISY playback, GPS,
YouTube, Excel, and DropBox. It can perform up to seven tasks
simultaneously.
3. BRAILLE SENSE U2 QWERTY (MODEL H432Q) is a Braille
and electronic notetaker and word processor designed for use
by individuals who are blind or have low vision. This compact,
portable notetaker has a 9-key Perkins-style Braille keyboard, a
QWERTY (alphabetic) keyboard, a 32-cell braille display, and an
optional LCD display. It provides the functionality of a laptop
computer, including WiFi, chat, document processing, DAISY playback, GPS,
YouTube, Excel, and DropBox.
4. BRAILLEPHONE is a portable braille telephone device designed
for use by individuals who are deaf blind. This device can be
used for telephone communication or it can be used for face-to-
face communication between a person who is deaf blind and
any other person using a telecommunications device for the
deaf (TDD) or deaf relay service. In addition, the system is
 designed to enable those who are deaf blind to access most computer
systems running DOS- or Windows-based software.
5. DEAFBLIND COMMUNICATOR is a communication system for
use by individuals who are deaf blind. The system consists of
two separate portable components. The main unit is the DB
BrailleNote, which is a BrailleNote mPower (available with either
a Perkins Braille or QWERTY alphabetic keyboard and with either
an 18-cell or 32-cell Braille display) installed with deafblind
software.
6. FACETOFACE is a communication system designed for use by
individuals who are deaf-blind. The system allows a user who is
deaf-blind to communicate wirelessly with a sighted partner at a
distance of up to 30 feet. The system includes software, a
Hewlett Packard iPAQ Pocket PC with thumb keyboard, and a
CompactFlash Bluetooth card. The software also can run on a
PAC Mate notetaker (not included), available with either a 20-cell or 40-cell
refreshable braille display
7. HIMS CHAT is a communicator program designed for use by
that allows people with or without disabilities to communicate
with individuals who are deaf blind using an Apple iPhone, iPod
Touch or iPad. This application (or app) facilitates face-to-face
communication between the deaf-blind person and another
person via a Bluetooth connection between an iPhone, iPod
Touch or iPad, and a Braille Sense notetaker (Braille Sense U2, OnHand or U2
QWERTY) or a Braille EDGE 40 braille display and keyboard .
8. HUMANWARE COMMUNICATOR is a multilingual face-to-face conversation
app designed to help deaf-blind individuals communicate on an everyday
basis. This app is intended to establish a text conversation between a deaf-
blind person and a sighted person. All interaction appears both on the deaf-
blind persons refreshable Braille display, as well as visually on the screen of
the iOS device.
9. KENTUCKY PORTA BRAILLE & KENTUCKY POCKET BRAILLE is an
interactive Braille computer terminal with a 20 cell refreshable Braille display,
Braillewriter Keyboard and up to 256K of memory. Pocket Braille is a less
expensive note taking and writing system and can be used as a paperless
Braille writer. Contents of its memory can be transmitted to a host computer
and edited there.
10.MOBILE LORM GLOVE allows individuals who are deaf and
blind who use Lorm, a tactile signing language, communicate
with each other via mobile technology. The prototype called,
Mobile Lorm Glove, relies on Lorm. The bottom side of the glove
has pressure sensors which translate Lorm into visual or audible
forms of communication, such as text messages or speech over
a mobile phone.
11.SCREEN BRAILLE COMMUNICATOR is a communication
device designed for use by individuals who are deaf blind. This
small, lightweight communicator enables the user to
communicate with sighted people who may not know Braille by
way of a Braille keyboard. One side of the communicator has a
 Braille keyboard and a refreshable Braille display, while the other side has an
alphabetic keyboard and a visual display.
12.TELLATOUCH (MODEL 22-0501-1) is a manual braille writer
and refreshable braille display designed for use in
communication with individuals who are deaf blind. This
communication device for the deaf blind has a keyboard with
four rows of keys, and a braille display. The top three rows of
the keyboard have keys for the alphabet, and the fourth row has
the keys of a standard braille keyboard. To receive messages, the deaf blind
user places a hand over the braille display.

COMMUNICATION DISORDER
DEFINITION

Communication is defined as the act or process of using words, sounds, signs, or

behaviors to express or exchange information or to express your ideas, thoughts,
feelings while the term "communication disorder" is very general, encompassing a
wide variety of difficulties in receptive or expressive language, speech production,
hearing and central auditory processing. Communication disorders range from mild
to severe and diagnosis may be complex because of the tendency for a child to
exhibit difficulties in more than one area.

Disorders impairing a patients communication abilities may involve voice,

speech, language, hearing, and/or cognition. Recognizing and addressing
communication disorders is important; failure to do so may result in isolation,
depression, and loss of independence to the learners. Communication disorders can
be grouped into two main categories:

Hearing Disorders - People with Hearing Disorders do not hear sounds clearly.
Such disorders may range from hearing speech sounds faintly, or in a distorted way,
to profound deafness.

Speech and Language Disorders - these disorders affect the way people talk and
understand. These disorders may range from simple sound substitutions to the
inability to use speech and language at all.

Many children who do not develop speech at expected ages are those who tend
to have low muscle tone and/or difficulty planning purposeful movements for
speech production. Children with developmental motor speech disorders may have
no specific neurologic diagnosis. However, an understanding of the nature of their
motor learning difficulties provides the basis for effective treatment.

Diagnosis of speech production difficulty in young children involves

understanding of phonological development (linguistic) and the process of
developing speech motor control (motor). Understanding the relative contributions
of phonology and motor control to overall impairment in speech production is
critical to the process of making appropriate treatment decisions. If a motor disorder
is identified, our role is to further define each childs strengths and weakness in
specific stages of speech motor development.

The ability to communicate is our most human characteristic. Human

communication is essential to learning, working, and social interaction.

TYPE AND CHARACTERISTICS

Hearing

Hearing loss might be suspected when a person does not always hear sounds
such as telephone or doorbell ringing, turns his or her ear toward the source of
sound, frequently asks the speaker to repeat, turns the TV or radio up too loud, or
shows obvious signs of confusion or misunderstanding of speech. Some of the
causes of hearing loss are chronic ear infections, heredity, birth defects, health
problems at birth, certain drugs, head injury, viral or bacterial infection, exposure to
loud noise, aging, and tumors.

Speech and Language

Disorders might be present when a person's speech or language is different

from that of others of the same age, sex, or ethnic group; when a person's speech
and/or language is hard to understand; when a person is overly concerned about his
or her own speech; or when a person frequently avoids communicating with others.
Some of the causes of speech and language disorders are related to hearing loss,
cerebral palsy and other nerve/muscle disorders, severe head injury, stroke, viral
diseases, mental retardation, certain drugs, physical impairments such as cleft lip or
palate, vocal abuse or misuse, inadequate speech and language models; frequently,
however, the cause is unknown.

Here are some examples:

Dysphonia is classified as either an organic or a functional disorder of the

larynx.
Dysarthria, encompasses a group of motor speech disorders caused by a
disturbance in the neuromuscular control of speech.
Apraxia, occurs in the presence of significant weakness or incoordination of the
muscles of speech production.
Aphasia is a language disorder that results from damage to the areas of the
 brain responsible for language comprehension and expression. It is the loss of
speech and language abilities resulting from stroke or head injury.
Cognitive-communicative disorder affects the ability to communicate by
impairing the pragmatics, or social rules, of language.
Delayed Language: a noticeable slowness in the development of the vocabulary
and grammar necessary for expressing and understanding thoughts and ideas.
Stuttering: an interruption in the rhythm of speech characterized by hesitations,
repetitions, or prolongations of sounds, syllables, words, or phrases, for
example, cow . . . boy, tuh-tuh-tuh-table, ssssun.
Articulation Disorders: difficulties with the way sounds are formed and strung
together usually characterized by substituting one sound for another (wabbit for
rabbit), omitting a sound (han for hand), or distorting a sound (shlip for sip).
Voice Disorders: inappropriate pitch (too high, too low, never changing or
interrupted by breaks); loudness (too loud or not loud enough); or quality
(harsh, hoarse, breathy, or nasal).
Phonological Disorders are sound production disorders in which patterns of
errors, or phonological processes, are identified and thought to be linguistically
based. Use of phonological processes (e.g. omitting ending sounds or
substituting front sounds for back sounds) is typical as children progress through
stages of speech and language development.
Speech impediment (also referred to as a speech disorder)

ASSESSMENT

Most experts agree that it is important to identify children with developmental

delays or disorders as early as possible. Intervention at earlier stages in the child's
development may have a greater chance of reducing the short-term and long-term
negative consequences of these disorders (Guralnick, 1998).

Language delay is the most common type of developmental problem seen in

preschool age children (Rescorla and Schwartz, 1990). Depending upon the level of
delay that is considered abnormal, studies suggest that from three to ten percent or
more of children in the 2 to 3 year old range may have a communication delay
(Rescorla and Schwartz, 1990). Some authors report that children with
communication disorders make up from 25% to 50% or more of young children
eligible for early intervention programs (McLean and Cripe, 1997; Goodman, 1998).

Early identification and early intervention may be especially important for young
children with significant communication disorders (McLean and Cripe, 1997). The
assessment of language in children under age 3 is challenging, however, since there
is considerable variability in the rates at which children develop language skills.
Moreover, the dividing line between typical and delayed language is not always
clear.

A thorough evaluation by a speech-language pathologist or audiologist is

needed to determine a person's communication strengths and weaknesses. After
this evaluation, the speech-language pathologist or audiologist will be able to
provide a plan for meeting individual needs.

Professionals who are skilled to help out our CSNs

Speech-Language Pathologist

A speech-language pathologist is a professional educated in the study of human

communication, its development, and its disorders. By evaluating the speech and
language skills of children and adults, the speech-language pathologist determines
if communication problems exist and decides the best way to treat these problems.

Audiologist

An audiologist is a professional educated in the study of normal and impaired

hearing. The audiologist determines if a person has a hearing impairment, what
type of impairment it is, and how the individual can make the best use of remaining
hearing. If a person will benefit from using a hearing aid or other listening device,
the audiologist can assist with the selection, fitting, and purchase of the most
appropriate aid and with training the individual to use the aid effectively.

Assessing, describing, and interpreting an individual's communication ability

requires the integration of a variety of information gathered in the evaluation
process. This includes the following information:
Case history, including medical status, education, socioeconomic, cultural, and
linguistic backgrounds and information from teachers and other related service
providers
Patient/client/student and family interview
Review of auditory, visual, motor, and cognitive status
Standardized and/or non-standardized measures of specific aspects of speech,
spoken and non-spoken language, cognitive-communication, and swallowing
function, including observations and analysis of work samples
Identification of potential for effective intervention strategies and
compensations
Selection of standardized measures for speech, language, cognitive-
communication, and/or swallowing assessment with consideration for
documented ecological validity and cultural sensitivity
Follow-up services to monitor communication and swallowing status and ensure
appropriate intervention and support for individuals with identified speech,
language, cognitive-communication, and/or swallowing disorders

Where Can You Find Speech-Language Pathology and Audiology Services?

Speech-language pathologists and audiologists provide professional services in

many different types of facilities such as:
public and private schools
Hospitals
rehabilitation centers
nursing care facilities
community clinics
colleges and universities
private practice
state and local health departments
state and federal governmental agencies
It is important for all parents of young children to receive accurate information
about typical language development and communication disorders including:

typical language development in infants and young children

ways to recognize possible communication disorders as early as possible
risk factors and clinical clues for communication and hearing disorders
steps to take if a communication disorder is suspected

It is important that parents and other primary caregivers of children who have a
possible communication disorder receive accurate information about typical
language development and communication disorders to allow them to:

function as active partners with health care providers in monitoring the overall
development and health of the child
become informed advocates for their children
develop informed and reasonable expectations about typical language
development, the nature and outcome of communication disorders, and
appropriate assessment and intervention methods if a delay or disorder is
suspected

Formal Assessment

This involves the use of standardized tests to identify errors in the production of
individual speech sounds (phonemes) in initial, medial and final positions in single
words. The child may have an articulation disorder if errors continue past the
expected age.

No test can be completely culture-free and well-developed standardized tests are

not available individuals in the United States who speak a language other than
English or Spanish. One must recognize that most formal testing is unfamiliar to
individuals who have not had exposure to the mainstream educational context. The
culture of testing includes both nonverbal and verbal components.
Nonverbal aspects of the testing culture comprise the following:
perception of time
how one is expected to learn
attitudes toward display of abilities

Verbal aspects of the testing culture comprise the following:

functions of language
content of language
organization of the language

Informal Assessment

Communicative behaviors begin at birth and evolve over time. Communication

is integral to all aspects of a child's development, and the quality of the child's
communication has a long-term impact on socialization and on learning.

An important aspect of communication includes the reciprocal interaction of the

infant/young child with others. The form of communication varies with a child's age
and developmental status. During the first year of life, the child's communication
involves hearing, physical contact, body movement, gesture, facial expression, and
vocalization. During the child's second year of life, it is common for the child to
develop individual spoken words. The typical child's language development is often
quite rapid leading to the use of two-word combinations and a great increase in
vocabulary. During the third year, vocabulary usually continues to increase rapidly,
and the child uses increasingly complex elements of language.

Every aspect of the assessment process for young children with communication
disorders involves the parents in a variety of ways. Parents have an important role
in helping to monitor the development and health of their child. Parents and other
caregivers (potentially including grandparents, babysitters, and family day care
providers) are the richest source of information about a child's development.

Parents are often present during the assessment sessions, and observation of
child-parent interactions is an important aspect of assessment. Parents also have an
important role in helping professionals make decisions about assessment and
treatment goals for the child. Because parents play a critical role in the
identification and assessment process, there is a need for parents to understand
communication development in young children. Informing and involving the parents
provides an opportunity for them to be active participants in the care of their child.

In cases where a child is acquiring more than one language or dialect, it is

recommended that the assessment process take into account the child's abilities in
each language being acquired and consider the influence of one language upon the
other.
Clinical judgment and natural language samples involving a parent or other family
member interacting with the child are particularly important ways to evaluate a
child's language development while taking into account the child's cultural and
linguistic background.
It is recommended that, whenever.

EDUCATIONAL MEASUREMENT

Test accommodations should be differentiated from test modifications. Test

accommodations reflect minor adjustments made to the testing situation that do
not compromise the test's standardized procedure. Depending on the individual and
the nature of the test, you may choose to adapt administrative procedures to
accommodate the student's needs.

It should be noted that test scores would be invalid for testing a client who is not
reflected in the normative group for the test's standardization sample, even if the
test were administered as instructed. However, these tests can provide valuable
descriptive information about a client's abilities and limitations in the language of
the test.

Test modifications alter the administration process upon which a test has been
standardized, changing the difficulty level of the tasks, and further invalidate the
norm-referenced scores. These modifications include the following:
 rewording and providing additional test instructions other than those allowed
when presenting trial items
providing additional cues or repeating stimuli on items that do not permit these
allowing extra time for responses on timed subtests
skipping items that are inappropriate for the student (e.g., items with which the
client has had no experience)
asking the student for an explanation of correct or incorrect responses (when
not standard procedure)
using alternate scoring rubrics

GENERAL APPROACH IN TEACHING

Services to students with communication problems may be provided in individual or

small group sessions, in classrooms or when teaming with teachers or in a
consultative model with teachers and parents. Speech-language pathologists
integrate students' communication goals with academic and social goals.

FAMOUS PEOPLE

Rowan Atkinson - (born 6 January 1955) Rowan

is an English comedian, writer and actor famous for
his British roles in the television series Mr.Bean and
Blackadder. He has been listed as one of the 50
funniest acts in British comedy. Rowan's first Mr.Bean
television appearence was in1990 on New Years Day
in a half hour special for Thames Television. His strong
talent in facial expressions has made him capable of
doing visually based comedies with little or no
dialogue, he has sometimes been called "the man
with the rubber face". Atkinson had a stutter as a child
and had problems with the letter B. He oversomes it
through over-articulation which he turned into a comic
device.

Sam Neill - (born 14 September 1947) Sam Neill is a

New Zealand television and film actor most renown for
his role as Alan Grant in the hit movie Jurassic Park. After
working at the New Zealand National film unit as an
actor and director he was given a role in the Australian
classic film Sleeping Dogs. Neil was eventually suppose
to play a role in the movie Lord of the Rings by peter
jackson but had to turn the offer down due to his
immediate business with the Jurassic Park III movie. As a
child, Sam had a stutter which he worked very hard to
control. In a rare instance, you may still make this
stutter out in some of his movies.
 Aristotle - (384 BC - 322 BC) Aristotle was a Greek
philosopher writing on many different subjects including
zoology, biology, ethics, government, politics, physics,
metaphysics, music, poetry and theater. He was also a
great teacher for Alexander the Great. Aristotle was one
of the first to point out that epilepsy and genius were
often closely connected. Aristotle had an inaccurate
conception of the cause of stuttering. He thought it was
caused by a malfunctioning tongue.

Bruce Willis - Walter Bruce Willis (born March 19,

1955) is a German-born American actor and singer. He
came to fame in the late 1980s and has since retained a
career as both a Hollywood leading man and a
supporting actor. Being the leading actor in some of the
greatest action movies Bruce Willis has had stuttering
problems throughout his youth and was always scared it
would affect his acting career. Fortunately he
successfully grew out of it not too much from a therapist
but from being an actor, it actually removed his speech
disorder.

Julia Roberts - Academy Award-winning actress. Julia

Fiona Roberts (born October 28, 1967) is an Academy Award
winning American film actress and former fashion model.
Roberts has become the highest paid actress in the world,
topping the annual power list of top earning female stars for
four consecutive years (2002-2005). Julia Roberts admitted
the fact that she stuttered when she was younger without
ever going into much detail, but she now speaks fluidly and
is a respected actress.

Coco Martin - An award winning Filipino Actor who

started his career with Indie Films is also known for
having speech disorder: lisps. He is having a hard
time pronouncing words correctly and he also has
the tendency to swap the sounds while talking.
EMOTIONAL AND BEHAVIORAL
DISORDERS
EMOTIONAL AND BEHAVIORAL DISORDERS
According to the CDC (Centers for Disease Control and Prevention),
approximately 8.3 million children (14.5%) aged 417 years have parents whove
talked with a health care provider or school staff about the childs emotional or
behavioral difficulties. Nearly 2.9 million children have been prescribed medication
for these difficulties.

Definition of Emotional and Behavioral Disorders

This was written by Eli Bower in 1957 and was revised and adopted by the US
Department of Education using the term seriously emotionally disturbed.
Intensity refers to the severity of childs problem. This factors is the easiest
to identify if one is guided with these questions. How does it get in the way of the
childs or societys goals? How much does it draw attention from others?
Pattern means the time when the problem occurs. Do problems occur only
during the school day? Only during Math class? Science class? At home? At
bedtime? Answers to these questions may yield very helpful diagnostic and
remediation information.
Duration refers to the length of time the childs problem has been present.
This implies that continuous observation has to be made. Some special educators
require a three month duration before they suggest that the child has an
emotional or behavioral problem.

IDEA defines emotional disturbance 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 a childs educational
performance:
An inability to learn that cannot be explained by intellectual, sensory, or
health factors.
An inability to build or maintain satisfactory interpersonal relationships with
peers and teachers
Inappropriate types of behavior or feelings under normal circumstances.
A general pervasive mood of unhappiness or depression
 A tendency to develop physical symptoms or fears associated with personal
or school problems.

The IDEA definition clearly specifies three conditions that must be met:
Chronicity a condition exhibiting one or more of the following characteristics over
a long period of time
Severity- to a marked degree
Difficulty in school adversely affects academic performance
As defined by IDEA, emotional disturbance includes schizophrenic or autistic
but does not apply to children who are socially maladjusted, unless it is determined
that they have an emotional disturbance. Likewise, there was no distinction
between serious and emotional disturbance and social maladjustment.
As evident in IDEAs definition, emotional disturbances can affect an
individual in areas beyond the emotional. Depending on the specific mental disorder
involved, a persons physical, social, or cognitive skills may also be affected. The
National Alliance on Mental Illness (NAMI) puts this very well:

CCBD Definition of Emotional and BehavioralDisorder

In 1989, the Council for Children with Behavioral Disorders, (CCBD) the major
professional Organization of Special Educators concerned with children with
emotional and behavioral Disorders, and the National Mental Health and Sped
Coalition wrote the following definition:

Emotional and Behavioral disorders are a disability characterized by:

Such disability is:
more than a temporary, expected response to stressful events in the
environment
is consistently exhibited in two different settings, at least one of which is
school- related
is unresponsive to direct intervention in general education or the childs
condition is such that general education interventions would be difficult

Classification of Emotional and Behavioral Disorders

The Diagnostic and Statistical Manual of Mental Disorders
The American Psychiatric Association (1994) enumerates three criteria that
must be met in determining the presence of emotional and behavioral disorders,
particularly among adults.
The person experiences significant pain or distress, an inability to work or
play, an increase risk of death, or a loss of freedom in important areas of life.
The source of the problem lies within the person, due to biological factors,
learned habits or mental processes and is not simply a normal response to
specific life events, such as the death of a loved ones.
The problem is not like a deliberate reaction to conditions such as poverty,
prejudice, government policy or other conflicts with society.

Quays Statistical Classification

Conduct Disorder is characterized by disobedience, being disruptive, getting
into fights, being bossy and temper tantrums
 Anxiety withdrawal, sometimes called anxiety disorder, is manifested by
social withdrawal, anxiety, depression, feelings of inferiority, guilt, shyness,
and unhappiness.
Immaturity shows in short attention span, extreme passivity, daydreaming,
preference for younger playmates, and clumsiness.
Socialized aggression is marked by truancy, gang membership, theft, and a
feeling of pride and belonging to a delinquent subculture.

Direct Observation and Measurement

Frequency indicates the rate at which the behaviors occur and how often a
particular behavior is performed.
Duration is a measure of the length and amount of time a child exhibits the
disordered behaviors.
Topography refers to the physical shape or form of behavior.
Magnitude refers to the intensity of the displayed behavior.
Stimulus control refers to the inability to select an appropriate response to
a stimulus.

Degree of Severity
The children who respond positively to therapy and intervention have a mild
level or degree of emotional and behavioral disorders. They can attend regular
classes and work successfully with the regular and special education teachers and
the guidance counselor. Those who have severe emotional and behavioral disorders
require intense treatment and intervention.

CHARACTERISTICS OF CHILDREN AND YOUTH WITH EMOTIONAL AND

BEHAVIORAL DISORDERS

Research on America children with emotional and behavioral disorders that

used national samples revealed that these children have average IQ scores with a
mean score of 86 points with more than half of the samples scoring between 91 and
90 points (Valdes et al., 1990). In another study (Cullinan et.al., 1992) concluded
that the higher mean score of 92. 6 were achieved by these children because they
attended regular classroom and received special education services. The research
data disprove the popular thinking that these children are poor in academic work.

Anxiety Disorders
We all experience anxiety from time to time, but for many people, including
children, anxiety can be excessive, persistent, seemingly uncontrollable, and
overwhelming. An irrational fear of everyday situations may be involved. This high
level of anxiety is a definite warning sign that a person may have an anxiety
disorder.
According to the Anxiety Disorders Association of America, anxiety disorders are the
most common psychiatric illnesses affecting children and adults. They are also
highly treatable. Unfortunately, only about 1/3 of those affected receive treatment.

OPPOSITIONAL DEFIANT DISORDER (ODD)

Often loses ones temper
Often argues with adults requests or rules
 Often actively defies or refuses to comply with adults request or rules
Often deliberately annoys people
Often blames others for ones mistakes or misbehavior
Often touchy or easily annoyed by others
Often angry and resentful
Often spiteful and vindictive

DELINQUENCY
It is a legal term that refers to the criminal offenses committed by an
adolescent. Delinquency is behavioral disorder. Studies show that a pattern of
antisocial behavior early in a childs life is a strong predictor of delinquency in
adolescence. Criminal careers start at an early age, usually by age social behavior
until adulthood. Oftentimes, they are beyond the control of their parents, family,
and friends. Many offenses are brought to court, but others remain unreported and
unknown.

Bipolar Disorder
Also known as manic-depressive illness, bipolar disorder is a serious medical
condition that causes dramatic mood swings from overly high and/or irritable to
sad and hopeless, and then back again, often with periods of normal mood in
between. Severe changes in energy and behavior go along with these changes in
mood.
For most people with bipolar disorder, these mood swings and related symptoms
can be stabilized over time using an approach that combines medication and
psychosocial treatment.

Conduct Disorder
Conduct disorder refers to a group of behavioral and emotional problems in
youngsters. Children and adolescents with this disorder have great difficulty
following rules and behaving in a socially acceptable ways. This may include some
of the following behaviors:
aggression to people and animals;
destruction of property;
deceitfulness, lying, or stealing; or
truancy or other serious violations of rules.

Eating Disorders
Eating disorders are characterized by extremes in eating behavioreither too
much or too littleor feelings of extreme distress or concern about body weight or
shape. Females are much more likely than males to develop an eating disorder.
Anorexia nervosa and bulimia nervosa are the two most common types of
eating disorders. Anorexia nervosa is characterized by self-starvation and dramatic
loss of weight. Bulimia nervosa involves a cycle of binge eating, then self-induced
vomiting or purging. Both of these disorders are potentially life-threatening.
Binge eating is also considered an eating disorder. Its characterized by
eating excessive amounts of food, while feeling unable to control how much or what
is eaten. Unlike with bulimia, people who binge eats usually do not purge afterward
by vomiting or using laxatives.

Obsessive-Compulsive Disorder
 Often referred to as OCD, obsessive-compulsive disorder is actually
considered an anxiety disorder. OCD is characterized by recurrent, unwanted
thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive
behaviors (hand washing, counting, checking, or cleaning) are often performed with
the hope of preventing obsessive thoughts or making them go away. Performing
these so-called rituals, however, provides only temporary relief, and not
performing them markedly increases anxiety.

Psychotic Disorders
Psychotic disorders is another umbrella term used to refer to severe mental
disorders that cause abnormal thinking and perceptions. Two of the main symptoms
are delusions and hallucinations. Delusions are false beliefs, such as thinking that
someone is plotting against you. Hallucinations are false perceptions, such as
hearing, seeing, or feeling something that is not there. Schizophrenia is one type of
psychotic disorder.

HOW TO ASSESS THESE CHILDREN?

Behavior Checklist for the Identification of Pupils with Hyperactivity from
Grades I-IV. The 45 items measures the extent of hyperactive behavior based
on time and frequency rates of temper outbursts, restlessness, shifting from
one task to another, bullying and teasing, fidgeting, oversensitivity and other
related behavior. Bautista (2002)
Aggression Inventory Scale for Adolescent that measures hostility,
disobedience, destructiveness, antisocial tendencies and dominance Rigonan
(2002)
Deviant Behavior Tendencies Scale that determines the range of deviant
behavior as manifested in acts such as defacing school properties, assaulting
or abusing students and school authorities, wearing or displaying
unacceptable attire and grooming, engaging in activities that interfere with
academic performance, achievements, and violence legal norms and policies.
Ibanez (2003)

EDUCATIONAL APPROACHES

APPLIED BEHAVIOR ANALYSIS

The regular teacher and the special education teacher work collaboratively in
developing and individualized plan or IEP. Applied behavior analysis strategies are
employed help the child learn new, appropriate responses and eliminate the
inappropriate ones

TEACHING SOCIAL SKILLS

Self-related behaviors: accepting consequences, ethical behavior, expressing
feelings, positive attitude toward self
Task- related behaviors: attending behavior, following directions, performing
before others, quality of work
Environmental behaviors: care for the environment, dealing with
emergencies, lunch-room behavior interpersonal behaviors: accepting
authority, gaining attention, helping others, making conversations
ALTERNATIVE RESPONSES
Knapczyk (1992, cited in Heward, 2003) developed the alternative responses
strategy in training four students with behavior problems to handle or defuse
provocative incidents. Instructions consisted of individualized videotape modeling
and behavior rehearsals. After watching the videotapes, the subject students
discussed the circumstances of the incidents with their special education teacher
and practiced specific alternative responses.

TEACHING SELF- MANAGEMENT SKILLS

Drabman, Spitalnik and O Leary taught a group of 9-and-10-year-olds to
record and evaluate their social and academic work behavior. The teacher did his
own recording and evaluation against which the students compared their work.
Students were rewarded with tokens. Later on, the students rated themselves and
decided how many tokens they had earned that day.
Children with the most serious emotional disturbances may exhibit distorted
thinking, excessive anxiety, bizarre motor acts, and abnormal mood swings.
Many children who do not have emotional disturbance may display some of these
same behaviors at various times during their development. However, when children
have an emotional disturbance, these behaviors continue over long periods of time.
Their behavior signals that they are not coping with their environment or peers.

FAMOUS PEOPLE WITH EBD

Britney Spears
Britney Jean Spears (born December 2, 1981) is a American
singer, dancer, songwriter, actress, and author. Her debut
album ...Baby One More Time propelled her to international
stardom in 1999. Now that she has left the Cedars-Sinai
Medical Center in Los Angeles, questions are being asked
whether or not Britney Spears has bipolar disorder, a serious
mental disorder characterized by mood swings between
extreme depression and mania. The rumor about her possible
bipolar disorder diagnosis comes from friends close to both
Britney Spears and her ex-husband, Keven Federline. Though some say she's on
drugs, while others say its post-partum depression. According to Dr. Diana
Kirschner, who has not treated Spears but is an expert on the subject, "people who
show patterns of behavior like Britney Spears are suffering from a dual diagnosis.
They have both a substance abuse problem and a bipolar disorder or manic
disorder.

PRINCESS DIANA
Diana, Princess of Wales (Diana Frances, nee Spencer; 1
July 1961 - 31 August 1997) was the first wife of
Charles, Prince of Wales. In the late 1980s, the marriage
of Diana and Charles fell apart, an event at first
suppressed, then sensationalized, by the world media.
Diana received a lump sum settlement of around
17,000,000 Pounds along with a legal order preventing
her from discussing the details. Many struggles with
depression led Diana to the eating disorder bulimia nervosa, which recurred
throughout her adult life.

ANGELINA JOLIE
Angeline Jolie, now a world famous actress and political
advocate, was once a moody gothic teen who used to cut
herself during bouts of depression. Shes still a little wacky,
and reportedly keeps an imaginary friend with whom she
has nightly consultations about her daily trials and
tribulations. Jolies bodyguard reported that her frequent
meltdowns and ridiculous demands were the makeup of a
self-centered and psychotic woman, and went so far as to
call her mentally abusive. Jolies own father has spoken out
about her depression, although Jolie was estranged from
him at the time for a number of reasons.

JOEL BILLY
Born (May 9, 1949) being a singer, a pianist and a songwriter
Billy Joel has won 6 Grammys and is both in the songwriter's
Hall of Fame and the Rock and Roll Hall of Fame. He has top ten
hits in the 70's, 80's and 90's which are quite rare for any pop
artist. He battled many times against depression and has tried
to commit suicide by drinking furniture polish. He then said "I
drank furniture polish, it looked tastier then bleach". He is now
semi-retired and continues to write and perform.

Brooke Shields
Brooke had everything fame could bring along with a pleasant
marriage and child. The birth of her child had caused her to
suffer from severe postpartum depression, it was suddenly at
the point where seeing a window would give her the feeling
that she had to jump out of her misery. She was suddenly
feeling shame and emptiness from the bottom up and would
sometimes not even answer to her crying baby. Fortunately
she has worked through the initial post natal depression and
enjoys the challenge of being a mother.
GIFTEDNESS AND TALENT
Federal or American Governments Definitions

The first federal definition of the gifted and the talented was contained in the
1972 Marland Report. Gifted and talented children are capable of high performance
and demonstrate potential ability in any of the following six areas:

General intellectual ability

Specific academic aptitude
Creative or productive thinking
Leadership ability
Ability in the visual or performing arts
Psychomotor ability

The Gifted and Talented Childrens Act of 1978 defined gifted and talented
children as those possessing demonstrated or potential abilities that give evidence
of high performance capability in such areas as intellectual, creative, specific,
academic or leadership ability, or in the performing or visual arts, and who, by
reason thereof require services or activities not ordinarily provided by the school.
The definition encompasses almost all of the areas where a person can demonstrate
outstanding performance. Almost all of the states have built their programs for
gifted and talented learners around the federal definition.

The 1991 Report on National Excellence: A Case for Developing Americas

Talent stated that talent occurs in all groups across all cultures and is not
necessarily revealed in test scores but in persons high performance capability in
the intellectual, creative and artistic realms. Giftedness is said to connote a mature
power rather than a developing ability.

Key Contemporary and Related Definitions

Renzullis Three-Trait Definition

Renzullis 1978 three-trait definition of giftedness continues to be cited in special

education literature. The definition states that giftedness results from the
interaction of: (1) above-average general abilities; (2) a high level of task
commitment; and (3) creativity. Gifted and talented children are those: possessing
or capable of developing this composite set of traits and applying them to any
potentially valuable area of human performance. Children who manifest or are
capable of developing an interaction among the three clusters require a wide
variety of educational opportunities and services that are not ordinarily provided
through regular instructional programs.

Piirtos Pyramid Model of Talent Development

Piirtos 1999 definition states that the gifted are those individuals who, by way of
having certain learning characteristics such as superior memory, observational
powers, curiosity, creativity and the ability to learn school-related subject matters
rapidly and accurately with a minimum of drill and repetition, have a right to an
education that is differentiated according to those characteristics. Piirto further
states that even if gifted students do not become producers of knowledge or makers
of novelty, special education should train them to become adults who will produce
knowledge or make new artistic and social products.

Piirtos pyramid model is composed of: (1) a foundation of genetic endowment; (2)
personality attributes such as drive, resilience, intuition, perception, intensity; and
the like; (3) the minimum intelligence level necessary for function in the domain in
which the talent is demonstrated; (4) talent in a specific domain such as
mathematics, writing, visual arts, music, science or athletics and; (5) the
environmental influences of five suns: the sun of home, community and culture,
school, chance and gender. Which talent is developed depends on the thorn of
passion, calling or sense of vocation.

Makers Problem-Solving Perspective

Another definition of giftedness and talent advanced by Maker in 1996 incorporates

high intelligence, high creativity, and excellent problem-solving skills. He
enumerates the following characteristics of a gifted person: a problem solver one
who enjoys the challenge of complexity and persists until the problem is solved in a
satisfying way. Such an individual is capable of:

(a) Creating a new or more clear definition of an existing problem

(b) Devising new and more efficient or effective methods
(c) Reaching solutions that may be different from the usual but are recognized as
being effective than previous solutions.

Theories and Definitions of Intelligence

1. Binet-Simon Scale (1890s)

Alfred Binet, a French psychologist (1857-1911) and his colleague, Theodore

Simon (1873-1961).

Binet was hired by the Paris School system to develop tests that would
identify children who were not learning and would not benefit from further
education. Together, Binet and Simon developed and co-authored a test to
roughly measure the intellectual development of young children between the
ages of three to twelve.

Binet developed a test that asked children to follow commands, copy

patterns, name objects and put things in order or arrange them properly.
From Binets work the term intelligence quotient or IQ evolved. The IQ is
the ratio of mental age to chronological age with 100 as the average.
Binets and Simons work influenced the growth of the intelligence testing
 movement.

2. Thorndikes Stimulus Response Theory

Edward L. Thorndike, an American psychologist (1874-1949). He developed a

multifactored test of intelligence that consisted of completion, arithmetic,
vocabulary and directions test (CAVD). The logic behind the CAVD test
eventually became the foundation of modern intelligence tests.

Thorndike drew and important distinction among three broad classes of

intellectual functioning: abstract intelligence that is measured by standard
intelligence tests, mechanical intelligence which is the ability to visualize
relationships among objects and understand how the physical world works,
and social intelligence which is the ability to function successfully in
interpersonal situations.

He proposed that abstract intelligence has four dimensions, namely, altitude

or the complexity of difficulty of tasks one can perform, width or the variety
of tasks of a given difficulty, area which is the function of width and altitude,
and speed which is the number of tasks one can complete in a given time.

Thorndike is cited for his work on what he considered as the two most basic
intelligences: trial and error and stimulus response association. His
proposition stated that stimulus response connections that are repeated are
strengthened while those that are not used are weakened.

3. L.L. Thurstones Multiple Factors Theory of Intelligence (1938)

Louis L. Thurstone, an American psychometrician (1887-1955) who studied

intelligence tests and tests of perception through factor analysis. His theory
stated that intelligence is made up of several primary mental abilities rather
than a general factor and several specific factors. His Multiple Factors Theory
of Intelligence identified the seven primary mental abilities as verbal
comprehension, word fluency, number facility, spatial visualization,
associative memory, perceptual speed, and reasoning.

4. Cattells Theory on Fluid and Crystallized Intelligence

Raymond B. Cattell, a British-American psychologist (1905-1998) theorized

that there are two types of intelligence:
Fluid Intelligence is essentially nonverbal and relatively culture free.
Fluid intelligence involves adaptive and new learning capabilities,
related to mental operations and processes on capacity, decay,
selection and storage of information.
Crystallized intelligence develops through the exercise of fluid
intelligence. It is the product of the acquisition of knowledge and skills
that are strongly dependent upon exposure to culture.

5. Sternbergs Triarchic Theory of Intelligence (1982)

 Robert Sternberg of Yale University theorized that intelligence is a fixed
capacity of a person. Hence, with higher intellectual capabilities, as in the
case with children and youth who are gifted and talented, almost every task
can be achieved at a high level of performance. Intellectual abilities must
increase with age, given the supportive environment effective teaching
learning conditions.

Triarchic theory three main parts:

Contextual intelligence emphasizes intelligence in its sociocultural
contexts. Persons who are high on the contextual dimension of
intelligence quickly recognize what factors influence success on
various tasks. They are adept at both adapting to and shaping their
environment so that they can accomplish their goals.
Experiential intelligence emphasizes insight and the ability to
formulate new ideas and combine seemingly unrelated facts or
information.
Componential intelligence emphasizes the effectiveness of information
processing. Sternberg defines component as the underlying cognitive
mechanisms that carry out the adaptive behaviour to novel situations.
There are two kinds of components.
1. Performance components are used in the actual execution of the
tasks. They include encoding, comparing, chunking and triggering
actions and speech.
2. Metacomponents - are the higher order executive processes used in
planning, monitoring, and evaluating ones working memory
program.

6. Gardners Theory of Multiple Intelligences (1983)

Howard Gardener is a psychologist and professor at Harvard University
Graduate School of Education and director of Project Zero. He did a massive
synthesis of a lot of research including brain research, evolutionary research
and genetic research.

The Multiple Intelligences

The MI theory advances that in teaching anything, a parent or teacher can draw on
childs many intelligences which are linguistic, logical-mathematical, bodily-kinetic,
spatial, musical, interpersonal, intrapersonal and naturalist. The theory rejects the
idea of central intelligence, rather, as the author says, it subscribes to each his
own learning style.

Gardener emphasizes that MI is originally not an educational theory. It is a theory on

how the mind is organized and developed. As opposed to general intelligence which
implies that there is one computer in the brain that determines whether a person
will be competent or incompetent at everything, he describes the mind as having 7,
8, 9 or even a dozen different computers. Some people have better computers
than the others because of who their parents are, where they live and how they
were trained.

1. Linguistic intelligence
Linguistic intelligence is the ability to use language to excite, please,
convince, stimulate or convey information. The indicators of linguistic
intelligence are manifested by persons who:
Ask a lot of questions, particularly why and what if questions
Have a good vocabulary, enjoy talking, can spell easily
Pick up new language easily, bilingual, trilingual, etc.
Enjoy playing with words, word games, word puzzles, rhymes
Enjoy reading, love stories, jokes, riddles
Like to write
Can talk about language skills

Linguistic intelligence can be developed through the use of the following activities:
reading fiction and non-fiction, literary work, newspapers, magazines, debates,
plays, listening to audiotapes, watching films, writing reports, stories, speeches.

Practitioners who have high linguistic intelligence include novelists, poets,

journalists, storytellers, actors, orators, comedians, politicians.

2. Logical-Mathematical Intelligence
Logical-mathematical intelligence is the ability to explore patterns,
categories and relationships by manipulating objects or symbols and to
experiment in controlled, orderly ways. The indicators of logical-
mathematical intelligence are manifested by persons who:
Want to know how things work
Are interested in if. . . .then logic
Oriented towards rule-based activities
Play with numbers, enjoy solving problems
Love to collect and classify objects

Logical-mathematical intelligence can be enhanced with the use of the following

activities: mazes, puzzles, outlines, matrices, sequences, codes, patterns, logic,
analogies, timelines, equations, games, formulas, theorems, calculations,
computations, syllogisms, probabilities.

Persons who excel in the following professions have high logical-mathematical

intelligence: mathematicians, scientists, computer engineers and programmers,
doctors, astronomers, inventors, accountants, lawyers, economists, detectives,
trivia champions.

3. Bodily-Kinesthetic Intelligence
Bodily-Kinesthetic intelligence refers to the ability to use fine and gross
motor skills in sports, the performing arts, or arts and crafts
production. The indicators of this component of the multiple
 intelligences are observed among person who:
Have a good sense of balance, good eye-hand coordination
Have sense of rhythm, graceful movement
Communicate ideas through gestures, body movements and
facial expressions read body language
Have early ease in manipulating objects and toys
Solve problems through doing

The following activities develop bodily-kinesthetic intelligence: role playing,

dramatization, skits, mimes, body language, gestures, facial expressions, dancing,
sports, games, experiments, laboratory work.

Persons who are successful in the following professions have high bodily-kinesthetic
intelligence: ballet and fold dancers, choreographers, sculptors, professional
athletes, gymnasts, surgeons, calligraphers, jewellers, watchmakers, carpenter,
circus performers.

4. Spatial Intelligence
Spatial intelligence is the ability to perceive and mentally manipulate a
form or object, perceive and create tension, balance and composition
in a visual or spatial display.
Some indicators of this aspect of MI are manifested by persons who:
Like to draw, doodle, sketch
Have keen eye for detail
Like to take things apart, like to build things
Have a good sense of relating parts to the whole
Enjoy puzzles, riddles
Remember places by description or image, can interpret maps
Enjoy orienteering, mechanically adept

Some of the activities that enhance spatial intelligence are: illustrations,

constructions, maps, paintings, drawing, mosaics, sketches, cartoons, sculptures,
storyboards, videotapes.

Persons who are successful in the following professions have high spatial
intelligence: urban planners, architects, engineers, surveyors, explorers, navigators,
mechanics, curators, map designers, fashion designers, florists, interior designers,
visual artists, muralists, photographers, movie directors, set designers, chess
players, cartoonists.

5. Musical Intelligence
Musical intelligence is the ability to enjoy, perform or compose a
musical piece. The indicators of musical intelligence are shown by
persons who:
Have sensitivity to sound patterns, hum or move rhythmically
Capture the essence of a beat and adjust movement patterns
according to changes
Have a good sense of pitch
 Hum tunes, can discriminate among sounds
Play with sounds, remember tunes and sound patterns

Persons who succeed in the following occupations have high musical intelligence:
composers, musicians, conductors, critics, opera artists, singers, rappers,
instrument makers and players, sound recording artists.

6. Interpersonal Intelligence
Interpersonal intelligence is the ability to understand and get along
with others. The indicators of this component of the multiple
intelligences are observed in persons who:
Demonstrate empathy towards others, feel so much for others
Are sensitive to the feelings of others
Act as mediator or counsellor to others
Relate well to peers and adults alike, like to be with other people
Are admired by peers, make friends easily
Display skills of leadership
Work cooperatively with others
Enjoy cooperative and group activities

The types of activities that will develop interpersonal intelligence include group
projects and charts, communication, social interaction, dialogs, conversations,
debates, arguments, consensus building, group work on murals and mosaics, round
robins, games, challenges and sports.

People who succeed in the fields of endeavour have high interpersonal intelligence:
teachers, social workers, doctors and nurses, anthropologists, counsellors,
priests/ministers, nuns, entrepreneurs, ombudsmen, managers, politicians,
salespersons, tour guides.

7. Intrapersonal Intelligence
Intrapersonal intelligence is the ability to gain access to and
understand ones inner feelings, dreams and ideas. The indicators of
this element of multiple intelligences are evidenced by people who:
Are goal-oriented, develop plans carefully
Are aware of their strengths and weaknesses, confident of their
own abilities and accept their limitations
Are self-regulating and self-directing, do not need to be told
what to do
Motivate themselves to engage in projects
Work towards the achievement of ones goals
Express preferences for particular activities
Communicate their feelings
Engage in creative thinking, novel and original ideas
Keep hobbies, productive pursuits, diaries

The activities that will enhance interpersonal intelligence include insight and
intuition building, creative and critical thinking, goal setting, reflection and self-
meditation, self-assessment, affirmation, keeping journals, logs and reflectionnaires,
I statements, discussion, interpretation and creative expression of values,
philosophical thoughts and ideas, quotations.

8. Naturalist Intelligence
Naturalist intelligence is the most recent addition to the original list of
seven multiple intelligences. Naturalist intelligence refers to the
persons ability to identify and classify patterns in nature. In prehistoric
times when people relied on hunting animals and gathering plants,
naturalist intelligence was used to sort what animals and plants were
edible or not. At present, a person uses his or her naturalist
intelligence in the ways he or she relates to the environment. A person
who has naturalist intelligence abilities is likely to be sensitive to
changes in flora and fauna weather patterns and similar environmental
factors.

Characteristics of Gifted and Talented Children and Youth

The previous discussions clearly indicate that giftedness and talent are a complex
condition that covers a wide range of human abilities and traits. That is why it must
be clearly understood that giftedness and talent vary according to social contexts.
Some students may excel in the academic subjects but may not show special
talents in the arts. On the other hand students who show outstanding talent in
sports and athletics, visual and performing arts or those with leadership abilities
may show only average or above average performance in academic subjects.

Highly gifted students, according to Silvermans studies (1995) have IQ scores 3

standard deviations or greater above the mean. The IQ score is greater than 145, or
35 to 55 points more or even higher than the average IQ scores of 90 to 110.
Among American children, there is only 1 child in 1,000 or 1 child in 10,000.

Silverman (2005) found the following characteristics among these highly gifted
individuals:

Intense intellectual curiosity

Fascination with words and ideas
Perfectionism
Need for precision
Learning in great intuitive leaps
Intense need for mental stimulation
Difficulty conforming to the thinking of others
Early moral and existential concern
Tendency toward introversion

There are times when the characteristics of gifted and talented persons are
misinterpreted as bordering on abnormal behaviour, aggressiveness, antisocial
behaviour, and the like.

Shaklee (1989, cited in Heward, 20003) listed the identifiers of young gifted and
talented children as follows:

Exceptional learner in the acquisition and retention of knowledge:

a. Exceptional memory
b. Learns quickly and easily
c. Advanced understanding/meaning of area

Exceptional user of knowledge in the application and comprehension of knowledge

a. Exceptional use of knowledge

b. Advanced use of symbol systems expressive and complex
c. Demands a reason for unexplained events
d. A reason well in problemsolving draws from previous knowledge and
transfers it to other areas.

Exceptional generator of knowledge individual and creative attributes

a. Highly creative behaviour in areas of interest and talent

b. Does not conform to typical ways of thinking, perceiving
c. Enjoys self-expression of ideas, feelings or beliefs
d. Keen sense of humour that reflects advanced, unusual comprehension of
relationships and meaning
e. Highly developed curiosity about cause; future, the unknown

Exceptional motivation individual motivational attributes

a. Perfectionism: striving to achieve high standards, especially in areas of talent

and interest
b. Shows initiative, self-directed
c. High level of inquiry and reflection
d. Long attention span when motivated
e. Leadership desire and ability to lead
f. Intense desire to know

Gifted and talented children may have special needs in one or more aspects of their
development and may experience a number of special stresses and difficulties.
These may include: extra pressure from parents and teachers to be continually
successful increased fear of failure and a sense of failure when not 'perfect'
expectations that they will spend unusual amounts of time practicing their special
skills such that they do not have normal play and recreation time developing high
demands and expectations of others frustration caused by having skills at different
stages of development (e.g. having advanced cognitive skills but only 'normal' for
age handwriting skills) difficulties in gaining access to a challenging level of
education appropriate to their needs inappropriate preschool or school curriculum
and/or placement difficulties relating to other children of the same age and finding
same age friends confusion in choosing a career for the child who is gifted in many
areas. The stresses sometimes experienced by gifted and talented children may
lead to a number of problems, including: deliberately not doing as well as they can,
in an effort to hide their differences emotional difficulties, such as depression,
stress, anxiety increased emotional intensity and sensitivity (including outbursts of
temper or tears) boredom in a normal classroom situation (which can lead to school
refusal and/or behavioural problems) limited social interaction and social
development. Despite the challenges that may face them, being gifted and talented
may also of course provide these children with many great opportunities and
experiences. In addition, research has shown that most gifted children are socially
and emotionally well adjusted.

Creativity as the Highest Expression of Giftedness

Creativity ability is considered as central to the definition of giftedness.

Clark (1986) refers to creativity as the highest expression of giftedness.

Stenberg (1988) suggests that creative, insightful individuals are those who make
discoveries and devise the inventions that ultimately change society.

There is no accepted definition of creativity. In his studies on creativity,

Guilford (1988) enumerates the following dimensions of creative behaviour:

Fluency the creative person is capable of producing many ideas per unit of
time.
Flexibility a wide variety of ideas, unusual ideas, and alternative solutions
are offered.
Novelty/originality low probability, unique words, and responses are used;
the creative person has novel ideas.
Elaboration the ability to provide details is evidenced.
Synthesizing ability the person has the ability to put unlikely ideas together.
Analyzing ability the person has the ability to organize ideas into larger,
inclusive patterns. Symbolic structures must often be broken down before
they can be reformed into new ones.
Ability to recognize or redefine existing ideas the ability to transform an
existing object into one of different design, function or use is evident.
Complexity the ability to manipulate many interrelated ideas at the same
time is shown.

A foremost authority on creative thinking and author of psychological test on

creativity,

Torrance (1993) found in a 30-year longitudinal study that high-ability adults who
were judged to have achieved far beyond their peers in creative endeavors possess
the following ten most common characteristics:

1. Delight in deep thinking

2. Tolerance of mistakes
3. Love of ones work
4. Clear purpose
5. Enjoyment in ones work
6. Feeling comfortable as a minority of one
7. Being different
8. Not being well-rounded
9. A sense of mission
10.The courage to be creative

Assessment of Gifted and Talented Children

Similar to screening and location and identification and assessment of exceptional

children, the following processes are employed:

1. Pre-referral intervention
Teachers are asked to nominate students who may possess the
characteristics of giftedness and talent through the use of a Teacher
Nomination Form
2. Multifactored evaluation
Information are gathered from a variety of sources using the following
materials:
Group and individual intelligence tests
Performance in the school-based achievement tests
Permanent records, performance in previous grades, awards received
Portfolios of student work
Parent, peer, self-nomination

Differentiated Curriculum and Instructional Systems

The skills in the Basic Elementary Curriculum of the Department of Education are
intended for average learners and lack the competencies that match the learning
characteristics of high-ablity students. A study of American gifted and talented
students found that 60% of all grade four students in a school district have already
mastered much of the content of the curriculum. Majority of the students scored
80% in a pretest in mathematics even before the school year began. A
differentiated curriculum that is modified in depth and pace is used in special
education programs for gifted and talented students.

Curriculum compacting
 Method of modifying the regular curriculum for certain grade levels by
compressing the content and skills that high-ability students are capable of learning
in a shorter period of time. At the Silahis Special Education Centers of Manila City
Schools, high-ability students study the fourth, fifth and sixth grades in a span of
two years.

Enrichment

This allows the students to study the content at a greater depth both in the
horizontal and vertical directions employing higher order thinking skills. The
differentiated curriculum goes beyond the so-called basic learning competencies
or BLC and allows the students access to advanced topics of interest to them.

Acceleration

Modifies the pace or length of time at which the students gain the skills and
competencies in the regular curriculum to accommodate the enrichment process.

Horizontal enrichment

Adds more content and increases the learning areas not found in the regular
curriculum for the grade level. The students go beyond the grade requirements and
move on to study the subjects in the higher grades. For example, mathematics
subjects like Algebra or Geometry that are partly included in the regular curriculum,
or, advanced subjects like Trigonometry and Calculus may be included in the
differentiated curriculum. Science, English and Filipino are enriched by expanding
the content covered in the same manner.

Vertical enrichment

This allows the students to engage in independent study, experimentation

and investigation of topics that interest them. Social studies and Makabayan
subjects lend themselves well to vertical enrichment activities that will give the
high-ability students opportunities to share their ideas in solving related problems at
home, the school and the community.

Most of the special education classes in the different regions of the country utilize
the:

Self-contained class

High-ability students are enrolled in a special class that is taught by a trained

special education teacher. Mainstreaming activities are arranged so that the
students can socialize with their peers, share their knowledge and assist in peer
mentoring the slow learners.

The Famous Gifted and Talented Children

 Elaina Smith

British Elaina Smith is a very wise and straight-

talking 9-year old girl from Coventry, West
Midlands. Whats so special about her? Elaina is
the worlds youngest agony aunt. She was
snapped up by Mercia FM when she was only
7.Her mother said they were listening to the radio
one morning while Elaina was getting ready for
school. The presenter asked for peoples advice
for a woman trying to get over a break-up and
Elaina said she wanted to phone in so we called
and I was surprised with what she came out with,
declared Elainas mom for Dailymail.co.uk. Are
you wondering what was the girls advisc? She
said the women should grab the girls, go bowling
and drink a mug of milk. The local radio station
was so impressed with her advice, they decided to offer Elaina a weekly breakfast
slot.
According to Dailymail.co.uk, these are some of Elainas top tips:
Andy: Hello Elaina, weve get a letter from someone here. It says,
Ive been single for far too long and all my friends have boyfriends, Im a
little bit worried about being left on the shelf. What can I do to meet Mr. Right?
Elaina: Go into town and shake your booty on the dance floor. Make sure
hes got money and a big car.
Andy: Weve had an email from Trish which says: My boyfriend has gone of
with my friend. What can I do to get him back? I really miss him.
Elaina: Hes not worth the heartache. Lifes too short to be upset with a boy. His
new girlfriend will always be thinking if he cheated with her then he will cheat
again.

Elis Tan Roberts

Meet Elise Tan Roberts, the youngest member of
Mensa! How smart is this small wonder? Her IQ is
an impressive 156. Compare Elises IQ to
Einsteins 160, and you will realize how smart she
is considering Elise was only 2 years old when her
IQ was assessed.
Elise joined Mensa, the oldest and largest high-IQ
society, when she was 2 years and 4 months old.
She is now 5. Elise Tan Roberts is in the top 0.2 % for her age, according to
Professor Joan Freeman, a distinguished psychologist who used the Stanford Binet
Intelligence Scale to evaluate Elise.

Alex Prior is Britains latest

conducting phenomenon. Born in 1992 to a
British father and Russian mother, the
talented composer and conductor
discovered his passion for music at a very
young age. Alexander started playing the
piano at the age of 3 and began composing five years later. He wrote more than 42
beautiful works, including ballets, symphonies, operas and concertos. This
extraordinary young man collaborated with the worlds most prestigious orchestras
and ensembles. Alexanders biography is remarkable, worth reading
Marko Calasan

Marko Casalan is a 10-year old little genius from Skopje, Macedonia. At the age of 8,
Marko was officially recognized as the worlds youngest certified computer system
admin. Widely regarded as the Mozart of Computers, Marko passed many of
Microsofts exams for IT professionals. The Microsoft officials gave me computer
games and DVDs with cartoons when I passed the exams because I am a child. That
was nice, but Im not really interested in those things. Id like to be a computer
scientist when I grow up and create a new operational system, declared Marko for
Timesonline.co.uk.

Gregory Smith

Gregory Smith (born 1989) has been

nominated four times for the Nobel Peace
Prize.[1] Gregorys first nomination came
when he was only 12 years old. This
exceptional teenager graduated at 10 from
Orange Park High School. Three years later,
Gregory graduated cum laude with a BS in
mathematics from Randolph-Macon College.

He has been in the company of the worlds

most notable political figures and Nobel Prize
winners and laureates: Michel Gorbachev, Bill
Clinton, Betty Williams, Desmond Tutu and
many more. He founded the International Youth Advocates Foundation. Gregorys
humanitarian and advocacy efforts on several continents earned him the four
nominations. According to ForceForGood.org, Gregory has organized humanitarian
aid projects for East Timor orphans, the youth in Sao Paulo, Brazil and is helping
Rwanda build their first public library. He is working with Christian Childrens Fund,
as Youth Ambassador, to build Peace Schools in Kenya and other conflict regions.

Akrit Jaswal

The Indian teenager gained international

attention as a physician, despite never
attending or graduating Medical School. While
most of us were playing with cars and dolls at
the age of seven, Akrit performed surgery! His
patient was a badly burned young girl whose
shepherd family couldnt afford surgery. Akrit
had the reputation of a medical genius, so
local doctors allowed him to observe various
surgeries. Driven by a strong passion for
anatomy and science, he used to read at six everything he could find on human
anatomy. Akrit was writing and reading by two and by the time he was five, he was
reading Shakespearein English. Akrit is now trying to find a cure for cancer. Ive
developed a concept called oral gene therapy on the basis of my research and my
theories. Im quite dedicated towards working on this mechanism, said the
teenager from Himachal Pradesh, India.

Ethan Bortnick

Ethan Bortnick, pianist, songwriter, composer, entertainer and one of the worlds
youngest philanthropists. Ethan, 11, has helped raise more than $25 million for so
many charities. He began playing the piano at the age of three and was composing
by the age of five. This hugely talented child is able to play any song by ear and his
complex compositions and performances are widely recognized as outstanding.
Ethan appeared on The Oprah Winfrey Show, The Tonight Show with Jay Leno, Good
Morning America, The Martha Stewart Show and many more.

The Latest Update

MANILA, PhilippinesA nonprofit organization has raised the need to set up a

database that would provide facts and figures on Filipinos with extraordinary talent.

The Philippine Center for Gifted Education Inc. (PCGE), a nonprofit actively searching
for gifted Filipinos and providing ways to improve their talents, estimates that up to
10 percent of the countrys young population of over 50 million (aged 1 to 21 years)
are gifted but not all of them have been identified.

With the help of the Department of Education (DepEd), the center is considering
establishing a database and the crafting of programs for the gifted through the
Association of Southeast Asian Nations (Asean) Summit on Giftedness on Oct. 24
and 25 at the Crowne Plaza Hotel, Ortigas Center, in Pasig City.

According to Ammie del Rey of the PCGE, the center has been working closely with
the DepEd since 2010 to identify gifted and high-ability children.
Up to now, the Philippines has no data and statistics on gifted children nationwide,
Del Rey said, attributing the absence of a database to lack of awareness in
identifying giftedness and high ability, as well as the reluctance of parents to have
their children identified as gifted.

Del Rey said there were previous cases where gifted children were overexposed
and their parents feared they would be treated differently.

She said the PCGE and the DepEd would soon begin the identification, assessment
and profiling of gifted and highly-able children.

Through the summit, after we have identified them, we hope to determine what
abilities they need to enhance and come up with programs to address obstacles to
their growth, she said.

The US-based National Society for the Gifted and Talented (NSGT) describes
giftedness, based on the US Department of Education definition, as the
characteristic of youth with outstanding talent who perform or show the potential
for performing at remarkably high levels of accomplishment when compared with
others of their age, experience or environment.
The summit expects to
Develop a better awareness of what giftedness and high ability are;
Be aware of issues in gifted education
Appreciate the state of the art in gifted education in the ASEAN region;
Identify the gaps that need to be worked on;
Be familiar with researches done in the area of giftedness and high ability;
and
Identify ways through which the ASEAN high ability and gifted can contribute
to national and regional development;
To form the ASEAN ASSOCIATION FOR HIGH ABILITY AND GIFTEDNESS (AAAG)

INTELLECTUAL DISABILITY
From Mental Retardation to Intellectual Disability

For many decades, mental retardation was the term of choice to describe an
individual with significant limitations in intellectual functioning and adaptive
behavior before it lost much professional acceptance. In fact, long before the use of
mental retardation, terminology such as idiot, imbecile and moron were used
frequently .
However, on January 5, 2010, during the 111th Congress of the United States
of America at the second session, the proposal to substitute mental retardation with
intellectual disability was raised by the Senate and House of Representatives. The
Act, cited as Rosas Law (Public Law PL111-256) named after a 9-year-old girl, Rosa
Marcellino, with Down syndrome, who was taunted frequently and pejoratively
called retarded in a demeaning manner in her school (Harris, 2013) aimed to
find a suitable and more dignified term to replace mental retardation.
During the debate in the 111 th Congress, the advocates settled for a
politically correct term cognitive disabilities to replace mental retardation. However,
the term intellectual disability soon caught up with the majority as it had a wider
acceptance. In August 2010, the Senate passed the Rosas Law. On September 22,
2010, the House of Representatives passed the law. Finally, on October 5, 2010,
President Barack Obama signed legislation (Public Law PL111-256) with the
approval of the Congress for changes in terminology dealing with mental retardation
to be substituted with intellectual disability and that person first language be used
when referring to such individuals in all federal laws, i.e., the Higher Education Act
of 1965, the Individuals with Disabilities Education Act (IDEA), the Elementary and
Secondary Education Act of 1965, the Rehabilitation Act of 1973, the Health
Research and Health Services Amendments of 1976, andas idiot, imbecile and
moron were used frequently.

DEFINITION
Intellectual disability is more than a disorder. It is a complex phenomenon
that changes over time and to define the term has always been a contentious
process. The following gives their own definition of the term:

IDEA (Individuals with Disabilities Education Act)

significantly subaverage general intellectual functioning, existing concurrently
with deficits in adaptive behavior and manifested during the developmental period,
that adversely affects a childs educational performance.

World Health Oraganization

means a significantly reduced ability to understand new or complex information

and to learn and apply new skills (impaired intelligence). This results in a reduced
ability to cope independently (impaired social functioning), and begins before
adulthood, with a lasting effect on development.

DSM-5 (Diagnostic and Statistical Manual for Mental disorders, Fifth

Edition)

A disorder with onset during the developmental period that includes both
intellectual and adaptive functioning deficits in conceptual, social, and practical
domains.

AIIRD (American Association on Intellectual and Developmental

Disabilities)

a disability characterized by significant limitations in both intellectual

functioningand in adaptive behavior, which covers many everyday social and
practical skills.

Definitions set a boundary and framework around the things that are
studied. However, in the area of intellectual disability, definitions and labels are
also a way of determining whether a person is eligible to gain access to services, or
should be excluded from service delivery. The definition of intellectual disability is
therefore much more than a point of
academic interest, but of major importance to both service providers and persons
with intellectual disability and their families. People with intellectual disability may
find the label intellectual disability useful in making sense of their world but at the
same time the term may also be a stigmatising experience.

Generally, individuals with intellectual disability has deficits on the following

aspects:

COGNITIVE SKILLS
 reasoning, problem solving, planning, abstract thinking, judgment,
academiclearning, and learning from experience

language and literacy; money, time, and number concepts; and self-direction

an IQ of approximately 70 or below on an individually administered IQ test

(DSM-V) as shown in the graph below:

ADAPTIVE SKILLS

personal care, work, money management, recreation, selfmanagement of

behavior, task organization

activities of daily living (personal care), occupational skills,healthcare,

travel/transportation,schedules/routines, safety, use of money, use of the
telephone

SOCIAL SKILLS

interpersonal skills, social responsibility, self-esteem, gullibility, navet,social

problem solving, and the ability to follow rules, obey laws

awareness of others thoughts and feelings; empathy, communication skills,

friendship abilities, social judgment

TYPES

According to degree/level

MILD
A mild intellectual disability is defined as an IQ between 50 and 70. A person
who can read, but has difficulty comprehending what he or she reads represents
one example of someone with mild intellectual disability.
MODERATE
A moderate intellectual disability is defined as an IQ between 35 and 50.
People with moderate intellectual disability have fair communication skills, but
cannot typically communicate on complex levels. They may have difficulty in social
situations and problems with social cues and judgment. These people can care for
themselves, but might need more instruction and support than the typical person.
Many can live in independent situations, but some still need the support of a group
home. About 10 percent of those with intellectual disabilities fall into the moderate
category.
PROFOUND
A severe or profound intellectual disability is defined as an IQ below
35.People with profound intellectual disability require round-the-clock support and
care. They depend on others for all aspects of day-to-day life and have extremely
limited communication ability. Frequently, people in this category have other
physical limitations as well. About 1 to 2 percent of people with intellectual
disabilities fall into this category.

ACCORDING TO DERIVATIVE/ETIOLOGY
Intellectual disability can also be linked with a number of genetic or inherited
conditions such as the following:
Chromosomal aberrations
Down syndrome - 47 chromosomes is present because an extra
chromosome 21. Common features includes low muscle tone, small
stature, an upward slant to the eyes, and a single deep crease across
the center of the palm
Cri-du-chat syndrome - characterized by a high-pitched voice and is
caused by a deletion in chromosome 5p3
Prader-Willi - results when the microdeletion is in the chromosome of
paternal origin. Persons with the Prader-Willi syndrome have an
excessive appetite and indiscriminate eating habits, leading to obesity.
Angelman syndrome - results when the microdeletion is in the
chromosome of maternal origin. Features includes severe speech
impairment, developmental delay and ataxia (problems with
movement and balance).

Disorders with autosomal- dominant inheritance

Tuberous sclerosis - caused by a mutation in a gene affecting the
formation of the ectodermal layer of the embryo. Skin lesions, epilepsy,
and calcifications in the brain are seen, as are tumors.

Disorders with autosomal-recessive inheritance

Phenylketonuria (PKU) - genetic disorder that is characterized by an
inability of the body to utilize the essential amino acid.

X-linked
Klinefelters syndrome - a condition that occurs in men who have
an extra X chromosome. The syndrome can affect different stages of
physical, language, and social development., delay in language, etc.
 The most common symptom is infertility. Boys may be taller than other
boys their age, with more fat around the belly
Turners syndrome - caused by a missing or incomplete X
chromosome. People who have Turner syndrome develop as females.
Some of the genes on the X chromosome are involved in growth and
sexual development, which is why girls with the disorder are shorter
than normal and have incompletely developed sexual characteristics.
Fragile X syndrome- also termed Martin-Bell syndrome or marker X
syndrome. Characteristics include an oblong face, prominent ears and
jaw, hyperactivity, delay in language, etc.

Maternal Infections
Microcephaly - means "small headednmoderate, severe,
and profoundess". Microcephalics fall within the categories of mental
retardation, but the majority shows little language development and is
extremely limited in mental capacity.
Hydrocephalus - the accumulation of an abnormal amount of
cerebrospinal fluid within the cranium causes damage to the brain
tissues and enlargement of the cranium.development and is extremely
limited in mental capacity.

Toxic Substances
Fetal Alcohol Syndrome (FAS) - CNS dysfunction, including mild-to-
moderate mental retardation, delay in motor development,
hyperactivity, and attention deficit

CHARACTERISTICS

All the intellectually disabled have one thing in common which is the
disability they have. However, they differ in every other aspect.The main
characteristics of the intellectually disabled fall under four aspects which are:

Physical
An underdevelopment in physical growth
Average weight and height usually less than normal peers of the
same chronological age
Physical deformation
Awkward gait, movement and balance

Cognitive
Less-than-average I.Q.
Underdeveloped speech and language skills
Poor: memory, attention, perception, imagination,thinking,
computing and concentration
Social
Underdeveloped ability of social adjustment
Lack of interests and orientations
Irresponsibility
Aloofness
Aggression
Low self-esteem

Emotional
Emotional imbalance
Excessive movement
Evidence of premature or late reactions
Primitive reactions

Generally, individuals with intellectual disability has difficulty learning and

processing information as quickly as people without an intellectual
disability,grasping abstract concepts such as money and time, understanding the
subtleties of interpersonal interactions (and so may sometimes behave awkwardly
or inappropriately in social situations) manipulating the ideas and concepts required
for planning and organisation.
Meanwhile, the types of intellectual disability according to degree or level
pose the following characterictics:
MILD
participates in and contributes to their families and their communities,
has important relationships in his/her life
works in either open or supported employment
may live and travel independently but will need support and help to handle
money and to plan and organise their daily life
may marry and raise children with the support of family, friends and the
service system,
may learn to read and write

MODERATE
has important relationships in his/her life
enjoys a range of activities with their families, friends and acquaintances
understands daily schedules or future events if provided with pictorial visual
prompts such as daily timetables and pictures
may learn to recognise some words in context, such as common signs
will need lifelong support in the planning and organisation of their lives and
activities

PROFOUND
recognises familiar people and may have strong relationships with key people
in their lives
has little or no speech and relies on gestures, facial expression and body
language to communicate
requires lifelong help with personal care tasks, communication and accessing
and participating in community facilities, services and activities
ASSESSMENT

The purpose of the assessment the following:

To determine if the person does have an intellectual disability. This in
effect is a determination of whether the person is eligible for services
made available to people with intellectual disabilities
To determine the person's current skill level
To determine the person's level of support need

The following are the most commonly used tools of assessment for intellectual
disability:

ASSESSMENT USED FOR INTELECTUAL ABILITY

Cognitive Assessment System Das-Naglieri (CAS)

Comprehensive Test of Nonverbal Intelligence Second Edition (CTONI-
2)
Kaufman Adolescent and Adult Intelligence Test (KAIT)
Kaufman Brief Intelligence Test Second Edition (KBIT-2)
Leiter International Performance Scale Third Edition (Leiter-3)
Reynolds Intellectual Assessment Scales (RIAS)
Slosson Intelligence Test Revised Third Edition (SIT-R3)
Stanford-Binet Intelligence Scales Fifth Edition (SB5)
Test of Nonverbal Intelligence Fourth Edition (TONI-4)
Universal Nonverbal Intelligent Test (UNIT)
Wechsler Adult Intelligence Scale Fourth Edition (WAIS-IV)
Wechsler Intelligence Scale for Children Fourth Edition (WISC-IV)
Woodcock-Johnson III Normative Update Tests of Cognitive Abilities
(NU)

ASSESSMENT FOR ADAPTIVE SKILLS

Comprehensive Test of Adaptive Behavior School 2nd Edition (ABS-

S:2)
Adaptive Behavior Assessment System Second Edition (ABAS II)
Comprehensive Test of Adaptive Behavior (CTAB)
Scales of Independent Behavior Revised (SIB-R)
Vineland Adaptive Behavior Scales, Second Edition
(Vineland-II)

ACHIEVEMENT MEASURES

Gray Oral Reading Test (GORT-5)

Scholastic Abilities Test for Adults (SATA)
Stanford Test of Academic Skills (TASK)
Test of Written Language (TOWL-4)
Wechsler Individual Achievement Test-III
 Wide Range Achievement Test, 4 Edition (WRAT-4)
Woodcock Reading Mastery Third Edition
Woodcock-Johnson Psychoeducational Battery-III

CONSIDERATONS FOR COGNITIVE TEST

Stability over time

For most, intelligence remains stable after 5 years of age
However, variability in individual growth patterns warrant periodic evaluation

STANDARD PRACTICES FOR ADAPTIVE SKILLS

Assess present functioning
Assess typical functioning
Consider the persons age and culture
Assessment using standardized measure of AB normed on general population
Compare persons adaptive behavior to community standards and
expectations
Use multiple informants
Retrospective assessment
Mental Retardation/Intellectual Disability

EDUCATIONAL PLACEMENT
Many kinds of educational placements are possible for students who have
mental retardation (SMR):
Specialized, segregated school solely for SMR and/or students who have other
disabilities
Specialized, segregated classes for SMR located within regular public (government)
or private schools
Special rooms in a regular school to which SMR can go for a portion of the day
while remaining in a regular classroom the rest of the time
Full-time placement in regular education settings;
Individual tutoring, private or public
Combinations of these and any other settings, e.g., part-time placement in a
community work setting plus attending a specialized class for SMR.

In the past, children with mental retardation were usually placed in self-
contained classes. Though this traditional approach is still relatively common,
increasingly, students with mental retardation are now included in mainstream
schools and even regular classes. This is particularly the case for those with mild to
moderate retardation. Typically, these students receive their special education in
either a resource room, where they work with special education teacher one-to-one
or in a small group, or in the regular classroom where the special education teacher
works for them. In this model, the amount of time students spend outside the
regular classroom depends on their individual needs. Thus, some may spend nearly
the entire day in the regular classroom while others may be there for less than an
hour.
At present, many children with mild and moderate mental retardation are
enrolled in the regular classroom. They are mainstreamed in the academic subjects
under the tutelage of the regular teacher and the special education teacher. The
special education teacher provides individualized instruction on the school subjects
and tasks recommended by the regular teachers and directs family members to
help with assignments and class projects.
When students with mild or moderate mental retardation are enrolled in
regular classes, the regular teacher and the special education teacher work
together to help the child attain the goals and objectives set for the school year.
This is what we call inclusive education because the regular class has a student with
a disability who has been assessed to be capable of learning side by side with
normal students. The Individual Education Plan (IEP) is prepared by the teachers
and parents to identify and indicate the goals for the school year and the objectives
and activities during the entire school year for successful inclusive education.
Among the advantages generally cited of including students with intellectual
disability in integrated, normalized settings are several, including a belief that to do
so is far less expensive than providing specialized services. Some students may
learn by watching the appropriate behaviors of the non-disabled students (although
some may not be able to imitate others behaviors, appropriate or inappropriate).
Regular students may come to better understand and appreciate those who have
mental retardation. Familiarity may result in better relationships, although this is far
from guaranteed. However, it does seem reasonable that the greater the contact
the student with mental retardation have with ordinary society, the better they may
be able to operate in it, experiencing greater choice and independence.
Important factors that must be considered in making actual placement
decisions for an individual student include: (a) the match between the curriculum
and the students needs and abilities;(b) the SMR behavior and its effect on other
students and on the SMR own learning; (c ) the training, skills and attitudes of the
staff in each possible placement; (d) the need/availability of specialized equipment;
(e) the evidence of each programs effectiveness for children who have
characteristics similar to the SMR; and (f) future plans and probabilities for the SMR
work and living arrangements.
In short, there are no easy or simple answers to the educational placements
for SMR. There is no one answer, no one universally appropriate placement for all
SMR. Appropriate placements depend on the needs and abilities of the individual
SMR, our concepts of human rights and dignity, our beliefs about the effects of
nature and nurture on the course of SMR, and the availability of resources including
trained staff and current technology.

Special educators must always remember the nature and the essence of
special education includes individualized instruction based on the childs needs and
characteristics, tightly sequenced tasks, sensory stimulation, careful arrangement
of the environment to minimize distraction and maximize attention to relevant
stimuli, immediate reward for correct performance, tutoring in functional skills, and
above all, the belief that every child should be educated to the maximum possible
for that child.

EDUCATIONAL PROGRAMS

Early Intervention Program

The skills that are normally learned during early childhood are taught at a
time when the child is still young and more malleable than when he or she would
have grown older and less flexible. The opportunities to learn the adaptive skills
early are enhanced and this increases the chances for the child to be able to cope
with the demands of future environments. Home and the participation of the
parents and family members play an important role in this program. Effective early
intervention takes place in the natural setting at home. In addition to the behaviour
skills, social and emotional bonds are developed that set a strong base for future
special education programs and activities.
Rationale for Early Intervention
1.Secondary disabilities that would have gone unnoticed can be observed.
2.Can prevent the occurrence of secondary disabilities.
3.Lessen the chances for placement in a residential school.
4.Members learn how to offer support and fulfil the childs need for
acceptance, love, and belongingness.
5.Hasten the childs acquisition of the desirable learning and behaviour
characteristics for the attainment of his or her potential.

Modes of Early Intervention

1.Home-based Instruction Program

The goal is to provide a continuous program of instruction both in school and at
home for a more effective management of the handicapping condition.
2.Head Start Program
Addresses pre-school education for the socially and economically deprived children
who are four to six years old. The program operates on the principle of early
intervention as a preventive measure against behaviour problems among young
children that may lead to juvenile delinquency.
3.Community-based Rehabilitation (CBR) Services
Measures taken at the community level that use and build on the resources of the
community to assist in the rehabilitation of those who need assistance including the
disabled and handicapped persons, their families, and their community as a whole
(WHO, 1984).
4.Urban Basic Service Program
An early intervention scheme based on the principle of home-based instruction.
Children with disabilities in the barangays or villages identified as depressed or
underserved, who are not receiving special education services were placed in this
program.

GENERAL APPROACHES

The Curriculum
Students with mental retardation need a functional curriculum that will train
them on the life skills which are essentially the adaptive behaviour skills. The goal
and direction of a functional curriculum is towards self-direction, regulation and the
ability to select appropriate options in everyday life at home, in school, and in the
community. The functional curriculum fosters independent living, enjoyment of
leisure and social activities and improved quality of life.
A number of curricular programs for children with developmental disabilities
are implemented in the United States and other Western Countries.
The curriculum for MH children falls into the following six areas of learning:
1. Language
2. Mathematics
3. Personal and Social Development
4. Perceptual Motor
5. Aesthetics and Creativity
6. Practical Skills

These six areas of learning encompass twelve basic subjects as follows:

1. Language
2. Mathematics
3. Computer Learning
4. Self-Care
5. General Studies
6. Perceptual Motor Training
7. Physical Education
8. Music
9. Art and Craft
10. Home Economics
11. Design and Technology
12. Independent Living Skills

Methods of Instruction
Teaching children with mental retardation requires explicit and systematic
instruction. Among these methods are the following:

1.Applied Behavior Analysis (ABA) this is derived from the theory and
principles of behaviour modification and the effect of the environment on the
learning process.

2.Task Analysis is the process of breaking down complex or multiple skills into
smaller, easier-to-learn subtasks. Direct and frequent measurement of the
increments of learning is done to keep track of the effects of instruction and to
introduce needed changes whenever necessary.

3.Active Student Response (ASR) the observable response made to an

instructional antecedent is correlated to student achievement. Systematic feedback
through positive reinforcement is employed whenever needed by rewarding the
students correct responses with simple positive comments, gestures or facial
expressions. Meanwhile incorrect responses are immediately correct by asking the
student to repeat the correct responses after the teacher.

4.Transfer of Stimulus method emphasizes the application of learned skills in

the natural environment. Correct responses are rewarded through positive
reinforcement. Conversely, generalization and maintenance of learned skills or the
extent to which students can apply correctly what they have learned across settings
and over time are measured and recorded.

Teaching the Basic Skills

Academic Expectancy
The Estimation of a pupils academic potential or expectancy is generally
made on the basis of his mental age as measured by standardized intelligence test.
In planning an academic program for children with mental retardation, teachers will
need to use the mental ages of each of their pupil in order to: (1) Estimate whether
or not each pupil is functioning up to his indicated capacity, and (2) set realistic
goals for each student in the basic skills areas. This information, if used wisely, can
also be helpful to teachers in total curriculum planning and can help avoid some
rather costly teaching errors
Oral Communication
The ability to listen purposefully and to speak effectively are clearly essential
skills which all children must learn. However, while many children in the regular
grades come to school with considerable facility in oral communication, this often
may not be true with pupils who are mentally retarded. Because of this, special
teachers should provide many experiences which will help their students to develop
the skills to the maximum potential.
Reading
It is generally considered to be one of the most difficult subjects for the
mentally retarded in the entire special class curriculum. It is also regarded as one of
the most important. The ability to read is basic to many activities, both in school as
well as in adult life, and it is an important key to adequate social and vocational
adjustment
Children with intellectual disabilities need t be able to read for the same practical
and functional reasons that all people read. Although they will not use reading as
extensively as other people, most special class students can learn to read
sufficiently well by the time they leave school so that they can use it independently
in most practical life situations.

3 types of reading for the Mentally Retarded:

1.Reading for protection being able to recognize and understand various signs and
labels found at home and in the school and community.
2.Reading for information and instruction reading for specific information as well
as reading of various kinds.
3.Reading for enjoyment reading simple books, magazines, and selected parts of
newspapers.

Handwriting
Handwriting is essentially a motor skill that develops gradually in all children
as they progress through school. The methods and procedures for teaching
handwriting to children with intellectual disability are very similar to those used in
teaching handwriting to all children and much of the instruction in this area centers
around functional activities such as making copies of reading materials or writing
letters. In addition, the emphasis in both programs is on neatness, legibility, and
accuracy.

Spelling
The aim of the spelling program in special classes should be to teach children
with intellectual disability to spell correctly the important and commonly used words
they will need in order to function independently in most practical life situations.
The methods for teaching spelling to children with intellectual disability, again, are
similar to those employed in teaching spelling to all children. In carrying out the
spelling program, teachers may wish to prepare their own spelling lists made up f
some words from the regular spelling texts, together with appropriate words from
the present unit work that is being carried on in the class at the time.
Written Language
Most educable children with intellectual disability will not use written language in
adult life as extensively as will other persons. However, there are a number of
occasions when they will need the skill, for example, in writing personal letters,
making various lists of things to be remembered or filling out a variety of forms.
Some activities which can be carried on in the classroom to develop minimal
independence in this skills are: writing simple stories by individuals or by the class,
answering comprehension questions from the daily reading program, writing thank
you notes and others.

Arithmetic
It is also generally considered to be difficult but very important subject to be
learned by the educable children with intellectual disability. Although these pupils
will not use arithmetic as extensively as other people, they will nevertheless be
confronted with daily situations involving the use of this skill, like telling time, using
money, measurements and the like. Because it is a practical skill in daily living,
teachers have a responsibility to help each pupil develop proficiency in arithmetic to
the maximum of his potential.

FAMOUS PEOPLE WITH MENTAL RETARDATION

1. Kim Peek Known as the mega savant, was diagnosed to have the mental
disorder since birth and died when he was 58. The famous movie Rain, is based on
the biography of this great man.

2. Chris Burke He had a genetic defect called the Downs syndrome at time
of his birth. In his adulthood, he always attended special schools and fought an
enduring battle against his mental illness. He was well known for his humor and
friendly nature. He became famous as a TV actor in ABCs show Life Goes On, aired
on the WLS Channel 7 at 6 pm every Sunday.

3. Gretchen Josephson She was a writer who suffered from severe MR,
caused as a result of Downs syndrome. She became renowned after the publication
of her book, named Bus Girl. This book is a collection of poems inspired from her
life and her life-long struggle against her mental illness.

4. Dwight Mackinto a famous artist who also experienced the lifetime effects
of mental retardation. Although he was diagnosed with this kind of mental illness,
many people admired him because of his great determination and overwhelming
success despite of all the challenges that he experienced. Just like the other victims
of severe mental retardation, Mackinto was also diagnosed with a genetic mental
disorder called Downs syndrome at the time of his birth. And he noticed the effects
of severe mental retardation in his performance when he was already at the stage
of early adulthood.
5. Paula Sage Scottish film actress and Special Olympics netball athlete. Her
role in the 2003 film AfterLife brought her a BAFTA Scotland award for best first time
performance and Best Actress in the Bratislava International Film Festival, 2004.
Afterlife won the Audience Award at The Edinburgh Film Festival 2003. It also won
Sage a role as Donna McCabe in BBC Scotlands River City soap.
6. John Mark Johnny Stallings son of former University of Alabama head
football coach Gene Stallings and subject of the book Another Season: A Coachs
Story of Raising an Exceptional Son. (ISBN 0767902556). John Mark's courage and
attitude had a positive impact on all who came in contact with him. He also deeply
affected Coach Stallings' perception of football, and the coach's approach on the
field.

7. Karen Gaffney is the president of the Karen Gaffney Foundation, a non-

profit organization championing the journey to full inclusion for people with Down
syndrome and other disabilities. In 2001 she became the first person with Down
syndrome to complete a relay swim of the English Channel. Her 2007 swim across
the nine mile span of Lake Tahoe became the subject of the documentary Crossing
Tahoe: A Swimmer's Dream. She has also earned two gold medals from the Special
Olympics, and completed 16 swims across San Francisco Bay, including the Escape
from Alcatraztriathlon. In 2010, she received the Global Down Syndrome Quincy
Jones Exceptional Advocacy Award. Karen Gaffney became the first living person
with Down syndrome to receive an honorary doctorate degree when she received an
honorary Doctor of Humane Letters degree from the University of Portland on May
5th, 2013, for her work in raising awareness regarding the abilities of people who
have Down syndrome. She graduated from St. Mary's Academy high school in
Portland in 1997, and in 2001 she graduated from Portland Community College with
an Associate of Science degree and a teacher's aide certificate.

8. Judith Scott was an internationally renowned American fiber artist. She

was a fraternal twin to Joyce Scott, and she was born profoundly deaf, mute, and
with Down syndrome. She worked at the Creative Growth Art Center in Oakland,
California.

9. Miguel Tomasin - singer with Argentinian avant-rock band, Reynols.

About Reynols: Reynols (an Argentine band led by a drummer, Miguel Tomasin,
with Down syndrome) earned a measure of fame with a series of high-concept art
projects, including a symphony for 10,000 chickens, an album of blank tapes
playing, and a disc of "dematerialized" music (an empty CD case).
Reynols' drummer and band leader Miguel Tomasin was once asked how
popular the band was in Argentina (where it was the house band on the hit medical
program "The Health of Our Children"), to which he replied, "We're more famous
than a frozen glass of wool." Music from Inside the Mirror for the Mega-Mind Ears.
Source: (http://www.ishitnoise.com/wiki/index.php?title=Reynols)

10. Lauren Elizabeth Potter is an American actress, best known for her role
as Becky Jackson on the television show Glee. Potter portrays the character Becky
Jackson, a cheerleader with Down syndrome, on the TV show Glee. In November
2011, President Barack Obama appointed Potter to the President's Committee for
People with Intellectual Disabilities, where she will advise the White House on issues
related to that population
LEARNING DISABILITY
Case Analysis:

Elizar is a typical, healthy, good-looking, middle class, 14- year-old boy who studies
in a private school. Unlike his classmates in kindergarten eight years ago, Elizar is
still in third grade. According to the results of the mental ability tests, his IQ score is
within the average range. But he failed the school subjects consistently. He did most
poorly in Language, Reading and Mathematics. The teachers complained about his
inability to pay attention and to concentrate on the lessons. He also tended to
disrupt the class with his impulsive and hyperactive behavior which got him into
fights with his classmates and problems with the teacher and school administrators.
Elizar had spent the last five years in five different schools.

There are a number of students in regular classes whose mental ability is within
the range or may even be above average but who do not learn the skills in the basic
education curriculum that are suitable to their chronological ages and grade levels.
These students have learning disabilities.

- Julieta A. Gregorio, Students with Learning Disabilities

Learning Disability

-a generic term that refers to a heterogeneous group disorders manifested by

significant difficulties in the acquisition and use of listening, speaking, reading,
writing, reasoning or mathematical abilities.

-American National Joint Committee on Learning Disabilities (NJCLD), 1989

3 behavior problems:

(a) inattention, (b) hyperactivity and (c) impulsivity

Learning and Behaviour Characteristics of Children with Learning

Disabilities:

1. READING poses the most difficulty among all the subjects in the curriculum

2. WRITTEN LANGUAGE poses severe problems in one or more of the following

areas:
 a. Handwriting
b. Spelling
c. Composition
d. Writing (which is illegible and low)

3. SPOKEN LANGUAGE poses problems on the mechanical uses of language in

syntax or grammar, semantics or word meanings and phonology or the breakdown
of words into their component sounds and blending individual sounds to compose
words.

4. PRAGMATICS OR SOCIAL USES OF LANGUAGE poses problems on the ability

to carry on a conversation.

5. MATHEMATICS PROBLEMS are recognized as second to deficiencies in reading,

language and spelling.

6. These children TEND TO FAIL AND BE RETAINED IN A GRADE LEVEL.

The level of academic achievement tends to decrease progressively as the
grade level increases.

7. BEHAVIOR PROBLEMS remain consistent across grade levels both in school, in

the community and at home.

8. SOCIAL ACCEPTANCE is low

Perceptual, Perceptual-Motor, and General Coordination Problems:

1. Visual and/or auditory perceptual disabilities

2. Difficulty with physical abilities
3. Having problems with attention and hyperactivity

Memory, Cognitive and Metacognitive Problems:

1. Attention deficits
2. Poor Memory

Difficulties in Learning:

Dyslexia- Severe difficulty in learning to read

Dysgraphia- Severe difficulty in learning to write

Dyscalculia- Severe difficulty in learning to do mathematical concepts and

computation

Dysorthographia- Severe difficulty in learning to spell

3 Criteria in Determining the Presence of Learning Disabilities:

1. Severe discrepancy between the childs potential and actual achievement
2. Exclusion or absence of mental retardation, sensory impairment and other
disabilities
3. Need for special education services

ASSESSMENT:

1. Norm- Referenced Tests

-These tests are designed to measure how many of the skills in each learning-
(a) English, (b) Filipino, (c) Mathematics, (d) Science and (e) Makabayan- have been
learned or mastered.
-Students with learning disabilities manifest deficits in the expected number
of skills for mastery in a particular grade level.
-Examples:
(a) National Achievement Test, (b) Regional Achievement Test and (c)
School-Based Achievement Test

2. Process Tests
-These tests are designed to measure how an individual processes
information.
-Students with learning disabilities manifest problems in visual perception,
auditory perception and visual-motor coordination.

-Examples:
(a) Illinois Test of Psycholinguistic Abilities and (b) Marianne Frostig
Developmental Test of Visual Perception

Sample Readings of Dyslexic Child:

Original Text-

What I did Last Summer?

My friend Mark bought a dog from the pet shop for $148. His
parents gave him the money but said that he would have to pay half to them over
the summer by doing special chores around the yard. He figured he could repay
his parents 74 dollars. Later that day, I came over to share his excitement. With the
dogs big ears and wagging tail, we played all day. Mark chose a blue collar for him.
The 3 of us passed our summer days bike riding, hiking, and playing ball.

Readings of the child-

Mhat I bib last snwwer

Wy frieub Roddie donght a bop frow the det shod for $148. His
darents pave hiw the wouey pnt saip that he wonlp have to day half to thew over
the snwwer dy poinp sbecial chores aronud the yarp. He fipnreb he conlp rebay his
dareuts L4 bollars. Later that pay, I cawe over to share sih exciteweut. With the
bops pip ears aup mappinb tail, we blayeb all bay. Roddie chose a dlne collar for
hiw. The E of ns bassep onr snwwer pays dike ripinp, hikiup, and blayinp pall.

Sample Writings of a Dysgraphic child:

 \

3. Criterion- Referenced Tests

-are used to determine the mastery level of a predetermined criterion that
the student should be capable of achieving.
-Areas:
(a) Reading, (b) Language and (c) Mathematics

4. Informal Reading Inventory

-Used to determine the students reading ability. It usually consists of a series
of progressively more difficult sentences and paragraphs for oral reading.
-The students mistakes in reading skills are recorded particularly in the
pronunciation of vowels and consonants, omissions, reversals, substitutions and
comprehension.

5. Direct daily measurement of learning

-Used to determine a students performance in progressively learning a particular
skill.

TEACHING STUDENTS WITH LEARNING DISABILITY:

Diagnostic-Prescriptive-Evaluation Approach

1. The results of assessment are used directly to draw up an Individualized

Education Plan (IEP).
2. The long term annual goals that the students can achieve are identified, then the
short-term quarterly objectives are prescribed.
3. Monthly, weekly and daily instructional plans are written to achieve the preset
goals and objectives of teaching.
4. Formative and summative evaluation procedures are employed to track the
mastery of the skills.

Strategies:

Provide high structure and clear expectations

-Children who are LD tend to have difficulty focusing, getting started and
setting priorities. Creating a clear structured program allows the student to be
exposed to fewer distractions and possible avoidance and allow for greater focus on
work related tasks.

Allow flexibility in classroom procedures

-allowing the use of tape recorders for note taking and test-taking when
students have trouble with written language. Keep in mind that the greater the
number of options in responding to a task, the greater chance that a particular
students learning style will be useful and successful.

Learning materials should easily accessible, well organized and stored in the same
place each day
-The less the LD student has to worry about, comprehend or remember, the
greater chance for success. Too many details can easily overwhelm this type of
student.

All assignments should be presented on the blackboard as well as orally presented

-This multilevel sensory approach will only enhance the chances of the child
being able to bring home the correct assignment. This will also cut down on parent
child frustration which often occurs when the child with learning disabilities brings
home part of the assignment or and assumption of what needs to be done due to a
lack of ability in copying quickly.

-Make sure that the child's desk is free from all unnecessary materials

-Correct the student's work as soon as possible to allow for immediate gratification
and feedback.

-Try to separate him from students who may be distracting

What Types of Instructional Technology can be Effective?

1.Word processing
2.Speech recognition
3.Digital voice recorders
4.Computer programs

Famous People with LD

1. Tom Cruise
2. Winston Churchill
AUTISM
What is autism?

I DEA specifically defines autism as follows:

..a developmental disability significantly afecting verbal and nonverbal
communication and social interaction, generally evident before age three, that
adversely afects a childs educational performance.
A child who shows the characteristics of autism after age 3 could be diagnosed as
having autism if the criteria above are satisfied. [34 CFR 300.8(c)(1)]
Other characteristics often associated with autism are engaging in repetitive
activities and stereotyped movements, resistance to environmental change or
change in daily routines, and unusual responses to sensory experiences. The term
autism does not apply if the childs educational performance is adversely affected
primarily because the child has an emotional disturbance, as defined in IDEA.

What are the Characteristics of Autism Spectrum Disorders?

Each of the disorders on the autism spectrum is a neurological disorder that

affects a childs ability to communicate, understand language, play, and relate to
others. They share some or all of the following characteristics, which can vary from
mild to severe:
Communication problems (for example, with the use or comprehension of
language);
Difficulty relating to people, things, and events;
Playing with toys and objects in unusual ways;
Difficulty adjusting to changes in routine or to familiar surroundings; and
Repetititive body movements or behaviors.
These characteristics are typically evident before the age of three.

Children with autism or one of the other disorders on the autism spectrum
can differ considerably with respect to their abilities, intelligence, and behavior.
Some children dont talk at all. Others use language where phrases or conversations
are repeated. Children with the most advanced language skills tend to talk about a
limited range of topics and to have a hard time understanding abstract concepts.
Repetitive play and limited social skills are also evident. Other common
symptoms of a disorder on the autism spectrum can include unusual and sometimes
uncontrolled reactions to sensory informationfor instance, to loud noises, bright
lights, and certain textures of food or fabrics.

What are the Specific Disorders on the Autism Spectrum?

There are five disorders classified under the umbrella category officially
known as Pervasive Developmental Disorders, or PDD. As shown below, these are:
Autistic Disorder
SYMPTOMS
A total of six (or more) items from (a), (b), and (c), with at least two from (a), and
one each from (b) and (c):
qualitative impairment in social interaction, as manifested by at least two of
the following:
o marked impairment in the use of multiple nonverbal behaviors such as
eye-to-eye gaze, facial expression, body postures, and gestures to
regulate social interaction
o failure to develop peer relationships appropriate to developmental
level
o a lack of spontaneous seeking to share enjoyment, interests, or
achievements with other people (e.g., by a lack of showing, bringing,
or pointing out objects of interest)
o lack of social or emotional reciprocity
qualitative impairments in communication as manifested by at least one of
the following:
o delay in, or total lack of, the development of spoken language (not
accompanied by an attempt to compensate through alternative modes
of communication such as gesture or mime)
o in individuals with adequate speech, marked impairment in the ability
to initiate or sustain a conversation with others
o stereotyped and repetitive use of language or idiosyncratic language
o lack of varied, spontaneous make-believe play or social imitative play
appropriate to developmental level
restricted repetitive and stereotyped patterns of behavior, interests, and
activities, as manifested by at least one of the following:
o encompassing preoccupation with one or more stereotyped and
restricted patterns of interest that is abnormal either in intensity or
focus
o apparently inflexible adherence to specific, nonfunctional routines or
rituals
o stereotyped and repetitive motor mannerisms (e.g., hand or finger
flapping or twisting, or complex whole-body movements)
o persistent preoccupation with parts of objects

Delays or abnormal functioning in at least one of the following areas, with onset
prior to age 3 years: (1) social interaction, (2) language as used in social
communication, or (3) symbolic or imaginative play.
Rett syndrome;
It is a rare genetic disorder that affects the way the brain develops . It occurs
almost exclusively in girls.Most babies with Rett syndrome seem to develop
normally at first, but symptoms surface after 6 months of age. Over time, children
with Rett syndrome have increasing problems with (a) movement, (b) coordination
and (c) communication that may affect their ability to use their hands, communicate
and walk.

Babies with Rett syndrome are generally born after a normal pregnancy
and delivery.
Most seem to grow and behave normally for the first six months. After that, signs
and symptoms start to appear.

The most pronounced changes generally occur at 12 to 18 months of age, over a

period of weeks or months.

SYMPTOMS

Slowed growth. Brain growth slows after birth. Smaller than normal head size is
usually the first sign that a child has Rett syndrome. It generally starts to become
apparent after 6 months of age. As children get older, delayed growth in other parts
of the body becomes evident.
Loss of normal movement and coordination. The most significant loss of
movement skills (motor skills) usually starts between 12 and 18 months of age. The
first signs often include a decrease of hand control and a decreasing ability to crawl
or walk normally. At first, this loss of abilities occurs rapidly and then continues
more gradually.
Loss of communication and thinking abilities. Children with Rett syndrome
typically begin to lose the ability to speak and to communicate in other ways. They
may become uninterested in other people, toys and their surroundings. Some
children have rapid changes, such as a sudden loss of speech. Over time, most
children gradually regain eye contact and develop nonverbal communication skills.
Abnormal hand movements. As the disease progresses, children with Rett
syndrome typically develop their own particular hand patterns, which may include
hand wringing, squeezing, clapping, tapping or rubbing.
Unusual eye movements. Children with Rett syndrome tend to have unusual eye
movements, such as intense staring, blinking or closing one eye at a time.
Breathing problems. These include breath-holding (apnea), abnormally rapid
breathing (hyperventilation), and forceful exhalation of air or saliva. These problems
tend to occur during waking hours, but not during sleep.
Irritability. Children with Rett syndrome become increasingly agitated and irritable
as they get older. Periods of crying or screaming may begin suddenly and last for
hours.
Abnormal behaviors. These may include sudden, odd facial expressions and long
bouts of laughter, screaming that occurs for no apparent reason, hand licking, and
grasping of hair or clothing.
Seizures. Most people who have Rett syndrome experience seizures at some time
during their lives. Symptoms vary from person to person, and they can range from
periodic muscle spasms to full-blown epilepsy.
Abnormal curvature of the spine (scoliosis). Scoliosis is common with Rett
syndrome. It typically begins between 8 and 11 years of age.
Irregular heartbeat (dysrhythmia). This is a life-threatening problem for many
children and adults with Rett syndrome.
Constipation. This is a common problem in people with Rett syndrome.

Childhood Disintegrative Disorder

* also known as Heller's syndrome

* very rare condition in which children develop normally until at least two years of
age
Childhood disintegrative disorder is part of a larger category called autism spectrum
disorder. However, unlike autism, someone with childhood disintegrative disorder
shows severe regression after several years of normal development and a more
dramatic loss of skills than a child with autism does.
Treatment for childhood disintegrative disorder involves a combination of
medications, behavior therapy and other approaches.

SYMPTOMS
Typically they show a dramatic loss of previously acquired skills in two or more of
the following areas:

Language, including a severe decline in the ability to speak and have a

conversation
Social skills, including significant difficulty relating to and interacting with others
Play, including a loss of interest in imaginary play and in a variety of games and
activities
Motor skills, including a dramatic decline in the ability to walk, climb, grasp
objects and perform other movements
Bowel or bladder control, including frequent accidents in a child who was
previously toilet trained
Loss of developmental milestones may occur abruptly over the course of days to
weeks or gradually over an extended period of time.

Pervasive Developmental Disorder Not Otherwise Specified (often referred

to as PDD-NOS).

Individuals receive this diagnosis if they have some but not all of the characteristics
of classic autism. Their functioning level is usually moderate to high. It is sometimes
called atypical autism.

Common characteristics
Like children with autism or Aspergers disorder, children with PDDNOS will find
social interaction hard, or show repetitive behavior. Although children have these
difficulties, their social skills are generally better than children with autism or
Aspergers disorder.
Although there are subtle differences and degrees of severity between these
five conditions, the treatment and educational needs of a child with any of these
disorders will be very similar. For that reason, the term autism spectrum
disordersor ASDs, as they are sometimes called is used quite often now and is
actually expected to become the official term to be used in the future .
The five conditions are defined in the Diagnostic and Statistical Manual,
Fourth Edition, Text Revision (DSM-IV-TR) of the American Psychiatric Society (2000).
This is also the manual used to diagnose autism and its associated disorders, as
well as a wide variety of other disabilities.
At the moment, according to the 2000 edition of the DSM-IV, a diagnosis of
autistic disorder (or classic autism) is made when a child displays 6 or more of 12
symptoms across three major areas:
social interaction (such as the inability to establish or maintain
relationships with peers appropriate to the level of the childs development,
communication (such as the absence of language or delays in its
development),
behavior (such as repetitive preoccupation with one or more areas of
interest in a way that is abnormal in its intensity or focus). When children display
similar behaviors but do not meet the specific criteria for autistic disorder, they may
be diagnosed as having one of the other disorders on the spectrumAspergers,
Retts, childhood disintegrative disorder, or PDDNOS. PDDNOS (Pervasive
Developmental Disorder Not Otherwise Specified) is the least specific diagnosis and
typically means that a child has displayed the least specific of autistic-like
symptoms or behaviors and has not met the criteria for any of the other disorders.
Terminology used with autism spectrum disorders can be a bit confusing,
especially the use of PDD and PDDNOS to refer to two different things that are
similar and intertwined. Still, its important to remember that, regardless of the
specific diagnosis, treatments will be similar.

What Causes an ASD?

The causes of autism and the other disorders on the spectrum are not known.
Researchers are currently studying such areas as neurological damage and
chemical imbalances within the brain. These disorders are not due, however, to
psychological factors or, as has been widely reported in the press, to childhood
vaccines.

What Are The Diagnostic And Assessment Instruments Appropriate For

Use With Children With Autistic Spectrum Disorders?

The following instruments are used by educators, clinicians, and researchers to

assess children suspected of, or previously diagnosed with, a pervasive
developmental disorder. The instruments were selected for this list because they
are used to measure specific dimensions of a child's development, environment, or
family. The instruments listed provide measures of development in different
domains of functioning. Rate of change in those domains is sometimes used as a
baseline or as a follow-up measure of developmental progress or response to
educational programming. Some of the instruments listed below are critically
reviewed in Burros' Mental Measurement Yearbook

Diagnostic Assessment

Autism Diagnostic Interview - Revised

 The Autism Diagnostic Interview-Revised (ADI-R) is a semi-structured,
investigator-based interview for caregivers of children and adults for whom autism
or pervasive developmental disorders is a possible diagnosis. Two studies (Lord,
Rutter, R LeCouteur, 1994; Lord, Storoschuk, Rutter, R Pickles, 1993) were
conducted to assess the psychometric properties of the ADI-R. Reliability was tested
among 10 autistic (mean age 48.9 months) and 10 mentally handicapped or
language-impaired children (mean age 50.1 months), and validity was tested
among an additional 15 autistic and 15 nonautistic children. Results indicated the
ADI-R was a reliable and valid instrument for diagnosing autism in preschool
children. Inter-rater reliability and internal consistency were good, and inter-class
correlations were very high.

A standard diagnostic interview is conducted at home or in a clinic. The ADI-R is

considered by some professionals in the field as a measure of high diagnostic
accuracy. It takes several hours to administer and score. The ADI-R is recognized as
one of the better standardized instruments currently available for establishing a
diagnosis of autism. It is a semi-structured interview administered to subjects'
caregivers which determines whether or not an individual meets the Diagnostic and
Statistical Manual of Mental Disorders (3rd ed., revised) criteria for autism. The
authors of the ADI-R plan to update the scoring procedure so it reflects DSM-IV
criteria. The assessment begins with a home visit by a therapist who interviews the
child's parents. A home visit provides a chance to meet the child and to get a sense
of the parents' priorities. This interview may be scheduled as part of the in-clinic
assessment (Rutter, Lord, & LeCouteur, 1990).

Prelinguistic Autism Diagnostic Observation Schedule

The Prelinguistic Autism Diagnostic Observation Schedule (PL-ADOS) (DiLavore,

Lord, & Rutter, 1995) is a semi-structured observation scale for diagnosing children
who are not yet using phrase speech and who are suspected of having autism. The
scale is administered to the child with the help of a parent. This instrument provides
an opportunity to observe specific aspects of the child's social behavior, such as
joint attention, imitation, and sharing of affect with the examiner and parent. PL-
ADOS scores are reported to discriminate between children with autism and children
with nonautistic developmental disabilities. The resulting diagnostic algorithm is
theoretically linked to diagnostic constructs associated with International
Classification of Diseases (10th revision) and DSM-IV criteria for autism.

Childhood Autism Rating Scale

The Childhood Autism Rating Scale (CARS) was developed by the Treatment and
Education of Autistic and Related Communication Handicapped Children (TEACCH)
program staff in North Carolina to formalize observations of the child's behavior
throughout the day. This 15-item behavior-rating scale helps to identify children with
autism and to distinguish them from developmentally disabled children who are not
autistic. Brief, convenient, and suitable for use with any child older than two years
of age, the CARS makes it much easier for clinicians and educators to recognize and
classify autistic children. Developed over a 15-year period, with more than 1,500
cases, CARS includes items drawn from five prominent systems for diagnosing
autism. Each item covers a particular characteristic, ability, or behavior. After
observing the child and examining relevant information from parent reports and
other records, the examiner rates the child on each item. Using a seven-point scale,
he or she indicates the degree to which the child's behavior deviates from that of a
normal child of the same age. A total score is computed by summing the individual
ratings on each of the 15 items. Children who score above a given point are
categorized as autistic. In addition, scores falling within the autistic range can be
divided into two categories: mild-to-moderate and severe. Professionals who have
had only minimal exposure to autism can easily be trained to use CARS. Two
training videos showing how to use and score the scale are available from Western
Psychological Services (WPS) (Schopler, Reichler, DeVellis, & Daly, 1988; Schopler,
Reichler, & Renner, 1986).

Autism Behavior Checklist

The Autism Behavior Checklist (ABC) is a general measure of autism. It is not as

reliable as the CARS or ADI-R. Correlations between the ABC and CARS ranged from
0.16 to 0.73 in a study by Eaves and Milner (1993). The CARS correctly identified 98
percent of the autistic subjects; it identified 69 percent of the possibly autistic as
autistic. The ABC correctly identified 88 percent of the autistic subjects, while it
identified 48 percent of the possibly autistic as autistic. In two separate studies,
teachers' ratings on the ABC failed to reveal a common set of characteristics of
students with high functioning Autistic Disorder (Myles, Simpson, & Johnson, 1995)
and Asperger's Disorder (Ghaziuddin, N., Metler, Ghaziuddin, M., Tsai, & Luke, 1993).

Checklist for Autism in Toddlers

The Checklist for Autism in Toddlers (CHAT) is a screening instrument designed

to detect core autistic features to enable treatment as early as eighteen months.
The most effective treatment currently available for autism is early educational
intervention, beginning as soon as possible after a child's diagnosis. Unfortunately,
intervention rarely begins before the age of three years because few autistic
children are diagnosed before they reach preschool age. CHAT offers physicians a
means of diagnosing autism in infancy so that educational programs can be started
months or even years before most symptoms become obvious. According to the
authors, "We stress that the CHAT should not be used as a diagnostic instrument,
but it can alert the primary health professional to the need for an expert... referral."

This first study (Baron-Cohen, Allen, & Gillberg, 1992) using the CHAT re- vealed
that key psychological predictors of autism at thirty months are showing two or
more of the following at eighteen months: (a) lack of pretend play, (b) lack of
protodeclarative pointing, (c) lack of social interest, (d) lack of social play, and (e)
lack of joint-attention. The CHAT detected all four cases of autism in a total sample
of 91 eighteen-month-old children. The authors recommend that if a child lacks any
combination of these key types of behavior on examination at eighteen months, it
makes good clinical sense to refer him or her for a diagnostic assessment by a
specialist with experhse m auQsm.

A second study (Baron-Cohen, Cox, Baird, Swettenham, Nightingale, Morgan, Drew,

& Charman, 1996) concluded that "consistent failure of three key items from the
CHAT at eighteen months of age carries an 83.3 percent risk of autism, and this
pattern of risk indicator is specific to autism when compared to other forms of
developmental delay." In the second study, research data on 16,000 children
suggested that children who failed three items on the CHAT are at high risk of being
autistic. The items include protodeclarative pointing (pointing at an object to direct
another person's attention to it not to obtain the item, but simply to share an
interest in it); gaze monitoring (turning to look in the same direction as an adult is
looking); and pretend play. The false positive rate for detection of autism using the
CHAT is estimated at 16.6 percent.

Real Life Rating Scale

The Real Life Rating Scale (RLRS) (Freeman, Ritvo, Yokota, & Ritvo, 1986) is a
scale used to assess the effects of treatment on 47 behaviors in the motor, social,
affective, language, and sensory domains among autistic persons. The RLRS is
applicable in natural settings by nonprofessional raters, is rapidly scored by hand,
and can be repeated frequently without affecting inter-observer agreement. Data
are presented on inter-rater agreement among novice and experienced observers.
Instructions for the scale, target behaviors, and definitions are appended to the
journal article.

Pervasive Developmental Disorder Screening Test

The Pervasive Developmental Disorder Screening Test (PDDST) (Siegel, 1996) is

designed to be administered in settings where concerns about possible autistic
spectrum disorders arise. Different "stages" of the PDDST correspond to
representative populations in (a) primary care clinics; (b) developmental clinics; and
(c) autism clinics. The PDDST is designed as a screening test and is a parent report
measure. As such, it does not constitute a full clinical description of early signs of
autism but does reflect those early signs that have been found to be reportable by
parents and correlated with later clinical diagnosis.

Autism Screening Instrument for Educational Planning (2nd ed.)

The Autism Screening Instrument for Educational Planning (2nd ed.) (ASIEP- 2)
(Krug, Arick, & Almond, 1993) is a major revision of one of the most popular
individual assessment instruments available for evaluating and planning for
subjects with autistic behavior characteristics. Standardized and researched in
diagnostic centers throughout the world, ASIEP-2 uses five components to provide
data on five unique aspects of behavior with individuals from eighteen months
through adult- hood. The components of the ASIEP examine behavior in five areas:
Sensory, Relating, Body Concept, Language, and Social Self-Help. The ASIEP-2
samples vocal behavior, assesses interactions and communication, and determines
learning rate. In combination, ASIEP-2 subtests provide a profile of abilities in
spontaneous verbal behavior, social interaction, educational level, and learning
characteristics. Revisions to the ASIEP-2 include a new decision matrix, a new
norming table section, and simplified administration of the Prognosis of Learning
Rate Subtest. The author reports a strong intercorrelation among the ASIEP-2
subtests and the utility of the battery to distinguish among groups of subjects with a
variety of disabilities. ASIEP-2 components have been normed individually.
Percentiles and standard scores are provided for the five subtests.
Diagnostic Checklist for Behavior-Disturbed Children (Form E-2)

The Form E-2 Diagnostic Checklist (Rimland, 1971), developed at the Institute
for Child Behavior Research, was proposed as an assessment instrument that
differentiates between cases of "classical" autism and a broader range of children
with "autistic-like" features. Questions on Form E-2 reference behaviors in children
between birth and age six years. This questionnaire is completed by the child's
parents. The form is intended to be used to identify autism for "biological research."
Rimland is clear that Form E-2 is not designed to determine whether or not a child is
autistic for the purposes of being admitted to an educational or rehabilitative
program.

Gilliam Autism Rating Scale

Designed for use by teachers, parents, and professionals, the Gilliam Autism
Rating Scale (GARS) (Gilliam & Janes, 1995) helps to identify and diagnose autism in
individuals ages three through twenty-two years and to estimate the severity of the
problem. Items on the GARS are based on the definitions of autism adopted by the
DSM-IV. The items are grouped into four subtests: stereotyped behaviors,
communication, social interaction, and developmental disturbances. The GARS has
three core subtests that describe specific and measurable behaviors.

An optional subtest (Developmental Disturbances) allows parents to con- tribute

data about their child's development during the first three years of life. Validity and
reliability of the instrument are high. Coefficients of reliability (internal consistency,
test-retest, and inter-scorer) for the subtests are all in the 0.80s and 0.90s.
Behaviors are assessed using objective, frequency-based ratings. The entire scale
can be completed in five to ten minutes by persons who have knowledge of the
child's behavior or the greatest opportunity to observe him or her. Standard scores
and percentiles are provided.

Developmental Assessment

Psychoeducational Profile-Revised

The Psychoeducational Profile-Revised (PEP-R) (Schopler, Reichler, Bashford,

Lansing, & Marcus, 1990) offers a developmental approach to the assessment of
children with autism or related developmental disorders. It is an inventory of
behaviors and skills designed to identify uneven and idiosyncratic learning patterns.
The test is most appropriately used with children functioning at or below the
preschool range and within the chronological age range of six months to seven
years. The PEP-R provides information on developmental functioning in imitation,
perception, fine motor, gross motor, eye-hand integration, cognitive performance,
and cognitive verbal areas. The PEP-R also identifies degrees of behavioral
abnormality in relating and affect (cooperation and human interest), play and
interest in materials, sensory responses, and language.

The PEP-R kit consists of a set of toys and learning materials that are presented to a
child within structured play activities. The examiner observes, evaluates, and
records the child's responses during the test. There are 131 developmental and 43
behavioral items on the PEP-R. The total time required to administer and score these
items varies From 45 minutes to 1.5 hours. Because it is not a test of speed,
variations in total testing time depend on the child's levels of functioning and any
behavior management problems that arise during the testing situation. At the end
of the session, the child's scores are distributed among seven developmental and
four behavioral areas. The resulting profiles depict a child's relative strengths and
weaknesses in different areas of development and behavior. The Developmental
Scale tells where a child is functioning relative to peers. The items on the Behavioral
Scale have the separate, but related, assessment function of identifying responses
and behaviors consistent with a diagnosis of autism. The PEP-R provides a third and
unique score called emerging. A response scored "emerging" is one that indicates
some knowledge of what is required to complete a task, but not the full
understanding or skill necessary to do so successfully.

The Adolescent and Adult Psychoeducational Profile (AAPEP) extends the PEP- R to
meet the needs of adolescents and adults.

Southern California Ordinal Scales of Development

The Southern California Ordinal Scales of Development (SCOSD), which is

available from Western Psychological Services, was developed by the California
Department of Education, Diagnostic Center in Southern California (1985). The
developmental scales of cognition, communication, social affective behavior,
practical abilities, gross motor, and fine motor abilities are based on two
fundamental principles. First, they draw extensively on the developmental theories
of Jean Piaget. Each scale is divided according to the levels and stages that Piaget
describes in his writings on human development. Second, the SCOSD incorporates
assessment techniques that aim to minimize the constraints of traditional,
standardized ability testing. When possible, the examiner is encouraged to observe
the child in his or her natural environment, using materials that are readily available
and familiar. In interpreting the results of assessment, the examiner arrives at a
total picture of the child's abilities in terms of the particular developmental scale.

The SCOSD is criterion-referenced rather than norm-referenced. Assessment

procedures are flexible, rather than fixed, and the scoring system takes into account
the quality as well as the quantity of responses.

Developmental Play Assessment Instrument

The Developmental Play Assessment Instrument (Lifter, Sulzer-Azaroff, Ander-

son, R Edwards-Cowdery, 1993) is an instrument used to assess the play develop-
ment of children with disabilities relative to the play of nondisabled children. The
developmental quality of toy play is evaluated according to the level of pretend play
and the frequency and variety of play activities within the level identified.

Brigance Inventory of Early Development

 The Brigance Inventory (Brigance, 1978) is criterion-referenced rather than
norm-referenced. While useful for assessment purposes, its value is in identifying
instructional objectives, serving as a guide for measuring those objectives, and
providing an ongoing tracking system. The Brigance Inventory is intended for
informal assessment of several aspects of child development and is for children
functioning at developmental levels from birth to seven years of age. Major areas
assessed include general knowledge and comprehension, speech and language,
preacademics, self-help, and psychomotor skills. Within these major areas, there are
98 subtests of sequenced developmental skills.

The Brigance Inventory permits different administrations to be used, such as

observation, direct testing of the child, or reports from caretakers, child-care
workers, or teachers. To elicit the child's maximum performance, clinicians are
encouraged to allow children to respond in any possible fashion, such as pointing,
eye localizations, or verbalizing. Clinicians are encouraged to adapt materials to
best meet the needs of the child to get a response.

Reliability and validity measures of the Brigance Inventory are limited, as is true of
most criterion-referenced instruments. There is no reported reliability or validity
data in the manual.

The value of the Brigance Inventory lies in its ability to identify a child's pattern of
strengths and weaknesses in several areas. The items are representative of a
curriculum appropriate for an early childhood program and thus are easily linked to
instructional planning and intervention (Bagnato, 1985). Another benefit of relating
items to teaching and planning is that repeated assessments with the Brigance
Inventory can pinpoint areas of gains and losses. The obvious caution here is to
avoid teaching to the test since the items are so very specific. (See an article by
Gory, 1985, for a review of the Brigance Inventory.)

Adaptive Assessment

The parent personality and situational variables component consists of seven

subscales: competence, isolation, attachment, health, role restriction, depression,
and spouse. The PSI is particularly helpful in assessing early identification of
dysfunctional parent-child systems, prevention programs aimed at reducing stress,
intervention and treatment planning in high stress areas, family functioning and
parenting skills, and assessment of child-abuse risk.

The PSI Short Form is a derivative of the full-length test and consists of a 36- item,
self-scoring questionnaire-profile. It yields a Total Stress score from three scales:
parental distress, parent-child dysfunctional interaction, and difficult child.

The Parental Stress Scale

The Parental Stress Scale (PSS) (Berry R Jones, 1995) is a newly developed
general measure of stress. Analyses of responses completed by 1,276 parents
suggested that the PSS is reliable, both internally and over time. Initial evaluation of
the PSS showed a stable consistency for assessing stress across parents of differing
parental characteristics. The validity of PSS scores was supported by predicted
correlations with measures of relevant emotions and role satisfaction and significant
discrimination between 129 mothers of children in treatment for emotional-
behavioral problems and developmental disabilities compared with mothers of
children not receiving treatment. Factor analysis suggested a four-factor structure
underlying responses to the PSS.

Questionnaire on Resources and Stress

The Questionnaire on Resources and Stress (QRS) (Holroyd, 1974; 1987)

consists of 55 items on 11 scales: parental affliction, pessimism about child
development, overprotection/dependency, anxiety about the future of the child,
social isolation, burden for members of the family, financial problems, lack of family
integration, intellectual incapacitation, physical incapacitation, and need for the
care of the child. The QRS contains 285 items in 15 rational nonoverlapping scales.
It was administered to parents of 43 individuals with disabilities four-sixteen years
old evaluated in an outpatient psychiatry clinic. The QRS is used in research to
assess ecological causes of stress and general levels of stress in families. There is a
short form of the QRS (see Randall, Sexton, Thompson, & Wood, 1989). Holroyd
(1988) reviewed studies that have used the QRS for families with members with
disabilities to compare parents of clinical groups with normal controls, parents of
children with different clinical conditions, and pre- and postintervention. These
studies are examined in terms of the relationship of 15 QRS scales to child variables
(e.g., age, degree of disability); parent variables (e.g., marital status, educational
level); and family variables (e.g., nationality/culture). It is concluded that the QRS
fulfills requirements for an acceptable level of validity.

Family Adaptability and Cohesion Evaluation Scales III

The Family Adaptability and Cohesion Evaluation Scale (FACES III and FACES IV)
(Olson, 1986; 1994) provides measures of perceived cohesion and adaptability of
families. This instrument is relatively well researched. It has been used to assess,
for example, the differences between "the ideal and the real representation of
family," as perceived by parents and adolescent children. FACES has been used to
assess marital satisfaction. Combined with the Clinical Rating Scale, a related family
assessment in- strument, these two assessment tools can be used for making a
diagnosis of family functioning and for assessing changes over the course of
treatment.

Family Assessment Interview

The Family Assessment Interview (FAI) (Koegel, Koegel & Dunlap, 1996) is a
simple protocol for collecting information from families in preparation for selecting
and designing an intervention plan. Items in this brief instrument are designed to
enable a "good contextual fit" for the intervention strategy. Interview data based on
family members' ideas and reactions to the function of problem behaviors, support
strategies, and issues for implementation are actively solicited throughout the
assessment and support plan development process. The family assessment
interview focuses on information about the ways in which the family structures its
daily patterns and routines. It helps identify the family's successful strategies for
addressing problem behaviors. Sources of stress for the family are identified and
discussed.

Child Improvement Locus of Control Scale

The Child Improvement Locus of Control Scale (CILC) (DeVellis, DeVellis, Revicki,
Lurie, Runyan, & Bristol, 1985) assesses belief about a child's ability to improve. The
instrument is based on two research studies to develop and validate the CILC
scales. In the first study, 145 parents (average age 37.8 years) of autistic children
completed a questionnaire tapping beliefs about their children's improvement. In
Study 2, 175 parents of physically ill children were given the CILC items. The
following relationships were observed: (a) parental beliefs in child influence
increased with child age; (b) belief in external factors (chance and divine Influence)
was greater among African American parents; and (c) belief in parent influence
decreased with illness severity.

Family Environmental Scale

The Family Environmental Scale (FES) (Moos & Moos, 1981; Moos, 1974) is an
inventory which assesses behavior patterns within the family on subscales, such as
control, active-recreational orientation, intellectual cultural orientation, and
cohesion. Norms are available on large national samples of distressed families as
well as smaller samples of families with autistic children. The FES can be given to
parents at the beginning and middle of the child's intervention program. It assesses
family dynamics at key points during the intervention process. The questionnaire
can be completed by both of the child's parents if both participate in the child's
care.

What are the General Approaches of Educating Children with Autism?

TEACCH Approach

TEACCH Autism Program developed the concept of the Culture of Autism as a

way of thinking about the characteristic patterns of thinking and behavior seen in
individuals with Autism Spectrum Disorders (ASD).

CULTURE OF AUTISM
Relative strength in and preference for processing visual information (compared to
difficulties with auditory processing, particularly of language)
Frequent attention to details but difficulty understanding the meaning of how
those details fit together
Difficulty combining ideas
Difficulty with organizing ideas, materials, and activities
Difficulties with attention. (Some individuals are very distractible, others have
difficulty shifting attention when it is time to make transitions)
 Difficulty with concepts of time, including moving too quickly or too slowly and
having problems recognizing the beginning, middle, or end of an activity
Communication problems, which vary by developmental level but always include
impairments in the social use of language (called pragmatics)
Tendency to become attached to routines, with the result that activities may be
difficult to generalize from the original learning situation and disruptions in routines
that are upsetting, confusing, or uncomfortable
Very strong interests and impulses in engaging in favored activities, with
difficulties disengaging once engaged
Marked sensory preferences and dislikes.

TEACCH developed the intervention approach called Structured TEACCHing, which

is based on understanding the learning characteristics of individuals with autism
and the use of visual supports to promote meaning and independence. TEACCH
services are supported by empirical research, enriched by extensive clinical
expertise, and notable for its flexible and individualized support of individuals with
Autism Spectrum Disorder (ASD) and their families.
PRINCIPLES OF STRUCTURED TEACCHING:

Understanding the culture of autism

Developing an individualized person- and family-centered plan for each client or
student, rather than using a standard curriculum
Structuring the physical environment
Using visual supports to make the sequence of daily activities predictable and
understandable
Using visual supports to make individual tasks understandable

COMMON MYTHS AND MISUNDERSTANDINGS ABOUT THE TEACCH

APPROACH

MYTH: TEACCH is only for children

FACT: TEACCH works with individuals of all ages with ASD. For example, our
supported employment and residential/vocational program for adults is highly-
regarded, with very effective demonstrations of the application of Structured
TEACCHing principles and techniques for adults. On an individual, as-needed basis,
we provide personal counseling, marital counseling, and vocational guidance to
college students, graduate students, and other individuals with ASD who have
careers and independent lives.

MYTH: TEACCH is only for individuals with intellectual disabilities

FACT: TEACCH works with individuals with ASD at all developmental levels, from
individuals with significant mental retardation to those with superior intelligence
and academic achievement.

MYTH: TEACCH is only for students in self-contained classrooms

FACT: Structured TEACCHing can be provided in any educational setting, including

regular education classrooms, specials such as music, art, PE, and foreign
language, speech/language and occupational therapy sessions, as well as in the
cafeteria, school bus, and playground. It is not necessary for a student to be in a
self-contained or special education setting in order to receive the visual information
and organizational supports of Structured TEACCHing.

In addition, services based on the TEACCH approach are now used with individuals
from early childhood through adulthood in a variety of settings, including early
intervention programs; public and private school classrooms; families homes,
residential programs, and private housing; play and other social groups; summer
camps and other recreation programs; individual and group counseling sessions;
and both competitive and sheltered employment sites.

MYTH: TEACCH programs do not teach language

FACT: Professionals from TEACCH were innovators of methods for teaching and
supporting language development in students with ASD. We consider meaningful,
spontaneous communication to be a vital goal for all people with ASD. We do
suggest that activities for learning language and/or social communication have a
visual or physically concrete component because of the relative strength in visual
processing and difficulty with auditory comprehension that is characteristic of
students with ASD.

MYTH: By focusing on independence, TEACCH further isolates already lonely people

with autism spectrum disorders

FACT: Although Structured TEACCHing values independence highly and has

established it as an important educational priority, developing enjoyable social
interactions and meaningful social relationships are also important priorities.
Structured TEACCHing can be an excellent foundation for facilitating social activities
that would otherwise be too unpredictable and confusing for students with ASD.
Applied Behavior Analysis
Applied Behavior Analysis is the process of systematically applying interventions
based upon the principles of learning theory to improve socially significant
behaviors to a meaningful degree, and to demonstrate that the interventions
employed are responsible for the improvement in behavior.
ABA is a discipline that employs objective data to drive decision-making about
an individuals program. That is, data is collected on responses made by the
individual to determine if progress is being made or not; if there is no progress
under a particular intervention, we need to reevaluate the program and change it so
that the child begins to make progress.

8 Successful People with Autism Spectrum Disorders

1. Temple Grandin
Temple Grandin was diagnosed with autism in 1949, at 2 years old. With the help
of great teachers and family members, Grandin graduated from a school for gifted
children and went on to receive a bachelor's degree in psychology and a doctorate
degree in animal science. She's spent her life working to both improve the
treatment of animals and to bring awareness to autism.

2. James Durbin
As a contestant on season 10 of "American Idol," James Durbin was open about
having Tourette syndrome and Asperger syndrome. Durbin feels that his Asperger
syndrome has helped him focus on his vocal talents. Since "American Idol," he has
continued working on his music. He released his first album in 2011 and is releasing
his second in 2014.

3. John Elder Robison

John Elder Robison wrote the New York Times bestseller, "Look Me in the Eye,"
published in 2007. In the book, he writes about it was like growing up with Asperger
syndrome but not being diagnosed until he was 40 years old. Robison has helped
with autism research and has published two more books, "Be Different" and "Raising
Cubby."

4. Daryl Hannah
Daryl Hannah was diagnosed with autism as a child and felt isolated from others
her age. Her experiences of isolation helped driver her love of old movies and
interest in acting. Hannah's acting career has spanned more than three decades.
She has starred in dozens of films, including "Wall Street," "Grumpy Old Men," and
the "Kill Bill" movies. Hannah is also an environmental activist. In an interview with
People magazine, a friend remarked that when she "feels passionate about
something, she loses all her fears."

5. Satoshi Tajiri
Some children with ASD may be excited to learn that the creator of Pokemon was
diagnosed with Asperger syndrome. Satoshi Tajiri turned his childhood fascination
with bugs into the worldwide phenomenon of Pokemon. Representatives of Nintendo
have remarked on Tajiri's creativity but have also called him reclusive and eccentric.

6. Sarah Lonsert
 Sarah Lonsert, who was diagnosed with Asperger syndrome in third grade,
became the youngest songwriter to win the USA Songwriting Competition in 2009
when she was 17 years old. Since then, she has won several other songwriting
competitions, released her own album, and acted on stage and in films.

7. Susan Boyle
Known for surprising the judges and viewers with her incredible vocal skills on
"Britain's Got Talent" in 2009, Susan Boyle has released five albums, been
nominated for two Grammy Awards, and won the Radio Forth Award in 2013. As a
child, Boyle was diagnosed with brain damage, but she sought a better diagnosis as
an adult. In 2012, she was diagnosed with Asperger syndrome. Boyle has said the
diagnosis was a relief because she has a "clearer understanding of what's wrong."

8. Dan Aykroyd
"Blues Brothers" and "Ghost Busters" star Dan Akyroyd was diagnosed with
Asperger syndrome in the early 1980s after his wife convinced him to see a doctor.
He's said that he has an obsession with ghosts and law enforcement, which led to
the creation of "Ghost Busters." Aykroyd's career as an actor, writer, and producer
has spanned 40 years.

Kids often love to see people "just like" them. While the path of every child with
ASD will be different, seeing well-known successful people with ASD can help inspire
children as well as give them someone to look up to.
Current Trends
DSM-5: the changes
In May 2013 a new version of the Diagnostic and Statistical Manual of Mental
Disorders (DSM) was launched the DSM-5. The DSM-5 changes the way autism
spectrum disorder (ASD) is diagnosed. The changes reflect the current
understanding of ASD, based on research.
The DSM-5 replaces the old manual (DSM-IV). The DSM-5 makes the
following key changes to autism spectrum disorder (ASD) diagnosis.
New single diagnosis of ASD
This single diagnosis replaces the different subdivisions autistic
disorder, Aspergers disorder and pervasive developmental disorder not
otherwise specified.
New severity ranking
An ASD diagnosis now has a severity ranking level 1, 2 or 3. The ranking
depends on how much support the person needs. This reflects the fact that some
people have mild symptoms and others have more severe symptoms.
ASD diagnosis based on two areas
Professionals will now diagnose ASD on the basis of difficulties in two areas.
A child will need to have difficulties in both areas to be diagnosed with ASD. This
approach replaces the previous three areas social interaction, language and
communication, and repetitive and restricted behaviour and interests.

Social and communication problems have been merged into one area
deficits in social communication. Difficulties in this area include rarely using
language to communicate with other people, not speaking at all, not responding
when spoken to, or not copying other peoples actions, such as clapping.

The second area is fixated interests and repetitive behaviour. Examples of this
include lining toys up in a particular way over and over again, or having very narrow
and intense interests.

Sensory sensitivities
Sensory sensitivities were not in the DSM-IV. In the DSM-5, they have been included
as a behaviour within the fixated interests and repetitive behaviour category.
Examples might be not liking labels on clothes, or eating only foods of certain
colours or textures.

Symptoms from early childhood

According to the DSM-5, for a diagnosis of ASD a child must have had symptoms
from early childhood, even if these are not recognised until later.

This change is to encourage professionals to diagnose ASD in early childhood. But it

also means that a diagnosis can be made when it becomes clear that childrens
abilities arent equal to the social demands being put on them. For example, at an
age when a child is expected to have two-way conversations, you might notice that
he can answer only simple questions.

Diagnosis of two or more disorders

If a child has other symptoms that meet the criteria for other disorders, shell be
diagnosed as having two or more disorders for example, ASD and ADHD. This
technically wasnt possible with the DSM-IV, although many professionals did
diagnose other disorders along with ASD.

New diagnosis of social communication disorder (SCD)

Social communication disorder (SCD) is similar to ASD. But according to the
DSM-5, the main difference between SCD and ASD is repetitive behaviour. It will
take time and clinical practice experience for the meaning of this category to
become clear. If a child has at least two repetitive behaviours, it could point to a
diagnosis of ASD. If not, it could point to a diagnosis of SCD.

TRAUMATIC BRAIN INJURY

"Traumatic brain injury means 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; psychosocial behavior; physical functions; information processing;
and speech. The term does not apply to brain injuries that are congenital or
degenerative, or brain injuries induced by birth trauma.

Clinical Definition of Traumatic Brain Injury

The Brain Injury Association of America defines a traumatic brain injury as an
insult to the brain,not of degenerative or congenital nature, caused by an extern
al physical force that may produce a diminished or altered state of consciousnes
s,
which results in an impairment of cognitive abilities orphysical functioning. It can
als
result in the disturbance of behavioral or emotional functioning.

TYPES
A. Penetrating Injuries
In these injuries, a foreign object (e.g., a bullet) enters the brain and
causes damage to specific brain parts. This focal, or localized, damage occurs
along the route the object has traveled in the brain. Symptoms vary
depending on the part of the brain that is damaged.
B. Closed Head Injuries
Closed head injuries result from a blow to the head as occurs, for
example, in a car accident when the head strikes the windshield or
dashboard. These injuries cause two types of brain damage:
Primary brain damage, which is damage that is complete at the time of
impact, may include:
skull fracture: breaking of the bony skull
contusions/bruises: often occur right under the location of impact or
at points where the force of the blow has driven the brain against the bony
ridges inside the skull
hematomas/blood clots: occur between the skull and the brain or
inside the brain itself
lacerations: tearing of the frontal (front) and temporal (on the side)
lobes or blood vessels of the brain (the force of the blow causes the brain to
rotate across the hard ridges of the skull, causing the tears)
nerve damage (diffuse axonal injury): arises from a cutting, or
shearing, force from the blow that damages nerve cells in the brain's
connecting nerve fibers
Secondary brain damage, which is damage that evolves over time after
the trauma, may include:
brain swelling (edema)
increased pressure inside of the skull (intracranial pressure)
epilepsy
intracranial infection
fever
hematoma
 low or high blood pressure
low sodium
anemia
too much or too little carbon dioxide
abnormal blood coagulation
cardiac changes
lung changes
nutritional changes

TBI Severity Levels

Mild- Only when there is a change in the mental status at the time of the
injury; concussion.
Moderate- Loss of consciousness last for minutes to hours; confused for
days or weeks. Impairments can be temporary or permanent.
Severe- Unconscious state for days, weeks, or months. Impairments are
permanent.

What physical problems occur after TBI?

Physical problems may include hearing loss, tinnitus (ringing or
buzzing in the ears), headaches, seizures, dizziness, nausea, vomiting, blurred
vision, decreased smell or taste, and reduced strength and coordination in the body,
arms, and legs.
What communication problems occur after TBI?
People with a brain injury often have cognitive (thinking) and
communication problems that significantly impair their ability to live independently.
These problems vary depending on how widespread brain damage is and the
location of the injury.

Brain injury survivors may have trouble finding the words they need to
express an idea or explain themselves through speaking and/or writing. It may be
an effort for them to understand both written and spoken messages, as if they were
trying to comprehend a foreign language. They may have difficulty with spelling,
writing, and reading, as well.
The person may have trouble with social communication, including:
taking turns in conversation
maintaining a topic of conversation
using an appropriate tone of voice
interpreting the subtleties of conversation (e.g., the difference between
sarcasm and a serious statement)
responding to facial expressions and body language
keeping up with others in a fast-paced conversation
Individuals may seem overemotional (overreacting) or "flat" (without
emotional affect).
Muscles of the lips and tongue may be weaker or less coordinated after TBI.
The person may have trouble speaking clearly.
The person may not be able to speak loudly enough to be heard in
conversation.
Muscles may be so weak that the person is unable to speak at all.
Weak muscles may also limit the ability to chew and swallow effectively.
What cognitive problems occur after TBI?
Cognition (thinking skills) includes an awareness of one's surroundings,
attention to tasks,memory, reasoning, problem solving, and executive functioning
(e.g., goal setting, planning, initiating, self-awareness, self-monitoring and
evaluation).
Trouble concentrating when there are distractions (e.g., carrying on a
conversation in a noisy restaurant or working on a few tasks at once).
Slower processing or "taking in" of new information.
New learning can be difficult.
Executive functioning problems.

ASSESSMENT

Educational Placement
Inclusion : The student will be in a regular classroom. In addition to the
teacher, a special education teacher will be available to adjust the curriculum
to the student's abilities. While this arrangement allows the student to be in
class with peers, it may not provide the intensive help some students need.
Special Class: Children with disabilities who do not meet the criteria for
inclusion in the regular class. While the special education teacher handles the
class, partial mainstreaming in regular classes maybe worked out. There
maybe more than one grade level in a special class. The class may be located
in the Special Education Center or special education resource room in the
regular schools or in special schools.
Hospital - bound Instruction: The special education program of the
hospital admits children with physical disabilities and chronic illnesses who
 cannot study in regular schools.
Homebound or home-based instruction: children are regularly visited by
itinerant special education teachers in their home who provide instruction
based on their needs and capabilities.

Educational Strategies
Transition from hospital or rehabilitation center to the school
Education teams ( regular and special education, guidance councilors,
administrators and the family )
IEP concerned with cognitive, social/behavioral and sensorimotor domains
Procedures to solve focus and sustaining attention for long periods,
remembering previously learned facts and skills, learning new things, dealing
with fatigue and engaging in appropriate social behavior
Emphasis on the cognitive processes not just curriculum content
Addressing long-term needs in addition to immediate and annual IEP goals.
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.

Learning Strategies
o Give the student more time to finish schoolwork and tests.
o Give directions one step at a time. For tasks with many steps, it helps
to give the student written directions.
o Show the student how to perform new tasks. Give examples to go with
new ideas and concepts.
o 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.
o Check to make sure that the student has actually learned the new skill.
o Give the student lots of opportunities to practice the new skill.

Specialized Learning Strategies

The Direct Instruction (DI) model

Based on the principle of applied behavior analysis ( Engelmann &
Carnine, 1982 )
Includes pacing, frequent opportunity to respond, feedback &
reinforcement to maintain student engagement and ensure learning.
These principles can be applied in designing an instructional program
with students with a TBI (Glang, Singer, Cooley, & Tish, 1992).

Stated requests or precision commands

Consist of steps teachers can use to prevent escalation of behavior
 problems by giving clear instructions.
Allowing the student a chance to comply without interrupting and
reinforcing students who follow the request promptly.

Errorless learning
Discrimination training with early prompting and support that is
systematically faded to ensure successful responding
Individuals are not allowed to guess on recall tasks, but are
immediately provided with the correct response, instructed to read the
response, and write it down (Mateer et al., 1997).
If errors do occur they are followed by nonjudgmental corrective
feedback (Ylvisaker et al., 2001).

Providing specific training in self-management or self-monitoring

strategies
involves teaching students to evaluate and monitor their own behavior
and performance
One simple approach involves routine recording of behavior
the use of a checklist of open-ended questions to guide students
through an assignment
the use of assignment rubrics to allow students to self-evaluate their
progress
the use of emotion logs to allow students to self-monitor their emotions
(e.g., rating anger levels and responses on an Anger Log; Bowen et al., 2004).

Positive Reinforcement
used to create a rewarding environment and successfully reintegrate
children with brain injury into school settings (Gardner et al., 2003).
Praise is an extremely effective form of positive reinforcement and
should be given more frequently than reprimands or directives
social reinforcement (e.g., smile, thumbs up, high five), token
economies
social reinforcement (e.g., smile, thumbs up, high five), token
economies
Opportunity to engage in a preferred activity or gain access to more
preferred activities may be offered contingent on engaging in or meeting
criteria on a less preferred task (Slifer et al., 1997).
Behavioral Momentum
another strategy that has been used to increase positive behaviors and
compliance in brain injury rehabilitation (Slifer et al., 1997).
making requests with which the students have a high probability of
compliance before making a low-probability requestsimilar to the
momentum of objects in motion.

OTHER HEALTH IMPAIRMENTS

Introduction
A child who has an other health impairment is very likely to be eligible for
special services to help the child address his or her educational, developmental, and
functional needs resulting from the disability.
These students are unable to function physically and/or academically with
peers of the same age and grade expectancy level. They require the provision of
specialized instructional services & modification in order to participate in the school
program.
IDEAs Definition:
having limited strength, vitality, or alertness, including a heightened alertness to
environmental stimuli, that results in limited alertness with respect to the
educational environment, that
Is due to chronic or acute health problems; and
Adversely affects a childs educational performance.
A child with another health impairment (one not mentioned in the discussion) may
be found eligible for special services and assistance. Whats central to all the
disabilities falling under Other Health Impairment is that the child must have:
limited strength, vitality, or alertness due to chronic health problems; and
an educational performance that is negatively affected as a result.
General Characteristics:
may miss school frequently for doctors appointments or due to illnesses;
may have physical restrictions;
inattentiveness due to health impairments and/or medications;
other medication side effects, such as increase thirst;
academic lags
Asthma
A condition in which your airways narrow and swell and produce extra mucus
that causes the following symptoms:
Shortness of breath
Chest tightness or pain
Trouble sleeping caused by shortness of breath, coughing or wheezing
A whistling or wheezing sound when exhaling (wheezing is a common sign of
asthma in children)
Coughing or wheezing attacks that are worsened by a respiratory virus, such
as a cold or the flu
It is triggered by allergens (certain foods, pets, pollen), irritants (smog,
cigarette smoke), exercises, or emotional stress. The severity of asthma
varies greatly.
Diabetes
A disorder of metabolism that affects the way the body absorbs and breaks
down sugars and starches in food. Children with diabetes have insufficient insulin, a
hormone normally produced by the pancreas necessary for proper metabolism &
digestion of food.
Early symptoms include:
extreme thirsts & hunger, more fatigue, weight loss (despite a good
appetite), frequent urination, cuts that are slow to heal, extreme hunger, blurry
vision
Epilepsy
A convulsive disorder commonly known as seizure, a disturbance of
movement, sensation, behavior, and/or consciousness caused by abnormal
electrical activity in the brain.
The specific causes of epilepsy are not clearly known. It is believed that
people become seizure-prone when a particular area on the brain becomes
electrically unstable.
Many children experience a warning sensation, known as aura, a short
sensation before seizure. It takes different forms in different people: distinctive
feelings, sights, sounds, tastes, and even smells.
Although the symptoms listed do not necessarily mean that a person has
epilepsy, it is wise to consult a doctor if you or a member of your family experiences
one or more of them:
Blackouts or periods of confused memory;
Episodes of staring or unexplained periods of unresponsiveness;
Involuntary movement of arms and legs;
Fainting spells with incontinence or followed by excessive fatigue; or
Odd sounds, distorted perceptions, or episodic feelings of fear that cannot be
explained.
Hemophilia
A rare hereditary disorder in which the blood does not clot as quickly as it
should. The most serious consequences are usually internal. Internal bleeding can
cause swelling, pain, and permanent damage to joints, tissues, & internal organs
may necessitate blood transfusion.
The disorder occurs when a person is born without the protein (or with too
little of it) that causes blood to clot. With very few exceptions, this disorder usually
occurs only in males. However, its a myth that persons with bleeding disorders
such as hemophilia bleed to death from even minor injuries.
In truth, the condition ranges mild to severe. Symptoms include:
Excessive bleeding
Excessive bruising
Easy bleeding
Nose bleeds
Abnormal menstrual bleeding
Sickle Cell Anemia
Anemia, in general, is a condition where an individuals blood has less than a
normal number of red blood cells or the red blood cells themselves dont have
enough hemoglobin (which carries oxygen throughout the body).
A type of anemia where the hemoglobin is abnormal and the red blood cells
often become shaped like the letter C, making them sickle-shaped (like a crescent).
This shape, in turn, makes it difficult for the red blood cells to pass through
small blood vessels, causing pain and damaging organs.
The disease is inherited and primarily affects people of African descent.
Symptoms include:
chronic anemia, periodic episodes of pain (in the arms, legs, chest, and
abdomen)
A neurobiological disorder characterized by tics (involuntary, rapid, sudden
movements) and/or vocal outbursts that occur repeatedly. Its an inherited,
neurological disorder that is first noticed in childhood (ages of 7 and 10). It is four
times as likely to occur in boys as in girls.
Tourette Syndrome
Tourette syndrome was once strongly associated with the exclamation of
obscene words or socially inappropriate remarks. In fact, only a small minority of
people with Tourettes have this symptom.
For most, Tourettes involves:
tics, along a range of simple (e.g., rapid eye-blinking, facial grimacing,
 shoulder-shrugging) to complex (involving several muscle groups, such as
hopping, bending, or twisting); and
vocalizations, also along a range of simple (throat-clearing, sniffing,
grunting) to complex (involving words or phrases).

Evaluation/Assessment
Evaluation of Other Health Impairments shall include the following:
A. The evaluation report used for initial eligibility shall be current within one
year and include the following:
an evaluation from a licensed heath services provider that includes:
medical assessment & documentation of the students health;
any diagnoses & prognoses of the childs health impairments;
information, as applicable, regarding medications; and
special health care procedures,
special diet and/or activity retrictions.
a comprehensive psycho-educational assessment which includes measures that
document the students educational performance in the following areas:
pre-academics or academic skills,
adaptive behavior,
social/emotional development,
motor skills,
communication skills, and
cognitive ability.

B.documentation, including observation &/or assessment, of how Other Health

Impairment adversely impacts the childs educational performance in his/her
learning environment.

Prenatal Phthalate Exposure Linked to Increased Risk of Childhood Asthma

*** For the first time, researchers from the Mailman School of Public Health at
Columbia University in New York, NY, say they have found a link between prenatal
exposure to two phthalates commonly found in household products and an
increased risk of childhood asthma.
According to the research team, including senior author Dr. Rachel Miller,
past studies have suggested that childhood exposure to phthalates - a group of
chemicals commonly used in plastics, cosmetics and other products - can increase
asthma risk.
The team found that children born to mothers exposed to high levels of butylbenzyl
phthalate (BBzP) during pregnancy were 72% more likely to develop asthma, while
children born to mothers exposed to high levels of di-n-butyl phthalate (DnBP) had
a 78% higher risk of the condition, compared with children of mothers who had low
exposure to both chemicals.
"While it is incumbent on mothers to do everything they can to protect their
child, they are virtually helpless when it comes to phthalates like BBzP and DnBP
that are unavoidable. If we want to protect children, we have to protect pregnant
women."
U.S. F.D.A. Okays Injectable Diabetes Drug
*** Washington The US Food and Drug Administration (FDA) has approved a new
injectable diabetes drug from Eli Lilly and Co. for adults with the most common form
of the disease.
 The agency on Thursday cleared the drug, Trulicity, as a weekly injection to
improve blood sugar control in patients with type 2 diabetes, which afects more
than 26 million Americans. The drug is part of a new class of medicines called GLP-1
agonists, which spur the pancreas to create extra insulin after meals. Type 2
diabetes accounts for 90 percent of US cases of the disease and occurs when the
body doesnt properly produce or use the hormone insulin. Drugs to treat the
disease represent a large slice of Lillys product portfolio, which includes the
insulins Humalog and Humulin.
Indianapolis-based Lilly is counting on new drugs like Trulicity to replace
falling revenue from blockbusters like the antidepressant Cymbalta, which is facing
cheaper generic competition after the expiration of its patent. The FDA approved
Trulicity based on six studies in 3,342 patients that showed improvements in blood
sugar control. The drug was studied as a stand-alone therapy and in combination
with other commonly used diabetes drugs, such as metformin.
Lilly will be required to conduct follow-up studies on cases of thyroid cancer,
heart problems and other potential safety issues with the drug. The FDA is also
requiring Lilly to educate doctors about the drugs various risks.

Fish Oil May Help Curb Seizure Frequency In Epilepsy

Low doses of fish oil may help to curb the frequency of epileptic seizures
when drug treatment no longer works, suggests a small study. The omega-3 fatty
acids found in fish oil are able to cross over from the bloodstream into heart cells
where they work to stabilize heart rhythm and protect against heart attacks. This is
particularly important for people with epilepsy because they have a significantly
high risk of having a heart attack.
The researchers in the current study wanted to know what diference, if any,
low dose fish oil made to seizure frequency and/or cardiovascular health.
Twenty four people, whose epilepsy was no longer responsive to drugs were
therefore given three separate treatments, each lasting 10 weeks, and separated
by a period of 6 weeks.
Two people on the low dose were completely seizure free during the 10 week
trial. No one taking the high dose fish oil or the placebo was seizure free. Low dose
fish oil was also associated with a modest fall in blood pressure of 1.95 mm Hg over
the 10 week period, unlike high dose fish oil which was associated with an average
increase of 1.84 mm Hg.The researchers caution that a much larger study is needed
to confirm or refute these findings before any firm conclusions can be drawn, and
recommendations made.
But they write: "Low dose fish oil is a safe and low cost intervention that may
reduce seizures and improve cardiovascular health in people with epilepsy." It exists
as Other health impairment is an umbrella term encompassing
hundreds of types of impairments that may result in a chronic condition limiting the
individual's ability to effectively access the educational environment. This category
is determined by limitations in the three areas of strength, vitality, and alertness,
and these students may be cognitively intact. Three leading classifications under
other health impairment include epilepsy, asthma, and diabetes.

However, it is the subcategory of attention-deficit/hyperactivity disorder (AD/HD)

that will probably impact your classroom most frequently. According to the DSM-IV,
AD/HD is defined as a "persistent pattern of inattention and/or hyperactivity-
impulsivity that is more frequently displayed and severe than is typically observed
in individuals at a comparable level of development." (p. 85)

Because of the wide parameters of the other health impairment category, the bulk
of this section will be devoted to those students with AD/HD, as they are the highest
incidence condition in this category. They are also the students most likely to be
impacted negatively by their condition; students with epilepsy, asthma and other
conditions in the other health impairment category may have little or no adverse
impact on educational performance when their conditions are properly medicated.

Characteristics

IDEA lists a number of different chronic health problems as possible reasons for the
other health impairment label, including asthma, attention deficit disorder, attention
deficit hyperactivity disorder, diabetes, epilepsy, cardiac conditions, hemophilia,
leukemia, rheumatic fever, sickle cell anemia, and nephritis. It would be impossible
to list all of the possible characteristics under such a large disability category. The
primary issue in other health impairments, whatever the condition, the resulting
symptoms could adversely impact the student's educational performance. If a child
has diabetes, but it is controlled through medication and does not impact learning,
special education services are not appropriate for that child.

Students with AD/HD are categorized according to their characteristics into three
distinct subtypes: predominantly inattentive AD/HD, predominately hyperactive-
impulsive AD/HD and combined type AD/HD.

Students with the predominately inattentive type of AD/HD will exhibit six or more
of the following characteristics:

Does not pay attention to detail and often makes mistakes across a number
of activities
Has difficulty maintaining attention during activities
Does not complete schoolwork or other assigned activities
Has difficulty with organization of activities
Avoids activities that require mental effort or concentration
Loses materials necessary to complete assignments
Easily distracted
Forgetful in many activities

Students with the predominantly hyperactive-impulsive type of AD/HD will exhibit

six or more of the following characteristics:

Fidgets or squirms in seat

Gets up or leaves seat frequently during class
Runs about or climbs when inappropriate, and is generally restless
Difficulty in engaging in play activities quietly
Talks excessively
Blurts out answers
Has difficulty waiting for their turn
Interrupts others
Students with the combined type of AD/HD will have some features of both the
inattentive type and the hyperactive-impulsive type of AD/HD. This is the largest
population of students carrying the AD/HD label.

Teaching Strategies

Without the appropriate supports, students with AD/HD may experience long-term
difficulties in academic, social, and emotional functioning. However, there are a
number of strategies that can be taught to these students to enable them to have
more control over their own educational outcomes:

Allow extra time for these students to shift from one activity or environment
to the next.
Teach these students specific techniques for organizing their thoughts and
materials. Organize the classroom accordingly, and keep all materials in
permanent locations for easy access.
Allow extra time for finishing assignments or for testing.
For more complex activities, simplify steps to make them more manageable.
Seat the student close to the teacher and away from any peers that might be
distracting.
Post a daily and weekly schedule that clearly delineates each activity. These
schedules can then be used as prompts to direct the student back on task.
Keep these schedules as consistent as possible, and keep unstructured time
at a minimum.

In a more global sense, teaching these students to create their own goals and
objectives can help them learn to manage their lives across any number of
environments and activities. This process includes the following steps:

Clearly define your goal.

Develop objectives to achieve this goal.
Define the actions necessary to achieve the desired outcome.

Teaching this process gives control back to the individual, allowing for greater
motivation and self-awareness.

ORTHOPEDIC IMPAIRMENTt
Orthopedic affecting bones or muscles
Impairment to make (something) weaker or worse

Meaning
According to the Individuals with Disabilities Education Improvement Act of
2004 (IDEA), orthopedic impairment is as follows: a severe orthopedic impairment
that adversely affects a child's educational performance. The term includes
impairments due to the effects of congenital anomaly (e.g., clubfoot, absence of
some member, etc.), impairments due to the effects of disease (e.g., poliomyelitis,
bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy,
amputations, and fractures or burns that cause contractures) (Pierangelo &
Giuliani, 2007, p. 268)
Types
Orthopedic impairments often are divided into three main categories to help
characterize the potential problems and learning needs of the students involved.
These categories are neuromotor impairments, musculoskeletal disorders, and
degenerative diseases.
Although neuromotor impairments involve the central nervous system (brain,
spinal cord, or nerves that send impulses to muscles), they also affect a child's
ability to move, use, feel, or control certain parts of the body
Cerebral palsy is also classified by which limbs (arms and legs) are affected. Major
classifications include
1)hemiplegia (left or right side),
2)diplegia (legs Spastic -very tight muscles occurring in one or more muscle
groups that result in stiff, uncoordinated movements)
3)Athetoid (movements are contorted/twisted, abnormal, and purposeless)
The common types of neuromotor impairments are cerebral palsy, spinal chord
injuries and spina bifida.
Cerebral palsy refers to several non-progressive disorders of voluntary movement
or posture that are caused by malfunction of or damage to the developing brain that
occurs before or during birth or within the first few years of life. Individuals with
cerebral palsy have abnormal, involuntary, and/or uncoordinated motor movements.
4)Ataxic (poor balance and equilibrium in addition to uncoordinated
voluntary movement)
5)Mixed (any combination of the types)
6)Affected more than arms; paraplegia (only legs), and quadriplegia (all
four limbs).
Spinal cord injuries occur when a traumatic event results in damage to cells
within the spinal cord or severs the nerves that relay signals up and down the spinal
cord. It causes paralysis, loss of sensation, and loss of reflex function.
Spinal cord injuries occur suddenly and without warning.
The four types of spinal cord injuries are:
1) compression;
2) contusion;
3) lacerations; and
4) central cord syndrome
Spina bifida is a developmental defect of the spinal column. Spina bifida is
characterized by an abnormal opening in the spinal column and frequently involves
some paralysis of various portions of the body. It may or may not affect intellectual
functioning. Spina bifida is usually classified as either spina bifida occulta or spina
bifida cystica. Spina bifida occulta is a mild condition while spina bifida cystica is
more serious.
There are 3 types of spina bifida:
1)Spina bifida occulta; and Spina bifida cystica
2)Meningocele
3)myelomeningocele

Musculoskeletal disorders are composed of various conditions that can

result in various levels of physical limitations. Some examples of musculoskeletal
disorders include juvenile rheumatoid arthritis limb deficiency, club-foot and
muscular dystorphy.
Degenerative diseases are composed of various diseases that affect motor
development. The most common degenerative disease found in the school
population is muscular dystrophy. Muscular dystrophy is a group of inherited
diseases characterized by progressive muscle weakness from degeneration of
muscle fibers.
There are 43 types of muscular dystrophy, most of which are caused by
alterations in specific genes.
The most common type is Duchenne muscular dystrophy, and it only
affects boys.It is a genetic disease passed from mother to son or it can arise in a
young boy due to a spontaneous genetic mutation.
Characteristics
Children with orthopedic impairments have a wide range of characteristics
that are specific to the underlying diagnosis.
For example, a child with a spinal cord injury could have immobility limited to
one side of his or her body, just the arms or legs, or total paralysis. A child with
cerebral palsy may have movement but need a wheelchair because he or she has
slow, uncontrolled movements that make it difficult to walk. The referral
characteristics for the student with an orthopedic impairment fall more into the area
of physical characteristics. These may include paralysis, unsteady gait, poor muscle
control, loss of limb, etc.
Many students with orthopedic impairments have problems with motor skills,
such as those involved in using standard writing tools, turning pages or books, or
exploring and participating in typical classroom activities.
Some students have associated speech impairments or multiple disabilities
that may affect particular academic areas. An orthopedic impairment may also
impede speech production and the expressive language of the child.

Assessment
Most orthopedic impairments are identified before a child enters school, but
sometimes they are missed or do not appear until a later age. A teacher may notice
signs of poor coordination, frequent accidents, or complaints of acute or chronic
pain.
The assessment must include a thorough medical evaluation of the child's
orthopedic impairment by a licensed physician. Other data generally include
documentation of observations and assessments of how the orthopedic impairment
affects the child's ability to learn in the educational environment, as well as
observations concerning mobility and activities of daily living.
It is important to assess a student's social and physical adaptive behaviors
through various checklists, inventories, rating scales, and interviews with those who
know the child best. The severity of functional limitations must be such that they
adversely impact the child's education performance.
A social history supplements the medical history, as does basic screening
information on hearing, vision, speech and language skills, and development in
areas such as cognition and social/emotional, or self-help behaviors. A team method
is taken for assessment and recommendations. The team that assesses a child with
an orthopedic impairment must involve a parent and at least one of the child's
general education classroom teacher(s). It should also include a licensed special
education teacher, school counselor and/or psychologist, a licensed physician, and
other profession personnel as appropriate.
 For example, a licensed physical therapist or occupational therapist should
assess specific motor dysfunction in gross and fine motor development,
neuromuscular development, daily living activities, sensory integration, and the
need for adaptive equipment. The assessment also considers the permanent nature
of the child's impairment. Usually the condition will not be considered an orthopedic
impairment if it is not going to last at least 60 days.
More than one test always should be used to evaluate a child's needs for
services. In all, the assessment must take into consideration the entire education
from all angles, not just physical access to buildings, computers, libraries, or
equipment that facilitates learning. For instance, a child may need to receive
occupational therapy or other treatments, requiring time away from the general
education classroom. Educators will need to develop adaptive strategies and adopt
a hands-off approach at times to help students develop some independence. Then,
too, social and peer issues also must be considered. The final evaluation should
describe how the orthopedic impairment adversely affects a student's areas of
development.

Placement
Placement is a key consideration for students with orthopedic impairments.
The goal is inclusion in general education classes, but some students may need
services from resource rooms, special classes, schools, or residential facilities, as
well as hospital or homebound programs. In 2004, the U.S. Department of Education
reported that about 46% of school-age children receiving special education services
under the orthopedic impairments category were educated in general education
classrooms. Setting up the appropriate placement, services, and environment
begins with asking the student what he or she needs and evolves through the
assessment and individualized education plan (IEP) process.
Students with orthopedic impairments may present unique challenges in
adapting instructional environments that call for creative solutions. Some students
may be paralyzed and require assistance moving from place to place. A student
may require assistance with basic self-care such as toileting. These and other needs
call on teachers to perform duties that historically have not been part of their role in
school.
Becoming familiar with orthotics, prostheses, adaptive devices, and the
specific characteristics of a student's impairment can improve the experience for
student and teacher.
States may have specific qualification requirements for teachers who participate in
special education programs for children with orthopedic impairments, including
basic study of disabilities, anatomy, physiology, and therapeutic

General Approaches
As with most students with disabilities, the classroom accommodations for
students with orthopedic impairments will vary dependent on the individual needs
of the student. Since many students with orthopedic impairments have no cognitive
impairments, the general educator and special educator should collaborate to
include the student in the general curriculum as much as possible.
In order for the student to access the general curriculum, the student may
require these accommodations:
Special seating arrangements to develop useful posture and movements
Instruction focused on development of gross and fine motor skills
 Securing suitable augmentative communication and other assistive devices
Awareness of medical condition and its affect on the student (such as getting
tired quickly)
Because of the multi-faceted nature of orthopedic impairments, other
specialists may be involved in developing and implementing an appropriate
educational program for the student. These specialists can include:
Physical Therapists who work on gross motor skills (focusing on the legs,
back, neck and torso)
Occupational Therapists who work on fine motor skills (focusing on the arms
and hands as well as daily living activities such as dressing and bathing)
Speech-Language Pathologists who work with the student on problems with
speech and language
Adapted Physical Education Teachers, who are specially trained PE teachers
who work along with the OT and PT to develop an exercise program to help
students with disabilities
Other Therapists (Massage Therapists, Music Therapists, etc.)

Famous people

1.Hermann of Reichenau - (1013 July 18 - 1054 September 24) - also called

Hermannus Contractus or Hermannus Augiensis or Herman the Cripple. 11th
century scholar, composer, music theorist, mathematician, and astronomer. He
composed the Marian prayer Alma Redemptoris Mater. He was beatified in 1863. He
was crippled by a paralytic disease from early childhood. He was born with a cleft
palate, cerebral palsy and spina bifida. As a result, he had great difficulty moving
and could hardly speak.

2.Stephen Hopkins - (March 7, 1707 - July 13, 1785) - Stephen

Hopkins was born in Scituate (then a part of Providence), Rhode
Island. He attended the first Continental Congress in 1774, and
was a party to the Declaration of Independence in 1776. He
recorded his name with a trembling right hand, which he had to
guide with his left. Hopkins had cerebral palsy, and was noted to
have said, as he signed the Declaration, "My hand trembles, my heart does not."

3.Rene Kirby - Rene Kirby (born February 27, 1955) is an

American film and television actor. Kirby used spina bifida to his
advantage when he played his role in shallow Hal, he was also in
"Stuck on you" with Matt Damon. He is the living proof that you
can lead a productive life even with disabilities.
4) Frida Kahlo - (July 6, 1907 - July 13,
1954) was a Mexican painter, who has
achieved great international popularity.
She painted using vibrant colors in a style that was
influenced by indigenous cultures of Mexico as well as
European influences that include Realism, Symbolism,
and Surrealism. Kahlo contracted polio at age six, which
left her right leg looking thinner sometimes than the other (a deformity Kahlo hid by
wearing long skirts). It has also been conjectured that she also had spina bifida that
would have affected both spinal and leg development.

5. Kristi Yamaguchi - Kristine Tsuya "Kristi" Yamaguchi (Kristi Hedican) (born July
12, 1971) is an American figure skater and the 1992
Olympic Champion in women's singles. Yamaguchi
also won two World Figure Skating Championships in
1991 and 1992 and a U.S. Figure Skating
Championships in 1992. She won two national titles in
1989 and 1990 and one junior world title in 1988 as a
pairs skater with Rudy Galindo. In December 2005,
she was inducted into the U.S. Olympic Hall of Fame.
Yamaguchi began skating as a child, as physical
therapy for her club feet.

6.Ruth Sienkiewicz-Mercer (September 23, 1950 -

August 8, 1998) - A quadriplegic and American disability
rights activist Sienkiewicz-Mercer was born in
Northampton, Massachusetts. She was a healthy baby,
but was afflicted with a severe bout of encephalitis at
the age of five weeks. She is best known for her
autobiography I Raise My Eyes to Say Yes, co-authored
with Steven B. Kaplan. At thirteen months, she was
diagnosed with cerebral palsy resulting from the
encephalitis. Her control over her entire body, except for
her face and digestive system, was severely impaired;
though not completely paralyzed, she could not care for herself or communicate
through speech as most people know it. Due to her
inability to communicate normally, she was
diagnosed as an imbecile at the age of five

7. Abbey Nicole Curran - (born 1987) - Abbey

Curran represented Iowa at the Miss USA 2008
pageant in Las Vegas, held on April 11, 2008. Curran
was born with Cerebral Palsy. She and has made an
appearance on The Ellen DeGeneres Show, CBS The
Early Show, Inside Edition, Access Hollywood, Extra,
and CNN Headline News. Curran is the current chairman of her own non-profit
pageant "The Miss You Can Do It Pageant" for young girls and women with special
needs and challenges. Diagnosed at age 2, Abbey Curran wants other girls like her
to know they can compete like anyone else.

8. Bonner Paddock - Born with Cerebral Palsy, Bonner Paddock lived his early
years playing sports as if he didn't have a disability at all.
He was not accurately diagnosed until the age of 11, and
even received news he not might make to his 20th
birthday. As an adult with cerebral palsy, he became the
first person with Cerebral Palsy to reach the summit of
the tallest freestanding mountain in the world, Mt.
Kilimanjaro, unassisted, to demonstrate that life without limits is possible. This
achievement was documented in the film Beyond Limits, narrated by Michael Clarke
Duncan in 2009. Bonner tackled the climb with the determination and vigor that has
defined his life. OM Foundation (OMF) is the progression of Bonner Paddock's overall
mission, which had little to do with individual success and everything to do with
aiding others in constructing the first learning center to serve children with and
without disabilities in Orange County and across the globe.

9. Apolinario Mabini y Maranan was a Filipino

revolutionary leader, educator, lawyer,
and statesman who served as the firstPrime Minister
of the Philippines, serving first under
the Revolutionary Government, and then under
the First Philippine Republic.
Mabini performed all his revolutionary and
governmental activities despite having lost the use
of both his legs to Polio shortly before the Philippine
Revolution of 1896.

10. Aya Kit was a Japanese girl who wrote a diary about her personal
experiences while suffering fromspinocerebellar ataxia.
She was diagnosed with this disease when she was 15
years old. Her diary, entitled 1 Litre no Namida was
first published in her native Japan on February 25,
1986, more than two years before her death at the age
of 25. Kito had the incurable disease for 10 years and
suffered both emotional and physical pain, which was
subsequently stressful to her family as well. Her
mother, Shioka Kito, publicized her diary to give hope
to others.

Current Trends

The recent decreases in the incidence of spina bifida reflect the success of a
major public health strategy, specifically, the implementation of campaigns to
promote folic acid supplementation for women of childbearing age. During the
period from 1991 to 2003, the incidence of spina bifida dropped from 24.9 to 18.9
per 100,000 live births. All of the decrease came after the U.S. Food and Drug
Administration authorized the enrichment of cereals with folic acid in 1996 and then
made it mandatory in 1998. The decrease in the incidence of spina bifida was larger
and the economic benefit was greater than had been projected before adoption of
the policy.
To reduce further the rates of spina bifida and other neural tube defects, the
Center for Disease Control is actively promoting the greater consumption of folic
acid by women of childbearing age (the agency estimates that 50 to 70 percent of
these conditions are related to folic acid deficiency).
Research overwhelmingly demonstrates that parent involvement in children's
learning is positively related to achievement. Further, the research shows that the
more intensively parents are involved in their children's learning; the more
beneficial are the achievement effects. Efforts are needed to involve more parents
in the education of their children with orthopedic impairments and other disabilities,
and to provide them with resources to assist their children.

MULTIPLE DISABILITIES
Multiple disabilities is a disability category under IDEA. As you might expect,
children with multiple disabilities have two or more disabling conditions that
affect learning or other important life functions. To qualify for special
education services under this category, both of the student's disorders must
be so significant that her/his educational needs could not be met in programs
that are designed to address one of the disabilities alone.
The percentage of students having severe and multiple disabilities is very
low. Approximately .1 to 1 percent of the general school-age population and
approximately 2 percent of the total population of school age students have
severe and multiple disabilities.
 It is not likely that more than one student with severe and multiple disabilities
would be enrolled in a general classroom at any given time.

Who falls under the category of Multiple Disabilities?

A child with mental retardation and a sensory impairment such as a visual
impairment or blindness could be served under the category multiple
disability. However, the IDEA regulations include one exception. Deaf-
blindness is excluded under the category multiple disability.

Characteristics
Movement difficulties
Sensory losses
Behavior problems
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 (domestic, leisure, community
integration, and vocational)
Presence of primitive reflexes
Possibly nonambulatory

Causes
There is no identifiable cause in 40% of cases of multiple disabilities. Most
individuals with multiple disabilities with known causes are due to prenatal
biomedical factors.
Other possible causes may be linked to genetic metabolic disorders,
dysfunction in production of enzymes leading to a buildup in toxic substances
in the brain, or brain malformations.

There are three categories:

 Prenatal causes:
Chromosomal abnormalities
Viral infections
Drug and Alcohol use during pregnancy
Mother`s malnutrition
Physical trauma to the mother
Perinatal causes:
Lack of oxygen supply to the baby`s brain
Physical injury to the baby`s brain at birth
Contracted infections during birth
Postnatal causes:
Childhood infections such as meningitis & encephalitis
Traumatic brain injury from an accident or abuse
Lead poisoning
Reactions to medication
Exposure to toxins or other environmental conditions
As with other disabilities, the severity and complexity of the disability
depends on the genetic abnormality, the amount of damage to the brain, and
the environment in which the child is raised

How it May Affect Development

An individual with multiple disabilities may be challenged with:
Motor delays
Abnormal muscle tone
Muscle atrophy, contractures
Problem balancing
Behavioral problems
For many individuals, posture and range of motion are more appropriate
criteria to assess compared to strength and skills.

Diagnosis
Students with severe and multiple disabilities are identified at birth or in the
early stages of life, or after a traumatic accident or illness. These children are
identified by medical professionals. Assessments performed on these
students are to primarily help teachers understand the student`s needs and
how they can motivate and provide the best possible services to the student.
There are several different ways in which these assessments take place. They
include:
Standardized Assessments
Authentic Assessments in which includes observing the student in his/her
natural environment
Person-Centered Approach which includes the input of family and friends on
what the student`s abilities, strengths, and goals are to create an educational
plan that includes the uniqueness of the student.
Functional-Ecological Assessment which includes observations, video or
digital recordings to determine the natural cues that the environment
contains and how the student may react or respond to those cues around
them
Assessment Suggestions
Traditional or standardized assessments are often not practical.
Authentic assessments have to be developed to suit the needs of the student.
Keep in mind these assessments should be functional to skills the student will
need in life.
For many individuals, posture and range of motion are more appropriate
criteria to assess compared to strength and skills.

Strategies and Modifications

Early intervention is necessary
Involvement of the appropriate professionals, i.e., occupational therapists,
speech/language therapists, physical therapists, etc.
The physical arrangement of the classroom will need to best accommodate
this child. Consideration of special equipment.
Integration among their peers is important to assist these students with
social development.
Ensuring that all students demonstrates respect for the multiple disabled
student. It is the teachers responsibility and needs to be taken seriously with
ongoing activities that develop respect from the other students in the class.
An Individual Education Plan will need to be carefully planned out and
adjusted on a regular basis and will need to be aligned to the child.
Assistive technologies
Care needs to be given in your expectations of this student to ensure the
child does not become frustrated.

Effective Teaching Strategies

Maintain a small teacher to student ratio
Learn from caregivers what the child likes and dislikes
Use positive reinforcement
Establish rapport
Talk to child as if they were any other child
Mirror their movements to see if they notice assessing
Obtain behavior management information use consistently
Use all forms of communication sign, language, visual and tactile
Slow instructions avoid excess words
Learn what primitive reflexes are still present
Focus instruction on lifetime physical activity
Teach in the pool
monitor temperature of pool (most cases the warmer the water the better)
learn of any allergies of chlorine
Find out as much information about the child as possible allergies and
feeding procedures
Use sensory integration instruction when appropriate