As the term suggests, this disability category encompasses a combination of conditions that may impact a student's ability to learn and achieve success in an academic setting. Students with severe disabilities are typically included under this umbrella terminology.
Multiple disabilities are defined in one regulation as "concomitant impairments (such as mental retardation-blindness, mental retardation-orthopedic impairment, etc.), the combination of which causes such severe educational problems that they cannot be accommodated in special education programs solely for one of the impairments." (34 C.F.R., sec. 300[b])
This disability category includes those students with the most severe physical, cognitive, and communicative impairments. 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 any number of skill areas.
The U.S. Department of Education reports 5,971,495 students receiving special education services in the 2003-2004 school year. Of that number, roughly 2.2%, or 132,333 students, received special education services based on a classification of multiple disabilities.
The multiple disability category represents a wide range of specific conditions and impairments. The best places for a classroom teacher to learn about their individual student with multiple disabilities are past assessments and Individualized Education Programs. The next step in learning about the student is to form a relationship with the student's parents, as they are really the greatest experts on the capabilities of their child.
However, children with multiple disabilities will typically share deficits in five distinct areas of development: intellectual functioning, adaptive skills, motor skills, sensory functioning, and communication skills.
Impact on Learning
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. The ability levels of these students can vary widely, from functional academics to basic life skills. However, most of these students are still quite capable of learning at their own level when provided the appropriate supports and materials.
While developing age-appropriate adaptive skills is a challenge for students with multiple disabilities, their ability to learn can help provide them with some level of independence in a number of life skills areas. Appropriate educational programming for these students should include self-care and self-advocacy components, as these skills are absolutely essential for their inclusion in the community.
Deficits in motor development can impact independence in these self-care areas and can also force limitations on mobility and access to the environment. These deficits may be a result of poor muscle tone or an unavoidable aspect of the specific condition. Physical therapy in conjunction with orthopedic supports may be necessary to ensure independent travel.
Sensory impairments may also be present in students with multiple disabilities, and knowing the specifics of their hearing and/or visual impairment is absolutely essential to the development of an appropriate instructional program. Refer to the specific category sections on these impairments for more detailed information on the potential impact on learning caused by sensory impairments.
Perhaps most importantly, students with multiple disabilities have deficits in the area of communication, making it difficult for them to communicate their wants, needs, and pains to those around them. 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.
Determining an appropriate educational program for a student with multiple disabilities can be a daunting task due to the variety of pervasive supports needed by these students. The planning process should be a multidisciplinary process, including parents, teachers, physical therapists, assistive technology teachers, and any number of additional support staff. Of course, at the center of the planning process should be the student, and the strengths and desires of the student should guide the entire process. Specific steps to success need to be identified, and timelines set for each educational objective. In addition, resources and supports needed for the student to achieve his goals should be defined and addressed.
One area of support that can be particularly effective for all involved is peer tutoring. Peer tutoring has been proven to have positive results for students with multiple disabilities in a number of separate research studies. However, care must be taken that the tutoring is not a one-way relationship, but is reciprocal. The student with multiple disabilities should also be able to provide something to the tutoring process, even if it is a simple social behavior. Some training on both sides will be necessary to make this a fruitful support system.
Assistive technology can be an effective tool for students with multiple disabilities in overcoming functional and communicative limitations. A variety of evaluations should be conducted by qualified professionals to determine the appropriate technological support for the needs of the individual student. Positioning, language, motor skills, and sensory issues all need to be considered in implementing the most effective support system. Both the environment and the specific tasks to be addressed should also guide the selection of the most appropriate assistive technology.
One particularly promising technological support can be found in the handheld personal computer. Using software such as the Visual Assistant, teachers and service providers can program a number of different skill sets and instructions to be accessible to the student at any time. These technology can include visual information in the form of digital pictures or line drawings, as well as audio messages and instructions. This can be instrumental in helping students gain independence in the community, such as during vocational training activities. These handheld computers use a touch screen, making them more accessible to students with motor control issues. Best of all, they are portable, and the students can take the computer with them into nearly any setting. They can also be quite effective in supporting communication with unfamiliar individuals, making them an excellent instrument for use in an augmentative communication system.
Augmentative and Alternative Communication (AAC)
Supporting meaningful communication in individuals with multiple sensory, cognitive, and physical impairments has been a central concern for special education and rehabilitation professionals for many years. Sign language is the most obvious choice of communicative skills that can aid communication and can be very effective in developmentally capable individuals with dual sensory impairments. However, in individuals with multiple disabilities and additional cognitive issues, sign language can sometimes be a limiting communication strategy. Gestural communication alone often restricts social interaction in this population to the immediate present, to items or things that can be touched at that particular moment. In addition, many individuals with coexisting physical impairments are unable to effectively use gestural communication of any kind due to limitations in their fine motor skills. Materials and tools designed to augment communication for students with multiple disabilities can be used to bridge this gap and provide these individuals with the means to communicate and make purposeful choices in their lives.
The use of augmentative communication systems for individuals who are unable to communicate by other means has been steadily increasing over the last thirty years, as both technology and research has risen to the challenge. Augmentative and alternative communication can be defined as any instructional technique, device, or system that serves to support and bolster communication in individuals with multiple sensory, physical, and cognitive impairments. This can include tangible and tactile symbol systems, choice boards, object prompts and symbols, physical modeling and prompting, and any number of techniques reliant on computer or microswitch technology. Microswitches are typically used with those students with the most limited physical range of motion; these devices control for fatigue by allowing the manipulation of technology with the least expenditure of energy. The ultimate goal of augmentative and alternative communication devices and systems is to provide the student with the means to communicate effectively with others, sharing in the countless emotional and social benefits that can come from a reciprocal interaction with another person. Whether low tech or high tech, augmentative communication devices all share four key features: symbols, displays, selection, and output.
There are a number of excellent organizations that can help support classroom instruction for students with severe and multiple disabilities. The information presented in this section is intended as just a very brief description of multiple disabilities and their impact on learning. Much more in-depth information and instructional strategies can be accessed through the following organizations:
American Association on Intellectual and Developmental Disabilities
AAIDD promotes progressive policies, sound research, effective practices and universal human rights for people with intellectual and developmental disabilities.444 North Capitol Street, NW, Suite 846
Washington, DC 20001-1512
The Arc of the United States
The Arc is the world's largest community based organization of and for people with intellectual and developmental disabilities. It provides an array of services and support for families and individuals and includes over 140,000 members affiliated through more than 850 state and local chapters across the nation. The Arc is devoted to promoting and improving supports and services for all people with intellectual and developmental disabilities.1660 L Street NW, Suite 301
Washington, DC 20036
Center for Disability and DevelopmentDept. of Educational Psychology
4225 Texas A&M University
College Station, TX 77843-4225
Council for Exceptional Children
The Council for Exceptional Children (CEC) is the largest international professional organization dedicated to improving educational outcomes for individuals with exceptionalities, students with disabilities, and/or the gifted. CEC advocates for appropriate governmental policies, sets professional standards, provides continual professional development, advocates for newly and historically underserved individuals with exceptionalities, and helps professionals obtain conditions and resources necessary for effective professional practice.1110 North Glebe Road, Suite 300
Arlington, VA 22201-5704
TASH (formerly The Association for Persons with Severe Handicaps)
TASH is a civil rights organization for, and of, people with mental retardation, autism, cerebral palsy, physical disabilities and other conditions that make full integration a challenge. They provide information, linkage with resources, expert assistance toward fighting inequities, legal expertise, and targeted advocacy.29 W. Susquehanna Avenue, Suite 210
Baltimore, MD 21204
March of Dimes Birth Defects Foundation
The March of Dimes mission is to improve the health of babies by preventing birth defects, premature birth, and infant mortality. They carry out this mission through research, community services, education and advocacy to save babies' lives. March of Dimes researchers, volunteers, educators, outreach workers and advocates work together to give all babies a fighting chance against the threats to their health: prematurity, birth defects, low birthweight.1275 Mamaroneck Avenue
White Plains, NY 10605
National Rehabilitation Information Center (NARIC)
The core mission of the Center is to collect and disseminate the results of research funded by the National Institute on Disability and Rehabilitation Research (NIDRR). NARIC staff members have been dedicated to providing direct, personal, and high-quality information services to anyone throughout the country.4200 Forbes Boulevard, Suite 202
Lanham, MD 20706
United Cerebral Palsy Associations, Inc.
The national organization and its nationwide network of affiliates strive to ensure the inclusion of persons with disabilities in every facet of society—from the Web to the workplace, from the classroom to the community. As one of the largest health charities in America, the mission of United Cerebral Palsy is to advance the independence, productivity and full citizenship of people with disabilities through an affiliate network.1660 L Street N.W., Suite 700
Washington, DC 20005
Hunt, N., and Marshall, K. (2006). Exceptional children and youth. Boston, MA: Houghton Mifflin Company.
National Dissemination Center for Children with Disabilities (2004). Fact Sheet 10. Retrieved February 1, 2008 from www.nichcy.org/pubs/factshe/fs10txt.htm.
Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives. Special education in today's schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.
U. S. Department of Education, Office of Special Education Programs. (2005). IDEA data website (http.//www.ideadata.org).