summary 183

Focus on Idioms.
Idioms may be hard for English-language learners to un-derstand, because their overall
meaning can be quite dif-ferent from their individual parts. Still, idioms can be used
effectively to focus students' attention on important dif-ferences between standard and
contextual definitions of words, as well as to increase student comprehension. For example,
in a history class devoted to the rise of labor unions, a union leader was quoted as using the
idiom "hit them in the pocketbook where it hurts." The teacher ex-plained carefully that this
expression was not to be taken literally and that it simply meant the unions wanted to hurt
managers by causing them to lose money.
Develop Word Banks.
A word bank is a place where key vocabulary is stored and posted for students' reference
throughout a teaching unit or beyond. Selection of words for word banks should be based on
their relevance for understanding key concepts, high frequency of use, and relevance for
students' lives. For example, in a Unit on the topic of the greenhouse ef-fect, explaining what
the ozone layer is would be more im-portant than presenting the definition of fluorocarbons.
Word banks can be created by groups of students or by students individually. They can also
be visually displayed. For example, as a word is introduced, its meaning and key attributes
can be written on chart paper and posted in the for students with special needs. Reasonable
adaptations are those that maximize student success without taking a disproportionate amount
of time or diminishing the education of the other students in the class. The steps in
INCLUDE are as follows: identify environmental, curricular, and instructional classroom
demands; note student learning strengths and needs; check for poten-tial areas of student
success; look for potential problem areas; use information gathered to brainstorm instructional adaptations; decide which adaptations to imple-ment; and evaluate student progress.
An important part of the INCLUDE strategy is an-alyzing classroom demands.
Demands covering four major areas should be analyzed: classroom organization, classroom
grouping, instructional materials, and in-structional methods. Classroom organization
includes Physical organization, classroom routines, classroom cli-room. The displays can
then become reference points for students, can help students remember definitions and relationships among words, and can provide guides for cor-rect spelling. Word banks can also
be dynamic; as students learn more about words, this new information can be added to
existing definitions. For example, the class that was learning the word audience came across
the term audience share in an article students read about a current television show. The class
added this use of audience to its visual display.
Use Visual Organizers.
Visual organizers can help students access and understand vocabulary that they could
not understand if presented only verbally. Examples of using visual organizers to teach
vocabulary are described in Chapter 9.

From the Research

Carlo et al. (2004) significantly improved the depth of vo-cabulary knowledge,
understanding of multiple meaiiings, and reading comprehension of the fifth-grade English.
language learners who were integrated in classrooms with English-speaking students. The
strategies of presenting vo-cabulary words in meaningful contexts, providing access to word
meanings in students' primary languages, and pre-senting vocabulary in multiple contexts
worked well for both groups of students. mate, behavior management including classroom
rules and monitoring, and the use of time. Key aspects of classroom grouping involve the use
of whole-class and small instructional groups, same-skill and mixed-skill groups, and one-toone instruction. Instructional mate-rials that need to be considered are basal textbooks,
content-area textbooks, manipulatives and models, and instructional and assistive technology.
With regard to teaching demands, two common instructional models used in schools are
direct and indirect instruction. Sometimes students With special needs may require sup-port
in the form of scaffolds when participating in indi-rect teaching. Also, consider the demands
of your student practice activities, and follow guidelines for using practice effectively.
Finally, take into account how student learning needs may interact with your classroom
evaluation system including tests and grading.

185
WORKING THE STANDARDS (continued)
Further Readings 185
CEC STANDARDS REFLECTED IN THIS CHAPTER:
CRC Content Standard #5 states that special educators
Foster environments in which diversity is valued and in-dividuals are taught to live
harmoniously and produc-tively in a culturally diverse world. Shape environments to
encourage the independence, self-motivation, self-direction, personal empowerment, and selfadvocacy of individuals with exceptional learn-ing needs.
CEC Content Standard #7 states that special educators fa-cilitate instructional planning in a
collaborative context, including the individuals with exceptionalities, families, professional
colleagues, and personnel from other agencies as appropriate.
BACK TO THE CASES
The standards and principles just listed relate to the cases described at the beginning of this
chapter: Mr. Rodriguez and Josh. The questions and activities that follow demon-strate how
these standards and principles,along with other concepts that you have learned about in this
chapter, con-nect to the everyday activities of all teachers.
Further Readings

Arends, R. L (2004). Learning to teach (6th ed.). New York: McGraw-Hill. An invaluable
resource for teachers that provides models and strategies for teaching all subject areas at all
levels. Curry, C. (2003). Universal design: Accessibility for all learners. Educational
Leadership, 61(2), 55-60. Provides an excellent overview of applications for universal design
to all aspects of the classroom. Kameenui, E. J., & Darch, C. (1995). Instructional classroom
management: A proactive approach to behavior management. White Plains, NY: Longmont.
Describes a wealth of practical strategies for preventing be-havioral problems through
carefully planned instruction.
Mr. Rodriguez
Mr. Rodriguez has provided a digital copy of the text and, a daily review of previously
presented content, outlines of lectures, and small-group discussions to support Marvel's
learning of content. Step 7 of the INCLUDE strategy asks teachers to evaluate student
progress. (See INTASC Princi-ples 1.03 and 4.04.) Using information in this chapter and
Chapter 4, suggest two assessment methods that Mr. Ro-driguez might use to assess Manuel's
progress. Explain why you selected these two methods.
Josh
Josh's peers may have difficulty adjusting to his speech. As a result, they may shy from
interactions with him. Based on information provided in this chapter, name two ways in
which Ms. Stewart can use routines, classroom organiza-tion, instructional materials, or
specific teaching methods to support Josh's interactions with peers. (See INTASC Prin-ciples
5.01 and 5.03, and CEC Standard 5.) Explain why you believe these methods would be
helpful for Josh.
Visit the companion welisite (http://www.ablongman, com/friend4e) for a complete
correlation of this - chapter to the INTASC Principles and CRC Standards.
Marchand-Martella, N. E., Slocum, T. A., & Martella, R. C. (2004). Introduction to direct
instruction. Boston: Allyn and Bacon. An indispensable guide to published direct instruction
pro-grams.

187
After you read this chapter, you will be able to
1. Describe what it means to say that a student has a low-incidence disability, and apply the
INCLUDE strategy to effectively instruct these students in your classroom.
2. Describe the characteristics of students with moderate, severe, and multiple disabilities,
including mental retardation, and deaf-blindness, and the accommodations general educators
can make for them.
3. Explain the characteristics of students with sensory impairments (that is, vision or hearing
loss) and the accommodations general educators can make for them.
4. Explain the characteristics of btudents with physical, medical, and health impairments and
the accommodations general educators can make for them.
5. Outline the characteristics of students with autism spectrum disorder and the
accommodations general educators can make for them.
6. Critically analyze your own beliefs about and skills for implementing inclusive practices
for students with low-incidence disabilities.
KEY TERMS AND CONCEPTS
Acquired immune deficiency syn-drome (AIDS) (p. 217) Asperger syndrome (p. 224)
Augmentative and alternative com-munication (AAC) (p. 198) Autism (p. 222) Autism
spectrum disorder (ASD) (p. 222) Down syndrome (p. 194) Functional curriculum (p. 194)
Hearing impairments (p. 201) Low-incidence disabilities (p. 188) Orthopedic impairments
(OD (p. 213) Other health impairments (OHI) (p. 213) Traumatic brain injury (TBI) (p. 213)
Visual impairments (p. 201)
KYLIE IS A first-grade student with a moderate intellectual disability. She is described by
her teachers and her mother as a "bundle of energy," and she is enthusiastic about school and
all the activities that occur in her classroom. Although Kylie is just learning to recog-nize
colors and identify shapes and is a prereader, she receives nearly all her in-struction in the
first-grade classroom. Because Ms. Wilson often uses cutouts, Puppets, or other concrete
strategies to illustrate the literature being read, Kylie follows along without much difficulty.
When other students work on writing or editing, Kylie works with a computer program, either
practicing shapes and colors or learning to recognize her name. What are the learning
characteris-tics and needs of students like Kylie?What are appropriate expectations for
Kylie's teacher to have for her this year? What accommodations does Kylie need to succeed
in first grade? If Ms. Wilson has a question about Kylie, how can she find an answer?
JULIAN IS A fifth-grade student who was diagnosed last year with cancer. According to
federal guidelines, he is eligible to receive special education as other health im-paired. Julian
underwent chemotherapy and experienced many side effects, including hair loss, lack of
appetite, and tendency to bruise. Now more chemotherapy is needed, and a bone marrow

transplant is being consid-ered. Julian often misses one or More days of school after
treatment because of side effects such as nausea and fa-tigue. He also was hospitalized twice
when he developed a dangerously high fever. Despite Julian's illness, he is en-thusiastic about
finishing elementary school and moving on to middle school. His teachers prepare work for
him when he will be absent for several days, and his special eduCation teacher monitors him
closely to ensure that he does not fall significantly behind in his studies. Julian's mom reports
that he relies on the e-mails he receives from classmates and the personal notes from his
teachers to see him through difficult times. "School," she explains,

188
"gives Julian an anchor in the normal activities of a child. It reminds hilu that his illness is not
all there is to his life." What types of accommodations is Ju-lian likely to need? What is your
rewonsibility as an educa-tor to help Julian not only keep up academically but also remain o
true clossrom comunity member?
CARTER IS AN eighth-grade student diag-nosed with an autism spectrum disorder (ASD)
who has some remarkable skills. His math achieve-ment is far above grade level, and he has a
prodi-:giOus_ability to remember facts and figures,. Particularly about his favorite subjects
currently, presidents of the United States and South Ameri-can countries. However, his
reading and written language skills are somewhat below grade level. Carter also has many
routines that he insists on following in school. For example, before he leaves the classroom,
he counts the books in his backpack, reties-his shoes, and says as he leaves the room, whos
your daddy?" Any change in the schedule of the day or interference with his personal routines
can lead to disruptive behavior. S What is Ii autism spectrum 'disorder? What should Carter's
teacher's do to help him learn? What accommodations might Corte, need now, in middle
school, and later, in high school?
ALYSSA IS A senior this year. She plans to be-come a special education teacher someday,
and she is studying hard to improve her chances of suc-ceeding in college. As the result of a
very high fever, Alyssa has had a profound hearing loss since she seas 3 months old. Alyssa
did not learn a lot of sign language until she began high school. She now prefers signing to
oral language as a commank, tion approach, and she has an interpreter who ac-companies her
to core academic classes. Alyssa's most difficult subject is English. She has problems writing
down her ideas logically and elaborating on them. How does a hearing loss or deafness
affect learning for students like Alyssa?What ore Alyssa's responsibilities for self-adyococy?
Whot can her teachers do to help her prepare for college?
Students like Kylie,Julian, carter,-and Alyssa have the same rights as other students to be Part
of a classroom community with non disabled peers. For Kylie and other young children with
significant disabilities, attending first grade with peers prepares them for the demands of
school and also creates the expectation that they can fiilly participate in typical educational
environmentsand live as valued and contributing members of communities after their school
years. For Carter and Alyssa, success in cone depends on receiving the strong academic
background available in general educau classes. However, because of their disabilities these
and other students in inclusi schools might need specialized equipment, instruction, or other
assistance.
In this chapter, you will learn about the characteristics and needs of students with low
incidence disabilities, which encompass moderate, severe, and multiple disab. ities; sensory
impairments; physical, medical, and health disabilities; and autism. lit federal terms for these
disabilities and the number of students with these disabili served through IDEA are
summarized in Table 6.1. You also will explore accomnio dons specific to the unique needs of
these students that general education teachers other professionals can make to enable them to
learn.

what Are Low-Incidence Disabilities?

When you work with students with low-incidence disabilities, you will notice immedately the
diversity of their abilities and needs, the range of educational services they acess, and the
variety of specialists who ensure they receive an appropriate education.
190
The following points can help you keep in perspective these students' uniqueness and' your
role in their education. First, students with low-incidence disabilities together make up only
about 10 percent of all the students with disabilities in schools. That means that you are
unlikely to teach these students every year unless your school houses a program that brings
together students with these disabilities from across your school district, sometimes referred
to as a cluster program or a district class. Otherwise, you may encounter a student with a lowincidence disability only a few times in your career.
Second, students with low-incidence disabilities often have received some type of special
education services from birth or shortly thereafter. They might come to kindergarten already
having attended an infant program or a preschool program in a daycare, inclusive preschool,
or special education setting in which their special needs were addressed. You also may find
that many supports and extensive technical assistance are available for students with lowincidence disabilities.
Third, students with low-incidence disabilities need the same type of attention from you that
other students do. If you are unsure about a student need, ales nearly always best to rely on
the same professional judgment you use in worlcing with other students. If you encounter
difficulty, you can access the technical support that special education professionals offer.
Students with certain disabilities, especially significant or complex ones, often are
accompanied by paraprofessionals or personal assistants who might work with them for
several years. Such an individual may be able to offer insight about responding . to a given
student, but the responsibility for ensuring the student's success is yours.
You may have many concerns about meeting the needs of a student with a low-incidence
disability in your classroom. The Professional Edge on page 191 features, questions you can
ask to prepare for a student with a low-incidence disability to join your class. The questions
address the student's strengths and potential, learning and social needs, and physical or health
needs. They also cover domains in which accommodations' might be needed, including the
physical arrangement of the classroom. What other questions would you add to these lists?
If you look ahead in this textbook, you will find that this chapter as well as Chapter 7, on
high-incidence disabilities, address students with intellectual disabilities. 'This dual
consideration occurs because the federal category of mental retardation is used all students
with intellectual disabilities, whether mild, moderate, or severe. This cha ter addresses only
students with moderate or severe intellectual disabilities. Studen with mild intellectual
disabilities have characteristics and needs more similar to tho of students with learning and
behavioral disabilities, and they are discussed with tho groups in Chapter 7.

If you work with children who are under 9 years of age, you may hear the term
developmentally delayed. States have the option of using this broader, possibly less
stigmatizing term to refer to young students who have disabilities, in-cluding those who have
mental retardation and other disabilities discussed in this chapter.
ANALYZE AND REFLECT
Why is collaboration so im-portant when you teach students with low-inci-dence disabilities?
With whom do you anticipate you will need to collabo-rate?
What might be some of the opportunities and problems that could occur as part of this
collaboration? Wit PM hat Accommodations Can You Make for Students with Moderate,
Severe, or Multiple Disabilities?
Students with moderate, severe, or Multiple disabilities include those whose intellectual
impairments and adaptive behavior deficits are so significant and pervasive that considerable
support is needed for them to learn. This group also includes students with multiple
disabilities, that is, students who have two or more disabilities that significantly affect their
learning. Both groups of students typically have a curriculum that, differs somewhat from
that of other students in your class, but many students with such significant disabilities can
still learn in a general education setting, partially accessing the general curriculum. They also
can benefit from social interactions wi classmates who do not have disabilities.

191
Federal Disability Category
What AN. Low-Inciden ryies?* 191
sSchool-Age2Sotuode2notso wi aith Low-Incidence Disabilities Receiving Special Educatic
Defining Characteristics
Percen _Total All Stu Number of Receiv. Students IDEA S.
t7,
Mental retardation Significant below-average general intellect,.. functioning 612,978 10.6c .
92 with deficits in adaptive behavior Identified between birth and 18 years of age Adversely
affect educational performance lt Two or more disabilities so interwoven that rone can be
122,559 2.1 .19 dMiusab4;lie ties identified as the primary disability Adversely affect
educational performance Hearing Hearing loss is permanent or fluctuating, milc to profound
70,767 1.2 .11 impairments in nature, in one or both ears Loss may be referred to as hard of
hearing or ceof Adversely affect educational performance Orthopedic Physically disabling
conditions that affect locomotion or '73,057 1.3 .11 impairments motor functions May be

the result of a congenital anomaly, aciisease, an accident, or other causes Adversely affect
educational performance
Other health Conditions resulting in limited strength, vitality, or alert- 291,850 5.1 .44. .
impairments ness and caused by chronic or acute health problems Adversely affect
educational performance Visual Vision loss in which student cannot successfully use vision
25,975 0.5 .04 impairments as a primary channel for learning or has such reduced acuity or
visual field that processing information visually is signifi-cantly inhibited and specialized
materials or modifications are needed Adversely affect educational performance Deafblindness Presence of both a vision loss and a hearing disability that 1,320 0.02 .00 causes
severe communication and related proOtems Adversely affects educational performance
Autism Developmental disability characterized by impairments in 78,749 1.4 .12
communication. learning, and reciprocal socia, interactions. Usually identified in infancy or
early childhood Adversely affects educational performance Traumatic brain Impairment
manifested by limited strength, ozatity, alert- 14,844 0.3 .02 injury ness, or other impaired
development resulting from a traumatic brain injury Adversely affects educational
performance iffnellaftatIOWINSMIAS=WZICtidaVAAVIAM19.3,4,1742". 411.4
..A.A7NIVIMAZI* Wct 'Students ages 6-21 receiving services through IDEA. Part 811.5.
Department of Education, 20021. Approximately 28,683 additional students re-ceived
services categorized as having developmental delays, and some of :-ese students have lowincidence disabilities. 'Because federal categories of disability do not distinguish among
studentu with various degrees of mental retardation, it is difficult to provide a Precise
estimate of the number of students with moderate or severe cogri:'..e disabilities. However,
approximately one-third of the students in this category have moderate or severe cognitive
disabilities. SOURCE: From Twenty-Fourth Annual Report to Congress on the Implementc,,
of the Individuals with Disabilities Education Act. 2002. Washington. DC: U.S. Department
of Education.

192
Special EMPFASIS On
...................................................................................................... ...
Physical Education
Whether in elementary, middle, or high school, physical education often is the first area
considered for the inclu-sion of students with low-incidence disabilities. In many schools,
physical education teachers work with all students - attending the school, both those with
disabilities and those without.
No one would disagree with the fact that students with low-incidence disabilities need as
much as any stu-dent to participate in physical activities. Evidence sup-ports inclusive
approaches. Lorenzi, Horvat, and Pellegrini (2000) studied typical elementary students and
those with mental retardation as they shared unsupervised recess time. They found that for

both groups, boys tended to have a higher level of activity and to raise their heart rates more
than girl, but they also found that both boys and girls with intellectual disabilities raised their
heart rates more classmates. The authors concluded that inclusive racess setting fostered
healthy habits for students with disabilities.
Strategies and Approaches
The key to successfully including students with low-incidence disabilities in physical
education classes is Careful planning With the students IEP teams using the INCLUDE
strategy. Here are soma guidelines for accommodating students:
Whenever possible, allow time for students to gain independence in the activities.
Focus on student abilities, not disabilities. Use student and parent information to give
yourself greater under-standing of what students are capable of learning and doing.
Encourage students to choose and adapt activities.
Maintain activity integrity, but make enough changes so that students can participate
successfully. ^ Emphasize cooperative games. One example is a relay race in which the
objective is to "beat the clock," that is, improve personal performance
Avoid elimination games. Students who most need to participate often are the first
eliminated.
Maintain students' right to take risks. Be careful about assuming that certain activities are
not suitable for cer-tain students.
When introducing activities, keep explanations simple, demonstrate, use rnultisensory
approaches, check for understanding, break instruction into small pieces, and ensure students
understand any safety issues.
Check the physical environment to be sure it is appropriatefor example, ensure the space
is large enough to accommodate wheelchairs, shortened distances for students with stamina
problems, and consistency for students with visual impairments.
Adapt equipment as neededfor example, change the weight, color, or size of balls or
targets.
Modify student rotes when appropriate, for example, by having students stay on base while
another student runs, by simplifying the type of movement required, or by changing scoring
to foster student success.
Modify rules to enhance successful participation, example, by adapting time given for an
activity.
Use peers without disabilities to assist students wi disabilities by having them share roles,
tutor or coach or assist students during class activities.
193

interpreted carefully and are not helpful in designing instruction for students, an over-all IQ
score of less than 70 with significant difficulty in the area of adaptive behaviors (for example,
ordering a meal in a restaurant) leads to eligibility for special education in the category of
mental retardation. Students with moderate or severe intellectual disabilities generally have
IQ scores of approximately 55 or below. Leaders in the ficld argue that a more appropriate
strategy for identifying individuals with intellectual dis-abilities is to define the disability by
adding other key factors, including social partici-pation, health, and individual functioning
within the broader context of school, home, and community (American Association on
Mental Retardation, 2002). Kylie, whom you learned about at the beginning of the chapter, is
a student with a moderate intel-lectual disability. As you read the following sections; think
about how she might learn in your classroom.
LEARNING NEEDS AND RATE Generally, students with moderate or severe in-tellectual
disabilities have several noticeable characteristics. First, the amount of infor-mation they can
learn may be limited, and the rate at which they learn may be slow. These two factors suggest
that considerable repetition of skills essential for adult func-tioning is needed. For example,
Destiny, a middle school student with a severe intel-lectual disability, is working to learn to
communicate her needs to others. She has a communication device that enables her to
indicate that she needs a drink of water, that she needs to use the bathroom, and that she is
hungry. Her paraprofessional some-times works with her on this skill, but her classmates also
ask her questions related to these needs. Jordan, an elementary student with a moderate
intellectual disability, is learning a variety of preacademic skills within his general education
classroom, in-cluding telling a story from a picture book, recognizing his name and address,
and un.- derstanding directional prepositions such as up, down, inside, and outside. He
rehearses these as opportunities arise during general instruction, and when other students are
completing individual assignments that are beyond his capability, he works on his skills on
the computer, sometimes with a peer assistant. Students with moderate or severe intellectual
disabilities need to learn many other essential skills. One example is social skills. Several IEP
goals and objectives may relate to participating in one-to-one or small-group interactions with
peers, responding to questions asked by others, and sharing toys, games, or materials. These
students also may need to learn how to participate appropriately in nonacademic and
extracurricu-lar activities such as field trips and after-school programs (Wagner, Cadwallader,
Garza, & Cameto, 2004). Without direct assistance from teachers implementing in-clusive
practices, these students may have difficulty making friends throughout their school careers
(Dore, Dion, Wagner, & Brunet, 2002; Geisthardt, Brotherson, & Cook, 2002; Turnbull,
Pereira, & Blue-Banning, 2000).
MAINTENANCE OF LEARNED SKILLS A second characteristic of individuals with
moderate or severe intellectual disabilities is that they may have difficulty main-taining their
skills; without ongoing practice, they are likely to forget what they once learned. In the
classroom, you may find that this means that iris not necessary to pro-vide new activities each
day. For example, Jordan, the student mentioned previously who is learning to recognize his
name and address, will need computer practice on that skill for many days. In addition, once
he has identified the information, he should prac-tice printing it on cards, writing it on the

chalkboard, and saying it aloud. Extensive practice on a single skill using many approaches is
usually appropriate.
GENERALIZATION OF LEARNING A third characteristic of students in this group is that
they may have difficulty generalizing skills learned in one setting or situ-ation to another
setting or situation. It is thus critical that they learn as many skills as Possible in context. For
example, rather than having these students practice buttoning and unbuttoning out of context,
as part of a segregated classroom exercise, they can

194 CHAPTER 6 Students with Low-Incidence Disabilities

apply this skill in the morning and afternoon as they enter and leave school wearing coats or
sweaters. Older students need to learn how to greet classmates and teacher, appropriately, for
example, with a handshake or by just sa:i-ing hello instead of shouting or tightly hugging
them. This skill is most easily taught as students meet and greet people throughout the school,
not in a special education classroom.
SKILL COMBINATION One additional characteristic of students with moderate to severe
intellectual disabilities is difficulty combining a series of small skills into a larger one. For
example, a student may be taught each step involved in making a sand-wich, but unless the
steps are taught in an integrated way, the student probably is going to have difficulty carrying
them out in a logical sequence. Some older students are learning to use personal digital
assistants (PDAs) to help them remember sequences of skills (Davies, Stock, & Wehmeyer,
2002). How might this student characteristic affect your instruction of them?
Crystal is a young woman with Down syndrome, a condition that often includes a moderate
intellectual disability. Her story is typical for such a student in a school district committed to
inclusive education. She attended elementary school with her peers even though she did not
always learn the same things they were learning. Her teachers expected her to behave
appropriately, and her peers helped her when she got confused by the teacher's directions or
otherwise needed support in the classroom. As she moved to middle school, she participated
with peers in co-taught science and social studies classes and in elective classes such as foods
and computers, and she received some of her reading and math instruction in a special
education classroom. In high school, she took several classes, including choir, U.S. history,
home economics, career exploration, and family living. She also entered a vocational
preparation program so she would be ready to get a job after high school. At 21, Crystal
graduated from high school. She now works in a local medical office. Her job includes
duplicating medical records, doing simple fil-ing tasks, running errands, and helping get mail
ready to send. Crystal's success as an adult is in large part a result of learning many skills
fostered while in inclusive schools..,
INSTRUCTIONAL PRINCIPLES Three principles usually guide instruction for students
with moderate or severe intellectual disabiliti. (Hickson, Blackman, & Reis, 1995.

1. Functional curriculum. In a functional curriculum, the goals for students are based' on
the real-life skills they need to succeed. For example, a student might benefit more
from learning to make purchases than learning to write a story because most adults
make purchases regularly but not all inust have story-writing skills. The most
important job skills Crystal learned during her school career were punctuality,
following multiple-step directions, and keeping her voice appropriately low. the goals
for students are
2. Community-based education. Most students, but especially based on the real-life
skills they those with significant intellectual disabilities, benefit from ap-need to
succeed. plying skills learned in school to real-life settings and activities -- (Burcroff,
Radogna, & Wright, 2003). Community-based education might include applying
money and counting skills ata restaurant, interacting with people who live in a
retirement center, and exploring job possibilities in hotels, assisted living centers, and
other businesses.
3. Age appropriateness. Individuals with disabilities, even very significant disabilitiO)
should use materials that look appropriate for their age and should learn skills or
variations of skills that typical learners their age are acquiring. For example, students
with significant intellectual disabilities in high schools should not be using materials
designed for young children. Similarly, life skills appropriate for young children
taking turns, sharing, and following directions, skills that can be learned in the school
setting with other children. Specific vocational skills such as operating a cash register
or stocking shelves should be reserved for older students who are chronologically
much closer to using such skills.

219
coped with their illnesses, and they can be useful for explaining the needs of these students to
peers without disabilities.
3. Consider including death education in your curriculum if you have a student with a lifethreatening condition such as cancer. A special educator, counselor, or social worker probably
can prepare a unit and help you pretests it.
4. Work closely with families. Parents cast often be the most valuable source of in-formation
concerning their children's status and needs. They can also alert you to upcoming changes in
inedications and emotional problems occurring at hotne, and they cast help their children
work on missed school assignments (Shepard & Mahon, 2002).
In terms of academic and curricular adaptations, you should respond to students di have
health impairments as you would to other students with disabilities. Using the INCLUDE
strategy, you can identify their needs. If modifications in the environ-ment, curriculum, or
instruction are needed, you can carry them out using the sugges-tions made throughout the
remainder of this text.
Traumatic Brain Injury

Taiumatic brain injury (TB1), sometimes called acquired brain injwy, occurs when a student
experiences a trauma to the head from an external physical force that results in an injury to
the brain, often including a temporary loss of consciousness. TBI is the leading cause of
disability and death among children, and it has many causes, including Olin, bicycle and
motor vehicle accidents, sporting accidents, accidents on playground equipment, child abuse,
and gunshot wounds (Brain Injury Association of America, 2004; Youse, Le, Cannizzaro, &
Coelho, 2002). More than 1 million children and ado-lescents sustain a TBI each year.
Although most of these injuries are mild, some 30,000 youngsters have a lifelong disability as
a result of TBI (Keyser-Marcus, Briel, Sherron-Targest, Yasuda, Johnson, & Wehman, 2002;
Dissemination Center for Children with Disabilities, 2004b). Whether TBI is the result of a
severe injury or a mild one, it can have a pervasive and significant impact on a student's
educational performance.
Recovery from a TBI can take months or even years, and someStudentS with severe TBI
spend time in rehabilitation after their hospitalization:and before returning to school. Other
students with mild or moderate injuries are likely to go directly from the hospital back to their
homes and schools (Clark, Russman, & Orme, 1999). Students with TBI often return to
school at some point during the recovery process, but pre-dicting their abilities and the point
at which they will reach their best outcomes is impossible given various lengths of recovery
time and alternative patterns for treatment.
One of the most perplexing aspects of teaching students with TBI is that they can appear just
as they did prior to their injuries and yet have significant learning and social problems. They
can also seem to be "back to normal" one day, only to deem lethargic and incapable of
learning the next day. Because of the extreme variability in needs of students with TBI, the
information presented in this section should be considered illustrative if you teach a student
with TBI, seeking input foist a specialist is essential.
CHARACTERISTICS OF STUDENTS WITH TRAUMATIC BRAIN INJURY Intellectually, students with TBI might have the same abilities they had before, or they night
experience a loss of capacity. For example, after an automobile accident, Michael, a high
school honor student who used to be a class leader, was left struggling to remaster basic math
facts. His injury affected Isis school learning. Students might experience difficulty initiating
and organizing their learning tasks, remembering what

220
they have learned, and reasoning or problem solving. They might also have difficulty
processing verbal information and producing spoken and written language.
Students with TBI also have physical needs. Depending on the severity of the injury and the
extent of recovery, some students have limited use of their arms and legs. Others have
problems in fine motor movements such as those needed to grasp a pencil or turn the pages of

a book. Yet others have limited strength and stamina. Students with these needs sometimes
attend nelson! only part of the day.
Socially and emotionally, students with TBI experience many difficulties. Sometimes they
have changes in their personalities; they are not who they used to be. For example, they often
remember what they were able to do prior to their injuries and .sometimes become depressed
as they recognize their current limitations (NationalDissemination Center for Children with
Disabilities). Because they often need a high degree of structure and do not respond well to
change, they can display behavior problems when a sudden change in schedule occurs, as
Nvhen an assembly interrupt an accustomed routine. Some students lose their ability to
interpret and respond appropriately to social cues. As a result, they might laugh at
inappropriate times, speak loudly when everyone else has realized a whisper is needed, or
wander off when distracted by something. Their behaviors can be puzzling or frustrating
unless yot understand how to respond to them. Some of the most common challenges for
students with TBI, along with potential responses teachers can make, are included in Table
6.3.
FAMILIES AND TRAUMATIC BRAIN INJURY It is especially important to In order for
professionals non families as part of congiderations about TBI. Often, parents or siblings
have with nessed a student in a totally unresponsive state, and they have psychologically
prepared fornthe possibility of death. They might be tremendously relieved that the student
sure vived but at the same time traumatized by the amount of physical care the stud needs and
by the drain On financial and psychological family resources. Depending the amount of
uncertain about the extent to which the student can eventually recover the impact of theTBI
on the student's intellect and personality, and the family's ability to provide for the-student's
needs, families can experience a range of emotion including shock, denial, sorrow, and anger
(Mason, O'Sullivan, O'Sullivan, & Cull and td farnity-r If t nem.bers, and 2000). Eventually,
Many families adapt. You need to be sensitive to the family's stress and their changing
capacity to follow up on homework as well as schoolwork to suport your efforts.
TEACHING STUDENTS WITH TRAUMATIC BRAIN INJURY If you teach a student
with TBI, you might attend at least one planning meeting to discuss the details of the
student's abilities and needs and to prepare you for helping the student in the classroom. This
transition planning, which typically occurs when a student is moving from the hospital or
rehabilitation center back to school, is essential to ensure that appropriate expectations are set
for the student, procedures are established for responding to changes in the student's
condition, and all services are coordinated (Lemanek, 2004).
In your classroom, adaptations relate to physical nedds, instructional and organizational
routines, academic content, and the social environment. Because students with TBI need
structure and routine, you should follow a consistent patern in classroom activities, expect the
consistent types of studen responses, and keep supplies and materials in a consistent place in
the classroom. If a break in routine is necessary, you can prepare the student by alerting him,
assigning a buddy and staying in close proximity.

If you teach a student with TBI. you might attend at least one planning meeting to discuss the
details of the student's abilities and needs and to prepare you for helping the student in the
classroom.

,
221
What Accommodations Can You Maid for Students with Physical. Medical, or Health
Disabilities? 221
, , Classroom Accornmodations for Students with Traumatic Brain Injury Post-TBI
Cognitive Challenges Macroenvironment Microenvironrnent Structure and Pacing Teaching
Style
Attention/ Seat student near Use peer note takers. Use small groups for Refocus student
with Concentration teacher. Use tape recorders. teaching, verbal and/or nonver Minimize distractions. Provide assignments Alternate instruction, bat cues. Use FM
unit and and activities in writ- activity, and rest. Plan frequent breaks. earplugs to minimize
leg. Schedule classes to external noise. capitalize on periods Use large-print books
Provide out-of-class- with low density on of highest attention. room activities in the page.
low-stimulation envi-ronrnents.
Information- Use peer note takers Slow the pace of class- Do not rush or chat-Processing
Speed and tape recorders, room instruction. lenge the student. Review taped Allow extra
time for Provide anticipatory materials/peer notes completion of in-class cuing to prepare to
identify missed crit- tests/assignments/ responses in advance. ical information. homework.
emory
EFex:g
Frequently repeat Reduce homework information, to load. enhance processing abilities.
Allow more time for student to respond. Provide written mated- Use tape recorder to
Utilize the student's Provide adequate repe-als to back up review critical informa- best
learning modality tition for mastery. classroom instruction. tion. (e.g., visual, auditory).
Encourage student to Use an organizer as an Encourage tape-record- repeat information to
external memory aid. ing new class content, ensure comprehension.
Test using multiple-choice format.
Use fact cards and cue sheets to aid recall. Use highlighters to focus attention to
information.
Encourage writing down class assign-ments in daily organizer.

 Designate a specific Develop a system to Review daily routines Encourage student to

location to return indicate that home- to reorient student. use organizer daily. homework.
work has been handed Cue student to record Break large projects or Display classroom
in. homework assign- tasks into component schedule. Use a binder with sub- ments, parts or
steps. ject sections and Encourage outlining Prepare student before pockets for homework.
oral and written the topic shifts. Color-code sections of assignments. binder and book covers
by subject. Create maps to aid between-class travel; do in-school travel training. WIN .1,
C. SOURCE: Adapted from Students with Traumatic groin Injury: Identification, Assessment,
c-d Clossroom Accom-modations, by M. Hibbard, W. A. Gordon, T. Martin, B. Raskin, and
M. Brown, 2001, New 1,rk: Research and Training Center on Community Integration of
Individuals with Traumatic Brain injury, Mo., Sinai School of Medicine. Retrieved November
22, 2004, from http://mssm.eduitbinet/alt/pubsitbikids,i.
222
222 CHAPTER 6 Students with Low-Incidence. Disabilities 000.ablongman.com/friend4e
ANALYZE AND REFLECT What characteristics of stu-dents with TBI create chal-lenges
for teachers working with them? How do the suggestions in Table 6.3 apply to your own
antici-pated teaching situation?
RESOURCES -...-.... The Brain Injury Associa-tion of America, Inc. web-site, at
http://www. biausa.org, includes infor-mation about causes, cost, prevention, and treatment of
MI. It even has a kid's come,
You nsay need to ns;ske changes in the academic expectations for a student with TB!.
Because students might know information one day but forget it the next, or learn with ease
sometimes but struggle to leans at other times, the need for flexibility is on-going. Students
are also likely to become frustrated with their irn the way they did in the past, so your
patience in reteaching information, providing addi-tional examples and exercises, and using
strategies to help them focus attention is essential. Socially, emotionally, and behaviorally,
students with TBI rely on you to set clear expectations but also to be supportive of and
responsive to their changing needs. One student, Gary, had been in a coins but gradually
regained enough ability to function that he returned to his middle school, at first for only an
hour or two each day and eventually for the entire day. However, he continued to forget
common words and grew increasingly frustrated when he could not convey messages. His
teachers began providing the words he needed. Because many students with TBI seem unable
to form a realistic picture of how they are functioning, you might need to confront them gently about socially inappropriate behavior. Frustrated with his language skills, Gary yelled at
friends, yet his sentences remained unclear. Teachers intervened to help him learn to control
his anger and to assist friends to understand him. Students with TBI also might overestimate
their abilities. Informally, you can assist in this area by dis-cussing realistic options for the
near future and, with older students, for career choices. In general, many adaptations needed
by students with TBI are much the same those needed by students with physical or health
disabilities, learning disabilities, emotional disabilities. The uniqueness of students with TBI
and the reason they grouped as a separate category in IDEA is that their needs are difficult to

predi change either slowly or rapidly, and vary in intensity. With patience and a willingn by
teachers to meet students wherever they are and work forward from there, studen with TBI
can achieve school success.
.................... .............. . aggfigl! .......... hat Accommodations Can You Make for Students with
Autism Spectrum Disorders?
Autism was first identified as a disorder in 1943 by Dr. Leo Kanner. Since then, it been the
source of much research and ongoing professional debate. At various tim autism was viewed
as either a type of emotional disability or as a special form of me tal retardation. However,
professionals now recognize that autism is a unique disor that occurs in many forms, and they
usually refer to this disability as autism spe disorder (ASD) to convey its diverse nature. The
prevalence of autism spectrum orders has been rising steadily over the past decade, partly due
to better diagnosis ( example, Gillberg, 1999; Fombonne, 2003). This disability affects boys
more di girls, in a ratio of approximately 4:1 to 5:1, and it often occurs with other disorders.
particular, it is estimated that 70 percent or more of individuals with autism also mental
retardation (Ghaziuddin, 2000), but that number could be an overestiman because of the
communication difficulties that accompany the disability and the suiting problems in
obtaining accurate estimates of ability. What is important to member is that some individuals
with autism spectrum disorders do not ha intellectual disabilities and may be gifted or
talented (Nash & Bonsteel, 2002). If teach a student with autism spectrum disorder, you will
find that it is both reward'
223
What Accommodations Can You Make far Students with Autism Spector) Disorders? 223
and challenging, that sometimes the student is a frustrating enigma and others times the
student's progress in learning and contributions to the school community are ex-citing.
...haracteristics of Students with Autism Spectrum Disorders kithough autism is like 'oust of
the other low-incidence disabilities in that it can exist in many forms, from mild to severe,
and cannot be treated as a single disorder with a single set of adaptations, it does have
specific characteristics.
_lOCIAL RELATIONSHIPS Students with autism have seriously impaired social relationships. Many students with autism resist human contact and social interactions from a
very early age, and they have difficulty learning the subtleties of social interac-tions (Myles
& Southwick, 1999). They often do not make eye contact with others, and they can seem
uninterested in developing social relationships. For example, typical Young children often ask
teachers to watch them do something ("Look at men, and ;hey bring interesting items to share
with the teacher and their classmates. A young child with autism, however, may not seek out
such-opportunities for social interactions. Albert, a 13-year-old with autism, discussed his
problems in the social domain.. He maintained that others viewed him as extremely ugly, but
he did not understand why he did not have friends. When an interviewer asked him what he
talked about with others, the two topics he mentioned were:mind-and smells in the

environment (Cesaroni: & ' . Garber, 1991). He did not take on the perspective of others, and
he did not understand-' that others' interests, so different from his own, also were part of
social interaction. 1 COMMUNICATION Many students with autism spectrum disorder
also experi-ence problems in both verbal and nonverbal communication (Scheuermann &
Webber, 2002). They often have significantly delayed language development, and, if they hav
'language skills, they struggle to maintain a, conversation with another person. In writingabout her experiences of being .autistic, Temple Grandin, One of the most famous
'Individuals with autism spectrum disorder and a university professor Who has designed
_.,.livestock facilities, provides clear examples of her communication problems (Grandin,
2002). She explains that when she was little she simply did not have the words to communicate, and so she frequently resorted to screaming. She also 'comments that as she grew
up, she observed others, but she did not understand how to fit in. Unlike Grandin, many
students with autism spectrum disorders cannot write or otherwise .clearly communicate
about their experiences, and they may use inappropriate behav-lots instead of words to
convey many needs. Unless taught alternative behaviors, they "might hit a peer as a as-ay of
saying hello, or run from a classroom instead of saying they do not like the assignment just
given. Some students with autism have ecbalalic speech; they repeat what others have said
instead of producing original communication. STUDENT INTERESTS Another
characteristic of students with autism is a very 'united range of interest. For example, a
student may be fascinated with radios to the exclusion of nearly everything else. \Viten
students with autism have such an interest, they can spend literally hours and hours absorbed
ha a private world of exploration. . They might act bored with every topic and every activity
unl.. . to their sine--cal interest. Such a narmw range of interest often lass a negative impact
on social re-' lationships with peers and adults because the student does not discern that
others are not as interested in their preferred topic.
RESEARCH NOTE i I II it all I Mt Facilitated communication (FC) is a controversial cam,
munication approach some-times implemented with individuals with autism. Based on the
belief that these individuals have ex-treme difficulty with ex-pressive communication, it
requires that a coach sup-port an individuars hand, wrist, or elbow, thus allow-ing that
individual to type on a computer. keyboard. Although some profession-als claim
extraordinary re-sults from this method, a review of controlled studies finds no support for
FC (Mostert, 2001).
224
224 CHAPTER 6 Students with Low-Incidence Disabilities
RESEARCH NOTE Although some individuals contend that autism can be linked to MMR
(measles-mumps-rubella) vaccine, the Centers for Disease Control and Prevention (2002)
reports that no published scientific evi-dence supports this claim.
www.ablongman.com/frien
4

STUDENT STRESS Students with autism bases low threshold for and difficultv dealing
with stress (Myles & Adreon, 2001). A change in classroom seating assign.: ments could be
difficult for a student with autism, as could the introduction of a new route trom the
classroom to o bus or an alternative order for the day's activities. Par, ticular noises or odors
or a noisy environment also can be stressful. Many student; with autism respond to stress
with stereotypic behaviors. They complete the same ac. don or motion again and again. For
example, they may rock rapidly in their chairs, spin an object repeatedly, or twirl themselves
or their arms. In other situations, students might develop a ritual to complete a task. They
might need 10 minutes to prepare to complete an assignment because they need to arrange
paper and pencil on the desk in a precise pattern. check that all books in the desk are also
stored in a specific order, an make sure the desk is aligned precisely at the intersection of tiles
on the classroom floor. In your classroom: you should be aware of potentially stressful
situations fora student with autism. Volt can allow time for the student to prepare for die
situation, talk about the situation well in advance, assign a peer partner to assist the student,
an enlist the assistance of a special educator or paraprofessional. If a student's response stress
is demonstrated with aggressive or extremely disruptive behavior, you shoal work closely
with a special educator, behavior consultant, or other specialist to addr the problem. In some
instances, the student might need to spend part of the school d in a more structured, less
stressful environment, such as the school library or learnt center.
STUDENTS WITH ASPERGER SYNDROME: One group of students with aun spectrum
disorder that should be highlighted is those with Asperger syndrome. A versity of students
may-be identified with this disability (Barnhill, Hagiwara, Myles, . Simpson, 2000):
Studeli.ts with Asperger syndrome are ch acterized by extraordinary-difficulty in social
interactions In your classroom. you as making eye contact, using facial expressions appropria
should be aWare, of potehtialiy -and.understnndingthnsemaf others, and seeking out Peers
other people, even though language and cognitive den stressful situations fora .student
.ment:aie typical. They also may have difficulty in using 1 with autism. g,uage correctly,
confusing whether to use first-person (" , second-person ("you"), or third-person ("she" or
"he") p nouns. These students also may insist on specific routines the classroom and at home,
and as noted earlier, they may have extraordinary, inter in a topic (for example. models of
aircraft, countries in Asia) to the extent that they not realize that others may not share their
interest. Many students with Asperger , drome have very high intellectual ability, and they
appropriately spend the school with peers in general education classrooms. However, because
of their difficulty social interaction, they may struggle to make friends. Carter, the student
you mesas; beginning of this chapter, has Asperger syndrome.
Accommodations for Students with Autism Spectrum Disorders Although it is impossible to
provide a comprehensive list of strategies for helping stud with autism spectrum disorders to
succeed in your classroom, the following suggestio lustrate how your efforts can make a
significant difference in these students' lives.
RESPONDING TO BEHAVIOR Students with autism spectrum disorders o have behaviors
that are unusual and can be disturbing to teachers and students wh not understand them, and
these behaviors can interfere with learning. However, m