Exceptional Learners Chapters 13-15

Prevalence of Giftedness

Fed reports and legislation have assumed that 3% to 5% of the U.S. school population could be considered to have special gifts or talents. The prevalence of giftedness is a function of the def that's used; if giftedness is defined as the top x percent on a given criterion, the question of prevalence has been answered. Of course, if x percent refers to a percentage of a national sample, the prevalence of gifted pupils in a given school or cultural group may vary from that of the comparison group, regardless of the criteria that are used to measure performance.

Intro to Learners with Low-Incidence, Severe, and Multiple Disabilities

The def of low-incidence, severe, and multiple disabilities, like the def of all other categories of disabilities is controversial. Disabilities are particularly mystifying when they're seldom seen, multiple, or severe. The causes and meanings of such disabilities, and the life course of the people who have them, may be particularly difficult to understand.

Prevalence and Need of Physical Disabilities and OHI

o 1% of the school-age pop (about 500,000) are classified as having physical disabilities. About 75,000 of these have orthopedic disabilities, but the majority has other health probs. o Increase in percentage of school pop served by SPED due to health probs. However, the needs of many students with physical disabilities are unmet because the number of kids and youths with such disabilities is growing, and health and social service programs aren't keeping up. Increases in prevalence might be due to improvements in the identification of and med services provided to kids with certain conditions. Many kids with severe and multiple disabilities and those with severe, chronic illnesses or severe injuries, who in the past wouldn't have survived long, can now live a normal lifespan. Improvements in med care might not lower number of people with disabilities unless there's also a lowering of risk factors in the environment (accidents, toxic substances, poverty, malnutrition, disease, and interpersonal violence).

Psychological and Behavioral Characteristics of Learners with Physical Disabilities and OHI

o Academic Achievement: impossible to make many valid generalizations about the academic achievement of kids with physical disabilities because they vary so widely in nature and severity of their conditions. The environmental and psychological factors that determine what a kid will achieve academically are also extremely varied, and generalizations about academic outcomes are impossible. Many students with physical disabilities have erratic school attendance because of hospitalization, visits to physicians, bed-rest requirements, and so on. Some learn well with ordinary teaching methods; others require special methods because they have intellectual disability or sensory impairments in addition to physical disabilities. Because of the frequent interruptions in their schooling, some fall considerably behind their age peers in academic achievement, even though they have normal intelligence and motivation. The two major effects of a physical disability, especially if it is severe or prolonged, are that a child might be deprived of educationally relevant experiences and that they might not be able to learn to manipulate educational materials and respond to educational tasks the way most children do. Some children with mild or transitory physical problems have no academic deficiencies at all; others have severe difficulties. Some students who have serious and chronic health problems still manage to achieve at a high level. Usually, these high-achieving children have high intellectual capacity, strong motivation, and teachers and parents who make every possible special provision for their education. Children with neurological impairments are, as a group, most likely to have intellectual and perceptual deficits and therefore to be behind their age peers in academic achievement. o Personality Characteristics: Those with physical disabilities are as varied in their psychological characteristics as kids without disabilities, and they're apparently responsive to the same factors that influence the psychological development of other children. How children adapt to their physical limitations and how they respond to social-interpersonal situations greatly depend on how parents, siblings, teachers, peers, and the public react to them. § Public Reactions: Public attitudes can have a profound influence on how kids with physical disabilities see themselves and on their opportunities for psychological adjustment, education, and employment. If the reaction is one of fear, rejection, or discrimination, they might spend a great deal of energy trying to hide their stigmatizing differences. If the reaction is one of pity and an expectation of helplessness, they'll tend to behave in a dependent manner. To the extent that other people can see children with physical disabilities as people who have certain limitations but are otherwise just like everyone else, children and youths with disabilities will be encouraged to become independent, productive members of society. Several factors seem to be causing greater public acceptance of people with physical disabilities. Professional and civic groups encourage support and decrease fear of people with disabilities through information and public education. People with physical disabilities are increasingly visible in the media, and they are often portrayed in a more realistic and positive light. Government insistence on the elimination of architectural barriers that prevent citizens with disabilities from using public facilities serves to decrease discrimination. Programs to encourage hiring workers with disabilities help the public to see those with physical disabilities as constructive, capable people. Laws that protect every child's right to public education bring more individuals into contact with people who have severe or profound disabilities. But many children with physical disabilities are still rejected, feared, pitied, or discriminated against. The more obvious the physical flaw, the more likely it is that the person will be perceived in negative terms by the public. Public policy regarding kid's physical disabilities has not met the needs of most of these children and their families. In particular, as successful medical treatment prolongs the lives of more and more children with severe, chronic illnesses and other disabilities, issues of who should pay the costs of treatment and maintenance and which children and families should receive the limited available resources are becoming critical. § Kid's and Families' Reactions: children's reactions to their own physical disabilities are largely a reflection of how others respond to them. Shame and guilt are learned responses; kids will have such negative feelings only if others respond to them by shaming or blaming them for their physical differences. Children will be independent and self-sufficient (within the limits of their physical disabilities) rather than dependent and demanding only to the extent that they learn how to take care of their own needs. And they will have realistic self-perceptions and set realistic goals for themselves only to the extent that others are honest and clear in appraising their conditions. The desire to participate in the same activities as most kids and the fantasy that the disability will disappear are to be expected. With proper management and help, kids can eventually accept their disability and live a happy life. Fear and anxiety are also to be expected—proper management can minimize emotional stress. Imp considerations regarding psychological effects include age of kids and nature of the limitation, but these factors aren't uniform in their effects. Managing the consequences of the child's behavior is a crucial aspect of education and rehabilitation. Adolescence is a difficult time for most parents, and the fact that a child has a physical disability does not necessarily mean that the family will find a youngster's adolescence more difficult or less difficult. Family support, school experiences, medical treatment, and attitudes have a very significant effect on the life of a child with a chronic health problem. Besides the school and society at large, the family and its cultural roots are important determinants of how and what children with physical disabilities will learn; therefore, it's important to take cultural values into account in teaching children not only about the academic curriculum but about their disability as well.

Prevention of Physical Disabilities

o Although some physical disabilities aren't preventable by any available means, many or most are. For instance, failure to wear seat belts, helmets, and other safety devices accounts for many disabling injuries. Likewise, driving under the influence of alcohol or other drugs, careless storage of drugs and other toxic substances, careless storage of firearms, use of alcohol and other drugs during pregnancy, and a host of unsafe and unhealthful practices that could be avoided cause many disabilities. For example, lowering the incidence of obesity and increasing healthful diet and healthful physical activity could do much to prevent health complications of children, particularly diabetes. o Teenage moms are more likely than older women to be physically battered. Teens are also more likely to give birth to premature or low-birthweight babies, and these babies are at high risk for a variety of psychological and physical problems when they reach school age. Thus, preventing adolescent pregnancies would keep many babies from being born with disabilities. Inadequate prenatal care, including maternal infections and inadequate maternal nutrition during pregnancy, also contributes to the number of babies born with disabilities. And for young kids, immunization against preventable childhood diseases could lower the number of those who acquire disabilities. o Child abuse is a significant contributing factor in creating physical disabilities in the US, and its prevention is a critical prob. Teachers can play imp role in detecting, reporting, and preventing child abuse and neglect because, next to parents, they spend the most time with kids. o Kids who're already disabled physically, intellectually, emotionally, are more at risk for abuse than are kids without disabilities. Kids with disabilities are more vulnerable and dependent—easy targets for abuse. Some of the characteristics of kids with disabilities are sources of additional stress for their caretakers and may be contributing factors in physical abuse. Kids with disabilities are disproportionately represented among abused kids and need for training is great for parents of kids with disabilities. o Phenylketonuria (PKU) is thought of as a prob associated with intellectual disability, but it's also an issue involving other disabilities. Inborn metabolic disorders can result in intellectual disability and in other disabilities associated with brain damage. Metabolic disorders may result in the buildup of neurotoxins, which can cause any of the disabilities associated with brain damage.

Other Conditions Affecting Health or Physical Ability

o An extremely wide array of diseases, physiological disorders, congenital malformations, and injuries can affect students' health and physical abilities and create a need for SPED and related services. Chronic diseases and health conditions of children have increased dramatically during recent decades. These diseases and health-related conditions include childhood obesity, diabetes, and asthma. o Special educators need to be familiar with the range of physical disabilities and the types of accommodations that might be necessary to provide an appropriate education and related services. Moreover, teachers should understand that chronic diseases make many children's lives complicated and difficult because of possible hospitalizations, restrictions of activity, medications, teasing, and other consequences that, essentially, rob children of the experiences most of us associate with being kids o Asthma is an increasingly common lung disease characterized by episodic inflammation or obstruction of the air passages such that the person has difficulty in breathing. Usually, the difficulty in breathing is reversible (i.e., is responsive to treatment). Severe asthma can be life threatening, and in some cases, it severely restricts a person's activities. The disease can also get better or worse for poorly understood reasons, and the unpredictability of the condition can make finding satisfactory treatment difficult. o Cystic fibrosis (CF) is the most common autosomal recessive disease that leads to death. CF affects the lungs and the pancreas when the exocrine system produces a thick mucus that blocks the pancreatic ducts, the bronchi, and the intestines. Chronic illness in children with CF often means absences from school, which can be challenging to academic achievement. In recent years medical advances have led to longer life expectancies of individuals with CF (late 30s). o Congenital malformations and disorders can occur in any organ system, and they may range from minor to fatal flaws in structure or function. In many cases, the cause of the malformation or disorder isn't known; other conditions are known to be hereditary or caused by maternal infection or substance abuse (including alcohol, by the mom during pregnancy. o More accidents each year. Many of those who don't acquire TBI receive spinal cord injuries that result in partial or total paralysis below the site of the injury. Others undergo amputations or are incapacitated temporarily. o Children with acquired immune deficiency syndrome (AIDS) often acquire neurological problems, including intellectual disability, cerebral palsy, seizures, and emotional or behavioral disorders. Infants may contract the disease during the birth process. Although HIV does often result in neurological damage and cognitive impairment, it appears that at least in some cases the damage may be reversible with state-of-the-art drug therapies o Fetal alcohol spectrum disorders result in disabilities acquired by children of moms who abuse alcohol during pregnancy. The abuse of other substances by moms also has negative implications for their children. If the mom is a substance abuser, then the probability of neglect and abuse by the mother after her baby is born is also high. Many women who are intravenous drug users not only risk chemical damage to their babies, but also might give them venereal diseases such as syphilis, which can result in disabilities. Children of mothers who are intravenous drug users are also at risk for being born with AIDS. o Programs for students who are medically fragile must be particularly flexible and open to revision. Daily health care plans and emergency plans are essential, as are effective lines of communication among all who are involved with the student's treatment, care, and schooling. Decisions regarding placement of these students must be made by a team that includes health care providers and school personnel as well as the students and their parents. o Whether it's appropriate for children who're dependent on ventilators or other med tech to attend general education is debatable. Educators and parents together must make decisions in each individual case, weighing medical judgment about danger to the child as well as the interest of the child in being integrated with peers into as many typical school activities as possible.

Educational Considerations for Many Students with Low-Incidence, Multiple, and Severe Disabilities

o Augmentative and Alternative Communication (ACC): For some individuals with severe and multiple disabilities, oral language is out of the question; they have physical or cognitive disabilities, usually as a result of neurological damage, that preclude their learning to communicate through normal speech. Educators and professionals must design a system of augmentative and alternative communication (AAC) for them. AAC includes any manual or electronic means by which such a person expresses wants and needs, shares information, engages in social closeness, or manages social etiquette. Some of these individuals can't make any speech sounds at all; others need a system to augment their speech when they cannot make themselves understood because of environmental noise, difficulty in producing certain words or sounds, or unfamiliarity with the person with whom they want to communicate. Manual signs or gestures are useful for some individuals. But many individuals with severe physical limitations can't use their hands to communicate through the usual sign language; they must use another means of communication, usually involving special equipment. Dr. Nikki Kissane, now a surgeon, developed a simplified sign language system while a University of Virginia undergraduate student. Children and adults with limited speech capabilities can learn and use her simplified signs more easily than traditional signs. The problems to be solved in helping individuals communicate in ways other than signing include selecting a vocabulary and giving them an effective, efficient means of indicating elements in their vocabularies. Although the basic ideas behind AAC are quite simple, selecting the best vocabulary and devising an efficient means of communication for many individuals with severe disabilities are extraordinarily challenging. As one AAC user put it, "The AAC evaluation should be done with the AAC user involved in the process from step one. It is the augmented speaker who will be using the device every day, both personally and professionally, not the AAC specialist." A variety of approaches to AAC have been developed, some involving relatively simple or so-called low-technology solutions and some requiring complex or high-technology solutions. Many different direct-selection and scanning methods have been devised for AAC, depending on individual capabilities. The system that is used may involve pointing with the hand or a head-stick, eye movements, or operation of a microswitch by foot, tongue, or head movement or breath control. Sometimes, the individual can use a typewriter or computer terminal that is fitted with a key guard so that keys are not likely to be pressed accidentally or use an alternative means for selecting keystrokes. Other students use communication boards, which offer an array of pictures, words, or other symbols and can be operated with either a direct-selection or scanning strategy. The content and arrangement of the board will vary, depending on the person's capabilities, preferences, and communication needs. Some researchers are trying to make it possible for young AAC users to talk about same stuff as others youngsters do, and some are training AAC users to tell those with whom they communicate how to interact with them more effectively (train AAC users in pragmatics). AAC challenges: Slower than natural communication, Relies on a vocabulary selected by others when users are illiterate, and Must be constructed for variety of social contexts, allow accurate and efficient communication without undue fatigue, and support the person's learning of lang and academic skills. The remarkable increase in the power and availability of microcomputers (including small devices such as tablets and smartphones) is radically changing the ability to provide AAC and make sure that the user's words are communicated. New ways of using computer-based devices and new apps for such devices may lead to breakthroughs that will allow people with severe disabilities to communicate more effectively, even if they have extremely limited muscle control. Furthermore, existing software suggests ways of encouraging children to use their existing language skills. Parents need to be aware of the availability of AAC and demand equipment and training that are effective for their kid. o Behavior Problems: self-stimulation, self-injury, tantrums, aggression toward others, or combo of these. Must find solutions to these probs in treating the person with respect and helping them participate in typical school and community activities. Controversy—some assume that behavior probs won't occur if appropriate programs of instruction are provided and others suggest that functional behavioral assessment (FBA), positive behavioral support (PBS), and nonaversive treatments will be sufficient in all cases. Others claim positive behavioral supports and nonaversive treatments are insufficient in some cases. § Self-Stimulation: any repetitive, stereotyped behavior that seems to have no immediately apparent purpose other than providing sensory stimulation. Self-stimulation (a form of stereotyped movement) may take a wide variety of forms, such as swishing saliva, twirling objects, hand-flapping, fixed staring, and the like. Repetitive, stereotyped behavior (sometimes called stereotypy) may have multiple causes, including social consequences, in addition to sensory stimulation. The high rate, lack of subtlety, and social inappropriateness of such self-stimulation differentiate it from the norm. Self-stimulation becomes problematic when it occurs at such a high rate that it interferes with learning or social acceptability or when it occurs with such intensity that it does injury. Some individuals with autism or other pervasive developmental disabilities engage in self-stimulation to the exclusion of academic and social learning. In most of these cases, it appears that only intrusive, directive intervention will be successful in helping the individual learn academic and social skills. § Self-Injurious Behavior (SIB): repeated physical self-abuse, such as biting, scratching, or poking oneself, head-banging, etc. Unchecked, often results in self-mutilation. Self-stimulation an be so frequent and intense that it becomes SIB. § Tantrums: Severe tantrums can include a variety of behaviors, including self-injury, screaming, crying, throwing or destroying objects, and aggression toward others. Sometimes, the event that sets off a tantrum is unknown, at least to the casual observer. Often, however, a tantrum is precipitated by a request or demand that the individual do something (perhaps a self-care task or some academic work), and the consequence of the tantrum is that the demand is withdrawn, thus reinforcing the tantrum behavior. Tantrums impose a handicap on the individual who uses them to avoid learning or doing important things. They stymie socialization. Teachers who work most successfully with those with tantrums don't withdraw reasonable demands for performances—they modify their demand or circumstance in some way or alternate their demands for performance in ways that are less likely to set off a tantrum. § Aggression Toward Others: sometimes without warning or only after subtle indications of imminent assault that only someone who knows the person well is likely to perceive. § Lack of Daily Living Skills: the absence or significant impairment of the ability to take care of one's basic needs, such as dressing, feeding, or toileting. Many people with severe and multiple disabilities must be taught the adaptive behavior that's expected of older kids and adults. These adaptive behaviors include a wide variety of tasks involving clothing selection and dressing, food prep and eating, grooming, socializing, using money, using public transportation, playing games or other recreation, etc. § Functional Behavioral Assessment (FBA) and Positive Behavioral Intervention and Support (PBIS): Teachers are focusing on the immediate and alterable influences on behavior rather than on immutable or historical reasons for behavior. FBA entails finding out why or under what circumstances prob behavior is exhibited, and PBIS involves creating an environment that supports positive behavior. FBA often reveals how a student uses self-stimulation, SIB, tantrums, or aggression against others. A student might behave inappropriately to escape or avoid unpleasant or nonpreferred activities or tasks. In many instances, researchers and practitioners find that the student has no other effective and efficient means of communication. The task, therefore, is to figure out how the student is using unacceptable communication and teach the student a more effective, efficient, and acceptable means of letting others know what they want or is feeling. FBA has led to the discovery that sometimes people with severe and multiple disabilities use inappropriate behavior to communicate a variety of their wants or needs. PBIS is the vehicle for teaching students how to behave more appropriately. Making PBIS a part of managing behavior across school, home, neighborhood, and community is particularly important. Strategies of PBIS: remove high-frustration activities, select functional and meaningful curricula, reduce fear/anxiwty about a situation through precorrection, teach more appropriate ways to make requests/express oneself, use behavior modification to reinforce desired behaviors and communicate non-acceptability, and create activities that build on student interest and strength.

Transition to Adulthood for the Gifted

o By adolescence, these students tend to be aware of their relative strengths and weaknesses. o In many ways, transitions for these youths tend to mirror the problems in transitions faced by adolescents and young adults with disabilities. Not all adolescents and young adults with special gifts or talents take transitions in stride. Many need personal and career counseling and a networking system that links students to school and community resources. o If there is a central issue in the education of adolescents with special gifts or talents, it is that of acceleration versus enrichment. Proponents of enrichment believe that these students need continued social contact with their age peers. They argue that such students should follow the curriculum of their age peers and study topics in greater depth. Proponents of acceleration believe that the only way to provide challenging and appropriate education for students with special gifts and talents is to let them compete with older students. These educators argue that because the cognitive abilities of these students are advanced beyond their years, these students should proceed through the curriculum at an accelerated pace. o Acceleration for adolescents with special gifts or talents can mean enrollment in advanced placement courses, early entrance to college, or enrollment in college courses while they are attending high school. Some of the most highly gifted students might even be admitted early to graduate study. Other students with special gifts or talents who are nonetheless less dramatically different from their age peers may not benefit from radical acceleration. Acceleration programs, particularly in mathematics, have been evaluated favorably. It's important to provide counseling and support services for students who enter college early to ensure that they have appropriate, rewarding social experiences that enhance their self-esteem, as well as academic challenges and successes. § Acceleration: A Nation Deceived Report: A Nation Deceived: How Schools Hold Back Its Brightest Students summarized 50 years of research on the various forms of acceleration and came to the singular conclusion that acceleration, in many of its forms and under many different circumstances, benefits gifted students both academically and socially. Effective acceleration programs match the level and complexity of the curriculum to the readiness and motivation of the student. A Nation Deceived dispels many myths associated with acceleration including the belief that the majority of students aren't socially mature enough to advance grades, holding students to their grade level is the "safer" educational route, and acceleration results in gaps in students' knowledge. The types of acceleration are early admission to kindergarten, early admission to first grade, grade skipping, continuous progress, self-paced instruction, subject-matter acceleration/partial acceleration, combined classes, curriculum compacting, telescoping curriculum, mentoring, extracurricular programs, correspondence courses, early graduation, concurrent/dual enrollment, advanced placement, credit by examination, acceleration in college, and early entrance into middle school, high school, or college. o Beyond acceleration and enrichment, adolescents with special gifts or talents often need attention to social and personal development if they are to make successful and gratifying transitions to adulthood and careers. They may benefit from opportunities to socialize with and learn from other students who have similar characteristics and face similar challenges. They may be able to obtain particular benefit from reflecting on the nature and meaning of life and the directions they choose for themselves. Given proper supports, they can often make use of self-determination and survival skills.

Traumatic Brain Injury (TBI)

o Commonly accepted definitions of TBI specify the following: 1) There's injury to the brain caused by an external force. 2) The injury isn't caused by a degenerative or congenital condition. 3) There's a diminished or altered state of consciousness. 4) Neurological or neurobehavioral dysfunction results from the injury. Most definitions also specify that the injury be followed by impairments in abilities required for learning in school and everyday functioning. o TBI can result from two categories of injury: open or closed. Open head injuries involve a penetrating head wound from such causes as a fall, gunshot, assault, vehicular accident, or surgery. Those with closed head injuries have no open head wound but may have brain damage caused by internal compression, stretching, or other shearing motion of neural tissues within the head. A common cause of closed head injuries is porting and recreational accidents. o Soldiers have often acquired TBI as a result of improvised explosive devices (IEDs). They may experience open head injuries or closed head injuries. The effects of damage to the brain and the resulting symptoms can be severe with either type of injury. o The educational definition of TBI focuses on impairments in one or more areas important for learning. The federal (IDEA) definition of TBI states that it is "an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. The term does not apply to injuries that are congenital or degenerative, or brain injuries induced by birth trauma." o The effects of TBI range from very mild to profound, and TBI is often part of or accompanied by other med issues. Often, the effects are immediate, and these immediate effects set TBI apart from most other disabilities. The sudden change presents particular probs to families, teachers, and the individual sustaining the injury. However, sometimes the effects of TBI aren't seen immediately after the injury but appear months or even years later. o Possible effects of TBI: probs remembering, probs learning new things, speech/language probs, difficulty sequencing things, difficulty in making sense of things/processing info, extremely uneven abilities or performance (able to do some things but not others), extremely uneven progress (quick gains sometimes, no gains other times), inappropriate manners or mannerisms, failure in understanding humor or social situations, unreasonable anxiety or fear, becoming easily tired/frustrated/angered, irritability, sudden and exaggerated mood swings, aggression, depression, perseveration (persistent repetition of 1 thought or behavior). o TBI defies a narrow def, reinforcing the basic principle of SPED individualization and the importance of IEPs. o 1 of big difficulties with TBI is that it's often "invisible." In some cases, a person with TBI has paralysis, slurred speech, or some other indicator of brain damage but in many cases, the person with TBI looks like everyone else. o Brain Injury in Athletics: incidence of concussions in organized sports resulting in ER visits has doubled recently for kids 8-13, and more than doubled for kids 14-19. New rules in organized athletics designed to help prevent serious TBI are result of med advances in the diagnosis and treatment of concussion, along with media attention and organized awareness efforts. Despite this, probs still exist. Concerns that athletic trainers in the National Collegiate Athletic Association (NCAA) answer directly to football coaches. Therefore, if players are injured (e.g., suffer a concussion), the trainers' job is to keep the player safe, but coaches want them back on the field. Another challenge is that if a player is exhibiting symptoms, they may not disclose this to the coach for fear of losing playing time. However, the NCAA now provides guidelines for the evaluation of concussive symptoms on the sideline of sporting events and states that a player may not return to play until concussive symptoms have subsided completely. Enforcing these guidelines remains a critical issue in college athletics. Repeated concussions put a person at risk for chronic traumatic encephalopathy (CTE). Chronic traumatic encephalopathy (CTE) is a degenerative brain disease caused by repetitive trauma to the brain. This trauma may include un-symptomatic sub-concussive blows that are never even diagnosed, as well as more severe concussions and brain injuries. The first signs of CTE to appear are behavioral (e.g., impulsivity and physical and verbal abuse) and mood changes (e.g., depression and anxiety), followed by neurocognitive decline (e.g., problems with memory, executive functioning, and attention). The emergence of CTE as a med condition in the scientific community originated with the case study of an autopsy performed on a dead NFL player reported by Dr. Bennett Omalu and his team (movie made about this). Tragic suicides of football players further publicized the debilitating effects of CTE. Some are donated their brains to help researchers learn more about how to prevent and treat CTE. Research has found that 99% of the former NFL players studied had some level of CTE. Unfortunately, symptoms of CTE often don't appear at the time of the injury and instead shows up years later. Attend more to the seriousness of diagnosed concussions. Consider the danger of participating in contact sports. Learn how to better protect the most imp organ in the body—the brain. o Prevalence of TBI: difficult to determine but occurs at alarming rate among kids and youths. 0.04% of 6-21 pop are identified as needing SPED services. 16% of those with TBI are considered to have moderate to severe impairment, with some cases leading to death. Males are more prone to TBI, and age range in which TBI is mostly likely to occur for males and females is late adolescence and early adulthood. CEC refers to TBI as a "silent epidemic" due to its increasing prevalence and because many serious head injuries are unreported and some cases go undetected or are mistaken for other disabilities. Some of the upsurge is due to increased survival rates because of med advances. Prevalence is disconcerting because so many of TBI causes are preventable or avoidable by following safety precautions. o Causes of TBI: Among kids younger than 5, accidental falls are the dominant cause of TBI, with vehicular accidents and child abuse causing substantial injuries as well. After 5, and increasingly through adolescence, vehicular accidents (including accidents involving pedestrians, bicycles, motorcycles, and cars) account for the majority of TBI; assaults and gunshot wounds are increasingly prevalent among youths at older ages. Closed head injuries may be caused by a variety of events besides vehicular accidents, including a fall or abuse such as violent shaking of a child by an adult. o Educational Considerations for TBI: varied and depend on nature and severity of the injury and the age and abilities of the person at the time of the injury. Significant issue is helping fam members, teachers, and peers respond appropriately to the sudden and dramatic changes that may occur in the student's academic abilities, appearance, behavior, and emotional state. Need training about TBI and its ramifications if students are to be reintegrated successfully into the schools and classrooms they attended before the injury. Essential features of appropriate ed for students with TBI: 1) Well-planned transition from hospital to school, 2) Team approach (general and special education teachers, guidance counselor, administrators, other service providers, family), 3) IEP for cognitive, social/behavioral, and sensorimotor domains, 4) Strategies for sustaining attention, memory, learning new things, dealing with fatigue, engaging in appropriate social behavior, 5) Emphasis on cognitive processes rather than a focus on content alone, and 6) Plans to address long-term and immediate needs. A major problem in reentry to school after TBI—at least if the consequences are serious—is that students with TBI tend to see themselves as not having changed, whereas peers and teachers are likely to notice that they are not the same. Our societal emphasis on productiveness, organization, independence, and achievement can contribute to negative attitudes toward a student with TBI. "Academic deficits displayed by survivors of TBI conflict with achievement values, not only causing discomfort in teachers, but frustration and perhaps a sense of rejection in the young person." Many teachers don't want students with TBI in their classrooms, probably because these students exhibit characteristics that teachers find troublesome. Thus, a student's returning to school after TBI is a major issue that typically requires a team approach involving a variety of professionals. Collaboration and problem solving by this team are essential to the success of the student's reentry. The assessment of a student's academic and social skills following TBI is tricky because it's often difficult or impossible to separate physiological causes or reasons for difficulty with a task from other causes. More important than knowing precisely what difficulties have a physiological cause is pinpointing just what the student's academic and social learning difficulties are. Here again, a team approach is essential. Neurologists can often provide information about the consequences of TBI that helps teachers set reasonable expectations and teach coping skills that help the student to compensate for abilities that will not return. o Language Disorders and TBI: might acquire a lang disorder after a period of normal development, or acquire a more severe lang disorder than existed before the injury. Language or speech disorders are the greatest complicating factor in most students' return to school following TBI. A loss of ability to understand and formulate language due to brain injury is sometimes referred to as a motor-speech disorder. The student may have trouble finding or saying words or constructing sentences that are appropriate for the topic of conversation or social context. Problems like these can be a source of frustration, anger, and confusion for students with TBI. The language problems associated with TBI are primarily related to the cognitive and social demands of communication. The student might have problems with tasks that demand responding quickly, organizing, dealing with abstractions, sustaining attention (especially if there are distractions), learning new skills, responding appropriately in social situations, and showing appropriate affect. In fact, TBI can potentially disrupt all aspects of the give-and-take of social interaction that are required for effective communication. The effects of TBI on language are extremely variable, and careful assessment of the given individual's abilities and disabilities is critically important. Interventions may range from making special accommodations, such as allowing more response time or keeping distractions to a minimum, to focusing on instruction in the social uses of language. Some with TBI can't communicate orally using the muscles of speech and must rely on alternative or augmentative communication systems. o Social and Emotional Problems: TBI can cause violent aggression, hyperactivity, impulsivity, inattention, and a wide range of other emotional or behavioral problems, depending on what parts of the brain are damaged. The emotional and behavioral effects of TBI are determined by more than the physical damage; they also depend on the student's age at the time of injury and the social environment before and after the injury. Home, community, or school environments that foster misbehavior of any child or youth are known to be associated with increased risk for acquiring TBI. Such environments are extremely likely to worsen any emotional or behavioral problem resulting from TBI. Creating an environment that is conducive to and supportive of appropriate behavior is one of the great challenges of dealing effectively with the results of brain injury. Many of the typical behavior modification or behavior management strategies that are used with other students who have emotional or behavioral difficulties are appropriate for use with students who have TBI. Consistency, predictability, and reinforcement (praise, encouragement, and other rewards) are particularly important, as is developing rapport with the student. Developing a good personal relationship with a student with TBI can be particularly challenging, as such students can be unpredictable, irritable, and angry with those who are trying to help.

Early Intervention for Learners with Physical Disabilities and OHI

o Early identification and intervention are critical for children with physical disabilities. Identifying signs of developmental delay so that intervention can begin as early as possible is important in preventing further disabilities that can result from lack of teaching and proper care. Early intervention also maximizes the outcome of therapy. Communication skills are difficult for some children with physical disabilities, and they are a critical objective of any preschool program. o Besides communication, the 1st concern of teachers of young children with physical disabilities should be handling and positioning. Handling refers to how the child is picked up, carried, held, and assisted; positioning refers to providing support for the child's body and arranging instructional or play materials in certain ways. Proper handling makes the child more comfortable and receptive to education. Proper positioning maximizes physical efficiency and ability to manipulate materials; it also inhibits undesirable motor responses while promoting desired growth and motor patterns. Proper positioning for 1 child might not be appropriate for another. o The teacher of young children with physical disabilities must know how to teach gross motor responses (e.g., head control, rolling over, sitting, standing, and walking) and must understand how abnormal reflexes that may be a part of developmental disabilities can interfere with learning basic motor skills. If the child has severe neurological and motor impairments, the teacher might need to begin by focusing on teaching the child to eat (e.g., how to chew and swallow) and to make the oral movements that are required for speech. Fine motor skills, such as pointing, reaching, and releasing, can be very imp. These motor skills are best taught in the context of daily lessons that involve self-help and communication. o Motor skills shouldn't be taught in isolation, but as part of daily living and learning activities that'll increase the kid's communication, independence, creativity, motivation, and future learning. Learning social responsiveness, appropriate social initiation, how to play with others, and prob solving are other imp goals for which the teacher must develop instructional strategies.

Transition for Learners with Physical Disabilities and OHI

o Fact that kids are enabled to walk doesn't meant they'll be able to walk all their lives. They might require continued services if they're to continue walking as adults. Much depends on the management and training the person received and continues to receive. Services for those with CP should be planned keeping in mind an entire life perspective rather than just the child-focused approach. Reduced contact when kids grow up often results in gen deterioration of the quality of life of adults with disabilities and their careers. o Choosing a Career: In working out an occupational goal for the adolescent or young adult with physical disabilities, it's important to carefully assess the individual's specific abilities, disabilities, and motivation. Postsecondary education must be considered in light of the individual's interests, strengths, demands, and accessibility. Some disabilities clearly rule out certain occupational choices. With other disabilities, high motivation and full use of residual function can make it possible to achieve unusual professional status. One of the greatest problems in dealing with adolescents who have physical disabilities is helping them to attain a realistic employment outlook. Intelligence, emotional characteristics, motivation, and work habits must be assessed at least as carefully as physical limitations. Furthermore, the availability of jobs and the demands of certain occupations must be taken into account. Occupational outlook for students with physical disabilities is varied. The outlook for employment of students with physical or multiple and severe disabilities has been improved dramatically by legislation and research and demonstration projects. More accessible transportation and buildings, increased skill in using technology to allow people to accomplish tasks at work, and greater commitment to preparing people with disabilities for work are resulting in more personal independence, economic self-sufficiency, and social acceptance, which benefit not only people with disabilities but the economy and society as well. We now recognize that preparing for work begins in childhood. Long before adolescence, children, including those with physical disabilities, need to be taught about and to explore various careers. They need to be thinking about what they like to do as well as what they are particularly good at and about the demands and rewards of various kinds of jobs. The objective should be to help students select appropriate training and enter a career that makes maximum use of their abilities in ways that they find personally gratifying. Supported employment for people with severe disabilities is a relatively new concept that is being widely adopted. New techs, especially in computing and other electronic devices, offer great promise for enabling students with physical disabilities to achieve personal independence, to acquire education and training that will make them employable, and to find employment. In some cases, the tech is readily available, and educators only need to become aware of available software and apps (e.g., software may allow functions of keys to be altered, save keystrokes, or provide substitutions for physical manipulation of materials). Sometimes an individual's ability to use standard equipment is greatly enhanced by a simple modification such as orientation or location. Teachers must look for simple, inexpensive, or cost-free ways to facilitate the performance of students with disabilities—don't overlook the obvious. o Sociosexuality: until recently, physical disabilities were assumed to cancel human sexuality. People who weren't typical physically, especially if they had limited mobility, were thought of as having no sex appeal and as having little/no ability or right to function sexually. Now recognized that people with disabilities have a right to family life education, including sex education, and to a full range of human relationships, including appropriate sexual expression. Sociosexual education for students with physical disabilities, as for all, should begin early, continue through adulthood, and include information about the structures and functions of the body, human relationships and responsibilities, and alternative modes of sexual gratification. Youths with physical disabilities need to experience close friendships and warm physical contact that is not sexually intimate. Most physical disabilities, even if severe, don't in themselves kill sexual desire or prevent sexual gratification, nor do they preclude marriage and children. The purpose of SPED and rehabilitation is to make exceptional individuals' lives as full and complete as possible. In the case of youths with physical disabilities, this might involve teaching or providing alternative means of sexual stimulation and accepting sexual practices and relationships that are different from the norm. With sensitive education and rehabilitation, satisfying sociosexual expression can be achieved by all but a small minority of people with disabilities.

Cultural Values Regarding Students with Special Gifts and Talents and their Education

o In American culture, it's difficult to elicit sympathy and next to impossible to arrange sustained pub support for ed that meets the needs of kids wot special gifts, especially intellectual gifts. o Our society loves the good things that people with extraordinary gifts produce, but it hates to acknowledge superior intellectual performance. Opponents of SPED for students with special gifts argue that it's inhumane and un-American to segregate such students for instruction and to allocate special resources for educating those who are already advantaged. There's the danger of leaving some children out when only the ablest are selected for special programs. However, it seems impossible to argue against SPED for students with special gifts and talents without arguing against SPED in general, because all SPED involves recognizing and accommodating unusual individual differences.

Psychological and Behavioral Characteristics of Giftedness

o In many societies, individuals with special gifts have been stereotyped in 1 of 2 ways: (1) as physically weak, socially inept, narrow in interests, and prone to emotional instability and early decline; or, in the opposite direction, (2) as superior in intelligence, physique, social attractiveness, achievement, emotional stability, and moral character and immune to ordinary human frailties and defects. Although it might be possible to find a few individuals who seem to fit 1 stereotype or the other, the vast majority of people with special gifts or talents fit neither. o A common misconception is that genius predisposes people to mental illness. o Majority of students who show giftedness enter jobs that demand greater-than-average intellectual ability, creativity, and motivation. Not all such students enjoy job success in demanding jobs; some choose career paths that don't make use of their talents, or they fail to distinguish themselves. o Many of these students are happy, well liked by their peers, emotionally stable, and self-sufficient. They may have wide and varied interests and perceive themselves in positive terms. Nevertheless, some experience bullying and are traumatized but it. Giftedness can be stigmatizing. o Often acutely sensitive to their own feelings and those of others, and they're highly concerned about interpersonal relationships, intrapersonal states, and moral issues. Many are self-aware, self-assured, socially skilled, and morally responsible. o But assuming that gifted students never need ed in morality is a big mistake. They sometimes bully others and some can and have used their special gifts for nightmarish purposes. o Giftedness includes a wide variety of abilities and degrees of diff from average. The nature and degree of a person's giftedness may affect their social and emotional adjustment and ed and psychological needs. o Child prodigies are kids whose development and accomplishments meet or exceed those of adults with extraordinary talent. They often astonish others at an early age and often need opportunities that more typical students don't require and would find intimidating.

Def and Classification of Physical Disabilities and OHI

o Kids with physical disabilities or other health impairments (OHI) are those whose physical limitations or health problems interfere with school attendance or learning to such an extent that they require special services, training, equipment, materials, or facilities. o Children with physical disabilities might also have other disabilities of any type or special gifts or talents. Thus, the characteristics of children with physical disabilities are extremely varied. The child's physical condition is the proper concern of the medical profession, but when physical problems have obvious implications for education, teaching specialists are needed. The fact that the primary distinguishing characteristics of children with physical disabilities are medical conditions, health problems, or physical limitations highlights the necessity of interdisciplinary cooperation. o Kids may have congenital anomalies, defects with which they're born, or they may acquire disabilities through accident or disease after birth. Some physical disabilities are mild and transitory; others are profound and progressive, ending in incapacitation and early death. Some are increasingly common chronic diseases. Discussing physical disabilities generally is difficult because the variety of these disabilities is so great. o An acute illness or condition may be very serious or severe, but it either resolves on its own or with treatment, and the person recovers. o A chronic condition is ongoing. It occurs or re-occurs over a long period of time; it usually doesn't resolve, even with the best treatment. Examples of chronic conditions: cerebral palsy, muscular dystrophy, and arthritis. o An episodic condition occurs repeatedly, although most of the time the person functional normally. Its occurrence is limited primarily to successive episodes. The episodes don't necessarily become more serious or severe over time. Asthma and seizure disorders tend to be episodic. o A progressive condition is 1 that becomes more and more serious or severe over time, usually involving more complications or deterioration. Muscular dystrophy is an example of a physical prob that's usually progressive.

Origins of Giftedness

o Main factors that contribute to giftedness: genetic and other biological factors, such as neurological functioning and nutrition; and social factors, such as fam, school, the peer group, and community. o Although giftedness may be determined in part by one's genetic inheritance, whatever genetic combos are involved are exceedingly complex and not distributed according to race or social class. Idea that giftedness is entirely inherited is terrible idea. However, kids aren't born with equal capabilities. o Families, schools, peer groups, and communities have great influence on the development of giftedness. Stimulation, opportunities, expectations, demands, and rewards for performance all affect kid's learning. o How to nurture a child's giftedness: Someone takes a personal interest in child's talent; Parents are role models; Learner receives specific parental encouragement and reward; Adults take it for granted that the child will learn; Expected behaviors and values related to the talent are present in home; Teaching was informal in many settings; Family interacted with tutor/mentor; Parents observed practice, instructed, rewarded; Parents sought special instruction; and Encouraged participation in public events. o The ways schools can nurture kid's giftedness has received too little attention.

Prosthetics, Orthoses, and Adaptive Devices for Daily Living

o Many individuals with physical disabilities use prosthetics, orthoses, and other adaptive devices to help them function better on a daily basis. o A prosthesis is an artificial replacement for a missing body part (e.g., an artificial hand or leg). o An orthosis is a device that enhances the partial functioning of a part of a person's body (a brace or a device that allows a person to do something). o Adaptive devices for daily living include a variety of adaptations of ordinary items found in the home, office, or school—such as a device to aid bathing or hand washing or walking—that make performing the tasks required for self-care and employment easier for the person who has a physical disability. o The most important principles to keep in mind are use of residual function, simplicity, and reliability. Choice of the most useful prosthesis will depend on careful eval of each individual's needs. Each individual's abilities and preferences must be evaluated in designing the prosthesis. o Residual function is often important even when a prosthesis, orthosis, or adaptive device is not used. For example, it may be crucial for the child with cerebral palsy or muscular dystrophy to learn to use the affected limbs as well as possible without the aid of any special equipment because using residual function alone will make the child more independent and can help to prevent or delay physical deterioration. Moreover, it's often more efficient for a person to learn not to rely completely on a prosthesis or orthosis, as long as he or she can accomplish a task without it. Spectacular technological developments often have very limited meaning for the immediate needs of the majority of individuals with physical disabilities. It might be years before expensive experimental equipment is tested adequately and marketed at a cost that most people can afford, and a given device might be applicable only to a small group of individuals with an extremely rare condition. Even though a device may provide greater ability to participate in ordinary childhood activities, the current cost of some technological devices is clearly a barrier to their widespread use. Common standby prostheses, orthoses, and other equipment adapted to the needs of individuals will continue to be the most practical devices for a long time to come. o The greatest significance of a tech advance often lies in how it changes seemingly ordinary items or probs. The greatest problem today isn't in devising new or more sophisticated assistive technology but rather in accurately evaluating children and youths to determine what would be most useful for them and then making that technology available. Most schools do not now make maximum use of available technology. Many children and youths who need prostheses or other assistive devices, such as computers, special vehicles, and self-help aids, are not carefully evaluated and provided with the most appropriate equipment. o Two social issues involving prosthetics are social acceptance and participation in sports.

Identification of Giftedness

o Measuring giftedness is a complicated matter. Appropriate methods of early identification will help children with special talents achieve self-fulfillment and aid them in developing their special potential to make a unique and valuable contribution to society. The most common methods of identifying giftedness include IQ (based on group or individual tests), standardized achievement test scores, teacher nominations, parent nominations, peer nominations, self-nominations, and evaluations of student work or performance. Typically, some combo of several of these methods is used. o Educators must take into account the varied definitions of giftedness and recognize the effects of cultural variation on kid's behavior. In addressing multicultural differences, it's imp to recognize the variations of socioeconomic status, lang, and values that occur within various ethnic and cultural groups, not just between them. o 8 gen identification principles to ensure fairness: 1) Assessments exceed a narrow conception of talent, 2) Separate and appropriate identification strategies are used to identify different aspects of giftedness, 3) Reliable and valid instruments and strategies are used to assess talent, 4) Appropriate instruments are used for underserved populations, 5) Each child is viewed as an individual, recognizing the limits of a single score on any measure, 6) A multiple-measure/multiple-criteria approach is followed, 7) Appreciation is shown for the value of the individual case study and the limitations of combinations of scores, 8) Identification and placement are based on individual students' needs and abilities rather than on the numbers who can be served. o Identification methods should focus on balancing concern for identifying only those students whose capabilities are markedly above average with concern for including all who show promise for gifted performance.

Early Intervention for Learners with Low-Incidence, Severe, and Multiple Disabilities

o Most kids with multiple and severe disabilities are identified at birth or soon thereafter because their disabilities are very noticeable to parents, physicians, and/or nurses. Some newborns require extensive med treatment and are immediately placed in neonatal intensive care units (NICUs). o Other kids might seem typical at birth but are recognized as having pervasive developmental disabilities within the 1st couple years. In the case of very serious TBI, a person might be developing normally until the event that causes severe brain damage. o Early intervention= early in the child's life or as soon as possible after the disability is detected. § Research- or Value-Based Practices: Early intervention programs should be based on techniques that research has shown to be effective. When research hasn't provided definitive evidence of an approach's effectiveness, the approach should be based on values held by the early childhood special education community. Some of these value-based practices are providing individualized practices for each child and family, communicating with family members in a non-paternalistic manner and with mutual respect and caring, making center environments safe and clean, and providing opportunities for families to have access to medical decision making. § Fam-Centered Practices: Don't assume that parents don't have anything to offer regarding how to work with their kids. Emphasize that parents, siblings, and extended fam can be a valuable and integral part of the educational process. IDEA also recognizes that parents and families should be central to the educational process for infants and toddlers. The requirement for individualized family service plans (IFSPs), in fact, dictates that the family be central in the decision-making process for the child. A family-centered philosophy means taking into account the particular priorities and needs of the family when developing an educational intervention plan for the kid. § Multicultural Perspective: All SPED programming should be culturally sensitive. Early intervention pros should adopt a multicultural perspective because parents are often still coping with the stress of having their kids diagnosed with a disability. Have someone who can speak the fam's lang. Communicate respect, caring, and sensitivity. Provide unbiased and nondiscriminatory services with regard to race, disability, gender, religious, and ethnic and cultural orientation. Provide services that are effective. § Cross-Disciplinary Collaboration § Developmentally and Chronologically Age-Appropriate Practices: Developmentally appropriate practice (DAP): practice of using educational methods that are at the developmental levels of the kid and that meet the kid's individual needs. Many early childhood special educators agree with idea of DAP, but believe it should be balanced with the need for using educational methods that are also chronologically age appropriate. They believe that young kids with disabilities should be educated as much as possible alongside their same-age peers rather than with much younger peers who don't have disabilities.

Correcting Misconceptions about Learners with Physical Disabilities and Other Health Impairments

o Myth: Cerebral palsy is a contagious disease. Fact: Cerebral palsy isn't a disease. It's a nonprogressive neurological injury. It's a disorder of muscle control and coordination caused by injury to the brain before or during birth or in early childhood. o Myth: Physical disabilities of all kinds are decreasing because of med advances. Fact: Because of advances in med tech, the number of kids with physical disabilities is increasing. The number of survivors of serious med conditions who develop normally or have mild impairments, such as hyperactivity and learning disabilities, is also increasing. o Myth: The greatest ed prob involving kids with physical disabilities is providing highly specialized instruction. Fact: The greatest ed prob is teaching people without disabilities about what it's like to have a disability and how disabilities can be accommodated. o Myth: The more severe a person's physical disability is, the lower the person's intelligence is. Fact: A person can be severely physically disabled by cerebral palsy or another condition but have a brilliant mind. o Myth: People with epilepsy are mentally ill. Fact: People with epilepsy (seizure disorder) aren't any more or less predisposed to mental illness. o Myth: Arthritis is found only in adults, particularly the elderly. Fact: Arthritic conditions are found in people of any age, including young kids. o Myth: People with physical disabilities have no need for sexual expression. Fact: People with physical disabilities have normal sexual urges and need outlets for sexual expression. o Myth: Physical disabilities shape people's personalities. Fact: People with physical disabilities have the full range of personality characteristics found among those who don't have physical disabilities. No particular personality characteristics are associated with physical disability. o Myth: If a kid with a physical disability such as cerebral palsy or spina bifida learns to walk as a young kid, then they'll maintain that ability throughout life. Fact: Continuing intervention through adolescence and adulthood is required in many cases. Unless they have continued support for ambulation, adolescents or adults might find walking much more difficult or might give up walking, even if they learned to walk as kids.

Correcting Misconceptions about Learners with Low-Incidence, Multiple, and Severe Disabilities

o Myth: People with severe and multiple disabilities have problems so debilitating that the best they can hope for is employment in a sheltered workshop. Fact: With intensive and extensive instruction, many with severe and multiple disabilities can now be employed in more integrated work settings. o Myth: People with severe and multiple disabilities have problems so debilitating that the best they can hope for is to live under close supervision in a large residential facility. Fact: With intensive and extensive instruction, many can now live independently or semi-independently by themselves or in a small community residential facility (CRF). o Myth: A person with traumatic brain injury (TBI) can be expected, with time, to recover completely and function without disabilities. Fact: Some with TBI do recover completely, but many don't. Usually, a person with TBI has long-term disabilities that may be compensated for in many ways, but these disabilities don't ordinarily disappear completely, even with the best treatment and rehabilitation. o Myth: For students with Usher syndrome whose vision will deteriorate over time, it's best not to introduce braille and training with a long cane while their vision is still relatively good because to do so stigmatizes them. Fact: Braille and orientation and mobility training shouldn't wait until the later stages of vision loss. Getting a head start on learning these complex skills almost always outweighs any stigmatization that might occur. o Myth: People who can't speak have extreme difficulty making themselves understood to others. Fact: With an appropriate augmentative or alternative communication (ACC) system, people who can't speak can carry on a normal convo, sometimes very near the rate of speakers without disabilities. The flexibility, speed, and usefulness of communication with AAC systems are increasing rapidly with new techs, and they now often allow a user to approximate typical verbal exchanges between speakers. o Myth: The only really effective way of controlling the undesirable behavior of people with severe and multiple disabilities is to use punishment. Fact: Functional behavioral assessment and positive behavioral supports are being used more frequently to replace undesirable behavior with desirable behavior—without the use of punishment. Often, the key is finding out what the person is trying to communicate and helping them find a more effective, efficient way of communicating that to others. o Myth: Braille is only for people who're blind. Fact: It's helpful to teach braille to 2 groups of people who aren't blind: 1) those who have visual impairments so severe that they can't read print reliably and 2) those whose condition will worsen with time to the point at which braille will be their only option.

Correcting Misconceptions about Learners with Special Gifts and Talents

o Myth: People with special intellectual gifts are physically weak, socially inept, have narrow interests, and are prone to emotional instability and early decline. Fact: Wide individual variations exist among individuals with special intellectual gifts, and most are healthy, well adjusted, socially attractive, and morally responsible. o Myth: People who have special gifts or talents are in a sense superhuman. Fact: People with special gifts or talents aren't superhuman; rather, they're human beings with extraordinary gifts in particular areas. Like everyone else, they may have particular faults. o Myth: People with special gifts or talents tend to be mentally unstable. Fact: Those with special gifts or talents are about as likely to be well adjusted and emotionally healthy as those who don't have such gifts. o Myth: We know that 3-5% of the pop has special gifts or talents. Fact: The percentage of the pop that's found to have special gifts or talents depends on the def of giftedness used. Some definitions include only 1 or 2% of the pop; others over 20%. o Myth: Giftedness is a stable trait, always consistently evident in all periods of a person's life. Fact: Some of the remarkable talents and outstanding productivity of people with special gifts develop early and continue throughout life; in other cases, a person's gifts or talents aren't noticed until adulthood. Occasionally, a child who shows outstanding ability becomes a nondescript adult. o Myth: People who have special gifts do everything well. Fact: Some who're characterized as having a special gift have superior ability of many kinds; others have clearly superior talents in only 1 area. o Myth: People have special intellectual gifts if they score above a certain level on intelligence tests. Fact: IQ is only 1 indication of 1 kind of giftedness. Creativity and high motivation are as important as gen intelligence. Gifts or talents in some areas, such as the visual and performing arts, aren't assessed by IQ tests. o Myth: Students who have a true gift or talent for something will excel without SPED. They need only the incentives and instruction that are appropriate for all students. Fact: Some kids with special gifts or talents will perform at a very high level without SPED of any kind, and some will make outstanding contributions even in the face of great obstacles to their achievement. But most won't come close to achieving at a level commensurate with their potential unless their talents are deliberately fostered by instruction that's appropriate for their advanced abilities.

Neuromotor Impairments

o Neuromotor impairment is caused by injury to the brain or spinal cord (neurological damage) that also affects the ability to move parts of one's body (motor impairment). May be associated with injury to the brain before, during, or after birth. o TBI involves brain damage with an identifiable external cause (trauma) after birth. Brain injury can also be acquired from a variety of nontraumatic causes: hypoxia (reduced oxygen to the brain, as might occur in near drowning), infection of the brain or its linings, stroke, tumor, metabolic disorder (such as may occur with diabetes, liver disease, kidney disease), or toxic chemicals or drugs. o In many cases of brain damage, it's impossible to identify the exact cause of the neuromotor impairment. Muscular weakness or paralysis is often one of the symptoms. Because these kids usually can't move about like others, their ed typically requires special equipment, special procedures, or other accommodations. o Cerebral Palsy (CP): not a disease, not contagious, not progressive, no remissions. Cerebral palsy is a disorder of movement and posture. It is caused by a brain injury that occurred before birth, during birth, or during the first few years after birth. The injury hinders the brain's ability to control the muscles of the body properly. The brain tells our muscles how to move and controls the tension of the muscles. Without the proper messages coming from the brain, infants with cerebral palsy have difficulty learning basic motor skills such as crawling, sitting up, or walking. CP can be considered part of a syndrome that includes motor dysfunction, psychological dysfunction, seizures, and emotional or behavioral disorders due to brain damage. Some with CP show only 1 indication of brain damage, such as motor impairment; others show combos of symptoms. The usual def refers to paralysis, weakness, lack of coordination, and/or other motor dysfunction because of damage to the kid's brain before it's matured. Symptoms can be so mild that they're detected only with difficulty or so profound that the person is almost completely incapacitated. No cure, but intensive long-term physical and occupational therapy in combo with a surgical procedure in which the surgeon cuts selected nerve roots below the spinal cors that cause spasticity in the leg muscles allows some kids with spastic CP to better control certain muscles. Such treatment allows some non-ambulatory kids to walk and helps others to walk more normally. § Causes and Types of CP: Anything that can damage the brain during its development can cause CP. Before birth, maternal infections, chronic diseases, physical trauma, or maternal exposure to toxic substances or X-rays, for example, can damage the brain of the fetus. During the birth process, the brain can be injured, especially if labor or birth is difficult or complicated. Premature birth, hypoxia, high fever, infections, poisoning, hemorrhaging, and related factors can cause harm after birth. In short, anything that results in oxygen deprivation, poisoning, cerebral bleeding, or direct trauma to the brain can be a possible cause of CP. Although CP occurs at every social level, it is more often seen in children born to mothers in poor socioeconomic circumstances. Children who live in such circumstances have a greater risk of incurring brain damage because of factors such as malnutrition of the mother, poor prenatal and postnatal care, environmental hazards during infancy, and low birthweight. However, the prevalence of CP in children with very low birthweight has declined in recent years due to better neonatal treatment available for infants born prematurely. The 2 most widely accepted means of classification of CP specify the limbs that are involved and the type of motor disability. Some individuals have a mixture of various types of CP. Classification according to the extremities involved applies not just to CP but to all types of motor disability or paralysis. The most common classifications are quadriplegia (all four limbs are involved) and paraplegia (only the legs are involved). Likewise, classification by type of movement applies not only to CP, but also to other types of neuromotor disabilities. Spasticity refers to stiffness or tenseness of muscles and inaccurate voluntary movement. Choreoathetoid is the term applied to abrupt, involuntary movements and difficulty maintaining balance. Atonic refers to floppiness or lack of muscle tone. The important point about CP is that the brain damage affects strength and the ability to move parts of the body normally. The difficulty of movement may involve the limbs as well as the muscles involving facial expressions and speech. As a result, someone with CP might have difficulty moving or speaking or might exhibit facial contortions or drooling. But these results of brain damage don't necessarily mean that the person's intelligence or emotional sensitivity has been affected by the damage affecting muscle control. § Associated Disabilities and Educational Implications: CP is a developmental disability—a multi-disabling condition that is far more complex than a motor disability alone. When the brain is damaged, sensory abilities, cognitive functions, and emotional responsiveness as well as motor performance are usually affected. A high proportion of children with CP are found to have hearing impairments, visual impairments, perceptual disorders, speech problems, emotional or behavioral disorders, intellectual disability, or some combo of these disabling conditions in addition to motor disability. In a recent study, children with CP had a high prevalence of mental health problems and ADHD; however, specific disorders were difficult to detect because of their complexity. They might also exhibit such characteristics as drooling or facial contortions. Some with CP have normal or above-average intellectual capacity, and a few test within the gifted range. Nevertheless, the average tested intelligence of children with CP is lower than the average for the general population. We must be very cautious in interpreting the test results of children with CP, however, because many standardized tests of intelligence and achievement might be inappropriate for individuals with special difficulties in perception, movement, or response speed. Furthermore, the movement probs of a kid with CP might become more apparent when the kid is in a state of emotional arousal or stress—this can complicate using typical testing procedures, which tend to be demanding and stressful. Need special equipment and procedures and also require same SPED procedures and equipment as kids with vision, hearing, or communication disorders, learning disabilities, emotional or behavioral disorders, or intellectual disability. Careful and continuous educational assessment of the kid's capabilities is very imp. Teaching the kid who has CP demands competence in lots of areas of SPED and experience in working with a variety of disabling conditions in a multidisciplinary setting. o Seizure Disorder/Epilepsy: A seizure occurs when an abnormal discharge of electrical energy in certain brain cells occurs. The discharge spreads to nearby cells. Effects vary based on the location of the cells and how far the abnormal discharge spreads. A person with epilepsy has a chronic neurological condition and has recurrent seizures. Because seizures reflect abnormal brain activity, it isn't surprising that they occur more often in kids with developmental disabilities (intellectual disability, cerebral palsy) than in kids without disabilities. § Causes and Types of Epilepsy: Seizures are caused by damage to the brain. The most common immediate causes include lack of sufficient oxygen (hypoxia), low blood sugar (hypoglycemia), infections, and physical trauma. Certain conditions, such as those just listed, tend to increase the chances that neurochemical reactions will be set off in brain cells. In many cases, the causes are unknown. Some types of seizures may be progressive; that is, they may damage the brain or disrupt its functioning in such a way that having a seizure increases the probability of having another. Even though the cause of seizures isn't well understood, it's important to note that with proper medication, most seizures can be controlled. Seizures may differ along these dimensions: • Duration: Seizures may last only a few seconds or for several minutes. • Frequency: Seizures may occur as frequently as every few minutes or only about once a year. • Onset: Seizures may be set off by certain identifiable stimuli or may be unrelated to the environment, and they may be totally unexpected or be preceded by certain internal sensations. • Movements: Seizures may cause major convulsive movements or only minor motor symptoms (e.g., eye blinks). • Causes: Seizures may be caused by a variety of conditions, including high fever, poisoning, trauma, and other conditions mentioned previously; but in many cases, the causes are unknown. • Associated disabilities: Seizures may be associated with other disabling conditions or may be unrelated to any other medical problem or disability. • Control: Seizures may be controlled completely by drugs, so that the individual has no more seizures, or they may be only partially controlled. § What to do When Someone Has a Seizure: During a seizure: • Protect the person from injury. • Keep them from falling if you can, or try to guide the person gently to the floor. • Try to move furniture or other objects that might injure the person during the seizure. • If the person is having a seizure and is on the ground when you arrive, try to position the person on their side so that fluid can leak out of the mouth. But be careful not to apply too much pressure to the body. • Do not force anything, including your fingers, into the person's mouth. Putting something in the person's mouth may cause injuries to them, such as chipped teeth or a fractured jaw. You could also get bitten. • Do not try to hold down or move the person. This can cause injury, such as a dislocated shoulder. • Pay close attention to what the person is doing so that you can describe the seizure to rescue personnel or doctors: • How the person's body moved • How long the seizure lasted • How the person acted before the seizure • How the person acted immediately after the seizure • Whether the person suffered any injuries from the seizure • After a seizure: • Check the person for injuries. • If you could not turn the person onto their side during the seizure, do so when the seizure ends and the person is more relaxed. • If the person is having trouble breathing, use your finger to gently clear their mouth of any vomit or saliva. • Loosen tight clothing around the person's neck and waist. • Provide a safe area where the person can rest. • Do not give anything to eat or drink until the person is fully awake and alert. • Stay with the person until they're awake and familiar with the surroundings. Most people will be sleepy or confused after a seizure. § Educational Implications: About ½ of all kids with epilepsy have average or higher intelligence—just as is true for the gen pop. Among kids with epilepsy who don't have intellectual disability, however, the incidence of learning disabilities seems to be higher than among kids who don't have epilepsy. Although many with epilepsy have other disabilities, some don't. General and special education teachers need to help dispel ignorance, superstition, and prejudice toward people who have seizures and provide calm management for the occasional seizure the child may have at school. SPED teachers who work with students with severe intellectual disability or teach children with other severe developmental disabilities need to be prepared to manage more frequent seizures as well as to handle learning problems. The teacher should record the length of a child's seizure and the type of activity the child was engaged in before it occurred. This info will help physicians in diagnosis and treatment. If a student is being treated for a seizure disorder, the teacher should know the type of medication and its possible side effects. Some children who don't have intellectual disability but have seizures exhibit learning and behavior problems. These problems might result from damage to the brain that causes other disabilities as well, or they might be the side effects of anticonvulsant meds or the result of a mismanagement by parents and teachers. Teachers must be aware that seizures can interfere with the kid's attention or the continuity of ed. Brief seizures might require the teacher to repeat instructions or allow the kid extra time to respond. Frequent major convulsions might prevent even a bright student from achieving at the usual rate. Many students with epilepsy have no learning problems at all. However, some do have learning disabilities, and children with epilepsy have emotional or behavioral disorders more often than those without epilepsy. If children with epilepsy do have problems in school, their school adjustment can be improved dramatically if they are properly assessed, placed, counseled, taught about seizures, and given appropriate work assignments. The quality of life of children with epilepsy is related to the same risk factors that affect quality of life for others with disabilities, including problems with executive function, problems with adaptive behavior, low IQ, psychosocial difficulties, low family income, and early age of onset. o Spina Bifida (SB) and Other Spinal Cord Injuries: Neurological damage can involve only the spinal cord, leaving the brain unaffected. Spinal cord injury can occur before or after birth, affecting the individual's ability to move or control bodily functions below the site of the injury. During early fetal development, the 2 halves of the embryo grow together or fuse at the midline. Incomplete closure results in congenital midline defects such as cleft lip and cleft palate. Spina bifida is a congenital midline defect that results from failure of the bony spinal column to close completely during fetal development. It is 1 type of neural tube defect (a malformation of the spine, spinal cord, or brain). The defect may occur anywhere from the head to the lower end of the spine. Because the spinal column is not closed, the spinal cord (nerve fibers) can protrude, resulting in damage to the nerves and paralysis and/or lack of function or sensation below the site of the defect. Spina bifida is often accompanied by paralysis of the legs and of the anal and bladder sphincters because nerve impulses cannot travel past the defect. Surgery to close the spinal opening is performed in early infancy, but this doesn't repair the nerve damage. Although spina bifida is one of the most common birth defects resulting in physical disability, its causes are not known entirely. We do know that many cases of spina bifida may be prevented by the addition of folic acid in the diets of women of childbearing age. Additionally, recent scientific research has determined a possible genetic link in spina bifida. Spinal cord injuries resulting from accidents after birth are also a major cause of paralysis. The basic difference between spina bifida and other spinal cord injuries is that the individual who is injured after birth has gone through a period of normal development and must adjust to an acquired disability. § Educational and Social Implications: The extent of the paralysis resulting from a spinal cord injury depends on how high or low on the spinal column the injury is. Some kids with spinal cord injuries can walk independently, some need braces, and others have to use wheelchairs. Lack of sensation and ability to control bodily functions also depend on the nature of the injury. Therefore, the implications for education are extremely varied. However, factors other than muscle weakness or paralysis alone affect a child's ability to walk. Careful analysis of motivation and other environmental inducements to walk are critically important. Some will have acute medical problems that might lead to repeated hospitalizations for surgery or treatment of infections. Lack of sensation in certain areas of the skin can increase the risk of burns, abrasions, and pressure sores. The child might need to be repositioned periodically during the school day and monitored carefully during some activities that involve risk of injury. Because the student with spina bifida has deficiencies in sensation below the defect, he or she may have particular problems in spatial orientation, spatial judgment, sense of direction and distance, organization of motor skills, and body image or body awareness. Lack of bowel and bladder control in some children will require periodic catheterization. Many children can be taught to do the procedure known as clean intermittent catheterization themselves, but teachers should know what to do or obtain help from the school nurse. § Spina Bifida and Learning Disabilities: kids with spina bifida often have intelligence in the average range. However, kids with SB are at an increased risk of learning disabilities. In particular, learning disabilities affect math abilities, reading comp, and executive function. Must identify the academic strengths and weaknesses—including IEP goals that focus on academic needs in addition to physical needs—and should be a focus of team meetings.

Transition to Adulthood for Learners with Low-Incidence, Severe, and Multiple Disabilities

o Not long ago, best employment was a sheltered workshop. Now, much wider range of options is available, including competitive employment alongside workers who don't have disabilities. o Changing Philosphy: Emphasis on self-determination. Pros have developed a number of person-centered plans, which focus on the student's preferences and those of the fam in planning for the future. Authorities now recommend that natural supports be an integral part of transition planning. Rather than always creating new services for a person's particular needs, using natural supports, professionals first try to find the available resources already existing in the workplace or the community. With respect to work, the use of natural supports might mean training co-workers to provide assistance rather than immediately assuming that a job coach is required. With respect to community living, the use of natural supports might mean the person with a disability could live in an apartment, with assistance in daily living skills from a neighbor, family member, or paid attendant, rather than living in a residential facility with attendants. o Vocational Programming: A student's IEP must contain a transition plan, beginning no later than age 16 (and by age 14 when appropriate). The transition plan should contain recommendations for how to ready the student for the world of work and/or for postsecondary education or training. For many students with severe and multiple disabilities, vocational training should begin in elementary school, because it might take several years for them to acquire all the skills needed to hold down a job successfully. In elementary school, the training might consist of learning to keep on schedule, building social skills, performing work-like tasks (e.g., helping to take attendance, collecting lunch money), and beginning to learn about different types of jobs. In secondary school, the focus shifts to involving students in actual work situations in the community with the help of a job coach. The students should be involved in selecting these placements, which should vary sufficiently so that the students experience a good sample of the kinds of jobs available and can discover what they are good at and enjoy. In the early stages, this might involve the students' volunteering in several different types of placements. Later, it's preferable for students to engage in paid work placements. Being paid adds to the reality of the experience and provides an opportunity for students to learn how to handle finances. o Community and Domestic Living Skills: Community skills: using transportation, shopping, using telephones, managing money, and using the Internet. Domestic living skills: preparing meals, doing laundry, doing housekeeping, performing yard maintenance. Domestic living skills are often taught in a school setting—interact with peers, integration, won't be at home anyway. Now, people can work alongside people without disabilities and live independently or semi-independently by themselves or in a small community residential facility (CRF).

Intro to Giftedness

o People who have special gifts or the potential for gifted performance can go through life unrecognized. Sometimes their special talents or gifts aren't discovered because their friends and families don't think their abilities are imp. Sometimes they aren't recognized because they aren't given opportunities or training. Especially in the case of those who're poor or members of minority groups, students with gifts and talents may be deprived of chances to demo and develop their potential. o Unlike disabilities, gifts and talents are abilities that almost everyone believes should be fostered deliberately and celebrated. Yet giftedness isn't without risk of stigma and rejection. Many have a low level of tolerance for other who eclipse ordinary people, especially in academic knowledge or achievement. Kids who achieve above and beyond may be criticized, socially isolated, or pressured by their parents, other kids, or school personnel to be like everyone else. They may be teased, bullied, rejected, or hated. o Defining and identifying kids with special gifts or talents involve the same difficulties as defining and identifying kids with intellectual disability or emotional or behavioral disorders. All of the theoretical and philosophical issues involving disability and SPED apply to giftedness and SPED. May not feel the same moral obligation to help those with special gifts to become even better and to distinguish themselves further by fulfilling their highest promise. The desirability or necessity of helping the highest-achieving students to reach their full potential is often questioned. The emphasis is on programs to develop the talents of all students, with less special attention given to those who might be identified as gifted/talented. Some researchers have noted this trend toward downplaying or neglecting giftedness. The neglect of our most talented students is an ugly secret of contemporary American pub ed policy.

Intro to Physical Disabilities and Other Health Impairments (OHI)

o People with physical disabilities must battle to overcome the limitations imposed by their physical conditions and battle to be accepted by others. o People with physical disabilities or differences are often stared at, feared, teased, social rejected, or treated cruelly. Sometimes people feel embarrassed about someone else's disability and don't seem to understand the feelings of the person who has the disability. Or people might feel that an acquired physical disability must change someone's personality dramatically.

Educational Considerations for Giftedness

o Recognition that equity for many students with special gifts/talents may require SPED. No fed requirement exists for SPED for gifted students. State and local policies are uneven and often inadequate. o Schools should help students to identify and understand their own best abilities. o Highly talented students suffer boredom and negative peer pressure in heterogenous classrooms. Students are entitled to challenging and appropriate instruction if they're to develop their talents fully. For some, this instruction might be available only in a setting apart from their age mates. Effective instruction should be a greater concern than keeping a student in a classroom with age peers. o Fam support plays a crucial role in development of talent, but many students also need special school supports to achieve full potential. SPED for student with special gifts should have 3 characteristics: 1) Curriculum designed to accommodate advanced cognitive skills, 2) Instructional strategies consistent with content areas, and 3) Arrangements facilitating appropriate grouping. o States and localities have devised a wide variety of plans for educating students with special gifts or talents. Generally, the plans can be described as providing enrichment, additional experiences provided to students without placing them in a higher grade, or acceleration, placing the students ahead of their age peers. Many variations of enrichment and acceleration have been invented, ranging from gen ed placement with little or no assistance for the teacher to special schools offering advanced curricula in special areas such as science and mathematics or the arts. STEM high schools—special high schools emphasizing science, technology, engineering, and mathematics—are appropriate for some gifted students. Between the extremes of regular classrooms in which the teacher tries to go it alone and special schools for gifted students are consulting teacher programs, resource rooms, community mentor programs (in which highly talented students work individually with professionals), independent study programs, special classes, and rapid advancement of students through the usual grades, including early admission to high school or college. The types of services offered vary greatly within the school systems of given states and from state to state. o Acceleration and advanced placement seem to be particularly effective. However, no single type of program option meets the needs of all students who have special gifts or talents. Ideally, assessment, identification, and instruction are closely linked, whether students have disabilities or special gifts and talents—or both. When including students with disabilities and special gifts and talents, it is important to use strategies that meet the needs of both types of students. o Advances in telecommunications, the presence of computers in the home and classroom, and the call for excellence in U.S. education are three developments with implications for educating the most able students. The possible uses of computers for enhancing the education of extraordinarily high-performing students are enormous. Using software tutorials, accessing data banks, playing or inventing intellectually demanding computer games, writing and editing in English and foreign languages, learning computer languages, and solving advanced problems in mathematics are only a few of the possibilities.

Orthopedic and Musculoskeletal Disorders

o Some kids are physically disabled because of defects or diseases of the muscles or bones. Even though they don't have neurological impairments, their ability to move is affected. Most of the time, muscular and skeletal problems involve the legs, arms, joints, or spine, making it difficult or impossible for the child to walk, stand, sit, or have use of their hands. The problems may be congenital or acquired after birth, and the causes can include genetic defects, infectious diseases, accidents, or developmental disorders. o 2 of the most common musculoskeletal conditions affecting children and youths are muscular dystrophy and juvenile rheumatoid arthritis. Muscular dystrophy is a hereditary disease that is characterized by progressive weakness caused by degeneration of muscle fibers. No cure exists yet for muscular dystrophy, but advances in pharmacology are promising. Juvenile rheumatoid arthritis is a potentially debilitating disease in which the muscles and joints are affected; the cause and cure are unknown. It can be a very painful condition and is sometimes accompanied by complications such as fever, respiratory problems, heart problems, and eye infections. Among children with other physical disabilities, such as cerebral palsy, arthritis may be a complicating factor that affects the joints and limits movement. These and other conditions can significantly affect a student's social and academic progress at school. A wide variety of other congenital conditions, acquired defects, and diseases also can affect the musculoskeletal system. These include the spinal curvature known as scoliosis or missing or malformed limbs. The student's intelligence is unaffected unless additional disabilities are present. Regarding the musculoskeletal prob itself, SPED is necessary only to improve the student's mobility, to ensure that they maintain proper posture and positioning, to provide for ed during periods of confinement to hospital or home, and to make the ed experience as normal as possible.

Neglected Groups of Students with Special Gifts and Talents

o Students who're disadvantaged by economic needs, racial discrimination, disabilities, or gender bias are often overlooked in programs for gifted and talented students. In fact, many groups of gifted learners are neglected in a diverse, multicultural society. o Can't ignore these 2 facts: 1) Children from higher socioeconomic levels already have many of the advantages, such as more appropriate education, opportunities to pursue their interests in depth, and intellectual stimulation, that special educators recommend for those with special gifts or talents. 2) Far too many individuals with special gifts or talents are disadvantaged by life circumstances or disabilities and have been overlooked and discriminated against, resulting in a tremendous waste of human potential. o Underachievers: Identifying underachieving gifted students is very difficult, in part because no universally accepted definition exists. Students can fail to achieve at a level consistent with their abilities for a variety of reasons, including low expectations, lack of motivation, the influence of peers, family trauma, and other causes. Many females achieve far less than they have the ability to achieve because of social or cultural barriers to their selection or progress in certain careers, even though males are most often identified by teachers as underachieving gifted students. Students who're members of racial or ethnic minorities are often underachievers because of bias in identifying or programming for their abilities. Likewise, students with obvious disabilities are frequently overlooked or denied opportunities to achieve. Underachievement of children with special gifts or talents can result from any of the factors that lead to underachievement in any group, such as emotional conflicts or a chaotic, neglectful, or abusive home environment. A frequent cause is inappropriate school programs—schoolwork that is unchallenging and boring because these students have already mastered most of the material or because teachers have low expectations or mark students down for their misbehavior. A related problem is that underachievers with special gifts or talents often develop negative self-images and negative attitudes toward school. When students show negative attitudes toward school and self, any special abilities they might have will likely be overlooked. 1 way of preventing or responding to underachievement is allowing students to skip grades or subjects so that school becomes more nurturing and provides greater interest and challenge. However, acceleration is not always appropriate, nor is it typically sufficient by itself to address the problems of the underachieving student with exceptional abilities. Counseling, individual and fam therapy, and a variety of supportive or remedial strategies are possible alternatives or additions to acceleration. Underachievement shouldn't be confused with nonproductivity. Students with extraordinary ability shouldn't be expected to be constantly producing something remarkable. o Students from Low Socioeconomic Status Families or Who Live in Remote Areas: Children who are reared in poverty might not have toys, reading materials, opportunities for travel and exploration, good nutrition and medical care, and many other advantages that more affluent families typically provide. Lack of basic necessities and opportunities for learning can mask intelligence and creativity. Families of children in inner-city areas don't have the financial resources to provide the opportunities and early experiences to foster talent. Yet support for gifted students from low-income families often appears to be an easy target for elimination in tight state or local budgets. Children who live in rural or remote areas might not have access to many of the educational resources typically found in more populated regions. Many of those who live in remote areas also experience economic deprivation and lack the advantages that children from affluent families have. o Cultural- and Ethnic-Minority Groups: Some ethnic groups, such as many ethnic minorities from Asian countries, are included in programs for gifted students more often than would be suggested by their percentage of the general population. However, other ethnic groups, especially African Americans and Spanish-speaking students, are underrepresented in programs for gifted students. Some of the greatest challenges in the field today are identifying culturally diverse and disadvantaged students with special abilities and then including and retaining these students in special programs. Many ethnic minority students with special gifts/talents remain underachievers, even if they recognize the importance of achievement in American society. Educators should: • Devise and adopt culturally sensitive identification criteria. • Provide counseling to raise the educational and career aspirations of students in underrepresented groups. • Make high-achieving models from all ethnic groups available. • Retain underrepresented ethnic students in programs for gifted students. • Adopt a workable system to ensure the inclusion of underrepresented groups. • Build relationships with the families of minority children. The larger social-environmental issue of making families and communities safe, as well as intellectually stimulating, for kids and youths of all cultural and ethnic backgrounds must be addressed. Equal opportunity for development outside the school environment would help address the underrepresentation of minority students in programs for students with extraordinary abilities. o Students with Disabilities: The education of students with disabilities and special gifts or talents is a newly emerging field. The idea that students can be twice exceptional (meaning that they have both a disability and a special gift or talent) is 1of the best ideas in gifted education. The major goals of SPED for twice-exceptional students are identifying gifted and talented students with specific disabilities, performing research and development, preparing teachers and other pros to work with such children and youths, improving interdisciplinary cooperation for the benefit of such children and youths, and preparing students for adult living. Educators should consider the full range of programs for gifted and talented students for those who are twice exceptional, including acceleration. Our stereotypic expectations of people with disabilities frequently keep us from recognizing their abilities. Don't want to foster the myth that giftedness is found as often among students with disabilities as among those who do not have disabilities. But clearly, students with special gifts or talents as well as disabilities have been a neglected population. A key factor in meeting these students' needs is the collaboration of a variety of disciplines and institutions to provide appropriate technology and training. Many schools and school districts may be unaware of how their culture or policies create barriers to access to AP courses for students who are twice exceptional. Schools should embrace the Equity Policy Statement of the College Board and encourage a wider range of students who are interested in challenging themselves to participate in advanced coursework. Similarly, SPED teachers can give guidance to general educators on how to provide accommodations and supports that do not sacrifice quality or lower standards of expectations. Finally, all school personnel from special educators to guidance counselors to advanced placement teachers should recognize the important role they can play in terms of mentoring and supporting students who are twice exceptional. Indeed, positive mentoring can boost confidence and facilitate risk taking—essential components of success. o Females: comprise the largest group of neglected students with special gifts or talents. Haven't had equal opportunity and motivation to enter many academic disciplines or careers that have by tradition been dominated by males (chemistry, physics, med, dentistry). When females have entered these fields, they've often been rewarded inappropriately. Females with special gifts or talents lag behind males in many measures of achievement and aptitude (e.g., professional and career achievement, standardized test scores, grades) and tend not to pursue courses of study or careers involving science, engineering, and math. In short, they are underrepresented in many fields of advanced study and in professions and careers that carry high status, power, and pay. We can only presume to know the reasons for their underrepresentation: lower parental expectations for females, overemphasis on and glamorization of gender differences, school and societal stereotypes of gender roles, and educational practices that are detrimental to achievement (e.g., less attention to high-achieving girls, expectations of less independence of girls). Research suggests that the problems of neglect and underrepresentation of females with exceptional abilities are much more complex than previously believed. Like underrepresentation of ethnic and cultural minorities, the problems involving females are closely tied to cultural, social, and political issues, and they do not have simple or easy solutions. Nevertheless, the education of females with special gifts or talents might be improved by encouraging females to take risks by enrolling in challenging courses, to make career choices appropriate for their abilities, and to explore avenues that break stereotypical female roles. o Gender Identity: our society still struggles in many ways with gender identity, and 1 aspect of that struggle is decoupling gender identity and the identification of gifted and talented people.

Def of Giftedness

o Students with special gifts excel in some way compared to others of the same age. o Little agreement on how giftedness should be defined. School systems have widely differing practices regarding the ed of students with special gifts/talents because the term gifted has no clear-cut def. Disagreements about def are due to differences of opinion regarding these questions: In what ways do students with disabilities excel? How is giftedness measured? To what degree must a student excel to be considered to have a special gift or talent? Who should be in the comparison group? Why should students with special gifts be identified? o Any def of giftedness is shaped to a large extent by what the surrounding culture believes is most useful or necessary for its survival. o Precocity: remarkable early development o Insight: noticing most relevant information, finding novel ways of using information o Genius: rare intellect; remarkable aptitude in some area o Creativity: expressing novel ideas; asking new, important questions o Talent: special ability, aptitude, accomplishment o Giftedness: combined cognitive superiority, creativity, and motivation resulting in something of value o No fed law requires SPED for students with special gifts or talents, although fed legislation encourages states to develop programs and support research. The fed mandate for SPED applies only if the student has a disability in addition to giftedness. However, most states mandate programs, and the most common elements of state definitions are (1) general intellectual ability, (2) specific academic aptitude, (3) creative thinking ability, (4) advanced ability in the fine arts and performing arts, and (5) leadership ability. The field of SPED is beginning to appreciate the different ways in which giftedness can be expressed in various areas of human endeavor. o Educators are starting to acknowledge the extent to which the meaning of giftedness is rooted in cultural values. There are many different abilities and many different ways of measuring them. What's considered giftedness and how it's measured depend to a large extent on what a culture values and believes. Most experts now acknowledge that intelligence isn't all there is to giftedness. o Sternberg's Conceptualization of Giftedness: Analytic giftedness: ability to take a problem apart, understand the parts and their interrelatedness (measured by I Q tests). Synthetic giftedness: insight, intuition, creativity, or adeptness at coping with novel situations. Practical giftedness: applying analytic and synthetic skills to solution of everyday problems o A pop idea today is that people have "multiple intelligences." The theory of multiple intelligences is widely held to be legit, but few, if any, reliable applications of the theory to teaching exist. o Most experts in educating students with special gifts/talents suggest that giftedness refers to superior abilities in specific areas of performance, which may be exhibited under some circumstances but not others. Even though giftedness is believed to be a remarkable ability to do something that society values, it isn't an inherit, immutable trait that a person necessarily carries for life. Having a special gift in 1 area doesn't mean that a person is good at everything. All measures of intellectual ability, with no exceptions, tap into what's already been developed.

Def and Prevalence of Low-incidence, Severe, and Multiple Disabilities

o TASH is a major pro organization focused on individuals with severe disabilities. TASH defines a disability as "severe" if it results in the person needing ongoing support in more than 1 major life activity necessary to reside in the community and to enjoy a quality of life similar to that of members of the population without disabilities. Examples of life activities are such things as being able to communicate, engage in self-care, and learn skills to be employed and live in the community. o People with a severe disability in any area typically have more than one disability. Furthermore, a combo of mild disabilities may present severe educational problems. As noted in IDEA: "Multiple disabilities means concomitant impairments... the combination of which causes such severe educational problems that they cannot be accommodated in special education programs solely for one of the impairments." o IDEA also states: "The term "children with severe disabilities" refers to children with disabilities who, because of the intensity of their physical, mental, or emotional problems, need highly specialized education, social, psychological, and medical services in order to maximize their full potential for useful and meaningful participation in society and for self-fulfillment. The term includes those children with severe emotional disturbance (including schizophrenia), autism, severe and profound mental retardation, and those who have two or more serious disabilities, such as deaf-blindness, mental retardation and blindness, and cerebral palsy and deafness. Children with severe disabilities may experience severe speech, language, and/or perceptual-cognitive deprivations, and evidence abnormal behaviors, such as failure to respond to pronounced social stimuli, self-mutilation, self-stimulation, manifestation of intense and prolonged temper tantrums, and the absence of rudimentary forms of verbal control, and may also have intensely fragile physiological conditions." o Low-incidence, severe, and multiple disabilities are often linked conceptually, They occur in only a small percentage of cases of disability. Nearly any low-incidence, severe disability will involve extensive and ongoing support in more than 1 major life activity. Low-incidence, severe, and multiple disabilities tend to go together. All of the low-incidence, severe, and multiple disabilities discussed probably affect fewer than 1% of the pop. o Much of what's in this chap applies to some with autism and to those with severe or profound intellectual disability, too.

Early Intervention for the Gifted

o The giftedness of young kids presents special problems of definition, identification, programming, and evaluation. o Although educators have made progress in building model programs and providing better services for young kids with special gifts, negative attitudes toward such efforts persist. Barriers inhibiting the development of better education for these children include lack of parental advocacy, lack of appropriate teacher training, an emphasis on older students of extraordinary ability, financial constraints, and legal roadblocks such as laws preventing early admission to school. The barriers to early identification and programming for students with special gifts or talents include school policies and ideologies that refuse to advance students to grades beyond their chronological age peers. o Many questions remain unanswered about the education of young children who have special gifts. Relatively little is known about how advantageous it is to identify and provide programs for such children before they are 3rd or 4th grade or how best to train parents and teachers to work with preschoolers with special abilities. o Young children with disabilities need the best possible early intervention to make sure that all of their abilities, including any special gifts they might have, aren't overlooked. Although not a panacea, early admission to school and acceleration through grades and subjects offer significant advantages for some young students with special gifts or talents. What many young children with special abilities need most is the freedom to make full and appropriate use of school systems as they now exist. They need the freedom to study with older children in specific areas in which their abilities are challenged. Such children need to be able to get around the usual eligibility rules so that they can go through the ordinary curriculum at an accelerated rate. Unfortunately, relatively few preschoolers with special gifts receive the kind of educational programming appropriate for their abilities.

Deaf-Blindness

o Those who're deaf-blind are at risk for having extensive probs in communicating and navigating their environments. o Outcomes for people with deaf-blindness depend on 3 factors: 1) Quality and intensity of instruction received, 2) Degree and type of visual and auditory impairment varies dramatically: Deaf-blindness covers those with hearing impairments ranging from mild to profound, and the term covers those with visual impairments ranging from low vision to those who're totally blind. Generally, the more severe the impairments, the greater is the impact on a person's ability to adapt, and 3) Vast majority have other disabilities and medical conditions that may affect educational and life outcomes (intellectual disabilities, autism, and/or physical disabilities. o Definition of Deaf-Blindness: even more controversial than defining deafness or blindness. IDEA describes deaf-blindness as a person: (1)(i) Who has a central visual acuity of 20/200 or less in the better eye with corrective lenses, or a field defect such that the peripheral diameter of visual field subtends an angular distance no greater than 20 degrees, or a progressive visual loss having a prognosis leading to one or both of these conditions: (ii) Who has a chronic hearing impairment so severe that most speech cannot be understood with optimum amplification, or a progressive hearing loss having a prognosis leading to this condition; and (iii) For whom the combination of impairments described in paragraphs (1)(i) and (ii) of this definition causes extreme difficulty in attaining independence in daily life activities, achieving psychosocial adjustment, or obtaining a vocation; (2) Who, despite the inability to be measured accurately for hearing and vision loss due to cognitive or behavioral constraints, or both, can be determined through functional and performance assessment to have severe hearing and visual disabilities that cause extreme difficulty in attaining independence in daily life activities, or obtaining vocational objectives; or (3) Who meets any other requirements that the Secretary may prescribe. o Prevalence of Deaf-Blindness: very rare (rarer than deafness and blindness alone). 1 in 1,000 persons from birth-21 has deaf-blindness. o Causes of Deaf-Blindness: § Genetic/Chromosomal Syndromes: some inherited, and some result from damaged genetic and/or chromosomal material. Dozens of genetic/chromosomal are now known to be associated with deaf-blindness. Most common are CHARGE syndrome, Usher syndrome, and Down syndrome. · CHARGE syndrome: caused by a gene mutation. Characterized by physical anomalies present at birth—structural defects resulting in difficulties swallowing and breathing. Coloboma: condition in which the kid is born with an abnormally shaped pupil and/or abnormalities of the retina or optic nerve. Coloboma can result in a variety of visual probs, including deficits in visual acuity and extreme sensitivity to light. · Usher syndrome: inherited condition. Hearing impairment and retinitis pigmentosa: can result in vision probs starting in infancy, early child hood, or teenage years, with the condition becoming progressively worse—results in probs seeing in low light, night blindness, and in a narrowing of the field of vision, tunnel vision. A mutation in any 1 of about 11 genes can result in Usher syndrome. Although it's 1 of the most common hereditary causes of deaf-blindness, its overall prevalence is low—about 16,000 in US. o The Genetics of Usher Syndrome and its Geographic Distribution: About 1 in 75 people carries an Usher gene, but most don't realize they have it. Usher syndrome is an autosomal-recessive disorder, meaning that for a child to have the condition, both parents must be carriers of the gene. And with each such pregnancy, there is a one-in-four chance of the child having Usher syndrome. Thus, the chance of having a child with Usher syndrome is relatively rare even among those who carry the gene, and that is why the prevalence of Usher syndrome is so low. However, the odds of producing an offspring with Usher syndrome rise dramatically among people who're related. Unfortunately, social forces have operated historically to make the likelihood of intermarriage higher among a certain cultural group: the Acadian French of south Louisiana. This has resulted in a relatively higher number of people with Usher syndrome in this area of the country. Hurricane Katrina (2005) and the British Petroleum oil spill (2006) have resulted in a pop displacement along the LA Gulf Coast. It's possible that this dispersion will result in a decrease in intermarriage, which would result in fewer offspring with Usher syndrome. · Down Syndrome: sometimes associated with deaf-blindness. Not inherited—results from damaged chromosomal material. § Prenatal Conditions: 2 of the most common types of prenatal conditions, rubella/German measles and congenital cytomegalovirus (CMV), can cause intellectual disability and/or deaf-blindness. § Postnatal Conditions: meningitis and TBI. o Psychological and Behavioral Characteristics of Deaf-Blindness: § Probs Accessing Info: access to usual sources of info (Internet, TV, newspapers) is more difficult. Restricted access to info can have a negative impact on the ability to communicate. § Probs Communicating: without a strong commitment by teachers and other pros and parents to providing a variety of opportunities for communication, the kid can become socially isolated. Pattern for this isolation can begin at birth—baby has limited ability to interact with their parents and the environment, presenting context for an unpredictable world. Difficult to reverse this pattern of isolation. At risk for developing behavioral disorders such as anxiety, depression, and psychosis. Pros and parents must work together to provide a supportive environment that's rich in communication opportunities. Examples of importance of providing a lang-rich environment: Helen Keller and Anne Sullivan and Laura Bridgman and Samuel Gridley Howe. · Laura Bridgman: 1st documented case of a deaf-blind person to learn lang. Laura became ill with scarlet fever at 2, and it left her deaf and blind. Samuel Gridley Howe was social activist and in 1832, was named the head of Perkins School for the Blind. After reading a newspaper account of Laura, Howe visited her parents and convinced them to send the 8-year-old to Perkins in 1837. There, he and his teachers worked painstakingly with Laura for several years. Although her achievements weren't as spectacular as Keller's, Bridgman's accomplishments were extraordinary for the time, because many authorities believed that to be deaf-blind was to be mentally retarded. Furthermore, had it not been for Bridgman, Keller might never have received the instruction that unlocked her intellect. Helen's parents were alerted to the potential of teaching their own daughter after reading about Bridgman's accomplishments. Furthermore, Helen's teacher, Annie Sullivan, herself a former student at Perkins, consulted Howe's reports on Laura before embarking on her journey to tutor Helen. Howe and others began to open eyes of society to fact that people with disabilities were teachable. § Probs Navigating the Environment: difficulties with orientation and mobility (O&M). § Social-Emotional Development: at risk for social-emotional difficulties. Typical developmental milestones such as attachment, development of empathy, and friendships are more difficult due to these kid's dual sensory impairments. o Educational Considerations: very imp to identify deaf-blindness early. In addition to educational intervention, early med intervention, such as cochlear implants, is best provided ASAP. O&M and communication are needed for social interaction so imp that these skills are taught effectively. § Imp of Direct Teaching: more reliant on having teachers instruct them directly because of their restricted sensory input. § Imp of Structured and Predictable Routines: teachers and pros must provide sense of security. 1 of best ways to do this is through use of predictable, structured routines. Specifically, for infants who are deaf-blind, following objectives are recommended: • Create a predictable routine by identifying at least 5 daily activities that can be scheduled in the same sequence each day. • Identify predictable sequences within specific activities (i.e., "subroutines"). • Identify and use specific auditory, visual, tactile, olfactory, and kinesthetic cues to help the infant anticipate familiar activities. School routines: turn-taking routines, travel or movement routines, and communication routines. § Communication: hands critical in communication—hands become voice/primary means of expression. Braille and touch cues, which often entails the special educator providing info by touching the hands or face of the student. Adapted signs: tactual versions of signing. § Orientation and Mobility (O&M): diff from O&M training for those with only visual impairment because adaptations are needed to communicate with people with deaf-blindness—interpreter, adapted signs, and/or touch cues to communicate with deaf-blind student. Also, it's sometimes necessary to alert the public that a traveler is deaf-blind. Some pros advocate the use of assistance cards: small and held up by person at a busy or unfamiliar intersection and words on card indicate that the person is asking for assistance and is deaf-blind. § Special Considerations for Students with Usher Syndrome: most have progressive visual impairment—braille and O&M training shouldn't be delayed until they can no longer function as seeing individuals.

Educational Considerations for Learners with Physical Disabilities and OHI

o We forget that many with physical disabilities can learn to do many or all of the things that most people without disabilities do, although sometimes they must perform these tasks in different ways (e.g., a person who does not have the use of the hands might have to use the feet or mouth). Accepting the limitations imposed by physical disabilities without trying to see how much people can learn or how the environment can be changed to allow them to respond more effectively is an insulting and dehumanizing way of responding to physical differences. This is true in academics, but it is also the case in physical education. Adapted physical education is now a SPED feature of all school programs that make appropriate adaptations for students with disabilities. o Educating students with physical disabilities isn't so much a matter of special instruction for kids with disabilities as it is of educating the rest of the pop. o Design adaptations in buildings, furniture, household appliances, and clothing can make it possible for someone to function efficiently as a person without disabilities in the home, school, or community. o Objectives of educators working with kids with physical disabilities should include autonomy and self-advocacy. Should be encouraged and taught the skills they need to take care of themselves to the max extent, which requires knowledge of the physical limits created by the disability and sensitivity to the kid's social and academic needs and perceptions. o Individualized Planning: Students with complex physical disabilities typically require a wide array of related services as well as SPED. The IEPs for these students tend to be particularly specific and detailed. The instructional goals and objectives often include seemingly minute steps, especially for young children with severe disabilities. Many of the children under 3 who need SPED and related services are children with physical disabilities. These children, under federal law, have an individualized family service plan (IFSP). o Educational Placement: may be educated in any 1 of several settings, depending on the type and severity of the condition, the services available in the community, and the med prognosis for the condition, but most are able to be in gen ed settings. If they typically attend gen ed classes but must be hospitalized for more than a few days, they may be included in a class in the hospital itself. If they're confined to their homes, a visiting or home-bound teacher can provide tutoring until they can return. Most kids are being integrated into the public schools because of advances in med treatment, new developments in bioengineering (allowing them greater mobility and functional movement), decreases in or removal of architectural barriers and transpiration probs, and the movement toward pub ed for all kids. o Educational Goals and Curricula: Educational goals and curricula cannot be prescribed for children with physical disabilities as a group because their individual limitations vary so greatly. Even among children with the same condition, goals and curricula must be determined after assessment of each child's intellectual, physical, sensory, and emotional characteristics. A physical disability, especially a severe and chronic one that limits mobility, may have two implications for education: (1) The child might be deprived of experiences that children without disabilities have, and (2) the child might find it impossible to manipulate educational materials and respond to educational tasks the way most children do. For example, a child with severe CP can't take part in most outdoor play activities and travel experiences and might not be able to hold and turn pages in books, write, explore objects manually, or use a computer without special equipment. This student might require adapted physical education. For children with an impairment that is only physical, curriculum and educational goals should ordinarily be the same as those for children without disabilities: reading, writing, arithmetic, and experiences designed to familiarize them with the world around them. In addition, special instruction might be needed in mobility skills, daily living skills, and occupational skills. Because of their physical impairments, these children might need special, individualized instruction in the use of mechanical devices that will help them to perform tasks that are much simpler for people without disabilities. Children with other disabilities in addition to physical limitations will require further adaptation of curricula. Educational goals for students with severe or profound disabilities must be related to their functioning in everyday community environments. Special educators and other pros need to analyze community tasks (e.g., crossing streets, using money, riding public transportation, greeting neighbors) and plan efficient instruction for individuals with severe disabilities. Efficient instruction in such skills requires that teaching occur in the community environment. The range of educational objectives for kids with physical disabilities is often extended beyond the objectives and curricula typically provided for other students in school. Ed on death/dying might be particularly imp in classrooms in which a student has a terminal illness. Teachers should be direct and open in this discussion and should seek available resources and turn to other pros for help. o Adapted Physical Ed: Adapted physical education (APE) is an instructional service, not a setting or placement. Students receive APE when their disability necessitates a physical education program different from that of their peers. The difference can be in the form of an alternative activity, an instructional modification or adaptation, or different criteria for success. APE can be part of an integrated program for students with and without physical disabilities or can be a stand-alone program for students with disabilities only. Any student with an IEP may be eligible for APE. Necessary adaptations are determined by IEP team members. Any student with gross motor skill deficits or limits in strength, flexibility, or physical fitness should be considered for APE services. • Reduce the size of the playing field through reducing the size of the soccer field, goal area, basketball court, or length of a race. • Change the size of equipment by using larger or more colorful balls, increasing the size of the bat but decreasing weight, using larger rackets, lighter bows, or scoops for catching. • Reduce the playing area by adding more players to the field or court. • Modify basic rules such as everyone plays seated, less mobile players get two or three bounces to get to the ball in tennis, rest periods or frequent substitutions are allowed, shorten the game, or partner activities. • Use specialized equipment such as a ramp or bumpers for bowling, a batting tee, or a sit-ski for skiing. o Links with Other Disciplines: many kids with physical disabilities have other disabilities too, so multiple disciplines are often required and SPED is only 1 of many services needed. Many will need physical therapist and/or occupational therapist—can give suggestions about helping kids use their physical abilities to the greatest extent possible, continuing therapeutic management in the classroom, and encouraging independence and good work habits. Specialists in prosthetics and orthoses design and build artificial limbs, braces, and other devices—developing these involves collab among several disciplines, including med, biomechanics, and engineering. Cooperation with psychologists and social workers. Working with fam and community agencies. Speech-lang therapists (especially for those with cerebral palsy)—how to max kid's learning of speech and lang. Adapted PE. § Integrating Physical and Occupational Therapy in Gen Ed Settings: Physical therapy: addresses sensory and gross motor functions; can assist by identifying optimal positions for various tasks; teach how to move within classroom and school environment; and develop students' movement, strength, coordination. Occupational therapy: support for daily living skills such as dressing, bathing, and toileting, as well as fine motor skills (handling small objects, handwriting, oral-motor skills). When planning for the integration of physical or occupational services in the classroom, the classroom teacher should consider the following questions: • What are educationally relevant services versus medically relevant services? For example, an educationally relevant service would be to work on transfer and handling techniques with the teacher and paraprofessional to position a student for instruction. A medically relevant therapy would be strength building. • What are the educationally relevant IEP goals, and how can therapy support progress toward those goals? For example, mobility independence, ability to operate assistive technology, improved posture, and improved upper extremity coordination are all therapy goals that directly relate to improved educational outcomes. • What type of service is necessary: direct, indirect, or both? Direct services involve hands-on treatment provided directly by the therapist. Preferably, these treatments occur within the natural environment (classroom, playground, gym) where the skill is expected. Indirect services, on the other hand, involve consultation or monitoring support. Under a consultation model, the therapist makes recommendations for instructional modifications, activity enhancement, environmental modifications, adaptation of materials, or schedule alterations. The therapist may even train the classroom teacher in ways to provide direct services. Monitoring involves periodic evaluations of student progress and related training for team members. A combination of direct and indirect services provides both direct services for certain goals or skills and consultation support for others. • Is peer support appropriate? As students become more skilled, peer support can be solicited. This reduces the dependence a student has on any one individual and encourages interdependence—an important skill as students mature. By working with therapists to identify ways to support therapy within the classroom, teachers learn ways to reduce the physical challenges students can encounter within general education settings, while fostering the development of necessary physical and occupational skills.