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

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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. Educational Placements
For no other group of exceptional learner is the continuum of educational services and placement options more relevant
During the 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.

20. 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.