The identification and

Remediation of Disabilities
Introduction
● Importance of early diagnosis
● Early remediation
● High to low prevalence
Learning Disability
Learning Disability
● The largest special education category
● 4 types: 1. Overall underachievement

2. Reading disabilities (most common)

3. Mathematics disabilities

4. Written expression disabilities

● Coexistent disabilities: 1. reading and mathematics most common

2. Dyslexia - reading and written expression

Learning Disability
● Unexpected underachievement
● Unable to keep pace with peers
● Cannot see the relationship between effort and accomplishment
Learning Disability
● The heterogeneity of learning disabilities challenges educators
● Each student requires a unique response
3 Types of Characteristics
● Academic
● Social
● Behavioral
Learning Disability-Academic characteristics
● Unexpected underachievement
● Difficult to teach
● Unable to solve problems
● Uneven academic abilities
● Weak basic language skills
● Poor reading skills: word reading, fluency, comprehension
● Poor poor written language skills: spelling, grammar, written
expression
Learning Disability- Academic characteristics
● Poor math skills: numbers sense, calculations, math reasoning,
problem solving
● Metacognitive and cognitive difficulties
● Memory deficits
● Unable to generalize
Learning Disability-Social Characteristics
● Immature
● Socially unacceptable behavior
● Misinterpret social and nonverbal cues
● Poor decision-making skills
● Victimized
● Unable to follow social conventions
● Rejected
● Naive
● Shy, withdrawn, insecure
● Unable to predict social consequences
Learning Disabilitity-Behavioral Style
● Inattentive
● Distractible
● Hyperactive
● Impulsive
● Poorly coordinated
● Unmotivated
● Dependent
● Disorganized
Evaluation
● IQ test
● Standardized academic achievement test
● Test neurodevelopmental function: language, memory, attention,
motor skills
Remediation
● Teach students to “learn how to learn”
● Direct instruction
● Learning strategy instruction
● A sequential, simultaneous structured multi-sensory approach
● Break learning into small steps
● Administer probes
● Regular quality feedback
● Use diagrams, graphics and pictures to augment words
● Model instructional practices
Remediation
● Ample well designed intensive practice
● Engage students with process type questions
● Scaffolding
● Explicit instruction
● Continuous assessment
● Successful Strategies for Teaching Students with Learning Disabilities. (n.d.). Retrieved from
https://ldaamerica.org/successful-strategies-for-teaching-students-with-learning-disabilities/
Speech or Language
Impairment (SLI)
SLI
● Co-occurrence with learning disability of 96%
● Most common disability of childhood
● Relationship between preschool language problems and later reading
and writing problems
● Embrace a wide variety of conditions
● Do not confuse with language delay or language difference
SLI Identification in Infant
● Challenges in response to sounds
● Atypical birth cries
● Limited response to others
● Prelock, P.A., Hutchins, T., Glascoe, F.P. (2008)
SLI Identification in Toddler and Preschool
● Limited comprehension of spoken language
● Difficult interactions with peers and others
● Delays in first words and word combinations
● Prelock, P.A., Hutchins, T., Glascoe, F.P. (2008)
SLI Identification in School age child
● Difficulties following directions
● Difficulty attending and comprehending oral and written language
● Problems producing narratives
● Problems using language appropriately in social context
● Prelock, P.A., Hutchins, T., Glascoe, F.P. (2008)
Evaluation
● Parents’ Evaluations of Developmental Status (PEDS)
● Ages and Stages Questionnaire
● Infant-Toddler Checklist for Language and Curriculum
● PEDS: Developmental Milestones (PEDS-DM)
● Pediatric Symptom Checklist
● Safety Word Inventory and Literacy Screener (SWILS)
● Prelock, P.A., Hutchins, T., Glascoe, F.P. (2008)
SLI Remediation
● Teach understanding of words and concepts through the use of actual
objects, pictures and photographs; progress from the concrete to abstract
● Consistently check understanding
● Seating position to facilitate use of prompts, cues or other strategies
● Capture student’s attention before instruction
● Use slower rate of speech as necessary
● Use role play
● Multiple activities can be useful: telephoning, reporting, video, telling jokes,
role playing
● Specific Speech and Language Disorder. Retrieved from
https://www.sess.ie/categories/specific-speech-and-language-disorders
 Attention Deficit/
Hyperactivity Disorder
(ADHD)
ADHD
● Many symptoms overlap other disabilities
● Many diagnosed with ADHD are already being treated for a disability
ADHD Identification
3 main characteristics

● Hyperactivity: 1. Fidgeting or squirming in seat

2. Not remaining seated when expected

3. Inappropriately running or climbing

4. Difficulty engaging quietly in leisure activities

5. Excessive talking

● Impulsivity
● Inattention
ADHD Diagnosis (DSM-5)
● Inattention or Hyperactivity-Impulsivity must persist for at least 6 months
● Either condition must be maladaptive and inconsistent with development and
must include at least 6 of the symptoms listed
DSM-5 Inattention Symptoms
● Fails to give close attention to details, careless mistakes
● Difficulty sustaining attention
● Does not seem to listen when spoken to directly
● Does not follow through and fails to finish
● Difficulty organizing
● Avoids engagement in tasks requiring sustained mental effort
● Often loses things needed for tasks or activities
● Often forgetful of daily activities
DSM-5 Hyperactivity-Impulsivity Symptoms
● Often fidgets or squirms
● Often leaves seat inappropriately in class
● Often runs about or climbs excessively
● Often has difficulty playing or engaging in leisure quietly
● Often “on the go” or “driven by a motor”
● Often talks excessively
● Often blurts out answer before question finished
● Often has difficulty awaiting turn
● Often interrupts or intrudes on others
ADHD Remediation
● <6 years old behavior therapy is first line before medication added
● >6 years old behavior therapy and medication suggested
● The goals of behavior therapy are to learn and strengthen positive behavior
and eliminate unwanted or problem behavior.
● Behavior therapy is the initial treatment for <6 year old:

1. as it works as well as medication in this age group

2. It gives parents skills and strategies to help their child

3. due to higher level of side effects in this age group

4. long term effects not well-studied

● Attention-Deficit/Hyperactivity Disorder (ADHD). (n.d.). Retrieved from

https://www.cdc.gov/ncbddd/adhd/treatment.html
ADHD Remediation
Medication

● Many students with ADHD receive medication

● Ritalin, Dexedrine, Concerta
● Medication does help focus attention and reduce hyperactivity
● Does not have a positive effect on academic performance
● Should be considered a last resort
 Intellectual and
Developmental Disabilities
Diagnostic Feature 1
A deficiency of cognitive ability. An IQ of 70, which corresponds to at least two
standard deviations below the mean or average IQ of 100, is generally considered
the cut off for ID.
Diagnostic Feature 2
Limited adaptive behavior expressed in

1. Conceptual skills: language, literacy, concepts of numbers and time, setting

goals
2. Social skills: interpersonal skills, ability to follow rules and law, avoid being
victimized
3. Practical skills: personal care, occupational skills, healthcare
Diagnostic Feature 3
Onset before age of 18
Characteristics
● difficult to remember events or the proper sequence
● low motivation
● difficulty with problem solving
● learned helplessness
● socially marginalized
● can be independent and well adjusted as adults
Characteristics
● An impaired cognitive ability causes extensive detrimental effects for the
individual with ID.
● Difficulties learning new skills, remembering and transferring knowledge to
new and different situations.
● Short-term and long-term memory is impaired.
● Things can be remembered incorrectly, slowly or without adequate detail.
Signs and Symptoms
● Difficulty communicating and socializing
● Low IQ score
● Difficulty talking or delayed talking
● Difficulty remembering
● Unable to connect actions with consequences
● Inability to perform everyday tasks such as getting dressed or inability to
independently use a bathroom
Remediation
● Communication Intervention
● Appropriate personalized supports over sustained periods will improve the
level of life functioning
● With explicit systematic instruction and and delivery of supports, adaptive
behavior can improve
● Behavioral intervention
● Peer-Mediated /Implementation/Implemented Treatment
● Intellectual Disability. (n.d.). Retrieved from
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942540&section
Emotional Behavioral
Disorders (EBD)
EBD Externalizing Behaviors
● Undercontrolled and acting-out style
● Aggressive-physically and mentally
● Arguing
● Impulsive
● Coercive
● Noncompliant
● High level of irritating behavior
● Bullying
● Antisocial behavior
● Violates basic right of others
EBD Externalizing Behaviors
● Tantrums
● Hostile and defiant
● Ignores teachers’ reprimands
● Causes or threatens physical harm to people and/or animals
● Steals, causes property damage
● Uses lewd or obscene gestures
● hyperactive
EBD Internalizing Behaviors
● Overcontrolled and inhibited style
● Withdrawn
● Lonely
● Depressed
● Anxious
● Self-harm
● Mental disease: affective disorders, anxiety disorders, schizophrenic
disorders Delusions, loosening of associations), eating disorders
EBD Remediation
● Zero tolerance policies are too be avoided as they can be harmful to students
● Recent research promotes academically-focused interventions
● Peer-assisted learning strategies, class-wide peer tutoring and self-
management interventions are recognized as effective
● Self-management techniques: self-evaluation, self-instruction, self-monitoring,
goal-setting, strategy instruction
● Tiered intervention, RTI and PBIS, are effective
● Effective Programs for Emotional and and Behavioral Disorders. (2013).
Retrieved from
https://www.district287.org/uploaded/A_Better_Way/EffectiveProgramsforEm
otionalandBehavioralDisordersHanover2013.pdf
 Health Impairments
or
Special Health Care Needs
Special Health Care Needs
2 major categories

● Those with chronic illness: asthma, cystic fibrosis, diabetes , congenital

heart conditions, TB, childhood cancer, blood disorders
● Those with infectious disease: HIV/AIDS, STORCH, hepatitis B
Special Health Care Needs-Characteristics
● Health care needs can be so burdensome everything else becomes
secondary
● Symptoms may be secondary to the illness or condition; or to medications
and treatments
● May experience times when they are too sick for education
● May be home-bound
● Barriers to learning: fatigue, absences, inconsistent ability to pay attention,
muscle weakness, lack of physical coordination
Special Health Care Needs
● Identification/diagnosis made medically, should be evident
Special Health Care Needs-Remediation
● UDL strategies should help these students participate in general and special
education
● Internet-based online schooling may be helpful
● Accessing the general education curriculum from a distance (ie. Skype, etc)
should be available to these students
● home-bound/hospital instruction
Autism Spectrum Disorders
(ASD)
ASD

More children are being diagnosed with ASD. This may reflect:

● Improved diagnostic techniques

● Broader and more inclusive definitions
● It is still a low-incidence disability affecting .6% of school age children
ASD: DSM-5 criteria
A. Persistent deficits in social communication and social interaction across
multiple contexts
● Deficits in social-emotional reciprocity: back-and -forth conversation,reduced
sharing of interests and emotions; failure to initiate or respond to social
interactions
● Deficits in nonverbal communication: abnormalities in eye contact and body
language, deficit in the understanding and use of gestures; to lack of facial
expression and nonverbal communication
● Deficits in developing, maintaining and understanding relationships:
difficulties in adjusting behavior, difficulty making friends; absence of interest
in peers
ASD: DSM-5 criteria
B. Restricted repetitive patterns of behavior, interests or activities
manifested by at least 2 of the following:

● Stereotyped or repetitive motor movements, use of objects or speech (lining

up toys, echolalia)
● Insistence on sameness, inflexible adherence to routines, ritualized patterns
of verbal and nonverbal behavior (extreme distress at small changes, difficulty
with transitions, rigid thinking patterns, need to eat same food every day)
● Highly restricted, fixated interest which are abnormal in intensity or focus
● Hyper or hypo-activity to sensory input or unusual interest in sensory aspects
of the environment (apparent indifference to pain/temperature, adverse
response to specific sounds or textures, excessive smelling or touching of
objects, visual fascination with lights or movement)
ASD: DSM-5 criteria
C. Symptoms must be present in early developmental period

D. Symptoms cause clinically significant impairment in social, occupational, or

other important areas of functioning

E. These disturbances are not better explained by intellectual disability (ID) or

global developmental delay. ASD and ID frequently co-occur.

DSM-5 also provides criteria to grade severity: Level 1, Level 2, Level 3

ASD Remediation
● Family involvement important
● Set goals based on assessment that target deficits, consider family priorities
● Focus on initiating spontaneous communication and reciprocal
communication and generalize across activities, environments and others
● Use a multimodality communication system that is individualized
● Incorporate cultural, linguistic and personal values into therapies
● Use a range of approaches to enhance communication skills
● Use developmental sequences and processes of language development to
provide a framework for determining baselines
● Measure progress using systematic methods to assess benefit of treatments
● Autism. (n.d.). Retrieved from
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935303&section=
Treatment
Multiple Severe Disabilities
(MSD)
MSD
● Largest group within low-incidence disabilities
● Adults were institutionalized in the past
● Today many live in group homes
● Each individual is unique
MSD Identification
● A combination of conditions which impact a student’s ability to learn and
achieve success
● Includes students with the most severe physical, cognitive, communication
impairments
● Average or above-average intelligence
● 2 or more coexisting impairments
● Generally need extensive support
● Cannot be accommodated in special education programs solely for one of
the impairments
● Multiple Disabilities. (n.d.). Retrieved from
http://www.projectidealonline.org/v/multiple-disabilities/
MSD Characteristics
● Limited speech or communication
● Mobility difficulties
● Tendency to forget skills through disuse
● Difficulty generalizing skills
● Need support for major life activities
MSD Remediation
● Multidisciplinary support: including physical therapists and assistive
technology personal
● Peer tutoring: proven to have positive results, must be reciprocal
● Assistive Technology (AT): an effective tool, hand-held computer with
specialized software can provide independence
● Augmentative and Alternative Communication: For student who cannot
otherwise communicate because of physical and cognitive impairments. Use
of AAC has increased due to advances in technology and EBR. Examples
include choice boards and techniques reliant of computers and microswitches.
● Multiple Disabilities. (n.d.). Retrieved from
http://www.projectidealonline.org/v/multiple-disabilities/
Developmental Delay
(DD)
DD-IDEA
● Ages 3 to 9 years of age
● Allows a child with a disability to receive special education before the specific
disability can be identified
● Delaying diagnosis may avoid 1) misdiagnosis of disability in child that me be
developing slowly and may catch up; 2) misdiagnosis the specific disability
DD Characteristics
● General developmental delay based on developmental milestones at certain
ages (2 months, 4 months, etc)
● Developmental milestones include assessments of first step, first smile; other
milestones evaluate when and how children play, learn and move (crawl,
walk)
DD Remediation
● Treatment individualized based on deficit and age
● Check vision and hearing
● Intervention can include: speech and language therapy, occupational therapy,
physical therapy, behavior therapy
Physical Disabilities
(PD)
PD
● IDEA 2004 uses the term orthopedic impairments
● 2 major groups: Neuromuscular impairment & Musculoskeletal conditions
● Neuromuscular impairment: seizure disorder (most common impairment in
school), cerebral palsy, multiple sclerosis, muscular dystrophy, polio, spinal
cord disorders
● Musculoskeletal conditions: juvenile arthritis, limb deficiencies, skeletal
disorders
PD Characteristics
● Physical disability and cognitive disabilities not linked
● Characteristics depend on the affliction
● Poor muscle control
● Impaired mobility
PD identification
● Medical diagnosis
PD Remediation
● All schools must meet the special architectural codes required by the
Americans with Disabilities Act
● Classroom accommodations: The student may need more room to move
around a classroom, or require a larger desk
● Assistive technology and services based upon need
Deaf and Hard of Hearing
Deaf and Hard of Hearing
● The deaf have hearing loss is so severe with or without hearing aids or
assistive hearing device it seriously affects the ability to process spoken or
auditory information by hearing
● Hard of hearing have a less profound loss of hearing
● Undiscovered hearing loss and deafness can affect development and have
lasting consequences
Conductive hearing loss
● Sound waves prevented from reaching the inner ear due to damage to the
outer or middle ear
● Mild to moderate disability
Sensoroneural hearing loss
● Damage to inner ear or auditory nerve
● Less common
● Hear frequencies at different sensitivity levels, uneven hearing loss
● Less amenable to correction
Age at loss of hearing-Prelingual
● Hearing loss before they can speak or understand language
● Seriously affects the ability to communicate with others and learn
academically
● Many learn with a combination of sign language and oral communication
Age at loss of hearing-Postlingual
● Hearing loss after they have learned to speak and understand language
● Many are able to retain their ability to use speech and communicate orally
Recognition-Screening
● NIH recommends screening of all newborns by 3 months of age
● Due to cost of screening this has not been implemented
● Auditory Brain Response (ABR): most often used, examines the brain’s
response to sound
● Evoked Otoacoustic Emissions (EOAE): monitors sounds produced in the
inner in response to stimulation
Screening in 2010
● Hearing loss is not identified in babies today prompting calls for universal
screening
● 1 in 1000 babies have congenital hearing loss
● Average age of diagnosis between 14 months and 36 months
● Undiagnosed hearing loss is expensive
● NIH recommends screening of all newborns by 3 months of age
● 85% of babies not screened in hospital
● NIH recommends screening of all newborns by 3 months of age
● Due to cost of screening this has not been implemented
● Detecting Hearing Loss in Infants and Young Children. (2010). Retrieved from
https://www.nidcd.nih.gov/newsletter/2000/winter/detecting-hearing-loss-
infants-and-young-children
Screening in 2014 (Progress!)
● 96.1% of infants screened before 1 month of age
● 6,163 infants were diagnosed with permanent hearing loss
● Screening targets permanent childhood hearing loss
● The onset of hearing loss can occur at any time
● Therefore developmental milestones, , hearing skills and and speech and
language milestones should be monitored in all children
● Newborn Hearing screening. (n.d.). Retrieved from
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935234&section=
Key_Issues
Remediation (providing access)
● The earlier intervention begins the more likely speech, language and social
skills will reach their full potential
● Technology: hearing aids, cochlear implants, bone-anchored hearing aids,
other assistive devices (FM system, captioning, text messaging, telephone
amplifiers, flashing and vibrating alarms, audio loop systems, portable sound
amplifiers, TTY (Text Telephone or teletypewriter)
● Surgery: for certain causes
● Hearing Loss in Children. (2018). Retrieved from
https://www.cdc.gov/ncbddd/hearingloss/language.html
Remediation (providing access)
● Communication Tools such as American Sign Language (ASL) which is now
taught in colleges to college students. Other techniques include Manually
Coded English (MCE), Conceptually Accurate Signed English (CASE), cued
speech, fingerspelling, natural gestures, listening/auditory training, spoken
speech, speech reading,
● Hearing Loss in Children. (2018). Retrieved from
https://www.cdc.gov/ncbddd/hearingloss/language.html
Remediation
● Visual supports: captioning, visual cues, props, graphic organizers,
educational interpreters
● Decrease background noise (FM system, etc)
● Decrease “visual noise” with better lighting and fewer visual distractors
● Positive influences: high family and school expectations, family support,
appropriate services and trained providers (should be in IEP); good
communication between providers
Visual Disabilities
Visual Disability
● 64% spend over 80% of their time in general education
● 2 subgroups: blind (may see shadows or some motion), low vision (use sight
for school activities including reading)
● Congenital blind: onset at birth or during infancy
● Adventitiously blind: onset after age of 2; they can remember objects
Characteristics
● Vast majority use vision as primary method of learning
● Residual vision can be developed through training and practice
● Participate in inclusive classrooms at a high rate
● The impact of the visual disability depends on age of onset, severity type of
visual loss and coexisting disabilities
● Students have a limited ability to learn incidentally from their environment
Identification
● Medical diagnosis made during physical examination and surveillance of
developmental landmarks
Remediation
● Must be taught compensatory skills and adaptive techniques in order to
acquire knowledge
● “Expanded core curriculum”: communication skills, social interaction skills,
orientation and mobility, independent living skills, recreation and leisure skills,
use of assistive technology, visual efficiency, career education skills and self-
determination.
● Classroom accommodations should be individualized. Access to to textbooks
and instructional materials is essential. This can include Braille, recorded
media, large print text, optical devices and computers.
● Visual Impairments. (n.d.). Retrieved from
http://www.projectidealonline.org/v/visual-impairments/
Remediation-Assistive Technology
● Reading glasses
● Braille translation software and printer
● Braille notetaker, electronic Braille writer
● Screen reader
● Screen enlargement software
● Talking calculator
● Magnifiers,
● Telescopes
● Visual Impairments. (n.d.). Retrieved from
http://www.projectidealonline.org/v/visual-impairments/
Traumatic Brain Injury
(TBI)
TBI
● TBI became a distinct special education category with IDEA 1990, reflecting
improved survival secondary to medical advances
● In many cases effects are mild and symptoms resolve
● Injuries which are more severe can lead to permanent brain damage or death
● Recent concerns regarding chronic traumatic encephalopathy (CTE)
(especially in professional foootball players) and the unknown sequelae of
repeated concussions in school-age children (will this also lead to CTE?)
Identification
● TBI symptoms may not occur for days to weeks following the injury
● Concussion is the mildest form: headache, neck pain, nausea, dizziness,
ringing in the ears, tiredness
● Moderate to severe TBI have additional symptoms: worsening or persistant
headache, repeated nausea or vomitting, seizures, inability to awaken from
sleep, slurred speech, weakness or numbness in arms or egs, dilated eye
pupils
Identification
Additional signs of concussion and TBI that educators and parents should be
aware of after head trauma:

● Appears dazed and stunned

● Acts differently
● Confusion
● Answers questions slowly
● Difficulty thinking, remembering, concentrating
● Feeling more slowed down
● If present get immediate medical care
Identification
● Chronic physical sequelae of TBI are documented with medical examinations
and imaging (CT and MRI)
Remediation
● Depends on severity
● Full recovery possible for mild TBI with medical treatment. However the
student is vulnerable to additional episodes. Any potential cause of trauma
should be eliminated.
● More severe injuries may require hospitalization and surgery. When the
student has stabilized deficits can be assessed. they may require physical
therapy, occupational therapy, speech therapy, psychological counseling,
vocational counseling or cognitive therapy. These should be included in the
IEP.
Remediation
● A student’s instructional goals and strategies may change depending upon
the injury
● Provide repetition and consistency
● Avoid figurative language
● Reinforce lengthening periods of attention
● Probe skill acquisition frequently with repeated practice
● Teach compensatory strategies to increase memory
● Be cognizant of reduced stamina, provide rest periods
● Distraction-free environment
● Employ assistive technology and services as well as classroom
accomodations as needed
● Traumatic Brain Injury. (2013). Retrieved from
http://www.projectidealonline.org/v/traumatic-brain-injury/
Deaf-Blindness
Deaf-Blindness
● Many have residual hearing and/or vision
● Most have other disabilities such as intellectual disability and developmental
disability
● Cannot be accommodated by special education programs solely meant for
visual disability or deaf and hard of hearing alone.
● Most need considerable support
● Exceptionally restricted world
● Isolation, communication and mobility are critical issues
Identification
● Many disparate etiologies
● Medical history
● Assessment of deficiencies
Remediation-Teaching strategies
Communication is essential for the child to access the surrounding environment.

● Exploring objects in a “nondirective” manner, student has control

● Allow time to respond due to slow response times
● Symbolic communication: touch cues, object symbols, sign language,
gestures, picture symbols, Braille, lip-reading speech, large print
● Deaf-Blindness. (2013). Retrieved from
http://www.projectidealonline.org/v/deaf-blindness/
Remediation-Assistive technology
● These students can now access the general education curriculum through the
use of technology
● The AT devised for visual disabilities and deafness and hard of hearing can
also be helpful for deaf-blindness
● Deaf-Blindness. (2013). Retrieved from
http://www.projectidealonline.org/v/deaf-blindness/