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Federal, Government, and/or Medical Definitions

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Federal, Government, and/or Medical Definitions

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During the 2000-2001 school year the states reported to the United States Department of Education that they provided 112,559 children with multiple disabilities. The article discuses different characteristics a person with multiple disabilities would most likely have. As stated, “Limited speech or communication, difficulty in basic physical mobility, tendency to forget skills through disuse, trouble generalizing skills from one situation to another; and/or a need for support in major life activities.” These characteristics doesn’t apply to everyone with multiple disabilities because it varies on the level, combination of disabilities, and age. However, there are medical implication and educational implication of multiple disabilities. Severe disabilities can come with a wide range of medical issues. Seizures, sensory loss, hydrocephalus, and scoliosis are just a few of the conditions that might occur. When developing educational services, these factors should be taken into consideration. Educational programs must include a range of components to address the diverse requirements of people with severe and/or multiple disabilities in order to be effective.

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Adapted from NICHCY

The Individual with Disabilities Education Act defines multiple disabilities as: concomitant impairments (such as mental retardation-blindness, mental retardation-orthopedic impairment, etc.), the combination of which causes such severe educational needs that they cannot be accommodated in special education programs solely for one of the impairments. The term does not include deaf-blindness.

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

What is the Incidence of Multiple Disabilities?

In the 2000-2001 school year, the states reported to the U.S. Department of Education that they were providing services to 112,559 students with multiple disabilities (U.S. Department of Education, Twenty-fourth Annual Report to Congress, 2002).

What are the Characteristics?

People with severe or multiple disabilities may exhibit a wide range of characteristics, depending on the combination and severity of disabilities, and the person's age. There are, however, some traits they may share, including:

Limited speech or communication;

Difficulty in basic physical mobility;

Tendency to forget skills through disuse;

Trouble generalizing skills from one situation to another; and/or

A need for support in major life activities (e.g., domestic, leisure, community use, vocational).

Medical Implications of Multiple Disabilities

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

Educational Implications of Multiple Disabilities

In the past, students with severe and/or multiple disabilities were routinely excluded from public schools. Since the implementation of Public Law 94-142 (the Education of the Handicapped Act, now called the Individuals with Disabilities Education Act, or IDEA), public schools now serve large numbers of students with severe and/or multiple disabilities. Educational programming is likely to begin as early as infancy. At that time, as well as later on, the primary focus is upon increasing the child's independence.

In order to be effective, educational programs need to incorporate a variety of components to meet the considerable needs of individuals with severe and/or multiple disabilities. Programs should assess needs in four major areas: domestic, leisure/recreational, community, and vocational. These assessments enable the identification of functional objectives (objectives which will result in the learner's increased skill and independence in dealing with the routine activities of his/her life). Instruction should include: Expression of choice; communication; functional skill development; and age-appropriate social skills training.

Related services are of great importance, and the multidisciplinary approach is crucial. Appropriate people such as speech and language therapists, physical and occupational therapists, and medical specialists need to work closely with classroom teachers and parents. Because of problems with skill generalization, related services are best offered during the natural routine in the school and community rather than removing a student from class for isolated therapy.

Frequently, classroom arrangements must take into consideration students' needs for medications, special diets, or special equipment. Adaptive aids and equipment enable students to increase their range of functioning. For example, in recent years computers have become effective communication devices. Other aids include: wheelchairs, typewriters, headsticks (head gear), clamps, modified handles on cups and silverware, and communication boards. Computerized communication equipment and specially built vocational equipment also play important roles in adapting working environments for people with serious movement limitations.

Integration with nondisabled peers is another important component of the educational setting. Attending the same school and participating in the same activities as their nondisabled peers are crucial to the development of social skills and friendships for people with severe disabilities. Integration also benefits nondisabled peers and professionals through positive attitude change. People with severe disabilities are those who traditionally have been labeled as having severe to profound mental retardation. These people require ongoing, extensive support in more than one major life activity in order to participate in integrated community settings and enjoy the quality of life available to people with fewer or no disabilities. They frequently have additional disabilities, including movement difficulties, sensory losses, and behavior problems.

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Adapted from NICHCY The Individual with Disabilities Education Act defines multiple disabilities as: concomitant impairments (such as mental retardation-blindness, mental retardation-orthopedic impairment, etc.), the combination of which causes such severe educational needs that they cannot be accommodated in special education programs solely for one of the impairments. The term does not include deaf-blindness.

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This article discusses the role teachers play in the lives of students with multiple disabilities, gives an overview of the meaning of multiple disability, describing the variability of this term, and shares strategies to best support these students. Additionally, it describes the need for early intervention and how this plays a role in the development of the student. It also stresses the importance of understanding each of your students disabilities, stating, “it is vital to understand the nature of the child’s disabilities (to the fullest extent possible), and tailor your interventions accordingly.” This source is especially useful for teachers, who are responsible for assessing the child's disability and determining on the best course of action to ensure their success.

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Learn how to best support children with multiple disabilities such as intellectual disability, mobility issues, visual or auditory deficits, language delay, brain injury.

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Sharon is a 5-year-old who has multiple disabilities. Sharon has an intellectual disability, problems with mobility, and a speech impairment that can be hard for others to understand what she is properly saying. Sharon began receiving special services called early intervention. Early intervention helps children since their birth time up until they are 3 years old. This special service has helped her to crawl, stand, and walk with braces! However, in preschool her parents are very involved in the services she is receiving for her special learning needs. Having Multiple Disability can be very tough, but it doesn’t mean you can’t get through things. Sharon is only 5 years old, but nothing stops her from being who she is. In the text it stated, “Her parents also know how determined Sharon can be when she’s learning something new. She’s going to learn it, by golly, there’s no stopping her.”

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See fact sheets on other disabilities
Sharon's Story

Sharon is an active five year old who loves to spend time with her grandmother. She also loves to fingerpaint and play with the family dog. Sharon has multiple disabilities. When she was born, she didn't get enough oxygen. As a result, she has an intellectual disability, problems with mobility, and a speech impairment that makes it hard to understand what she's saying. That doesn't stop Sharon from chattering, though. She has a lot to say.

For Sharon's parents, it's been a long road from Sharon's birth to today. When she was just a baby, she began receiving special services called early intervention. These services help children with disabilities from birth to their third birthday. In early intervention, Sharon learned to crawl and to stand and-finally!-to walk with braces.

Now in preschool, Sharon receives special education services. Like early intervention, these services are meant to address her special learning needs. Her parents are very involved. They sit down often with the preschool staff and talk about Sharon's progress. The team also talks about Sharon's challenges and how to address them. Last week, for example, Sharon got a picture board to help her communicate. She's busy learning to use it.

Sharon's parents know that Sharon will always need some support because of her multiple disabilities. But her parents also know how determined Sharon can be when she's learning something new. She's going to learn it, by golly, there's no stopping her.

Causes of Multiple Disabilities

Having multiple disabilities means that a person has more than one disability. What caused the disabilities? Often, no one knows.

With some children, however, the cause is known. For example, Sharon's disabilities were caused by a lack of oxygen at birth. Other causes can include:

Chromosomal abnormalities

Premature birth

Difficulties after birth

Poor development of the brain or spinal cord

Infections

Genetic disorders

Injuries from accidents (1)

Whatever the cause, the result is that the child has multiple disabilities. Fortunately, there's help available. Keep reading to find out more.

Multiple Disabilities Aren't All the Same

The term multiple disabilitie s is general and broad. From the term, you can't tell:

how many disabilities a child has;

which disabilities are involved; or

how severe each disability is.

Many combinations of disabilities are possible. For example, one child with multiple disabilities may have an intellectual disability and deafness. Another child may have cerebral palsy and autism. Sharon, above, had three different disabilities. All have multiple disabilities-but oh, such different ones!
To support, parent, or educate a child with multiple disabilities, it's important to know:

which individual disabilities are involved;

how severe (or moderate or mild) each disability is; and

how each disability can affect learning and daily living.

The different disabilities will also have a combined impact. That's why it's also important to ask: How does the combination of these disabilities affect the child's learning, balance, use of the senses, thinking, and so on?

The answer will help parents and involved professionals decide what types of supports and services the child needs now and in the future.

Have You Recently Learned that Your Child has Multiple Disabilities?

If so, you may find it helpful to read two articles on this website:

Help for Children with Multiple Disabilities

When children have multiple disabilities, they are often eligible for the type of help that Sharon, our story girl, is receiving. In fact, more than 8,000 children in preschool (ages 3-5) received special education and related services in the U.S. in the Fall of 2011 because of their multiple disabilities. ( 2) More than 125,000 school-aged children did, too. ( 3)

For babies and toddlers | When a baby is born with multiple disabilities, his or her parents should know that there's a lot of help available-and immediately. Shortly after the diagnosis of multiple disabilities is made, parents will want to get in touch with the early intervention system in their community. We'll tell you how in a moment.

Early intervention is a system of services that helps infants and toddlers with disabilities (until their 3rd birthday) and their families. Early intervention services are available in every state and territory, as required by the Individuals with Disabilities Education Act (IDEA). These services may be provided on a sliding-fee basis. This means that the costs to the family will depend upon their income.

To access early intervention services in your area, ask your child's pediatrician for a referral. You can also call the local hospital's maternity ward or pediatric ward, and ask for the contact information of the local early intervention program.

For children in school | IDEA also requires that special education and related services be made available to every eligible child with multiple disabilities. This includes preschoolers (ages 3-21). These services are specially designed to address the child's individual needs associated with the disabilities. The services are provided at no cost to families.

To access special education services for a school-aged child with multiple disabilities, get in touch with your local school system. Calling the elementary school in your neighborhood is an excellent place to start.

IDEA's Definition of Multiple Disabilities

Speaking of IDEA, this very important federal law defines the term multiple disabilities as follows.
Multiple disabilities...
...means concomitant [simultaneous] impairments (such as intellectual disability-blindness, intellectual disability-orthopedic impairment, etc.), the combination of which causes such severe educational needs that they cannot be accommodated in a special education program solely for one of the impairments. The term does not include deaf-blindness. [§300.8(c)(7)]

As you can see, there's more to IDEA's definition of multiple disabilities than having more than one impairment or disability. A key part of the definition is that the combination of disabilities causes the student to have severe educational needs. In fact, those educational needs must be severe enough that they cannot be addressed by providing special education services for only one of the impairments.

The federal definition of multiple disabilities gives two examples of possible combinations of disabilities:

intellectual disability and blindness; and

intellectual disability and orthopedic impairment.

But these are just examples. A child may have another combination of disabilities that causes severe educational needs-cerebral palsy and autism, for example, or blindness and an emotional disturbance. Whatever the combination is, a child served under IDEA's category of "multiple disabilities" will have a special education program that is designed to address the educational needs that arise from all of the child's disabilities, not just one.

Note that IDEA does not include deaf-blindness as an example of multiple disabilities. That's because deaf-blindness is defined separately and is a disability category of its own under IDEA.

Beyond the Federal Definition

So, what level of educational need is considered "severe enough" to make a student with multiple disabilities eligible for special education? Each state defines this for itself. So it's important to know your state's definition of multiple disabilities. It's also important to know:

how each disability affects the child's learning and functioning, and

how the combination of disabilities does as well.

Bear in mind that it's hard to say how a combination of specific disabilities will affect an individual child. That will depend on the disabilities involved and their severity.

The Evaluation Process

An in-depth evaluation of the child must be conducted (with parental consent) before any services or supports may be provided under IDEA. This evaluation is free of charge to families. Its purpose is to gather detailed information about:

the nature and extent of the child's disabilities; and

the educational or developmental needs resulting from those disabilities.

With information from the evaluation, parents and involved professionals can then work together to decide what services and supports the child will receive, given his or her individual needs.

Supporting Children with Multiple Disabilities

Most children with multiple disabilities will need some level of help and support throughout their lives. How much support a child needs will depend on the disabilities involved. A child with mild multiple disabilities may only need intermittent support (meaning, support is needed every now and again, or for particular tasks). Children with multiple, more severe disabilities are likely to need ongoing support.

Support in major life activities | When considering what supports a child needs, it's helpful to think about major life activities. "Major life activities" include activities such as:

caring for oneself;

performing manual tasks;

seeing, hearing, eating, and sleeping;

walking, standing, lifting, and bending;

speaking and communicating;

breathing;

learning;

reading;

concentrating and thinking; and

Are any of these major life activities a challenge for the child because of his or her disabilities? Five-year-old Sharon has difficulties with caring for herself, walking, standing, and communicating. Her intellectual disability makes learning, reading, concentrating, and thinking a challenge. Not surprisingly, these are the areas where Sharon needs extensive support. Only time will tell how much support she'll need as she grows older.

Tips for Parents

Learn about each of your child's disabilities. The more you know, the more you can help yourself and your child.

Love and play with your child. Treat your son or daughter as you would a child without disabilities. Take your child places, read together, have fun.

Know your child's needs, play to his or her strengths. Each child with multiple disabilities has learning needs, yes, but each also has his or her own set of skills, strengths, interests, enthusiasms, and preferences. These can be used to motivate your child and enrich learning, growth, and individuality.

Don't let the labels get you down. What terms should you use to describe your child's disabilities? There may be many to choose from (e.g., delay, developmental disability, cerebral palsy, physical disability, speech or language disorder, multiple disabilities), and each one describes a different aspect of your child. Learn to understand and be comfortable with using each one. This will help you be an advocate for your child and his or her unique gifts and challenges.

Encourage your child to be independent. For example, help your son or daughter learn self-care skills such as getting dressed, grooming, and doing laundry.

Team with the professionals working with your child. As a parent, you have the right to participate in team meetings where your child's education or program is being planned. Be there. Share your unique knowledge of who your son or daughter is; advocate that the program address your child's needs.

Investigate assistive technology (AT). AT is appropriate, even essential, for many children with multiple disabilities. Without AT, there may be many tasks they simply cannot do or will have difficulty doing. Computers, augmentative/alternative communication systems, communication boards, head sticks, and adaptive switches are just some examples of helpful AT. Visit the Family Center on Technology and Disability to learn more about which AT devices may be useful to your child:
http://www.fctd.info

Practice and reinforce. Do your child's disabilities affect his or her intellectual functioning? If so, he or she will be slower to learn new things and will have difficulty applying that learning in new situations. Be concrete. Give lots of hands-on opportunities for learning and practice. Give feedback immediately. Repeat the learning task in different settings.

Give your child chores. Keep in mind his or her age, mental capacity, attention span, and abilities. If necessary, divide tasks into small steps. Explain what your child is supposed to do, step by step, until the chore is done. Demonstrate. Offer help when it's needed and praise when things go well.

Find out what your child is learning at school. Look for ways to apply it at home. For example, if the teacher is reviewing concepts of money, take your child to the supermarket with you to help keep track of what money you're spending.

Look for social opportunities in the community (such as Scouts) or activities offered through the department of sports and leisure. Joining in and taking part will help your child develop social skills and have fun.

Talk with other parents whose children have disabilities -especially those who have one or more of the same disabilities as your child. Other parents can be a fountain of practical advice and emotional support. Suggestions for finding parent groups:

Visit the websites of the disability organizations you've identified to see if they have a parent group nearby.

We also suggest reading Parent Groups, available online at: https://www.parentcenterhub.org/parentgroups/

Get in touch with your State's (CPRC). PTIs and CPRCs know the relevant resources in your state and community. They can also give you information about disabilities, the educational rights of your child, or strategies for being an effective advocate for your child. Find your PTI and/or CPRC, at: Parent Training and Information Center (PTI) and possibly the Community Parent Resource Center
https://www.parentcenterhub.org/find-your-center/

Be patient, be hopeful. Your child, like every child, has a whole lifetime to learn and grow.

Tips for Teachers

Know the needs, play to the strengths. Each student with multiple disabilities will have his or her own set of skills, strengths, and learning needs. Learning more about each disability of the student will be helpful in addressing those learning needs. Also find out more about the student's strengths and interests, enthusiasms, and preferences. These can be used to motivate the student and enrich the education he or she receives. Parents are a great source of this information. So is the student!

Be familiar with the student's IEP. If you have a student with multiple disabilities in your class, chances are that he or she has an individualized education program (IEP). The IEP will spell out the educational and functional goals to be worked on. You may have been part of the team that developed the IEP. If not, it's important to be familiar with what the student's IEP requires. Ask for a copy. Consult with administrators and other teachers, as needed, to make sure that the supports and services listed in the IEP are provided.

Allow partial participation, as necessary. Partial participation means that students with multiple disabilities aren't excluded from activities because they might not be able to complete a task fully or independently. Modifications can be made to the task itself or to how students participate.

Consider assistive technology (AT). AT is appropriate, even essential, for many students with multiple disabilities. Without AT, there may be many tasks they simply cannot perform or will have difficulty performing. Computers, augmentative/alternative communication systems, and communication boards are just some examples of helpful AT. Visit the Family Center on Technology and Disability to learn more about which AT devices may be useful to a given student:
http://www.fctd.info

Practice and reinforce. Does your student's disabilities affect his or her intellectual functioning? If so, he or she will be slower to learn new things and will have difficulty applying that learning in new situations. Be concrete; give lots of hands-on opportunities for learning and practice. Give feedback immediately. Repeat the learning task in different settings.

Encourage the student's independence. It's natural to want to help a student who's struggling to do a task single-handedly, especially when you know there's a disability involved. But it's important for the child to develop the skills it takes to live as independently as possible, now and in the future.

Resources and Organizations

Organizations

References

2 Data Accountability Center. (2012, August). Table B1-2. Number of children ages 3 through 5 served under IDEA, Part B, by disability and state: Fall 201 1. Rockville, MD: Author.

3 Data Accountability Center. (2012, August). Table B1-3. Number of students ages 6 through 21 served under IDEA, Part B, by disability and state: Fall 2011. Rockville, MD: Author.

4 Federal law at 42 USC §12102 defines "major life activities" as follows: "major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working."

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See fact sheets on other disabilities Sharon is an active five year old who loves to spend time with her grandmother. She also loves to fingerpaint and play with the family dog. Sharon has multiple disabilities. When she was born, she didn't get enough oxygen.

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Family Members of Individuals with Disabilities

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Family Members of Individuals with Disabilities

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This article discusses pressures that having a child with multiple disabilities can put on family life, how this can affect other siblings, and strategies to make sure your child with disabilities is an active part of the family. The information in this article is important to be aware of for the child’s success, the author states, “the efforts of a child’s family to provide life experiences and obtain necessary services can make a tremendous difference.” This source is useful in helping define ,multiple disabilities in a family setting.

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Family Life When Your Child Has Multiple Disabilities

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No two children are the same, and this becomes even clearer when children have multiple disabilities. Your child's strengths and needs are uniquely hers. Children with visual and multiple disabilities vary greatly in their abilities, interests, capacity to use vision and other senses, family background, and personalities.