Understanding Multiple Disabilities in Special Education

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MULTIPLE DISABILITY
 
P . KAMARAJ,  Faculty , NIEPMD, ECR ,Muttukadu , Chennai
9840380628
 
TNTEU , B.Ed –SPECIAL EDUCATION
PROGRAM
 
Course 5 : Assessment and Identification of Needs of Persons with Multiple Disabilities
 
Unit –III : Multiple Disabilities and other disability conditions
 
Sub Unit 3.1 : Multiple Disabilities Meaning , Definitions and classifications
Sub Unit 3.2 : Various combinations of Multiple Disabilities and Associated conditions
such as epilepsy motor and sensory condition
Sub Unit 3.3 : Implication of Functional limitations for Education of children with
multiple disabilities
 
 
MULTIPLE DISABILITIES
 
children with multiple disabilities are often called
Severe handicapped
Severely and profoundly handicap
Dual sensory impaired
Additional disabilities
Multiple disabilities
 
 
DEFINITION
 
“Multiple disabilities” means concomitant impairments (such as mental retardation-
blindness, mental retardation orthopedic impairment), the combination of which causes
such severe educational problems that the students cannot be accommodated in Special
Education program solely for one of the impairment. The term does not include
students with deaf-blindness  - USOSE (2004)
 
DEFINITION
 
Multiple Disability” mean a combination of two or more disabilities as defined in
clause (i) of section (2) of the Persons with Disabilities (Equal Opportunities, Protection
of Rights and Full Participation) Act 1995
 
DEFINITION
 
Those children excluded from school on the basis of extensive mental, physical, and or
behavioral impairments that are permanent in nature
 
CLASSIFICATIONS
 
The classification of children with Multiple Disabilities are based on the combinations and
severity
 
Moderate , Severe & Profound condition of any one of the disability in the combination
makes the person become multiple disabilities.
In the diagnostic assessment and evaluation process it is addressed that the impairment or
the disability condition is more than 60 %  among the bench mark disabilities become
multiple disabilities in turn they are also called as the children having  high support needs.
 
THE COMBINATIONS OF MULTIPLE
DISABILITIES
 
The children with Multiple disabilities may be reported with various combinations as
given below
A child may have reported with concomitant impairment of Intellectual and locomotor
disability  or
A child may have reported with concomitant impairment of Intellectual and sensory
disability  or
A child may have reported with concomitant impairment of Intellectual and any other
developmental disabilities
Such as Intellectual  Disability (ID) + Autism Spectrum Disorders (ASD) , ID +
Cerebral Palsy (CP)
ID+ Deafblind(DB) or DB or ASD+ DB  or CP+DB  etc. …
 
CHARACTERISTIC FEATURE
 
General appearance
Self help activities
Motor function
Language & Communication
Sensory
Learning
Social and Emotional
Physical/Health condition
 
GENERAL APPEARANCE
 
Under build / Thin built
Unsteady of body control
Clumsiness of appearance
Micro cephalic or hydro cephalic head
Squint
Pigeon chest
Drools
Asymmetrical body features
Flexed or Drooped body condition
Retarder physical growth
 
MOTOR FUNCTIONS
 
Presence of abnormal reflexes
Unstable body condition
No active movements of body and limbs
Developing abnormal pattern of posture and movements
Flexion and hyper tonicity of joins and muscles
Extended or Hypo tonicity of joins and muscles
Sits or stands with supports
Lying on the floor or bed for long time
Drags the body for movements
Depend on others for his mobility
Carries by others  manually or using a wheel chair
Hesitate to move around and experiences of fall or hurt while moving around
 
SELF HELP ACTIVITIES
 
Poor oral hygiene
Decay of the tooth
Show feeble movement of feeding
Shows difficulties in sucking , swallowing , biting and chewing
Poor intake
Chokes while feeding
Poor toilet skill , no toilet indication, cries after defecation and urination
Cooperates for brushing , bathing and dressing.
Custodial of other for his self help activities
Vulnerable to gets infected due to poor maintenance of his clothes, body and places
 
LANGUAGE AND COMMUNICATION
 
Severe to profound delay in language and communication development
Very poor in using the body or limbs for communication
Cries or coos or vocalises for communication
Uses minimal facial expression for communication
Uses eye gazing for communication
Shows agitate movement or moves his limbs for communication
Depend on AAC
 
SENSORY
 
Presence of sensory impairment
Uses residual senses for the functional activities
Shows hyper or hyposensitivity in one or more of the seven senses
Does not use effectively the sensory modalities for learning
Poor abstraction
Does not involve effectively the metacognitive process for learning
Doesn't get much opportunity for learning.
Poor anticipation and reactions
Hesitates to explore with environment /surroundings
 
SOCIAL AND EMOTIONAL
 
Looks  Fearful
Gets frustrated , angry and upset that can be observed in the face.
Have difficulty forming interpersonal relationship
No or hardly any friends
Doesn’t react immediately any emotional situations
Does not able participate effectively in the games and play
No or minimal exposed to the visitors and other community functions
Poor maintenance of his body , clothes and surroundings
Not able to defend or indicate on certain circumstances and Victim of ant bites ,
mosquitoes bites  or any other insect bites
.
 
LEARNING
 
Has poor gross fine motor movements
Uses his/her residual senses for learning
Shows very poor or lethargic response to stimuli
Shows poor visual, auditory ,tactile and kinesthetic processing skills
Forgets skills through disuse
Has limited abstract thinking
Difficulty in locating the directions of sound
Difficulties in visual tracking and visual discrimination
Exposed to limited environment for learning
Experience of being isolated at home or at other places
 
HEALTH
 
Febrile convulsion or Seizures  / Epileptic conditions  may be having Simple , Partial to
Complex seizures
Metabolic disorders  liken MPS I&II ,PKU etc.
Undernourished /Malnourished
Constipation sometimes bleedings
Sensory loss –loss of hearing threshold and visual acuity and poor reflexarc
Hydrocephalus and scoliosis
Physically clumsy and awkward
No reactions to various sensory insults like hot or cold contacts , spicy or any other
tastes , bad smells.
 
ASSESSMENT TO UNDERSTAND THE
BIO-BEHAVIOURL STATE
 
BIO BEHAVIOURAL STATE     It has 3 parts
A-Behavior state
B-Learning environment
C- Format for recording the data
 
ASSESSMENT
 
BEHAVIOR STATE:
Sleep states
Intermediate state
Preferred awake stage
Other awake stage
 
 
ASSESSMENT
 
LEARNING ENVIRONMENT VARIABLES:
Materials
Modality
Activity
Social contact
Position
Environmental/Setting
 
 
ASSESSMENT
 
FORMAT FOR RECORDING:
30 observation records to be made in each data sheets
 
 
 
THE SIGNIFICANCE OF BBS
ASSESSMENT
 
The BBS assessment will help special educators and the therapist to understand to find
the right time ( Active Alert Time)  for providing the intervention and to avoid certain
times for the child to take rest.
 
It also provide the information on engaging the child for intervention with the right
persons , the materials preferred by the child to learn in the appropriate place and
context.
 
IMPLICATION OF LEARNING
 
Children with multiple disabilities are experiencing various difficulties in performing their
activity of daily living , using their motor skills effectively , learning the content like any
other children , communicating with others effectively. The also have the difficulties in using
the space and establishing the social relationship with others.
The BBS gives the directions to understand the feasibilities of using the active time, place ,
persons and the materials for planning the intervention program
The program checklist which is developed by NIEPID (formerly called NIMH) for children
with Profound Intellectual Disability is found to be useful for developing the functional
activities to enable them to live as closely as possible with their family and community.
The support Intensity program developed by American Association of Intellectual and
Developmental Disability (AAIDD) provides a meaningful direction to the special education
teachers , therapist and the parents to develop appropriate supports to perform the skills.
 
FACP –PMR ASSESSMENT
 
It has 4 sections
Section A covers checklist of skills
Section B covers checklist of problem behavior
Section C coves checklist of general problems
Section D covers progress report
 
SKILLS IDENTIFIED FOR FACILITATING THE
LEARNING OF CHILDREN WITH SEVERE AND
PROFOUND INTELLECTUAL DISABILITIES
(MULTIPLE DISABILITIES)
 
1.Eating Skills -14 Items identified
2.Drinking  Skills-8 items identified
3.Toileting skills-16 items identified
4.Dressing Skills-9 items were identified
5.Motor skills -36 items identified
6.Communication Skills-19 items identified
7.Social Skills-12 items  identified
8.Visual Skills-10 items identified
 
 
 
 
INDIVIDUALISED CARE AND
TRAINING  PLAN
 
ASSESSMENT ON SUPPORT INTENSITY
NEED IN VARIOUS AREAS
 
SUPPORT INTENSITY NEED ANALYSIS USING SIS
Home living activities
Community and Neighborhood activities
School Participation Activities
School Learning Activities including  the use of technology
Health and Safety Activities
Advocacy  Activities
Medical & Behavioural
Other assessment related to Physical therapy  , occupational therapy and the Speech
therapy will have its own schedule to follow.
 
ASSESSMENT ON SCHOOL
PARTICIPATION ACTIVITIES
 
School participation activities:  Examples
Being included in general education class room including the library and technology rooms
Participating in activities in common school areas (e.g . play ground hall ways ,cafeteria)
Participating in co-curricular
Getting to school (includes accessible transportations)
Moving around with in the school and transitioning between activities
Facilities for Participating in large scale test taking activities required by state education
system.
Following class room and school rules
Keeping track of personnel belongings at school & Keeping track of schedule at school
Barrier free Space for the children with multiple disability to participate in activates
 
ASSESSMENT ON SCHOOL LEARNING
ACTIVITIES
 
School learning activities: Example
Appropriate seating arrangements for learning
Accessing grade level curriculum content and curriculum access
Learning academic skills using assistive technologies
Learning and using metacognitive skills
Completing academic tasks using assistive technology
Learning how to use and using problem solving and self regulation strategies in the class
room
Participating in class room level evaluation such as tests in flexible way
Accessing health and physical education curricula
Completing homework assignment
 
SCORE ON MEDICAL AND
BEHAVIOURAL ACTIVITIES
 
Medical and Behavioural activities:
0= No support needed
1 = some support needed (i.e., providing monitoring and /occasional assistance)
2 = Extensive support needed (i.e., providing regular assistance to manage the medical
condition or behavior)
 
TYPES OF SUPPORT REQUIRES
 
0=None
1=Monitoring
2=Verbal/gestural prompting
3=Partial Physical assistance
4=Full Physical Assistance
 
FREQUENCY OF SUPPORT REQUIRES
 
0=Negligible
1=Infrequently
2=Frequently
3=Very frequently
4=Always
 
DAILY SUPPORT TIME REQUIRES
 
0=None
1=Less than 30 Minutes
2=30 Minutes to less than 2 hours
3=2 Hours to less than 4 Hours
4=4Hours or More
 
INDIVIDUALISED SUPPORT PLAN
 
Based on the intensity of support needed  on the  type of support , frequency , time and
support required for medical and behavioural aspect the resources are developed in the
process of Individualised Support Plan
 
The individualised support plan is focused on successful achievement of the activities
targeted for the child with all kind of supports
 
This support plan does not give importance on the activities which the children shows
unsuccessful.
 
REFERENCES
 
Individuals with Disability Education Act (2004) United States
Myreddy.V., Narayan .J.(2004)FACP –PMR .NIEPID (formerly NIMH)
.Secunderabad.
AAIDD(2016). Support Intensity Scale.US
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Multiple disabilities refer to the presence of two or more impairments that significantly impact educational performance, leading to challenges in standard special education settings. This includes various combinations of disabilities such as mental retardation, blindness, orthopedic impairment, and others. Children with multiple disabilities may require high support needs due to the severity and complexity of their conditions. Proper assessment, classification, and understanding of their needs are crucial for providing effective education and support.


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  1. MULTIPLE DISABILITY P . KAMARAJ, Faculty , NIEPMD, ECR ,Muttukadu , Chennai Kamaraj_nimh@yahoo.com 9840380628

  2. TNTEU , B.Ed SPECIAL EDUCATION PROGRAM Course 5 : Assessment and Identification of Needs of Persons with Multiple Disabilities Unit III : Multiple Disabilities and other disability conditions Sub Unit 3.1 : Multiple Disabilities Meaning , Definitions and classifications Sub Unit 3.2 : Various combinations of Multiple Disabilities and Associated conditions such as epilepsy motor and sensory condition Sub Unit 3.3 : Implication of Functional limitations for Education of children with multiple disabilities

  3. MULTIPLE DISABILITIES children with multiple disabilities are often called Severe handicapped Severely and profoundly handicap Dual sensory impaired Additional disabilities Multiple disabilities

  4. DEFINITION Multiple disabilities means concomitant impairments (such as mental retardation- blindness, mental retardation orthopedic impairment), the combination of which causes such severe educational problems that the students cannot be accommodated in Special Education program solely for one of the impairment. The term does not include students with deaf-blindness - USOSE (2004)

  5. DEFINITION Multiple Disability mean a combination of two or more disabilities as defined in clause (i) of section (2) of the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act 1995

  6. DEFINITION Those children excluded from school on the basis of extensive mental, physical, and or behavioral impairments that are permanent in nature

  7. CLASSIFICATIONS The classification of children with Multiple Disabilities are based on the combinations and severity Moderate , Severe & Profound condition of any one of the disability in the combination makes the person become multiple disabilities. In the diagnostic assessment and evaluation process it is addressed that the impairment or the disability condition is more than 60 % among the bench mark disabilities become multiple disabilities in turn they are also called as the children having high support needs.

  8. THE COMBINATIONS OF MULTIPLE DISABILITIES The children with Multiple disabilities may be reported with various combinations as given below A child may have reported with concomitant impairment of Intellectual and locomotor disability or A child may have reported with concomitant impairment of Intellectual and sensory disability or A child may have reported with concomitant impairment of Intellectual and any other developmental disabilities Such as Intellectual Disability (ID) + Autism Spectrum Disorders (ASD) , ID + Cerebral Palsy (CP) ID+ Deafblind(DB) or DB or ASD+ DB or CP+DB etc.

  9. CHARACTERISTIC FEATURE General appearance Self help activities Motor function Language & Communication Sensory Learning Social and Emotional Physical/Health condition

  10. GENERAL APPEARANCE Under build / Thin built Unsteady of body control Clumsiness of appearance Micro cephalic or hydro cephalic head Squint Pigeon chest Drools Asymmetrical body features Flexed or Drooped body condition Retarder physical growth

  11. MOTOR FUNCTIONS Presence of abnormal reflexes Unstable body condition No active movements of body and limbs Developing abnormal pattern of posture and movements Flexion and hyper tonicity of joins and muscles Extended or Hypo tonicity of joins and muscles Sits or stands with supports Lying on the floor or bed for long time Drags the body for movements Depend on others for his mobility Carries by others manually or using a wheel chair Hesitate to move around and experiences of fall or hurt while moving around

  12. SELF HELP ACTIVITIES Poor oral hygiene Decay of the tooth Show feeble movement of feeding Shows difficulties in sucking , swallowing , biting and chewing Poor intake Chokes while feeding Poor toilet skill , no toilet indication, cries after defecation and urination Cooperates for brushing , bathing and dressing. Custodial of other for his self help activities Vulnerable to gets infected due to poor maintenance of his clothes, body and places

  13. LANGUAGE AND COMMUNICATION Severe to profound delay in language and communication development Very poor in using the body or limbs for communication Cries or coos or vocalises for communication Uses minimal facial expression for communication Uses eye gazing for communication Shows agitate movement or moves his limbs for communication Depend on AAC

  14. SENSORY Presence of sensory impairment Uses residual senses for the functional activities Shows hyper or hyposensitivity in one or more of the seven senses Does not use effectively the sensory modalities for learning Poor abstraction Does not involve effectively the metacognitive process for learning Doesn't get much opportunity for learning. Poor anticipation and reactions Hesitates to explore with environment /surroundings

  15. SOCIAL AND EMOTIONAL Looks Fearful Gets frustrated , angry and upset that can be observed in the face. Have difficulty forming interpersonal relationship No or hardly any friends Doesn t react immediately any emotional situations Does not able participate effectively in the games and play No or minimal exposed to the visitors and other community functions Poor maintenance of his body , clothes and surroundings Not able to defend or indicate on certain circumstances and Victim of ant bites , mosquitoes bites or any other insect bites.

  16. LEARNING Has poor gross fine motor movements Uses his/her residual senses for learning Shows very poor or lethargic response to stimuli Shows poor visual, auditory ,tactile and kinesthetic processing skills Forgets skills through disuse Has limited abstract thinking Difficulty in locating the directions of sound Difficulties in visual tracking and visual discrimination Exposed to limited environment for learning Experience of being isolated at home or at other places

  17. HEALTH Febrile convulsion or Seizures / Epileptic conditions may be having Simple , Partial to Complex seizures Metabolic disorders liken MPS I&II ,PKU etc. Undernourished /Malnourished Constipation sometimes bleedings Sensory loss loss of hearing threshold and visual acuity and poor reflexarc Hydrocephalus and scoliosis Physically clumsy and awkward No reactions to various sensory insults like hot or cold contacts , spicy or any other tastes , bad smells.

  18. ASSESSMENT TO UNDERSTAND THE BIO-BEHAVIOURL STATE BIO BEHAVIOURAL STATE It has 3 parts A-Behavior state B-Learning environment C- Format for recording the data

  19. ASSESSMENT BEHAVIOR STATE: Sleep states Intermediate state Preferred awake stage Other awake stage

  20. ASSESSMENT LEARNING ENVIRONMENT VARIABLES: Materials Modality Activity Social contact Position Environmental/Setting

  21. ASSESSMENT FORMAT FOR RECORDING: 30 observation records to be made in each data sheets

  22. THE SIGNIFICANCE OF BBS ASSESSMENT The BBS assessment will help special educators and the therapist to understand to find the right time ( Active Alert Time) for providing the intervention and to avoid certain times for the child to take rest. It also provide the information on engaging the child for intervention with the right persons , the materials preferred by the child to learn in the appropriate place and context.

  23. IMPLICATION OF LEARNING Children with multiple disabilities are experiencing various difficulties in performing their activity of daily living , using their motor skills effectively , learning the content like any other children , communicating with others effectively. The also have the difficulties in using the space and establishing the social relationship with others. The BBS gives the directions to understand the feasibilities of using the active time, place , persons and the materials for planning the intervention program The program checklist which is developed by NIEPID (formerly called NIMH) for children with Profound Intellectual Disability is found to be useful for developing the functional activities to enable them to live as closely as possible with their family and community. The support Intensity program developed by American Association of Intellectual and Developmental Disability (AAIDD) provides a meaningful direction to the special education teachers , therapist and the parents to develop appropriate supports to perform the skills.

  24. FACP PMR ASSESSMENT It has 4 sections Section A covers checklist of skills Section B covers checklist of problem behavior Section C coves checklist of general problems Section D covers progress report

  25. SKILLS IDENTIFIED FOR FACILITATING THE LEARNING OF CHILDREN WITH SEVERE AND PROFOUND INTELLECTUAL DISABILITIES (MULTIPLE DISABILITIES) 1.Eating Skills -14 Items identified 2.Drinking Skills-8 items identified 3.Toileting skills-16 items identified 4.Dressing Skills-9 items were identified 5.Motor skills -36 items identified 6.Communication Skills-19 items identified 7.Social Skills-12 items identified 8.Visual Skills-10 items identified

  26. INDIVIDUALISED CARE AND TRAINING PLAN Sl No Activity Current Level Positioning Procedure Material Evaluation Remarks

  27. ASSESSMENT ON SUPPORT INTENSITY NEED IN VARIOUS AREAS SUPPORT INTENSITY NEED ANALYSIS USING SIS Home living activities Community and Neighborhood activities School Participation Activities School Learning Activities including the use of technology Health and Safety Activities Advocacy Activities Medical & Behavioural Other assessment related to Physical therapy , occupational therapy and the Speech therapy will have its own schedule to follow.

  28. ASSESSMENT ON SCHOOL PARTICIPATION ACTIVITIES School participation activities: Examples Being included in general education class room including the library and technology rooms Participating in activities in common school areas (e.g . play ground hall ways ,cafeteria) Participating in co-curricular Getting to school (includes accessible transportations) Moving around with in the school and transitioning between activities Facilities for Participating in large scale test taking activities required by state education system. Following class room and school rules Keeping track of personnel belongings at school & Keeping track of schedule at school Barrier free Space for the children with multiple disability to participate in activates

  29. ASSESSMENT ON SCHOOL LEARNING ACTIVITIES School learning activities: Example Appropriate seating arrangements for learning Accessing grade level curriculum content and curriculum access Learning academic skills using assistive technologies Learning and using metacognitive skills Completing academic tasks using assistive technology Learning how to use and using problem solving and self regulation strategies in the class room Participating in class room level evaluation such as tests in flexible way Accessing health and physical education curricula Completing homework assignment

  30. SCORE ON MEDICAL AND BEHAVIOURAL ACTIVITIES Medical and Behavioural activities: 0= No support needed 1 = some support needed (i.e., providing monitoring and /occasional assistance) 2 = Extensive support needed (i.e., providing regular assistance to manage the medical condition or behavior)

  31. TYPES OF SUPPORT REQUIRES 0=None 1=Monitoring 2=Verbal/gestural prompting 3=Partial Physical assistance 4=Full Physical Assistance

  32. FREQUENCY OF SUPPORT REQUIRES 0=Negligible 1=Infrequently 2=Frequently 3=Very frequently 4=Always

  33. DAILY SUPPORT TIME REQUIRES 0=None 1=Less than 30 Minutes 2=30 Minutes to less than 2 hours 3=2 Hours to less than 4 Hours 4=4Hours or More

  34. INDIVIDUALISED SUPPORT PLAN Based on the intensity of support needed on the type of support , frequency , time and support required for medical and behavioural aspect the resources are developed in the process of Individualised Support Plan The individualised support plan is focused on successful achievement of the activities targeted for the child with all kind of supports This support plan does not give importance on the activities which the children shows unsuccessful.

  35. REFERENCES Individuals with Disability Education Act (2004) United States Myreddy.V., Narayan .J.(2004)FACP PMR .NIEPID (formerly NIMH) .Secunderabad. AAIDD(2016). Support Intensity Scale.US

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