This chapter discusses severe and multiple disabilities. It defines these terms, estimates their prevalence, and identifies common causes. It also describes the characteristics of individuals with severe disabilities and discusses important educational supports and services from early childhood through adolescence and into adulthood. These include assessments, instruction, inclusion, transition planning, and addressing bioethical issues.

1. Chapter Twelve
SEVERE AND MULTIPLE DISABILITIES
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2. CHAPTER FOCUS POINTS
Focus 1
What are the three components of the TASH definition of severe disabilities?
Focus 2
Define the terms multiple disabilities and deaf-blindness as described in IDEA.
Focus 3
Identify the estimated prevalence and causes of severe and multiple disabilities.
Focus 4
What are the characteristics of persons with severe and multiple disabilities?
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3. CHAPTER FOCUS POINTS
Focus 5
Identify three types of educational assessments for students with severe and
multiple disabilities.
Focus 6
Identify the features of effective services and supports for children with severe
and multiple disabilities during the early childhood years.
Focus 7
Identify the features of effective services and supports for children with severe
and multiple disabilities during the elementary school years.
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4. CHAPTER FOCUS POINTS
Focus 8
Describe four outcomes that are important in planning for the transition
from school to adult life for adolescents with severe and multiple disabilities.
Focus 9
Describe four features that characterize successful inclusive education for
students with severe and multiple disabilities.
Focus 10
Describe four bioethical dilemmas that affect people with severe disabilities
and their families.
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5. CASE STUDY:
THE BEGINNING OF A NEW CIRCLE OF FRIENDS
 Joanne and Jennifer
 Inclusion in general education classroom
 Peer support
 Establishment and maintenance of friendships between
students with disabilities and peers without disabilities
 Impact on students with and without disabilities
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6. DEFINITIONS
 Historical Descriptions of Severe Disabilities
 Historically, terminology has communicated a sense of
hopelessness and despair.
 Today terminology is changing again to define severe disabilities
based upon educational need with an emphasis on supporting
the student in an inclusive setting.
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7. DEFINITIONS
 The TASH definition focuses on three factors:
 The relationship of the individual with the environment
(adaptive fit), requiring the individual to cope with the demands
of various environments as well as requiring these environments
to accommodate the need of the individual.
 The need to include people of all ages.
 Extensive “ongoing support” in life activities.
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8. DEFINITIONS
 The IDEA Definitions of Severe and Multiple Disabilities
 IDEA does not include the term “severe disabilities” as one of the 13
categorical definitions.
 Individuals with severe disabilities may be subsumed under any one of
IDEA’s categories, including the categories of multiple disabilities and deaf-
blindness.
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9. DEFINITIONS
 The IDEA Definitions of Severe and Multiple Disabilities
(continued)
 Multiple disabilities are defined in IDEA as concomitant impairments that
may combine to cause such severe educational problems that they cannot
be accommodated in special education programs solely for one of the
impairments.
 Deaf-Blindness is a dual sensory impairment resulting from concomitant
vision and hearing difficulties that cannot be accommodated in a program
for children with blindness or children with deafness.
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10. PREVALENCE
 Prevalence estimates generally range from no more that 0.1 to 1%
of the general population.
 The USDOE (2007) estimated that 131,682 students between the
ages of 6 and 21 were served in public schools under the label
multiple disabilities. This is 2% of the over 7 million students
considered eligible for services under IDEA.
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11. PREVALENCE
 The USDOE also reported 1,600 students between the ages
of 6 and 21 were labeled deaf-blind. Overall, about 14,000
individuals in the United States are identified as deaf-blind.
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12. CAUSATION
 Disabilities may be the result of genetic or metabolic problems (e.g. Rh
incompatibility). Most identifiable causes are genetic in origin.
 Other causes involve prenatal conditions such as poor maternal health,
drug abuse, infectious disease, advanced maternal age, radiation
exposure, and venereal disease.
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13. CAUSATION
 Postnatal factors associated with poisoning, accidents,
malnutrition, physical and emotional neglect, and infectious
diseases are known contributors.
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14. CHARACTERISTICS
 Intelligence and Academic Achievement
 Adaptive Skills
 Speech and Language Skills
 Physical and Health
 Vision and Hearing
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15. EDUCATIONAL SUPPORTS AND
SERVICES
 Assessment
 Identifying the Disability
 Assessing for Instruction
 School Accountability
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16. THE EARLY CHILDHOOD YEARS
 Services and Supports for Infants and Toddlers
 Effective programs are both child and family-centered.
 Child-centered services begin with infant stimulation programs and continue as the child
develops through health care, physical therapy, occupational therapy, and
speech/language services.
 Family-centered programs are holistic in their approach. Supports include parent
training, counseling, and respite care.
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17. THE EARLY CHILDHOOD YEARS
 Services and Supports for Preschool-Age Children
 Goals for preschool programs serving children with severe disabilities
should blend the principles and elements of DAP, multicultural education,
and special education and should include:
 Maximizing the child’s development in a variety of important developmental areas.
 Developing the child’s social interaction and classroom participation skills.
 Increasing community participation through support to family members and other care-
givers.
 Preparing the child for inclusive school placements and providing support for transition
into elementary school.
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18. THE ELEMENTARY SCHOOL YEARS
 Self-determination
 Parental Involvement
 Teaching Functional Skills
 Assistive Technology and Augmentative Communication
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19. THE ADOLESCENT YEARS
 Outcomes important in the transition planning process for students with
severe disabilities include:
 Establishing a network of friends and acquaintances.
 Developing the ability to regularly use community resources.
 Securing a paid job.
 Establishing independence and autonomy in making lifestyle choices.
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20. INCLUSIVE EDUCATION
 Effective educational programs for students with severe
and multiple disabilities include continual opportunities
for interaction with their nondisabled peers. This
requires:
 Placement of students in general education schools and
classrooms.
 Systematic organization of opportunities for interaction
between students.
 Specific instruction in valued post-school outcomes.
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21. SEVERE DISABILITIES AND
BIOMEDICAL DILEMMAS
 Medical technology advances have resulted in an increasing number
of infants with severe and multiple disabilities surviving and living
into their adult years.
 This has prompted ethical issues and an interest in bioethics.
 Genetic Engineering
 Genetic Screening and Counseling
 Selective Abortion and Withholding Medical Treatment
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