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According to the article "About IDEA" from the U.S. Department of Education's Individuals with Disabilities Education Act (IDEA) website, "The Individuals with Disabilities Education Act (IDEA) is a law that makes available a free appropriate public education to eligible children with disabilities throughout the nation and ensures special education and related services to those children" (2019). This Act recognizes 13 categories of eligible disabilities which are listed below. I have included the exact legal definitions of the disabilities as they are listed in IDEA as well as information from our course textbook by Bryant, Bryant, and Smith. I have also linked resources about each disability category if you would like to explore more.

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"Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child’s educational performance" (U.S. Department of Education, 2018).

Characteristics of autism can include social problems such as difficulty with communication and interacting with others, repetitive behaviors, a set pattern of behaviors with a resistance to change, limited interests or activities as well as intense and overly focused interests (can include numbers, details, facts), and repeating words or phrases without meaning also known as echolalia (Bryant, Bryant, & Smith, 2019).

See the Autism Speaks website linked below for more information and resources about this disability.

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"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" (U.S. Department of Education, 2018).

Communication is quite possibility the greatest challenge that individuals with deaf-blindness encounter. Considerable effort is required by the individual. They must fight isolation and mobility as well. Manual communication including sign language, gestures, body language, and hand over hand (which was used by Hellen Keller and her teacher Anne Sullivan!) can be used by these individuals to talk to others and express their needs (Bryant, Bryant, & Smith, 2019).

See the National Center on Deaf-Blindness website linked below for more information and resources about this disability.

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About Deaf-Blindness > What is Deaf-Blindness

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NCDB works to improve the quality of life for children who are deaf-blind, their families, and teachers.

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"Deafness means a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification, that adversely affects a child’s educational performance" (U.S. Department of Education, 2018).

Deaf "students' educational performance, their interactions with others, and their participation in the community are influenced by their hearing problems" (Bryant, Bryant, & Smith, 2019, p. 173).

See the American Society for Deaf Children website linked below for more information and resources about this disability.

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"Emotional disturbance means 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 child’s educational performance:

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

(B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

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

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

(E) A tendency to develop physical symptoms or fears associated with personal or school problems" (U.S. Department of Education, 2018).

There are three groups of behavioral disorders: externalizing, internalizing, and low incidence. Externalizing behaviors can be characterized by aggressive, impulsive, noncompliant, coercive, or even argumentative behaviors. These behaviors are aimed towards others and are persistently irritating and aggressive (Bryant, Bryant, & Smith, 2019). Internalizing behaviors are characterized by withdrawn, anxious, and depressed behaviors. Depression can be very hard to recognize in younger children but can include feelings of guilt, rejection, and low self-esteem. Low-incidence conditions are rare but incredibly serious. An example of one of these conditions includes schizophrenia (Bryant, Bryant, & Smith, 2019).

See the Center for Parents Information & Resources article linked below for more information and resources about this disability.

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Links updated, November 2021
This information in Spanish

The mental health of our children is a natural and important concern for us all. The fact is, many mental disorders have their beginnings in childhood or adolescence, yet may go undiagnosed and untreated for years. ( 1)

We refer to mental disorders using different "umbrella" terms such as emotional disturbance, behavioral disorders, or mental illness. Beneath these umbrella terms, there is actually a wide range of specific conditions that differ from one another in their characteristics and treatment. These include (but are not limited to):

anxiety disorders;

bipolar disorder (sometimes called manic-depression);

conduct disorders;

eating disorders;

obsessive-compulsive disorder (OCD); and

psychotic disorders.

You may be reading this fact sheet with one of these specific disorders in mind, or you may be looking for information about emotional disturbances in general. In either case, keep reading to find out what different emotional distubances have in common, how they are defined in federal law, and where to find more detailed information on specific disorders.
Quick-Jump Menu
Definition
IDEA defines emotional disturbance as follows:
We've chosen to use the term "emotional disturbance" in this fact sheet because that is the term used in the nation's special education law, the Individuals with Disabilities Education Act (IDEA).

"...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 child's educational performance:

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

(B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

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

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

(E) A tendency to develop physical symptoms or fears associated with personal or school problems." ( 2)

As defined by IDEA, emotional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance. ( 3)

Characteristics

As is evident in IDEA's definition, emotional disturbances can affect an individual in areas beyond the emotional. Depending on the specific mental disorder involved, a person's physical, social, or cognitive skills may also be affected. The National Alliance on Mental Illness of Southern Arizona puts this very well:

Mental illnesses are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. ( 4)

Some of the characteristics and behaviors seen in children who have an emotional disturbance include:

Hyperactivity (short attention span, impulsiveness);

Aggression or self-injurious behavior (acting out, fighting);

Withdrawal (not interacting socially with others, excessive fear or anxiety);

Immaturity (inappropriate crying, temper tantrums, poor coping skills); and

Learning difficulties (academically performing below grade level).

Children with the most serious emotional disturbances may exhibit distorted thinking, excessive anxiety, bizarre motor acts, and abnormal mood swings.

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.

Causes

No one knows the actual cause or causes of emotional disturbance, although several factors-heredity, brain disorder, diet, stress, and family functioning-have been suggested and vigorously researched. A great deal of research goes on every day, but to date, researchers have not found that any of these factors are the direct cause of behavioral or emotional problems.

According to NAMI, mental illnesses can affect persons of any age, race, religion, or income. Further:

Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan. ( 5)

Frequency

Of the 74.5 million children in the United States, an estimated 17.1 million have or have had a psychiatric disorder. ( 6) Half of all psychiatric illness occurs before the age of 14, and 75% by the age of 24. The most common psychiatric disorders in childhood are anxiety disorders, AD/HD and disruptive behavior, depression and bipolar disorders, and eating disorders. ( 7)

Help for School-Aged Children

IDEA requires that special education and related services be made available free of charge to every eligible child with a disability, including preschoolers (ages 3-21). These services are specially designed to address the child's individual needs associated with the disability-in this case, emotional disturbance, as defined by IDEA (and further specified by states). In the 2016 school year, more than 349,000 children and youth with emotional disturbance received these services to address their individual needs related to emotional disturbance. ( 8)

Determining a child's eligibility for special education and related services begins with a full and individual evaluation of the child. Under IDEA, this evaluation is provided free of charge in public schools.
10 Basic Steps in Special Education Questions Often Asked by Parents about Special Education Services Evaluating Children for Disability Developing Your Child's IEP
There is a lot to know about the special education process, much of which you can learn here on the CPIR site. We invite you to read the wide range of publications we offer on the topic, especially:

A Look at Specific Emotional Disturbances

As we mentioned, emotional disturbance is a commonly used umbrella term for a number of different mental disorders. Let's take a brief look at some of the most common of these.

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.

The term "anxiety disorder" is a broad term covering several different disabilities that share the core symptom of irrational fear. These include such different disorders as generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder (also called social phobia), and specific phobias. ( 9)

According to the Anxiety Disorders Association of America, anxiety disorders are the most common psychiatric illnesses affecting children and adults. ( 10) They are also highly treatable. Unfortunately, only about 36.9% of those affected receive treatment. ( 11)

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. ( 12)

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. ( 13)

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 way. ( 14) 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. (15)

Treatment will depend on the child's symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:

helping the child learn how to better solve problems, communicate, and handle stress, as well as how to control impulses and anger (what's known as cognitive-behavioral therapy);

family therapy;

peer group therapy (to help better social and interpersonal skills); and

medications (although these are not typically used to treat conduct disorder). (16)

Eating disorders are characterized by extremes in eating behavior-either too much or too little-or feelings of extreme distress or concern about body weight or shape. Females are much more likely than males to develop an eating disorder. ( 17)

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. ( 18)

Binge eating is also considered an eating disorder. It's characterized by eating excessive amounts of food, while feeling unable to control how much or what is eaten. Unlike with bulimia, people who binge eat usually do not purge afterward by vomiting or using laxatives. ( 19)

According to the National Eating Disorders Association:

Treating an eating disorder generally involves a combination of psychological and nutritional counseling, along with medical and psychiatric monitoring. Treatment must address the eating disorder symptoms and medical consequences, as well as psychological, biological, interpersonal, and cultural forces that contribute to or maintain the eating disorder... Many people utilize a treatment team to treat the multi-faceted aspects of an eating disorder. ( 20)

Obsessive-Compulsive Disorder

Often referred to as OCD, obsessive-compulsive disorder is actually considered an anxiety disorder (which was discussed earlier in this fact sheet). OCD is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors (handwashing, 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. ( 21)

A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain. ( 22) Treatment for most people with OCD should include one or more of the following:

therapist trained in behavior therapy;

Cognitive Behavior Therapy (CBT);

medication (usually an antidepressant). (23)

"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. ( 24) There are others as well.

Treatment for psychotic disorders will differ from person to person, depending on the specific disorder involved. Most are treated with a combination of medications and psychotherapy (a type of counseling). ( 25)

More about School

As mentioned, emotional disturbance is one of the categories of disability specified in IDEA. This means that a child with an emotional disturbance may be eligible for special education and related services in public school. These services can be of tremendous help to students who have an emotional disturbance.

Typically, educational programs for children with an emotional disturbance need to include attention to providing emotional and behavioral support as well as helping them to master academics, develop social skills, and increase self-awareness, self-control, and self-esteem. A large body of research exists regarding methods of providing students with positive behavioral support (PBS) in the school environment, so that problem behaviors are minimized and positive, appropriate behaviors are fostered. (See the resource section at the end of this fact sheet for more information on PBS.) It is also important to know that, within the school setting:

For a child whose behavior impedes learning (including the learning of others), the team developing the child's Individualized Education Program (IEP) needs to consider, if appropriate, strategies to address that behavior, including positive behavioral interventions, strategies, and supports.

Students eligible for special education services under the category of emotional disturbance may have IEPs that include psychological or counseling services. These are important related services available under IDEA and are to be provided by a qualified social worker, psychologist, guidance counselor, or other qualified personnel.

Recognizing and Addressing the Impact of COVID-19 | As young people return to in-person schooling in the 2021-2022 school year, they may bring with them the impact of the pandemic's trauma. This makes it essential that schools consider the possibility that many students will need to be re-evaluated to determine if they need additional services, especially behavioral support and mental health services, than they needed prior to COVID-19. Two resources of great relevance to reopening schools and returning students are the following:

Other Considerations

Children and adolescents with an emotional disturbance should receive services based on their individual needs, and everyone involved in their education or care needs to be well-informed about the care that they are receiving. It's important to coordinate services between home, school, and community, keeping the communication channels open between all parties involved.

The Importance of Support

Families often need help in understanding their child's disability and how to address the needs that arise from the disability. Help is available from psychiatrists, psychologists, and other mental health professionals that work in the public or private sector. There is also a network of mental health support operating in every state as well as locally.

To locate systems of support in your community or state, visit the organizations we've listed below. They can connect you with local resources, including support groups that provide connection and understanding, information, referral, and advocacy for those living with emotional disturbance.

There are also support groups available from organizations that address specific mental disorders under the umbrella term of emotional disturbance. See the resources at the end of this fact sheet to identify some of these groups.

Resources of More Information

AACAP | American Academy of Child and Adolescent Psychiatry | AACAP offers Facts for Families, a series in English, Spanish, and several other languages that includes many briefs on specific mental disorders, including the ones mentioned in this publication.

AACAP also operates different Resource Centers, which offer consumer-friendly definitions, answers to frequently asked questions, clinical resources, expert videos, Facts for Families, and much more. Visit the Resource Center home page if you are concerned with one of the following:

Anxiety Disorders

Autism

Bipolar Disorder

Conduct Disorder

Depression

Oppositional Defiant Disorder

NIMH | National Institute of Mental Health | NIMH is clearly a source of authoritative information on specific mental disorders. Phone: 1.866.615.6464. TTY: 1.866.415.8051

NAMI | National Alliance on Mental Illness | NAMI is an excellent source of information and connection on mental illness, including the individual disorders mentioned in this fact sheet. NAMI's website and toll-free helpline are available in English and Spanish.

SAMHSA is the Substance Abuse & Mental Health Services Administration. It offers many resources to consumers, including:.

Detailed information on specific emotional disturbances, or related issues such as positive behavior supports, is also available from these sources:

Anxiety Disorders Association of America | https://adaa.org/

Center on Positive Behavioral Interventions and Supports | The PBIS Center provides research-based information on how to provide behavioral supports to children who need them. | https://www.pbis.org

Conduct Disorders | A soft place to land for battle-weary parents
https://www.conductdisorders.com/community/

Encyclopedia of Mental Disorders | http://www.minddisorders.com/index.html

National Eating Disorders Association
1.800.931.2237 | www.nationaleatingdisorders.org

Something Fishy | (eating disorders)
https://www.something-fishy.org

**Highly Rated Resource! This resource was reviewed by 3-member panels of Parent Center staff working independently from one another to rate the quality, relevance, and usefulness of CPIR resources. This resource was found to be of "High Quality, High Relevance, High Usefulness" to Parent Centers.
________________________________________

References

2 | Code of Federal Regulations, Title 34, §300.8(c)(4)(i)

3 | Code of Federal Regulations, Title 34, §300.8(c)(4)(ii)

5 | Ibid.

7 | Ibid.

11 | Ibid.

13 | Ibid.

14 | American Academy of Adolescent and Child Psychiatry. (2013, August). Conduct disorder: Facts for families. Washington, DC: Author. Available online at:
http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Conduct_Disorder_33.aspx

15 | Ibid.

16 | Johns Hopkins Medicine Health Library. (n.d.). Conduct disorder in children. Baltimore, MD: Author. Online at:
https://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/conduct_disorder_90,P02560

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Links updated, November 2021 This information in Spanish The mental health of our children is a natural and important concern for us all. The fact is, many mental disorders have their beginnings in childhood or adolescence, yet may go undiagnosed and untreated for years.

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"Hearing impairment means an impairment in hearing, whether permanent or fluctuating, that adversely affects a child’s educational performance but that is not included under the definition of deafness in this section." (U.S. Department of Education, 2018).

Type of loss, age of onset, and degree of loss are three dimensions that are used to describe hearing problems. These are important to consider. The two types of hearing loss are conductive and sensorineural. Blockages or damage to the outer or middle ear can cause conductive hearing loss. This is generally a mild to moderate disability. Damage to the inner ear or the auditory nerve result in sensorineural hearing loss (Bryant, Bryant, & Smith, 2019).

See the Hearing Loss Association of America website linked below for more information and resources about this disability.

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Types, Causes and Treatments of Hearing Loss - the Basics

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There are three types of hearing loss. In the sections below you will find information about the types, causes and treatments for hearing loss.

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"Intellectual disability means significantly subaverage general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child’s educational performance" (U.S. Department of Education, 2018).

"Today, more than 500 genetic causes of intellectual and developmental disabilities are known, and because of advances in medical research, more are being identified" (Bryant, Bryant, & Smith, 2019, p. 144). There are three characteristics that define intellectual and developmental disabilities: problems with cognition, problems with adaptive behavior, and need for supports in order to maintain independence. These disabilities can be mild or severe, depending (Bryant, Bryant, & Smith, 2019). Mild intellectual and developmental disabilities are characterized by learning difficulties. These individuals can work and have good relationships with others. Moderate intellectual and developmental disabilities are characterized by developmental delays (Bryant, Bryant, & Smith, 2019). These individuals can perform some independence with their self-care and can communicate with others. Their academic skills are adequate. They may need supports to be able to live and work in a community. Severe intellectual and developmental disabilities require continuous support (Bryant, Bryant, & Smith, 2019). Profound intellectual and developmental disabilities are characterized by "severe limitation in self-care, continence, communication, and mobility; has continuous need of supports" (Bryant, Bryant, & Smith, 2019, p. 143).

See the Project IDEAL article linked below for more information and resources about this disability.

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Intellectual Disabilities - Project IDEAL

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Defining, characteristics, impact on learning, and teaching strategies for intellectual disabilities.

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"Multiple disabilities means concomitant impairments (such as intellectual disability-blindness or intellectual disability-orthopedic impairment), the combination of which causes such severe educational needs that they cannot be accommodated in special education programs solely for one of the impairments" (U.S. Department of Education, 2018).

Individuals with multiple disabilities are unique due to the combination of their disabilities. This also means that there is a wide range of skills and abilities as well as problems depending on their diagnoses  (Bryant, Bryant, & Smith, 2019). With this being said, a few common characteristics include "limited speech or communication, difficulty in basic physical mobility, tendency to forget skills that are rarely used, trouble generalizing skills from one situation to another, a need for support in major life activities (e.g. home care, leisure, community use, vocational)" (Bryant, Bryant, & Smith, 2019, p. 167).

See the ThoughtCo article linked below for more information and resources about supporting students with this disability.

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Children with multiple disabilities will have a combination of various disabilities that may include: speech, physical mobility, learning, mental retardation, visual, hearing, brain injury and possibly others. Along with multiple disabilities, they can also exhibit sensory losses and behavior and or social problems. Children with multiple disabilities, also referred to as multiple exceptionalities will vary in severity and characteristics.

These students may exhibit weakness in auditory processing and have speech limitations. Physical mobility will often be an area of need. These students may have difficulty attaining and remembering skills and or transferring these skills from one situation to another. Support is usually needed beyond the confines of the classroom. There are often medical implications with some of the more severe multiple disabilities which could include students with cerebral palsy and severe autism and brain injuries. There are many educational implications for these students.

Strategies and Modifications for Multiple Disabilities

What can you do?

Early intervention is necessary as soon as the child begins school.

Involvement of the appropriate professionals, i.e., occupational therapists, speech/language therapists, physiotherapists, etc.

A team approach at the school level involving external agency/community liaison who meet on a regular basis is essential

The physical arrangement of the classroom will need to best accommodate this child. Consideration of special equipment and assistive technology is essential.

Integration among their peers is important to assist these students with social development. It's important to integrate multiple disabled children as much as is possible. Research does indicate that when these students attend their community school and participate in the same activities as their peers is social skills develop and are enhanced. (Sometimes these students are placed full-time in a regular classroom with support, however, in the majority of cases, these students are placed in a developmental skills type of classroom with some integration.

Ensuring that all students demonstrate respect for the multiply disabled student becomes a teacher 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.

Remember, these children are often completely dependent on others for most/all of their daily needs.

Assistive technologies may assist this child and the support team will need to decide which assistive technologies will be most appropriate.

A safety plan will need to be developed and is often included in the IEP.

Care needs to be given in your expectations of this student to ensure the child doesn't become frustrated.

Most importantly, these identified children are to be given the same rights as non-identified school age children including screening, evaluation and an appropriate program and services.​

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Strategies for Supporting Students With Multiple Disabilities

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Children with multiple disabilities will have a combination of various disabilities that may include: speech, physical mobility, learning, mental retardation, visual, hearing, brain injury and possibly others. Along with multiple disabilities, they can also exhibit sensory losses and behavior and or social problems. Children with multiple disabilities, also referred to as multiple exceptionalities will vary in severity and characteristics.

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"Orthopedic impairment means a severe orthopedic impairment that adversely affects a child’s educational performance. The term includes impairments caused by a congenital anomaly, impairments caused by disease (e.g., poliomyelitis, bone tuberculosis), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures)" (U.S. Department of Education, 2018).

Physical impairments can range from mild to severe depending on the diagnosis. It is important that physical barriers are eliminated proactively in their day to day lives whenever it is possible (Bryant, Bryant, & Smith, 2019). Some of these individual can have physical disabilities and developmental disabilities, but it is wrong to assume that they automatically go hand in hand. "Although some degree of intellectual and developmental disabilities may be present in about half of these children, others may be intellectually gifted" (Bryant, Bryant, & Smith, 2019, p. 172).

See the Project IDEAL article linked below for more information and resources about this disability.

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Definition

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

Prevalence

The U.S. Department of Education reports 5,971,495 students receiving special education services in the 2003-2004 school year. Of that number, roughly 1.1%, or 68,188 students, received special education services based on a classification of orthopedic impairments.

Characteristics

The IDEA category of orthopedic impairments contains a wide variety of disorders. These can be divided into three main areas: neuromotor impairments, degenerative diseases, and musculoskeletal disorders. The specific characteristics of an individual who has an orthopedic impairment will depend on both the specific disease and its severity, as well as additional individual factors.

A neuromotor impairment is an abnormality of, or damage to, the brain, spinal cord, or nervous system that sends impulses to the muscles of the body. These impairments are acquired at or before birth, and often result in complex motor problems that can affect several body systems. These motor problems can include limited limb movement, loss of urinary control, and loss of proper alignment of the spine. The two most common types of neuromotor impairments are cerebral palsy and spina bifida.

Cerebral palsy refers to several nonprogressive 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. The four most common types of cerebral palsy include:

Spastic (very tight muscles occurring in one or more muscle groups that result in stiff, uncoordinated movements)

Athetoid (movements are contorted, abnormal, and purposeless)

Ataxic (poor balance and equilibrium in addition to uncoordinated voluntary movement)

Mixed (any combination of the types)

Cerebral palsy is also classified by which limbs (arms and legs) are affected. Major classifications include hemiplegia (left or right side), diplegia (legs affected more than arms); paraplegia (only legs), and quadriplegia (all four limbs).

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.

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.

Musculoskeletal disorders are composed of various conditions that can result in various levels of physical limitations. Two examples of musculoskeletal disorders include juvenile rheumatoid arthritis and limb deficiency.

Impact on Learning

The specific impact on learning of an individual is contingent upon the disease, its severity, and individual factors. Two individuals with identical diagnoses may be quite different in terms of their capabilities.

Many students with orthopedic impairments have no cognitive, learning, perceptual, language, or sensory issues. However, individuals with neuromotor impairments have a higher incidence of additional impairments, especially when there has been brain involvement. For most students with orthopedic impairments, the impact on learning is focused on accommodations necessary for students to have access to academic instruction.

Teaching Strategies

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.)

Assistive Technology

Due to the various levels of severity of orthopedic impairment, multiple types of assistive technology may be used. As with any student with a disability, the assistive technology would need to address a need of the student to be able to access the educational curriculum. For students with orthopedic impairments, these fall into three categories:

Devices to Access Information: These assistive technology devices focus on aiding the student to access the educational material. These devices include:

speech recognition software

screen reading software

augmentative and alternative communication devices (such as communication boards)

academic software packages for students with disabilities

Devices for Positioning and Mobility: These assistive technology devices focus on helping the student participate in educational activities. These devices include:

canes

walkers

crutches

wheelchairs

specialized exercise equipment

specialized chairs, desks, and tables for proper posture development

Organizations

United Cerebral Palsy Associations, Inc.

1660 L Street NW, Suite 700
Washington DC 20036

Web: www.ucp.org

United Cerebral Palsy of Texas

The national organization and its nationwide network of affiliates strive to ensure the inclusion of persons with disabilities in every facet of society-from the Web to the workplace, from the classroom to the community. As one of the largest health charities in America, the mission of United Cerebral Palsy is to advance the independence, productivity and full citizenship of people with disabilities through an affiliate network.

1016 La Posada, Suite 145
Austin, TX 78752

Email: info@ucptexas.org
Web: www.ucptexas.org

Center for Disability and Development

Dept. of Educational Psychology
4225 Texas A&M University
College Station, TX 77843-4225

Easter Seals--National Office

Easter Seals offers help, hope and answers to more than a million children and adults living with autism and other disabilities or special needs and their families each year. Services and support are provided through a network of more than 550 sites in the U.S. Each center provides exceptional services that are individualized, innovative, family-focused and tailored to meet specific needs of the particular community served.

230 West Monroe Street, Suite 1800
Chicago, IL 60606-4802

Web: www.easter-seals.org

March of Dimes Birth Defects Foundation

The March of Dimes mission is to improve the health of babies by preventing birth defects, premature birth, and infant mortality. They carry out this mission through research, community services, education and advocacy to save babies' lives. March of Dimes researchers, volunteers, educators, outreach workers and advocates work together to give all babies a fighting chance against the threats to their health: prematurity, birth defects, low birthweight.

1275 Mamaroneck Avenue
White Plains, NY 10605

Phone: 914-428-7100; 888-663-4637
Email: askus@marchofdimes.com
Web: www.marchofdimes.com

National Rehabilitation Information Center (NARIC)

The core mission of the Center is to collect and disseminate the results of research funded by the National Institute on Disability and Rehabilitation Research (NIDRR). NARIC staff members have been dedicated to providing direct, personal, and high-quality information services to anyone throughout the country.

4200 Forbes Boulevard, Suite 202
Lanham, MD 20706

Email: naricinfo@heitechservices.com
Web: www.naric.com

Spina Bifida Association of America

The Spina Bifida Association (SBA) serves adults and children who live with the challenges of Spina Bifida. Since 1973, SBA has been the only national voluntary health agency solely dedicated to enhancing the lives of those with Spina Bifida and those whose lives are touched by this challenging birth defect. Its tools are education, advocacy, research, and service.

4590 MacArthur Boulevard, N.W., Suite 250
Washington, DC 20007

National Institute of Neurological Disorders and Stroke (NINDS)

The mission of NINDS is to reduce the burden of neurological disease - a burden borne by every age group, by every segment of society, by people all over the world. NINDS conducts, fosters, coordinates, and guides research; operates research projects, program projects, and research center grants; and collects and disseminates research information related to neurological disorders.

National Institutes of Health
National Institue of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824

Web: www.ninds.nih.gov

References

Gargiulo, R.M. (2006). Special education in contemporary society: An introduction to exceptionality. Belmont, CA: Thomson Wadsworth.

Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives: Special education in today's schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

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

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"Other health impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that—

(i) Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and

(ii) Adversely affects a child’s educational performance" (U.S. Department of Education, 2018).

Two major groups that have OHI include students with chronic illnesses and students with infectious diseases. Many chronic illnesses are mentioned above. Infectious diseases (that are not mentioned) can include Hepatitis B, HIV/AIDS, and STORCH infections. Characteristics of students with OHI that cause barriers to their learning include fatigue, muscle weakness, loss of coordination, inability to pay attention, and frequent absences (Bryant, Bryant, & Smith, 2019). "Some symptoms are directly related to medications and treatment, and others are a function of the disease, illness, or condition" (Bryant, Bryant, & Smith, 2019, p. 164).

See the National Association of Special Education Teachers article linked below for more information and resources about this disability.

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IDEA Definition of Other Health Impairments

According to IDEA, an Other Health Impairment is defined as:
Other health impairment means having limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that:

(i) is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and
(ii) adversely affects a child's educational performance [34 C.F.R. 300.7(c)(9)].

Overview of Other Health Impairments

Many conditions and diseases can significantly affect a child's health and ability to function successfully in school. Most health impairments are chronic conditions; that is, they are always present, or they recur. By contrast, and acute condition develops quickly with intense symptoms that last for a relatively short period of time. To be served under the OHI category, the student's health condition must limit strength, vitality, or alertness to such a degree that the student's educational progress is adversely affected. More than 200 specific health impairments exist, and most are rare (Turnball et al., 2004). Within this category is Attention Deficit/Hyperactive Disorder. Only time will tell whether AD/HD finds its way to another special education category or whether it becomes a category of its own in the future. Presently, the inclusion of AD/HD has caused a significant increase in the size of the category (U.S. Department of Education, 2001).

Causes-Etiology of Other Health Impairments

The etiology of specific health impairments varies. Most result from infections, genetic factors, environmental influences, prenatal influences, perinatal influences, and postnatal influences. However, they can be grouped into some general areas (Smith, 2004):

Allergies e.g. Hepatitis

Heredity e.g. Hemophilia

Accidents e.g. seizure disorders

Multiple factors e.g. Epilepsy

Unknown

Prevalence of Other Health Impairments

According to the 26th Annual Report (U.S. Department of Education, 2004), 449,093 students between the ages of 6 to 21 years of age were identified as having other health impairments. This represents approximately 7.5 percent of all students having a classification in special education, or less than 1% of all school-age students.

Age of onset of Other Health Impairments

Due to the various types of health impairments that adversely affect children's performances in school, no specific age of onset can be generalized to the entire school-age population that receives special education services. Some health impairments are congenital (present at birth) and other conditions are acquired during the child's development as a result of accident, illness or unknown cause.

Gender Features of Other Health Impairments

Due to the number and specific types of health impairments covered in this section, no statement concerning gender patterns can be generalized.

Familial Patterns of Other Health Impairments

Due to the number and specific types of health impairments covered in this section, no statement concerning familial patterns can be generalized.

Cultural Features of Other Health Impairments

Although European Americans are proportionately underrepresented among students with disabilities, their highest representation is in the "Other Health Impairments" category.

Characteristics of Other Health Impairments

According to the Starbright Foundation (2002; cited in Turnball et al., 2004), there are numerous complex challenges facing children with health impairments. Common issues are: "loss of sense of control, lack of understanding about the condition, fear, worry, anxiety, stress, anger, and guilt, changes in family dynamics, isolation, isolation, medical noncompliance, boredom, depression, pain, decreased self-esteem, negative body image, and impact on identity and social interactions, including those at school" (p. 313).
Some general characteristics faced by individuals with other health impairments may include but not limited to:

Fatigue

Mobility issues

Issues involving attention

Coordination difficulties

Muscle weakness

Frequent absences or lateness's to school

Stamina

Inability to concentrate for long periods of time

Educational Implications of Other Health Impairments

When responsible educators encounter diseases and conditions they know little about, they seek out all the information they need to provide an appropriate education to students involved (Smith, 2004). One of the main considerations in the education of these students is the use of the team approach in developing and carrying out a child's educational program. The team generally includes the parents, teachers, medical professionals, and health-related professionals such as a physical therapist. Parents are critical members of the team and should be involved in all educational decisions. Sirvis (1988) noted that the team should design a program that meets the needs of the student in five basic goal areas: "(a) physical independence, including mastery of daily living skills; (b) self-awareness and social maturation; (c) communication; (d) academic growth; and (e) life skills training" (p. 400). Interdisciplinary services such as occupational and physical therapy and speech and language therapy are of prime importance for youngsters who have physical disabilities.

It is often necessary to modify and adapt the school environment to make it accessible, safe, and less restrictive since discriminating architecture doesn't have to discriminate (Leibrock & Terry, 1999, p.17). Accessibility guidelines are readily available, and when these guidelines are followed the environment becomes easier for the child to manage independently.

It is important that modifications be no more restrictive than absolutely necessary so that the student's school experiences can be as normal as possible. While it is necessary to stress the importance of avoiding overprotection of students with physical or health impairments, it is also important to permit students with disabilities to take risks just as their able-bodied cohorts do.
Recent advances in technology have helped to make life more nearly normal for students with physical disabilities. For example, students with cerebral palsy can use computer terminals to aid in communication. Through technology, even a person with the most severe handicaps can have greater control over communication and daily living skills.

Modifying the environment may mean providing special adaptive equipment such as specially designed desks, positioning devices, wedges, or standing tables. Adaptations also may include establishing procedures for dealing with medical emergencies when students have serious medical problems.

Finally, what role teachers should play in the medical management of children is an ongoing and contentious issue (Temple, 2000) since teachers are being called on to assume more responsibilities for the medical management of their students (Heller et al., 2000).

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curriculum for children with disabilities

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summer camps for children with disabilities

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family educational rights and privacy act

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Comprehensive Overview of Other Health Impairments

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According to IDEA, an Other Health Impairment is defined as:Other health impairment means having limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that: (i) is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and(ii) adversely affects a child's educational performance [34 C.F.R.

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"(i) General. Specific learning disability means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.

(ii) Disorders not included. Specific learning disability does not include learning problems that are primarily the result of visual, hearing, or motor disabilities, of intellectual disability, of emotional disturbance, or of environmental, cultural, or economic disadvantage" (U.S. Department of Education, 2018).

"Despite having normal intelligence, students with learning disabilities do not achieve academically on par with their classmates without disabilities. Some face challenges in almost every academic area" (Bryant, Bryant, & Smith, 2019, p. 132).

See the American Psychiatric Association article linked below for more information and resources about this disability.

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"Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance" (U.S. Department of Education, 2018).

Speech impairments can sound unintelligible or unpleasant. They negatively affect communication and the communication process. Language impairments disrupt communication. They also interfere with the ability to understand the speaker's messages and intent (Bryant, Bryant, & Smith, 2019). There are three types of speech impairments: articulation problems (producing sounds), fluency problems (interruptions to the flow of speech), and voice problems (pitch or loudness are effected). There are also three different types of language situations which include language impairments, language delays, and language differences (Bryant, Bryant, & Smith, 2019).

See The American Speech-Language-Hearing Association (ASHA) website linked below for more information and resources about this disability.

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Speech is how we say sounds and words. Language is the words we use to share ideas and get what we want.

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"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. Traumatic brain injury applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. Traumatic brain injury does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma" (U.S. Department of Education, 2018).

Depending on the extent of the injuries, TBI range from mild to severe. Effects of the injury can last indefinitely. Some individuals with TBI can have seizures, also (Bryant, Bryant, & Smith, 2019).

See the MAYO Clinic article linked below for more information and resources about this disability.

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Traumatic brain injury-Traumatic brain injury - Symptoms & causes - Mayo Clinic

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If a head injury causes a mild traumatic brain injury, long-term problems are rare. But a severe injury can mean significant problems.

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"Visual impairment including blindness means an impairment in vision that, even with correction, adversely affects a child’s educational performance. The term includes both partial sight and blindness" (U.S. Department of Education, 2018).

"Many professionals talk about visual disabilities in four very different ways:
1. By identifying the reason for the visual loss
2. By considering the severity of the problem
3. By taking into account when the loss occurred
4. By determining whether the criteria for being considered legally blind are met" (Bryant, Bryant, & Smith, 2019, p. 177).

There are two subgroups of those with visual impairments: individuals with low vision and individuals who are blind. If someone is congenitally blind, they have been blind since birth or during their infancy. If someone is adventitiously blind, it had an onset after 2 years of age (Bryant, Bryant, & Smith, 2019).

See The Nemours Foundation article linked below for more information and resources about this disability.

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The human eye is like a camera that collects, focuses, and transmits light through a lens to create an image of its surroundings. In a camera, the image is created on film or an image sensor. In the eye, the image is created on the retina, a thin layer of light-sensitive tissue at the back of the eye.

Like a camera, the human eye controls the amount of light that enters the eye. The iris (the colored circular part of the eye) controls the amount of light passing through the pupil. It closes up the pupil in bright light and opens it wider in dim light. The cornea is the transparent, protective surface of the eye. It helps focus light, as does the lens, which sits just behind the iris.

When light enters the eye, the retina changes the light into nerve signals. The retina then sends these signals along the optic nerve (a cable of more than 1,000,000 nerve fibers) to the brain. Without a retina or optic nerve, the eye can't communicate with the brain, making vision impossible.

What Is Visual Impairment?

Many people have some type of visual problem at some point in their lives. Some can no longer see objects far away. Others have problems reading small print. These types of conditions are often easily treated with eyeglasses or contact lenses.

But when one or more parts of the eye or brain that are needed to process images become diseased or damaged, severe or total loss of vision can occur. In these cases, vision can't be fully restored with medical treatment, surgery, or corrective lenses like glasses or contacts.

The American Foundation for the Blind estimates that 10 million people in the United States are visually impaired. Visual impairment is a term experts use to describe any kind of vision loss, whether it's someone who cannot see at all or someone who has partial vision loss.

Some people are completely blind, but many others have what's called legal blindness. They haven't lost their sight completely but have lost enough vision that they'd have to stand 20 feet from an object to see it as well as someone with perfect vision could from 200 feet away.

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What Causes Visual Impairment?

People rarely lose their eyesight during their teen years. When they do, it's usually caused by an injury like getting hit in the eye or head with a baseball or having an automobile or motorcycle accident.

Some babies have congenital blindness, which means they are visually impaired at birth. Congenital blindness can be caused by a number of things - it can be inherited, for instance, or caused by an infection (like German measles) that's transmitted from the mother to the developing fetus during pregnancy.

Conditions that may cause vision loss after birth include:

Amblyopia (pronounced: am-blee-OH-pee-uh) is reduced vision in an eye caused by lack of use of that eye in early childhood. Some conditions cause a child's eyes to send different messages to the brain (for example, one eye might focus better than the other). The brain may then turn off or suppress images from the weaker eye and vision from that eye then stops developing normally. This is also known as a "lazy eye." Strabismus (misaligned or crossed eyes) is a common cause of amblyopia, since the brain will start to ignore messages sent by one of the misaligned eyes.

Cataracts are cloudy areas in part or all of the lens of the eye. In people without cataracts, the lens is crystal clear and allows light to pass through and focus on the retina. Cataracts prevent light from easily passing through the lens, and this causes loss of vision. Cataracts often form slowly and usually affect people in their 60s and 70s, but sometimes babies are born with congenital cataracts. Symptoms include double vision, cloudy or blurry vision, difficulty seeing in poorly lit spaces, and colors that seem faded.

Diabetic retinopathy (pronounced: reh-ton-AH-pa-thee) occurs when the tiny blood vessels in the retina are damaged due to diabetes. People with retinopathy may not have any problems seeing at first. But if the condition gets worse, they can become blind. Teens who have diabetes should be sure to get regular eye exams because there are no early warning signs for this condition. To help prevent retinopathy, people with diabetes should also avoid smoking, keep their blood pressure under control, and keep their blood sugar at an even level.

Glaucoma is an increase in pressure inside the eye. The increased pressure impairs vision by damaging the optic nerve. Glaucoma is mostly seen in older adults, although babies may be born with the condition and children and teens can sometimes develop it as well.

Macular (pronounced: MAH-kyoo-lur) degeneration is a gradual and progressive deterioration of the macula, the most sensitive region of the retina. The condition leads to progressive loss of central vision (the ability to see fine details directly in front). Macular degeneration is often age related (it occurs in older people, especially older than 60), but sometimes it can occur in younger people. Excessive exposure to sunlight and smoking can increase the risk for age-related macular degeneration. Symptoms may include increased difficulty reading or watching TV, or distorted vision in which straight lines appear wavy or objects look larger or smaller than normal.

Trachoma (pronounced: truh-KO-muh) occurs when a very contagious microorganism called Chlamydia trachomatis causes inflammation in the eye. It's often found in poor rural countries that have overcrowded living conditions and limited access to water and sanitation. Blindness due to trachoma has been virtually eliminated from the USA.

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What Do Doctors Do?

If you, your parent, or your doctor suspects a visual problem, you'll probably pay a visit to an ophthalmologist (pronounced: af-thal-MAH-luh-jist), a medical doctor who specializes in examining, diagnosing, and treating eyes and eye diseases. When someone goes for an examination, the ophthalmologist will look at the structure of that person's eye.

Other simple tests an ophthalmologist may perform include:

Visual acuity test. A person reads an eye chart to measure how well he or she sees at various distances.

Visual field test. Ophthalmologists use this test to measure side, or peripheral, vision.

Tonometry test. This test determines the fluid pressure inside the eye to evaluate for glaucoma.

If your doctor determines that you have an eye condition that is likely to cause visual impairment, many treatments are available. Options may include eyeglasses, contact lenses, and eye drops or other medicines.

In some cases, surgery may be required. For instance, cataracts are often treated by removing the clouded lens and replacing it with an intraocular lens (an artificial plastic lens that requires no special care and restores vision).

Other methods can compensate for vision loss. Guide dogs can help people get from place to place independently. Braille allows those with visual impairment to read and write. Special equipment such as microscopic and telescopic glasses and voice-recognition software can make school and homework easier.

What's It Like to Be Visually Impaired?

Just as you don't think about your eye color every day, people with visual impairment don't always think about their condition every day either.

Someone with sight problems can become isolated from others more easily, though. If a visually impaired person asks for assistance, don't hesitate to help. But someone who uses a cane or a guide dog is probably self-sufficient and may not need help.

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When one or more parts of the eye or brain that are needed to process images become diseased or damaged, severe or total loss of vision can occur. Read all about visual impairment.

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Bryant, D. P., Bryant, B. R., & Smith, D. D. (2019). Teaching students with special needs in inclusive classrooms (2nd ed.). Thousand Oaks, CA: SAGE Publications, Inc.

U.S. Department of Education. (2018, May 25). Sec. 300.8 Child with a disability. Retrieved November 23, 2019, from https://sites.ed.gov/idea/regs/b/a/300.8.

U.S. Department of Education. (2019). About IDEA. Retrieved November 23, 2019, from https://sites.ed.gov/idea/about-idea/.