MULTIPLE DISABILITY

ASSESSMENTS
DEFINITION
SCREENING &
HISTORY DIAGNOSIS PREVALENCE

HEARING
CHARACTERISTICS IMPAIRMENT CAUSES
VISUAL
PSYCHOLO IMPAIRMENT PROBLEMS,
MENTAL CHALLENGES
GICAL &STRUGGLES
RETARDATION
BEHAVIO LOCOMOTORS PEOPLE WITH
RAL DISABILITY
SPECIAL
LEARNING FAMILY
PHYSICAL/ CEREBRAL NEEDS
TEACHE
HEALTH PALSY
RS
“We, the ones who are challenged, need to be heard. To be
seen not as a disability, but as a person who has, and will
continue to bloom. To be seen not as a handicap, but as well
intact human being”
- Robert M. Hensel
Multiple Disability is one of the disabilities that falls under the
13 + 1 disability of IDEA (Individuals with Disability Education
Act). Multiple disability, as defined by Individuals with Disability
Education Act (2010), is a concomitant [simultaneous
impairments (such as Intellectual disability-blindness, intellectual
disability-Orthopedic impairment, etc.), the combination of which
causes such severe educational needs that they cannot be
accommodated in a special education program solely for one of
the impairments.
Furthermore, National Dissemination Center for Children
with Disabilities (2013) stated that people with severe
disabilities are those who traditionally have been labeled
as having severe to profound mental retardation. These
people require ongoing, extensive support in more than
one major life activity in order to participate in integrated
community settings and enjoy the quality of life available
to people with fewer or no disabilities.
Finally, multiple disability is often referred to as
having "two or more disabilities in the same person.
"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 of bladder infections.
History of Multiple Disability in France by
Association des paralyses de France (1996)
In the 1950 and 1960's, institutional pediatricians
began to be aware of the number of children
suffering from encephalopathy's- also referred to as
"profoundly retarded" - who were not receiving any
particular medical attention or special purpose care.
In contrast, 'cerebrally-impaired' individuals with
preserved intellect were well known and treated
cases, thanks to the work of Professor Tardieu.
1965-1966: The 'Les Tout Petits' organization (Prof.
Minkovski) hosted some children in conditions that
were still very difficult at the time.
Foundation of the Committee of Study and Care of
the Profoundly Retarded, which established
consultation places, home support mechanisms, as
well as specialized institutions (1968-1970-1974)
and organized the first information session on
multiple disabilities in January 1972.
1972-1973: Professor Fontan proposed the term
'polyhandicap' (severe congenital multiple
disabilities); Prof. Clément Launay, CESAP's
president, emphasized the pluridisciplinary
management strategy required by these multiple
disabilities.
1975: law framework in support of persons with
disabilities and Law on Social and Medical
Institutions. The term 'polyhandicap' [multiple
disabilities] did not figure in the legislation, but
the Section 46 of the framework law provided
for Specialized Housing for adults 'without a
minimum level of independence'.
1984: The National Center for Disability Studies and
Research created a disability studies group that
provided updates on the status of the three major
groups of associated disabilities: ‘
• Polyhandicap': severe disability with multiple
manifestations, excessive limitation of
independence and profound mental retardation;
prevalence rate of 2 out of 1,000.
• "Plurihandicap ': situational combination of
one or several disabilities with intact
intellectual function; prevalence rate of 0.5
out of 1,000.
• Surhandicap': 'overcharge' of behavior
disorders in pre-existing severe disabilities;
prevalence rate of 3 out of 1,000.
1984: Severe disabilities with multiple
manifestations, motor impairments, and severe
or profound mental retardation leading to
excessive limitations in independence and
capacity of perception, expression and relation.
1986; Departmental circular about children with
associated disabilities.
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.
According to the Center for Parent Information
and Resources (2013), people with severe or
multiple disabilities may exhibit a wide range of
characteristics, depending on the combination
and severity of disabilities, and the person's age.
There are, however, some traits they may share,
including:
 Psychological
• May feel ostracized.
• Tendency to withdraw from society.
• Students with multiple disabilities may
become fearful, angry, and upset in the face
of forced or unexpected changes.
• May execute self-injurious behavior.
 Behavioral
• May display an immature behavior inconsistent
with chronological age.
• May exhibit an impulsive behavior and low
frustration level.
• May have difficulty forming interpersonal
relationships.
• May have limited self-care skills and independent
community living skills
 Physical / health
• A variety of medical problems may include
severe disabilities. Examples include
seizures, sensory loss, hydrocephalus, and
scoliosis.
• May be physically clumsy and awkward.
• May be unsuccessful in games involving motor skills

 Limited speech or communication

 Difficulty in basic physical mobility:
 Tendency to forget skills through disuse;
 Trouble generalizing skills from one situation to another;
and / or
 A need for support in major life activities (e.g., domestic,
leisure, community use, vocational)
• According to Abhiyan (2015), there are no
standardized checklists for screening and
identifying children with Multiple Disabilities.
But a screening checklist for single disabilities
that illustrates the various combinations of
disabilities in multiple disability can be used to
identify which combination of disabilities the
child has.
The following checklist can be used by parents,
workers or early intervention teachers to observe
and identify the children with disabilities for early
identification of multiple disabilities in children.
(This checklist is mainly used for screening
children in the age group of 6 months to 2 years)
I. Hearing Impairment

1. Does a child turn towards the source of sound /

voice from the back or towards one side of the
body?
2. Does he / she have discharge from the ear?
3. Does the child use gestures excessively, while
communicating?
4. The child does not speak or has defective
speech?
5. The child does not understand spoken language?
II. Visual Impairment

1. The child does not follow an object moving

before his eyes?
2. The child does not reach for toys and things held
in front of him?
3. One eye moves differently from the other;
including squint?
4. Eyes are either red or have a yellow discharge, or
the tears flow continuously.
5. The child has a tendency to bring pictures, books
or toys very close to the eyes?
III. Mental Retardation

1. Does the child respond to name / voice?

2. Does the child hold the head steadily?
3. Can the child walk well as per his age?
4. Can the child have toilet control / eat /
drink by himself by the fourth year?
5. Does the child get fits?
IV. Locomotors Disability

1. The child is not able to raise both the arms fully

without any associated difficulties.
2. The child is not able to grasp objects without any
associated difficulty.
3. The child has absence of any part of the limb.
4. The child has a difficulty in walking.
V. Cerebral Palsy

1. Whether child's milestones are delayed?

2. Head unsteady even by 8 months of age?
3. Is the muscle tone of the body in the child
different, like stiffness or flaccid?
4. Does the child show preference for one side of
the body?
5. Does the child exhibit unusual posture?
Students with multiple disabilities, such as severe
to profound mentally retardation combined with
motor and visual impairment, are usually unable to
engage in constructive activity or play a positive
role in their daily context (Holburn, Nguyen. &
Vietze, 2004; Lancioni, O 'Reilly, et al., 2004; Reid,
Phillips, & Green, 1991).
Microswitches are technical tools that may help
them improve their status by allowing them to
control environmental events with small and simple
responses suitable to their condition. The source
could stay on for a few seconds after each response.
Microswitches are mechanically
operated electrical switches
designed with an actuator and
terminals called common, normally
open and normally closed. A micro
switch is also known as a snap
action switch, they operate by using
a spring loaded lever to open and
close a set of internal contacts
inside the unit.
How does a microswitch work?
Power is typically attached to the
common terminal, this leads into the
switch and energizes the spring and
because the spring is touching the
normally close pin it sends power
out here, this is called a resting state.
Once the arm is moved the power is
then transferred to the normally open
pin.
For students with a greater interaction or
communication potential, Microswitches could also
serve as a means for choosing among various
environmental concerns.
Where choice is possible, a program might be devised
that
(a) introduces sets of stimuli to enrich the student's
environment,
(b) Ensures that the student can choose among the
stimuli, and
(c) Monitors the student's purposefulness in selection
USA

According to the U. S. Department of Education, Office

of Special Education Programs (2005), in the 2000-2001
school year, the states reported to the U.S. Department
of Education that they were providing services to
112,559 students with multiple disabilities.
In the 2003-2004 school year, the U.S. Department
of Education reports 5,971,495 students receiving
special education services. Of that number, roughly
2.2%, or 132,333 students, received special
education services based on a classification of
multiple disabilities.
PHILIPPINES

Children with multiple disabilities is a

rather complicated group as it includes various
combinations with respect to the number, kind,
and profoundness of their disabilities.
Although, there is always one leading
disability in every case. In the Philippines, the
general classification of this category of
children is usually based on the leading
disability. (Small Economic Enterprises
Development Inc., 2001)
According to the Center for Parent Information
and Resources, (2013), having multiple
disabilities means that a person has more than
one disability. What caused the disabilities?
Often, no one knows.
With some children, however, the cause is
known. Other causes can include:
chromosomal abnormalities, premature
birth, difficulties after birth, poor
development of the brain or spinal cord,
infections, genetic disorders, and injuries
from accidents.
Many types of chromosomal abnormalities exist,
but they can be categorized as either numerical or
structural. Numerical abnormalities are whole
chromosomes either missing from or extra to the
normal pair. Structural abnormalities are when
part of an individual chromosome is missing, extra,
switched to another chromosome, or turned upside
down.
Chromosomal abnormalities can occur as an
accident when the egg or the sperm is formed
or during the early developmental stages of the
fetus.
A premature birth is a birth that takes place
more than three weeks before the baby's
estimated due date. In other words, a
premature birth is one that occurs before the
start of the 37th week of pregnancy.
Difficulties After Birth

Life-threatening conditions that can happen

after giving birth include infections, blood
clots, postpartum depression and postpartum
hemorrhage.
The brain and spinal cord of a growing fetus
develop from a simple structure called the neural
tube. If the neural tube doesn’t fuse together, the
baby will have a neural tube defect. Types of neural
tube defects include spina bifida, anencephaly and
encephalocele.
Sometimes there is a mutation, a change in a gene
or genes. The mutation changes the gene's
instructions for making a protein, so the protein
does not work properly or is missing entirely. This
can cause a medical condition called a genetic
disorder.
According to the Center for Parent Information
and Resources, (2013), early intervention is a
system of services that helps infants and
toddlers with disabilities (until their 3rd
birthday) and their families.
Early intervention services are available in every
state and territory, as required by the Individuals
with Disabilities Education Act (IDEA). These
services may be provided on a sliding-fee basis.
This means that the costs to the family will depend
upon their income.
A. People with Special Learning Needs

Stress in people with profound disabilities has

been investigated by physiological recording
methods (Chaney, 1996).
 This author suggests that stress arises because
of the inability of people with profound intellectual
and multiple disabilities to control their
environment through prevention of, or adjustment
to, threatening situations.
B. Family

Parents of multiply disabled children may find

themselves caught up in all the labels that medical
and educational professionals may use to describe
their children.
 They may also find themselves overwhelmed
with the number of professionals they need to
consult about their children's conditions and by the
sheer volume of appointments they need to keep.
C. Teachers

The following are the struggles of teachers /

schools in handling children with multiple
disability: finding a setting suitable to the child's
intelligence level, a child's ability to effectively
communicate with teachers
support staff and peers, a student's ability to
function in the classroom, assessing and
compensating for visual or hearing impairments
(The study of Cates, and Smiley (1999) entitled
"Multiple Disabilities: Is Rural Inclusion
Possible?" focused on the difficulties faced by rural
school districts in their efforts to serve children
with severe multiple disabilities.
Mainstreaming advocates believe that special
education teachers require in-depth training and
extensive support. Suggestions for rural schools
include:
(1) Computer applications utilizing Internet, e-
mail, and distance learning;
(2) Team teaching interactions at both the
elementary and secondary levels;
(3) Peer tutoring and service education
(experiences in volunteerism) of mainstreamed
public school students who can assist their
special education counterparts;
(4) Collaboration between nondisabled and
disabled students in after-school activities;
(5) Faculty involvement in non-school
activities;
(6) Working relationship with community
medical and health care professionals; and
(7) Professional educators serving as an
integral part of family support systems.
Prepared by:

JENNY ROSE D. NAVARRO

MA. SHERVIC H. BUCAO
JHON DAVE N. BAYON-ON