Persons with multiple disabilities have two or more serious disabilities that cause severe educational needs. They have complex instructional needs due to interactional effects of their disabilities. Multiple disabilities include cognitive, physical, sensory and health impairments requiring extensive supports. Accurate assessment is challenging due to limitations, so interviews regarding adaptive behaviors are more informative. Legislation requires public education and related services. Current trends favor inclusion with necessary supports when possible, though some controversy remains.

1. Multiple
Disabilities
Vanessa G. Cabag

2. Multiple Disabilities
Definition
Persons with multiple disabilities have a
combination of two or more serious
disabilities (e.g., cognitive, movement,
sensory), such as mental retardation with
cerebral palsy.
Vanessa G. Cabag

3. Multiple Disabilities
The U.S. federal government definition includes those who
have more than one impairment, "the combination of
which causes such severe educational needs that they
cannot be accommodated in special education programs
solely for one of the impairments“
Dual sensory impairment, or deaf-blindness, is defined as a
separate disability group.
Multiple disabilities have interactional, rather than additive, effects,
making instruction and learning complex.
Vanessa G. Cabag

4. Multiple Disabilities
In 1996 Fred Orelove and Dick Sobsey defined this group as individuals with
mental retardation who require extensive or pervasive supports and who also
possess one or more significant motor or sensory impairments and/or special
health care needs. These physical and medical problems result in the
presence of two or more of the following characteristics:
restriction of movement
skeletal deformities
sensory disorders
seizure disorders
lung and breathing control; or
other medical problems related to these characteristics, such as skin breakdown
or bladder infections.
Vanessa G. Cabag

5. Multiple Disabilities
Causes
In nearly half of the children born with multiple disabilities there is
no identifiable cause. In the rest of the known causes there are:
Chromosomal abnormalities,
Developmental disorders of the brain,
Metabolic disorders; and
Negative prenatal environmental influences.
Vanessa G. Cabag

6. Multiple Disabilities
Primary Measures Used to Diagnose
Individual intelligence tests
&
Tests of adaptive behavior
Early assessment of:
movement limitations
muscle tone and flexibility
seizure activity
breathing control
sucking and swallowing
vision and hearing; and
Vanessa G. Cabag

7. Multiple Disabilities
genetic makeup are also, and prenatal assessment of genetic
material or physical identification of deformities via sonograms
may be conducted.
Vanessa G. Cabag

8. Multiple Disabilities
Accurate psychological testing of these individuals is challenging due to
their frequent limitations in controlled movement, vision, hearing,
communication, or cooperative behavior.
Thus, interviews with family members and educators regarding the
person's adaptive behavior skills (i.e., communication, self-care, home
living, social skills, community use, self-direction, health and safely,
functional academics, leisure, and work) may be more informative and
reliable than a norm-based IQ or achievement score.
Vanessa G. Cabag

9. Multiple Disabilities
Characteristics
People with multiple disabilities have a combination of various
disabilities that may include:
speech
physical mobility
learning
mental retardation
visual
hearing
brain injury; and
possibly others.
They may also have sensory losses and behavior and /or social
problems.
Vanessa G. Cabag

10. Multiple Disabilities
Perhaps the most significant characteristic of many
people with multiple disabilities is
deficits in the area of communication,
making it difficult for them to communicate their wants,
needs, and pains to those around them.
Vanessa G. Cabag

11. Multiple Disabilities
This limitation can be devastating to the emotional and intellectual
development of the child, but can be addressed through the use of
assistive technology and augmentative communication systems.
Vanessa G. Cabag

12. Multiple Disabilities
Children ages 3 to 5 are considered to have multiple disabilities when
they demonstrate concomitant cognitive, physical, and/or sensory
impairments which result in severe delays in development. Children
with multiple disabilities will typically share deficits in five distinct areas
of development:
intellectual functioning
adaptive skills
motor skills
sensory functioning
communication skills
Vanessa G. Cabag

13. Multiple Disabilities
This disability category includes those students with the most severe
physical, cognitive, and communicative impairments. Most of the students
served under the multiple disability category do have some level of cognitive
impairment, but the specific diagnosis of this impairment can often be
ambiguous or undetermined.
It should be noted however, that these students can also have average
or even above-average intelligence. The common connection between
students in this category is not just that they have two or more
coexisting impairments, but that they generally need extensive support
across many skill areas.
Vanessa G. Cabag

14. Multiple Disabilities
Prevalence
Definitions of this highly variable group with both severe and
multiple disabilities are less precise than some other disability
groups, making an estimate of their prevalence difficult.
Prevalence ranges from less than .25 percent to .50 percent of
the population; and is considered relatively uniform across
socioeconomic classes.
Vanessa G. Cabag

15. Multiple Disabilities
Variety of Diagnostic Labels
(1)severe or profound levels of mental retardation (IQ scores below 40)
(2)mental retardation that requires extensive or pervasive supports for an
extended time
(3)autism, childhood disintegrative disorder, or Rett syndrome (several types of
autism spectrum disorders)
(4)various genetic disorders accompanied by extensive mental retardation (e.g.,
Tay-Sachs disease, untreated phenylketonuria, tuberous sclerosis, LeschNyhan syndrome)
Vanessa G. Cabag

16. Multiple Disabilities
Individuals with several autism spectrum disorders, by
definition, have significant developmental delays in
communication and social interaction, and may exhibit
extensive limitations in many adaptive skills. Thus, their
disability may be extensive enough to fit the definition for
mental retardation and severe disabilities, though this is not
true for all persons identified with autism (e.g., Asperger's
syndrome).
Vanessa G. Cabag

17. Multiple Disabilities
Implications of Educational
Legislation
Legislation in the early 1970s addressed the right to education and
other rehabilitation services for all individuals with disabilities. In
1975 the Education for All Handicapped Children Act (known since
1990 as the Individuals with Disabilities Education Act, or IDEA)
formed the legal basis for public education for all children, including
those with severe and multiple disabilities.
Vanessa G. Cabag

18. Multiple Disabilities
IDEA added requirements that are especially valuable for these
individuals, including:
(1) early intervention starting at birth or whenever a disability is
suspected;
(2) related services such as physical, occupation, and speech and
language therapy, including augmentative and alternative
communication (AAC) methods;
Vanessa G. Cabag

19. Multiple Disabilities
(3) the requirement for a plan and services to facilitate transition to
work and adulthood; and
(4) a value placed on inclusion in general education with
nondisabled peers.
Most states provide services to these students until age twenty-two
or beyond, focusing upon functional skill development.
Vanessa G. Cabag

20. Multiple Disabilities
Prior to the 1975 law mandating public education for all children,
students with severe and multiple disabilities, if educated, received
services in institutions or settings operated by parent groups or
state mental health departments. When laws enacted in the mid1970s required publicly funded special education, most schools
established programs for these students but continued to isolate
them from their nondisabled peers in separate buildings or selfcontained classrooms in elementary schools.
Vanessa G. Cabag

21. Multiple Disabilities
Currently in many states, the "least restrictive environment" for
most of these students is the age-appropriate school setting
alongside nondisabled peers, though not necessarily in the
general education classroom. Currently, a majority of these
students are served in separate classrooms for most of the
school day.
Vanessa G. Cabag

22. Multiple Disabilities
Since 1975 U.S. courts have defined specific portions of special
education law. For those with severe and multiple disabilities,
several legal battles have resulted in:
(1) summer educational programs being required in many states to
lessen or prevent skill regression;
(2) interventions that enable students to stay at school (e.g., providing
catheterization for those unable to urinate voluntarily);
Vanessa G. Cabag

23. Multiple Disabilities
(3) related services and technology to assist with movement,
positioning, speech, and alternate forms of communication;
(4) the mandate to educate all students with disabilities, and not
limit services based on an assessment of educational potential; and
(5) the provision of regular opportunities for interaction with
nondisabled peers and inclusion in general education classrooms–
or justification for not providing these opportunities.
Vanessa G. Cabag

24. Multiple Disabilities
While all states are required to provide a free and appropriate
education for these students, there are many differences in how
localities implement the law and thus in the actual quality of
educational services for these students.
Vanessa G. Cabag

25. Multiple Disabilities
Educating Students with Severe
and Multiple Disabilities
When compared to their peers, most students with severe and
multiple disabilities learn more slowly, forget more readily, and
experience problems generalizing skills from situation to
situation.
Vanessa G. Cabag

26. Multiple Disabilities
These characteristics are best addressed when educators follow accepted
practices.
First, the public education of these students must start early and
continue at some level throughout life.
Second, all students typically need speech and language
intervention, while many others will need physical and occupational
therapy. Students with sensory impairments may need interpreters
and mobility trainers, while some with medical needs may require
nursing services or supervision.
Vanessa G. Cabag

27. Multiple Disabilities
Third, because the educational teams of students are often large,
close collaboration between members is essential if their
expertise is to result in improved student functioning. The
benefits of integrating therapy into natural activities is widely
accepted over the traditional practice of isolated, or pull-out,
therapy.
Vanessa G. Cabag

28. Multiple Disabilities
Fourth, curriculum for these students tends to be;
functional in nature
reflecting skills needed in everyday life across
domestic
leisure
school
community
vocational domains
Vanessa G. Cabag

29. Multiple Disabilities
Students are taught to;
make choices
communicate in functional ways (which may include
AAC methods such as signing, use of pictures, etc.)
develop useful skills that reduce their dependence on
others
learn social skills suited to their chronological age
Vanessa G. Cabag

30. Multiple Disabilities
Fifth, when skills are taught in multiple, normalized settings,
generalization problems are lessened. Thus, communication and
social skills are most effectively taught in the context of
interactions with typical classmates, while job and community
skills are best taught during community-based instruction.
Vanessa G. Cabag

31. Multiple Disabilities
Trends and Controversies
Several important trends, some considered controversial because they
advocate the inclusion of these students in general education with the
necessary supports, reflect improvements in the lives of these students.
First, through advancements in medicine and technology these
individuals not only experience longer lives, but also have better
options in mobility, communication, sensory augmentation, and
other areas.
Vanessa G. Cabag

32. Multiple Disabilities
Second, starting in the 1960s, there has been gradual
improvement in societal attitudes toward people with
significant disabilities. This has led to legal protections, special
education, community living alternatives, supported
employment, and an increase in relevant supports.
Vanessa G. Cabag

33. Multiple Disabilities
Third, with the Timothy W. decision (Timothy W. v. Rochester,
New Hampshire, School District, 1989), "free and appropriate
education for all" was reaffirmed, schools were required to
keep current with best practices for educating those with
significant disabilities, and the procedure of selecting who can
and cannot learn was declared illegal.
Vanessa G. Cabag

34. Multiple Disabilities
The current trend to include individuals with severe or multiple
disabilities in classrooms and community activities with their
nondisabled peers has been particularly controversial.
Special education placement data show gradual growth of students with
disabilities who are placed in a general education setting, but much slower
growth for students with severe and multiple disabilities. Schools have
complained that they are not able to include these students or provide the
necessary supports and services to achieve a meaningful education for all
involved.
Vanessa G. Cabag

35. Multiple Disabilities
Some general education teachers have communicated an unwillingness to
have these students in their classrooms, even with support, and they also
may lack the required skills necessary to teach these children in a general
education classroom.
However, there are numerous examples of schools meaningfully including
these students in ways that promote social and educational participation, as
well as evidence to support the benefits of inclusion for both students with
severe disabilities and typical classmates. More research, the dissemination
of information on inclusion, and improvements in teacher training are
needed.
Vanessa G. Cabag

36. Multiple Disabilities
Vanessa G. Cabag

37. Multiple Disabilities
THANK YOU
And
GOD BLESS 
Prepared by: Miss Vanessa G. Cabag
Vanessa G. Cabag