17 3.3 Categories of Disabilities – And Their Ambiguities

So far we have said a lot about why inclusion has come to be important for teachers, but not much about the actual nature of students’ disabilities. Part of the reason for delaying was because, to put it simply, disabilities are inherently ambiguous. Naming and describing “types” of them implies that disabilities are relatively fixed, stable, and distinct, like different kinds of fruit or vegetables. As many teachers discover, though, the reality is somewhat different. The behavior and qualities of a particular student with a disability can be hard to categorize. The student may be challenged not only by the disability, but also by experiences common to all students, disabled or not. Any particular disability, furthermore, poses problems more in some situations than in others. A student with a reading difficulty may have trouble in a language arts class, for example, but not in a physical education class; a student with a hearing impairment may have more trouble “hearing” a topic that he dislikes compared to one that he likes. Because official descriptions of types or categories of disabilities overlook these complexities, they risk stereotyping the real, live people to whom they are applied (Green, et al., 2005). Even the simplifications might not be a serious problem if the resulting stereotypes were complimentary—most of us would not mind being called a “genius”, for example, even if the description is not always true. Stereotypes about disabilities, however, are usually stigmatizing, not complimentary.

Still, categories of disabilities do serve useful purposes by giving teachers, parents, and other professionals a language or frame of reference for talking about disabilities. They also can help educators when arranging special support services for students, since a student has to “have” an identifiable, nameable need if professionals are to provide help. Educational authorities have therefore continued to use categories (or “labels”) to classify disabilities in spite of expressing continuing concern about whether the practice hurts students’ self-esteem or standing in the eyes of peers (Biklen & Kliewer, 2006). For classroom teachers, the best strategy may be simply to understand how categories of disabilities are defined, while also keeping their limitations in mind and being ready to explain their limitations (tactfully, of course) to parents or others who use the labels inappropriately.

That said, what in fact are the major types of disabilities encountered by teachers? Let us take them one at a time, beginning with the more common ones.

Learning Disabilities

A learning disability (or LD) is a specific impairment of academic learning that interferes with a specific aspect of schoolwork and that reduces a student’s academic performance significantly. An LD shows itself as a major discrepancy between a student’s ability and some feature of achievement: the student may be delayed in reading, writing, listening, speaking, or doing mathematics, but not in all of these at once. A learning problem is not considered a learning disability if it stems from physical, sensory, or motor handicaps, or from generalized intellectual impairment (or mental retardation). It is also not an LD if the learning problem really reflects the challenges of learning English as a second language. Genuine LDs are the learning problems left over after these other possibilities are accounted for or excluded. Typically, a student with an LD has not been helped by teachers’ ordinary efforts to assist the student when he or she falls behind academically—though what counts as an “ordinary effort”, of course, differs among teachers, schools, and students. Most importantly, though, an LD relates to a fairly specific area of academic learning. A student may be able to read and compute well enough, for example, but not be able to write.

LDs are by far the most common form of special educational need, accounting for half of all students with special needs in the United States and anywhere from 5 to 20 percent of all students, depending on how the numbers are estimated (United States Department of Education, 2005; Ysseldyke & Bielinski, 2002). Students with LDs are so common, in fact, that most teachers regularly encounter at least one per class in any given school year, regardless of the grade level they teach.

Defining Learning Disabilities Clearly

With so many students defined as having learning disabilities, it is not surprising that the term itself becomes ambiguous in the truest sense of “having many meanings”. Specific features of LDs vary considerably. Any of the following students, for example, qualify as having a learning disability, assuming that they have no other disease, condition, or circumstance to account for their behavior:

  • Albert, an eighth-grader, has trouble solving word problems that he reads, but can solve them easily if he hears them orally.
  • Bill, also in eighth grade, has the reverse problem: he can solve word problems only when he can read them, not when he hears them.
  • Carole, a fifth-grader, constantly makes errors when she reads textual material aloud, either leaving out words, adding words, or substituting her own words for the printed text.
  • Emily, in seventh grade, has terrible handwriting; her letters vary in size and wobble all over the page, much like a first- or second-grader.
  • Denny reads very slowly, even though he is in fourth grade. His comprehension suffers as a result, because he sometimes forgets what he read at the beginning of a sentence by the time he reaches the end.
  • Garnet’s spelling would have to be called “inventive”, even though he has practiced conventionally correct spelling more than other students. Garnet is in sixth grade.
  • Harmin, a ninth-grader has particular trouble decoding individual words and letters if they are unfamiliar; he reads conceal as “concol” and alternate as “alfoonite”.
  • Irma, a tenth-grader, adds multiple-digit numbers as if they were single-digit numbers stuck together: 42 + 59 equals 911 rather than 101, though 23 + 54 correctly equals 77.

With so many expressions of LDs, it is not surprising that educators sometimes disagree about their nature and about the kind of help students need as a consequence. Such controversy may be inevitable because LDs by definition are learning problems with no obvious origin. There is good news, however, from this state of affairs, in that it opens the way to try a variety of solutions for helping students with learning disabilities.

Assisting Students With Learning Disabilities

There are various ways to assist students with learning disabilities, depending not only on the nature of the disability, of course, but also on the concepts or theory of learning guiding you. Take Irma, the girl mentioned above who adds two-digit numbers as if they were one digit numbers. Stated more formally, Irma adds two-digit numbers without carrying digits forward from the ones column to the tens column, or from the tens to the hundreds column. The image below shows the effect that her strategy has on one of her homework papers. What is going on here and how could a teacher help Irma?

Directions: Add the following numbers:


42 23 11 47 97
911 77 59 611 1511

Three out of the six problems are done correctly, even though Irma seems to use an incorrect strategy systematically on all six problems.

Metacognition and Responding Reflectively

Part of Irma’s problem may be that she is thoughtless about doing her math: the minute she sees numbers on a worksheet, she stuffs them into the first arithmetic procedure that comes to mind. Her learning style, that is, seems too impulsive and not reflective enough. Her style also suggests a failure of metacognition, which is her self-monitoring of her own thinking and its effectiveness. As a solution, the teacher could encourage Irma to think out loud when she completes two-digit problems—literally get her to “talk her way through” each problem. If participating in these conversations was sometimes impractical, the teacher might also arrange for a skilled classmate to take her place some of the time. Cooperation between Irma and the classmate might help the classmate as well, or even improve overall social relationships in the classroom.

Constructivism, Mentoring, and the Zone of Proximal Development

Perhaps Irma has in fact learned how to carry digits forward, but not learned the procedure well enough to use it reliably on her own; so she constantly falls back on the earlier, better-learned strategy of single-digit addition. In essence, Irma has lacked appropriate mentoring from someone more expert than herself, someone who can create a “zone of proximal development” in which she can display and consolidate her skills more successfully. She still needs mentoring or “assisted coaching” more than independent practice. The teacher can arrange some of this in much the way she encourages to be more reflective, either by working with Irma herself or by arranging for a classmate or even a parent volunteer to do so. In this case, however, whoever serves as mentor should not only listen, but also actively offer Irma help. The help has to be just enough to ensure that Irma completes two-digit problems correctly neither more nor less. Too much help may prevent Irma from taking responsibility for learning the new strategy, but too little may cause her to take the responsibility prematurely.

Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (or ADHD) is a problem with sustaining attention and controlling impulses. As students, almost all of us have these problems at one time or another, but a student with ADHD shows them much more frequently than usual, and often at home as well as at school. In the classroom, the student with ADHD may fidget and squirm a lot, or have trouble remaining seated, or continually get distracted and off task, or have trouble waiting for a turn, or blurt out answers and comments. The student may shift continually from one activity to another, or have trouble playing quietly, or talk excessively without listening to others. Or the student may misplace things and seem generally disorganized, or be inclined to try risky activities without enough thought to the consequences. Although the list of problem behaviors is obviously quite extensive, keep in mind that the student will not do all of these things. It is just that over time, the student with ADHD is likely to do several of them chronically or repeatedly, and in more than one setting (American Psychiatric Association, 2000). In the classroom, of course, the behaviors may annoy classmates and frustrate teachers.

Differences in Perceptions: ADHD Versus High Activity

It is important to note that classrooms are places that make heavy demands on not showing ADHD-like behaviors: students are often supposed to sit for long periods, avoid interrupting others, finish tasks after beginning them, and keep their minds (and materials) organized. Ironically, therefore, classroom life may sometimes aggravate ADHD without the teacher intending for it to do so. A student with only a mild or occasional tendency to be restless, for example, may fit in well outdoors playing soccer, but feel unusually restless indoors during class. It also should not be surprising that teachers sometimes mistake a student who is merely rather active for a student with ADHD, since any tendency to be physically active may contribute to problems with classroom management. The tendency to “over-diagnose” is more likely for boys than for girls (Maniadaki, et al., 2003), presumably because gender role expectations cause teachers to be especially alert to high activity in boys. Over-diagnosis is also especially likely for students who are culturally or linguistically non-Anglo (Chamberlain, 2005), presumably because cultural and language differences may sometimes lead teachers to misinterpret students’ behavior. To avoid making such mistakes, it is important to keep in mind that in true ADHD, restlessness, activity, and distractibility are widespread and sustained. A student who shows such problems at school but never at home, for example, may not have ADHD; he may simply not be getting along with his teacher or classmates.

Causes of ADHD

Most psychologists and medical specialists agree that true ADHD, as opposed to “mere” intermittent distractibility or high activity, reflects a problem in how the nervous system functions, but they do not know the exact nature or causes of the problem (Rutter, 2004, 2005). Research shows that ADHD tends to run in families, with children—especially boys—of parents who had ADHD somewhat more likely than usual to experience the condition themselves. The association does not necessarily mean, though, that ADHD is inborn or genetic. Why? It is possible that parents who formerly had ADHD may raise their children more strictly in an effort to prevent their own condition in their children; yet their strictness, ironically, may trigger a bit more tendency, rather than less, toward the restless distractibility characteristic of ADHD. On the other hand (or is it “on the third hand”?), the parents’ strictness may also be a result, as well as a cause of, a child’s restlessness. The bottom line for teachers: sorting out causes from effects is confusing, if not impossible, and in any case may not help much to determine actual teaching strategies to help the students learn more effectively.

Teaching Students With ADHD

Research also shows that ADHD can be reduced for many students if they take certain medications, of which the most common is methylphenidate, commonly known by the name Ritalin (Wilens, 2005; Olfson, 2003). This drug and others like it act by stimulating the nervous system, which reduces symptoms by helping a student pay better attention to the choices he or she makes and to the impact of actions on others. Unfortunately the medications do not work on all students with ADHD, especially after they reach adolescence, and in any case has certain practical problems. Drugs cost money, for one thing, which is a problem for a family without much money to begin with, or for a family lacking medical insurance that pays for medications—a particularly common situation in the United States. For another thing, drugs must be taken regularly in order to be effective, including on weekends. Keeping a regular schedule can be difficult if parents’ own schedules are irregular or simply differ from the child’s, for example because of night shifts at work or because parents are separated and share custody of the child.

In any case, since teachers are not doctors and medications are not under teachers’ control, it may be more important simply to provide an environment where a student with ADHD can organize choices and actions easily and successfully. Clear rules and procedures, for example, can reduce the “noise” or chaotic quality in the child’s classroom life significantly. The rules and procedures can be generated jointly with the child; they do not have to be imposed arbitrarily, as if the student were incapable of thinking about them reasonably. Sometimes a classmate can be enlisted to model slower, more reflective styles of working, but in ways that do not imply undue criticism of the student with ADHD. The more reflective student can complete a set of math problems, for example, while explaining what he or she is thinking about while doing the work. Sometimes the teacher can help by making lists of tasks or of steps in long tasks. It can help to divide focused work into small, short sessions rather than grouping it into single, longer sessions. Whatever the strategies that you use, they should be consistent, predictable, and generated by the student as much as possible. By having these qualities, the strategies can strengthen the student’s self-direction and ability to screen out the distractions of classroom life. The goal for teachers, in essence, is to build the student’s metacognitive capacity, while at the same time, of course, treating the student with respect.

Intellectual Disabilities

An intellectual disability is a significant limitation in a student’s cognitive functioning and daily adaptive behaviors (Schalock & Luckasson, 2004; American Association on Mental Retardation, 2002). The student may have limited language or impaired speech and may not perform well academically. Compared to students with learning disabilities discussed earlier, students with intellectual disabilities have impairments to learning that are broader and more significant. They score poorly on standardized tests of intelligence. Everyday tasks that most people take for granted, like getting dressed or eating a meal, may be possible, but they may also take more time and effort than usual. Health and safety can sometimes be a concern (for example, knowing whether it is safe to cross a street). For older individuals, finding and keeping a job may require help from supportive others. The exact combination of challenges varies from one person to another, but it always (by definition) involves limitations in both intellectual and daily functioning.

As a teacher, you may hear more than one term for describing students with intellectual disabilities. If the disability is mild, teachers sometimes refer to a student with the disability simply as a “slow learner”, particularly if the student has no formal, special support for the disability, such as a teaching assistant hired specifically to assist the student. If the disability is more marked, then the student is more likely to be referred to either as having an intellectual disability. In this chapter we primarily use the term intellectual disability, because it has fewer negative connotations while still describing one key educational aspect of the disability, cognitive impairment. Keep in mind, however, that actual intellectual disabilities are always more than cognitive: they also involve challenges about adapting to everyday living.

Levels of Support for Individuals With Intellectual Disabilities

Intellectual disabilities happen in different degrees or amounts, though most often are relatively mild. Traditionally the intensity or “amount” of the disability was defined by scores on a standardized test of scholastic aptitude (or “IQ test”), with lower scores indicating more severe disability. Because of the insensitivity of such tests to individuals’ daily social functioning, however, current trends are toward defining intensities by the amount of support needed by the individual. The table below summarizes the most commonly used scheme for this purpose, one created by the American Association on Intellectual and Developmental Disabilities (AAMR, 2002). Levels of support range from intermittent (just occasional or “as needed” for specific activities) to pervasive (continuous in all realms of living).

Levels and Areas of Support for Intellectual Disabilities
Level of support Duration of support Frequency of support Setting of support Amount of professional assistance
Intermittent Only as needed Occasional or infrequent Usually only one or two (e.g. 1-2 classes or activities) Consultation or monitoring by professional
Limited As needed, but sometimes continuing Regular, but frequency varies Several settings,  but not usually all Occasional or regular contact with professionals
Extensive Usually continuing Regular, but frequency varies Several settings,  but not usually all Regular contact with professionals at least once a week
Pervasive May be lifelong Frequent or continuous Nearly all settings Continuous contact and monitoring by professionals

Source: American Association on Mental Retardation, 2002: Schalock & Luckassen, 2004.

As a classroom teacher, the intellectual disabilities that you are most likely to see are the ones requiring the least support in your classroom. A student requiring only intermittent support may require special help with some learning activities or classroom routines, but not others; he or she might need help with reading or putting on winter clothes, for example, but primarily on occasions when there is pressure to do these things relatively quickly. Students requiring somewhat more support are likely to spend somewhat less time in your classroom and more time receiving special help from other professionals, such as a special education teacher, a speech and language specialist, or an assistant to these professionals. These circumstances have distinct implications for ways of teaching these students.

Teaching Students with Intellectual Disabilities

There are many specific techniques that can help in teaching students with mild or moderate intellectual disabilities, but most can be summarized into three more general strategies. The first is to give more time and practice than usual; the second is to embed activities into the context of daily life or functioning where possible; and the third is to include the child both in social and in academic activities, rather than just one or the other. Let us look briefly at each of these ideas.

Giving more time and practice than usual.

If a student has only a mild intellectual disability, he or she can probably learn important fundamentals of the academic curriculum—basic arithmetic, for example, and basic reading. Because of the disability, though, the student may need more time or practice than most other students. He or she may be able to read many words by sight (day, night, morning, afternoon, etc.), but need longer than other students to recognize and say them. Or the student may know that 2 + 3 = 5, but need help applying this math fact to real objects; you (or a helper) might need to show the student that two pencils plus three pencils make five pencils.

Giving extra help takes time and perseverance, and can try the patience of the student (and of you, too). To deal with this problem, it may help to reward the student frequently for effort and successes with well-timed praise, especially if it is focused on specific, actual achievements; “You added that one correctly”, may be more helpful than “You’re a hard worker”, even if both comments are true. Giving appropriate praise is in turn easier if you set reasonable, “do-able” goals by breaking skills or tasks into steps that the student is likely to learn without becoming overly discouraged. At the same time, it is important not to insult the student with goals or activities that are too easy or by using curriculum materials clearly intended for children who are much younger. Setting expectations too low actually deprives a student with an intellectual disability of rightful opportunities to learn—a serious ethical and professional mistake (Bogdan, 2006). In many curriculum areas, fortunately, there are already existing materials that are simplified, yet also appropriate for older students (Snell, et al., 2005). Special education teacher-specialists can often help in finding them and in devising effective ways of using them.

Adaptive and Functional Skills

Students with intellectual disabilities present especially clear examples of a universal dilemma of teaching: since there is not enough time to teach everything, how do we choose what to teach? One basis for selecting activities is to relate learning goals to students’ everyday lives and activities, just as you would with all students. This strategy addresses the other defining feature of mental retardation, the student’s difficulties with adapting to and functioning in everyday living. In teaching addition and subtraction, for example, you can create examples about the purchasing of common familiar objects (e.g. food) and about the need to make or receive change for the purchases. Similar considerations apply to learning new reading or oral language vocabulary. Instead of simply learning words in a “basic reading” series (or reading textbook), try encouraging the student to learn words that are especially useful to the student’s own life.

Often the student, not you yourself, is the best person to decide what these words actually are.

An adaptive, functional approach can help in nonacademic areas as well. In learning to read or “tell time” on a clock, for example, try focusing initially on telling the times important to the student, such as when he or she gets up in the morning or when school starts. As you add additional times that are personally meaningful to the student, he or she works gradually towards full knowledge of how to read the hands on a clock. Even if the full knowledge proves slow to develop, however, the student will at least have learned the most useful clock knowledge first.

Include the student deliberately in group activities.

The key word here is inclusion: the student should participate in and contribute to the life of the class as much as possible. This means that wherever possible, the student attends special events (assemblies, field days) with the class; that if the class plays a group game, then the student with the disability is part of the game; that if classmates do an assignment as a group, then if at all possible the student is assigned to one of the groups. The changes resulting from these inclusions are real, but can be positive for everyone. On the one hand, they foster acceptance and helpfulness toward the child with the disability; classmates learn that school is partly about providing opportunities for everyone, and not just about evaluating or comparing individuals’ skills. On the other hand, the changes caused by inclusion stimulate the student with the disability to learn as much as possible from classmates, socially and academically. Among other benefits, group activities can give the student chances to practice “belonging” skills—how to greet classmates appropriately, or when and how to ask the teacher a question. These are skills, I might add, that are beneficial for everyone to learn, disabled or not.

Behavioral Disorders

Behavioral disorders are a diverse group of conditions in which a student chronically performs highly inappropriate behaviors. A student with this condition might seek attention, for example, by acting out disruptively in class. Other students with the condition might behave aggressively, be distractible and overly active, seem anxious or withdrawn, or seem disconnected from everyday reality. As with learning disabilities, the sheer range of signs and symptoms defies concise description. But the problematic behaviors do have several general features in common (Kauffman, 2005; Hallahan & Kauffman, 2006):

  • they tend to be extreme
  • they persist for extended periods of time
  • they tend to be socially unacceptable (e.g. unwanted sexual advances or vandalism against school property)
  • they affect school work
  • they have no other obvious explanation (e.g. a health problem or temporary disruption in the family)

The variety among behavioral disorders means that estimates of their frequency also tend to vary among states, cities, and provinces. It also means that in some cases, a student with a behavioral disorder may be classified as having a different condition, such as ADHD or a learning disability. In other cases, a behavioral problem shown in one school setting may seem serious enough to be labeled as a behavioral disorder, even though a similar problem occurring in another school may be perceived as serious, but not serious enough to deserve the label. In any case, available statistics suggest that only about one to two per cent of students, or perhaps less, have true behavioral disorders—a figure that is only about one half or one third of the frequency for intellectual disabilities (Kauffman, 2005). Because of the potentially disruptive effects of behavioral disorders, however, students with this condition are of special concern to teachers. Just one student who is highly aggressive or disruptive can interfere with the functioning of an entire class, and challenge even the best teacher’s management skills and patience.

Strategies for Teaching Students With Behavioral Disorders

The most common challenges of teaching students with behavioral disorders have to do with classroom management—a topic discussed more thoroughly in (“Classroom management”). Three important ideas discussed there, however, also deserve special emphasis here: (1) identifying circumstances that trigger inappropriate behaviors, (2) teaching of interpersonal skills explicitly, and (3) disciplining a student fairly.

Identifying Circumstances that Trigger Inappropriate Behaviors

Dealing with a disruption is more effective if you can identify the specific circumstances or event that triggers it, rather than focusing on the personality of the student doing the disrupting. A wide variety of factors can trigger inappropriate behavior (Heineman, Dunlap, & Kincaid, 2005):

  • physiological effects—including illness, fatigue, hunger, or side-effects from medications
  • physical features of the classroom—such as the classroom being too warm or too cold, the chairs being exceptionally uncomfortable for sitting, or seating patterns that interfere with hearing or seeing
  • Students with special educational needs
  • instructional choices or strategies that frustrate learning—including restricting students’ choices unduly, giving instructions that are unclear, choosing activities that are too difficult or too long, or preventing students from asking questions when they need help

By identifying the specific variables often associated with disruptive behaviors, it is easier to devise ways to prevent the behaviors, either by avoiding the triggers if this is possible, or by teaching the student alternative but quite specific ways of responding to the triggering circumstance.

Teaching Interpersonal Skills Explicitly

Because of their history and behavior, some students with behavior disorders have had little opportunity to learn appropriate social skills. Simple courtesies (like remembering to say please or thanks) may not be totally unknown, but may be impractical and seem unimportant to the student, as might body language (like eye contact or sitting up to listen to a teacher rather than slouching and looking away). These skills can be taught in ways that do not make them part of punishment, make them seem “preachy”, or put a student to shame in front of classmates. Depending on the age or grade-level of the class, one way is by reading or assigning books and stories in which the characters model good social skills. Another is through games that require courteous language to succeed; one that I recall from my own school days, for example, was called “Mother, May I?” (Sullivan & Strang, 2002). Still another is through programs that link an older student or adult from the community as a partner to the student at risk for behavior problems; a prominent example of such a program in the United States is Big Brothers Big Sisters of America, which arranges for older individuals to act as mentors for younger boys and girls (Tierney, Grossman, & Resch, 1995; Newburn & Shiner, 2006).

In addition, strategies based on behaviorist theory have proved effective for many students, especially if the student needs opportunities simply to practice social skills that he has learned only recently and may still feel awkward or self-conscious in using (Algozzine & Ysseldyke, 2006). Several behaviorist techniques, including the use of positive reinforcement, extinction, generalization, and the like. In addition to these, teachers can arrange for contingency contracts, which are agreements between the teacher and a student about exactly what work the student will do, how it will be rewarded, and what the consequences will be if the agreement is not fulfilled (Wilkinson, 2003). An advantage of all such behaviorist techniques is their precision and clarity: there is little room for misunderstanding about just what your expectations are as the teacher. The precision and clarity in turn makes it less tempting or necessary for you, as teacher, to become angry about infractions of rules or a student’s failure to fulfill contracts or agreements, since the consequences tend already to be relatively obvious and clear. “Keeping your cool” can be especially helpful when dealing with behavior that is by nature annoying or disrupting.

Fairness in Disciplining

Many strategies for helping a student with a behavior disorder may be spelled out in the student’s individual educational plan, such as discussed earlier in this chapter. The plan can (and indeed is supposed to) serve as a guide in devising daily activities and approaches with the student. Keep in mind, however, that since an IEP is akin to a legal agreement among a teacher, other professionals, a student and the student’s parents, departures from it should be made only cautiously and carefully, if ever. Although such departures may seem unlikely, a student with a behavior disorder may sometimes be exasperating enough to make it tempting to use stronger or more sweeping punishments than usual (for example, isolating a student for extended times). In case you are tempted in this direction, remember that every IEP also guarantees the student and the student’s parents due process before an IEP can be changed. In practice this means consulting with everyone involved in the case—especially parents, other specialists, and the student himself—and reaching an agreement before adopting new strategies that differ significantly from the past.

Instead of “increasing the volume” of punishments, a better approach is to keep careful records of the student’s behavior and of your own responses to it, documenting the reasonableness of your rules or responses to any major disruptions. By having the records, collaboration with parents and other professionals can be more productive and fair-minded, and increase others’ confidence in your judgments about what the student needs in order to fit in more comfortably with the class. In the long term, more effective collaboration leads both to better support and to more learning for the student (as well as to better support for you as a teacher!).

Physical Disabilities and Sensory Impairments

A few students have serious physical, medical, or sensory challenges that interfere with their learning. Usually, the physical and medical challenges are medical conditions or diseases that require ongoing medical care. The sensory challenges are usually a loss either in hearing or in vision, or more rarely in both. Whatever the specific problem, it is serious enough to interfere with activities in regular classroom programs and to qualify the student for special educational services or programs.

Physical challenges that are this serious are relatively infrequent compared to some of the other special needs discussed in this chapter, though they are of course important in the lives of the students and their families, as well as important for teachers to accommodate. Only about one percent of US students have a hearing loss serious enough to be served by special programs for such students (United States Department of Education, 2005). Only about half that number have visual impairments that lead them to be served by special programs. For two reasons, though, these figures are a bit misleading. One reason is that many more students have vision or hearing problems that are too mild (such as wearing eyeglasses for “ordinary” nearsightedness). Another is that some students with serious sensory impairments may also have other disabilities and therefore not be counted in statistics about sensory impairments.

Hearing Loss

A child can acquire hearing loss for a variety of reasons, ranging from disease early in childhood, to difficulties during childbirth, to reactions to toxic drugs. In the classroom, however, the cause of the loss is virtually irrelevant because it makes little difference in how to accommodate a student’s educational needs. More important than the cause of the loss is its extent. Students with only mild or moderate loss of hearing are sometimes called hearing impaired or hard of hearing; only those with nearly complete loss are called deaf. As with other sorts of disabilities, the milder the hearing loss, the more likely you are to encounter the student in a regular classroom, at least for part of the day.

Signs of Hearing Loss

Although determining whether a student has a hearing loss may seem straightforward (“Just give a hearing test!”), the assessment is often not clear cut if it takes the student’s daily experiences into account. A serious or profound hearing loss tends to be noticed relatively quickly and therefore often receive special help (or at least receives additional diagnosis) sooner. Mild or moderate hearing loss is much more common, however, and is more likely to be overlooked or mistaken for some other sort of learning problem (Sherer, 2004). Students with a mild hearing loss sometimes have somewhat depressed (or lowered) language and literacy skills—though not always, and in any case so do some students without any loss. They may also seem not to listen or attend to a speaker because of trouble in locating the source of sounds—but then again, sometimes students without loss also fail to listen, though for entirely different reasons. Students with hearing loss may frequently give incorrect answers to questions—but so do certain other students with normal hearing. In addition, partial hearing loss can be hidden if the student teaches himself or herself to lip read, for example, or is careful in choosing which questions to answer in a class discussion. And so on. Systematic hearing tests given by medical or hearing specialists can resolve some of these ambiguities. But even they can give a misleading impression, since students’ true ability to manage in class depends on how well they combine cues and information from the entire context of classroom life.

In identifying a student who may have a hearing loss, therefore, teachers need to observe the student over an extended period of time and in as many situations as possible. In particular, look for a persistent combination of some of the following, but look for them over repeated or numerous occasions (Luckner & Carter, 2001):

  • delayed language or literacy skills, both written and oral
  • some ability (usually partial) to read lips
  • less worldly knowledge than usual because of lack of involvement with oral dialogue and/or delayed literacy
  • occasionally, tendency to social isolation because of awkwardness in communication

Teaching Students With Hearing loss

In principle, adjustments in teaching students with hearing loss are relatively easy to make though they do require deliberate actions or choices by the teacher and by fellow students. Interestingly, many of the strategies make good advice for teaching all students!

  • Take advantage of the student’s residual hearing. Seat the student close to you if you are doing the talking, or close to key classmates if the students are in a work group. Keep competing noise, such as unnecessary talking or whispering, to a minimum (because such noise is especially distracting to someone with a hearing loss). Keep instructions concise and to-the-point. Ask the student occasionally whether he or she is understanding.
  • Use visual cues liberally. Make charts and diagrams wherever appropriate to illustrate what you are saying. Look directly at the student when you are speaking to him or her (to facilitate lip reading). Gesture and point to key words or objects—but within reason, not excessively. Provide handouts or readings to review visually the points that you make orally.
  • Include the student in the community of the classroom. Recruit one or more classmates to assist in “translating” oral comments that the student may have missed. If the student uses American Sign Language (ASL) at home or elsewhere, then learn a few basic, important signs of ASL yourself (“Hello” “thank you” “How are you?”). Teach them to classmates as well.

Visual Impairment

Students with visual impairments have difficulty seeing even with corrective lenses. Most commonly the difficulty has to do with refraction (the ability to focus), but some students may also experience a limited field of view (called tunnel vision) or be overly sensitive to light in general. As with hearing loss, labels for visual impairment depend somewhat on the extent and nature of the problem. Legal blindness means that the person has significant tunnel vision or else visual acuity (sharpness of vision) of 20/200 or less, which means that he or she must be 20 feet away from an object that a person with normal eyesight can see at 200 feet. Low vision means that a person has some vision usable for reading, but often needs a special optical device such as a magnifying lens for doing so. As with hearing loss, the milder the impairment, the more likely that a student with a vision problem will spend some or even all the time in a regular class.

Signs of Visual Impairment

Students with visual impairments often show some of the same signs as students with simple, common nearsightedness. The students may rub their eyes a lot, for example, blink more than usual, or hold books very close to read them. They may complain of itchiness in their eyes, or of headaches, dizziness, or even nausea after doing a lot of close eye work. The difference between the students with visual impairment and those with “ordinary” nearsightedness is primarily a matter of degree: the ones with impairment show the signs more often and more obviously. If the impairment is serious enough or has roots in certain physical conditions or disease, they may also have additional symptoms, such as crossed eyes or swollen eyelids. As with hearing loss, the milder forms ironically can be the most subtle to observe and therefore the most prone to being overlooked at first. For classroom teachers, the best strategy may be to keep track of a student whose physical signs happen in combination with learning difficulties, and for whom the combination persists for many weeks.

Teaching Students With Visual Impairment

In general, advice for teaching students with mild or moderate visual impairment parallels the advice for teaching students with hearing loss, though with obvious differences because of the nature of the students’ disabilities.

  • Take advantage of the student’s residual vision. If the student still has some useful vision, place him or her where he can easily see the most important parts of the classroom—whether that is you, the chalkboard, a video screen, or particular fellow students. Make sure that the classroom, or at least the student’s part of it, is well lit (because good lighting makes reading easier with low vision). Make sure that handouts, books and other reading materials have good, sharp contrast (also helpful with a visual impairment).
  • Use non-visual information liberally. Remember not to expect a student with visual impairment to learn information that is by nature only visual, such as the layout of the classroom, the appearance of photographs in a textbook or of story lines in a video. Explain these to the student somehow. Use hands-on materials wherever they will work, such as maps printed in three-dimensional relief or with different textures. If the student knows how to read Braille (an alphabet for the blind using patterns of small bumps on a page), allow him to do so.
  • Include the student in the community of the classroom. Make sure that the student is accepted as well as possible into the social life of the class. Recruit classmates to help explain visual material when necessary.  Learn a bit of basic Braille and encourage classmates to do the same, even if none of you ever become as skilled with it as the student himself or herself.


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Introduction to Education by Shannon M. Delgado and Sarah Mark is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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