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Educating Exceptional Children: Emotional and Behavioral Disorders, Physical Disabilities, Health Impairments, Traumatic Brain Injury

Introduction

Some children have the ability to learn, yet they may not gain substantial knowledge throughout their years in school. In general, teachers have high expectations for their students to learn and achieve while under their direction. However, some students will not succeed or achieve because they cannot.

This certainly is a contradiction to what has been stated previously. However, most classrooms have a few students with an inability to behave, failing to act within the classroom's social and academic norms. Children who have been diagnosed with emotional and behavioraldisorder have the ability to learn but they seemingly refuse to learn as their teacher expects. For teachers, learning to supervise properly students' actions and behaviors is paramount to classroom management and order. Classrooms with low stress and students actively engaged support student learning and success.

Learning can be frustrating and students may experience failure a few times. This is an important component to learning. Failure can be motivating, leading students to discover gaps in their knowledge about a particular topic. Most students live through the experiences and hopefully learn from them. Students with emotional and behavioral disorders, however, livewith the experiences of intrapersonal and interpersonal conflict daily. As a "handicapped" disability, an emotional and behavioral disorder is disturbing to society. Students with this disorder are unable to behave according to the rules of society and the classroom. It is hard to imagine the world of a person with an EBD; it is likely a world of uncertainty and risk. However, when teachers understand the nuances of this disorder and the tools needed to help these students become aware of their inappropriate behaviors they will have the ability to make differences in student's lives.

Teachers have numerous roles and responsibilities. They are responsible for responding to children's expectations, as well as those of the guidance counselor, caregiver, and parents. They can play the role of peacemaker, disciplinarian, and educator. Furthermore, teacher roles demand a technical knowledge, critical for the well-being of their students.

Special needs of persons with disabilities may result from a wide range of physical or other health impairments. Whether a child can be successful in academics and social skills or whether that child enjoys the best quality of life possible in the classroom may depend upon the teacher's understanding and response to the needs of students with physical disabilities, other health impairments, and traumatic brain injury. The majority of students with physical impairments are in regular classrooms for many hours daily. Therefore, it is necessary for teachers to understand the impact of neurological and orthopedic impairments, such as various limb deficiencies, cerebral palsy, spina bifida, muscular dystrophy, spinal cord injuries, and traumatic brain injury. Teachers need to be able to respond effectively, appropriately, and immediately to the needs of students with chronic health conditions, such as epilepsy, diabetes, asthma, cystic fibrosis, hemophilia, and HIV/AIDS.

Although at first glance these responsibilities may seem overwhelming, the consequences of irresponsibility in this matter are intolerable. Nevertheless, the challenges are indeed manageable. Teachers need to become experts when the need becomes evident. When the responsibility begins with them, teachers must become experts through experiential learning in cooperation with other professionals.

Emotional and Behavioral Disorders

What Is an Emotional and Behavioral Disorder?

As in the case of learning disabilities, controversy surrounds emotional and behavioral disorders, not only in the terms used for identification, in the difficulties with definitions, and in the subjectivity of assessment decisions, but additionally, in the difficulty of dealing with the students themselves. As defined in the Individuals with Disabilities Education Act (IDEA 2004), a student with an emotional disturbance exhibits behavior that "adversely affects educational performance . . . over a long period of time [and] to a marked degree." According to IDEA, students with emotional disturbances must exhibit one or more of the following five characteristics: (a) failure to learn not due to any other disability, an exclusionary clause, (b) inability to get along with others, (c) inappropriate behavior or feelings under normal circumstances, (d) depression, or (e) personal or school phobias. The definition also includes schizophrenia but excludes social maladjustment.

The Council for Exceptional Children recognized several disadvantages with the current federal definition. While there is flexibility in determining who may have an emotional disability, the definition is based on Social Deviance Theory and therefore subjective with vague criteria such as a teachers' tolerance of unacceptable behavior.

Individual states continue to struggle with the exclusion of social maladjustment, which has resulted in the educational needs of juvenile delinquents not being met. According to Heward (2003), adjudicated delinquents are often behaviorally disordered and receive little if any special education services. With all the problems in the current definitions and the guidelines for educating students with EBD lacking specificity, advocates and educators are concerned with how allstudents with disabilities will be educated appropriately with the services they need to be successful.

Characteristics of Emotional and Behavioral Disorders

How can a child be emotionally disturbed, or in more acceptable terms, have an emotional or behavioral disorder? Emotional and behavior disorders include, among others,attention deficit hyperactivity, conduct disorders, anxiety and mood disorders, schizophrenia, and pervasive developmental disorders. Characteristic behaviors that teachers need to address include externalizing and internalizing behaviors. According to Eisenberg et al. (2004), externalizing behaviors are the actions of an individual that interfere with others; unfortunately, the prognosis for children who exhibit frequent antisocial, noncompliant, aggressive behaviors is poor. Internalizing behaviors are the actions of an individual that interfere with personal development. Such behaviors as anxiety, depression, or withdrawal may go unnoticed and can be very dangerous.

Emotional and/or behavioral disorders can result in academic performance that is generally below grade level, with more than one-half of the students with EBD dropping out of school (Eisenberg et al., 2002).Therefore, these disorders have a negative impact on learning and school achievement. Students without EBD are able to focus, stay on task, and enjoy academic and social success.

Students with EBD lack social competence and are unable to form interpersonal relationships. The effectiveness of any behavioral or academic intervention for students with EBD begins with teachers helping their students develop social skills as well as academic competence. When students are able to interact socially according to a situation's norms and rules, they may begin to create meaningful personal relationships. Hope for the students will begin with teachers who understand the characteristics of the disorder, have the necessary skills to deal with the student's EBD in the classroom, and understand the role a teacher can play in the student's success.

Causes of Emotional and Behavioral Disorders

How one explains disturbed human behavior determines how one will intervene to change that behavior. Consequently, there are seven conceptual models, each of which attempts to define abnormal behavior by its causes and, on that basis, its treatment: biogenetic, psychodynamic, psychoeducational, humanistic, ecological, behavioral, and social-cognitive.

Who Has Emotional and Behavioral Disorders?

Problems relating to the identification and education of students with EBD begin with the federal definition of the disability, specifically relating to the five characteristics of EBD and their duration and intensity, the subjective judgments of teachers, and community tolerance of and response to unacceptable behavior. Such problems influence both estimates of prevalence of students with EBD and assessment procedures to identify those students who need special education services.

It is important to estimate the number of students who may have EBD for funding purposes, teacher training, and providing adequate services. It is estimated that 33% of students may have significant behavior problems in school, while 3% to 7% and as much as 10% may require special services (Green, 2004). Surprisingly, less than one percent (0.7%) receive special education services for emotional disturbance. It is not surprising, however, that males with their externalizing behavior problems are identified far more often than females who suffer internalizing emotional and behavioral problems (Eisenberg et al., 2002). In addition to the problems with definition, the low number of identified students may be a result of the stigma of the label, the lack of teachers able and willing to work with the students, the costs of ancillary services (e.g., counseling), and even the IDEA restrictions on suspension and expulsion of students with serious behavior problems.

Persons who commit crimes under the age of 18 may be adjudicated as juvenile delinquents by the courts. The unresolved issue is whether juvenile delinquents have serious emotional and behavioral disorders and, as a result, should receive special education services or whether they are socially maladjusted and denied special education. State departments of education have taken different stands on this issue. For example, some states have determined that a student with a conduct disorder, often a juvenile delinquent, is socially maladjusted and is therefore ineligible for special education. On the other hand, other states will readily serve juvenile delinquents in special education under the disability category of emotional disturbance.

The purpose of assessment of students with EBD is to provide information for informed educational decisions, including special education eligibility and the design and evaluation of behavioral interventions. Assessment involves screening, psychological evaluation, direct observation and measurement, and functional behavioral assessment.

How Do You Teach Students With Behavioral and Emotional Disorders?

Once again, a meaningful personal relationship with students with EBD is the prerequisite to effective teaching. A belief that the student can change his or her behavior becomes evident through compassionate consistency and structure, as well as a warm, loving teacher who sets boundaries. Heward (2003) calls these teacher attributes differential acceptance andempathetic relationship. In the midst of a chaotic and threatening world and with a caring teacher, these students learn to believe in themselves. Armed with appropriate curriculum and behavior management skills, the teacher nurtures the student's power to achieve. Teachers of students with EBD recognize what they can control and change. Teachers who are able to keep their students on task and interested, all the while reminding their students with EBD to display proper behavior in a learning environment can contribute greatly to student achievement.

Physical Disabilities, Health Impairments, and Traumatic Brain Injury

Teachers are committed to meet the needs of all students, an overwhelming challenge indeed when considering merely the differences in learning skills and abilities in any group of students. Now add physical disabilities, health impairments, and traumatic brain injury to the challenge; the teacher's response is now critical to the very life of the student. Consider the infinite variability of physical, medical, and neurological conditions as a result these disabilities, conditions that range from mild to severe and demand environmental modifications and medical and technological assistance. The teacher's advanced knowledge and skills are necessary not only for the education of the student, but for the physical survival of the child.

Physical Disabilities and Health Impairments

The definition by IDEA for orthopedic impairment includes (a) orthopedic impairments relating to the skeletal system (bones and muscles) and (b) neuromotor impairments relating to the central nervous system (movement). Other health impairments as defined by IDEA affect a child's strength, vitality and alertness, and may be chronic (lifelong) or acute (episodic) conditions, congenital (at birth) or acquired later in life. If either orthopedic or other health impairment adversely affects a child's educational performance, then the child can receive special education services.

Prevalence of Physical Disabilities and Health Impairments

According to the U.S. Department of Education (2002), 20% of school-age children (12 million) have chronic medical conditions. Special education serves less than 80 thousand children with physical impairments and 300 thousand with other health impairments because (a) students may receive services under other categories or (b) they do not need services.

Physical Disabilities and Health Impairments

The impact of physical and health impairments is so varied that effective teacher response demands knowledge of the condition and the uniqueness of its impact on the child's physical, emotional, social, and cognitive development. Additionally, teachers must challenge their own belief system about a child's ability to learn as well as staying current on all new neurological and developmental scientific information. Physical disabilities and health impairments of children's educational performance range along a continuum from mild to severe or normal to extreme. Having a strong underpinning in special education about the limitations of children's physical and emotional disabilities helps teachers become expert in these matters thereby dispelling false assumptions about the academic potential of the student.

Traumatic Brain Injury

According to the Individuals with Disabilities Education Act, a Traumatic Brain Injury is an acquired condition distinct from congenital or diseased malformation of the brain. The U.S. Department of Health, (2008), provides information on the incidence and prevalence of traumatic brain injury in the United States. It reports that there are 1,500,000 new cases each year.

• There are two types of brain injuries: open and closed head injuries and the degrees of head injury ranges from mild to severe.


• Mild − concussion: brief loss of unconsciousness, headaches, dizziness


• Moderate − contusion with hematoma: extended unconsciousness, cognitive and behavioral impairments


• Severe − coma: prolonged unconsciousness, permanent physical, behavior, and cognitive impairments

Teachers need to know the signs and effects of traumatic brain injury, so they can develop appropriate curriculum and provide accommodations for students reentering school, such as:

• Shortened school day, frequent breaks


• Beginning and ending school with planning and review


• Modifications in movement, assignments, testing


• Behavior management and counseling


• IEP review every 30 days

There are several effective strategies for students with traumatic brain injury in the regular education classroom. Educational approaches must be based on transdisciplinary teams' recommendations. Often the recommendations involve related services such as environmental modifications, special health care routines, independence and self-esteem therapy, and educational placement alternatives.

Current Issues and Future Trends

Students with physical and health impairments and traumatic brain injury are facing a future defined by the new and innovative court laws and regulations, as well as the new neuronscientific brain research, which is creating the underpinnings for new and emerging technologies, animal assistance, employment, life, and self-advocacy skill training.

Conclusion

Students with emotional and behavioral disorders present the most demanding challenges to educators. They engage in unacceptable behaviors not because they are unwilling but because they are unable. Emotional and behavioral disorders are considered disabilities under IDEA. Understanding who such students are will enable a teacher to respond effectively to their needs.

Physical and other health impairments encompass a wide range of disabilities. Students with such impairments are often in regular education classrooms. The goal of this module has been to enhance teacher understanding the various types of the impairments and their impact on the lives of the students and the responsibilities of the teacher. Based on accurate knowledge and in cooperation with health care professionals, teachers need to provide support, assistance, modifications, and accommodations as necessary.

References

Eisenberg, N., Gutherie, I. K., Fabes, R. A., Shepard, S., Losoya, S., Murphy, B. C.,

Jones, S., Poulin, R., & Reiser, M. (2002). Prediction of elementary school children's

externalizing problem behaviors from attentional and behavioral regulation and

negative emotionality. Child Development, 71(5), 1367-1382.

Eisenberg, N., Spinrad, T. L., Fabes, R. A., Reiser, M., Cumberland, A., Shepard, S. A., Valiente, C., Losoyo, S. H., Guthrie, I. K., & Thompson, M. (2004). The relations of effortful control and impulsivity to children's resiliency and adjustment. Child Development, 75(1), 25-46.

Greene, R. W. (2001). The explosive child: A new approach for understanding and parenting easily frustrated chronically inflexible children. New York: Harper Collins

Heward, W. L. (2003). Exceptional children: An introduction to special education (7th ed.). Upper Saddle River, NJ: Merrill.

Individuals With Disabilities Education Improvement Act, Pub. L. No. 108-446 (2004).

U.S. Department of Health and Human Services (2008). How common are brain injuries. Retrieved October 15, 2008 fromhttp://www.nichcy.org/Disabilities/Specific/Pages/HowCommonTBI.aspx

© 2010. Grand Canyon University. All Rights Reserved.

Hearing Impairments and Visual Impairments

Introduction

Teachers expect students to pay attention and listen carefully to directions, to instruction, and to one another. So much of what happens in school is verbal. Therefore, so much of what students do often depends upon what they hear and understand. Persons with hearing impairments must obtain and share information in a manner very different from persons without hearing impairments. Some may use residual hearing enhanced with assistive technology along with normal speech; others may use sign language. A different way of obtaining and sharing information or communicating is not necessarily a disability; some may argue that this is simply a difference.

As in the case of communication, hearing is a complex process. Teachers need to understand what is necessary for persons to hear, how to communicate effectively with persons who have hearing impairments, and what educational modifications, accommodations, and available technologies are necessary to provide an appropriate education. In addition, teachers need to be sensitive to concerns of the Deaf community, where hearing impairment is a way of life and not perceived as a disability.

Persons with visual impairments need to learn to do differently what others take for granted, such as orientation and mobility, self-care skills, and/or learning. Persons with visual impairments can share such experiences with accommodations and modifications or technology. Teachers who have an understanding of these individuals' needs are most effective at providing the necessary modifications and assistive technology in order to provide the most appropriate and successful learning experiences.

Hearing Impairments

The sense of hearing provides "information about the world ... from all directions, 24 hours a day" (Heward, 2003, p. 363). Most importantly, through the sense of hearing, people learn communication, language, speech, and, ultimately, reading and writing. To understand hearing impairments, teachers first must understand sound and hearing. Spoken language ranges from 500 to 2,000 Hz with some sounds above (the /s/ phenome) or below (the /m/ phenome) that range. Such considerations are important in determining the extent to which a student can discriminate speech sounds.

According to IDEA 2004, a hearing impairment is a hearing loss that "adversely affects educational performance." Deafness is"ahearing impairment so severe that the child cannot understand what is being said even with a hearing aid." In other words, a student is hard of hearing if he or she can learn through the hearing sensory channel but needs special assistive devices. A student is deaf if he or she cannot learn through hearing at all and must access information through other means. The Deaf community, however, does not consider hearing impairment a disability but a way of life, a culture with its own language.

The effects of hearing loss on communication and learning are varied according to "the type and degree of hearing loss, age at onset, the attitudes of the child's parents and siblings, opportunities to acquire a first language . . . and the presence or absence of other disabilities" (Heward, 2003, p. 365).

There are several types of hearing loss. It may be unilateral (one ear) or bilateral (both ears), congenital (at birth), or acquired (after birth, prelingual or postlingual). There is conductive hearing loss, corrected by surgery, medical treatment, or hearing aids, and sensorineural hearing loss, a result of damage to auditory nerve fibers of the cochlea, which currently is not correctable by surgery, medical treatment, or hearing aids. Hearing loss may be mild, moderate, moderate-severe, severe, or profound. Age of onset will certainly influence how a person learns new skills.

There are causes of congenital and acquired hearing loss. Causes of congenital hearing loss include genetic factors such as autosomal dominant hearing loss, and prenatal, perinatal, and postnatal factors such as maternal rubella or congenital rubella,with one symptom asDeafness. Causes of acquired hearing loss include otitis media (an infection of the middle ear), meningitis, Ménière's disease, and noise exposure or noise induced hearing loss.

Assessment of infants is through physiological reaction to sound, auditory brain stem response, and otoacoustic emission screening. Screening of newborn infants (required in 29 states) is important for early intervention. There are techniques such as pure tone audiometry, which produces an audiogram. There is also speech audiometry and alternative audiometric techniques that involve play, operant conditioning by reinforcing a response to sound, and behavior observation of a response to sound.

Assistive technology includes sound amplification such as hearing aids, assistive listening devices, and cochlear implants. Sound supplement and replacement may include the use of interpreters. The Americans with Disabilities Act (ADA) addresses the legal issue relating to hearing interpreters. In addition, there is speech-to-text translation, television captioning, telecommunication relay services, and alerting devices.

To educate students with hearing impairments, teachers begin with an awareness and understanding about resource device availability, student strengths and needs in the classroom. There are oral/aural approaches as in the auditory rehabilitation for children, including auditory learning, speech reading, and cued speech. There is also total communication as in the total communication educational approach, which includes manually coded English, finger spelling, American Sign Language, and the bilingual-bicultural approach.

The major issue surrounding education of students with hearing impairments revolves around the best way to learn to communicate, vis a vis the use of residual hearing (learning to live in a hearing world), sign language, total communication, or cochlear implants. The Deaf community takes a strong stand: Deaf students should participate in Deaf Culture or American Deaf Culture.

Visual Impairments

The five senses provide the raw data that people process and integrate for a meaningful learning experience. Lacking one or more sources of input severely restricts an individual's development in many ways. In fact, most information is taken in through the visual process. Visual discrimination, visual memory, and visual motor integration all work in concert to influence our learning. A visual impairment forces a person to use other senses for exploring the environment. It is important for teachers to have a clear understanding of the role vision plays in learning. The definition of visual impairment and its impact on learning are also critical aspects that teachers need to understand. The information that teachers hold about hearing impairment guides them to respond effectively to unique needs of students with visual impairments. An effective response demands knowledge of current technology.

What are visual impairments? There are legal definitions. Visual acuity, "the ability to clearly distinguish forms or discriminate details" (Heward, 2003, p. 404) is measured by a comparison of a person's ability to read at 20 feet, the distance at which a person with normal vision can read the same material. A legally blind person can see at 20 feet with corrective lenses what a person with normal vision can see at 200 feet (20/200). A person who reads at 20 feet after correction in the better eye what the person with normal vision can read at 70 feet is legally partially sighted. Normal fieldofvision is 160 to 170 degrees. A person with a normal field of vision of 20 degrees or less (e.g., tunnel vision) is considered legally blind.

There are also educational definitions. Visual disability including blindness according to the IDEA is found in Section300.7(c) (13) Visual impairment including blindness. How does one use vision to learn? A student who is blind cannot learn through the visual channel and must use touch and hearing. A functionally blind student primarily uses touch and hearing to learn and severely restricted vision for some tasks. A student with low vision uses vision to learn with assistance from touch and hearing.

Impact of Visual Impairments: Characteristics

The impact of a visual impairment is significant at many levels. The impact of a visual impairment at an early age affects cognitive, physical and social-emotional development. More specifically, it influences the individuals' perceptions and daily experiences, learning styles, language development, and motor functioning.

• The Age of Onset (Congenital or Adventitious Blindness): A person born blind will have learned everything through the other senses, especially hearing and touch. Meaning of visual experiences (e.g., color) will be very different from sighted individuals. People who lose vision retain visual memory but must rebuild their lives socially and emotionally and learn so many new skills.


• Cognition and Language: Sight provides the opportunity for a person to learn incidentally, receiving information effortlessly that allow discovering relationships in their experience, connecting discrete elements and integrating them into meaningful concepts. Think of specific examples of limitations relating to learning facing persons who are blind or visually impaired. Realize "the importance of repeated, direct contract through nonvisual senses" (Heward, 2003, p. 411).


• Motor Development and Mobility: Movement, coordination, strength, exploration, imitation, and balance are all related to vision. Why might a blind child engage in stereotypic behavior or blindisms (repetitive, purposeless movement)?


• Social Adjustment and Interaction: Social interaction is a visual experience; people receive nonverbal signals (gestures, facial expressions, body posture, eye contact) that give meaning to conversation. People seek interactions visually and express emotion visually. Blindisms may impede interactions with others. Without vision, social skill development may be impaired.

Educations of Persons with Visual Impairments

Assistive technology is a main component in the education of persons with visual impairments and includes Braille, tactile aids and manipulatives, technology products, services, and computer access. Curriculum is designed to meet the needs of students with visual impairments and includes orientation and mobility, listening and functional life skills, recreation and leisure, and transition. Least Restrictive Environmentof IDEA determines the placement of the student with visual impairments (1) in or outside the regular classroom provided by an itinerant or onsite special education teacher; (2) in a self-contained classroom in a regular school; or (3) in day or residential schools for the blind. If inclusion is to be successful, teachers must be aware of effective strategies.

Many challenges face educators and advocates of students with blindness or visual impairments:

• Together, blindness and visual impairments are a low incidence disability and consequently may be without the necessary political power to obtain funding and the highly specialized services for appropriate education.


• The continuing development of technology continues the hope for those with blindness and visual impairments.


• The most important issue confronting those who are blind and visually impaired is the attitude of others, often resulting in myths.

Conclusion

Through research, hearing impairments are now defined, types and causes are identified, and identification and assessment procedures are described. It is important for teachers to understand the effects of hearing loss and the current issues relating to educational approaches, assistive technologies, and educational placements. The most important issue surrounding the disability seems to be that it is not a disability at all.

Vision has been explained and visual impairments defined legally and educationally, its types and causes described. The special educator knows the need to adapt to the special needs for students who are blind or have low vision.

References

Heward, W. L. (2003). Exceptional children: An introduction to special education (7^th ed.). Upper Saddle River, NJ: Merrill.

Individuals With Disabilities Education Improvement Act (IDEA), Pub. L. No. 108-446 (2004).

© 2010. Grand Canyon University. All Rights Reserved.

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