Exceptional Children An Introduction to Special Education Tenth Edition William L. Heward © 2013, 2009, 2006, 2003, 2000 Pearson Education, Inc. All rights reserved.

Physical Disabilities, Health Impairments, and ADHD Chapter 11 Physical Disabilities, Health Impairments, and ADHD

Focus Questions How might the effects of an acute health condition on a student’s classroom participation and educational progress differ from those of a chronic condition? Why is the prevalence of chronic medical conditions in children much higher than the number of students receiving special education under the disability categories of orthopedic impairments and other health impairments? What does a classroom teacher need to know about physical disabilities and health impairments in children? Why do you think attention-deficit/hyperactivity disorder (ADHD) is not included as a separate disability category in IDEA? How might the visibility of a physical disability or health impairment affect a child’s self-perception, social development, and level of independence across different environments? 11-2 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Focus Questions (cont.) What are some of the problems that members of transdisciplinary teams for students with physical disabilities and multiple health needs must guard against? Of the many ways that the physical environment, social environment, and instruction can be modified to support the inclusion of students with physical disabilities, health impairments, and ADHD, which are most important? 11-3 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Components of IDEA Definitions Severe Orthopedic Impairment (OI) Congenital abnormality - club foot, absence of a limb Impairments caused by disease - poliomyelitis, bone tuberculosis Impairments by other causes - cerebral palsy, fractures, burns Adversely affecting educational performance Other Health Impairment (OHI) Limited strength, vitality, or alertness due to chronic or acute health problems Asthma, attention deficit/hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, leukemia, sickle cell anemia 11-4 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Prevalence Studies of the number of children with physical disabilities and health impairments have produced hugely diverse findings 1% of children receiving special education services are orthopedically impaired (OI) 11.6 % of children receiving special education services are otherwise health impaired (OHI) Two factors make the actual number of children with physical disabilities and health conditions much higher than the number receiving special education services under IDEA Many children with OI and OHI receive services under other categories Some do not require specialized educational services 11-5 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Orthopedic Impairments Cerebral Palsy A disorder of voluntary movement and posture Most prevalent physical disability in school age children No clear relationship between the degree of motor impairment and degree of intellectual impairment (if any) Classified according to muscle tone and motor movement Spastic, Athetosis, Ataxia, Rigidity, Tremor, Mixed Spina Bifida Congenital malformations of the brain, spinal cord, or vertebrae Can result in paralysis below affected vertebra Hydrocephalic condition common; treated with a shunt 11-6 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Orthopedic Impairments Muscular Dystrophy Progressive weakening and degeneration of the muscles No known treatment exists to stop or reverse any form of muscular dystrophy Spinal Cord Injuries Caused by penetrating injury, fracture, stretching, or compression of spinal cord Car accidents, sports injuries, and violence most common causes Results in paralysis below affected vertebra Males represent 80% of traumatic spinal cord injuries 11-7 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Other Health Impairments Seizure disorder (epilepsy) Caused by abnormal electrical discharges in the brain Three different categories based on severity Seizures can be controlled with medicine Diabetes Chronic disorder of metabolism Body unable to obtain and retain adequate energy from food Type 2 diabetes the most common form Treated with insulin, diet, and exercise 11-8 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Other Health Impairments Asthma Chronic lung disease resulting in a narrowing of airways Leading cause of absenteeism in school Causes are unknown but considered an interaction of heredity and environment Cystic Fibrosis Genetic disorder affecting pulmonary and digestive systems No reliable cure has yet been found HIV and AIDS Breakdown in the immune system prevents the body from fighting infections No known cure or vaccine exists 11-9 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Attention-Deficit/Hyperactivity Disorder The essential feature is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed Three ADHD subtypes: combined, predominantly inattention, and hyperactive-impulsive Most students with ADHD have the combined type Children with ADHD can be served under the “other health impairments” category or under Section 504 Estimates of prevalence of ADHD range from 3% to 7% of all school-age children Most children with ADHD struggle in the classroom There is comorbidity with other disabilities 11-10 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Causes and Treatments for ADHD The causes of ADHD are not well understood Evidence indicates that genetic factors may place individuals at a greater than normal risk of an ADHD diagnosis Research using neuroimaging technologies has shown that some individuals with ADHD have structural or biochemical differences in their brains Drug treatment Prescription stimulant medication is the most common intervention No clear evidence indicates that stimulant medications lead to improved academic achievement Behavioral intervention Methods include positive reinforcement for on-task behavior, modifying assignments and instructional activities to promote success, and systematically teaching self-control A deficit of executive functioning is a primary characteristic of children with ADHD 11-11 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Characteristics As a group, students with physical disabilities or health impairments function well below grade level academically Daily health care routines and medications have negative side effects on academic achievement Educational progress is often hampered by frequent and sometimes prolonged absences from school for medical treatment when flare-ups or relapses require hospitalization As a group, students with physical disabilities and health impairments perform below average on measures of social-behavioral skills Concerns about physical appearance are frequently identified as reasons for emotional difficulties and feelings of depression 11-12 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Variables Affecting Educational Performance Factors that affect educational needs include Severity with which the condition affects different areas of functioning Age of onset - children with congenital or acquired impairments have different needs Visibility - the visibility of impairment may cause some to underestimate the child’s abilities and limit opportunities 11-13 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Educational Approaches Students with physical disabilities or health impairments may need intensive instruction in a “parallel curriculum” to include using adaptive methods and assistive technology for mobility, communication, and daily-living tasks; increasing independence by self-administering special health care routines; and learning self-determination and self-advocacy skills Teaming often involves the collaboration of a transdisciplinary team including physical and occupational therapists, speech therapists, health care aides, and other specialists who frequently provide services to these students 11-14 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Educational Approaches (cont.) Environmental modifications include Adaptations to provide increased access to a task or an activity Changing the way in which instruction is delivered Changing the manner in which the task is done Examples of environmental modifications include wheelchair accessible classrooms or other assistive technology 11-15 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Educational Approaches (cont.) Assistive technology IDEA defines assistive technology as assistive technology devices and the services needed to help a child obtain and effectively use devices Devices include any item, piece of equipment, or product used to increase, maintain, or improve functional capabilities Services mean any service that directly assists with the selection, acquisition, or use of an assistive technology device 11-16 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Educational Approaches (cont.) Animal Assistance Providing personal care attendants Enhancing independence Providing social values as companions Special health care routines Individualized health care plan prescribes special health related needs Importance of positioning, seating, and movement Encourages the development of muscles and bones and helps maintain health skin Lifting and transferring procedures Prevents the development of pressure sores Helps maintain proper seating and positioning 11-17 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Educational Approaches (cont.) Independence and Self-Esteem Children need encouragement to develop A positive, realistic view of themselves and their physical conditions As much independence as possible The ability to explain their physical disability or health condition and to respond to questions Collaboration with self-help groups for people with similar disabilities 11-18 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Educational Placements For no other group of exceptional learner is the continuum of educational services and placement options more relevant During the 2008-2009 school year: 52% of students who received special education services under the category of orthopedic impairment were educated in general education classrooms; 17% in resource rooms; and 24% in separate classrooms 60% of students with health impairments were educated in general education classrooms; 24% in resource rooms; and 11% in separate classrooms Technology-dependent students need both a medical device and ongoing nursing care to avoid death or further disability 11-19 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.

Related Services in the Classroom Controversial issues concerning including students with physical impairments and special health care needs in general education classrooms The extent of responsibility properly assumed by teachers and schools Irving Independent School District v. Tatro Catheterization is a related service Cedar Rapids Community School District v. Garret F Nursing services are related services Acceptance is the most basic need of children with physical disabilities and health impairments 11-20 Heward Exceptional Children, 10e © 2013 Pearson Education, Inc. All rights reserved.