Exceptional Learners Chapters 9-12

Intro to Autism Spectrum Disorder (ASD)

Autism spectrum disorders (ASD) involve myriad aberrant perceptual, cognitive, linguistic, and social behaviors. Although some consistent patterns of behavior accompany autism, a great deal of variation in symptoms also is exhibited by those who have autism. Not only do the symptoms vary, but the severity of the symptoms can be wide ranging.

Autism Savant Syndrome

Extremely rare. Although their symptoms can be severe, with serious developmental delays in overall social and intellectual functioning, they have remarkable skills or talents, which often involve preoccupation with the memorization of facts. A person with autism savant syndrome might have extraordinary capabilities in playing music, drawing, or math calculations.

Mastering the Maze: The SPED Process

Transition Services (pages 78-86)

Identification of Hearing Impairment

o 3 types of hearing tests: screening tests, pure-tone audiometry, and speech audiometry. The audiologist may choose to give any number of tests from any 1 or a combo of these categories. o Screening Tests: available for infants and for school-age kids. As a result of an initiative by the fed government, 95% of all newborns are screened for hearing. Ideally, a 1-3-6 rule is followed: babies are screened at the hospital by 1 month, with those who show signs of hearing loss followed up by 3 months and entering a fam intervention program by 6 months. Unfortunately, many who're identified t 1 month slip through the cracks, aren't followed up, and aren't identified until they enter school. Some of the screening tests involve computer tech to measure otoacoustic emissions. The cochlea receives sounds and emits low-intensity sounds when stimulated by auditory stimuli. These sounds emitted by the cochlea are known as otoacoustic emissions, and they provide a measure of how well the cochlea is functioning. Many schools have routine screening programs in the early elementary grades. These tests, especially those that are group administered, are less accurate than tests done in an audiologist's office. o Pure-tone Audiometry: designed to establish the person's threshold for hearing at a variety of diff frequencies. Frequency, measured in hertz (Hz) units, has to do with the number of vibrations per unit of time of a sound wave; the pitch is higher with more vibrations, lower with fewer. A person's threshold for hearing is simply the level at which they can 1st detect a sound; it refers to how intense a sound must be before the person detects it. Hearing sensitivity/intensity is measured in decibels. Pure-tone audiometers present tones of varying intensities/decibel levels, at varying frequencies, or pitch (hertz). The zero-decibel level is frequently called the zero hearing-threshold level, or audiometric zero. Because the decibel scale is based on ratios, each increment of 10 dB is a tenfold increase in intensity. Testing each ear separately, the audiologist presents a variety of tones within the range of 0 to about 110 dB and 125 to 8,000 Hz until they establish the level of intensity (dB) at which the individual can detect the tone at a number of frequencies: 125 Hz, 250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz, 4,000 Hz, and 8,000 Hz. For each frequency, the audiologist records a measure of degree of hearing impairment. A 50-dB hearing impairment at 500 Hz, for example, means the individual can detect the 500-Hz sound when it is given at an intensity level of 50 dB, whereas the average person would have heard it at 0 dB. o Speech Audiometry: tests a person's detection and understanding of speech since the ability to understand speech is so important. The speech-reception threshold (SRT) is the decibel level at which 1 can understand speech. 1 way to measure the SRT is to present the person with a list of 2-syllable words, testing each ear separately. Audiologists often use the decibel level at which the person can understand ½ the words as an estimate of the SRT level. One's ability to hear speech with background noise interference can also be tested.

Intro to Hearing Impairment

o A hearing impairment can put a person at risk for isolation, caused primarily by communication problems. Child with hearing impairment is at disadvantage in virtually all aspects of English lang development. o Debate about whether kid who's deaf should be educated to communicate orally or through manual sign lang. o Gallaudet University= primary postsecondary institution for students with hearing impairment. o Not all deaf people join the Deaf community. Some become fluent enough in spoken English to function in mainstream society. Others able to straddle worlds of the hearing and the Deaf. All deaf, as well as their parents, struggle with critical choices about oral vs manual modes of communication and cultural identity. Many members of the Deaf community consider themselves part of a cultural minority rather than as having a disability.

Transition to Adulthood for ASD

o ASD continues into adulthood. Regardless of severity, fewer than ½ of young adults with ASD are employed (even less than young adults with intellectual disabilities). Programming that includes internships in last year of high school in work environments using applied behavior analysis can be very effective. o Transition Programming for People with More Severe ASD: majority don't live independently. In many ways, their outcomes similar to those with intellectual disabilities. Transition planning should begin as early as the elementary years and become gradually more intensive in middle school and beyond. Person-centered planning: person with disability is encouraged to make their own decisions as much as possible. More people with autism are being integrated into the community in small community residential facilities and in supported living settings, such as their own homes or apartments. Goal for work settings is for people with autism to be in competitive employment or supported competitive employment. o Transition Programming for People with Less Severe ASD: much of planning for transition to adulthood for people with Asperger syndrome addresses issues of social interaction. Social interaction issues tend to increase as they reach adolescence and adulthood. When people with Asperger syndrome experience job difficulties, cause is usually inappropriate social interactions rather than job performance. Important that employers, college instructors, etc. have solid understanding of nature of the disability. More colleges are developing programs for students with ASD—these programs should be individualized for each student and critical that the people who provide services to these students are devoted workers because it can be stressful and big time commitment. Room for improvement in society's attitudes towards those who behave differently from the norm but don't bother or harm others. Many with Asperger syndrome are becoming advocates for themselves and others—wrontplanet.net.

Transition to Adulthood for Communication Disorder

o Adolescents and adults in speech and lang intervention programs fell into 3 categories: the self-referred, those with other health problems, and those with severe disabilities. o May refer themselves because their phonology, voice, or stuttering is causing them social embarrassment and/or interfering with occupational pursuits. o With other health problems might have experienced damage to speech or lang capacities as result of disease or injury, or might have lost part of their speech mechanism through injury or surgical removal. Treatment of these individuals always demands an interdisciplinary effort. In some cases of progressive disease, severe neurological damage, or loss of tissues of the speech mechanism, the outlook for functional speech is not good. However, surgical procedures, medication, and prosthetic devices are making it possible for more people to speak normally. Loss of ability to use language is typically more disabling than loss of the ability to speak. o Individuals with severe disabilities might need the services of SLPs to help them achieve more intelligible speech. They might also need to be taught an alternative to oral language or given a system of augmented communication. One of the major problems in working with adolescents and adults who have severe disabilities is setting realistic goals for speech and language learning. Teaching simple, functional language—such as social greetings, naming objects, and making simple requests—may be realistic goals for some adolescents and adults. o A major concern of transition programming is ensuring that the training and support provided during the school years are carried over into adult life. To be successful, the transition must include speech-language services that are part of the natural environment. That is, the services must be community based and integrated into vocational, domestic, recreational, consumer, and mobility training activities. Speech-language interventions for adolescents and young adults with severe disabilities must emphasize functional communication—understanding and making oneself understood in the social circumstances that are most likely to be encountered in everyday life. Developing appropriate conversation skills (e.g., establishing eye contact, using greetings, taking turns, and identifying and staying on the topic), reading, writing, following instructions related to recreational activities, using public transportation, and performing a job are examples of the kinds of functional speech-language activities that may be emphasized. o Today, educators are placing much more emphasis on the language disorders of adolescents and young adults who do not fit into other typical categories of disabilities. o Some adolescents and adults with lang disorders are excellent candidates for strategy training, which teaches them how to select, store, retrieve, and process info. Others don't have the required reading skills, symbolic activities, or intelligence to benefit from the usual training in cognitive strategies.

Intro to Visual Impairment

o Although blindness is the least prevalent of all disabilities, at least in kids, people dread it—it's the 3rd most feared condition. o People who're blind sometimes feel awkward about their blindness, not knowing how to deal with it, especially when they aren't provided with appropriate social supports.

Assessment of Progress for Visual Impairment

o Assessment of Academic Skills: The use of braille is a significant aspect of academic success for students with blindness or low vision, and IDEA requires inclusion of braille instruction in the IEP; thus, it's important for teachers to monitor the progress of these students in braille skills. Curriculum-based measurement (CBM) is an effective method for measuring the academic progress of students with visual impairments in the particular curriculum to which they are exposed. Braille versions of CBM reading passages have similar technical adequacy to CBM passages used with readers who are sighted. Printed versions of passages can be translated into braille for use in monitoring students' braille reading rate and accuracy. However, teachers should modify standard CBM procedures for students with visual impairments because reading braille typically takes longer than reading print. Teachers can also use CBM techniques in mathematics. Commercial CBM measures are available to monitor students' progress in computational fluency, and these measures can be translated into Nemeth Code for use with students with visual impairment. o Assessment of Functional Skills: Orientation and mobility skills are critical to the successful adjustment of people with visual impairment, and thus should be the focus of assessment procedures. Traditional procedures for assessing O & M skills have comprised subjective checklists and self-report data. However, emerging technologies currently used for O & M training also offer promise for advancing progress-monitoring procedures. O & M instructors can use GPS as a systematic way to monitor their clients' travel proficiency. Evaluating these data frequently can help O&M instructors improve their clients' travel proficiency through data-based planning. o Testing Accommodations: Among the most common accommodations for students with blindness and low vision are presentation accommodations (e.g., test in braille, test in regular print with magnification, large-print test) and response accommodations (e.g., use of brailler). Scheduling accommodations are also important to students with visual impairments, given that students' reading rate in braille is usually slower than that of a sighted student. And with the burgeoning array of assistive technologies, states are having a difficult time keeping up with determining which accommodations should be allowed. Because of the low prevalence of visual impairments, these decisions are usually best made on an individual basis.

Prevalence of Visual Impairment

o Blindness is primarily an adult disability. Most estimates indicate that blindness is 1/10 as prevalent in school-age kids as in adults. 0.04% of the pop from 6-21 as "visually impaired." This is probably an underestimation because many blind kids also have other disabilities, and school systems are instructed to report only the "primary" condition.

Causes of Visual Impairment

o Causes Affecting Kids and Adults: § the most common visual problems are the result of errors of refraction. Refraction refers to the bending of the light rays as they pass through the various structures of the eye. Myopia, nearsightedness, hyperopia, farsightedness, and astigmatism, blurred vision, are examples of refraction errors that affect central visual acuity. Although all can be serious enough to cause significant impairment (myopia and hyperopia are the most common impairments of low vision), wearing glasses or contact lenses usually can bring vision within normal limits. Myopia results when the eyeball is too long; hyperopia results when the eyeball is too short. Myopia affects vision for distant objects, but close vision may be unaffected. Hyperopia affects vision for close objects, but far vision may be unaffected. If the cornea or lens of the eye is irregular, the person is said to have astigmatism. In this case, the light rays from the object in the fig are blurred or distorted. § Among the more serious impairments are those caused by glaucoma, cataracts, and diabetes. These conditions occur primarily in adults, but each, particularly the latter two, can occur in children. Glaucoma is actually a group of eye diseases that causes damage to the optic nerve. It is usually caused by excessive pressure of fluid (the aqueous humor) in the eye. Glaucoma is referred to as the "sneak thief of sight" because it often occurs with no symptoms. However, glaucoma can be detected through an eye exam; because it occurs more frequently in older people (and in African Americans), professionals recommend increasingly frequent checkups, starting at age 35 (and even more frequently for African Americans). § Cataracts are caused by a clouding of the lens of the eye, which results in blurred vision. In children, the condition is called congenital cataracts, and distance and color vision are seriously affected. Surgery can usually correct the problems caused by cataracts. § Diabetes can cause diabetic retinopathy, a condition that results from interference with the blood supply to the retina. o Causes Primarily Affecting Kids: 3 most common causes of blindness in kids: cortical visual impairment (CVI), retinopathy of prematurity (ROP), and optic nerve hypoplasia (ONH). CVI occurs in the brain, ROP occurs in the eye, and ONH occurs in nerve cells between the eye and the brain. § CVI is the leading cause of visual impairment and results from damage to parts of the brain responsible for vision. CVI often co-occurs with other neurological disabilities, such as cerebral palsy, seizures, epilepsy, etc. Plasticity of the brain in kids with CVI can result in unexpected changes in visual functioning—for example, some with CVI function better visually in low-light conditions and the eyesight of some can actually improve over time. Such irregularities make studying blindness due to CVI particularly challenging for researchers and practitioners. § ROP results in abnormal growth of blood vessels in the eye, when then causes the retina to detach. Prematurity heightens the risk of ROP because blood vessels of the eye aren't always fully developed until baby is full term or close to full term. In 2013, the American Academy of Pediatrics (AAP) issued a policy stating that low birthweight and/or premature babies should undergo a series of screening tests for ROP, and the AAP reaffirmed this policy in 2016. Although not completely curable, scientists are making progress in retarding the progression of the condition through medical procedures. § ONH involves underdevelopment of the optic nerve. Although ONH can occur on its own, it's usually accompanied by myriad other neurological disorders (cerebral palsy, seizures, intellectual disabilities, autism), resulting in a variety of behavioral and cognitive problems. The cause/s of ONH are unknown, though some researchers have pointed to health of the mom as a factor in some cases. The prevalence of ONH is on the rise; however, it isn't clear whether the increase is due to better diagnosis or some other, perhaps environmental, factors. § Retinitis pigmentosa is a hereditary condition that results in degeneration of the retina. It can start in infancy, early childhood, or the teenage years. It usually causes the field of vision to narrow, tunnel vision, and also affects one's ability to see in low light, night blindness. § Strabismus and nystagmus, 2 other conditions resulting in visual problems, are caused by improper muscle functioning. Strabismus is a condition in which 1 or both eyes are directed inward (cross eyes) or outward. Left untreated, it can result in permanent blindness because the brain will eventually reject signals from a deviating eye. Most cases can be corrected with eye exercises or surgery. Eye exercises sometimes involve the person's wearing a patch over the good eye for periods of time to force use of the eye that deviates. Surgery involves tightening or loosening the muscles that control eye movement. Nystagmus is a condition in which rapid involuntary movements of the eye occur, usually resulting in dizziness and nausea and is sometimes a sign of brain malfunctioning and/or inner ear problems.

Educational Considerations Concerning ASD

o Characteristics of ASD are quite varied. When severe, they carry a guarded prognosis, even with early, intensive intervention. Significant percentage of kids with severe symptoms are unlikely to recover completely, although they might make substantial progress. Those on mild end of spectrum can make progress so that they lead happy, productive lives, being employed and living independently. o Educational Programming Principles for Students with ASD: direct instruction of skills, instruction in natural settings, and behavior management when needed using functional assessment and positive behavioral intervention and support. § Direct Instruction of Skills: highly structured, directive approach that uses basic principles of behavioral psychology for analyzing tasks and how to best teach them. Applied behavior analysis (ABA): highly structured approach that focuses on teaching functional skills and continuous assessment of progress. Grounded in behavioral learning theory, ABA is a comprehensive approach that emphasizes positive reinforcement or rewarding of desired behaviors. Many pros avoid or deemphasize the use of punishment and research suggests that this hasn't resulted in a decrease in effectiveness. § Instruction in Natural Settings: applying behavioral psychology in natural settings and in natural interactions. Researchers constantly trying to make better instructional use of natural interactions by which kids normally learn lang and other social skills. § Behavior Management: sometimes kids with autism, especially those with severe levels of autism, display inappropriate behaviors such as biting, hitting, or screaming. Recommend combo of functional behavioral assessment (FBA) and positive behavioral intervention and support (PBIS) to reduce or eliminate behaviors. FBA involves determining the consequences (purpose the behavior serves for the person), antecedents (things that trigger the behavior), and setting events (contextual factors in which behavior occurs) that maintain such behaviors. PBIS involves finding ways to support positive behaviors rather than punishing negative behaviors and focuses on total environment of the student, including instruction. § Using Video Modeling and Video-Self Modeling: effectiveness of video modeling and self-modeling for increasing the functional, vocational, social communication, and behavioral skills of students with autism. During video modeling (VM), a competent peer or adult demos a behavior or skills that the target student will later perform. Video self-modeling (VSM) involves student watching a video of themselves competently completing a task. Done a lot with non-academic tasks, so researchers are exploring efficacy of VM and VSM for increasing academic skills. o Evidence-Based Specific Practices and Programs for Students with ASD: 27 specific practices or programs that qualified as evidence-based (met rigorous methodological standards). § Evidence-Based Specific Practices: examples are video self-modeling and social narratives. Social narratives: brief stories (which can also contain drawings or pics) describing social situations that present possible social interaction challenges while offering examples of appropriate responding. Teachers or therapists can individualize the stories according to particular social encounters with which that person struggles. § Evidence-Based Programs: examples are Picture Exchange Communication System (PECS), Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH), and Pivotal Response Training (PRT). Since deficits range widely with respect to type and severity, no 1 program is appropriate for all. PECS focuses on lang, TEACCH stresses structure, organization, and use of visual cues, and PRT targets pivotal/key skills that once learned, lead to progress in other skill areas. · For students with severe lang deficits, PECS involves use of pics to help students initiate and maintain functional communication. Example of augmentative and alternative communication (AAC) system. Using PECS, people with no or limited speech can initiate requests and describe observations through use of pics. Can be sued as an alternative communication system or as an augmentative communication support. PECS implementation consists of six phases: (a) Phase I: exchanging single pictures for desired activities or items, (b) Phase II: using the single pictures in new places or with different people, (c) Phase III: discriminating among pictures (i.e., selecting from two or more things), (d) Phase IV: constructing simple sentences such as pairing the "I want" picture with a desired item, (e) Phase V: learning to use PECS in response to the question, "What do you want?" and (f) Phase VI: using PECS to comment on the environment with simple sentence starters such as "I see," "I hear," and "I feel." · The TEACCH approach places heavy emphasis on structure. Activities are structured, using scheduling, organization, and routine, so that kids know what they'll be doing throughout the day. Emphasizes visual cues, such as labeling, color coding, pics of tasks, etc. · PRT uses a broader, more comprehensive intervention framework. PRT is based on the assumption that some skills are critical for functional in other areas. By focusing intervention on these pivotal skills, the effects of intervention can more easily spread to other skill areas. Emphasizes using ABA's structured approach of continuous assessment and reliance on behavioral learning theory to teach pivotal skills. Some of these pivotal areas are motivation, self-management, initiations, and responding to multiple cues. PRT fosters motivation by emphasizing natural rewards of the kid's own choosing. Managing one's own behavior is a skill that leads to autonomy and independence from control of others. PRT focuses on teaching them to more actively initiate responses, such as asking simple questions as the situation dictates. Teaching skill of responding to multiple cues target student's tendency to focus on environmental stimuli in an overly selective manner, perhaps staring for long periods of time at just 1 or a few objects or focusing on only 1 aspect of an object. § Animal Assisted Interventions (AAI): using animals to help treat ASD has mushroomed in popularity. Enough positive research support to bring it to market. Equine therapy in particular has been found to benefit people with ASD.

Causes of Hearing Impairment

o Conductive, Sensorineural, and Mixed Hearing Impairment: Professionals classify causes of hearing impairment on the basis of the location of the problem within the hearing mechanism. There are three major classifications: conductive, sensorineural, and mixed hearing impairments. A conductive hearing impairment refers to an interference with the transfer of sound along the conductive pathway of the middle or outer ear. A sensorineural hearing impairment involves problems in the inner ear. A mixed hearing impairment is a combination of the two. Audiologists attempt to determine the location of the dysfunction. The first clue may be the severity of the loss. A general rule is that hearing impairments greater than 60 or 70 dB usually involve some inner-ear problem. Audiologists use the results of pure-tone testing to help determine the location of a hearing impairment. They then convert the results to an audiogram, a graphic rep of the weakest/lowest-decibel sound the individual can hear at each of several frequency levels. o Hearing Impairment and the Outer Ear: in some kids, the external auditory canal doesn't form, resulting in a condition known as atresia. Kids may also develop external otitis, or "swimmer's ear," an infection of the skin of the external auditory canal. Tumors of the external auditory canal are another source of hearing impairment. Not as serious as problems of the middle and inner ears. o Hearing Impairment and the Middle Ear: although more serious than problems of the outer ear, they, too, usually result in a classification of hard of hearing rather than deaf. Most occur because the mechanical action of the ossicles is interfered with in some way. Most middle ear hearing impairments, unlike inner ear problems, are correctible with medical or surgical treatment. Most common problem with the middle ear is otitis media, an infection of the middle ear space caused by viral or bacterial factors, among others. It's common in young kids and is linked to abnormal functioning of the eustachian tubes. It can result in temporary conductive hearing impairment, and even these temporary losses can make the kid vulnerable for having lang delays. If untreated, otitis media can lead to rupture of the tympanic membrane. o Hearing Impairment and the Inner Ear: Most severe hearing impairments are associated with the inner ear. In addition to problems with hearing sensitivity, a person with inner ear hearing impairment can have additional problems, such as sound distortion, balance problems, and roaring or ringing in the ears. Causes of inner ear disorders can be hereditary or acquired. Genetic or hereditary factors are a leading cause of deafness in kids. Scientists have identified mutation in the connexin-26 gene as the most common cause of congenital deafness. Acquired hearing impairments of the inner ear include those due to bacterial infections (meningitis, the 2nd most frequent cause of childhood deafness), prematurity, viral infections (mumps and measles), anoxia at birth, prenatal infections of the mom (maternal rubella, congenital syphilis, and cytomegalovirus), Rh incompatibility, blows to the head, side effects of some antibiotics, and excessive noise levels. Congenital cytomegalovirus (CMV), a herpes virus, is the most frequent nongenetic cause of deafness in infants. Babies born to moms with CMV are vulnerable to its adverse effects, such as hearing impairment. CMV can result in other conditions, such as intellectual disabilities, visual impairment, and ADHD. Environmental factors can also cause hearing impairment—chief among these causes is repeated exposure to loud music, gunshots, or machinery.

Identification of ASD

o Diagnosis often made by psychiatrist using criteria in APA's DSM-5, which focus on communication skills, social interactions, and repetitive and stereotyped patterns of behavior. In addition to observing kid in the examining room and taking a detailed history from parents, clinicians can use behavioral observation instruments and ask parents and/or teachers to fill out behavior checklists. o Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R) are meant to be used together. ADOS involves observing kid in several semi-structured play activities and the ADI-R is used to interview caregivers about kid's functioning in lang/communication, reciprocal social interaction, and restricted, repetitive, and stereotyped behaviors. o American Academy of Pediatrics recommends that pediatricians be on alert for signs of autism at all well-child preventative care visits and that screening be done a 9-, 18-, 24-, and 30-month-old visits. o Autistic regression: circumstances whereby a child develops normally but then loses some speech and social skills; usually occurs between 1 and 3 years old; cause unknown; and occurs in 1 out of 3 cases of kids with autism.

Prevalence of Communication Disorders

o Difficult because extremely varied, sometimes difficult to identify, and often occur as part of other disabilities (intellectual disabilities, brain injury, learning disability, or autism). Million kids (1/5 of kids in SPED services) receive services primarily for lang or speech disorders. Speech-lang therapy is 1 of most frequently provided related services for kids with other primary disabilities. o Speech disorders: 8-9% of preschool children and 5% of school-age children. Language disorders: 2-3% of preschool children and 1% of school-age children. Communication disorders set to increase as med advances preserve lives of more kids and youths with severe disabilities that affect communication. Schools need more SLPs, special and gen ed teachers need greater knowledge of communication disorders, and teachers need to be more involved in helping students learn to communicate effectively.

Early Intervention for Visual Impairment

o Intensive intervention should begin as early as possible to help the infant with visual impairment begin to explore the environment. o O&M training is a critical component of preschool programming. More and more preschoolers are learning cane techniques. o Early literacy, numeracy, and cognitive skills should be addressed ASAP and finger strength should be a focus in order to become a proficient user of braille. o Preschoolers with visual impairments are less likely to initiate social interactions with their sighted peers, often preferring to be left alone. If not addressed early, this passivity may continue. Teachers must provide instruction in appropriate interactions using active engagement and repeated opportunities for learning—merely placing those with visual impairments with those who're sighted doesn't lead to them interacting together. o Involve parents so they can work with their kid at home, helping them with mobility and feeding, as well as being responsive to their infants' vocalizations. Parents, too, sometimes need support in coping with their reactions to having a baby with visual impairment.

Anatomy and Physiology of the Ear

o Ear is 1 of most complex organs. Many elements that make up the hearing mechanism are divided into 3 major parts: the outer, middle, and inner ear. The outer ear is the least complex and least important for hearing and the inner is the most complex and most important for hearing. o The Outer Ear: The outer ear consists of the auricle and the external auditory canal. The canal ends with the tympanic membrane (eardrum), which is the boundary between the outer and middle ears. The auricle is the part of the ear that protrudes from the side of the head. The part that the outer ear plays in the transmission of sound is minor. Sound is collected by the auricle and funneled through the external auditory canal to the eardrum, which vibrates, sending the sound waves to the middle ear. o The Middle Ear: comprises the eardrum and 3 tiny bones (ossicles) called the malleus (hammer), incus (anvil), and stapes (stirrup), which are contained within an air-filled space. The chain of the malleus, incus, and stapes conducts the vibrations of the eardrum along to the oval window, which is the link between the middle and inner ears. The ossicles function to create an efficient transfer of energy from the air-filled cavity of the middle ear to the fluid-filled inner ear. The Inner Ear: About the size of a pear. Intricate mechanism of thousands of moving parts. Because it looks like a maze of passageways and is highly complex, it's often called a labyrinth. The inner ear is divided into 2 sections according to function: the vestibular mechanism and the cochlea, though these sections don't function totally independent of each other. The vestibular mechanism, located in the upper portion of the inner ear, is responsible for the sense of balance and is very sensitive to acceleration, head movement, and head position. Info about movement is fed to the brain through the vestibular nerve. The most important organ for hearing is the cochlea. Lying below the vestibular mechanism, this snail-shaped organ contains the parts necessary to convert the mechanical action of the middle ear into an electrical signal in the inner ear that's transmitted to the brain. In the normally, functioning ear, sound causes the malleus, incus, and stapes to move. When the stapes moves, it pushes the oval window in and out, causing the fluid in the cochlea to flow. The movement of the fluid causes a complex chain of events in the cochlea, resulting in excitation of the cochlear nerve. With stimulation of the cochlear nerve, an electrical impulse is sent to the brain, and sound is heard.

Causes of ASD

o Early speculative causal theories have been replaced by more scientifically based set of theories. o Early Causal Theories: Asperger conjectured that there was a biological and hereditary basis for autism. Kanner also speculated cause was biological. Prevailing psychoanalytic ideas of the 1960s held sway for pros—idea that parents, especially moms, were the cause of their kid's autism. Bruno Bettelheim (1967) conceived a theory that cold and unresponsive moms caused autism. Most authorities attribute term refrigerator moms to Bettelheim. o Today's Causal Theories: Neurological, not interpersonal, factors are involved. Genetics, neurological factors, and environmental contributions interact to result in autism. Genetics can contribute to poor neuronal connections related to neurological anatomy and weakened synaptic strength that can lead to vulnerability to environmental factors (toxic chemicals, maternal health issues, early social deprivation) that results in symptoms of ASD. However, given range of symptoms and levels of severity of ASD, reasonable guess that no single neurological or genetic cause exists. § Neurological Basis of ASD: Researchers using neuroimaging techs noted that kids and adults with ASD have neurological deficits in several areas of the brain. Autism as a disorder of neural networks rather than as due to an abnormality in 1 particular part of the brain. Brain cells of people with autism exhibit deficient connectivity, referred to as neuronal underconnectivity, which disrupts the cells' ability to communicate with each other. Neuronal underconnectivity between front and back of the brain in people with ASD—deficiencies in communication between the frontal lobes, which are largely responsible for executive functioning and in the back of the brain, the occipital lobes, which are largely responsible for visual perceptual processing. Brains and heads of young kids with autism tend to grow suddenly and excessively around age 1, which is then followed by a deceleration, so that they're normal in size by adolescence. Significance of abnormally high rates of brain growth in 1st 2 years is underscored by fact that this is a time of critical importance to brain organization. Some believe that abnormal brain growth may be linked to elevated levels of growth hormones. Some researchers claim that those who have high levels of androgen (hormone responsible for controlling development of male characteristics) before birth in their mom's amniotic fluid are more likely to exhibit autistic traits. Some have come to refer to people with autism as having an extreme male brain (EMB). Theory is plausible, but most scientists continue to be skeptical about its validity because theory is based on relationship between androgen and autistic traits in the gen pop, not between androgen and those who've been diagnosed with autism. § Intestine-Microflora-Brain Basis of ASD: kids with autism are more likely to exhibit gastrointestinal distress (constipation and chronic diarrhea). Correlation between severity of autism symptoms and level of bacteria in the gut. Levels and types of bacteria differ in people with autism, with some bacteria elevated and some depressed compared to those without autism. Researchers have used mice to test out possibility of reducing autistic-like symptoms. Although research on link between autism and intestinal bacteria is promising, it's still highly exploratory. § Genetic Basis of ASD: strong scientific evidence for hereditary component. When kids is diagnosed, chances are 15% that their younger sib will also be diagnosed and this percentage is 25-75% higher in the pop as a whole. When identical twin has autism, chances great that the other will also have autism. Even if not diagnosed with autism, fam members of those with autism are more likely to exhibit autistic-like characteristics at a subclinical level, such as lack of close friends, preoccupation with narrow interests, and a preference for routines. Sporadic genetic mutations are involved in some cases—tiny gene mutations (spontaneous deletions and/or duplications of genetic material) that can result in autism are sometimes passed down to kids from 1 or both parents. Research has yet to identify all exact genes involved, but researchers are consistent in stating that no single autism gene exists.

Early Intervention for Hearing Impairment

o Ed for infants and preschoolers with hearing impairments is critical—can help facilitate the development of the kids and may be beneficial in reducing parents' stress levels. o Hearing parents, especially if they want to teach their infants sign lang, may need help in understanding the importance of visual modality in communicating with their kids. Hearing parents face a quandary over how to provide their kids with appropriate sign lang models. Signed English and ASL are difficult to learn well in a short amount of time. ASL is harder to acquire as an adult and can rarely be learned to the same degree of fluency as that possessed by a native ASL signer. Early intervention more important for families with hearing parents. o Educators have established preschool intervention projects to teach the basics of sign language to the parents of children who are deaf as well as to the children themselves. Such projects are generally successful at teaching the rudiments of sign to parents and infants. Once the child is ready to progress beyond one- and two word signed utterances, however, it's important that native signers be available as models. Authorities recommend a practice that is popular in Sweden: Adults who're deaf are part of early intervention efforts because they can serve as sign language models and can help hearing parents form positive expectations about their children's potential. Even though hearing parents might never be able to communicate fluently in sign language, it is important that they continue to sign with their child. Not only does signing allow parents a means of communicating with their child but it also demonstrates that they value the child's language and the Deaf culture.

Prevalence of Hearing Impairment

o Estimates of number of kids with hearing impairment vary considerably, due to the differences in def, populations studied, and accuracy of testing. Public schools identify about 0.10% of the pop from 6-21 as deaf or hard of hearing. There aren't separate figs for deaf vs hard of hearing, but hard of hearing students are more prevalent than those who're deaf. Some believe that many kids who're hard of hearing and could benefit from SPED aren't being served. o Hearing impairment is more prevalent in ethnically diverse pops and in those who're living in poverty. Of those kids who have a hearing impairment, over 30% come from Spanish-speaking homes. Relatively large numbers of other non-English speaking immigrants are deaf. This creates a big challenge—deafness by itself makes spoken lang acquisition in the native lang very difficult, let alone deafness plus attempting to learn a 2nd lang.

Educational Considerations for Communication Disorder

o Identification is responsibility of classroom teacher, SLP, and parents. By listening attentively and empathetically when children speak, providing appropriate models of speech and language for children to imitate, and encouraging children to use their communication skills appropriately, the classroom teacher can help not only to improve speech and language, but also to prevent some disorders from developing in the first place. o Facilitating the Social Use of Lang: lang must be taught as a way of solving problems by making oneself understood and making sense of what others say. Should be continuous opportunities for students and teachers to employ lang and obtain feedback in constructive relationships. School language is more formal than the language many children use at home and with playmates. It is structured conversation, in which listeners and speakers or readers and writers must learn to be clear and expressive, to convey and interpret essential information quickly and easily. Without skill in using the language of school, a child is certain to fail academically and virtually certain to be socially unsuccessful as well. Teachers need the assistance of speech-language specialists in assessing their students' language disabilities and in devising interventions. Part of the assessment and intervention strategy must also include examining the language of the teacher. Problems in classroom discourse involve both how teachers talk to students and how students use language. Learning how to be clear, relevant, and informative and how to hold listeners' attention are problems not only for students with language disorders but also for their teachers. o Question-Asking Strategies: when students fail to answer high-order questions because these are beyond their level of info or skill, the teacher should reformulate the prob at a simpler level. Teachers don't always clearly express their intent in questioning students or failt to explicitly delimit the topic of their questions. Teachers should clarify the problem and give unambiguous feedback to students' responses—lack of accurate, explicit feedback prevents students from learning the concepts involved in instruction. Teachers instruct students about lang and teach them how to use it—learn how to use lang in context of the classroom, specifically. Teacher's own use of lang is key factor in helping students learn effectively, especially if students have lang disorders. Keep in mind that lang disorder can change with a kid's development. o Teaching Literacy: Reading and Written Expression: Students with lang impairments often have reading deficits in word-recognition skills and comprehension. Less common for people who have pure speech disorders to have difficulties with reading, but those with lang, or lang and speech problems are at significant risk for reading disability. Students who have poor phonological awareness are typically unable to learn how to decode without intervention. Decoding refers to the ability to transfer the written words into speech. For those students with language impairments who learn how to decode, many will still have difficulty with reading comprehension. Thus, it is critical for the classroom teacher, SLP, and SPED teacher to work together to provide explicit and systematic intervention in reading for children with language impairments. In addition to reading problems, students with language impairment also have difficulty with written expression. The questions teachers ask to help students understand how to write for their readers are critical to overcoming disabilities in written lang. Intervention in lang disorders employs many of same strategies used in intervention in learning disabilities. Metacognitive training, strategy training, etc. are appropriate for student with lang disorders. o Enhancing the Personal Narratives of Students Who Use AAC: many students who use AAC experience difficulty in creating personal narratives. Personal narratives, stories about ideas or events 1 has experienced or is thinking about, can play an important role in shaping how young kids understand the world around them and connect with others. Through personal narratives, kids organize and remember events; attach significance to events; share event knowledge with others, creating a shared experience; and attach adult values that shape their understanding of events. Kids who use AAC can be restricted in their telling of personal narratives due to limitations of the AAC device or support used and by their lack of experience in creating narratives. Four features that have been shown to support personal narrative development are: • Interactive engagement during narrative development that includes the use of open-ended questions, verbal prompts, binary choices, verbal scaffolds, and modeling. • Use of a visual guide such as a story map and written record of the narrative. • Strategies to connect emotional state to an event as research has shown that children tend to remember events associated with an emotional experience. • Repeated opportunities to engage in personal narrative development. o Talking with Students: choose topic of interest to student; after initiating convo, let student take the lead; try not to ask lots of questions, and when you do, ask open-ended ones for which explanations are appropriate; use appropriate wait time with your questions; encourage question-asking in return, and give honest and open answers; keep your voice at an appropriate level, keep your pace moderate, and keep the convo light and humorous; avoid being judgmental or making snide remarks about the student's lang; don't interrupt the student when they're talking, and listen attentively (show respect); and provide as many opportunities as you can for student to use lang in social situations, and respond appropriately to student's attempts to use lang to accomplish their goals.

Psychological and Behavioral Characteristics of ASD

o Impaired Social Communication: deficits in social responsiveness. Don't respond normally to being picked up or cuddled. Might not show differential response to parents, siblings, or teachers compared to strangers. Might not smile or might smile or laugh when nothing is funny. Eye gaze often differs from that of others—avoid eye contact or look out corners of their eyes. Might show little or no interest in other people but be preoccupied with objects. Might not learn how to play normally. § Communicative Intent: the desire to communicate for social purposes. Many kids with ASD lack communicative intent. Some have severe lang impairment and some are mute. Those with severe impairments in lang typically show abnormalities in intonation, rate, volume, and content of their oral lang. Their speech sounds robotic, or they might exhibit echolalia, parroting what they hear. Might reverse pronouns. If they do acquire lang, they might have considerable difficulty using it in social interaction because they're unaware of the reactions of their listeners. § Joint Attention: deficits in social communication often link to impairment in ability to engage in joint attention. Joint attention: process by which an individual alerts another person to a stimulus via nonverbal means, such as gazing or pointing. § Pragmatics: social uses of lang. Often have problems with pragmatics. Might speak using abnormal voice inflection, such as monotone, talk too loudly or quickly or slowly, not be adept at taking turns talking in convo, engage in monologues, or repeat same thing over and over. Big reason that people with Asperger syndrome have difficulty in social interactions is that they aren't adept at reading social cues. Become ostracized from peer group, making it hard to make and keep friends and interact with others. Deficits in recognizing emotions, facial expressions, and vocal intonation may underly problems many people with ASD have in reading social cues. Many of the social interaction difficulties of those with Asperger syndrome are due to their inability to think about situations in nuanced way. They're often overly literal and often interpret situations using logic to the exclusion of emotion or sentiment. Hidden curriculum: the dos and don'ts of everyday living that most people learn incidentally or with little instruction from others—behaviors or ways of acting that most of us take for granted. All of these problems are often misinterpreted as the person as not wanting to engage socially with others—this isn't true for all people with autism. They experience isolation and social anxiety. o Repetitive/Restricted Behaviors: prone to abnormal sensory perceptions. May display stereotyped motor or verbal behaviors: repetitive, ritualistic motor behaviors such as twirling, spinning objects, flapping the hands, and rocking. Extreme fascination/preoccupation with objects and very restricted range of interests. Abnormal sensory perceptions of people with ASD can sometimes be manifested by being hyperresponsive or hyporesponsive to particular stimuli. Some with ASD experience hypersensitivity to visual stimuli (florescent lights) and others can be overly sensitive to touch. Some are totally the opposite of hyperresponsive and are unresponsive to auditory, visual, or tactile stimuli. Others have a combo of hypersensitivity and hyposensitivity. Degree of sensory sensitivity and number of stimuli to which 1 is sensitive is what make people with ASD different from the gen pop. Kids with ASD are likely to spend about twice as much time engaged in watching tv and playing video games and video game usage is more likely to become compulsive. On other hand, kids with ASD tend to spend little time using social media. Some experience a neurological mixing of the sense, synesthesia, which occurs when the stimulation of 1 sensory or cognitive system results in the stimulation of another sensory or cognitive system. o Attempts to Construct a Unifying Theory of ASD: 3 most prominent theories identify major impairments in executive functioning, weak central coherence, or theory of mind. Together these theories can help us begin to build a composite pic of ASD. § Executive Functioning (EF): ability to plan ahead in thoughtful ways is sabotaged by their problems with working memory (WM), inhibitory control or behavioral inhibition, and mental flexibility. § Central Coherence: natural inclination for most people to bring order ad meaning to info in their environment by perceiving it as a meaningful whole rather than as disparate parts. Those with autism get caught up in details (can't see the forest for the trees). Some don't seem to recognize that their way of processing info is disjointed, nor do they appear to have any desire or need to bring coherence to their fragmented perceptions. § Theory of Mind (ToM): person's ability to take the perspective of other people. More severe the ToM impairment, the lower the cognitive abilities and severity of autism symptoms. Can result in problems with social skills. Have varying degrees of difficulty inferring the thoughts of others—some don't seem to understand that their thoughts are different from those of others.

Is There a Link between ASD and Vaccines?

o In late 1990s and early 2000s, controversy about whether measles, mups, rubella, (MMR) vaccine causes autism. o In 1998, Andrew Wakefield and 12 coauthors published a paper in The Lancet on 12 cases of kids who had been referred to a clinic in England for gastrointestinal problems and lang deficits. o Although Wakefield et al. stated they didn't prove that MMR vaccine caused autism, public didn't understand this. Reported by the media and public fear spread in Europe and North America. o After pub of Wakefield article and its publicity, decrease in percentage of kids receiving the MMR vaccination in US. This decrease may have been cause of measles outbreaks in England and the US. o 10 of 13 authors of the article voiced concerns about the public reaction and offered a retraction. o In US, several fed agencies commissioned review of the evidence and concluded that there was no evidence that vaccines cause autism. The British General Medical Council (GMC) initiated an investigation and found irregularities in Wakefield's conduct: he failed to disclose a potential conflict of interest and he and 1 of colleagues hadn't selected the participants in an unbiased manner. GMC Fitness to Practice Panel recommended revocation of Wakefield's med license. In 2010, the Lancet published retraction of the Wakefield et al. study, citing methodological flaws. o Many parents remain unconvinced that MMR vaccinations didn't cause autism—kept in public eye by celebs like Jenny McCarthy. However, most scientists say no evidence links vaccine to ASD. Fact that kids start showing signs of autism shortly after shot coincides with age when kids start showing signs. 1/3 of kids with ASD develop normally after birth until about 2 years, at which time their development regresses.

Psychological and Behavioral Characteristics of Hearing Impairment

o In terms of functioning in an English lang-oriented society, deaf person is at much greater disadvantage than is someone who's blind. o Spoken Lang and Speech Development: most severely affected area of development in person with hearing impairment are the comprehension and production of the English lang. People who have hearing impairments are generally deficient in the lang used by most people of the hearing society in which they live—people with hearing impairment can be expert in their own form of lang, sign lang. Disadvantage in the following important areas: lang comprehension, lang production, and speech. Speech intelligibility is linked to the degree of the hearing impairment and the age of onset of the hearing impairment. Even after intensive speech therapy, it's rare for kids with prelingual profound deafness to develop intelligible speech. Infants who can hear their own sounds and those of adults before become deaf have an advantage over those born deaf. Kids who're deaf are handicapped in learning to associate the sensations they feel when they move their mouths, jaws, and tongues with the auditory sounds these movements produce. These kids also have difficulty hearing adult speech, which kids without impairment can hear and imitate. o The Impact of Cochlear Implants on Language: The FDA approved the 1st cochlear implant for use in adults 18 and older in the 1980s. Starting in 2000, the FDA approved cochlear implantation for kids 12 months or older. Cochlear implantation involves surgically inserting electronic elements under the skin behind the ear and in the inner ear. A small microphone worn behind the ear picks up sounds and sends them to a small computerized speech processor worn by the person. The processor sends coded signals to an external coil worn behind the ear, which sends them through the skin to the implanted coil. The internal coil sends the signals to electrodes implanted in the inner ear, and these signals are sent to the auditory nerve. Implantation increases ability to hear, resulting in between speech and lang production. However, implantation doesn't always lead to better literacy skills, like reading, spelling, and writing. The prospects for increasing reading comprehension are increased when instruction focuses on explicit instruction in phonological skills. The earlier the implant takes place, the better the kid's ability to hear and speak—however, results can still vary from person to person. o Sign Language: a manual lang used by people who're deaf to communicate; a true lang with its own grammar. Sign lang has suffered from several misconceptions—it isn't a true language. Notion that sign lang is simply a primitive, visual rep of oral lang similar to mime was 1st challenged by the pioneering work of William Stokoe at Gallaudet U. A linguist, Stokoe asserted that, analogous to the phonemes of spoken English, each sign in ASL consists of 3 parts: handshape, location, and movement. § Grammatical Complexity of Sign Language: has grammatical structure at the sentence level (syntax) as well as at the word or sign level. Handshapes, location, and movement are combined to create a grammar as complex as that of spoken lang. § Nonuniversality of Sign Language: no single, universal sign lang exists. Just as geographical or cultural separations result in diff spoken languages, they also result in diff sign languages. Sign languages, like spoken languages, evolve over time through common usage. The 1700s French clergyman Charles-Michel de l'Eppe is often referred to as "the father of sign lang." Some assume that de l'Eppe invented sign lang which isn't true—he promoted the usage of French Sign Lang, which already existed within the Deaf community. § The Black American Sign Lang (BASL) Dialect: there are also diff sign lang dialects, most often due to differences in geographic locations within a country. The BASL dialect is an example, in that the "geographic" discrepancy is based on segregation existing in schools historically—just as black hearing students were segregated, so too were black deaf students. Just as integration of black hearing students has been slow, so has integration of black deaf students—the black deaf school didn't integrate until 1978. Just as certain spoken English dialects are sometimes considered inferior, so too have students using BASL been looked down upon. § The Birth and Evolution of Nicaraguan Sign Language: need to communicate is a driving force in the development of sign lang. Fingerspelling: using simple signs to sign the alphabet. § Developmental Milestones of Sign Language: kids who're deaf reach the same lang development milestones in sign that kids who can hear reach in spoken lang, and do so at about the same time. § Neurological Foundations of Sign Language: studies show sign lang has the same neurological underpinning as does spoken lang. Using neuroimaging techs, researches collected evidence showing the left hemisphere of the brain is also the primary site responsible for sing lang acquisition and use. o Intellectual Ability: any IQ testing of people with hearing impairment must take their English lang deficiency into account. Pros should use multiple measures, with an emphasis on non-verbal, performance tests, rather than verbal tests. If performance tests are administered in sign, they offer a much fairer assessment of IQ. Standardized tests of ASL skills are available. o Academic Achievement: Most kids who're deaf have large deficits in academic achievement. Reading ability, which relies on English lang skills and is prob the most important area of academic achievement, is most affected. Link between hearing impairment and phonological and phonemic difficulties is logical given that phonology refers to the sounds of lang. Phonics-based intervention can result in a positive impact on lang development. The more explicit the instruction, the more effective the impact is on lang. Using sign lang to support phonics-based instruction also effective in teaching writing and reading. Several studies have demonstrated that children who are deaf who have parents who are deaf have higher levels of achievement and better language skills than do those who have hearing parents. Researchers do not agree about the cause, but many speculate that the positive influence of sign language is the cause. Parents who are deaf might be able to communicate better with their children through the use of ASL, providing the children with needed support. In addition, children who have parents who are deaf are more likely to be proficient in ASL, and ASL can aid these children in learning written English and reading. o Social Adjustment: at risk for problems in interacting socially with their peers. People who're def can face problems in finding others with whom they can converse. Many students who're deaf are at risk for poor self-concepts and loneliness. Without implementing strategic grouping, very little interaction typically occurs in inclusive settings between students who're deaf and those who aren't. This isn't always possible due to the low prevalence of hearing impairment. Some interventions using cooperative learning have succeeded in increasing interactions between students who're deaf and their peers who can hear. Some believe that the deaf kid who has parents who hear runs a greater risk of being unhappy than the kid whose parents are also deaf. Many parents who can hear or who are hard of hearing aren't proficient in ASL and are unable to communicate with their kids easily. Given that about 90% of kids who're deaf have hearing parents, this problem in communication is critical. The need for social interaction is prob most influential in leading many with hearing impairment to associate primarily with others with hearing impairment. § The Deaf Culture: many deaf people believe in the value of having their own Deaf culture and view this culture as a natural condition emanating from the common bond of sign lang. Factors demarcating Deaf community as a true culture: 1) Linguistic differentiation is at the heart of Deaf culture; many within the Deaf community view themselves as bilingual, with individuals possessing varying degrees of fluency in ASL and English. People who're deaf continually shift between ASL and English as well as between the Deaf culture and that of the hearing. 2) Attitudinal deafness refers to whether a person thinks of himself as deaf. It might not have anything to do with a person's hearing acuity. 3) Behavioral norms within the Deaf community differ from those in hearing society. A few examples of these norms are that people who are deaf value informality and physical contact in their interactions with one another, often giving each other hugs when greeting and departing, and their leave-takings often take much longer than those of hearing society. Also, they are likely to be frank in their discussions, not hesitating to get directly to the point of what they want to communicate. 4) Endogamous marriage patterns are evident from surveys showing rates of in-group marriage as high as 90%. The Deaf community tends to frown on "mixed marriages" between people who are deaf and those who are hearing. 5) Historical awareness of significant people and events pertaining to people who are deaf permeates the Deaf community. They are often deferential to elders and value their wisdom and knowledge pertaining to Deaf traditions. 6) Voluntary organizational networks are abundant in the Deaf community: National Association of the Deaf, the World Games for the Deaf (Deaf Olympics), and the National Theatre of the Deaf. § Concern for the Erosion of Deaf Culture: Many within the Deaf community and some pros are concerned that the cultural status of kids who're deaf is in peril. They believe that the increase in inclusion is eroding the cultural values of the Deaf culture. In the past, much of Deaf culture was passed down from generation to generation through contacts made at residential schools, but if they attend local schools, today's children who are deaf may have little contact with other children who are deaf. Many authorities now recommend that schools involve members of the Deaf community in developing classes in Deaf history and culture for students who are deaf who attend local schools. § Deaf Activism: The Gallaudet Experience: those who're deaf have been 1 of the most, if not the most, outspoken about their rights. Active in advocating a variety of social, educational, and medical policies. Deaf President Now Movement: 1980s at Gallaudet University, a liberal arts college for the deaf and hard of hearing, when students and faculty protested the board of trustees' selection of a hearing president. Since its founding in 1864, Gallaudet had never had a deaf president. But when on March 6, 1988, the trustees announced the appointment of yet another hearing president, faculty and students took to the streets and halls in protest. Having successfully shut down the university, organizers of the Deaf President Now Movement issued four demands: 1. that a deaf president be named immediately; 2. that the chair of the board resign; 3. that the board, which consisted of 17 hearing and 4 deaf members, be reconfigured to include a majority of deaf members; and 4. that there be no reprisals. After 8 days of protest, the board acceded to all demands, the most significant of which was the naming of a long-time faculty member who was deaf--I. King Jordan--as president of the university. Unity for Gallaudet Movement: Jane K. Fernandes, to be Jordan's successor. Students and faculty once again protested, holding rallies and blocking entrances to the school. The protests continued during the Fall semester, with more than 100 students arrested for blocking entrances. Given that Fernandes is also deaf, accounts vary as to why such a negative reaction occurred—some cited what they considered a flawed, non-inclusive selection process, but many pointed to concerns that Fernandes was not "deaf enough." They objected to her having stated that she wanted to be more inclusive by admitting more students with cochlear implants as well as those who had not grown-up learning sign language. (Fernandes herself reportedly grew up using speech and speechreading and didn't learn sign language until she was in her 20s.) In October 2006, Fernandes was removed as president by the board. In December, 2006, the board named Robert Davilla as an interim president. Deaf since the age of 8, Davilla had previously served in a number of high-level government and university positions. Also deaf, T. Alan Hurwitz became president in May, 2010. Hurwitz, whose background is engineering, came to the position after being president of the National Technical Institute for the Deaf. In 2016, Roberta Cordano became the first female deaf president of Gallaudet. § Deaf Activism: The Cochlear Implant Debate: Deaf activists aggressive in attacking what they consider an oppressive medical and educational establishment. Many within the Deaf community oppose cochlear implants, viewing the process as physically and culturally invasive. The more positive results are making it more difficult for those who are deaf, or their parents, to decide whether to choose cochlear implantation. One problem is that in order to reap the benefits of improved hearing from the implant, many professionals recommend intensive oral instruction. As we discuss later, many within the Deaf community favor manual (ASL) over oral teaching methods. So, they're concerned that persons with implants may not gain enough exposure to sign language, but the majority of children with implants still don't attain hearing and speaking skills within the range of hearing children. Again, this is a far cry from a cure, but for some, it's enough of an improvement to elect to undergo the surgery. § Deaf Activism: The Genetic Engineering Debate: Deaf parents could use in vitro fertilization, a procedure that's used to help infertile couples, whereby egg cells from the mom are fertilized in the lab and then placed in the mom's uterus. Parents who're deaf could choose to retain only fertilized eggs that have the connexin-26 mutation. Another option is artificial insemination by a donor who has a high probability of carrying genes leading to deafness.

Transition to Adulthood for Visual Impairment

o Independent Living: With proper training, preferably starting no later than middle school, most people who're blind can lead independent lives. However, evidence shows that many students who are blind aren't receiving the training necessary in daily living skills. Ironically, some professionals have asserted that the movement toward including students with visual impairment in general education and providing them access to the general education curriculum has led to a diminished emphasis on teaching skills necessary for independence. They say that itinerant teachers often do not have enough time to do much direct teaching of daily living skills. Many authorities also point out that a major reason why adolescents and adults with visual impairment might have problems becoming independent is because of the way society treats people without sight. A common mistake is to assume that they're helpless. People with visual impairment have a long history of arguing against paternalistic treatment by sighted society, often resisting governmental actions that were presumably designed to help them. For example, the NFB has passed resolutions opposing the universal installation of accessible pedestrian signals and underfoot raised dome detectable warnings. Accessible pedestrian signals (APSs) alert people who are blind to when it is safe to walk across an intersection. The most common types provide auditory or tactile cues or a combination of the two. The National Cooperative Highway Research Program has published a guide to best practices in implementing APSs. Raised dome detectable warnings alert people who are blind to unsafe areas, such as ledges next to tracks in subway stations. The NFB has stated that APSs might be needed at some complex intersections, but that they're not needed universally. They claim that APSs can be distracting and that continuously operating APSs add to noise pollution, which can interfere with the person's hearing traffic flow. The NFB asserts that the raised dome detectable warnings are also not needed in many instances and that they can lead to unstable walking conditions. Underlying the NFB's objection to both of these travel aids is its concern that sighted society will view people who are blind as needing more accommodations than necessary, thus reinforcing the notion that they're helpless. o Employment: many are unemployed, overqualified for the jobs they hold, and receive lower wages than are warranted. Employers often don't understand that with appropriate accommodations, blindness can be eliminated or reduced as a barrier to successful job performance. With proper transition programming, students with visual impairment, even those who're completely blind, can go onto hold jobs at every level of preparation. However, the transition programming should be intensive and extensive and include numerous well-supervised work experiences or internships. High on the list of ways to improve employment possibilities for those who are blind are job accommodations. Employees who are blind report that relatively minor adjustments can go a long way toward making it easier for them to function in the workplace. Suggested adaptations include improved transportation (e.g., car pools), better lighting, tinted office windows to filter light, prompt snow removal, regularly scheduled fire drills to ensure spatial orientation, hallways that are free of obstacles, and computer software (e.g., screen magnification programs) and reading machines that convert print into braille. Special and gen educators need to achieve the delicate balance between providing special programming for students with visual impairment and treating them in the same manner as they do the rest of their students.

Psychological and Behavioral Characteristics of Vision Impairment

o Language Development: most authorities believe that lack of vision doesn't have a very significant effect on the ability to understand and use lang. The blind child can still hear lang and might even be more motivated than the sighted kid to use lang because it's the main channel through which she communicates with others. o Intellectual Ability: § Performance on Standardizes Intelligence Tests: from what's known, there's no reason to believe that blindness results in lower intelligence. § Conceptual Abilities: Researchers, using conceptual tasks originally developed by noted psychologist Jean Piaget, have concluded that infants and very young kids who're blind lag behind their sighted peers. This is attributed to the fact that they rely more on touch to arrive at conceptualizations of many objects, and touch is less efficient than sight. However, these early delays don't last long especially once the kids begin to use lang to gather info about their environment. Have to take much more initiative to learn what they can from their environment. Exploring the environment motorically, however, doesn't come easily for infants and young kids with visual impairment, especially those who're blind. Some have serious delays in motor skills, such as sitting up, crawling, and walking. Adults should do as much as possible to encourage infants to and young kids to explore their environment. Critical that parents and teachers provide intensive and extensive instruction, including repetition, to help kids with visual impairment develop their conceptual abilities. o Functional Skills: degree to which a person with visual impairment has functional skills such as using vision under non-clinical conditions in familiar and unfamiliar settings is very important. Essence of having a visual impairment is needing to use a means other than eyesight to perform tasks—using braille, using magnifying devices, learning how to pour a glass of water. o Orientation and Mobility (O & M): skills refer to the ability to have a sense of where 1 is in relation to other people, objects, and landmarks (orientation) and to move through the environment (mobility). O&M skills are important for the successful adjustment of people with visual impairment. The ability to orient and move about the environment is associated with positive social adjustment and positive employment outcomes. Mobility skills vary greatly among people with visual impairment—difficult to predict who will be the best travelers. How much motivation and how much proper instruction 1 receives are critical to becoming a proficient traveler. Those who're totally blind actually develop better O&M skills than those who're partially sighted. § Cognitive Mapping: people who're blind can learn to make mental spatial reps of their environment, which can help them navigate through their environment. Sometimes referred to as mental mapping, cognitive mapping involves the ability to integrate the relative position of various points in the spatial environment in order to navigate it more efficiently. § Echolocation: Obstacle sense: a skill possessed by some who're blind, whereby they can detect the presence of obstacles in their environments; it isn't an indication of an extra sense, as popularly thought; it's the result of learning to detect subtle changes in the pitches of high frequency echoes, or echolocation. With experience, people who're blind can learn echolocation to a very high level of proficiency through practice (sighted people can do this too). Although echolocation can be important for the mobility of someone without sight, by itself it doesn't make its user a highly proficient traveler. Extraneous noises can render obstacle sense unusable; and it requires walking at a fairly slow speed to be able to react in time. Researchers study this in this hope of developing mobility aids that can help sharpen echolocation ability. Along with echolocation comes the misconception that blind people automatically develop better acuity in their other senses. Blind people don't have lowered thresholds of sensation in touch or hearing—what they do is make better use of the sensations they obtain. Through concentration and attention, they learn to make fine discriminations in touch and hearing. There's also a myth that many of those born blind are also born with innate musical talent—no evidence to support this. o Academic Achievement: Achievement tests are available in braille and large-print forms. Most professionals agree that direct comparisons of the academic achievement of students who are blind with that of sighted students must be interpreted cautiously because the two groups are tested under different conditions. The few studies that have been done suggest that both children with low vision and those who are blind are sometimes behind their sighted peers academically. Many authorities believe that when low achievement does occur, it is due not to the blindness itself, but to such things as low expectations or lack of exposure to braille. Learning to read braille is similar in some important ways to learning to read print—phonological awareness is an important component of learning to read braille as well as print. Students who're blind and who have poor phonological awareness would be candidates for "braille dyslexia;" and some conjecture that there might be some for whom their poor braille reading skills are linked to difficulties in processing tactile info. o Social Adjustment: most are socially well adjusted, but some do have a tendency to encounter problems with social competence. May be hard because social interactions among the sighted are often based on subtle cues, many of which are visual, and sighted society is often uncomfortable in its interactions with people who have visual impairment. § Subtle Visual Cues: sighted take for granted how often we use visual cues to help us in our social interactions—we learn most of these cues incidentally by observing others. Kids with visual impairment often need to be taught directly how to use these cues. Facial expressions, such as smiling, are a good example of visual cues that don't come spontaneously for people who have visual impairment. § Society's Discomfort with Blindness: sighted people feel ill at ease when interacting with people with visual impairments, which then interferes with smooth social interaction. Unfortunately, some who're blind feel that they must go to great lengths to appear "normal." § Stereotypic behaviors: repetitive, stereotyped movements such as body rocking, poking or rubbing the eyes, repetitive hand or finger movements, and grimacing. These can begin as early as a few months of age. They are by no means exclusively found in children with more severe visual impairment although they tend to be more prevalent in those who are blind compared to those with low vision. For many years, the term blindisms was used to refer to these behaviors because it was thought that they were manifested only in people who are blind; however, they are also sometimes characteristic of children with normal sight who have severe intellectual disabilities or autism. Several competing theories concern the causes of stereotypic behaviors—some believe that the behaviors are an individual's attempt to provide themselves with more stimulation to make up for a relative lack of sensory or social stimulation. Others believe them to be an individual's attempt to self-regulate stimulation in the face of overstimulation. In either case, most believe that these behaviors serve to stabilize the person's arousal level. Some even disagree about how much one should intervene to reduce or eliminate stereotypic behaviors. On the one hand, in the extreme, these behaviors can interfere with learning and socialization and can even be physically injurious. On the other hand, in moderation, such behaviors might help maintain an appropriate level of arousal. In addition, some have argued for society's need to be more tolerant of stereotypic behaviors.

Assessment of Progress for Communication Disorder

o Language assessment must consider: What child talks about, How child talks about things, How child functions in context of community, and How child uses language socially. o After developing the intervention plan, educators implement an ongoing assessment plan to monitor progress and identify outcome measures and to ensure that the student is meeting programmatic goals. Methods for monitoring the progress of students with language impairments may use a system of dynamic assessment that involves a cycle of teaching, followed by testing, and then reteaching as necessary. Teachers administer dynamic assessments during the learning process, and the SLP determines how the student performs with and without support. This information guides intervention as the SLP establishes what the student can do and where the student needs further intervention. Teachers can use dynamic assessments in the context of a response-to-intervention (RTI) program by SLPs. o Teachers can also use curriculum-based language and communication assessment (CBLA) to monitor students' progress. CBLA differs from curriculum-based measurement (CBM) in that it measures a student's speech, language, and communication skills required to learn the school curriculum. CBLA generally measures the communication skills required to participate in the school curriculum and the strategies the student employs to conduct curricular tasks. Based on the observations related to these two areas, the SLP then determines what skills the student needs to acquire and how to modify the task to ensure success. o As in other areas of education, the current trend requires that service providers demonstrate the value of communication intervention in terms of student outcomes. Currently, SLPs may rely on the National Outcomes Measurement System (NOMS) to measure the outcomes of students in communication interventions. In an effort to assist SLPs in documenting treatment outcomes, the American Speech Language Hearing Association formed the National Center for Treatment Effectiveness in Communication in the early 1990s. A result of these efforts is the NOMS, an online database assessment system. The SLP employs a series of scales that measure functional communication, and then evaluates these data, along with demographic and diagnostic data, to generate a report of outcomes based on the individual's intervention plan.

Definition and Classification of Visual Impairment

o Legal Def: involves assessment of visual acuity and field of vision. A person who's legally blind has visual acuity of 20/200 or less in the better eye even with correction or has a field of vision so narrow that its widest diameter subtends an angular distance no greater than 20 degrees. The fraction 20/200 means that the person sees at 20 feet what a person with normal vision sees at 200 feet. The inclusion of a narrowed field of vision means that a person may have 20/20 vision in the central field but severely restricted peripheral vision. Legal blindness qualifies a person for certain legal benefits, such as tax advantages and money for special materials. Also, a category referred to as low vision (sometimes referred to as partially sighted). People with low vision have visual acuity falling between 20/70 and 20/200 in the better eye with correction. o Educational Def: educators say visual acuity isn't very accurate predictor of how people will function or use whatever remaining sight they have. Although a small percentage of people who're legally blind have absolutely no vision, the majority can see to some degree. The ed def stresses the method of reading instruction. Individuals who're bling are so severely impaired they must learn to read braille, a system of raised dots by which people who're blind read with their fingertips. It consists of quadrangular cells containing 1-6 dots whose arrangement denotes diff letters and symbols. Alternatively, they use aural methods (audiotapes and recordings). Those who have low vision can read print, even if they need adaptations such as magnifying devices or large-print books.

Educational Considerations regarding Hearing Impairment

o Major prob is communication. Debate about how people who're deaf should converse. This controversy is sometimes referred to as the oralism-manualism debate, to represent two very different points of view: Oralism favors teaching people who are deaf to speak, whereas manualism advocates the use of some kind of manual communication. Manualism was the preferred method until the middle of the 19th century, when oralism began to gain predominance. Currently, most pros recommend both oral and manual methods in what is referred to as a total communication or simultaneous communication approach. However, many within the Deaf community believe that even the total communication approach is inadequate, and they advocate for a bicultural-bilingual approach, which promotes ASL as a first language and supports instruction in the Deaf culture. o Oral Approaches: The Auditory-Verbal Approach and the Auditory-Oral Approach: § Auditory-Verbal Approach: focuses exclusively on using audition to improve speech and lang development. Assumes that most kids with hearing impairment have some residual hearing that they can use to their benefit. It relies heavily on amplification tech, such as hearing aids and cochlear implants, and stresses that this amplification tech should be instituted as young as possible. Places heavy emphasis on speech training. Because kids with hearing impairments have problems hearing their own speech or that of others and often hear speech in a distorted fashion, they must be explicitly instructed in how to produce speech sounds. § Auditory-Oral Approach: similar to the auditory-verbal approach but stresses the use of visual cues, such as speechreading and cued speech. Sometimes inappropriately called lipreading, speechreading involves teaching kids to use visual info to understand what's said to them. Speechreading is a more accurate term than lipreading because the goal is to teach students to attend to a variety of stimuli in addition to specific movements of the lips. Cued speech is a way of augmenting speechreading. In cued speech, the person uses handshapes to rep specific sounds while speaking. 8 handshapes are cues for certain consonants, and 4 serve as cues for vowels. Cued speech helps the speechreader differentiate between sounds that look alike on the lips. Although it has advocates, cued speech isn't used widely in the US. § Criticisms of the Oral Approach: object to deemphasis of sign lang in this approach—unreasonable to assume that many kids with severe or profound degrees of hearing impairment have enough hearing to be of use. So, denying these kids access to ASL is denying them access to a lang to communicate. Also, speechreading is very difficult and good speechreaders are rare. Speechreading is difficult because speakers produce many sounds with little obvious movement of the mouth, English has many homophones, diff sounds that are visually identical when spoken, speakers vary in how the produce sounds, poor lighting, rapid speaking, and talking with one's head turned. o Total Communication/Simultaneous Communication: most schools have adopted the total communication approach, a combo of oral and manual methods. Total communication involves the simultaneous use of speech with one of the signing English systems. These signing systems are approaches that pros have devised for teaching people who are deaf to communicate. Fingerspelling, the rep of letters of the English alphabet by finger positions, is also used occasionally to spell out certain words. Dissatisfaction with total communication has been growing among some professionals and many within the Deaf community. The focus of the criticism has been on the use of signing English systems rather than ASL. Unlike ASL, signing English systems maintain the same word order as spoken English, thereby making it possible to speak and sign at the same time. Defenders of signing English systems state that the correspondence in word order between signing English systems and English helps students to learn English better. Advocates of ASL assert that the use of signing English systems is too slow and awkward to be of much benefit in learning English. They argue that word order is not the critical element in teaching a person to use and comprehend English. Advocates of ASL believe that fluency in ASL provides students with a rich background of information that readies them for the learning of English. Furthermore, they argue that ASL is the natural language of people who are deaf and that it should be fostered because it is the most natural and efficient way for students who are deaf to learn about the world. Unlike ASL, signing English systems are not true languages. o The Bicultural-Bilingual Approach: 1) ASL is considered the primary lang, and English is considered the secondary lang. 2) People who're deaf play an important role in the development of the program and its curriculum. 3) The curriculum includes instruction in Deaf culture. Can be structured so that ASL is learned 1st, followed by English, or the 2 can be taught simultaneously. Research on efficacy of this approach is in its infancy, however we know that these programs are promising and that ASL may contribute to the reading and writing skills of students who're deaf. Research comparing ASL, signing English systems, and the various approaches has been insufficient to conclude that only 1 approach should be used. o Technological Advances: § Hearing Aids: There are three main types of hearing aids: those worn behind the ear, those worn in the ear, and those worn farther down in the canal of the ear. The behind-the-ear hearing aid is the most powerful and is therefore used by those with the most severe hearing impairment. It's also the one that children most often use because it can be used with FM systems that are available in some classrooms. With an FM system, the teacher wears a wireless lapel microphone, and the student wears an FM receiver (about the size of a cell phone). The student hears the amplified sound either through a hearing aid that comes attached to the FM receiver or by attaching a behind-the-ear hearing aid to the FM receiver. Whether a student will be able to benefit from a hearing aid by itself depends a great deal on the acoustic qualities of the classroom. Although hearing aids are an integral part of educational programming, some children who are deaf can't benefit from them because of the severity and/or nature of the hearing impairment. Generally, hearing aids make sounds louder, not clearer, so if a person's hearing is distorted, a hearing aid will merely amplify the distorted sound. § TV, Video, Video Games, Movies, and YouTube and Captioning: Fed law requires that TVs with screens over 13 inches must contain a chip to allow 1 to view captions without a decoder—and also stipulates that virtually all new programming must be captioned. However, advocates such as the National Association of the Dead continue to press for better captioning. Captioning of video games is becoming more common. Many DVDs and programs available from streaming services are captioned. The Rear Window captioning system displays captions on transparent acrylic panels that movie patrons can attach to cup holders on their seats. The captions are actually displayed in reverse at the rear of the theater, and viewers see them reflected on their acrylic screen. Google now offers a way for people to caption videos they make. The videos can be imported directly to 3Play Media, a company that creates captions that're automatically sent to YouTube and added to the videos. Google also provides tools for video developers to create their own captions. § Telephone Adaptations: texting with smartphones. Text telephones (TT) (sometimes referred to as TTYs—teletypes or TDDS00telecommunication devices for the deaf). People can use a TT connected to a telephone to type a message to anyone else who has a TT. A special phone adaptation allows people without a TT to use the pushbuttons on their phone to "type" messages to people with a TT. The fed government now requires each state to have a relay service that allows a person with a TT to communicate with anyone through an operator, who conveys the message to a person who does not have a TT. The TT user can carry on a conversation with the non-TT user, or the TT user can leave a message. Another expanding technology is video relay service (VRS). VRS enables people who're deaf to communicate with people who hear through a sign language interpreter serving as an intermediary. § Computer-Assisted Instruction: visual displays of speech patterns on a computer screen can help someone with hearing impairment to learn speech. Software programs and online videos showing people signing are also available for use in learning ASL. Another example of computer-based technology is C-Print. With C-Print, a person who hears uses an abbreviation system that reduces keystrokes to transcribe on a computer what is being said by, for example, someone lecturing. Students who are deaf can read a real-time text display on their computers as well as receive a printout of the text at a later time. § Virtual Reality-Hologram-3D-Signing Avatars: working on using gesture-recognition tech to help young kids who're deaf practice ASL skills. The kid sits in front of a monitor and wears special wireless gloves whose movement can be monitored by the computer to determine how accurately the kid is signing. Development of avatars that use sign lang. § The Internet: Email. Blogs. Instant messaging. Flow of social networking sites (Facebook, Twitter, etc.). All can serve as vehicles for the Deaf community to stay connected and for people with and without hearing impairments to communicate with each other. § Newer Assistive Tech: videophones, webcams, 3D avatars, interactive white boards (SmartBoards), student response systems, and reading and writing software programs. o Service Delivery Models: Students who are deaf or hard of hearing can be found in settings ranging from gen ed classrooms to residential institutions. Since the mid-1970s, more and more of these students have been attending local schools in self-contained classes, resource rooms, and general education classes. Currently, about 87% of students with hearing impairments between the ages of 6 and 21 attend classes in local schools, and 60% spend at least 80% of their time in the general education classroom. They're also still served in special schools or residential settings more than students in most other disability categories. Many within Deaf community are critical of the degree of inclusion—they argue that residential schools have been a big influence in fostering the concept of a Deaf culture and the use of ASL. Inclusion, they believe, forces them to lose their Deaf identity and places them in a hearing and speaking environment in which it's hard for them to succeed. Usually only student with a hearing impairment, which can lead to a lack of peers with whom the student can communicate and a high degree of social isolation. Research on the effects of inclusion found that social and academic outcomes vary from student to student. Effective inclusive programming is related to support from the school admin and parents and opportunities for instruction in the gen ed classroom by special educators trained in def ed.

Speech Disorders

o Many diff types, degrees, and combos exist of speech disorders. Most speech disorders are treated primarily by an SLP, but gen and special ed teachers are expected to work collaboratively with the SLP in assessment and intervention. o Phonological disorders: occur in kids younger than 9; impaired ability to produce sounds in the kid's own lang; cause is unknown. Occurs in 4 or 5 in 100 kids, somewhat more often in boys. Difficult to distinguish conceptually from articulation disorders. Kids with articulation disorders simply have trouble producing sounds correctly. Kids with phonological disorder have poor inner rep of the sounds lang—might not understand contrasts between sounds or the distinctiveness of sound, resulting in how speech sounds are produced. Phonology is critical to literacy. Phonological awareness: understanding of the sound structure of lang; includes abilities to blend sounds into words, to segment words into sounds, and to manipulate the sounds of spoken lang. Without phonological awareness, a student cannot make sense of the alphabetic principle, which results in an inability to decode words. Some, but not all, children with phonological disorders lack phonological awareness. Some have serious problems with verbal working memory (remembering what was said or what they want to say) or word learning and word retrieval. Deficits in working memory and word retrieval are considered a phonological processing disorder. This disorder of the phonological system of language affects speech sound production and often affects literacy as well. o Articulation Disorders: involve errors in producing sounds—individual omits, subs, distorts, or adds speech sounds. Lisping involves sub or distortion of the s sound. Missing, subbed, added, or poorly produced word sounds can make a speaker difficult to understand or even unintelligible and may subject speaker to teasing/ridicule. Articulation errors considered disorder influenced by clinician's experience, number and types of errors, consistency of these errors, the age and developmental characteristics of the speaker, and the intelligibility of the person's speech. Age of child is a major consideration and the characteristics of the kid's lang community. Can be caused by biological factors, like brain damage or damage to the nerves controlling the muscles that are used in speech may make it difficult or impossible to articulate sounds. Among children with other disabilities, especially intellectual disabilities and neurological disorders such as cerebral palsy, the prevalence of articulation disorders is higher than that in the general population. Abnormalities of the oral structures, such as a cleft palate, can make normal speech difficult or impossible. Relatively minor structural changes, such as loss of teeth, can produce temporary errors. Poor articulation may also result from a hearing loss. Most schools screen all new pupils for speech and language problems, and in most cases, a child who still makes many articulation errors in the third or fourth grade will be referred for evaluation. Older children and adults sometimes seek help on their own when their speech draws negative attention. The decision to include or not include a child in speech-language therapy depends on several factors, including the child's age, developmental characteristics, and the pathologist's assessment of the likelihood that the child will self-correct the errors and of the social penalties, such as teasing and shyness, the child is experiencing. If the child misarticulates only a few sounds but does so consistently and suffers social embarrassment or rejection as a consequence, an intervention program is usually necessary. o Voice Disorders: characteristics of pitch, loudness, and/or quality that are abusive of the larynx; hamper communication; or are perceived as very diff from what's customary for someone of a given age, sex, and cultural background. Functional disorders are result of damage to the larynx. Organic disorders are result of physical conditions (growths in larynx). Neurological disorders are result of nervous system dysfunction. Misuse or abuse of voice can also lead to temporarily abnormal vocal quality. Disorders resulting from misuse and abuse of the voice and smoking or inhaling substances can damage tissues of the larynx. Sometimes psychological problems that lead to a complete loss of voice (aphonia) or to severe voice abnormalities. Voice disorders having to do with resonance—vocal quality—may be caused by physical abnormalities of the oral cavity (such as cleft palate) or damage to the brain or nerves controlling the oral cavity. Infections of the tonsils, adenoids, or sinuses can also influence how the voice is resonated. Most people who have severe hearing loss typically have problems in achieving a normal or pleasingly resonant voice. Finally, sometimes a person simply has not learned to speak with an appropriately resonant voice. Teachers need to observe children for common symptoms of voice disorders, such as hoarseness, aphonia, breathiness, odd pitch (voice too high or too low pitched), or an inappropriately loud or soft voice. A teacher who notes possible problems should ask an SLP to conduct an evaluation. Teachers should also monitor their own voices for indications of vocal stress. o Fluency Disorders: Dysfluencies: the hesitations, repetitions, and other interruptions of normal speech flow that are entirely normal parts of learning to use lang. When speaker's efforts are so intense or interruptions in flow of speech are so frequent or pervasive that they prevent understanding or draw extra attention, they're considered disorders. Most frequent type of fluency disorder is stuttering: speech characterized by abnormal hesitations, prolongations, and repetitions; may be accompanied by grimaces, gestures, or other bodily movements indicative of a struggle to speak, anxiety, blocking of speech, or avoidance of speech. Stuttering isn't common—1% of kids and adults are considered stutterers. More boys stutter. Many kids quickly outgrow their childhood dysfluencies. Those who stutter for more than 1.5 or 2 years appear to be at risk for becoming chronic stutterers. Early diagnosis is important to avoid chronic stuttering, but many educators and docs don't refer potential stutterers because they're aware of dysfluencies are normal part of speech-lang development. o Motor-Speech Disorders: muscles that make speech possible are under voluntary control. When damage occurs to brain areas that control these muscles or to nerves leading to the muscles, the ability to speak normally is disturbed. These disorders may involve controlling speech sounds, dysarthria, or planning and coordinating speech, apraxia. Both affect the production of speech, slow its rate, and reduce intelligibility. Someone can have both of these problems. Because they're caused by a neurological prob, they're called neurogenic disorders of speech. By listening to the person's speech and inspecting her speech mechanism, the SLP assesses the ability of the person with a motor-speech disorder or neurogenic speech disorder to control breathing, phonation, resonation, and articulatory movements. Medical, surgical, and rehabilitative specialists in the treatment of neurological disorders also must evaluate the person's problem and plan a management strategy. In cases in which the neurological impairment makes the person's speech unintelligible, an AAC system might be required. § Dysarthria: slow, labored, slurred, and imprecise speech. As a result of brain injury, the person's respiratory support for making speech sounds is affected, and his speech may be characterized by shallow breathing, hoarseness, and reduced loudness. Might not be able to produce speech sounds precisely because of muscle weakness. § Apraxia: disruption of motor planning and programming so that speech is slow, effortful, and inconsistent. May recognize that they're making errors and try to correct them, but the attempts make it even hard er to understand what they're trying to say. Developmental apraxia is a disorder of motor planning that emerges as the kid develops speech and lang skills. Kids with this disorder show significant delays in ability to produce speech sounds and to organize sounds into words for effective communication. Acquired apraxia: has similar symptoms but occurs because of a stroke or other type of brain damage after learning speech.

Assessment of Progress regarding ASD

o Monitoring Progress in Language Development: can help teacher or therapist determine if an intervention meets needs of the student. Assessment of expressive lang, particularly for young kids, should include measures from multiple sources—natural lang samples collected in various communicative contexts, parent report via questionnaire or interviews, and direct assessment through standardized measures. Content of lang assessment should be comprehensive, with measures of phonology, vocab, syntax, and pragmatics. Can have parents fill out MacArthur-Bates Communicative Development Inventories to monitor progress in lang development, which cover ages 8-37 months. Teachers may select the Clinical Evaluation of Lang Fundamentals-5 for older students—the CELF-5 measures receptive, expressive, grammatical, and semantic skills for people 5-21. o Monitoring Progress in Social/Adaptive Behavior: Taking only 5-10 minutes to administer, the PDD Behavior Inventory Screening Version (PDDBI-SV) monitors progress in social/adaptive behavior of students 18 months-12 ½ years old. Social Responsiveness Scale (SRS) is a parent/teacher scale that may be used to monitor progress in social/adaptive behavior and evaluates severity of social impairment of people with ASD between ages 4-18. The Autism Social Skills Profile (ASSP) is a standardized outcome measure that examines social skills of children and adolescents with autism spectrum disorder. The ASSP is completed by teachers or parents and includes three subscales: (1) Social Reciprocity, (2) Social Participation/Avoidance, and (3) Detrimental Social Behaviors. The Childhood Autism Rating Scale 2nd Edition (Cars2) is frequently used for screening and diagnostic purposes and can also be used to evaluate the effectiveness of interventions. CARS focuses on behaviors that deviate from those of typically developing children and is appropriate for children over 2 years old.

Definition and Classification of Hearing Impairment

o Most people who're deaf have some residual hearing. Pros in different fields define deaf and hard of hearing differently. o Those who maintain a physiological viewpoint are interested in the measurable degree of hearing impairment. Kids who can't hear sounds at or above a certain intensity/loudness level are classified as deaf; others with a hearing impairment are considered hard of hearing. Hearing sensitivity is measured in decibels (units of relative loudness of sounds). Zero decibels (0 dB) designates the point at which the average person with normal hearing can detect the faintest sound. Each following number of decibels that a person can't detect indicates a certain degree of hearing impairment. Those who maintain a physiological viewpoint generally consider people with hearing impairments of about 90 dB or greater to be deaf and people with impairments at lower decibel levels to be hard of hearing. o Those with an educational viewpoint are concerned with how much the hearing impairment is likely to affect the kid's ability to speak and develop language. Hearing impairment is a broad term that covers people with impairments ranging from mild to profound; it includes those who're deaf and hard of hearing. Education definitions of deaf and hard of hearing: A deaf person is one whose hearing disability precludes successful processing of linguistic info through audition, with or without hearing aids; and a person who's hard of hearing generally has residual hearing sufficient to enable successful processing of linguistic info through audition, with the assistance of a hearing aid. o The earlier the hearing impairment occurs in life, the more difficulty the kid has developing the lang of the hearing society. Pros use the terms congenitally deaf (those who are born deaf) and adventitiously deaf (those who acquire deafness some time after birth). o Prelingual deafness refers to deafness that occurs at birth or early in life before speech and lang develop. Postlingual deafness is deafness that occurs after the development of speech and lang. Experts differ about the dividing point between these 2 types. Some believe it should be about 18 months and others think it should be lower, at about 12 months or even 6 months. o Some pros find it useful to classify according to hearing threshold levels, such as mild (26-40 dB), moderate (41-55 dB), moderate-severe (56-70 dB), severe (71-90 dB), and profound (91 dB and above). These levels of loss of hearing sensitivity cut across the broad classifications of deaf and hard of hearing, which stress the degree to which speech and lang are affected rather than being directly dependent on hearing sensitivity. o Some object to adhering too strictly to any of the various classifications. Because these definitions deal with events hard to measure, they're not precise.

Correcting Misconceptions about Learners with Autism Spectrum Disorder

o Myth: Autism is a single, well-defined category of disability. Fact: Autism comprises a wild spectrum of disorders and symptoms, ranging from very severe to relatively mild. o Myth: People with autism spectrum disorders have intellectual disabilities and can't be involved in higher education or professions. Fact: Autism spectrum disorders include people from the full range of intellectual capacity. Although a high percentage do have intellectual disabilities, many with milder forms, such as Asperger syndrome, are highly intelligent, earn grad degrees, and are successful professionals. o Myth: All people with autism have impairments in some cognitive areas but are highly intelligent or geniuses in other areas. Fact: Only a very few have extraordinary skills. Called autism savant syndrome, these people aren't geniuses in the traditional sense, but they possess very highly developed specific skills in such things as memorization, math, art, or music in isolation from functional skills. o Myth: There's an autism epidemic that can't be explained. Fact: The number of cases has increased dramatically. Most authorities believe this is largely due to 3 things: a widening of the criteria used to diagnose autism, including the recognition of milder forms such as Asperger syndrome; a greater awareness of autism in the general public as well as in the medical, psychological, and educational professions; and the diagnosis of people as having autism who previously would've received a different diagnosis, e.g., as having intellectual disabilities. However, we can't rule out the possibility of toxins, such as air pollution, as contributing to the increase, if only a small way. o Myth: The measles, mumps, and rubella (MMR) vaccine causes autism. Fact: The Institute of Medicine of the National Academies commissioned a review of available evidence and concluded that the evidence favors rejection of a causal relationship between MMR vaccine and autism. Myth: Bad parenting, especially cold, nonresponsive mothering ("refrigerator moms") can cause autism. Fact: No evidence indicates that bad parenting can cause autism. Furthermore, even if a parent is relatively unresponsive, this might be in reaction to the infant's low level of arousal or because of parental stress regarding the kid's abnormal behavior.

Correcting Misconceptions about Learners with Communication Disorders

o Myth: Kids with lang disorders always have speech difficulties as well. Fact: It's possible for a kid to have good speech yet not make any sense when they talk; however, most kids with lang disorders have speech disorders as well. o Myth: People with communication disorders always have emotional or behavioral disorders or intellectual disabilities. Fact: Some kids with communication disorders are normal in cognitive, social, and emotional development. o Myth: How kids learn lang is now well understood. Fact: Although recent research has revealed a lot about the sequence of lang acquisition and has led to theories of lang development, exactly how kids learn lang is still unknown. o Myth: Stuttering is primarily a disorder of people with extremely high IQs. Kids who stutter become stuttering adults. Fact: Stuttering can affect people at all levels of intellectual ability. Some kids who stutter continue stuttering as adults; most stop before or during adolescence with help from a speech-lang pathologist (SLP). Stuttering is primarily a childhood disorder, found much more often in boys. o Myth: Disorders of phonology (articulation) are never very serious and are always easy to correct. Fact: Disorders of phonology can make speech unintelligible; it's sometimes very difficult to correct phonological or articulation problems, especially if the person has cerebral palsy, intellectual disabilities, or emotional or behavioral disorders. o Myth: There's no relationship between intelligence and communication disorders. Fact: Communication disorders tend to occur more frequently among individuals of lower intellectual ability, although they may occur in people who're very intelligent. o Myth: There isn't much overlap between lang disorders and learning disabilities. Fact: Problems with verbal skills—listening, reading, writing, speaking—are often central features of learning disabilities. The definitions of lang disorders and several other disabilities are overlapping. o Myth: Kids who learn few lang skills before entering kindergarten can easily pick up all the skills they need, if they have good peer models in typical classrooms. Fact: Early lang learning is critical for later lang development; a kid whose lang is delayed is unlikely to learn to use lang effectively merely by observing peer models. More explicit intervention is typically required. o Myth: English lang learners who've acquired proficient social lang will also succeed in academic tasks. Fact: Basic interpersonal communication skills (BICS) don't ensure students' academic success. Students require proficiency in more advanced lang skills, referred to as cognitive academic lang proficiency (CALP), to succeed in academic areas.

Correcting Misconceptions about Learners who're Deaf or Hard of Hearing

o Myth: People who're deaf are unable to hear anything. Fact: Most people who're deaf have some residual hearing. o Myth: Deafness isn't as severe a disability as blindness. Fact: Although it's impossible to predict the exact outcomes of a disability on a person's functioning, in general, deafness poses more difficulties in adjustment than blindness does. This is largely due to the effects hearing loss can have on the ability to understand and speak oral lang. o Myth: It's unhealthy for people who're deaf to socialize almost exclusively with others who are deaf. Fact: Many authorities now recognize that the phenomenon of a Deaf culture is natural and should be encouraged. In fact, some are worried that too much mainstreaming will diminish the influence of the Deaf culture. o Myth: In learning to understand what's being said to them, people with a hearing impairment concentrate on reading lips. Fact: Lipreading refers only to visual cues arising from movement of the lips. Some people who have a hearing impairment not only read lips but also take advantage of a number of other visual cues, such as facial expressions and movements of the jaw and tongue. They're engaging in what's referred to as speechreading. o Myth: Speechreading is relatively easy to learn and is used by the majority of people with a hearing impairment. Fact: Speechreading is extremely difficult to learn, and very few people who have a hearing impairment actually become proficient speechreaders. o Myth: American Sign Lang (ASL) is a loosely structured group of gestures. Fact: ASL is a true lang in its own right, with its own set of grammatical rules. o Myth: People within the Deaf community are in favor of mainstreaming students who're deaf into gen ed classrooms. Fact: Some within the Deaf community have voiced the opinion that gen ed classes aren't appropriate for many deaf students. They point to a need for a critical mass of students who're deaf in order to have effective educational programs for these people. They see separate placements as a way of fostering the Deaf culture. o Myth: Families in which both the child and the parents are deaf are at a disadvantage compared to families in which the parents are hearing. Fact: Research shows that kids who're deaf who have parents who're also deaf fare better in a number of academic and social areas. Authorities point to the parents' ability to communicate with their kids in ASL as a major reason for this advantage.

Correcting Misconceptions about Learners with Blindness or Low Vision

o Myth: People who're legally blind have no sight at all. Fact: Only a small percentage of people who're legally blind have absolutely no vision. o Myth: People who're blind have an extra sense that enables them to detect obstacles. Fact: People who're blind don't have an extra sense. Some can learn to develop echolocation skills by noting the change in echoes as they move toward objects. Likewise, better acuity in other sense doesn't arise on its own, but through intense concentration, they can develop fine discriminations in their remaining senses. o Myth: People who're blind have superior musical ability. Fact: People who're blind aren't inherently gifted in music. However, many pursue musical careers as 1 way in which they can achieve success. o Myth: Stereotypic behaviors (body rocking, head swaying) are always maladaptive and should be eliminated. Fact: Although more research is needed, some authorities maintain that these behaviors, except when they are extreme, can help persons who're blind regulate their levels of arousal. o Myth: Braille isn't very useful for the majority of people who're blind; it should only be tried as a last resort. Fact: Very few people who're blind have learned braille, primarily due to fear that using it is a sign of failure and to a historical pro bias against it. Authorities now acknowledge the utility of braille for people who're blind and for those with low vision whose conditions are likely to eventually lead to blindness. o Myth: If people with low vision use their eyes too much, their sight will deteriorate. Fact: Only rarely is this true. Wearing strong lenses, holding books close to the eyes, and using the eyes rarely harm vision. o Myth: Mobility instruction should be delayed until elementary or secondary school. Fact: Many authorities now recognize that even preschoolers can take advantage of mobility instruction, including the use of a cane. o Myth: The long cane is a simply constructed, easy-to-use device. Fact: Learning to use the long cane requires extensive, intensive instruction. o Myth: Guide dogs take people where they want to go. Fact: The guide dog doesn't tke the person anywhere; usually, the person must 1st know where they're going. The dog can be a protection against unsafe areas or obstacles. o Myth: Tech will soon replace the need for braille and for mobility aids such as the long cane and guide dogs. A breakthrough for restoring complete sight through tech is just around the corner. Fact: As amazing as some of the techs are in the field of vision impairment, it's doubtful that they'll replace braille, the long cane, or guide dogs anytime soon. Research on artificial vision is exciting, but it doesn't promise huge practical benefits for some time.

Language Disorders

o Newborn makes few sounds other than cries. With a few years, however, the kid can form the many complex sounds of speech, understand spoken and written language, and express meaning verbally. The major milestones in this ability to use lang are fairly well known by child development specialists, though the underlying mechanisms that control the development of lang are still not well understood. o The kid with a lang disorder may eventually reach many or most of the milestones shown for normal development, but at a later age than typically developing ids. Kids sometimes seem to catch up in lag development, only to fall behind typical development again at a later age. o No one knows how exactly how kids learn lang, but we do know that lang development is related in a general way to physical maturation, cognitive development, and socialization. The details of the process are still debated. 6 theories of lang that have dominated the study of human communication. The 6 theories and research based on them have established the following: Lang depends on brain development and proper brain functioning and lang disorders are sometimes a result of brain dysfunction; Lang learning is affected by consequences of language behavior and lang disorders can be a result of inappropriate learning; Lang can be analyzed as inputs and outputs related to the way information is processed and faulty processing may account for some lang disorder; Lang is acquired by a biological process that governs form, content, and usage and lang disorders are result of a failure to acquire or employ rule-governed aspects of lang; lang is one of many cognitive skills and lang disorders reflect basic problems in thinking and learning; lang arises from need to communicate in social interactions and lang disorder are a breakdown in ability to relate effectively to one's environment. o Each of the above theories contain elements of scientific truth, but none can explain the development and disorders of lang completely. Each has advantages and disadvantages for assessing lang disorders and devising effective interventions. Advances in neurological imaging tech may lead to better understanding of the biological bases of lang. However, pragmatic or social interaction theory is widely viewed as having most direct implications for SLPs and teachers because it focuses most directly on how communication skills can be fostered through adult-child interaction. o Classification of Lang Disorders: classification by etiology (cause) provides 2 subtypes: primary and secondary. A primary lang disorder has no known cause. A secondary lang disorder is caused by another condition, such as intellectual disabilities, hearing impairments, ASD, cerebral palsy, or TBI. o Primary Lang Disorders: § Specific lang impairment (SLI): lang disorder that has no identifiable cause—an unexpected and unexplained variation in the acquisition of lang. Often, SLI involves multiple aspects of lang. Academic problems, particularly in the areas of reading and writing, are common for kids with SLI. § Early expressive lang delay (EELD): significant lag in expressive lang (kid doesn't have a 50-word vocab or use 2-word utterances by age 2) that the kid won't outgrow. About ½ the kids whose lang development is delayed at 2 will gradually catch up developmentally but the other ½ won't catch up and will continue to have lang problems throughout their school years. § Lang-based reading impairment: reading prob (like dyslexia) based on a lang disorder. This disorder can't be identified until the kid begins learning to read and has problems. Research of phonological awareness, alphabet knowledge, and grammatical speech have helped in identifying kids who're vulnerable to this kind of disorder. A significant percentage of kids who manifest lang impairments in kindergarten will have obvious reading problems by 2nd grade. Evidence that phonological awareness and pragmatic, syntactic, and semantic knowledge is predictive of later reading comprehension, again indicating significant risk for kids with lang impairment. Research suggests that the magnitude of the reading impairment is greater when the lang impairment is paired with a speech sound disorder.

Prevalence of ASD

o Prevalence rate for ASD has increased dramatically in past few years. 1 in 68 now. From 2005-2011, prevalence of students 6-21 identified with ASD doubled, with most recent rate being 0.59%. o Prevalence is 5 times higher for boys than for girls. Males are more biologically susceptible to neurological dysfunction to pros having a biased tendency to refer and/or diagnose males when they exhibit behaviors outside the range of normalcy. o ASD occurs in all socioeconomic, ethnic, and racial groups. However, rates of autism are much lower in Latino pops, and when Latinos are diagnosed it's likely to be at a later age than white kids. Paradoxically, Latina moms of kids who're eventually diagnosed are more likely to be concerned about their kid's development or behavior at an earlier age than are white moms—this discrepancy may be due to less access to healthcare and/or they're less adept at traversing the healthcare and school domains. o Prevalence rate is just as high, if not higher, for countries in Europe and Asia. o Reasons for the prevalence growth are disputable. May be due to: 1) widening of the criteria used to diagnose autism, including recognition of those who're higher functioning. 2) Greater awareness of autism in the gen pub as well as the medical, psychological, and educational professions. 3) "Diagnostic substitution," the phenomenon of people now being identified as having ASD who previously would've been diagnosed as having intellectual disabilities or as having developmental lang disorders. Can't rule out possibility of some causes for increase as yet undetected factors, such as toxins—preliminary evidence suggests a relationship between amount of air pollution and prevalence of autism.

Intro to Communication Disorders

o Some people have serious problems producing a sufficiently clear voice quality, described as a voice disorder, and others are unable to comprehend the lang that others produce, described as a receptive lang disorder. People who're unable to produce fluent speech, or speech of an appropriate rhythm and rate have a fluency disorder, or stuttering. o Not all communication disorders involve disorders of speech and not all speech disorders are as handicapping in social interactions as stuttering, nor is stuttering the most common disorder of speech (1% of pop with long-term stuttering problem). 4x more boys stutter long-term. o Broad context of communication disorders because of the obstacles they present to social interaction, which is the major purpose of lang. 3 elements of communication considered when thinking about communication disorders: contexts in which communication occurs (in a group, in the classroom, etc.), the functions expressed by communication or the reasons 1 communicates (to request, to comment, to reason, etc.), and the actual execution of communication comprehension and expression.

Communication Variations

o Someone with a lang diff that's also a disorder has difficulty communicating in every lang environment, including the home lang community. o Systematic lang variations that are rule governed are dialects. A dialect may lead to a misdiagnosis of a lang disorder. On 1 hand, care must be taken not to mistake a cultural or ethnic diff for a disorder; on other hand, disorders that exist in the context of lang diff mustn't be overlooked. When assessing kid's lang, pro must be aware of limitations of normative tests and sources of potential bias. o A kid might not have a lang disorder, yet have a communicative diff that requires special teaching to promote academic achievement and social communication. Kids of nondominant cultures must be taught the rules for effective communication in the dominant culture. However, pros must also understand and accept the effectiveness of a kid's home lang in its cultural context. Failure to teach kids the skills they need to communicate effectively according to the rules of the dominant culture will deny them many opportunities. o Teachers must understand and help students understand that other dialects aren't inferior or limited lang systems. Must recognize cultural diffs regardless of the communication device being used. Multicultural issues arise in all communication interactions, including those in which AAC is used. o Although students might not have lang disorders, their lang variations could put them at a disadvantage in using lang in an academic context. Some have suggested that kids who come to school without mastery of the English of their textbooks should be taught it directly and consistently. o Recommendations regarding communication variations: Show sensitivity to and knowledge of various cultural values; Ask for help from families and colleagues; Visit students in their natural environments; Interact with students in classroom with their peers; and Know and respect features of dialects.

Definitions of Communication Disorder

o Speech and language are tools used for communication. Communication is the process of sharing information and involves many communicative functions, such as seeking social interaction, requesting objects, sharing ideas, and rejecting an object or interaction. It requires sending messages in understandable form (encoding) and receiving and understanding messages (decoding). It always involves a sender and a receiver of messages, but it does not always involve oral language. Communication can also be nonverbal; in fact, much of the meaningful interaction among humans is nonverbal. Language (both verbal and nonverbal) and speech are important tools for human communication. A communication disorder impairs the ability to transmit or receive ideas, facts, feelings, and desires and may involve language or speech or both, including hearing, listening, reading, or writing. o Language is the communication of ideas—sending and receiving them—through an arbitrary system of symbols used according to certain rules that determine meaning. Encoding or sending messages is referred to as expressive language. Decoding or understanding messages is referred to as receptive language. Speech, the neuromuscular activity of forming and sequencing the sounds of oral lang, is the most common symbol system used in communication between humans. o American Sign Language (ASL) doesn't involve speech sounds; it's a manual lang used by many who can't hear speech. Augmentative and alternative communication (AAC) for people with disabilities involving the physical movement of speech may consist of alternatives to the speech sounds of oral language (pic boards, ASL, gestures, and electronic devices that produce speech). o Speech disorders include problems in comprehension and expression. The problems may involve the form (phonology, morphology, syntax), content (semantics), or use of lang (pragmatics). Lang disorders may involve any 1 or a combo of the following 5 subsystems of language. § Phonology: the rules governing speech sounds—the particular sounds and how they're sequenced. § Morphology: the rules governing alterations of the internal organization of words, such as adding suffixes and other grammatical inflections to make proper plurals—verb tenses, for example. § Syntax: rules of organizing sentences in a meaningful way, including guidelines about using subjects and predicates and placing modifiers correctly. § Semantics: rules about attaching meanings and concepts to words. § Pragmatics: rules about using lang that for social purposes. o Diffs in speech or lang that are shared by people in a given region, social group, or cultural/ethnic group shouldn't be considered disorders. Similarly, the use of AAC systems doesn't imply that a person has a lang disorder—these systems support people who have temporary or permanent inabilities to use speech satisfactorily for communication. Those who use AAC systems might or might not have lang disorders in addition to their inability to use speech.

Educational Considerations regarding Visual Impairment

o Students with visual impairment have to rely on other sensory modalities to acquire info. If the teacher keeps in mind this diff, some of the most important teaching adjustments are based on common sense—call the student's name when addressing them, read aloud what you write on board, allow extra time to complete tasks when necessary, and give explicit directions. Students with little or no sight may require special modifications in braille, use of remaining sight, listening skills, and O&M training. o Braille: in 1800s France, Louis Braille introduced a system of reading and writing for people who, like him, were blind. Although it wasn't the first method developed, it was the 1 that became widely used. Unified English Braille (UEB) was developed to combine all braille codes and today, it's the preferred braille code for English-speaking countries. Basic unit of braille is a quadrangular cell, containing 1-6 dots. Diff patterns of dots rep letters, numbers, and punctuation marks. Although there's 1 braille symbol for each letter of the alphabet, braille also consists of a number of contractions whereby 1 symbol can stand for a word or part of a word. Using contractions leads to faster reading and reduces the space and time required to transcribe braille. Research suggests that introducing contractions to young students in the earliest stages of reading instruction leads to better literacy skills. Generally, the best method of reading braille involves using both hands. Two basic means of writing in braille are the Perkins Brailler and the slate and stylus. The Perkins Brailler has six keys, one for each of the six dots of the cell. When depressed simultaneously, the keys leave an embossed print on the paper. More portable than the Perkins Brailler is the slate and stylus. This pen-shaped instrument is pressed through the opening of the slate, which holds the paper between its two halves. Perhaps the most hotly debated topic in the field of visual impairment concerns whether students who are blind should be taught to use braille or another method of communication, such as a tape recorder or voice-activated computer. At one time, it was fairly common for students with blindness to use braille, but the percentage of students who are blind who use braille has steadily declined since the mid-1960s, when nearly half used braille. Today, it is estimated that only 8.6% of children use Braille as their primary mode of reading and writing. Many within the community of people who are blind are alarmed at the reduced availability of braille and assert that it has led to a distressing rate of illiteracy. For those who are blind, literacy equates with the ability to read and write braille. They charge that too few sighted teachers are proficient in braille and that these teachers do little to discourage the notion held by some that using braille indicates inferiority. Whether a person is comfortable in identifying themselves as blind is critical to whether they'll be motivated to learn braille. Advances in tech have also contributed to reduction in the use of braille. Tech has brought positive changes: tons of material can be accessed digitally or electronically. But tech may have drawbacks that aren't readily apparent—computerized magnification and straining to read enlarged print on a screen can fatigue the eyes and body, reducing one's desire to read for pleasure. Concerned that even when students do receive braille instruction, it isn't intense enough—students need daily instruction for several years. Lack of qualified braille instructors. Advocates of braille also point out that it's essential for most students who are legally blind to learn braille to lead independent lives. Bolstering their argument is research indicating that adults who had learned braille in childhood as their primary medium for reading were employed at almost twice the rate of those who had used print as their primary medium. A way of ensuring that braille becomes more readily available is through braille bills, now on the books in most states. Although the specific provisions of these bills vary from state to state, the National Fed of the Blind (NFB), a major proponent of braille bills, has drafted a model bill that specific that: 1) Braille must be available for students if any members of the IEP team indicate that it's needed; and 2) teachers of students with visual impairment need to be proficient in braille. Fed law reinforces this first component. § Braille Literacy Instruction: Barriers such as large caseloads, emphasis on core academic instruction over instruction in braille, lack of adequate assessment materials, and lack of administrative support for this specialized instruction all contributed to the challenge of delivering quality braille instruction. The 1997 amendments to IDEA sought to change that by requiring all IEPs for students with visual impairments to provide for instruction in braille unless an evaluation clearly demonstrates that this is not appropriate for the child's needs both now and in the future. Empirical research and professional recommendations support the need for 1.5 to 2 hours of daily braille literacy instruction to foster high literacy levels for students with visual impairments. Braille literacy instruction includes the use of braille as a primary reading medium, particularly during the early elementary years similar to the period of print-literacy development for students without visual impairments, and as a secondary reading medium to supplement or support the use of print. Recommendations included: 1. Overwhelming and universal support for daily braille instruction for a period of 1.5 to 2 hours during the early elementary grades (kindergarten through third grade) 2. The need for early intervention, provided in moderate to short sessions, for concept development 3. Pre-braille instruction (e.g., exposure to names in braille, tactile labels, writing experiences) for preschool and kindergarten-age students for periods of 30 minutes to 1 hour 4. Daily contact for a period of 1 to 2 hours for students with print literacy skills who are just learning braille 5. Teaching listening skills such as aural-reading and livereader skills on a moderate to periodic basis 6. Teaching keyboarding and word processing skills beginning in grades 1, 2, or 3 7. Braille slate and stylus instruction several days a week for moderate to short time periods beginning in third or fourth grade 8. Teaching students who are blind to write their signatures, spending 1 to 3 days per week for short sessions on this task beginning in middle school. One point of contention was over how much time should be devoted to the development of dual media—that is, teaching both print and braille. Some respondents called for teaching both daily and long sessions; others expressed concern regarding overloading students or the importance of establishing one primary mode. Clearly, this issue requires more research and attention. § Louis Braille and the Development of Braille: French aristocrat and soldier Captain Charles Barbier de la Serre—when his night-writing code, which was based on raised dots representing phonetic units, was rejected by the military, he presented it to the National Institute for the Young Blind. It didn't receive a favorable review there but served as motivation for 1 of the institute's students, Louis Braille, to perfect his own system. o Use of Remaining Sight: For many years, educators and parents expressed a great deal of resistance to having children with visual impairment use their sight in reading and other activities. Many myths contributed to this reluctance, including beliefs that holding books close to the eyes is harmful, strong lenses hurt the eyes, and using the eyes too much injures them. It's now recognized that this is true only in very rare conditions. In fact, most agree on the importance of encouraging people with visual impairment to use what sight they do have but not to the exclusion of braille for those who need it. Two visual methods of aiding children with visual impairment to read print are large-print books and magnifying devices. Large-print books. Major difficulty with large-print books is that they're bigger than usual and require more storage space and they're of limited availability, although, along with the American Printing House for the Blind, a number of commercial publishers are now publishing and marketing large-print books. Also, students who become dependent on them may have difficulties when they encounter situations, like jobs, in which large-print materials are unavailable. With advances in technology, more and more authorities are recommending magnifying devices instead of, or in addition to, large-print books. With respect to reading speed and comprehension, using magnifying devices is at least as effective as using large-print books for many students. Magnifying devices can be for close vision or distance vision. They can be portable, such as handheld magnifiers, monocular telescopes, or binocular telescopes that sit on eyeglass-type frames. Or they can be tabletop closed-circuit television scanners that present enlarged images on a television screen. Authorities highly recommend that students with low vision receive intensive instruction in the use of magnifying devices rather than being left on their own to use them. o Listening Skills: kids must be taught how to listen and teachers should provide a classroom environment as free from auditory distractions as possible. Listening skills are becoming more important because of the increasing accessibility of recorded material (major sources for material are the American Printing House for the Blind and the Lib of Congress). o Orientation and Mobility Training: O & M training is crucial. The ability of people with a visual disability to navigate their environment determines significantly their level of independence and social integration. Societal changes have made being a pedestrian—with or without blindness—even more challenging: Intersections are wider, often with multiple traffic signals for through, left-, and right-turn lanes that are set to change based on traffic flow. In addition, cars, especially hybrids, are now quieter and thus more difficult to detect. The National Highway Traffic Safety Administration (NHSTA) has instituted a "Quiet Car" rule mandating, that, as of 2019, electric vehicles make enough noise at low speeds to alert pedestrians that they are approaching. Four general methods aid the O & M of people with visual impairment: the long cane, guide dogs, tactile maps, and human guides. § Long Cane: Professionals most often recommend the long cane for those individuals with visual impairments who need a mobility aid. It is called a long cane because it's much longer than the canes typically used for support or balance. Long canes can be straight, folded, or telescopic; the last two types are more compact but not as sturdy as the straight cane. The user receives auditory and tactual information about the environment by moving the cane along the ground. Intensive training in using the long cane is usually required. § Guide Dogs: aren't as popular as people think. Must undergo extensive training. Users of guide dogs require extensive training. The intensive training, as well as the facts that guide dogs are large, walk pretty fast, and need to be cared for, make them questionable for kids. Guide dog doesn't take the person anywhere—person usually needs to know where they're going and dog serves as safeguard against walking into dangerous areas. Popular breeds are Labs, Golden Retrievers, and German Shepherds. Public must keep in mind that the dog is a worker and not a pet. Use of dogs to guide blind dates to mid-1500s but formal training of guide dogs to early 1900s, when after WWI, Germany, the US, and Great Britain established guide dog schools to accommodate blind veterans. § Human Guides: allow them to move about accurately and safely. However, most O&M specialists don't recommend this as primary means of navigation because it fosters too much dependence on other people. At times, however, use of a human guide is warranted. If someone looks like they need assistance, ask them if they want help. If physical guidance is required, allow the person to hold onto your arm above the elbow and to walk ½ step behind you. o Technological Aids: Visual impairment is perhaps the disability area in which the most technological advances have been made. Consistent with the more mainstream world of technology, startup companies focused on the population of individuals with visual impairments are proliferating; and many of the major companies, such as Apple, are also now tapping into this market. The infusion of technology has occurred primarily in two general areas: communication and information access, and O & M. In addition, some highly experimental research has been conducted on artificial vision. § Tech Aids for Communication and Info Access: Computers and software are available that convert printed material into synthesized speech or braille. Portable braille notetakers can serve the same function as the Perkins Brailler or slate and stylus, but they offer additional speech-synthesizer and word-processing capabilities. The user enters information with a braille keyboard and can transfer the information into a larger computer, review it using a speech synthesizer or braille display, or print it in braille or text. NFB-Newsline® is a free service available through the NFB that allows individuals to access magazines and newspapers 24 hours a day from any touchtone telephone. Over 300 newspapers, including most of the major ones are now available. Newsline is also available for iPhone. Descriptive Video Service® inserts a narrated description of key visual features of programs on television. It is also available in some movie theaters as well as some movies on videotape or DVD. Great strides have been made in recent years to make computers and the World Wide Web more accessible for people with disabilities, including those who have visual impairments. With respect to computer software, screen readers (such as JAWS® for Windows®) can magnify information on the screen, convert on-screen text to speech, or do both. § Tech Aids for Orientation and Mobility: There are now a number of products available or under development designed to aid those who are blind with navigating the environment. Many of them take advantage of GPS technology. Quite a few can be found on YouTube. In general, technology-based travel aids are of two types: computer-based and experience-based. The former relies on devices that depend on input based on pre-existing maps or routes developed using step-by-step algorithms. Some are advocating that the computer-based approach be combined with an experience-based approach. The experience-based approach allows for users to provide info about a route while traversing it. A user can make annotations along the way that may be useful to others when they travel the same route at a later time. Researchers are developing audio games, with the goal of helping those who're blind to improve their O&M skills. § Artificial Vision: several techniques are in experimental stages, with diff parts of the eye or brain the focus of prosthesis. These surgeries are very complicated, and the results are highly variable. Even when surgery is successful, those who've been blind since birth or from a young age, can find it overwhelming to adjust to the flood of visual sensation. § Cautions about Tech: Supporters of braille argue that although technological devices can contribute much to reading and acquiring information, these devices cannot replace braille. Braille proponents are especially concerned that the slate and stylus be preserved as a viable method of taking notes. They point out that just as computers have not replaced paper and pen or pencil for people who are sighted, neither can computers take the place of the slate and stylus for people who are blind. And using a long cane is still considered essential. o Service Delivery Models: The four major educational placements for students with visual impairment, from most to least separate, are residential school, special class, resource room, and general education class with itinerant teacher help. In the early 1900s virtually all children who were blind were educated in residential institutions. Today, itinerant teacher service, wherein a vision teacher visits several different schools to work with students in their general education classrooms, is the most popular placement for students with visual impairment. The fact is, the number of students with visual impairment is so small that most schools find it difficult to provide services through special classes or resource rooms. Residential placement is still a relatively pop placement model compared to other areas of disability—advantage is that services can be concentrated to this relatively low-incidence pop. In the past, most children who were blind attended such institutions for several years; today some may attend on a short-term basis (e.g., 1 to 4 years). The prevailing philosophy of integrating children with visual impairments into classes with sighted children is also reflected in the fact that many residential facilities have established cooperative arrangements with local public schools wherein the staff of the residential facility usually concentrate on training for independent living skills such as mobility, personal grooming, and home management, whereas local school personnel emphasize academics.

Anatomy and Physiology of the Eye

o The physical object that you see becomes an electrical impulse that is sent through the optic nerve to the visual center of the brain, the occipital lobes. Before reaching the optic nerve, light rays reflecting off the object being seen pass through several structures within the eye. The light rays do the following: § 1. Pass through the cornea (a transparent cover in front of the iris and pupil), which performs the major part of the bending (refraction) of the light rays so that the image will be focused § 2. Pass through the aqueous humor (a watery substance between the cornea and lens of the eye) § 3. Pass through the pupil (the contractile opening in the middle of the iris, the colored portion of the eye that contracts or expands, depending on the amount of light striking it) § 4. Pass through the lens, which refines and changes the focus of the light rays before they pass through the vitreous humor (a transparent gelatinous substance that fills the eyeball between the retina and lens) § 5. Come to a focus on the retina (the back portion of the eye, containing nerve fibers connected to the optic nerve, which carries the information back to the brain).

Historical Context: Kanner's and Asperger's Papers

o The seminal work in the field of autism began with 2 scientific papers published 1 year apart (1943 and 44) by physicians working independently: Leo Kanner (1943) and Hans Asperger (1944). Both were born and raised in Vienna, but Kanner came to the US and wrote his paper in English. Asperger's work was ignored for years, probably because it was published in German during WWII. Both used the term autistic to refer to the kids they observed. Autism was a label that was coined earlier in 1916 and was used to refer to people who has an extremely narrow range of personal relationships and resitricted interactions with their environment: "a withdrawal from the fabric of social life into the self. Hence the words 'autistic' and 'autism' from the Greek word autos meaning 'self.'" o Kanner's Paper: reported on the cases of 11 kids from the Child Psychiatric Unit at Johns Hopkins University. Kids' characteristics: inability to relate to others in an ordinary manner; extreme autistic loneliness that seemingly isolated the kid from the outside world; apparent resistance to being picked up or held by the parents; deficits in lang including echolalia; extreme fear reactions to loud noises; obsessive desire for repetition and maintenance of sameness; few spontaneous activities such as typical play behavior; bizarre and repetitive physical movement such as spinning or perpetual rocking. These kids were distinguished from those with schizophrenia in 3 ways: 1) The children with schizophrenia tended to withdraw from the world, whereas the children with autism never seemed to have made any social connections to begin with. 2) The children with autism exhibited some unique language patterns, such as pronoun reversals (e.g., I for it, he for she) and echolalia, the repetition of words or phrases. 3) The children with autism did not appear to deteriorate in their functioning over time, as did some children with schizophrenia. o Asperger's Paper: reported on 4 cases of kids he observed in a summer cap who played alone and didn't interact with others. These kids were different from Kanner's because they had average intelligence, although they seemed to channel their intellectual pursuits into obsessive preoccupations in narrow areas, and their lang was perceived as normal. Asperger referred to his cases as having "autistic psychopathy." 40 years later, his work gained scientific notoriety when Lorna Wing (1981) published a paper referring to Asperger's paper and sparked interest. She suggested naming the syndrome after him and it was her paper that drew attention to the condition and was catalyst for Asperger syndrome's becoming recognized as a condition meriting attention.

Assessment of Progress regarding Hearing Impairment

o These students are often included in state- and district-wide assessments—understand appropriate accommodations and alternate assessments specific to these students. o Assessing Academic Skills: curriculum-based measurement (CBM) to monitor progress in reading fluency and comprehension, written expression, and math. The STAR Reading, Math, and Early Literacy Assessments are useful for monitoring academic progress. These measures are computerized assessment tools that provide immediate info on student skills to assist with instructional planning. Most standardized assessments are biased toward the majority culture—educators must consider these biases carefully when making decisions as a result of students' outcomes. o Testing Accommodations: states developing guidelines for use of accommodations. Wide variability exists in how each state provides accommodations for students with hearing impairment. Most common presentation accommodations are sign interpretations for directions and for test questions, extended time, and small-group or individual admin. Most states allow signing directions without restriction, but some states consider the accommodation for signing questions a nonstandard accommodation, which affects scoring and interpretation of the test. Students also receive response accommodations such as signing responses to an interpreter.

Definition of Autism Spectrum Disorder

o Though autism has been a separate category under IDEA since 1990, it and other disorders are now typically collected under a broader term: autism spectrum disorder (ASD). The term spectrum emphasizes that the disabilities associated with ASD fall on a continuum from mild to severe. Though symptoms of ASD are wide ranging, the DSM-5 divides them into 2 general domains: social communication impairment and repetitive/restricted behaviors. States that the deficits begin in early childhood, even though they might not become evident until later, when the kid's poor communication skills become apparent. The DSM-5 no longer recognizes Asperger syndrome as a separate entity—ASD is an umbrella term. Typically, someone whose intellectual and verbal abilities are relatively high, but who still exhibits social communication deficits and repetitive/restricted behavior is often referred to as having Asperger syndrome.

Transition to Adulthood for Hearing Impairment

o Unemployment and underemployment (overqualified for a job) are problems. o Poor understanding among those who don't have hearing impairments of what it means to have a hearing impairment and of possible accommodations in the workplace. People with hearing impairments often aren't prepared to ask for the right accommodations and have difficulties making good career choices. o Expansion of postsecondary programming for students with hearing impairment. o Postsecondary Education: Before the mid-1960s, only institutuiton specifically for postsecondary ed of students with hearing impairment was Gallaudet College (now U). Traditional postsecondary schools were generally not equipped to handle their special needs. The fed government has funded a wide variety of postsecondary programs for students with hearing impairment. The two best-known ones are Gallaudet University and the National Technical Institute for the Deaf (NTID) at the Rochester Institute of Technology. The NTID program, emphasizing training in technical fields, complements the liberal arts orientation of Gallaudet University. At NTID, some students with hearing impairment also attend classes at the Rochester Institute of Technology with students who hear. In addition to Gallaudet and NTID, well over 100 postsecondary programs are now available in the US and Canada for students with hearing impairment. By law, Gallaudet and NTID are responsible for serving students from all 50 states and territories. Others serve students from several states, from one state only, or from specific districts only. Many will choose these schools, but some will go to traditional colleges and take advantage of the expanding roles of programs that have been established to facilitate the academic experiences of students with disabilities—accommodation often recommended is to provide sign lang interpreters in the classes. § Sign Language Interpreters: national shortage of adequately trained interpreters. Even when student have access to highly trained interpreters, the amount of info they can take in is far below that of their hearing peers. The role of interpreters generates a debate over using ASL versus transliteration. Transliteration, which is similar to signed English, maintains the same word order as spoken English. ASL, by contrast, requires the interpreter to digest the meaning of what is said before conveying it through signs. Most college instructors have limited, if any, experience in working with sign language interpreters. Even so, it is critical that instructors and interpreters work closely together to provide the optimum learning experience for students who are deaf while not disrupting other students in the class. o Family Issues: 95% of deaf adults choose deaf spouses, and 90% of their offspring have normal hearing. Hearing kids often serves as interpreters for their parents—self-confidence around authority figs but also face unpleasant biases and sometimes resent this role. Long tradition of preparing students who're deaf for manual trades, but these jobs are disappearing—deaf adults face more obstacles with job market.

Early Intervention for Communication Disorder

o Very important because the older the kid is when intervention is begun, the smaller the chance that they'll acquire effective lang skills; and without having functional lang, the kid can't become a truly social being. o Early Development and Early Intervention: 1st several years of life are truly critical for lang learning. Much of kid's lang, literacy, and social development depends on nature and quantity of the lang interactions they have with parents or other caregivers. Kids who enter school at a disadvantage tend to have experienced much lower rates of lang interaction; to have heard primarily negative, discouraging feedback on their behavior; and to have heard lang that's harsh, literal, and emotionally detached. The key to preventing many disabilities related to language development is to help parents improve how they relate to their children when they're infants and toddlers. Nevertheless, for many young children, intervention in the preschool and primary grades will be necessary. But such intervention must be guided by understanding of children's families, particularly the primary caretaker's (usually the mother's) views of language development. Preschoolers who require intervention for a speech or language disorder occasionally have multiple disabilities that are sometimes severe or profound. Language is closely tied to cognitive development, so impairment of general intellectual ability is likely to have a negative influence on language development. Conversely, lack of language can hamper cognitive development. Because speech is dependent on neurological and motor development, any neurological or motor problem might impair a child's ability to speak. Normal social development in the preschool years also depends on the emergence of language, so a child with language impairment is at a disadvantage in social learning. The preschool child's language therefore is seldom the only target of intervention. o Early Intervention in Delayed Lang Development: Many kids whose lang development is delayed show a developmental lag that they won't outgrow. They're frequently diagnosed as having intellectual disabilities or another developmental disability. Sometimes these kids come from environments where they've been deprived of many experiences, including the language stimulation from adults that is required for normal language development, or they have been severely abused or neglected. Regardless of the reasons for a child's delayed language, however, it's important to understand the nature of the delay and to intervene to give them the optimal chance of learning to use language effectively. Some children 3 years of age or older show no signs that they understand language and do not use language spontaneously. They might make noises, but they use them to communicate in ways that may characterize the communication of infants and toddlers before they have learned speech. In other words, they may use prelinguistic communication. For example, they may use gestures or vocal noises to request objects or actions from others, to protest, to request a social routine (e.g., reading), or to greet someone. When assessing and planning intervention for children with delayed language, it is important to consider what language and nonlanguage behaviors they imitate, what they comprehend, what communication skills they use spontaneously, and what part communication plays in their lives. It's also important, particularly with young children, to provide intervention in the contexts in which children use language for normal social interaction. For example, parents or teachers may use milieu teaching, a strategy to teach functional language skills in the natural environment. In this approach, teaching is built around the child's interests. Milieu teaching is a naturalistic approach in that it encourages designing intervention that are similar to the ordinary conversational interactions of parents and kids. Prelinguistic communication may be a good indication of a child's later ability to use lang. The effectiveness of milieu teaching may depend on moms' responsiveness to their kid's prelinguistic communication. o Involvement of Families: parents can by helped by pros to play important role in their kid's lang development. Work with parents as knowledgeable and competent partners whose preferences and decisions are respected. Intervention in early childhood is likely to be based on assessment of the child's behavior related to the content, form, and especially the use of language in social interaction. For the child who has not yet learned language, assessment and intervention will focus on imitation, ritualized and make-believe play, play with objects, and functional use of objects. At the earliest stages in which the content and form of language are interactive, it is important to evaluate the extent to which the child looks at or picks up an object when it is referred to, does something with an object when directed by an adult, and uses sounds to request or refuse things and call attention to objects. When the child's use of language is considered, the earliest objectives involve the child's looking at the adult during interactions; taking turns in and trying to prolong pleasurable activities and games; following the gaze of an adult; directing the behavior of adults; and persisting in or modifying gestures, sounds, or words when an adult does not respond. In the preschool, teaching discourse (conversation skills) is a critical focus of language intervention. In particular, preschool teachers emphasize teaching children to use the discourse that is essential for success in school. Preschool programs in which such language teaching is the focus may include teachers' daily individualized conversations with children, daily reading to individual children or small groups, and frequent classroom discussions. Current trends are directed toward providing speech and language interventions in the typical environments of young children. This means that classroom teachers and SLP must develop a close working relationship. The SLP might work directly with children in the classroom and advise the teacher about the intervention that they can carry out as part of the regular classroom activities. Alternatively, the SLP might work with the teacher directly to help her incorporate effective instructional practices for these students. The child's peers may also be involved in intervention strategies. Because language is essentially a social activity, its facilitation requires involvement of others in the child's social environment—peers as well as adults. Normally developing peers have been taught to assist in the language development of children with disabilities by doing the following during playtimes: establish eye contact; describe their own or others' play; and repeat, expand, or request clarification of what the child with disabilities says. Peer tutors can help in developing the speech and language of their classmates who may use different dialects. Another intervention strategy involving peers is sociodramatic play. Children are taught in groups of three, including a child with disabilities, to act out social roles such as those people might take in various settings (e.g., a restaurant or shoe store). The training includes scripts that specify what each child is to do and say, which the children can modify in creative ways.

Identification of Visual Impairment

o Visual acuity is most often measured with the Snellen chart, which consists of rows of letters. For the very young and/or those who can't read, the chart has rows of the letter E arranged in various positions, and the person's task is to indicate in what direction the "legs" of the Es face. o Although the Snellen chart is widely used and can be very helpful, it does have some limitations. First, it's a measure of visual acuity for distant objects, and a person's distance and near vision sometimes differ. Assessing near vision usually involves naming letters that range in size from smaller to larger on a card that is at a typical reading distance from the person's eyes. Second, and more important, visual acuity doesn't always correspond with how a student actually uses his vision in natural settings, which have variable environmental conditions (e.g., fluorescent lighting, windows that admit sunshine, highly reflective tile floors). Vision teachers, therefore, usually do a functional vision assessment. A functional vision assessment involves observing the student interacting in different environments (e.g., classroom, outdoors, grocery stores), under different lighting conditions to see how well the student can identify objects and perform various tasks.

Early Intervention for ASD

o most programming focuses on kids with severe degrees of ASD because they're more likely to be diagnosed earlier. o Early, intensive, and highly structured and should involve families. No intervention yet can claim universal success in enabling these kids to overcome their disabilities completely. o National Research Council identified essential features of effective preschool programs for kids with ASD: Entry in programs as early as possible; Intensive instructional programming; Repeated teaching in brief periods, one-on-one and small group instruction; Inclusion of family component, parent training; Low student/teacher ratios; and Ongoing progress monitoring o Early Intensive Behavioral Intervention (EIBI): anchored in the ABA tradition, EIBI requires considerable time commitments from therapists and parents in implementing structured training on discrete skills, starting when kid is 2/3 years old. Some pros, therefore, are cautious when recommending it, but several research reviews have found it to be effective in improving lang and functional skills in many young kids with autism. Some found that it's more effective when implemented before 2 years of age.