Educating Exceptional Children (MindTap Course List) [15 ed.] 0357625234, 9780357625231

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This is an electronic version of the print textbook. Due to electronic rights restrictions, some third party content may be suppressed. Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. The publisher reserves the right to remove content from this title at any time if subsequent rights restrictions require it. For valuable information on pricing, previous editions, changes to current editions, and alternate formats, please visit www.cengage.com/highered to search by ISBN#, author, title, or keyword for materials in your areas of interest. Important Notice: Media content referenced within the product description or the product text may not be available in the eBook version.

Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Educating

Exceptional Children 15th Edition James Gallagher Late of University of North Carolina at Chapel Hill

Mary Ruth Coleman University of North Carolina at Chapel Hill

Samuel Kirk Late of University of Arizona

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United Kingdom • United States

Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Educating Exceptional Children, Fifteenth Edition James Gallagher, Mary Ruth Coleman, and Samuel Kirk SVP, Higher Education Product Management: Erin Joyner

Last three editions, as applicable: © 2015, 2012, 2009 Copyright © 2023 Cengage Learning, Inc. ALL RIGHTS RESERVED. No part of this work covered by the copyright herein may be reproduced or distributed in any form or by any means, except as permitted by U.S. copyright law, without the prior written permission of the copyright owner. Unless otherwise noted, all content is Copyright © Cengage Learning, Inc.

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Library of Congress Control Number: 2022906143

ISBN: 978-0-357-62523-1 Cengage 200 Pier 4 Boulevard Boston, MA 02210 USA Cengage is a leading provider of customized learning solutions with employees residing in nearly 40 different countries and sales in more than 125 countries around the world. Find your local representative at: www.cengage.com. To learn more about Cengage platforms and services, register or access your online learning solution, or purchase materials for your course, visit www.cengage.com.

Notice to the Reader Publisher does not warrant or guarantee any of the products described herein or perform any independent analysis in connection with any of the product information contained herein. Publisher does not assume, and expressly disclaims, any obligation to obtain and include information other than that provided to it by the manufacturer. The reader is expressly warned to consider and adopt all safety precautions that might be indicated by the activities described herein and to avoid all potential hazards. By following the instructions contained herein, the reader willingly assumes all risks in connection with such instructions. The publisher makes no representations or warranties of any kind, including but not limited to, the warranties of fitness for particular purpose or merchantability, nor are any such representations implied with respect to the material set forth herein, and the publisher takes no responsibility with respect to such material. The publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or part, from the readers’ use of, or reliance upon, this material.

Printed in the United States of America Print Number: 01 Print Year: 2023

Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Leadership and Legacy of Dr. Samuel Kirk and Dr. James J. Gallagher

Courtesy of the University of Illinois Archives

Educating Exceptional Children was first published in 1962 as the new field of special education was emerging and teachers needed to be prepared to work with children who were beginning to be included in public schools across the country. Dr. Samuel Kirk, the director of the Institute for Research on Exceptional Children at the University of Illinois, was the founding author of Dr. Samuel Kirk, founding author of Education Exceptional Children this text. In the first edition, he tackled the growth and development of children with a range of exceptionalities and addressed identification and educational practices to meet their needs. Much has changed in the ensuing decades since the first edition, but the central issue at the heart of Dr. Kirk’s concerns remain with us today: how can we best serve students with exceptional learning needs within our schools? Dr. James J. Gallagher, a student and colleague of Dr. Kirk, came on board as co-author on the fourth edition of Educating Exceptional Children. Dr. Gallagher was the first Chief of the Bureau of Education for the Handicapped in the U.S. Office of Education. He was a pragmatic visionary working to making educational excellence for all children, a reality: ●









He realized that the complex needs of a child with disabilities would require a unique educational response and the Individualized Education Plan (IEP) was born. He understood that a prepared workforce of teachers would be critical to students’ success, and he wrote textbooks and created model demonstration sites. He knew that families were key to supporting child development and he advocated family-friendly practices. He believed that gifts and talents existed across all cultural and economic groups, and he advanced appropriate policies for identification and services. He saw that a strong infrastructure was critical for sustaining positive changes, and he developed a technical assistance model of support.

iii

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Leadership and Legacy of Dr. Samuel Kirk and Dr. James J. Gallagher

FPG Child Development Institute

iv

Dr. James J. Gallagher, pragmatic visionary for children with exceptional learning needs.

Dr. Kirk and Dr. Gallagher helped build the field of Special Education. Both worked tirelessly to ensure that children with exceptionalities were not forgotten. Their leadership shaped the laws, policies, and practices of the field. Their work is not finished… their legacy lives on. If you are reading this textbook, you are part of this living legacy. Thank you for helping make the world a better place for children with exceptionalities, their families, and the professionals who serve them!

Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Brief Contents

Dedication  xx Preface  xxi About the Authors   xxxiii

Part One 

Children with Exceptionalities, Their Families, and the Social Forces That Shape Special Education  1

1 Children and Youth with Exceptionalities and Their Families  3 2 Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools  37 Part Two 

High-Incidence Exceptionalities  73

3 4 5 6 7 8 9

Early Intervention Supports and Services  75 Children and Youth with Intellectual Disabilities  113 Children and Youth with Autism Spectrum Disorders  147 Children and Youth with Learning Disabilities  183 Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD)  221 Children and Youth with Emotional and Behavior Disorders  257 Children and Youth with Communication, Language, and Speech Disorders  295 10 Children and Youth with Gifts and Talents  333 Part Three 

L  ow-Incidence Exceptionalities  369

11 Children and Youth Who Are Deaf or Hard of Hearing  371 12 Children and Youth with Visual Impairments  409 13 Children and Youth with Physical Disabilities, Health Impairments, and Multiple Disabilities  445 Glossary  G-1 References  R-1 Subject Index   SI-1 Name Index   NI-1

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Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Contents

Dedication  xx Preface  xxi About the Authors   xxxiii

Part One  Children

with Exceptionalities, Their Families, and the Social Forces That Shape Special Education  1

1  Children and Youth with Exceptionalities and Their Families  3 1-1 The Child with Exceptionalities: An Overview  4 1-1a  Educational Areas of Exceptionalities  4

Digital Download: Box 1-1 Ask the Experts: Fostering Family Engagement by Becoming a Culturally Competent Teacher  17

Digital Download: Table 1.1 Disability Categories under IDEA (2004)  5 1-1b  Interindividual and Intraindividual Differences  7 TeachSource Video Connection  7

1-5 The Systems of Influence for Exceptional Children and Their Families  18 1-5a  Intersectionality of Culture, Race, Ethnicity,

1-2 Using the Information Processing Model to Understand Students with Exceptionalities  8 1-2a  The Information Processing Model  8 Digital Download: Figure 1.1 Information Processing Model  8 1-3 Major Causes of Exceptionalities  9 1-3a  The Interaction of Heredity and Environment  10 1-3b  Prevalence: How Many Children with Exceptionalities Are There?   11

Poverty, and Ability Status on the Child and Family  19 Box 1-2 Exceptional Lives • Exceptional Stories: A Day in the Life of Roger’s Family  21 1-5b  Family Response to a Child with a Disability  21 1-5c  Supporting the Family Across the Lifecourse of the Child  22 Digital Download: Table 1.2 Marcus’s Development and His Family  23

1-6 Family-Professional Relationships and Family-Centered Approaches  25

Special Education  14 1-4b  Disparities in Special Education Placement  15 1-4c  Disparate Impact of Disciplinary Measures  15 1-4d  Significant Disproportionality of Students with Gifts and Talents  16

TopFoto/The Image Works

1-4 Significant Disproportionality Across Children with Exceptionalities  13 1-4a  Disproportionality in Identification for

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Contents

Box 1-3 High Leverage Practice 3: Collaborate with Families to Support Student Learning and Secure Needed Services  26 Digital Download: Box 1-4 Mindfulness Matters: Mindful Listening  27 1-6a  Supporting Siblings of Children with Exceptionalities  28 Box 1-5: Concerns of Siblings of a Child with Disabilities  29

1-6b  Assessment of Families  29 1-6c  Family as Advocate: The Power of Parents  30 Moral Dilemma: How to Respond: Handling a Colleague’s Biased Comments  31 Summary  31 Digital Download: Future Challenges  32

2 Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools  37 2-1 Societal Responses to Children with Exceptionalities  38 2-2 The Role of Government  40 2-2a  A Summary of Special Education

2-5a  Inclusion of Students with Exceptionalities within General Education Classrooms  52 2-5b  Multitiered Systems of Support (MTSS)  54 Digital Download: Figure 2.3 Multi-tiered Systems of Support  55 Box 2-2 Exceptional Lives • Exceptional Stories: Inclusion for Cara  56 2-5c  Positive Behavior Interventions and Supports (PBIS)  57 Digital Download: Box 2-3 Mindfulness Matters: Moving from Chaos to Calm  58 2-5d  Co-Teaching for Students with Exceptionalities  59 2-5e  Continuum of Services for Students with Exceptionalities  59

Legislation  40 TeachSource Video Connection  43 2-3 The Role of the Courts  44 2-3a  Inclusion and Funding Issues  45 2-3b  Appropriate Special Education Services  46 2-3c  Parental Involvement  46

2-4 Addressing Systemic Racism and Creating Culturally Responsive Learning Environments  47 2-4a  Examining Systemic Racism  48 Digital Download: Box 2-1 Ask the Experts: Addressing the Impact of Systemic Racism on Students with Exceptionalities  48 2-4b  Implicit Bias in the Classroom  50 2-4c  Dismantling Racism and Creating Culturally Responsive Learning Environments  51

2-6 The Individualized Education Program and 504 Plans for Students with Exceptionalities  61 2-6a  Individual Education Program   62

Ethel Wolvovitz/Alamy Stock Photo

2-5 Organizing Schools to Address the Strengths and Challenges of Students with Exceptionalities  51

Box 2-4 High Leverage Practices: 1 Collaborate with Professionals to Increase Student Success and 2 Organize and Facilitate Effective Meetings with Professionals and Families  64 Digital Download: Table 2.6 Individualized Education Program (IEP)  65 2-6b  Section 504 Plans  66 Box 2-5 Case Example: Transition Planning Goals for Paul’s IEP  66 2-6c  Modification and Accommodations to Support Student Success  67 2-7 Universal Design for Learning  68 Moral Dilemma: FAPE for Students with Disabilties Who Attend Private Religious Schools Using Publicly Funded Vouchers  69 Summary  70 Digital Download: Future Challenges  71

Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Contents

Part Two

ix

High-Incidence Exceptionalities   73

3-1 History of Early Intervention  76 3-1a  Legislation on Early Intervention  78 3-2 What Is Early Intervention and Why Is It So Important?  79 3-2a  Why Is Early Intervention So Important?  79 3-2b  Profiles of Two Children Who Need Early Intervention Supports and Services  80

3-3 Family-Centered Support as Part of Early Intervention  82 3-3a  The Family-Centered Approach and Racial, Ethnic, and Linguistic Diversity  83 Box 3-1 Ask the Experts: Working with Families of Young Children (with or At-Risk for Disabilities) Whose Primary Language is not English  84 3-3b  Early Intervention in “Natural Environments”  85

3-4 Finding Young Children Who Need Early Intervention Support  87 3-5 Children with or At-Risk for Developmental Delays  89 Box 3-2 Exceptional Lives • Exceptional Stories: Welcome to Holland  90 3-5a  What Puts Children at Risk for Developmental Delays?  92 3-5b  Child Find for Children Who Need Early Intervention  94 Box 3-3: Elements of State Child Find Initiatives  95

3-6 Educational Responses for Children Needing Early Intervention  96 3-6a  Quality of Early Childhood Services  96 3-6b  MTSS Approaches for Young Children  98 Digital Download: Table 3.4 Levels of Support Provided in Tiers I, II, & III within an MTSS Framework  99

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3  Early Intervention Supports and Services  75

Box 3-4 High Leverage Practice 7: Establish a Consistent, Organized, and Respectful Learning Environment  100 Digital Download: Box 3-5 Mindfulness Matters: Early Experiences with Self-Regulation  101 3-6c  The Individualized Family Services Plan  101 3-6d  Collaboration and the Multidisciplinary Team  102 3-6e  Curriculum and Instruction for Young Children  103 TeachSource Video Connection  106

3-7 Navigating Transitions in Early Childhood  106 Box 3-6 Reaching & Teaching: Young Children with Exceptionalities in a Virtual Setting  107 Moral Dilemma: Using Genetic Counseling  108 Summary  108 Digital Download: Future Challenges  109

4  Children and Youth with Intellectual Disabilities  113 4-1 A Brief History of the Field of Intellectual Disabilities  114 4-2 Characteristics of Children with Intellectual Disabilities  114 4-3 Defining Intellectual Disabilities  115 4-3a  Levels of Impact and Support Needed for ID  116 4-3b  Prevalence of ID  117

4-3c  Measuring Intelligence and Adaptive Behavior  118 Box 4-1 High Leverage Practice 4: Use Multiple Sources of Information to Develop a Comprehensive Understanding of a Student’s Strengths and Needs  119

4-4 Biological and Environmental Causes of ID  120 4-4a  Genetic Factors and ID  120

Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Contents

Burger/Phanie/Age footstock

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Box 4-2: A Child with Fragile X Syndrome: Early Identification  121 4-4b  Toxic Agents and Causation of ID  122 4-4c  Environmental Factors That Influence ID  123

4-5 The Information Processing Model and Students with ID  123 Digital Download: Figure 4.2 Information Processing for Jaylen  123 TeachSource Video Connection  124 Box 4-3 ID: Remember Our Super Powers!!!  125

4-6 Educational Responses for Students with Intellectual Disabilities  125 4-6a  Organizational Structures to Support Students with Intellectual Disabilities  126 Digital Download: Box 4-4 Ask the Experts: Having High Hopes for the Future  126

4-6b  Multitiered Systems of Support for Students with ID  127 Digital Download: Table 4.1 Meeting the Needs of Students with Intellectual Disabilities: Information Processing and Universal Design for Learning  128 Digital Download: Table 4.2 Jaylen’s Measurable Annual Goals and Specially Designed Instruction  129 Box 4-5 Reaching & Teaching: Using Universal Design Online  130 4-6c  Positive Behavior Interventions and Supports  130 Box 4-6: Jaylen’s Functional Assessment  131 4-6d  Curriculum and Instruction for Students with Intellectual Disabilities  132 Box 4-7 High Leverage Practice 21: Teach Students to Maintain and Generalize New Learning Across Time and Settings  132 Digital Download: Table 4.3 Examples of Strategies for Teaching Students with ID  133 4-6e  Instructional Practices for Engaging Students with ID in Learning  134 4-6f  Strategies for Improving Social Skills of Students with ID  135 Digital Download: Box 4-8 Mindfulness Matters: Calming Down in the Face of Frustrations  136 Digital Download: Box 4-9 Ask the Experts: Opportunity and High Expectations—Inclusive Higher Education  138 4-7 Transitions to Post-Secondary School, Work, and Adult Life   139 4-7a  Outcomes for Adults with ID  139 Box 4-10 Exceptional Lives • Exceptional Stories: Ryan’s Readjustment  140 4-7b  Transition Planning for Students with ID  141 4-7c  Leisure Time and Sports  142 4-7d  Family Support  142 Moral Dilemma: Addressing IEPs in Virtual School  143 Summary  143 Digital Download: Future Challenges  144

5  Children and Youth with Autism Spectrum Disorders  147 5-1 History of Autism Spectrum Disorders  148 5-2 Characteristics of Children and Youth with Autism Spectrum Disorders  148 5-2a  Theory of Mind  149 Box 5-1 Exceptional Lives • Exceptional Stories: Mike Dolan and His Family  150

5-3 Defining and Identifying Autism Spectrum Disorders  151 5-3a  Subtypes of ASD  152

5-3b  Levels of Support for Individuals with ASD  153 5-3c  Prevalence of Autism  153 Digital Download: Table 5.1 Levels of Support for Success of Students with ASD   154 Digital Download: Box 5-2 Ask the Experts: Supporting Families in Accessing Early Intervention for Young Children with ASD  155 5-3d  The Importance of Early Identification of Children with ASD  156

Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Contents

xi

5-4 Genetic and Environmental Causes of ASD  157 5-4a  Genetics and ASD  157 5-4b  Mistaken Causes of Autism  158 5-4c  Neurology and Brain Development: 5-5 The Information Processing Model  159 5-5a  Input: Hyper- and Hyposensitivity to Sensory Stimuli  159 Digital Download: Figure 5.3 Information Processing Model for Children with Autism Spectrum Disorder  159 5-5b  Central Processing: Thinking  160 5-5c  Output: Response Mode  160 5-5d  Emotional Context: The Climate of the Classroom  160 Box 5-3 ASD: Remember Our Super Powers!!!  162

5-6 Educational Responses for Students with Autism Spectrum Disorders  162 5-6a  Organizational Structures to Support Students with ASD  163 Box 5-4 High Leverage Practice 9: Teach Social Behaviors  164 Box 5-5 High Leverage Practice 20: Provide Intensive Instruction  164 5-6b  Comprehensive Treatment Models for Students with ASD  165 Box 5-6 Reaching & Teaching: Teaching Children with ASD Online  165 5-6c  Curriculum and Instruction for Students with ASD  167 Digital Download: Table 5.2 Content Standards, Classroom Behaviors, and Evidence-Based Strategies   168 5-6d  Evidence-Based Practices for Students with ASD  168

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Recent Findings Related to ASD  158

Digital Download: Table 5.3 Evidence-Based Practices, Definitions, and Number of Articles Across Review Periods  169 5-6e  Creating a Structured Environment  172 5-6f  Behavior Issues for Students with ASD  173 Digital Download: Box 5-7 Mindfulness Matters: Recognizing My Feelings  174 5-6g  Assistive Technology to Support Communication for Students with ASD  175

5-7 The Role of Families and Communities in Supporting Individuals with ASD  175 5-7a  Family Involvement  175 TeachSource Video Connection  175 Box 5-8: Holiday Tips for Families Living with Autism   176 5-7b  Transition to the Teen Years and Young Adulthood  177 Moral Dilemma: Addressing IEPs in Virtual School  177 Summary  177 Digital Download: Future Challenges  178

6  Children and Youth with Learning Disabilities  183 6-1 A Brief Historical Overview of Learning Disabilities  184 6-2 Characteristics of Children with Learning Disabilities  184 6-3 Defining and Identifying Learning Disabilities and Looking at Causes  186 6-3a  Dyslexia  188 6-3b  Importance of Early Recognition of Children with Learning Disabilities  189 6-3c  Causes of Learning Disabilities  189 6-3d  Prevalence of Learning Disabilities  191 Digital Download: Box 6-1 Ask the Experts: Learning Disabilities from a Neurologist Viewpoint  192

6-4 Appropriate Identification of Bilingual Children  193

6-5 Using the Information Processing Model to Understand Learning Disabilities  194 Digital Download: Figure 6.1 Ray’s Information Processing Model  194 6-5a  Problems with Input  195 Box 6-2 LD: Remember Our Super Powers!!!  195 6-5b  Problems with Processing or Thinking  196 TeachSource Video Connection   197 Box 6-3 Reaching & Teaching: Input for Children with Reading Disabilities  198 6-5c  Problems with Output  198 6-5d  Problems with Executive Functions  199 6-5e  Emotional Context of Information Processing  199

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Contents

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Box 6-4 High Leverage Practice 8: Provide Positive and Constructive Feedback to Guide Students’ Learning and Behavior  200 Digital Download: Box 6-5 Mindfulness Matters: Managing Impulsivity: The Secret Signal  201 6-5f  The Information Processing Model as a System  201

6-6 Educational Responses for Students with Learning Disabilities  202 Box 6-6 Exceptional Lives • Exceptional Stories: A Painful Situation  202 6-6a  Organizational Structures and Support for Students with Learning Disabilities  204 Box 6-7 High Leverage Practice 5: Interpret and Communicate Assessment Information with Stakeholders to Collaboratively Design and Implement Educational Programs  207 6-6b  Curriculum and Instruction for Students with Learning Disabilities  208 Digital Download: Table 6.2 Meeting the Needs of Students with Learning Disabilities: Information Processing and Universal Design for Learning  209 Digital Download: Table 6.3 Using Universal Design Principles to Give Students with Learning Disabilities Access to Content Standards  211

6-7 Families of Children with Learning Disabilities  213 Digital Download: Table 6.4 Ideas for Parental Support for Students with Learning Disabilities  214

6-8 Transitions to Postsecondary Life for Individuals with Learning Disabilities  214 Moral Dilemma: Classroom Modifications  215

Summary  216 Digital Download: Future Challenges  217

7 Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD)  221 7-1 History of the Field of ADHD  222 7-2 Characteristics of Children with ADHD  223 Box 7-1: Symptoms of Attention-Deficit/Hyperactivity Disorder: DSM-5  224 7-2a  Let’s Meet Angelina  224 7-2b  Information Processing Model and ADHD  224 Digital Download: Figure 7.2 Information Processing Model for Angelina, a Child with ADHD  225 Box 7-2 ADHD: Remember Our Super Powers!!!  226

7-4 Comorbidity: ADHD and Other Areas of Disability or Concern  233 7-5 Using Medication for ADHD Symptoms  234 Box 7-5 Exceptional Lives • Exceptional Stories: Meet Michael  236

Box 7-3: Federal Regulations for Other Health Impairments  227 7-3a  Identification of Students with ADHD  227 7-3b  Families from Culturally/Linguistically Diverse Backgrounds  228 Digital Download: Box 7-4 Ask the Experts: What Do Psychologists Look for When Assessing a Child for ADHD?  230 7-3c  Neurological, Genetic, and Environmental Causes of ADHD  232

Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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7-3 ADHD Definition, Identification, and Causes  226

Contents 7-6 Educational Responses for Children with ADHD  238 7-6a  Organizational Structures to Support

Box 7-7 Reaching & Teaching: Using the Pomodoro Technique Online for Students with ADHD  247 Digital Download: Table 7.4 Evidence-Based Behavior Intervention Strategies  249 Digital Download: Box 7-8 Mindfulness Matters: Calming My “Monkey Mind”  250 7-7 Families of Children with ADHD  250 Box 7-9: Tips to Help Kids Stay Organized and Follow Directions  252

Students with ADHD  238 7-6b  Curriculum and Instruction for Children with ADHD  240 Digital Download: Table 7.2 Steps for Instructional Planning for Students with ADHD  241 Box 7-6 High Leverage Practices: 14 Teach Cognitive and Metacognitive Strategies to Support Learning and Independence and 16 Use Explicit Instruction  242 Digital Download: Figure 7.4 Four Variables for Success  243 TeachSource Video Connection  244 Digital Download: Table 7.3 Using Universal Design Principles to Give Students with ADHD Access to Content Standards  246

7-8 Transition to Post-secondary and Adult Life for Individuals with ADHD  252 Moral Dilemma: Austin’s Behavior  253

Summary  253 Digital Download: Future Challenges  254

8 Children and Youth with Emotional and Behavior Disorders  257 8-1 History of the Field of Emotional and Behavior Disorders  258 8-2 Characteristics of Students with EBD  259 8-2a  Strength-based Approaches

8-6 Educational Responses for Students with Emotional and Behavior Disorders  274 8-6a  Early Intervention and Support for Children at risk for EBD  275 Box 8-5 High Leverage Practice 22: Provide Positive and Constructive Feedback to Guide Students’ Learning and Behavior  276 8-6b  Organizational Structures to Support Students with EBD  277 8-6c  MTSS Approaches for Students with Emotional and Behavior Disorders  277 Digital Download: Table 8.4 Types of Data Useful for Data-Driven Decision Making  281 Box 8-6 High Leverage Practice 10::Conduct Functional Behavioral Assessments to Develop Individual Student Behavior Support Plans  282 8-6d  Wraparound Support for Students with EBD  282

to Support Positive Identity Formation  260 Box 8-1 EBD: Remember Our Super Powers!  261

8-3 Emotional and Behavior Disorders: A Slippery Definition  261 8-3a  DSM-5 Clinical Areas Related to Emotional and Behavioral Disorders  263 8-3b  Classifications of EBD: Internalizing and Externalizing Behaviors  264 8-3c  Possible Role of Implicit Bias and Systemic Racism in the Identification of Students with EBD  264

8-4 Causation of Emotional and Behavior Disorders  265 8-4a  Environmental Factors Influencing EBD:

8-5 Information Processing Model for Students with EBD  272 Digital Download: Figure 8.3 Information Processing Model for Students with Emotional and Behavior Disorders  272 Digital Download: Box 8-4 Mindfulness Matters:: Dealing with Anger  274

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Correlated Constraints  266 8-4b  Role of Maltreatment and Trauma in EBD  266 Box 8-2: Impact of the COVID-19 Pandemic on Child Maltreatment  267 8-4c  School Risk Factors  267 Box 8-3 Reaching & Teaching: Stopping Cyberbullying while Distance Teaching  271

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8-6e  Curriculum and Instruction for Students with EBD  283 TeachSource Video Connection  283 Digital Download: Table 8.5 Using Universal Design Principles to Give Students with EBD Access to Content Standards  284 Box 8-7 Ask the Experts: Why Art Education? A Special Way to Reach and Teach Our Students  285 8-6f  Building Social Competency   286

Box 8-8 Ask the Experts: The Importance of Self-Determination Skills  287 8-6g  Assistive Technology for Students with EBD  288 8-7 The Role of Family and Community  289 Moral Dilemma: Supporting Hakeem  290 8-7a  Transition and the Lifecourse of Students with EBD  290 Summary  290 Digital Download: Future Challenges  291

9 Children and Youth with Communication, Language, and Speech Disorders  295

Language  297 9-1b  Study of Linguistics  297

9-2 Characteristics of Students with and Definitions of Communication, Language, and Speech Disorders  298 Digital Download: Figure 9.2 Michelle’s Information Processing Model  299 Box 9-1: Speech, Language, and Communication Disorders: Remember Our Super Powers!  300 9-2a  Definitions of Communication, Language, and Speech  300 Digital Download: Box 9-2 Mindfulness Matters: Understanding Body-Language to Build Better Communications Skills  302

9-3 Typical and Atypical Language Development  305 Digital Download: Box 9-3 Ask the Experts: Equitable Speech/Language Services for Bilingual and Bicultural Children  306 9-3a  Disorders in Communication, Language, and Speech  308 9-3b  Prevalence of Communication, Language, and Speech Disorders  311

9-4 Importance of the Child’s Cultural and Linguistic Context  312 9-4a  Bilingual Learners  312 9-4b  Language Differences  312 9-4c  Dialects  313 9-5 Disability Areas and Problems with Communication, Language, and Speech  314 Box 9-4 Exceptional Lives • Exceptional Stories: Have You Ever Wondered What It Would be Like Not to

be Able to Communicate? It’s Very Frustrating. It’s Very Lonely It Hurts  315 9-5a  Assessment and Identification of Problems with Communication, Language, and Speech  316 9-5b  Assessment of Children from Culturally or Linguistically Diverse Backgrounds  317

9-6 Educational Responses for Children with Communication, Speech, and Language Disorders  317 9-6a  Organizational Structures to Support Students with Communication, Speech, and Language Disorders  317 Box 9-5: Ms. Boone’s Strategies to Build Community in Her Classroom  319 Box 9-6 High Leverage Practice 15: Provide Scaffolded Supports  320 Digital Download: Box 9-7 Ask the Experts: Speech-Language Therapist ~ The Value of One-on-One Connections with Each Child  321

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9-1 History of Communication, Language, and Speech Disorders  296 9-1a  Studying Brain Injury to Understand

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Contents Box 9-8 Reaching & Teaching: Working Online with Students Who Have Speech and Language Disorders  322 9-6b  Curriculum and Instruction for Students with Communication, Speech, and Language Disorders  322 Digital Download: Table 9.4 Using Universal Design Principals to Give Student with Communication, Speech, and Language Disorders Access Content Standards   324 9-6c  Assistive Technology for Augmentative and Alternative Communication  325

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TeachSource Video Connection  325 9-7 Family and Lifecourse Issues  327 9-7a  How Parents Can Support Their Child’s Communication  327 9-7b  Transitions for Students with Communication Disorders  328 Moral Dilemma: Children with Communication Disorders  329 Summary  329 Digital Download: Future Challenges  330

10  Children and Youth with Gifts and Talents  333 10-1 How the Field of Gifted and Talented Education Evolved and Why It Is Important   334 10-2 Characteristics of Students with Special Gifts and Talents and How the Information Processing Model Helps to Understand their Needs  335 10-2a  The Information Processing Model  336

Digital Download: Box 10-6 Ask the Experts: Upstanders Confront Anti-Black Racism and Close Excellence Gaps for Gifted Black Males  349 10-4a  Twice Exceptional, 2e, Students with Disabilities Who Are Also Gifted   352 10-4b  Summary Thoughts on Underrepresented Students with Gifts and Talents  352

Digital Download: Figure 10.1 Information Processing Model for Students with Gifts and Talents  336 10-2b  Neurology and Brain Development: What We Know about Students with Gifts and Talents  338 Box 10-1 Students with Gifts and Talents: Remember Our Super Powers!  338 10-2c  Social and Emotional Development of Students with Gifts and Talents  339 Digital Download: Box 10-2 Mindfulness Matters: Stress Reduction with Meditation  340 10-2d  Creativity  341

10-5 Educational Responses for Students with Gifts and Talents  353 10-5a  Organizational Structures to Support Students with Special Gifts and Talents  353 Digital Download: Table 10.2 Adapting Content Standards for Advanced Learners: Example from ELA Standards for Speaking and Learning; Strand 1, Comprehension and Collaboration  354 TeachSource Video Connection  355 10-5b  Other Organizational Strategies to Meet the Needs of Students with Gifts and Talents  357 Box 10-7 High Leverage Practice 17: Use Flexible Grouping  357 10-5c  Residential and Special Schools for Students with Gifts and Talents  358

Talents  344 Box 10-3 Exceptional Lives • Exceptional Stories: Terry and Lenny  345 Box 10-4: U-STARS~PLUS (Using Science Talents and Abilities to Recognize Students, Promoting Learning for Under-represented Students)  348 Box 10-5: Special Photos by Latrell Broughton  348

10-4 Continued Underrepresentation of Gifted Students from Racially, Ethnically, Socioeconomically Disadvantaged, and 2e Populations  349

© iStockphoto.com/skynesher

10-3 How Do We Define “Gifts and Talents” and Identify Students  342 10-3a  One Gift or Many?  344 10-3b  Children of Extraordinary Ability  344 10-3c  Identification of Students with Gifts and

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10-5d  Curriculum and Instruction for Students with Gifts and Talents  358 Digital Download: Table 10.3 Taxonomy of Cognitive Thinking  359 10-5e  Culturally Responsive Curriculum and Instruction for Students with Gifts and Talents  361 10-5f  Assistive Technology for Students with Gifts and Talents  362

Part Three

Box 10-8 Reaching & Teaching: Media Literacy for Students with Gifts and Talents  363

10-6 Family and Lifecourse Issues  364 Moral Dilemma: Supporting Students Who Experience Micro-Aggressions  365 Summary  365 Digital Download: Future Challenges  366

Low-Incidence Exceptionalities  369

11  Children and Youth Who Are Deaf or Hard of Hearing  371

Box 11-1: Signs and Sounds for Sammy  373

11-2 Characteristics of Children and Definitions of Deaf/Hard of Hearing  374 11-2a  Meet Three Children Who Are Deaf or Hard of Hearing  374 Digital Download: Figure 11.1 Kiesha’s Information Processing Model  375 Box 11-2: Students Who Are Deaf or Hard of Hearing: Remember Our Super Powers!  377 11-2b  Definitions of Deaf, Hard of Hearing, and Central Auditory Processing Disorders  377 TeachSource Video Connection  380 11-2c  Prevalence of Hearing Loss  380

11-3 Causes and Detection of Hearing Loss in Children and the Importance of Early Intervention  381 11-3a  Causes of Hearing Loss  381 11-3b  Assessing Hearing Levels in Children  382 11-3c  The Importance of Early Intervention

11-4c  Academic Development in Reading for Children with Hearing Losses  388 Box 11-5: Promising Elements of Reading Instruction for Children Who Are Deaf or Hard of Hearing  389 11-4d  Social and Personal Adjustment of Children with Hearing Loss  390 Digital Download: Box 11-6 Mindfulness Matters: Building Connections Through Mindful Movement  391 11-5 The Deaf Culture or Community and Bilingual Approaches to Deafness  391 11-5a  The Bilingual-Bicultural Approach to Deafness  392 Box 11-7: African-American Hearing Parents with Deaf/Hard of Hearing Children  393

11-6 Educational Responses for Children Who Are Deaf or Hard of Hearing  393 Box 11-8 Reaching & Teaching: Deaf Students in the Pandemic Age  394 11-6a  Organizational Structures and Supports for Students with Hearing Loss  395

for Children with Hearing Losses  383 Digital Download: Box 11-3 Ask the Experts: Infusing Deaf Adults in Early Intervention Support for Families  384 Box 11-4 Exceptional Lives • Exceptional Stories: A Gifted Eye: A Story of Mathew  386

11-4 Communication, Cognitive, Academic, and Social Development of Children Who Are Deaf or Hard of Hearing  387 11-4a  Impact of Hearing Levels on Language, Speech, and Communication  387 11-4b  Cognitive Development of Children with Hearing Losses  387

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11-1 History of Education for Individuals Who Are Deaf or Hard of Hearing  372

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Box 11-10 High Leverage Practice 19: Use Assistive and Instructional Technologies  401

11-6b  Curriculum and Instruction for Students with Hearing Loss  398 Box 11-9 High Leverage Practice 12: Systematically Design Instruction Toward a Specific Learning Goal  398 Digital Download: Table 11.3 Using Universal Design Principles to Give Students with Hearing Loss Access to Content Standards  399 11-6c  Assistive and Instructional Technology for Students Who Are Deaf or Hard of Hearing  400

11-7 Family and Lifespan Issues  402 11-7a  Transitions for Students Who Are Deaf or Hard of Hearing  403 Moral Dilemma: Students Who Are Deaf or Hard of Hearing  403 Summary  404 Digital Download: Future Challenges  406

12  Children and Youth with Visual Impairments  409 12-1 Brief History of the Field of Visual Impairments  410 12-2 Definitions, Causes, and Identification of Visual Impairments  411 12-2a  Causes of Visual Impairments  411 12-2b  Identification and Assessment

12-5 Culturally and Linguistically Diverse Children with Visual Impairments  421 12-6 Educational Responses for Students with Visual Impairments  422 12-6a  Organizational Structures to Support Students with Visual Impairments  422 Box 12-4 High Leverage Practice 18: Use Strategies to Promote Active Student Engagement  423 12-6b  Special Schools for Students Who Are Visually Impaired  424 12-6c  Assistive Technology for Students with Visual Impairments  425 Digital Download: Box 12-5 Ask the Experts: Who Can Benefit from Assistive Technology?  425 12-6d  Curriculum and Instruction for Students with Visual Impairments  427 Box 12-6 Reaching & Teaching: Lessons on Virtual Instruction for Students with Visual Impairments  428 TeachSource Video Connection  430

of Visual Impairments  412 12-2c  Vision and the Brain  413 12-2d  Prevalence of Visual Impairments  413

12-3 Characteristics of Children with Visual Impairments  413

12-4 Early Intervention for Children with Visual Impairments and the Importance of Family Support  419 12-4a  The Role of the Family in Supporting Children and Youth with Visual Impairments  420 12-4b  A National Agenda for Students with Visual Impairments  420

Dan Callister/Getty Images

Box 12-1: A Visit to the Beach for Angela, a Child Who Is Blind  414 12-3a  Halley and Wes  415 12-3b  The Information Processing Model for Halley  415 Digital Download: Figure 12.2 Information Procession Model for Halley  416 Box 12-2 Students with Visual Impairments : Remember Our Super Powers!  416 12-3c  Cognitive Development of Children with Visual Impairments  417 12-3d  Language Development for Children with Visual Impairments  417 12-3e  Personal and Social Adjustment  418 Box 12-3 Exceptional Lives • Exceptional Stories: One Person’s Reflections on the Consequences of Using a Unique Standard  418

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Box 12-7 High Leverage Practice 11: Identify and Prioritize Long- and Short-Term Learning Goals  430 Digital Download: Table 12.2 Using Universal Design Principles for Accessing Content Standards  431 12-6e  The Expanded Core Curriculum for Students with Visual Impairments  431 Digital Download: Table 12.3 Expanded Core Curriculum for Students with Low Vision and Blindness  433 Box 12-8: Coralyn’s Story  436

Digital Download: Box 12-9 Mindfulness Matters: Building a Sound Practice  437 12-6f  Putting it All Together: Individualized Education Programs  438

12-7 Transition to Independent Living and Work  438 Moral Dilemma: Preparing a class for a child with visual impairment  440 Summary  440 Digital Download: Future Challenges  441

13 Children and Youth with Physical Disabilities, Health Impairments, and Multiple Disabilities  445

Digital Download: Figure 13.1 Pam’s Information Processing Model  448 Box 13-1: Physical Disabilities, Health Impairments, and Multiple Disabilities: Remember Our Super Powers!  449 Digital Download: Box 13-2 Ask the Experts: Intersectionality and Hope for a More Inclusive Society  450

13-3 Definitions of Physical Disabilities, Health Impairments, and Multiple Disabilities  451 13-3a  Physical Disabilities  452 13-3b  Major Health Impairments  456 Digital Download: Figure 13.3 Teacher and School Roles in Supporting Children with Serious Health Needs  459 13-3c  Severe and Multiple Disabilities  460 Digital Download: Box 13-3 Mindfulness Matters: Maintaining Personal Control of My Body  461

13-5 Educational Responses for Children and Youth with Physical Disabilities, Health Impairments, and Multiple or Severe Disabilities  464 13-5a  Organizational Structures to Support Students with Physical Disabilities, Health Impairments, and Multiple or Severe Disabilities  464 13-5b  Curriculum and Instruction for Children with Physical, Multiple, or Severe Disabilities  466 Box 13-5 High Leverage Practice 13: Adapt Curriculum Tasks and Materials for Specific Learning Goals  467 Digital Download: Table 13.4 Using Universal Design Principles to Give Students with Physical Disabilities Access to Content Standards  468

13-4 Assessment of Children with Physical Disabilities, Health Impairments, and Multiple Disabilities  462 13-4a  Educational Assessments for Children with Physical or Multiple Disabilities  462 Box 13-4 High Leverage Practice 6: Use Student Assessment Data, Analyze Instructional Practices, and Make Necessary Adjustments That Improve Student Outcomes  463

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13-1 History of Special Education for Children and Youth with Physical Disabilities, Health Impairments, and Multiple Disabilities  446 13-2 Characteristics of Children and Youth with Physical Disabilities, Health Impairments, or Multiple Disabilities  447

Contents Box 13-6 Reaching & Teaching: Helping Students with Exceptionalities Who Are Struggling with Online Instruction  470 13-5c  Assistive Technology for Students with Physical Disabilities, Health Impairments, and Multiple Disabilities  471 TeachSource Video Connection  473 13-5d  Enhancing Self-Determination and Autonomy  474 13-6 Family and Lifespan Issues  474 13-6a  Honoring the Family’s Journey: Coping with Chronic Sorrow  475 Box 13-7 Exceptional Lives • Exceptional Stories: Counting on Me  476

13-6b  Culturally Responsive Practices  478 13-7 Transition for Students with Multiple and/or Severe Disabilities  478 Moral Dilemma: Inclusive Classroom?  480 Summary  480 Digital Download: Future Challenges  481

Glossary  G-1 References  R-1 Subject Index   SI-1 Name Index   NI-1

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Dedication This book is dedicated to students who have exceptional learning needs, to their families, and to the educators who work to ensure that each student’s strengths are nurtured and that their challenges are supported. Thank you!

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Preface

M

ore than sixty years ago, Sam Kirk, a brilliant scientist and educator, penned the first edition of Educating Exceptional Children. When the first edition of this text was published in 1962, the future for children with exceptional learning needs was just beginning to change. Still a decade ahead was the key legislation that promised children with disabilities a “free and appropriate public education” (FAPE). Still further ahead were the numerous court decisions that solidified the educational rights of these children with exceptionalities. The field has changed over the last decades and our understanding of how we can support student success has expanded and deepened. Each new edition of this textbook reflects our growing knowledge base on how to address the strengths and challenges of students so they can thrive. Each new edition, however, still holds to our original purpose: to help educators gain the knowledge and skills needed to support the success of students with exceptionalities in school and in life.

Overview of the 15th Edition The fifteenth edition (15e) builds on the strong foundation of previous editions, while carrying this seminal text into the future. Throughout the 15e, we focus on the bioecological factors that influence outcomes for the child and their family across the lifecourse. In each chapter, you will meet students and their families to bring the content of the chapter to life. The 15e takes a strength-based approach to students and incorporates a wealth of instructional/curriculum strategies to support student’s success (including evidence-based teaching methods, Universal Design for Learning, High Leveraged Practices, and Differentiated Instruction). Each chapter discusses the importance of a collaborative team approach to student’s strengths and challenges using the Multi-Tiered Systems of Support (MTSS) framework to address the academic/cognitive and social/emotional/behavioral needs of students. Each chapter has been thoroughly updated based on current research with over 420 new citations. In addition to the research update, new topics include: high leverage practices; developing cultural competence; addressing the challenges of disproportionate representation within special and gifted education (examining the roles of implicit bias and structural racism); using on online learning and lessons learned during the COVID-19 “pivot”; a focus on the importance of “belonging” which goes beyond inclusion; and strategies to enhance mindfulness within our classrooms and schools. We continue to address the important topics of genetics, neurology, assistive technology, and information processing, and to follow the CEC standards for knowledge and skills needed within the profession of special education. Key to the 15e is understanding that “belonging” goes well beyond “inclusion” and that respecting and supporting each student and their family is critical to building a sense of community. As part of this community building, we have worked to honor the changing language within the disability community. Language is always evolving; our intent is that our words speak to the importance

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Preface of respect and that they foster the spirit of belonging. The ongoing conversations about terminology are reflected within this text. Most often in the text we use person-first language, saying “student with a disability.” This person-first language is meant to recognize the personhood as being first and foremost. However, some members within the disability community feel that their disability is a central and defining aspect of who they are and that person-first language fails to honor this belief. You will see this discussion in Chapter 5 as we look at the movement to use “Autistic student” rather than “student with Autism.” We see this idea again in Chapter 11 as we explore “Deafhood.” These conversations are important and ongoing. We also see an evolution in language within our discussions of race and ethnicity. Terms are rapidly shifting, and throughout this text, we have tried to reflect these changes while maintaining respect for different preferences. When we cite specific research, we use the language that the researchers used; when we discuss specific issues, we use language that is respectful for the individual or the group. Our intent is to show the evolution of language while maintaining a deep respect for the individuals and groups impacted by the spoken and written words. As we do this, however, we are very aware that language used is a personal preference, and we encourage our readers to use the terms that people ask them to use because this is the best way to respect each individual. Throughout the 15e, we address four themes: ● ● ●



Bioecological factors that influence outcomes across the student’s lifecourse Culturally relevant and responsive teaching methods and school environments Collaborative and intensive supports and services to address the learning, social, and emotional requirements for each student’s success Strength-based approaches to students and their families.

Theme 1: Bioecological Factors that Influence Outcomes Across the Student’s Lifecourse A child’s development takes place within the context of the family, neighborhood, school, and community. Their development is influenced by the dynamic interactions, over time, that take place across this system. The child, in turn, influences the system itself, changing the way interactions take place and how resources are used. In addition to the immediate context of the child and their family, the greater system of social structures (e.g., laws, policies, values, beliefs) work to shape the outcomes of the individual across their lifecourse. We discuss these bioecological factors using Bronfenbrenner’s Bioecological Theory of Human Development (Bronfenbrenner & Morris, 2006) to explore how we can better support positive outcomes for students (Waski & Coleman, 2019). We also use this approach to explore the impact of structural and systemic racism on student outcomes. Theme 2: Culturally Relevant and Responsive Teaching Methods and School Environments Both special and gifted education continue to face challenges of disproportionate representation of students of color and of economically disadvantaged students. Within special education we see an over-representation of Black, brown, and economically disadvantaged students in many categories of disability; we see an under-representation of these same student groups within gifted education. Every chapter addresses appropriate identification and the disproportionate representation of culturally and linguistically different, and economically disadvantaged, students within special and/or gifted education. We also tackle specific challenges like the role of implicit bias in decision making, the need for family-centered interventions and culturally resonant practice in early intervention, the increasing identification of Latinx youth as learning disabled, the need for bilingual/bicultural approaches for students who are Deaf, and the underrepresentation of students of color within gifted education. We further examine how

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Preface developing cultural competence can support culturally relevant and responsive teaching methods and learning environments. In many of the chapters, we have gone directly to the “experts” to ask them how we can better address these needs within our classrooms and our programs (see special new special feature “Ask the Experts”). Theme 3: Intensive and Collaborative Supports and Services to Address the Learning, Social, and Emotional Requirements for each Student’s Success The key to success for students with exceptionalities is that they receive appropriate supports. Indeed, Schalock, Luckasson, and Tasse (2021), when discussing students with Intellectual Disabilities (ID), put it this way “…the most relevant difference between people with ID and the general population is that people with ID need different types and intensities of supports to fully participate in and contribute to society…” (pp. 64–65), and we could not agree more! In each chapter, we discuss the types and intensity of supports needed to help students thrive in school and in life. Addressing the strengths and challenges of students with exceptionalities often requires deep collaboration across multiple stakeholders. This collaboration begins with strong family partnerships during the initial recognition of need for additional support, it deepens with the development of the Individual Education Plan, and it continues across the lifecourse of the student as they learn to “adult.” We discuss collaborative, family-centered earlier intervention and transition planning for young children. We explore the role of multidisciplinary teams in the IEP process. We use the Multitiered Systems of Support (MTSS) to show how this collaboration can be supported within the K–12 environment, and we look at the transition process for post-secondary success of students. Collaboration between educators and family members is central to this support, but comprehensive support often must go beyond the school and family. We discuss “wrap-around” supports that may include mental health, medical support, parental education, job-coaching, and building social networks within neighborhoods and communities. This level of collaborative and intensive support is essential for student success. Positive outcomes for students with exceptionalities hinges on our ability to provide the supports and services needed for their success. Theme 4: Strength-based Approaches to Students and Their Families Every student has strengths and all families have assets. To often when we look at how we can support student’s success, we focus only on their areas of challenge, ignoring their strengths. To often when we work with families, we fail to identify and connect with their assets. At times, we may even view students and family members through a deficit lens that fosters negative beliefs about what our students can do and undermines our ability to build the strong partnerships needed for positive outcomes. When we use a strength-based approach, we intentionally look for, engage with, and enhance the abilities of our students, and we focus on the many ways that families can (and do) contribute positively to their child’s success. The use of a strength-based approach is central to everything we do to support students with exceptionalities and their families. This strength-based philosophy is integrated throughout each chapter. In the new feature, “remember our superpowers,” students remind us of what they are good at; the updated Information Processing Models now incorporate areas of strength; in each educational response section, we address the strengths of the students, and whenever we discuss working with families, we do so from a strength-based, family-centered, culturally responsive framework. Using a strength-based approach is not “just a nice thing to do” … it is a foundational mindset that is essential to supporting the success of students with exceptionalities.

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Preface

Organization of the 15th Edition This book is divided into three major sections. Part One provides the history and foundations of special education. Part Two deals with high-incidence exceptionalities (those experienced by more than 1 percent of the population). Part Three addresses low-incidence exceptionalities where students, whose needs are often quite complex, make up less than 1 percent of the general population. We have intentionally structured Chapters 3–13 to build from understanding the students and the identification process through the educational supports and services needed to address their strengths and challenges. Each chapter introduces the reader to a few students whose strengths and challenges exemplify the chapter’s area of exceptionality. We follow these students within the chapter to explore their needs and how we can support their success. In the educational response sections of the chapter, we see how specific strategies apply to these students. Our Educational Response shares the organizational structures (e.g., a continuum of services and MTSS) to support students. We also share specific curriculum and instruction strategies (e.g., Universal Design for Learning, High Leverage Practices, Evidence-Based Practices) to support student access to content standards. Please see the detailed table of contents for more information about text and chapter organization.

What’s New in the 15th Edition? With each edition, we get the chance to incorporate new features that can enhance learning for the reader. We are very excited about the new features for the 15e! Each new feature has been carefully chosen to bring an important perspective to the content in the chapter while updating the information with current knowledge, expertise, and understanding. The following are new features for the 15e: Ask the Experts—within each chapter, an expert within our field addresses a hot topic and shares their wisdom with the next generation of teachers. These essays are written in a conversational tone, inviting the reader to explore key ideas and to learn from the best of the best. Experts include: ● ● ●





● ● ●

● ● ● ●



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Dr. Cathy Kea—Developing Cultural Competence Dr. Kristina Collins—Addressing Systemic Racism Dr. Kelly Carrero—Working with Young Culturally/Linguistically Diverse Learners Dr. Kristin Bjornsdottier—Setting High Expectation for our Students and Our Selves Ms. Tammy Day—Exploring College Programs for Students with Intellectual Disabilities Dr. Jennifer Nietzel—Supporting Families of Students with ASD Dr. Susan Boutilier—The Neurology Behind Learning Disabilities Dr. Emily King—Moving Beyond Checklists to Identify the Strengths and Needs of Students with ADHD Dr. Dennis Cavitt—The Importance of Self-determination Dr. Beverly Gerber—The Importance of the Arts as a Key Part of Services Dr. Dina Castro—Working with Culturally/Linguistically Diverse Families Ms. Liz Parrot—How Important a Personal Relationship with The Speech Language Therapies Can Be for a Child Dr. Tarek Grantham—Upstanders Confront Anti-Black Racism and Close Excellence Gaps for Gifted Black Males Dr. Elaine Gale—Infusing Deaf Adults in Early Intervention for Families Dr. David Edyburn—Using Technology to Support Students Dr. Joy Banks—Intersectionality and Hope for a More Inclusive Society

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Preface Each of these essays is designed to invite further conversation and provide a jumping off point for in class or online discussions and further investigations of the topics addressed. High Leverage Practices—All of the new High Leverage Practices (HLP) (CEC/ CEEDAR) have been included in the 15e. Each HLP appears within the chapter and topic where its application can best be seen. The full list of HLPs, and the chapter in which it appears, is included in the back of the text cover. Readers can refer to this list to see where in the text each practice is addressed. High Leverage Practices can be incorporated within classroom discussions and lesson-planning activities to explore their application in practice. Remember Our Super Powers!!!—This feature captures the voices of students with exceptionalities as they share their “super powers.” So often we focus on the challenges that students face without taking time to celebrate their strengths. This feature also provides a jumping off point for discussions of what happens when we think about students’ strengths instead of focusing on their deficits. Reaching and Teaching Students in Virtual Learning Environments— We have learned many lessons from the rapid pivot to online learning that resulted from COVID-19. In these short essays, Dr. Jennifer Job shares lessons from this pivot that we may want to carry forward; sharing ways we can incorporate more online learning opportunities for our students. Mindfulness Matters—This special feature reminds us of the importance of the emotional climate of our schools and classrooms for supporting student success. Each chapter incorporates specific and practical strategies to nurture mindfulness. These strategies addresses: Mindful Listening; Mindful Learning Environments: From Chaos to Calm; Supporting Mindfulness with Young Children; Supporting a Calm Focus; Identifying Feelings; Managing Impulsivity; Calming the “monkey mind”; Dealing with Anger; Moving Beyond Words; Understanding the Neurology of Mindfulness; Connecting with Others; Using Sound to Focus the Mind; and Mindfulness of Personal Autonomy. The practice of mindfulness for students and teachers helps to create an environment of calm which supports learning. The concrete strategies offered in this section are designed to be implemented within a typical classroom and school.

Key Features Retained in the 15th Edition In addition to the new features, we have kept our best loved features for the 15e. These features include: Exceptional Lives Exceptional Stories—These vignettes share the experiences of children with exceptionalities and their families giving readers an important glimpse of what daily life maybe like for students and their families. Moral Dilemmas—These short vignettes present the reader with issues that teachers often face and ask them to think about how they would handle these difficult situations. There are no “right” answers to these dilemmas, but in reflecting on them, the readers can clarify their own beliefs and values. Future Challenges—The field of Special Education continues to evolve, and while we have made great strides, there are many challenges that we still face. This section shares some of these remaining challenges with the reader in hopes that they will help to address these challenges as they enter the field of special education.

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Preface Universal Design for Learning (UDL) Strategies for Content Standards— Chapters 3–13 share tables linking UDL strategies to content standards, showing how students can gain access to grade level curriculum benchmarks. Information Processing Model—In the 15e, we continue to emphasize the information processing model (IPM) to show the key elements of learning: taking information in (input), thinking about it (central processing), and using it in some way (output); information processing also includes decision making (executive function) which oversees the learning process. All of this information is placed within the emotional context which influences how we process information (i.e., how we learn). Understanding how a child processes information allows educators to adapt learning environments, teaching strategies, and curriculum to address the child’s strengths and challenges. Chapter 1 gives a detailed description of information processing model and Chapters 3–13 use the IPM to show the strengths and challenges for students within each area of exceptionality. Multitiered Systems of Support (MTSS)—We use the MTSS approach (formally RtI) to show how coordinated services can be organized to facilitate greater collaboration between general and special education through tiered supports and services. MTSS is designed to strategically match supports and services with the intensity of student’s strengths and challenges. Using this framework, we can provide extra support for students who do not need the intense and full services we provide through special education. We can also provide additional enhancements for children who need them. We present a three-tiered model: Tier I, focuses on solid supported access to the general curriculum to help students reach grade level benchmarks and enhanced experiences for students who have met benchmarks; Tier II, offers students targeted instruction, often using standardized materials and interventions, when they need additional support and or enhancements to meet with success; and Tier III is intensive and more individualized support and or enhancements for students. Many students with exceptionalities spend a large part of their school day within the general education classroom and tired services help to foster the collaborative support they need. Chapter 2 offers a full description of MTSS, and this model is used within the Educational Response sections of Chapters 3–13. Diversity and Disproportionate Representation—Disproportionate representation of racially, culturally, and linguistically different, and economically disadvantaged, children within special and gifted education is a pernicious and persistent challenge. Within special education, we see an overrepresentation of Black, Indigenous, Latinx, and economically disadvantaged students in many areas of disability. This pattern is reversed within gifted education, where the same children are markedly underrepresented. Poverty, while certainly contributing to these patterns, does not fully explain them. In other words, the intersectionality of race ethnicity, language, culture, and gender all make unique contributions to the patterns of disproportionate representation that poverty alone cannot account for. In Chapter 2, we explore deeply the impacts that structural and systemic racism and implicit bias can have on decisions to identify, place, and discipline students. Within each chapter, we address the specific issues related to appropriate identification and services for students of color. (Please see our earlier discussion of respect for evolving language preferences.) We discuss the social, as well as educational consequences of policies and practices, and explore the role of culturally inclusive curriculum and family-centered approaches to create culturally responsive services for all children. In many chapters, we have invited experts to share their wisdom on how we can solve these pernicious problems. Because we have integrated this content within each chapter, throughout the book, we have placed a special icon showing where this important information is located within each chapter.

Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Preface

Specific Chapter Updates in the 15th Edition Each chapter has been thoroughly updated reflect current research and practice. Here are the highlights for individual chapters:

Chapter 1: Children and Youth with Exceptionalities and Their Families In Chapter 1, we meet students with exceptionality within the context of their families. We explore child development across the lifecourse and examine the role of families in supporting their child’s success. We discuss importance of cultural competence to building strong family partnerships and look at how school and family relationships were impacted by the COVID pivot to online learning. The challenges of disproportionality of students of color in identification and services are discussed in-depth.

Chapter 2: Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools This chapter examines social and cultural influences on student outcomes within a bioecological focus of human development. The predominant influences from society come from the institutions of government, the courts, and the schools and each of these plays a role in shaping student outcomes. We have added deep discussion of how structural racism and implicit bias can impact students with exceptionalities and their families. We present ways to organize schools around a strength-based approach that moves from “inclusion” to “belonging” across a continuum of supports and services (including Multitiered Supports and Services).

Chapter 3: Early Intervention Supports and Services In Chapter 3, we explore the importance of early intervention supports and services to optimize outcomes for children. We have extended our discussion of family-centered culturally responsive practices to build strong partnerships, specifically with bilingual families. We have expanded our focus on early childhood mental health care and the use of MTSS frameworks to address social and emotional needs of young children and added a discussion of the impacts of early trauma on child development. We have also added a new section on the Division of Early Childhood (CEC) recommended practices.

Chapter 4: Children and Youth with Intellectual Disabilities Chapter 4 has been refocused with a strength-based approach to supports and services and the setting of personally challenging learning objectives for each student. The new AAIDD definition and classifications of support are presented and an in-depth discussion of the role of cultural biases in interpreting “adaptive behaviors” has been added. Instruction sections include all new evidence-based practices and strategies for acquisition, fluency, maintenance and generalization

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xxviii Preface of knowledge and skills. A new discussion of the role of person devices (e.g., cell phones, tablets) as part of assistive technology has been added.

Chapter 5: Children with Autism Spectrum Disorders Chapter 5 opens with a conversation about the changing preferences for terminology within the ADS community… person first or Autism first? The chapter has been refocused around strength-based approaches to supports and services for student’s success. An all-new evidence-based practices section drawing on the National Clearinghouse on Autism has been included and research-based predictors of successful transition to postsecondary experiences have been added.

Chapter 6: Children and Youth with Learning Disabilities Chapter 6 takes a new look at the neurological differences in structure and function of the brains for students identified with learning disabilities. We discuss the appropriate identification of student who are emergent English speakers. In the educational response section, we examine the interrelated relationship between academic and social/behavioral supports to the success of students with LD. Sections on accommodations and modifications; assistive technology; evidencebased practices; and transition services have all been updated.

Chapter 7: Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD) In Chapter 7, we take an updated look at the role of executive function in students with Attention Deficit Hyperactive Disorders (ADHD) and the neurological differences in structure and function of the brain. We look at the patterns of identification across gender, race, and ethnicity and discuss the comorbidities often associated with ADHD. In the educational responses section, we discuss multimodal treatment options to support students.

Chapter 8: Children and Youth with Emotional and Behavior Disorders The strength-based focus of Chapter 8 includes a new look at the bioecological context on human development and the correlated constraints that influence the lifecourse of students with EBD. We discuss the problems inherent in the IDEA definition of EBD and the role implicit biases can play in identification. We have added a discussion of the importance of developing positive self-concept, self-esteem, and self-efficacy within a wrap-around approach to supporting students with EBD.

Chapter 9: Children and Youth with Communication, Language, and Speech Disorders In this chapter, we examine how the strengths and challenges of children can be addressed through collaborative interdisciplinary teaming. Special emphasis is given to the bilingual and bicultural needs of children with language differences and the cultural competence needed to work with their families. Updated sections Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Preface include the use of assistive technologies and augmentative communication systems and the role of siblings as communication partners.

Chapter 10: Children and Youth with Gifts and Talents In this chapter, we explore how gifts are identified and how we can respond to the student’s educational needs. We have added new discussions on the underrepresentation of students from Black, Lantinx, Indigenous, and economically disadvantaged families within gifted education programs. We examine the roles of systemic racism and explicit bias on identification practices and the importance of developing cultural competence to address these issues. We review the use of multiple types and sources of information across multiple time-periods to strengthen identification practices and the need for nurturing programs to support the development of potential.

Chapter 11: Children and Youth Who Are Deaf or Hard of Hearing This chapter opens with a discussion of Deaf cultural and the preference of some members of the Deaf community to drop the “person first” language out of respect for individuals and the “Deafhood.” This ongoing discussion reflects the importance of words and the meaning they carry. The chapter includes an updated section on early intervention and the importance of integrating Deaf adults as part of the support team. We further examine the need for bilingual and bicultural support for students who are deaf or hard of hearing and their families. In the educational response section, we review new methods for teaching reading and the positive data these practices show on student outcomes.

Chapter 12: Children and Youth with Visual Impairments Chapter 12 includes a new section on culturally and linguistically diverse students and their families. We have updated the section on the important role that special schools can play in supporting students with visual impairments, their families, and their teachers. The assistive technology section is updated, and there is a new section on student’s transition to independent living as they learn to “adult.”

Chapter 13: Children and Youth with Physical Disabilities, Health Impairments, and Multiple Disabilities Chapter 13 looks at the importance of full and meaningful inclusion and building communities of belonging. We explore the role of intersectionality looking at gender, ability status, race, language, and socioeconomic levels on identify formation and on how we as teachers perceive our students. We have extended the discussion on student who are Deafblind to address concerns about touch-therapies like hand-over-hand and the need to respect personal bodily control and autonomy for all individuals. We have new section on self-determination, which also addresses personal autonomy. In the educational response section, we have added a new and extensive discussion of Comprehensive Literacy and the importance of reading instruction for all students. The assistive technology and augmentative communications sections have been updated. Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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15th Edition Special Features to Support Student Learning In each chapter of the 15e, we have included pedagogical features that are designed to help students master the course content while enhancing their learning. These learning support features include: Chapter Focus Questions—Each chapter begins with a set of focus questions that alert the reader to what they will be learning about within the chapter. The chapter follows the order of these questions, providing an outline for the chapter content. If students can give thoughtful answers to the focus questions, they are well on their way to understanding children with exceptionalities and their families. Visual Icons (CEC Standards, Brain, MTSS, Super Powers, HLP, Diversity, Content Standards, Mindfulness Matters, Exceptional Lives Exceptional Stories, Ask the Experts, Reaching and Teaching, Moral Dilemmas)—These icons offer a quick visual reference to important content areas that are addressed within each chapter. They alert the reader to the content and act as a visual reminder that this content is part of a larger thread of knowledge addressed throughout the text. TeachSource Video Connections—This feature shares footage from the classroom to place key chapter content within real-life scenarios. Critical-thinking questions help the reader reflect on the content in the video and extend the application of the information presented. Digital Downloads—These are practical tools that students can access online (e.g., figures, tables, boxes, teaching tips, expanded coverage of UDL and MTSS). Downloads can be used as references during classroom discussions, assessments, and lesson planning. They may also form the basis of portfolio artefacts that can support practical application of information during student teaching. Look for the Digital Download label that identifies these items: TeachSource Digital Download Margin Websites—In each chapter, we have selected key websites which offer extended resources for the reader. These are reliable sources of information where readers can pursue additional information on topics of special interest. Key Terms—Words that appear in bold text highlight important vocabulary. These words are defined in the glossary at the back of the book. Chapter Summary—These summaries highlight key concepts addressed within the chapter; helping the reader anchor learning by recapping the major points covered. Relevant Resources—Provided at the end of each chapter these resources can be used to support further learning for readers who wish to pursue an area of interest in more depth.

Ancillaries Supplemental Materials to Aid Teaching and Learning This edition offers an expanded and enhanced package of online support material for students and instructors. Instructor assets include an Instructor’s Manual, PowerPoint® slides, and a test bank powered by Cognero®. These supplemental materials were prepared by Dr. Jennifer Job, who also worked closely on the revision

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Preface of the 15th edition. Her area of expertise is curriculum and instruction, and she was a graduate student with the authors during her PhD studies. Additional instructor assets include an Educator’s Guide. Sign up or sign in at www.cengage.com to search for and access this product and its online resources.

MindTap™: The Personal Learning Experience MindTap for Gallagher/Coleman/Kirk, Educating Exceptional Children, 15e, is a fully customizable online learning platform with interactive content designed to help students learn effectively and prepare them for success in the classroom. Through activities based on real-life teaching situations, MindTap elevates students’ thinking by giving them experiences in applying concepts, practicing skills, and evaluating decisions, guiding them to become reflective educators.

Acknowledgments When Cengage contacted me to discuss the creation of the 15e of Educating Exceptional Children, I knew I faced a critical decision. I joined the author team in 2004 on the 11e and worked closely with my mentor, Dr. James Gallagher, on each ensuing edition. The 15e would be the first revision since his death in 2014. The prospect of taking on the 15e felt overwhelming. How could I take this on by myself… how could I do this alone? Soon after my initial wave of anxiety, I realized that I would not be “alone.” One of the major themes of the 14e had been “it takes a team,” something that both Dr. Gallagher and I firmly believe; very little, of importance, that we accomplish is ever done alone! As this understanding came back to me, I realized that I would not be undertaking the 15e alone… far from it. My gratitude goes out to the following people who have been part of the team that was so instrumental in the creation of the 15e: ●







Dr. James J. Gallagher, for mentoring me for over thirty years and preparing me to carry the work forward. Dr. Jennifer Job, for your careful and insightful support during the preparation of the 15e; your input and effort have made the book better! The content-reviewers who share their wisdom and expertise ● Chapter 4: Michael Wehmeyer, PhD ● Chapter 5: Emily King, PhD ● Chapter 13: Amanda Bock, PhD. My valued colleagues who agreed to serve as experts on topics of critical importance: ● Dr. Cathy Kea, for your patience in building my understanding and for your friendship over many years ● Dr. Kristina Collins, for your strong voice speaking out for social justice ● Dr. Kelly Carrero, for your undaunted enthusiasm and hard work to make the world a better place ● Dr. Kristin Björnsdóttir, for teaching me about high expectations of self and others ● Ms. Tammy Day, for your vision of what is possible for students with ID ● Dr. Jennifer Nietzel, for your dedication to excellence and for your unfailing willingness to contribute when you are needed ● Dr. Susan Boutilier, for working with such kindness and integrity and for being my big sister

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Dr. Emily King, for bring your heart and personal experience to your work and enriching the lives of all you touch Dr. Dennis Cavitt, for your leadership, insights, and hard work to make the world better Dr. Beverly Gerber, for your advocacy in supporting the arts to help all students thrive Dr. Dina Castro, for your courage and wisdom as you work to improve the lives of children and their families Ms. Liz Parrot, for your gentle but strong spirit in the face of all obstacles and for being my childhood and lifelong friend Dr. Tarek Grantham, for always being an upstander for the justice, you are an impeccable role model Dr. Elaine Gale, for your strong voice which ensures that the needs and rights of children who are deaf get heard Dr. David Edyburn, for your passionate commitment to creative ways to support student success through technology and for your friendship over the years Dr. Joy Banks, for the grace you bring to difficult situations and the wisdom you model in the face of adversity

You have my deep appreciation and gratitude! ●





The entire Cengage team—Lauran Whalen, Bianca Fiorio, Sheila Moran, Sibasis Pradhan, Anupam Bose, and Ashley Maynard, for all of their care and attention to this book and for their patience with me. The strong commitment to excellence that this team showed was a joy to see, and the personal support you offered me was very helpful. To the Gallagher Family, and especially to Dr. Shelagh Gallagher (my colleague and friend), for your unfailing encouragement and support as the 15e moved from concept to reality. Finally, to my husband, Dr. Phil Coleman, who has supported me with his complete confidence in my ability to succeed in whatever I choose to undertake; you are the wind in my sails!

It takes a team, and I am grateful beyond measure to this outstanding team. The 15e is better because of each of you! Thank you, Mary Ruth Coleman

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About the Authors

James J. Gallagher, PhD, (late) was a senior scientist emeritus and former director of FPG Child Development Institute, which he had been affiliated with since 1970. Prior to joining FPG, Dr. Gallagher was the first Chief of the Bureau of Education for the Handicapped in the U.S. Office of Education. He oversaw a wide range of new legislation representing the first major thrust by the federal government to help children with disabilities. The bureau was the leader in helping to implement laws that provided funds for research, personnel preparation, technical assistance, regional resource centers, centers for media development, and state grants to help with the education of children with disabilities. He was promoted to Deputy Assistant Secretary for Planning, Research, and Evaluation during the tenure of Commissioner Jim Allen. Dr. Gallagher also served as the assistant director of the Institute for Research on Exceptional Children at the University of Illinois at Champaign-Urbana. Dr. Gallagher has produced over 200 articles in a wide range of professional journals. He has also authored and edited a number of book chapters and books.

Mary Ruth Coleman, PhD, is Senior Scientist Emeritus, at the FPG Child Development Institute at the University of North Carolina at Chapel Hill. She directs Project U-STARS~PLUS (Using Science, Talents, and Abilities to Recognize Students~Promoting Learning in Under-served Students) and was the principal investigator on Project ACCESS (Achievement in Content and Curriculum for Every Student’s Success). She was the coprincipal investigator for the Early Learning Disabilities Initiative sponsored by the Emily Hall Tremaine Foundation. She has served three terms on the board of directors for the Association for the Gifted (TAG), one of which she was president; three terms on the board of the National Association for Gifted Children (NAGC); and two terms on the board of directors for the Council for Exceptional Children (CEC). She was president of the Council in 2007. She has published over 150 articles, chapters, and curriculum materials.

Samuel Kirk, PhD, (late) is the founding author of Educating Exceptional Children. He earned his doctorate in clinical psychology from the University of Michigan in 1935, which led to sixty years of work and research. He developed the term “learning disabilities” in the 1960s, after years of observation during work with teenagers with ID in Chicago and a training school in Ann Arbor. President John Kennedy named him as the director of the Federal Office of Education’s Division of Handicapped Children, and Dr. Kirk was instrumental in convincing the government to provide funding for training teachers to work with students with special needs. He was also the founding director of the Institute for Research on Exceptional Children at the University of Illinois. He ended his career at the University of Arizona.

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Children with Exceptionalities, Their Families, and the Social Forces That Shape Special Education

he purpose of this book is to introduce you to individuals with exceptional educational needs. As an educator, you will meet many students with exceptionalities, and you will play a key role in their success. Whether you plan to teach in general education, teach in special education, or specialize in speech pathology, school psychology, or educational administration, you will be part of a team that works with students and their families. Throughout this book, you will learn how to nurture, recognize, and respond to the strengths and needs of students with exceptionalities and how to support their accomplishments across their lifecourse. The exciting thing is that you will be prepared to make a difference in the lives of many students! In this first section, we take a close look at who children and youth with exceptionalities are. We explore the causes of exceptionality and the importance of families as

partners in their child’s success. We will review the rich history of special education over the past six decades, and we will learn about the social forces that play a significant role in child development and in special education policies and practice. In Chapter 1, we focus on children and youth with exceptionalities, their families, and the social environments that surround them. We will explore the intersectionality of race, ethnicity, economic inequities, and disability for the individual and for society. In Chapter 2, we examine the impact of three major social institutions on children and youth with exceptionalities: the government, the courts, and the schools. What you learn in Chapters 1 and 2 will provide the foundation for understanding the specific strengths and needs of the students with exceptionalities you will meet in the rest of the chapters. We welcome you as you join the team to support students with exceptionalities and their families!

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Children and Youth with Exceptionalities and Their Families

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Standards Addressed in This Chapter The inside book cover list the Council for Exceptional Children 2020 Intitial Practice-Based Professional Development Standards for Special Educators (K-12). Standards 1, 2, 5, 6, and 7 are addressed in this chapter.

Focus Questions 1-1 Who are children and youth with exceptionalities? 1-2 How can the information processing model (IPM) help us understand and support the unique strengths and challenges of individuals with exceptionalities? 1-3 What are some of the major causes of exceptionalities? 1-4 What is significant disproportionality and how does it impact students with exceptionalities? 1-5 In what ways do culture (e.g., race and ethnicity) and socio-economic ­status intersect with the family system and identity formation to influence the ­development of individuals with exceptionalities? 1-6 Why are family-centered approaches so critical for supporting each child’s ­success across their lifecourse?

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t’s not easy being different. We have all felt the sting of not belonging, of not feeling a part of the group. We have all felt overwhelmed when asked to do things beyond our skills and capabilities, and bored when asked to do simple things that do not challenge us. Of course, being different is not all bad—it is also what makes us interesting; each of us has strengths and challenges, and the specific patterns of these make us uniquely who we are. Some differences, however, impact how we learn: how we receive information through our senses; how we express our thoughts, needs, and feelings; and how we process information. Special adaptations in the education program are necessary to support our success when our differences impact how we learn. Everyone needs and deserves an educational environment where their differences are honored and addressed. And as educators, our job is to support individuals with special educational needs across a variety of environments to ensure that being different does not mean being left behind or left out!

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families

1-1  The Child with Exceptionalities: An Overview Who is the child with exceptionalities? If we define a child with exceptionalities as one who differs in some way from a group norm, then many children are exceptional. A child with red hair is “exceptional” if all the other children in the class have black, brown, or blond hair. A child who is a foot taller than their peers is “exceptional.” But these differences, though interesting to a geneticist, are of little concern to the teacher. Educationally speaking, students are not considered “exceptional” unless our typical educational supports and services must be modified to help them be successful. If a child’s exceptionalities mean additional support to read is needed, or if the child is so far ahead that they are bored by what is being taught, or if they are unable to adjust to the social needs of the classroom, then special educational responses become necessary. Our responsibility, as educators, is to match our educational supports and services with the strengths and needs of each child in order to develop their unique capabilities. Individuals with exceptionalities help us better understand human development. Variation is a natural part of humanity and through working with children who have exceptionalities, we learn about the many ways that all children develop and learn. In this way, we develop our teaching skills and strategies to better meet the needs of all students. We also come to understand that while differences make the child unique, the child with exceptionalities is a child first and shares the same basic needs as all children.

1-1a  Educational Areas of Exceptionalities

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A child with disabilities in thirteen different legal categories can be eligible for special education services (see Table 1.1). These categories are outlined in the Individuals with Disabilities Education Improvement Act of 2004, generally known as IDEA, an important piece of federal legislation (discussed in detail in Chapter 2). The definitions in the table are given in technical language, but they are the best descriptors we have for each area of exceptionality. Through case studies and vignettes in the chapters ahead, we will meet students who live with these disabilities. We will also come to see how we can support each child’s success. You may have noted that attention deficit disorder/attention deficit with hyperactivity disorder (ADD/ADHD) is not listed as its own category in special education. It is, however, included under Other Health Impairment; this will be discussed in Chapter 7. You may have also noticed that children with special gifts and talents are not included in Table 1.1. This is because the federal legislation that generated this list, does not address children with special gifts and talents. While there is no federal definition of students with gifts and talents, the National Association for Gifted Children (NAGC) offers the following definition: There are children with exceptionalities in almost every classroom in the country.

Students with gifts and talents perform—or have the capability to perform—at higher levels compared to others of the same age, experience, and environment in one or more

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The Child with Exceptionalities: An Overview

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Table 1.1  Disability Categories under IDEA (2004) Below are definitions of specific disability categories recognized for special education, as well as how many children they affect. These are federal terms and definitions. 1. Autism Incidence: 1.08% 1 in 100 2. Deafness Incidence: 0.17% Less than 2 in 1,000 3. Deaf-Blindness Incidence: less than 1 in 10,000 4. Emotional Disturbance Incidence: 0.52% Less than 1 in 100

A developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child’s educational performance. A hearing impairment so severe that a child is impaired in processing linguistic information through hearing, with or without amplification, that adversely affects a child’s educational performance. A combination of hearing and visual impairments that causes such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness. A condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance: a. An inability to learn that cannot be explained by intellectual, sensory, or health factors. b. An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. c. Inappropriate types of behavior or feelings under normal circumstances. d. A general pervasive mood of unhappiness or depression. e. A tendency to develop physical symptoms or fears associated with personal or school problems. The term includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance.

5. Hearing Impairment Incidence: 0.10% 1 in 1,000 6. Intellectual Disability Incidence: 0.92% About 1 in 100 7. Multiple Disabilities Incidence: 0.19% 2 in 1,000

8. Orthopedic Impairment Incidence: 0.05% 5 in 10,000

9. Other Health Impairment Incidence: 1.62% Less than 2 in 100

An impairment in hearing, whether permanent or fluctuating, that adversely affects a child’s educational performance but is not included under the definition of deafness. Significantly subaverage general intellectual functioning, existing concurrently [at the same time] with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child’s educational performance. Concomitant [simultaneous] impairments (such as intellectual disability– blindness, intellectual disability–orthopedic impairment, etc.), the combination of which causes such severe educational needs that they cannot be accommodated in a special education program solely for one of the impairments. The term does not include Deaf-Blindness. A severe skeletal impairment that adversely affects a child’s educational performance. The term includes impairments caused by a congenital anomaly, impairments caused by disease (e.g., poliomyelitis, bone tuberculosis), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures). Having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment: a. due to chronic or acute health problems such as asthma, attention-deficit disorder or attention-deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and b. adversely affecting a child’s educational performance (Continued)

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families

Table 1.1  Disability Categories under IDEA (2004)  10. Specific Learning Disability Incidence: 3.57% About 1 in 30 11. Speech or Language Impairment Incidence: 1.64% Less than 2 in 100 12. Traumatic Brain Injury Incidence: 0.04% 4 in 10,000

(Continued)

A disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations. A communication disorder such as stuttering, impaired articulation, a language impairment, or a voice impairment that adversely affects a child’s educational performance.

An acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child’s education performance. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.

13. Visual Impairment Including Blindness

An impairment in vision that, even with correction, adversely affects a child’s educational performance. The term includes both partial sight and blindness.

Incidence: 0.04% 4 in 10,000 Source: Individuals with Disabilities Education Improvement Act of 2004, Public Law 108–446, U.S. Department of Education, Washington, D.C.

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domains. They require modification(s) to their educational experience(s) to learn and realize their potential. Students with gifts and talents come from all racial, ethnic, and cultural populations, as well as all economic strata; require sufficient access to appropriate learning opportunities to realize their potential; can have learning and processing disorders that require specialized intervention and accommodation; and need support and guidance to develop socially and emotionally as well as in their areas of talent. (NAGC, 2021) Students with gifts and talents do have special needs (discussed in Chapter 10). They need to escape from boredom with the typical curriculum and be motivated to use their talents to the fullest. Every student has the right to reach their potential; this is the foundational principle of strength-based educational approaches. Educators take identification of students with exceptionalities quite seriously, because this identification leads to the educational supports and services to platform student success. Appropriate identification allows us to match supports and services to the student’s specific strengths and needs. If we know, for example, that a child has a specific learning disability in reading, we know what interventions should be put in place to support that child. There are also economic impacts for appropriate identification. Students who are formally identified as having disabilities (as defined in Table 1.1) can receive support from specialized personnel. These supports and services are provided through funds from the federal, state, and local governments; because of this, identification for special education services is a legal decision with policy and economic implications as well as educational impacts.

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Courtesy of the University of Illinois Archives

The Child with Exceptionalities: An Overview

Dr. Sam Kirk—a key figure in the beginnings and organization of special education, original author of this text, and director of the Institute for Research on Exceptional Children at the University of Illinois, 1948–1966.

1-1b  Interindividual and Intraindividual Differences Children with exceptionalities are different in various ways from other children of the same age. These differences between children are called interindividual ­differences, and they can present educators with many challenges. What sometimes goes unnoticed is that some students also show substantial intraindividual differences as well. Intraindividual differences are variances that occur within a single child, and understanding each child’s unique pattern of strengths and challenges can help us develop individualized approaches to their instruction. For example, Jason, who is 9, has the intelligence of an 11-year-old but the social behavior of a 6-year-old; both exceptionalities need to be addressed. One reason we need an individualized education program (IEP) for each student with exceptionalities is that their intraindividual differences must be addressed as much as their interindividual differences are. The individualized education plan will be discussed in greater detail in Chapter 2 and will also be addressed in each subsequent chapter. The ability to process information is one way to think about each individual’s pattern of strengths and challenges.

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Kristina: Modifications for a Culturally and Linguistically Diverse Student in an Inclusive Elementary Classroom Ms. Lee has 29 students in her class—some with special needs, some gifted, and some from different cultural backgrounds. One of her students is Kristina, a 9-year-old girl from Ukraine who speaks very little English and is behind academically due to education differences in her home country. What challenges does Ms. Lee face while teaching such a diverse classroom? How does she meet Kristina’s needs? Watch online

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families

1-2  Using the Information Processing Model to Understand Students with Exceptionalities The information processing model (IPM) helps us understand both how s­ tudents learn and what can happen to learning when there are problems with processing information (see Figure 1.1). We will use the IPM throughout the text to reflect on the problems students with exceptionalities often encounter with learning and to examine where their strengths with learning can be found.

1-2a  The Information Processing Model The information processing model helps us think about the complexities of how people learn, exploring the various components of learning that can be impacted by an educational exceptionality. Information processing explains how students interact with and respond to the world around them and describes how they learn through this engagement. Understanding how students learn is really important because, as educators, learning is our primary goal! So, what happens when students are learning? First, they receive information from their senses through input (visual, auditory, etc.). Next, they process this information using classification, reasoning, and evaluation (this is often what we mean by “thinking about it”). Processing information also involves memory, where students assign information to either short-term memory or long-term memory to store it for later use. The more deeply students process information, the more likely they are to remember it so they can use it when they need it. Finally, they respond to information through output, or doing something with the information, such as speaking, writing, or using it physically. Students’ output is often how we determine that they have indeed “learned” the information we are teaching. Students are aided in processing information by their executive function, or a decision-making ability. Their executive function allows them to choose what information to focus on (input), which involves attending and

Emotional Context

Stimulus

Vision Hearing Kinesthetic Haptic Gustatory Olfactory

Thinking

Response

Memory Classification Association Reasoning Evaluation

Speaking Writing Motor Response Social Interaction

Processing

Attention

Information Output

Executive Function

Information Input

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◗ Figure 1.1  Information Processing Model TeachSource Digital Download   Access online

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Major Causes of Exceptionalities

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1-3  Major Causes of Exceptionalities Exceptionality may stem from environmental and/or hereditary causes and is most often the result of complex interactions across both. An exploration of the roles of heredity and environment can help us recognize the origins of various kinds of exceptionality. We must understand, however, that in some cases we will not be able to determine the specific reasons a child is born with or later develops exceptionalities. Whether or not we are able to link the child’s exceptionalities to specific causal origins, the most critical thing is that we fully accept each child’s unique expression of who they are, including their exceptionalities.

© Monkey Business Images/Shutterstock.com

working memory, how to interpret this information (processing), and which options to use in response to this information (output) (Center on the Developing Child, 2016). Information processing takes place within an overall emotional context that influences every aspect of the system: input, processing, output, and executive function. The emotional context is critical for learning. When the emotional tone is hostile, or the classroom climate is stressful, then learning becomes more difficult. When students feel anxious, stressed, or fearful, their ability to learn is greatly diminished (Center on the Developing Child, 2016). If a student has met with repeated failures with prior learning, they may experience anticipatory anxiety in new but similar learning situations. Anticipatory anxiety undermines the student’s success with the new learning, and the cycle of failure can become a self-fulfilling prophecy. Using the IPM, we can see not only where the student has difficulties, but also where they have strengths. Some students are very good with visual memory— when they see the information, they “get it”—while others are better with auditory processing and prefer to hear the information. Many students seem to learn best when they interact with information in a concrete way using their kinetic senses or when they use multiple methods for input (seeing, hearing, and doing) simultaneously. Think about how you like to learn novel or complex information, like a new computer software program. How would you like to access information? How would you like to process that information? What would you like to do to show that you had learned the information? Your answers to these questions show you which areas of information processing are your natural strengths. You might also want to reflect on your least favorite ways of learning…these would show you the areas that you may experience difficulties with learning if they are the only way you can access information. Can you also imagine that these difficulties would be compounded if you are stressed, say by a deadline that is really tight? The emotional context for your learning will impact your success! Special education services are often required when a student is unable to process information effectively. The problems of a student may be in the input of information (e.g., visual and auditory); the internal processing of that information (using memory, reasoning, or evaluation); or in the output, responding to the information. The executive function can also be problematic with attending and decision making, and this creates difficulties across the information processing system. The good news is that when we know where the problems with processing are, we can readily determine how to bypass and/or augment the student’s areas of difficulty, using their areas of strength, to support learning! In each of the following chapters, we will present the information processing model and show which elements may be impacted by the exceptionality under discussion as we explore how to help each child meet with success.

Both heredity and environment play a role in shaping each child’s development.

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families

1-3a  The Interaction of Heredity and Environment

Human Genome Project www.genome.gov /human-genome-project

Few topics stimulate more fascination than the question of how we become who and what we are. What forces shape our development and sequentially build a confident and complex adult from an apparently helpless infant? For many decades, we have been aware of the effects that both heredity and environment have on the developing child. Because it is the job of educators to change the environment of the child through instruction, we have often ignored the role of heredity. But recent dramatic progress in the field of genetics makes the influence of heredity impossible to ignore. Historically, we have been through three major stages in our belief systems about the relative influence of heredity and environment, and each stage has had a profound effect on what we do as educators. Up until about 1960, it was strongly believed that heredity alone drove and determined various conditions related to intelligence, such as mild intellectual disability, giftedness, or mental illness. Our beliefs about the potency of heredity led us to conclude that it was more or less impossible to change a child’s trajectory, and so the role of educators was seen as helping individuals adapt as well as possible to their hereditary roll of the dice (Waski & Bryant, 2019). We discuss this trajectory more in Chapter 2. In the 1960s, there began a major movement emphasizing the important role played by environment in human development. This movement recognized that many exceptionalities could actually result from or be intensified by various environmental conditions. Researchers reasoned that mild developmental disabilities could actually be caused by lack of early stimulation, and special gifts and talents might emerge only because the environment for some children was incredibly favorable. Educators were encouraged to try to find ways to reverse unfavorable impacts of environmental effects and to encourage favorable outcomes through education (Ramey, 2019). Around 1990, a similar shift in the view of the relative roles of heredity and environment took place. The emphasis was placed on the progressive interaction between heredity and environment and the resulting effects of those interactions. Indeed, Gottlieb (1997) proposed that by changing the environmental conditions of early childhood, we could activate different patterns of genes, which then would influence behavioral changes. Our growing understanding of genetics seems to be proving him correct! Recent genetic research has made it clear that many conditions that lead to exceptionality are linked to interactions between genes (or our hereditary DNA) and our environment. Conditions such as fragile X syndrome (Bailey, 2021) intellectual and developmental disabilities (IDD), attention-deficit hyperactivity disorder (ADHD), and dyslexia are all seen to have strong genetic components (Wadsworth et al., 2015), yet all can be positively influenced by favorable environments. Some of the most dramatic scientific breakthroughs have been made by the Human Genome Project. The goals of this international project were to determine the complete sequence of the three billion DNA subunits (bases) and to identify all human genes, making them accessible for further biological study (Gilssen et al., 2014). The U.S. Department of Energy and the National Institutes of Health were the U.S. sponsors of this work. The initial goal—identifying the entire human genome—was reached in 2003, and the subsequent research projects based on this work include a number of findings related to children with exceptionalities. As our ability to identify specific genes has increased, we have become interested in gene-environment interaction. We now know that some of the earlier questions we asked were oversimplified (e.g., which gene causes which outcome?), and we have a more sophisticated understanding of the interaction between genes and environmental experiences that influence outcomes. We now understand that: a. Genes do not control behavior directly; b. Almost all behavioral traits emerge from complex interactions between multiple genes and environments; and

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Major Causes of Exceptionalities c. The causes of personality and ability are found across complex neural networks—not in a single location in the brain (with the exception of extreme causes of focal brain lesions) (Munafo & Flint, 2011). When we look at the interaction of genes with environment more closely, we can see that negative environments in combination with high-risk genes are more likely to lead to negative outcomes, while positive environments with low-risk genes most often lead to positive outcomes (see Figure 1.2). Note the red arrow in Figure 1.2; this indicates an intervening variable that changes the expected outcome. Intervening variables may include things like a sympathetic teacher or other adult who plays a supportive role. In short, we cannot say, for example, that an individual gene causes depression or ADD/ADHD, but rather that the complex mix of environmental influences and multiple genes can result in some unfavorable outcomes. Since at this point we can do little about the genes we inherit, we continue to concentrate on intervening within the environment to improve educational and social outcomes for children (Bergin & Bergin, 2019).

1-3b  Prevalence: How Many Children with Exceptionalities Are There? Establishing the prevalence—how many students with exceptionalities there are—may seem at first glance to be fairly easy; one either has the exceptionality (autism or learning disability or emotional disturbance) or one does not. In r­ eality, however, things are not that simple. There is a gradual continuum of strengths and needs within every category of exceptionality, and deciding who along these continuums will receive additional supports and services is not always clear-cut. Qualifications for each area of exceptionality are established by “cut-off points” that have been determined by educational, medical, and psychological professionals charged with identifying children with exceptionalities. The children on either side of this cut-off point, however, are very similar to one another. And students who have just missed the cut-off point for formal identification often still need

– Negative Environment (Stress, insensitive parenting)

+ Positive Environment (Sensitive, high-quality parenting)

– Allele A (High-risk gene)

+ Allele B (Low-risk gene)

– Allele A (High-risk gene)

+ Allele B (Low-risk gene)

– Negative Outcome (ADHD, antisocial, depressed, insecure)

+ Resilient (No negative outcome)

++ Exceptionally Good Outcome

+ Good Outcome

◗ Figure 1.2  Genes and Enviroment Interact to Influance Child Outcomes Source: From FREBERG. Discovering Biological Psychology, 2E.

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families additional support to be successful. We are also aware that there are likely many students with exceptionalities who are never formally identified for services. In spite of these challenges, we must attempt to determine how many students with exceptionalities there are so that we can plan to meet their needs. A reasonable estimate is that 7.1 million children in the United States can be classified across the categories of exceptionality (OSEP, 2021). This estimate is obtained by aggregating the reports from the fifty states. This means that approximately one out of about every ten children is exceptional, using the definitions for areas of disabilities given in Table 1.1. This high number of students is one reason for the extensive attention given to children with exceptionality in our school systems today. As noted above, these figures must be considered as only estimates, because while they reflect all identified students, they do not account for students whose exceptionalities have not been identified. Children with disabilities are not distributed equally across the defined ­categories—far from it! Figure 1.3 gives a breakdown of the six high-incidence categories of disabilities. The term high-incidence ­disabilities includes the categories

Percentage of School Children Specific Learning Disability Speech or Language Impairment Other Health Impairment

High Incidence Disabilities: Percentage of Students 6–21 Served under IDEA

Autism Intellectual Disability Emotional Disturbance 0

1

2

3

4

Deaf-Blindness Traumatic Brain Injury Visual Impairment Including Blindness Low Incidence Disabilities: Percentage of Students age 6–21 Served Under IDEA

Orthopedic Impairment Hearing Impairment Deafness Multiple Disabilities 0

0.05

0.1

0.15

0.2

◗ Figure 1.3  Prevalence of High and Low Incidence Disabilities Source: Data Accountability Center. (2013). Part B child count (2011) [data set]. Retrieved from https://www.ideadata.org/arc_toc13.asp#partbLRE

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Significant Disproportionality Across Children with Exceptionalities

FatCamera/E+/Getty Images

of disability that are most prevalent, composing at least 1 percent of all students within the school population. The prevalence of children in the gifted category is not included here because gifts and talents are not included in the federal legislation from which these figures are derived. We can estimate, however, that around 6 percent of ­students in our schools, or approximately 4.5 million children, will have identified gifts and talents (NCES, 2017). Figure 1.3 represents the number of students who are served by the U.S. Department of Education, drawing on reports from the fifty states (Data Accountability Center, 2013). Remember that these are the numbers of children receiving service—not necessarily all of the children in each specific category. There are likely a number of students with disabilities who are undiagnosed. By far the largest category of exceptionality is that of students with learning disabiliA disability is not always easily observed by teachers ties who make up 3.6 percent of the total school populaor peers. tion. About 1.6 percent of students are found in the Speech/ Language category, while close to 0.6 percent of children are either identified as having an intellectual disorder (ID) or a behavioral and emotional disorder (EBD). The category that has changed the most over the years is ASD. The actual figure as of 2021 is more than 1 percent, an increase of three to four times that was assumed twenty years ago. This increase in students with ASD has received substantial media attention, and it will be discussed in greater detail in Chapter 5. Figure 1.3 also provides estimates of prevalence of low-incidence disabilities. These are categories that make up less than 1 percent of the total school population. While there are fewer numbers of students with these exceptionalities, these students often have the most intense and complex needs. Students with multiple disabilities is the largest of these low-incidence categories at 0.19%. The reason for the small percentage (0.04%) for visual problems is that although many children wear glasses, this figure only includes children with “uncorrected” vision problems that can interfere with learning. The traumatic brain injury category makes up only about one-half of 0.1 percent of all children. Furthermore, while it is a serious condition, deaf-blindness in children is extremely rare (only one in ten thousand). The prevalence numbers for ADD/ADHD have been included in the Other Health Impairment category in the statistical reporting here. The link between ADD/ADHD and learning disabilities and between ADD/ADHD and emotional and behavior disorders is well documented and this makes it difficult to provide definitive numbers for students with ADD/ADHD. Prevalence patterns within each category of disability also differ by student race, ethnicity, and socioeconomic status. Next, we will take a more nuanced look at the disproportionate demographic distribution of students with exceptionalities.

1-4  Significant Disproportionality Across Children with Exceptionalities Significant disproportionality across racial, ethnic, and socio-economic populations continues to be one of the greatest challenges we face in appropriate identification of students with exceptionalities. This disproportionality is seen in the significant overrepresentation of students of color, with the exception of Asian

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families students, within special education as a whole (U.S. Department of Education, 2020). While there are different explications as to why disproportionality exists (Morgan et al., 2018; Morgan et al., 2019) the patterns of special education identification show that students of color (with the exception of Asian Students) are more likely to be identified for special education then White students. Three areas where we find disproportionality are (1) identification for special education, (2) educational placement once identified, and (3) disciplinary actions taken with students (National Center for Learning Disabilities, 2020). These three areas are intricately intertwined and show a disturbing pattern of the disparate impact educational policies and decisions can have for students of color.

1-4a  Disproportionality in Identification for Special Education Some researchers contend that racial disparity in identification of students for special education stem from the impact of poverty, which is often overlaid with race–claiming that it is the child’s poverty, not factors involving their race, that is at the root of the problem. While poverty is arguably an adverse contributing factor in child development (we will discuss this in greater detail later in the chapter), we also have substantial evidence of systemic and individual biases that influence identification, or eligibility, decisions. Looking at patterns of students identified for special education, Grindal and colleagues (2019) showed that while both race and income play a role, income alone does not explain the overrepresentation of children of color. In the three states studied by Grindal (2019), Black students from non-low-income families were almost twice as likely to be identified with intellectual disabilities or emotional disturbances as their White non-low-income peers. These troubling findings should give us pause as we reflect on our important role as educators to support the success of each of our students. Figure 1.4 shows the risk ratios or the likelihood of finding a child of a particular racial or ethnic background in special education programs as compared to the general population. Indigenous students are nearly twice as likely to be placed in special education as the general student population. Black students are 40 ­percent more likely to be identified with a disability when compared with all other ­students. Asian students, however, are 50 percent less likely to be identified for special education (National Center for Educational Statistics, 2020). 1.8

1.7

1.6 1.4

1.4 Risk Ratio

14

1.2 1

1

General Population

0.9

0.8 0.6

0.5

0.4 0.2 0

White

Black

Hispanic

Asian

Indigeonous

◗ Figure 1.4  Risk Ratios for Students Ages 6–21 Served under IDEA within Racial/Ethnic Groups Source: U.S. Department of Education. (2018). 40th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act. Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Significant Disproportionality Across Children with Exceptionalities While Black, Latino, and Indigenous students are over represented in ­special education, as a whole, the problem is more complex than this. Travers and Krezmien (2018) examined the underidentifaction of minority students with Autism Spectrum Disorders (ASD). If minority students with autism are not being identified, this mean that they are not receiving the interventions needed to support their success (this will be discussed again in Chapter 5). The goal of special education identification is to appropriately match students’ strengths and challenges with the supports and services they need to help them thrive. To meet this goal, we must accurately identify the students who need special educational supports.

1-4b  Disparities in Special Education Placement Once a student is formally identified with a disability, they become eligible for special education services. At this point a decision must be made as to how and where these services will be delivered and received. This decision is called ­placement, and legally, as we will see in Chapter 2, we must serve each student in what is called the least restrictive environment (LRE). The LRE is premised on the belief that students with disabilities should be educated in a setting with their nondisabled peers to the greatest extent possible. Disparities exist in placements for special education services, and students of color are more likely to be taught in settings separate from their general education peers. While 68 percent of White students with disabilities spend more than 80 percent of their time in general education classrooms, only 60 percent of Black students and 63 percent of Hispanic students are with their general education peers more than 80 percent of the time (NCES, 2021).

1-4c  Disparate Impact of Disciplinary Measures The third area of concern with significant disproportionality is the disparity impact of disciplinary practices across racial and ethnic groups. Black, Hispanic, and Native students often receive harsher discipline than their White counterparts (NCLD, 2020). Harsher punishments include the greater use of restraints, both physical and mechanical, with students with disabilities (NCLD, 2020). Physical restraints involve the immobilization the students by direct contact with an adult. Mechanical restraints involve the use of any equipment or device that restricts the student’s freedom of movement (this does not include devices used by trained school personnel and prescribed for the student, for example bands that help a child with cerebral palsy maintain a stable posture while seated). Mechanical restraints are used more frequently with Black students with disabilities then with students from other racial groups (NCLD, 2020). These punishments also include higher rates of suspension and expulsion, removing students from the classroom and school settings. Figure 1.5 shows how a large percentage of Black and multi-racial students receiving IDEA services suffer out-of-school suspension, even though these students make up a much smaller proportion of the special education population. These removals not only interrupt the student’s access to educational supports sending them out where they may receive little or no supervision, they also give the student the message that we do not think they belong with us. This message likely undermines the student’s connection with us and sabotages their motivation to continue their education. One likely outcome of this disparity in disciplinary practices is the higher drop-out rate for students of color—77 percent of White students with exceptionality graduated with a high school diploma in 2018, but only 66 percent of Black students and 71 percent of Hispanic students did (NCES, 2021). The impact that these disparities have on the lives of students is profound, and addressing them is the most critical challenge we are facing in special education today.

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families Students with Exceptionalities Reciving Out of School suspensions by Race/Gender 70% 60% 50%

27%

40%

20%

19%

30% 20% 10%

10% 6% 12%

17%

34%

27%

29%

10%

0% WHITE

LATINO

6%

BLACK Boys

MULTI-RACIAL

INDIGENOUS

ASIAN

Girls

◗ Figure 1.5  Students with Exceptionalities Reciving Out of School suspensions by Race/Gender Source: National Education Association. (2007). Truth in labeling: Disproportionality in special education. Author.

1-4d  Significant Disproportionality of Students with Gifts and Talents The very same students who are overrepresented in special education, students from Black, Hispanic, Native, and/or low-income families, are significantly underrepresented within gifted education programs (Rinn, Mun, & Hodges, 2020) while Asian and White students are overrepresented proportionately within gifted education programs (Hodges et al., 2018). Because there is no federal law mandating services for students with gifts and talents, states are left to determine how they will identify and serve these students. This also means that states are not required to report how many students they identify as gifted or what the demographic make-up is for the students they serve as gifted and talented, making it difficult to know the extent of the problem with underrepresentation. In a large study of identification practices, Hodge and colleagues (2018) identified the “risk ratio” for Black, Hispanic, and Native American students being identified for gifted education as 0.34—in other words, if you are a Black, Hispanic, or Native American student, you are about one-third as likely to be identified for gifted education as if you are a White or Asian student. Disproportionate underrepresentation within gifted education services is seen across all states (National Association for Gifted Children & Council of State Directors of Programs for the Gifted, 2018–2019). Figure 1.6 shows the disproportionality of gifted identification. If the representation were fair, then the percentage of students in gifted programs would closely match with the percentage in the population, but they don’t. White students make up 50 percent of the general population but 58 percent of gifted classes, while Black students make up 15 percent of the population but only 10 percent are identified as gifted students. This pattern of underrepresentation within programs for students with gifts and talents is pervasive and pernicious, and the Board of Directors of the National Association for Gifted Children has acknowledged the role of structural and systemic racism as contributing factors to the inequities in identification of students with gifts and talents (NAGC, 2020). While there are no quick fixes for the problem of significant disproportionalities in special and gifted education, one approach to the problem is to support the cultural competence of teachers. Cultural competence is the ability to relate effectively with people of different cultures and socio-economic backgrounds. Cultural competence includes awareness of one’s own cultural perspective, attitudes toward cultural differences, knowledge of different cultural practices and

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Significant Disproportionality Across Children with Exceptionalities

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Dispropotionality of Students Identified as Gifted/Talented by Race/Ethnicity 70 60 50

58.2 50.4

40 30 24.8

20

18

15.5

10

9.9

4.8

0 White

Black

Latino

Percent of population

9.6

3

Asian

3.2

Multi-Racial

1.1

0.8

Indigenous

Percent of gifted served

◗ Figure 1.6  Dispropotionality of Students Identified as Gifted/Talented by Race/Ethnicity Source: Department of Education, 2013–2014 State and National Estimations. Retrieved 2021 from https://ocrdata.ed.gov/estimations/2013-2014.

worldviews, and the development of cross-cultural skills. Developing cultural competence results in an ability to understand, communicate with, and effectively interact with people across cultures. As teachers become more culturally competent, the climate within the classroom and school shifts to better support all of the students with respect and caring. Dr. Cathy Kea shares her advice for developing a culturally competent teacher workforce (see Box 1.1).

Ask the Experts:

Fostering Family Engagement by Becoming a Culturally Competent Teacher

Dr. Cathy Kea

Box 1.1

Dr. Cathy Kea, Professor of Special Education at North Carolina A&T State University In today’s world, it is critical that our teachers become culturally competent so that they can connect in

meaningful ways with the diverse children and families they serve. Cultural competence is built on a foundation of knowledge and understanding, becoming comfortable with the unfamiliar, developing respect for the experiences of others, and being open to learning from them. In many ways, developing cultural competence requires the mindset of a researcher gathering information and looking for points of connection. And as with all research, the journey begins with genuine curiosity and lots of questions. As teachers, our first step on our journey toward cultural competence is to learn more about the community of our students. What is the focus of the community? Where do families live, play, eat, gather? What resources are available in the community? Are there parks, libraries, hospitals? Creating a profile of your students’ community will help you get to know and value their lives outside of school. Once we know our students’ communities, we need to get to know their families. How do our students’ parents feel about school? Do they readily accept invitations to participate in school activities, or

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families

Box 1.1

Ask the Experts:

Fostering Family Engagement by Becoming a Culturally Competent Teacher (Continued)

do they need more individual encouragement? What were their school related experiences and what do they expect/want for their child? What strengths do our families have that can enrich our school community? What are the family’s beliefs about disabilities, and what are their expectations for their child? Are there any points of “cultural conflict” between home and school expectations (e.g., disciplinary styles, interpretations of student behaviors, academic expectations for the student)? As we learn more about our students’ families, we build bridges of trust that help us connect and these can lead to meaningful family engagement. We also have to get to know our students. We need to know their name, their face, and their story. What is each student’s cultural background? What are their interests? How can you make sure that each student feels welcome and respected in your classroom? Examine your expectations for your students—are you setting the bar too low? In what ways can you become a “warm demander” asking your students to work hard to reach challenging goals? In what ways can you become more flexible as you support your students in reaching these challenging goals? Remember that as a teacher, it is your job to create a respectful classroom climate that honors cultural differences. You can do this through validating your students and their communities, affirming each student to build

TeachSource Digital Download

self-confidence, supporting each student’s sense of responsibility, empowering each student with highexpectations, and providing instruction that is both differentiated and culturally responsive. Finally, our cultural competence is reflected in our ability to create culturally responsive learning environments. Culturally responsive curriculum and pedagogy honors our students and their families. The curriculum we select reflects the cultural backgrounds of our students but also introduces them to other cultures. We design our learning activities to be inclusive and reflect different points of view. We present student-generated products and work to showcase their accomplishments. Our classroom is colorful, inviting, and respectful. We invite families to partner with us in ensuring their child is successful, and we create a welcoming classroom where students and families feel valued. Developing cultural competence is a life-long journey, and I invite you to join me on this exciting expedition!

Reflections: ●



What are the benefits of building strong relation­ ships with your students’ families? In what ways will building your own cultural competence help you establish meaningful relationships with your students and their families?

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1-5  The Systems of Influence for Exceptional Children and Their Families Each individual, with or without exceptionalities, is part of a larger system of dynamic forces that help to shape who they are and who they become. Bronfenbrenner’s bio-ecological model (2005) conceptualized this “system” as a series of circles of influence, moving from proximal (e.g., in immediate contact) to distal (e.g., more distant factors). This system exists within a given historical timeframe that establishes the chronological context for understanding the influences across the system. We have represented this model by showing the ­individuals and contexts that play a significant role in the child’s development and in the provision of support to the child’s families (see Figure 1.7). At the center of these circles of influence is the child. The closest, or most proximal, influence is the child’s family and the neighborhood in which the family lives. The child’s school is the next significant influencer. This level of influence includes all of the direct services provided to support the child and family. The child’s peers also play a role in shaping and influencing development, and this

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The Systems of Influence for Exceptional Children and Their Families

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Peers Family Child

Culture and Community

School

◗ Figure 1.7  Embedding Learning Goals within Class Activities

role increases throughout the lifecourse of the individual. The outer most circle of influence, in our representation, is the culture and community of the child. At this outer, or most distal level, we find policies and laws as well as societal customs and culturally contextual beliefs and values. Bronfenbrenner saw the influences across this system as dynamic and multi-directional; just as the family impacts the child, the child also impacts the family. The school and teacher have an influence on the child, but the child and family also help to shape the classroom and school. The cultural context of the community plays a role in how the family is supported, and the family can also influence the community. The chorological time plays a role in shaping the community where the child and family lives. Let’s look at these circles of influence more closely to explore their impact on the child and family.

The family is the first and most powerful influencer across the child’s lifecourse. Family members are the child’s first teachers and have the deepest and most vested interest in the child’s success. Once upon a time, the word family evoked an image of a mother, a father, and two or more children. Today’s families, however, are more varied. Families may be headed by same sex parents, grandparents, or single parents. They may be blended, adopted, or foster families. In fact, the National Institute of Mental Health defines “family” as “a network of mutual commitment” (2010). The most important feature of “family” is the sustained interest they have in each other’s well-being. Families are unique and complex. Each family has its own perspectives, but families that share cultural orientations often have similar values and beliefs. These values and beliefs influence child-rearing practices. Culture refers to the attitudes, values, customs, and languages that family and friends transmit to children. These attitudes, values, customs, and languages have been passed down from generations of ancestors and have formed an identifiable pattern or heritage. The child is embedded in the family, its habits, and its traditions; this is as true for the child with special needs as for other children. Although the child may be only slightly aware of these cultural influences, it makes a world of difference to the child’s

Jarenwicklund/iStock/Getty Images

1-5a  Intersectionality of Culture, Race, Ethnicity, Poverty, and Ability Status on the Child and Family

Siblings have a life-long relationship and they play a critical role in the family.

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families

Poverty Estimates, Trends, and Analysis https://aspe .hhs.gov/poverty-estimates -trends-and-analysis

experiences if their family is fourth-generation American or first-generation Irish, Mexican, Italian, Nigerian, or Taiwanese. Families’ religious beliefs, child-rearing practices, and attitudes toward a ­ uthority can often be traced to their cultural identity; school personnel need to understand and honor this in order to form positive relationships with the families. Children from different cultural backgrounds may encounter conflicting expectations and values in the home and in the school. We can easily assume that the differences between school and family are due to family idiosyncrasies, when in fact they often reflect the long history of the family within the cultural background of parents and grandparents. As Dr. Kea points out in the “Ask the Experts,” teachers can help children by becoming aware of the wide range of norms represented in their classrooms and communities. When values fostered by the school, such as competitiveness or working independently with a minimum of talking, conflict with a cultural preference for cooperation and for sharing ideas, tensions may arise between family and school expectations. Building a deeper understanding of the family’s culture is part of developing the cultural competence needed to build trust and resolve cultural conflicts if they emerge. In order to be more culturally aware, we often must become more self-aware (Pang, 2018). As teachers, we need to be aware of the factors shaping our own cultural views and values. This awareness builds an understanding that personal cultural beliefs and traditions that work well for us may not necessarily work for others. The child’s cultural context and the family’s beliefs and values must be honored, and this starts with identifying the strengths of the culture and family. Many families exist at or near the poverty line, a circumstance that makes expensive care for children with special needs extremely difficult, and single-heads-ofhousehold families are even more likely to live in poverty. Poverty has been linked with other factors that have a detrimental impact on child well-being. The adverse factors linked to poverty include divorce or separation of parents, parental death, witnessing adult and or neighborhood violence, family members serving time in jail, living with someone who has an alcohol or drug problem, and being treated or judged unfairly due to race or ethnicity (NCLD, 2020). Poverty may also mean that during the early developmental period when children need special help, they are less likely to receive it. The establishment of prekindergarten programs in public schools allows children with special needs to be identified at age 3 or 4 and to receive important care earlier (Haskins, 2019). A wide variety of child-care options have been established to try to meet the needs of young children. Evidence shows, however, that all too often the quality of early child care in the United States is not high enough (America’s Child Care Deserts, 2018). The result of uneven care for young children is that too many children enter kindergarten unprepared for school and at risk for increased school failure (Goldstein, McCoach, & Yu, 2017). An investment in early childhood education and support for families of young children may be one of our society’s greatest policy needs (Barnett, 2019). As we think about the circles of influence ­(Figure 1.7), we can see the intersectionality of culture, race, poverty, and ability status on the child and the family. Whatever the immediate problems the family and the exceptional child may have, they also have many strengths. A family’s ability to make the child feel loved and accepted; their willingness to seek support from friends, extended f­amily members, and counselors; or a reliance on strong religious faith are some of the strengths that should be respected as a foundation for building a support system for the child (Turnbull, 2019). Every family has assets, and these strengths form the core of each family’s ability to support their child’s success. The impact of environmental forces varies as the child grows: initially the ­family is predominant in caring for the child and acts as a link between the child and the larger environment (see Figure 1.7). The support of the family continues to be important but is joined by other factors as the child enters school. These factors will be discussed in Chapter 2.

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The Systems of Influence for Exceptional Children and Their Families

Box 1.2

Exceptional Lives • Exceptional Stories:

A Day in the Life of Roger’s Family

While there is no “typical” day for Roger’s family, today seems like a good one to show what things are like. It is Monday morning, and the week is just getting started! Roger is a five-year-old boy with cerebral palsy and developmental delays. Roger’s father and mother’s alarm goes off at 6:00 a.m., but Roger’s younger sister, Anna who is three years old is already up and playing. Roger’s mother, Susan, is setting out breakfast and beginning to think about her own workday as a teacher at a local school. Roger’s father, Dan, gets him washed and dressed, a task that is difficult because of Roger’s physical challenges, and down to the breakfast table. He then begins to get ready for his day at the construction company where he works. Roger attends a developmental pre-K program at his mother’s school, so he rides to school with her each day. His sister goes to a child-care center that is only a few blocks from their home, and she usually rides with her dad. Breakfast is a chaotic affair with no one sitting down at the same time. Susan gives Roger extra help eating because he has difficulty directing the spoon full of cereal and milk to his mouth. Susan puts the breakfast dishes in the dishwasher and remembers to take a container of her special homemade spaghetti sauce out of the freezer for dinner. Dad heads off with Anna while Mom helps Roger gather his bookbag so they can also head off as well.

In the late afternoon and evening, the same procedure is reversed. This time Mom picks up Anna because Dad is at a construction site on the other side of town. She is running late because she has been delayed by Roger’s teacher, who describes an incident involving a conflict with another child over possession of a toy. Roger’s mom is secretly delighted that he is asserting himself and trying to get what he needs, but she sympathizes with his teacher and the need for peace in the classroom. Sometimes she feels pulled between being Roger’s mom and being another teacher in his school. When she gets home there is still dinner to prepare, baths to be given, and stories to read before the Anna and Roger are tucked in. Is it any wonder that the parents are exhausted at the end of the day? Tomorrow will be even more challenging, because Roger has a medical check-up in addition to the normal daily activities, and the parents haven’t decided how they will get him to the doctor.

Reflections: ●



In what ways does Roger’s disability impact his family’s daily routine? What strategies do his parents use to manage their family’s needs?

1-5b  Family Response to a Child with a Disability The influences that impact relationships are bidirectional, and the presence of a child with disabilities will have a multifaceted impact on parents and family members (Dieleman et al., 2021). The context of the family, as noted earlier, also plays a role in the support they are able to provide. Parents of a child with disabilities may experience greater stress, reduced opportunities to pursue personal interests, less time to spend with friends, more financial worries, concerns about health of their child, and additional daily care that can wear down their energy (Dieleman, 2021). Box 1.2 shows the typical stresses and pressures on a family in caring for a child with cerebral palsy. The response of parents to hearing that they have a child with disabilities is remarkably varied and personal. The family response is critical because it may well determine the success of intervention and school programming for the exceptional child. In the family that is attentive and optimistic, the child can respond positively to educational stimulation. If parents cannot accept their child’s learning or developmental challenges, the child may not receive important early interventions that are critical for their future success (Lalvani, 2015). Parent identity, or how parents see themselves and their role, is thought to be relatively stable;

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families however, these self-perceptions may change in response to key events across the lifecourse of the family (Dieleman et al., 2021). Significant events might include the birth of a sibling or a change in marital, health, or work status. These changes will have a profound influence on all family members, including the child with disabilities.

1-5c  Supporting the Family across the Lifecourse of the Child As the child grows older, the peer group becomes a major force. Adolescence, with its focus on social development and career orientation, is a special challenge for the child with exceptionalities. Potential rejection or bullying by the peer group can have a powerful influence on the adaptation of the child with disabilities or the child with special talents (as it can on any vulnerable and self-conscious adolescent). Planning assistance for the post-school period is required, by law, once the student reaches the age of 16 to ensure a smooth transition from school to work or to other post-secondary opportunities. Transition planning is critical so that students with exceptionalities can move smoothly into young adulthood. Society, which includes the culture and community along with the work environment, impacts the student who is making the transition to adulthood. Throughout their lives, many adults with exceptionalities will be in contact with a support system that includes advocates, educators, friends, and service providers. In addition, representatives of the larger society (such as government leaders) often make rules that determine whether the exceptional person receives needed resources and supports to succeed. We can reflect on one family’s experience across the lifecourse of their son, Marcus, who is on the autism spectrum. Table 1.2 shares Marcus’s progress across developmental milestones and shares his family’s journey as they work to support him. Marcus is the first child of his parents, Magda and Juan, and they do not really know what to expect in terms of his development. As you look at Table 1.2, you can see that there are early indicators that Marcus’s development may be atypical, and these indicators are identified by his pediatrician Dr. Shah, when he is three and a half. His family has accepted him for who he is, not questioning his quiet nature. His parents are warm and loving. How do you think this helps with Marcus’s development? What impact do you think the bilingual home has on Marcus’s development of language? When Marcus is six years old, his little sister Maria is born. How does this change the family structure, and how does this impact Marcus? As Marcus moves into adolescence, how does his family support his interests? The family is central throughout a child’s development. Earlier in this chapter we discussed the roles of heredity and environment and looked at the positive impact that parents who are sensitive to their child’s needs can have on child outcomes. Thinking about Marcus’s family, what are some of the interactions between heredity and environment that contribute to his success? How has his environment impacted his outcomes? When a child is first diagnosed as having a serious disability, most parents feel shock and then denial, guilt, anger, and sadness before they finally reach acceptance. A few parents react with severe depression. Support groups composed of parents of children with similar disabilities can be quite effective in helping new parents by sharing ways in which they have faced similar challenges in their own families. A crisis that many parents of a child with exceptionalities face is the problem of providing daily care for the child. A child who has cerebral palsy or one who is hyper-sensitive may be difficult to feed, dress, and, or soothe. It is the continual, day-to-day responsibilities and care that often exhaust families. The realization

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The Systems of Influence for Exceptional Children and Their Families

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Table 1.2  Marcus’s Development and His Family Lifecourse Phases Neonatal

Typical Milestones

Marcus’s Milestones

+ Gestation period 37 weeks

+ Gestation estimated 35 weeks

+ Last three months rapid growth and development

+ Appropriate fetal growth and development

+ Birth weight 5.5–10 pounds

+ APGAR scores within average range

+Birth weight 6.4 pounds

+ APGAR scores average

+ Enjoys being held

+Does not make eye contact

+Sooths easily

+ Resists being held closely

Birth–Age 2 +Makes eye contact

+ Recognizes mother’s voice +Vocabulary develops with a few key words + Increased interest in social play +Begins to imitate others

+ Is hard to calm down once agitated (loud sounds) + Has a few words in both Spanish and English, but he does not talk very much

+ Standing and walking

+ Shows little interest in social engagement and prefers to play with inanimate toys

+ Identifies basic emotions (happy, sad, angry, afraid)

+ Does not seem distressed when mom leaves him at childcare

Marcus’s Family Concerns This is Magda and Juan’s first child. Juan works with a landscaping company and Magda is a head cashier at Walmart. Both are excited to have a child. Magda does not smoke or drink. Magda speaks English well, but Juan’s English is more limited, so Spanish is often used within the family.

Magda has seen her family doctor for monthly visits starting at her fifth month. Things seem to be going well and the plan is a natural delivery.

Marcus is their first child and so Magda and Juan do not really know what to expect. They love him for who he is and feel like he is just sort of shy and quiet. They do wonder if this may be because both Spanish and English are used in the family.

Magda only has two weeks’ maternity leave, so Marcus attends a small child-care center run by a neighbor. There are five other children ranging in age from a few months to four years old. Marcus is the youngest student. His child-care provider does not seem worried and says that all kids develop at their own pace. Spanish is the primary language used during child-care, but English is also used.

They have noticed that he seems to startle when there are loud noises, and he became really distressed when a fire alarm went off in the grocery store.

+ Does not imitate facial expressions Age 3–5

+ Increased vocabulary and use of language + Seeks out others to play with +Enjoys imaginative play + Masters basic preliteracy and numeracy skills + Can identify additional emotions (embarrassment, pride, shame, guilt) + Can count to 100 + Loves to listen to stories and can “read” the most familiar ones + Colors/paints pictures of family and pets

+ Vocabulary is still limited to a few words and seems to have regressed + Often repeats what others have said to him + Continues to avoid social and imaginative play + Becomes easily frustrated when he does not get what he wants + Counts to 150 by rote in a singsong voice, and often begins counting to “calm” himself + With a lot of support, is learning to recognize basic emotions (happy, sad, angry, afraid) + Is learning to use words to ask for things

Systems of Support

Juan and Magda are puzzled—they do not want to think of Marcus as delayed. They are worried. Should they take him out of his current care where he seems content and they know his caregiver? They decide that helping Marcus is the most important thing and they enroll him in the district’s pre-K program. The state also begins a series of home visits, which initially feel very invasive to Magda. Soon, however, she and the home-vising teacher become “friends” and the visits are a normal part of the family’s routine.

The birth is unremarkable and Marcus goes home with Magda and Juan on time.

Marcus was taken to the emergency room with a fever and ear infection. He then went to see a pediatrician for a wellness check. Dr. Shah was concerned. Marcus was nearly nonverbal, and his motor skills were delayed. She recommends he attend the public pre-K program as he qualifies for services for “developmental delays.” There is also a parent support program with home visits. She connects the family with the state’s Child Find Program to get things started. (Continued)

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families

Table 1.2  Marcus’s Development and His Family  (Continued) Age 6–12

+ Vocabulary of about 10,000 words by first grade, and it continues to grow + Ability to “dissemble” increases dramatically

+ Has developed a strong interest in how machines work (has taken apart the lawnmower at home)

+ Ability to identify a range of emotions continues to grow

+ Will talk extensively about machines and his baby sister

+ Understands verbal humor, word plays, and puns

+ See things as “black” or “white” or “right” or “wrong” with no middle ground

+ Can delay gratification for longer + Better understanding of what motivates others + Develops a more nuanced understanding of “right” and “wrong”

Age 13–19

+ Vocabulary in both English and Spanish continues to grow

+ Wants things to be predictable and becomes distressed when they change + Takes verbal interactions literally and does not understand most humor + Perseverates on tasks once engaged

+ Engages in reciprocal conversations

+ Cannot lie or dissemble

+ Puberty culminates

+ Puberty is on target

+ Level of abstract understanding increases

+ Thinking is still very literal with limited understanding of sarcasm, irony, and cynicism

+ Very aware of peers and can be easily embarrassed + Begins long-term planning and goal setting

+ Seems unaware of peer judgments and does not seem to care what others think

+ Growing interest and engagement with friends

+ Is puzzled by illogical behavior (saying one thing and doing another)

+ May question rules and authority roles

+ Follows rules to the letter

A second child, Maria, is born! Magda and Juan worry that she may have some of the same difficulties as Marcus, and they are also concerned as to how Marcus will respond to his new sibling. Marcus immediately takes to Maria—he is fascinated by her and wants to help. When she cries, he does become upset and asks his parents to please make her stop. School is going alright, but Marcus has only one friend and this is a younger child from his neighborhood. His parents are concerned about this. The family has learned to keep the schedule as consistent as possible to help Marcus. As Marcus has grown, he has started helping his father on Saturdays. With clear and specific directions, Marcus is really good at doing his job. He is very protective of his younger sister, Maria, and worries when she is out of sight (e.g., riding her bike to a neighbor’s). He is still pretty much a loner at school but does not seem to mind. Marcus want to be a mechanic, and so his dad has asked a family friend to let Marcus help him at his auto repair shop.

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The school has decided to place Marcus in the developmental kindergarten where he will get additional support and time. After two years, Marcus begins first grade. A team has determined that Marcus is on the autism spectrum and an Individual Education Plan (IEP) is developed for him. His parents partner with the school to support him. Marcus continues to be included within the general education classroom, receiving additional support from the special education co-teacher.

His teachers feel that Marcus is on target for graduation. He is taking basic education classes and has the support of the special education teacher. He goes to the resource room to take his tests and to get help with homework. The IEP team is working with him and his family to develop a transition plan to help him be ready when he graduates. This plan has begun to focus on auto mechanics, as this is Marcus’s goal for the future.

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Family-Professional Relationships and Family-Centered Approaches

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Families play a critical role in supporting their child’s development.

that their child may not go through a normal developmental process and may never gain independence as an adult also causes parents to worry about their child’s future. These ever-present worries have appropriately been called “chronic grief.” While the most intense experience of “grieving” may be at the time of diagnosis, parents experience recurring grief across their child’s lifecourse as they and their child navigate each new set of expectations. Parents and family members need the support and empathic professionals. There are many stresses in the lives of families who have children with disabilities, but their lives also can be filled with joy, laughter, and fun. Children can light up parents’ hearts with a smile, and parents of children with disabilities, just like other parents, have their favorite stories of their child’s adventures and antics. As a parent, your child is always your child first, and their exceptionality comes second.

1-6  Family-Professional Relationships and Family-Centered Approaches Over the past few decades, the relationship between professionals and families in the field of exceptional children has been changing. Recently, with the COVID-19 pandemic and many schools’ overnight pivot to virtual learning, the relationships between teachers and parents underwent some dramatic changes. Parents became teachers, and teachers worked to provide support for parents who were juggling work, home life, and sheltering-in-place requirements. In some cases, the shift to online learning led to a greater admiration of teachers by parents—and a reciprocal increase in teachers’ appreciation of parental support. It also led to mutual frustrations as the adults worked to navigate new ways of interacting with each other while trying to ensure that students’ needs were met. The COVID-19 pandemic also created a seismic shift across society revealing deep divides across economic strata, with the haves and the have-nots, and exacerbating already existing tensions around race and social justice. We are still learning what the long-term impacts of this will be on education. For now, we know

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families

High-Leverage Practices for Students with Disabilities https:// highleveragepractices.org/

that we have a new respect of teachers and the importance of schools; we hope that this appreciation will be sustained. Throughout the subsequent chapters, we will explore the lessons learned and discuss how education has been changed by the pandemic. Historically, the professional’s role was to explain the special needs of the child to the parents and give them directions and training for the proper care and treatment of the child. The mother was the traditional contact, and other family members played a lesser role. Today all family members are encouraged to play a significant role in the life of the child with disabilities, and supports are provided to help families meet the needs of their child. Collaboration with families has been identified as a high-leverage practice (HLP) in special education by the Council for Exceptional Children (CEC) and the Collaboration for Effective, Educator, Development, Accountability, and Reform (CEEDAR) Center. A high-leverage practice is one that has shown to be effective in improving outcomes for students with disabilities. High-leverage practices must also be applicable and important to the everyday work of teachers (CEC & CEEDAR, 2017). Twenty-two high-leverage practices for special education have been identified. All twenty-two of the HLPs for special education are listed in the back of this textbook and they can also be found on the CEC website. Each chapter in this book will feature the HLPs that are most relevant to the topics addressed within the chapter. High-leverage practice number 3, shared in Box 1.3, stresses the importance of collaborating with families. The highest levels of collaboration occur when professionals work in partnership with families, and when interventions are centered on the families’ identified needs. Turnbull and Turnbull (2002) describe the family-centered approach in this way: First, the family-centered model primarily attempted to honor family choice by changing the power relationship between professionals and families. Second, the family-centered model abandoned a pathology orientation and adopted a strengths orientation. Third, the entire family has become the unit of support—not just the child with a disability and the child’s mother. (p. 92) These three principles center the relationship between the family and professional on family needs, motivating special educators to look for the strengths in the child and family rather than focusing on deficits. The purpose of this family-focused (or family-centered) approach is to help parents become confident in their abilities

Box 1.3

High Leverage Practices:

High Leverage Practice 3: Collaborate with Families to Support Student Learning and Secure Needed Services.

Teachers collaborate with families about individual children’s goals, programs, and progress over time and ensure families are informed about their rights. Teachers prepare for their interactions with parents and/or guardians to develop and nurture strong positive relationships through communication, pro­ fessional competence, respect, commitment, equality, advocacy, and trust.

See the High-Leverage Practices in Special Edu­ cation website.

Reflection: ●

How could you use the advice given by Dr. Kea in the ask the experts section of this chapter to prepare for a parent-teacher meeting?

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Family-Professional Relationships and Family-Centered Approaches to meet the needs of their child and to ensure that professionals are incorporating the family’s perspective in working with each child. Because the family’s cultural values play a crucial role in shaping the child’s world, it is critical that these values are understood and honored by professionals working with the child and family. Identifying the family’s core values will take time and building trust (see earlier discussion in this chapter). Issues of core values may not be easy to discuss, but they can rest at the heart of parental concerns over time, and it starts with listening to the family. Box 1.4 shares one approach, mindful listening, to help build better understanding of parents’ concerns. The change from an almost exclusive emphasis on the child to an emphasis on the family, including the siblings and extended family members, means that professionals need a new set of skills. Teachers, psychologists, occupational therapists, and other professionals must work as a team with family members included as equal partners. The family-focused approach is essential to fully supporting the success of the child.

Box 1.4

Mindfulness Matters:

Mindful Listening

What is mindfulness? While there are many defini­tions of “mindfulness,” the core of being mindful is remaining calm and open in the present moment. The ability to bring non-judgmental awareness to our internal thoughts, feelings, and sensations, as well as to our external environment, takes practice. Why This Matters: Our busy lives are filled with distractions that scatter our focus. It is difficult to be at our best when we are distracted. Being completely present in each moment allows us to fully engage in the task at hand, and this supports our success. Practicing Mindfulness: Listening to others gives us a chance to practice mindfulness. When we listen mindfully, we attend to words, emotional tone, and body language in order to better understand what is being communicated. We focus on what is being said and on what it means. Mindful, or active, listening is really important when communicating with our students’ parents. Parents may feel worried about their child’s success; they may not trust that we see their child’s strengths; they may feel daunted by our use of jargon or overwhelmed by the mere presence of school personnel. Sometimes the emotional tone or intensity of the parent’s voice does not match the actual words being said. When this mismatch occurs, pay close attention to the feeling-tone to better understand the parent’s meaning! Strategies for Mindful Listening: 1. Remove obvious distractions (e.g., your cell phone) and minimize interruptions. 2. Make sure that the room and furniture are inviting and comfortable.

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3. When parents are speaking pay attention…try not to interrupt. Make notes if this helps you focus. When you write things down it reinforces to the parent that you value what they are saying and that you intend to remember it. 4. Restate, or paraphrase, what you think you heard and check to see if you “got it.” For example, “What I am hearing you say is that your main concern is that Treyvon does not seem to have made any friends in his new class. Did I understand you correctly?” Listen carefully to their response, and if it is different from your understanding, check in again. For example, “So your concerns go beyond friendships. You are worried because Treyvon is being picked on and bullied by two of his classmates…” 5. Ask questions to clarify your understanding and explore the parent’s expectations. For example, “What has Treyvon told you about this? What advice have you given Treyvon about dealing with this?” 6. Work to reach a conclusion that addresses concrete next steps with specific actions that everyone agrees to take. For example, “I will talk with Treyvon to find out where and when this is happening. We will work with his classmates to make sure that this behavior is stopped. Will you also talk with Treyvon to assure him that we are working to make sure that things change? And will you keep us posted on this?” 7. Follow-up with communications about what is being done. When we listen mindfully to our students’ parents, we will learn a lot and we are building a foundation of trust!

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families Years of experience and study have led to the following conclusions that ­support the family-centered approach: 1. Children and families are inextricably intertwined. Intentional or not, ­intervention with children almost invariably influences families; likewise, intervention and support with families almost invariably influence children. 2. Involving and supporting families is likely to be a more powerful intervention than one that focuses exclusively on the children. 3. Family members should be able to choose their level of involvement in ­program planning, decision making, and service delivery. 4. Professionals should attend to family priorities for goals and services, even when those priorities differ substantially from professional priorities (Turnbull & Turnbull, 2004). While professionals have gotten better at partnering with parents, siblings have unfortunately often been left out of the “family” centered approaches in spite of their critical life-long relationship with their brother or sister with disabilities (Sibling Support Project, 2021).

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1-6a  Supporting Siblings of Children with Exceptionalities

Siblings relationships are important within all families.

We now know enough about the family environment to dismiss the proposition that two children have the same experience when they are growing up merely because they live in the same household. The home environment is not experienced the same way by a child with disabilities as it is for their nondisabled sibling(s), or by an older daughter as it is by a younger son. Each family member has their own perspectives, roles, and relationships within the family and each experiences their family in their own unique way. The siblings of a child with disabilities will likely have a complex and evolving set of experiences within the family. Assumptions are often made that siblings in families with a child with a disability are inevitably neglected because the parents must pay so much attention to the child with disabilities. Following this assumption, we may conclude that siblings become resentful of the child with disabilities. But as with many assumptions, this one does not hold up under closer scrutiny. It is now clear that although sibling resentments may happen, this is not a foregone conclusion. When parents are sensitive to natural sibling rivalry and work to balance the needs of each child, siblings usually do well (Siblings Support Project, 2021). Siblings may be responsible for a greater amount of household tasks and may have additional child-care responsibilities, but as in other family situations, it is not so much the actions of the parents that count but how the sibling interprets these actions. If the sibling is sure of being loved and cared for by the parent, then being given additional responsibilities for the child with disabilities does not seem to cause a negative reaction (Siblings Support Project, 2021). Although each situation is different, there does not seem to be any evidence that the siblings of children with disabilities are more stressed or face greater adjustment problems than siblings of children without disabilities. Answering siblings’ questions with honest, compassionate information helps them understand that their brother or sister’s needs are an important part of the parents’ responsibilities. The questions in Box 1.5 are examples of concerns a sibling may have but may feel uncomfortable sharing. The fact that siblings may not verbalize fears and questions does not mean that they are not thinking about them. It is the parents’ responsibility to try to answer even unverbalized questions and anxieties that the brother or sister may have about the sibling with disabilities and the family.

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Family-Professional Relationships and Family-Centered Approaches

Box 1.5 ● ● ●

● ●

Concerns of Siblings of a Child with Disabilities

Why does my brother behave so strangely? Will my sister grow out of this? Will other brothers and sisters also have disabilities (can I catch it)? Will my brother ever be able to live on his own? Will I be expected to take care of my sister as an adult?

● ● ●



Am I loved as much as my brother? How can I tell my best friends about my sister? What am I supposed to do when other children tease my brother? Will my own children be more likely to have a disability?

The number of questions that siblings have does not diminish over time. The concerns evident in the questions will reflect developmental changes. For example, an illness or the death of one of the parents may heighten the siblings’ concern about their own responsibilities. If the parents are gone or are no longer able to care for the child with disabilities, will they be expected to share in the care of their sibling throughout their lifetime? Each family has to answer these questions in its own way, but the answers must be clear and unambiguous for all family members. You may want to think about the kinds of questions you would have if your brother or sister had a disability. A resource available to siblings of exceptional children is Sibshops, which are designed as workshops for siblings of children with special needs (Sibling Support Project, 2021). These Sibshops have been conducted in over 230 communities and eight countries, an indication of their popularity and usefulness. Originally designed by Don Meyer for children ages 8 to 13 who have siblings with special needs, these workshops are presented as having goals such as learning “how others handle situations commonly experienced by siblings with special needs” (Sibling Support Project, 2021). These Sibshops are commonly facilitated by a team of service providers who have been trained in the process of Sibshops—such as social workers, special education teachers, and psychologists. Comments from participants are positive, but no formal evaluation has been done on the effectiveness of these workshops. Johnson and Sandall (2005) surveyed thirty adults who had participated in Sibshops as children, and their comments showed the positive long-term impact the workshops had: ●  Over

90 percent of the respondents said Sibshops had a positive effect on the feelings they had for their siblings. ●  Over 66 percent said that Sibshops had taught them coping strategies. ●  Seventy-five percent reported that Sibshops affected their adult lives. ●  Ninety-four percent said they would recommend Sibshops to others. As we work to implement truly family-centered approaches, we must remember that siblings are critical family members who will likely have the longest relationship with each other as they move through their life together.

Sibling Support Project www.siblingsupport.org

1-6b  Assessment of Families Ann and Rud Turnbull of the University of Kansas developed the Family Quality of Life Scale (see Table 1.3), which provides a measure of family status and resilience in each of five major dimensions of family life (Hoffman et al., 2006). These

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families

Table 1.3  Family Quality of Life Scale Category

Sample Item

Family Interaction

My family solves problems together.

Parenting

My family members teach the children how to get along with others.

Emotional Well-being

My family has the support we need to relieve stress.

Physical Well-being

My family has a way to take care of our expenses.

Disability-Related Support

My family member with special needs has support to make progress at school or work.

© Jaren Jai Wicklund/Shutterstock.com

Source: Beach Center on Disabilities. (2006). Family Quality of Life Scale. Beach Center on Disabilities, Lawrence, KS.

Assessment of family interactions is important in planning with families.

dimensions include family interactions, parenting, emotional well-being, physical well-being, and disability related support. Understanding the family’s self-ratings across these scales helps professionals offer more targeted and appropriate support to the family. For each of the twenty-five items in the scale, the person responds on a five-point scale where 1 is very dissatisfied, 3 is neither satisfied nor dissatisfied, and 5 is very satisfied. This scale helps to answer questions such as, does having a child with disabilities influence family status? Studies done using the Family Quality of Life Scale indicate that having a child with a disability does seem to elevate family stress. This was particularly true for families with a child who has autism (Singer et al., 2011). Using the results of the scale, we can better identify areas where additional family support may be needed. Understanding and supporting the family’s quality of life is important because the well-being of the child is closely tied to family’s well-being (Dieleman et. al., 2021).

1-6c  Family as Advocate: The Power of Parents The recognition that society and the community at large, as well as schools, have a responsibility for caring for exceptional children stemmed in large measure from the activities of parents. Years ago, parents who were unable to get help for their children from local governments created their own programs in church basements, vacant stores, or any place that would house them. These informal groups, loosely formed around the common needs of the children, often provided important information to new parents struggling to find help for their child with disabilities. They were also a source of emotional support for parents, providing a means of sharing and solving the problems of accepting and living with exceptional children. These ad-hoc parent groups quickly realized that fundamental changes were needed in the allocation of educational resources at local, state, and federal levels; a casual, haphazard approach was not going to provide the kind

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Family-Professional Relationships and Family-Centered Approaches of help or support that parents or their children with exceptionalities needed. Moral Dilemma: Accordingly, large parents’ groups, How to Respond: Handling a such as the National Association of Retarded Children (now the Association Colleague’s Biased Comments of Retarded Citizens, ARC); the United Cerebral Palsy Association in the 1940s and 1950s; and the Association for Children Teachers often talk informally in the teacher’s work area. One day a group is discussing how to ensure that more families with Learning Disabilities in the 1960s (now the come for parent night. You and a few others have expressed Learning Disabilities Association of America, concerns that some of the parents from the nearby lowLDA) began to form. Parents of children with income housing complex will not likely attend. A colleague Down syndrome, autism (Autism Society of responds saying, “You really can’t worry about those families. America), and other specific conditions have They never come to support their child—it’s like they don’t also formed groups to advocate for their chileven care if their kids are failing!” How does this comment dren’s special needs. These parent organizations make you feel? What does this comment indicate to you about have successfully stimulated legislation at the your colleague’s mindset? What could you say to your colstate and federal levels, and this legislation has league? Could you use this conversation to begin a proactive supported: additional personnel preparation for approach to families? Looking at the advice from Dr. Cathy professionals working with children with disKea, given earlier in the chapter, in what ways could you build abilities; research into best practices and needs more cultural competence within your school faculty? of students and their families; and the provision of specialized equipment to support students. The efforts of these early parents laid the foundation for inclusive education, and to a large extent we can thank parents for the gains we have made as a society in the inclusion of individuals with disabilities in education settings. Margaret Mead said, “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”

Moral Dilemmas in Special Education The presence of exceptional children in our families and our communities can raise any number of moral and ethical questions. We will present some of these for your consideration in each of the following chapters.

Summary ●  More

than 7 million children are identified as having exceptionalities. There are thirteen categories of exceptionalities under IDEA (2004). Exceptional children show both interindividual (among children) and intraindividual (within themselves) differences. Both kinds of differences require special adaptation by the educators at school. ●  A student’s strengths and challenges with learning can be described using the information processing model which looks at input, central processing, output, executive functioning, and emotional context. ●  Exceptionalities are caused by a number of different factors. We are learning more every day about the genetic causes of exceptionalities, but environmental factors, such as nutrition and prenatal care, can contribute as well. ●  Significant disproportionality across racial, ethnic, and socio-economic populations continues to be one of the greatest challenges we face in appropriate identification, placement, and disciplinary actions. Black, Native, and Latino students are overrepresented in many special education categories but are underrepresented within programs for students who are gifted.

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families ●  Cultural

competence is the ability to relate effectively with people from different cultures. It begins with understanding one’s own cultural perspective and attitudes. Developing cultural competence is key to building strong partnerships with the families of our students. ●  Bronfenbrenner’s bioecological model shows how individual contexts plays a significant role in the child’s development across levels of support (e.g. family, neighborhood, school, community). Intersectionality of the child’s race, ethnicity, poverty, and ability status with the context of the child have a dynamic influence on both short and long-term developmental outcomes. ●  Family-centered practices honor the family’s strengths and needs, respect family wishes, and work to promote genuine partnerships with family members, including the siblings.

Future Challenges Every generation leaves, as its legacy to the next generation, certain problems for which solutions have not been found. There are many issues in the field of special education that today’s professionals have been unable to resolve. The endof-chapter sections titled “Future Challenges” briefly describe widely debated topics as a beginning agenda for the current generation of students, who will face these issues in their professional or private lives.

1. In what ways could we improve the ways we identify who is exceptional? The boundary line separating children with exceptionalities from nonexceptional children has become blurred where children with mild disabilities are concerned. Yet legislation and the courts call for eligibility standards to clearly separate children who should receive special education from those who should not. How do we distinguish, for example, between the child who is emotionally disturbed and the child who is experiencing a temporary behavior problem? What would happen if we did away with labeling students for identification? Are there better ways to ensure that students with exceptionalities get their needs met?

2. How should a student’s cultural and linguistic background be honored in the educational approach to children with special needs? We have only begun to consider how a child’s cultural background influences their education. With the increase of multicultural and multilingual students within our schools, developing cultural componence is essential. With few bilingual and bicultural special education teachers, we face a continuing challenge. How can we build more cultural competence across our teaching workforce?

3. How can we ensure that family-centered approaches include the siblings of children with exceptionalities? Siblings of the child with exceptionalities play a critical role in the family. Their relationship with their brother or sister is life long and yet even in the most “family friendly” programs, siblings’ needs and concerns are often overlooked. How can we ensure that the needs of siblings are addressed and that they are included in critical family support efforts? TeachSource Digital Download

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References of Special Interest to Teachers

Key Terms Strength-based educational approaches p. 6 Interindividual differences p. 7 Intraindividual differences p. 7 Individualized education program (IEP) p. 7 Information processing model p. 8 Short-term memory p. 8 Long-term memory p. 8 Executive function p. 8 Working memory p. 8 Emotional context p. 9 Anticipatory anxiety p. 9

High-incidence disabilities p. 13 Low-incidence disabilities p. 13 Significant disproportionality p. 13 Eligibility p. 14 Placement p. 15 Least restrictive environment p. 15 Cultural competence p. 16 Bronfenbrenner’s bio-ecological model p. 18 Culture p. 19 High-leverage practice (HLP) p. 26 Family-centered approach p. 26

References of Special Interest to Teachers High-Leverage Practices For Students with Disabilities. A collaboration of the CEC and the Collaboration for Effective Educator Development, Accountability and Reform, HLPs are a set of twenty-two classroom practices intended to address the most critical issues special education teachers encounter in the classroom. https://highleveragepractices.org/ IDEA (2004) Parent Guide. The Parent Guide helps parents and guardians of children with exceptionalities understand the ins and outs of IDEA (2004), the overarching special education law. The guide provides contacts and steps to help parents advocate for their children’s needs. www.ncld.org/wp-content/uploads/2014/11/IDEA-Parent-Guide.pdf Culturally Responsive Teaching. This overview explains the thinking behind culturally responsive teaching and how it improves the lives of children in the classroom. The guide provides seven tenets of culturally responsive teaching and how the teacher can achieve them. www.brown.edu/academics/education-alliance/teaching-diverse-learners /strategies-0/culturally-responsive-teaching-0 Understood: A program for families of kids with exceptionalities. Understood is a nonprofit dedicated to the families of children with exceptionalities. They offer customized, accessible resources and a community to help parents and teachers succeed. www.understood.org/

Journal Teaching Exceptional Children, Council for Exceptional Children (CEC). This journal is the practitioner-focused publication of the CEC. It features articles on best practices, materials for classroom use, and current issues in special education teaching and learning. https://exceptionalchildren.org/improving-your-practice/cec-publications /teaching-exceptional-children

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Chapter 1  |  Children and Youth with Exceptionalities and Their Families

Professional Organizations Council for Exceptional Children (CEC). The CEC is the largest international professional organization dedicated to improving the educational success of children and youth with disabilities and gifts and talents. The organization advocates for special education, sets professional standards, and provides professional development. www.cec.sped.org National Center for Learning Disabilities (NCLD). The NCLD advocates for children, parents, and teachers working with special education. The organization shares research, provides scholarships and awards, and provides resources for working with exceptionalities. www.ncld.org/

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Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools

2 Ch ap te r

Standards Addressed in This Chapter CEC Initial Practice-Based Professional Preparation Standards for Special Educators (K–12) 1, 2, 4, 5, 6, and 7 are addressed within this chapter. Please see the inside book covers for the complete list of these standards.

Focus Questions 2-1 How has society at large responded to children with exceptionalities over the years? 2-2 What government legislation supports and protects students with disabilities? 2-3 How have the courts influenced the development of educational services for children with disabilities? 2-4 In what ways can schools address systemic racism and create culturally responsive learning environments? 2-5 How can schools organize their supports and services for students with exceptionalities? 2-6 What is the individualized education program (IEP) and why is it so important for students with exceptionalities?

Bob Daemmrich/Alamy Stock Photo

2-7 How can we improve instruction with Universal Design for Learning (UDL)?

I

n Chapter 1, we discussed the nature of children with exceptionalities and their surrounding context of family, peers, and society, and we ended by acknowledging the critical role of parental advocacy in driving social change. In this chapter, we look at the impact of this advocacy on three major social institutions: governments, courts, and schools. How a society values and treats is most vulnerable citizens can be seen through these institutions, and a society’s response speaks volumes about its integrity. See Figure 2.1, which briefly explains the impact of each social institution on children with exceptionalities.

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools

The government provides the money and authority necessary to meet the special educational needs of students with exceptionalities.

The schools design special programs to educate students with exceptionalities and prepare them for a productive and satisfying adult life.

The courts rule on what is fair, just, and equitable with regard to students with exceptionalities.

◗ Figure 2.1  The Exceptional Child and Social Institutions

Each of the social institutions depicted in Figure 2.1 has its own rules and traditions that influence how decisions are made and how conclusions are reached. As discussed in Chapter 1, how a child with exceptionalities will fare in life depends to a large degree on the environmental circumstances around them; their family, school, community, and other social forces such as government and the courts. These factors all exist within a chronological time period that shaped their responses and changes them over time. This historic context helps us to understand how society’s attitudes toward individuals with exceptionalities have changed, explaining how we got where we are today and helping us think about where we need to go tomorrow.

2-1  Societal Responses to Children with Exceptionalities During the past century, enormous changes have taken place in the way society treats children with exceptionalities, moving from rejection, to the isolation of children with disabilities, toward their acceptance as full members of society. While far from perfect, our current level of acceptance has few precedents, representing a much more enlightened view than was evident even

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Societal Responses to Children with Exceptionalities

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in the recent past. The idea of educating every child to achieve their greatest potential is a relatively new idea. We can see this evolution of understanding reflected in Table 2.1, which shows how society would have responded, across history, to Marcus’s needs. You will recall from Chapter 1 that Marcus is on the autism spectrum and has difficulty communicating and forming relationships with others. In today’s schools, Marcus would receive special services to strengthen his social and communication skills and to build his academic achievement, but what would have happened to Marcus if he had been born in 1850 or 1900 or 1925 or 1950 or 1975? The field of special education evolved gradually from its early emphasis on the biological/medical problems of individuals with disabilities to our current focus on the educational supports and services needed to for success across their lifecourse. Before World War II, individual states were involved in a limited way in subsidizing programs in public schools for children with sensory disabilities (blindness, deafness) and physical impairments. Some states helped organize and support classes for children who had intellectual and developmental disabilities or behavioral problems. After World War II, many states expanded their involvement, providing financial support for special classes and services to local schools for children with all types of disability. This expansion caused two problems that many believed could only be solved by federal legislation. First, these new and larger programs created a personnel scarcity in the late 1940s and early 1950s. Professional special educators were in short supply, and the field of special education was not firmly established. (Special note to the reader, you are holding a piece of history: Educating Exceptional Children was one of the first textbook in special education; published in 1962, it helped prepare early teachers to work with students with exceptionalities!) Second, because not all states expanded their involvement in special education, organized parents’ groups

Table 2.1  Historical Review of Support for Marcus In 1850, only a smattering of physicians were interested in children like Marcus. Two doctors, Jean-Marc Itard and Edouard Seguin, were the first known individuals who tried to teach children with intellectual and developmental delays (which is likely how Marcus would have been viewed). In all likelihood, Marcus would have dropped out of school early, if he had had any schooling at all. At this same point in history, several individuals were interested in helping children who were deaf. Thomas Gallaudet and others were experimenting with various models of communication for children with hearing loss. However, this would not have been much help to Marcus. By 1900, there were some isolated stirrings within urban communities focused on starting classes for children with disabilities. These, however, would have been unlikely to help Marcus, who would probably have been called “mentally deficient” if he had received any attention at all. In 1922, the Council for Exceptional Children (CEC) was founded in order to organize teachers who were working to help children with exceptionalities and a few special classes could be found in urban settings, but these still would not have been much help to Marcus. In 1950, the post–World War II era saw the beginnings of special programs for children with exceptionalities in a few states (e.g., California and Illinois). If Marcus had been in the right place, he might have received some help in one of these special classrooms. By 1975, Congress had enacted legislation designed to provide real help for children like Marcus. The courts were validating parents’ claims to a free and appropriate education for their exceptional child. Still, autism was not a wellknown disorder, and any well-meaning efforts might not have been sufficient for Marcus’s needs. Today, there is a greater likelihood that Marcus would be seen by a multidisciplinary team of specialists (neurologists, psychologists, speech pathologists, etc.) who would be aware of his differences and the special adaptations needed to maximize Marcus’s strengths and abilities. The good news is that today Marcus’s opportunities to meet with educational success have greatly increased.

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools began asking why children with disabilities and their parents should be penalized because they lived in a particular state or a particular region of a state. Shouldn’t all U.S. citizens (in this case, the parents of children with disabilities) be entitled to equal treatment anywhere in the United States? The blatant unfairness of the situation called for attention at the federal level. Federal legislation was needed to provide resources to bring qualified people into special education and to equalize educational opportunities across the country and organized parents’ groups, with the support of other interested citizens, convinced Congress to help. This help was finally granted through a series of laws.

2-2  The Role of Government Federal, state, and local governments have had a long-lasting effect on the education of children with exceptionalities through the creation of policies, drafting of laws, and securing the necessary resources for the special supports and services. Legislation is a vehicle for change (Gallagher, 2006) because it sets out clear expectation and it is also the law!

2-2a  A Summary of Special Education Legislation Starting with the initial laws passed in the 1960s, steady progress has been made to ensure that the rights of individuals with exceptionalities and their families are protected.

Public Law 88-164 In 1963, Public Law (PL) 88-164 authorized funds for training professionals to work with children with special needs and for research and demonstration sites to show best practices for students with intellectual disabilities (ID) and Deafness. The law represented a strong initiative by President John F. Kennedy,

Early advocacy was critical to securing the laws needed to protect the rights of children with disabilities.

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Ethel Wolvovitz/Alamy Stock Photo

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The Role of Government whose interest was heightened by his sister’s ID. These first efforts were followed by many others, and from that small beginning emerged thirty years of legislation to ensure that all children with disabilities would have access to an appropriate education.

Public Law 94-142 In 1975, Congress passed PL 94-142, the Education for All Handicapped Children Act. The measure, which took effect in 1977, was designed “to assure that all handicapped children have available to them a free appropriate public education which emphasizes special education and related services designed to meet their unique needs” (Education for All Handicapped Children Act, 1975, p. 35). This act laid the foundation for special education with the establishment of six key provisions safeguarding student and family rights (see Table 2.2). These six provisions, zero rejection, non-discriminatory evaluations, individualized education program, least restrictive environment, due process, and parental participation, remain the core of special education protections today. To carry out the provisions of this law, the federal government promised to fund approximately 40 percent of the costs for meeting the needs of students with disabilities. However, this promise was never kept, and by 2017, the government was only funding approximately 14.6 percent of these costs. To receive even this limited aid, states were required to show evidence that they were doing their best to help children with disabilities receive needed services. Specific provisions in the law placed substantial pressure on public school systems, demanding more in the way of assessment, parental contact, and student evaluation than most school systems had been accustomed to providing.

Public Law 99-457 The Education for All Handicapped Children Act (PL 94-142) was, however, misnamed. It was not meant for all children of all ages, only school aged children. As it became increasingly evident that early intervention was critical, both for the children with exceptionalities and for their families, pressure increased for the law to be extended to include younger children. PL 99-457 (Education of the Handicapped Act Amendments of 1986) allocated federal funds for the states to develop plans and programs for children and their families from birth on. The title of the Education of the Handicapped Act was also changed to the Individuals with Disabilities Education Act, or IDEA. The impact of IDEA is discussed throughout the text.

Table 2.2  Six Key Provisions of the Education for All Handicapped Children Act (1975) ● ●









Zero reject. All children with disabilities must be provided a free and appropriate public education. Nondiscriminatory evaluation. Each student must receive a full individual examination before being placed in a special education program, with tests appropriate to the child’s cultural and linguistic background. Individualized education program. An individualized education program (IEP) must be written for every student with a disability who is receiving special education. The IEP must describe the child’s current performance and goals for the school year, the particular special education services to be delivered, and the procedures by which outcomes are evaluated. Least restrictive environment. As much as possible, children who have disabilities must be educated with children who do not. Due process. Due process is a set of legal procedures to ensure the fairness of educational decisions and the accountability of both professionals and parents in making those decisions. Parental participation. Parents are to be included in the development of the IEP, and they have the right to access their child’s educational records.

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools

Individuals with Disabilities Education Act 2004 (IDEA 2004) IDEA 2004 is the reauthorization of the original legislation (Education for All Handicapped Children Act, PL 94-142) designed to strengthen and improve earlier versions. Some of the major changes in IDEA 2004 include: of personnel. Special education specialists must hold full state certification as special education teachers and have a license to teach. They must demonstrate subject-matter competence in the academic programs they teach.      ● IEP standards (section 1400). IEPs (see more discussion later in the chapter) must reflect scientifically based instructional practices, cognitive behavioral interventions, and early intervention services, as appropriate. They must include plans for the use of assistive technology Federal legislation ensures that young children with special needs and short-term objectives for children receive the intervention that they need. with disabilities who take alternative assessments. ●  Transition planning. A transition plan must be included in all IEPs for students at age 16 and for younger students if appropriate. Transition planning must include instruction, community experiences, development of employment, and other post-school adult-living objectives. ShineTerra/Shutterstock.com

     ● Quality

A key feature of this legislation was the funding of professional development for special education teachers and higher education personnel. It also supported research and demonstration projects and outreach efforts to ensure that research findings made their way into the classroom. Technical assistance projects and parent education initiatives were also funded. In short, IDEA provided the necessary infrastructure that was critical for a modern educational system (Gallagher, 2006). Re-authorizations are intended to keep a law timely and relevant. It has been almost 20 years since IDEA has been re-authorized, and this process will likely take place within the next few years. It will be interesting to see how our current concerns about disproportionality and cultural competence, discussed in Chapter 1, as well as the increased use of distance/online learning as a result of the COVID-19 pandemic, will be reflected in the next version of the law. Other important pieces of legislation have played a role in the life of students with disabilities.

Section 504 of the Rehabilitation Act of 1973 (PL 93-112) This legislation protects the civil rights of individuals with disabilities with its key provision being that it is illegal to deny participation in activities or programs solely on the basis of a disability. Individuals with disabilities must have equal access to programs and services. One of the advantages of Section 504 is that students who might not meet the stringent criteria for IDEA 2004 eligibility, discussed in Chapter 1, may still receive services under Section 504. Problems such as failing grades, a pattern of suspensions, and chronic misbehavior may qualify a child for additional support under Section 504. This law acts as a bridge between general and special education.

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The Role of Government

Americans with Disabilities Act of 1992 The Americans with Disabilities Act of 1992 (PL 101336) extends civil rights to persons with disabilities. These rights are guaranteed without regard to race, color, national origin, gender, or religion through the Civil Rights Act of 1964. These three pieces of legislation, IDEA 2004, Section 504 of the Rehabilitation Act, and the Americans with Disabilities Act, make it clear that American society is determined to see that individuals with disabilities have equal access to educational resources and that they cannot be discriminated against solely on the basis of their disabilities.

No Child Left Behind Act of 2001 (PL 107-110)

TeachSource Video Connection

Aligning Instruction with

Sometimes a piece of legislation is so important that it Federal Legislation affects children with disabilities even if they were not Watch this video case, in which a principal, teachers, the target of the legislation. The No Child Left Behind and a student intern discuss modifying instruction (NCLB) Act of 2001 was a major education undertakto take federal legislation into account. Questions ing of the George W. Bush administration. The law no about the impacts of IDEA and NCLB are raised longer allowed schools to be measured by how the stuby the new intern, and other general education dent body as a whole performed, but instead required teachers and special education teachers chime in schools to measure and report on learning of students with their viewpoints. After listening to this discusin subgroups such as race, gender, socioeconomic stasion, reflect on how federal legislation impacts tus, and disabilities. The law was instrumental in showeducation practice. What are the pros and cons of ing gains being made (or not being made) by students federal educational legislation like IDEA? with exceptionalities, and the legislation set the expectation of achievement for those students. Watch online NCLB required schools to present test data, to prove their effectiveness, showing that all students had made a year’s growth for a year in school, requiring that students with disabilities be held to the same expectations as students without disabilities. This requirement was problematic for some students with disabilities who require more time for learning than their typically developing peers. While many children with exceptionalities responded well to the higher academic performance goals, some students were unable to meet these goals no matter how hard they and their teachers tried. In 2003, the Department of Education issued regulations to give the states greater flexibility. These regulations allowed states to use alternative assessments with up to 3 percent of their students for whom alternative academic standards would be appropriate. NCLB created a different problem for students with gifts and talents. For many students with gifts and talents, the state’s standards and assessments were not challenging enough and could often be reached with little or no effort (see Chapter 10).

American Recovery and Reinvestment Act of 2009 The goal of the American Recovery and Reinvestment Act was to stimulate economic activity in a number of areas, including financial and social institutions, and education, to ensure the long-time economic health of our nation. This act resulted in large funds being provided to the states under IDEA. These funds came to states on a one-time basis to improve the delivery of quality of early intervention services. Infants and toddlers with disabilities from birth to age 2 received $500 million in federal funds, and children ages 3 to 5 were provided $400 million in federal funds.

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools Because these were one-time funds, they were directed to activities such as Child Find to build data systems to track children, improve delivery of services, and establish accountability standards for young children with disabilities. It is important to note that children with disabilities were included in the omnibus effort of the federal government to strengthen the health and economy of our nation.

Every Student Succeeds Act (ESSA) 2015 SAUL LOEB/AFP/Getty Images

The reauthorization of No Child Left Behind (NCLB) Act took place in 2015 under President Obama’s administration, and the new law was named the Every Student Succeeds Act (ESSA). The impact of this re-authorization on students with disabilities included the continued provision to ensure that students with disabilities participate in state accountability systems; President Barack Obama signed the American Recovery and the granting of greater flexibility in how these Reinvestment Act, which provided millions of dollars in funding for accountability systems were designed; the incluearly intervention services. sion of additional assessment provisions to use effective accommodations; and the provision of better support for students with the most significant cognitive disabilities. In addition, ESSA required schools to engage with stakeholders in addressing school conditions that impact student learning, including disciplinary tactics used (see discussion in in Chapter 1 on disproportionate impact of restrain and seclusion).

Federal Actions for Students with Special Gifts and Talents Except for a brief period in the 1970s, there has been little federal legislation for the education of children who are gifted. The Javits Act (PL 100-297), named after U.S. senator from New York Jacob Javits, provided a small sum of money to support research and demonstration programs that focused on gifted students from economically disadvantaged circumstances, from culturally or linguistically diverse families, and on gifted students with disabilities (twice-exceptional). Programs funded through the Javits grants have helped with the development of alternative identification methods and service delivery models to more equitably meet the needs of students who are gifted (see Chapter 10 for a discussion of this movement).

2-3  The Role of the Courts Another of society’s social institutions, the court system, has played a significant role in clarifying and solidifying the rights of students with exceptionalities and their families. This movement toward judicial action was, in part, a recognition of the success of the Civil Rights movement in using the courts to establish their educational rights. In 1954, with the classic school desegregation case Brown v. Board of Education, the courts began to reaffirm the rights of minority citizens in a wide variety of settings. If court decisions could protect the rights of one group of citizens, they could do the same for another group: those with disabilities. Soon, supporters of people with disabilities were working to translate abstract legal rights into tangible social action through the judicial system. It is the duty of the courts to rule on the interpretation of the laws and regulations generated by the executive and legislative branches. If the law says that every child is entitled to a “free and appropriate public education,” how does that

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The Role of the Courts translate at the community level? Does that mean that a school cannot expel a child with disabilities? Many important court decisions have formed the foundation for special education, shaping how supports and services are delivered to students and their families. The underlying principle is that children with special needs deserve a free and appropriate public education (FAPE), just as do all children in the United States. If that right is being abridged, or if other inequities are being created, citizens can appeal to the courts for justice and equity. Over the years, a series of legal cases has solidified the rights of children with disabilities and their guaranteed right to FAPE in public schools. This right, however, has not been established for students who attend private and religious schools if public funding is not provided. A recent court case, Espinoza v. Montana Department of Revenue (2020) ruled that publicly funded school vouchers could be used to pay tuition for religious education schools (Cartagena, 2021). This decision will have ripple effects on private and religious schools’ responsibilities to provide a free and appropriate education for students with disabilities. Currently, privately funded schools are not required to accept or serve students with disabilities and the legal protections for students with disabilities do not hold for students in private or religious schools. A landmark case (1972) that began a series of court decisions in favor of children with exceptionalities and their right to FAPE was the Pennsylvania Association for Retarded Children (PARC) v. Commonwealth of Pennsylvania lawsuit and decision. In this case, the court decided that children with ID could not be excluded from school and did have a right to FAPE and that when the Pennsylvania state constitution said “all children are entitled to a free public education,” the term all did, in fact, refer to all children, including children with disabilities. Class action suits have been influential in changing the status of children with disabilities in the United States. A class action suit provides that legal action taken as part of the suit applies not only to the individual who brings the particular case to court but also to all members of the class to which that individual belongs. That means the rights of all people with disabilities can be reaffirmed by a single case involving just one child. The rulings in several court cases have reaffirmed the rights of individuals with disabilities and have defined the limits of those rights (see Table 2.3).

2-3a  Inclusion and Funding Issues After establishing the basic rights of children with disabilities to a free and appropriate public education, the courts then turned to the issues of inclusion (bring children with exceptionalities into regular classrooms), the least restrictive environment, and to defining what an “appropriate” program for children with exceptionalities should be. The results are a mixture of rulings, some supporting a strong version of inclusion and some supporting a continuum of services (McCarthy, 1994): ●  A

child with Down syndrome was placed in a general education program rather than in a special education class because of the presumed priority of inclusion in IDEA (Greer v. Rome City School District, 1991). ●  A court ruled that it is the responsibility of the school district to demonstrate that the child’s disabilities are so severe that they will receive little benefit from inclusion or will be so disruptive as to keep other classmates from learning (Oberti v. Board of Education of the Borough of Clementon School District, 1993). Clearly, these rulings reflect the specifics of each individual case and the interpretation of local or district courts. It may take a Supreme Court decision to provide more general guidance on the issue of what “appropriate” means for education of children with exceptionalities. Nevertheless, when the courts speak, people listen; because court decisions represent the law as we currently know it, they must be obeyed.

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools

Table 2.3  Court Cases Affirming the Rights of Children with Disabilities ●















A child with disabilities cannot be excluded from school without careful due process, and it is the responsibility of the schools to provide appropriate programs for children who are different (Pennsylvania Association for Retarded Children v. Commonwealth of Pennsylvania, 1972; Goss v. Lopez, 1974; Hairston v. Drosick, 1974). The presumed absence of funds is not an excuse for failing to provide educational services to children with exceptionalities. If sufficient funds are not available, then all programs should be cut back (Mills v. Board of Education, 1972). Children should not be labeled “handicapped” or placed into special education without adequate diagnosis that takes into account different cultural and linguistic backgrounds (Larry P. v. Riles, 1979). Bilingual children with exceptionalities need identification, evaluation, and educational procedures that reflect and respect their dual-language backgrounds (Jose P. v. Ambach, 1979). A child with disabilities is entitled to an appropriate, not an optimum, education (Board of Education v. Rowley, 1982). The Rowley decision was the first court decision that suggested that there was a limit to the resources that children with exceptionalities could expect. Subsequent case to the Rowley decision made it clear that such services, though not optimal, must be more than de minimus—that is, must provide sufficient support so the child with disabilities can benefit educationally (Polk v. Central Susquehanna Intermediate Unit 16, 1988) and must include challenging learning objectives (Endrew, F. v. Douglass County Schools, 2017). Schools must provide children with severe physical disabilities services they need to benefit from special educations. These services include health supports (e.g. clean intermittent catheterization) that require nursing care. Schools are not required to provide medical services that must be provided by a physician (Irving Independent School District v. Tatro, 1984; Cedar Rapids Community School District v. Garret F., 1999). School districts do not have unilateral authority to remove special education students from school for more than 10 consecutive days if the student’s behavior was a manifestation of their disability (supreme court Honig v. Doe, 1988).

Determining what meets the threshold of FAPE has been complicated by the COVID pivot to online and hybrid learning environments. Zirkel (2021) summarized these cases as primarily dealing with the Failure to Implement (FTI) category of FAPE indicating that there was wide variation across the case findings, but that courts often defer to the hearing officers’ decisions as to whether the student’s rights have been met.

2-3b  Appropriate Special Education Services During the last few years the questions raised in court cases have focused on whether the services recommended by the student’s IEP teams (IEPS will be discussed in depth later in this chapter) were adequate or appropriate, or implemented appropriately. Questions about the implementation of the IEP have taken on new importance with the pivot to online and hybrid learning due to COVID-19. There are currently several COVID cases underway with parental concerns that their child’s IEP requirements have not been implemented within the virtual learning environment. Initial hearings on these have had mixed results; however, several have found that districts have failed to implement the child’s IEP within the virtual context. Districts that have taken a one-size-fit-all approach to supports and services are most vulnerable. It will likely be several years before the court decisions offer more clarity as to student rights within different learning environments (Zirkel, 2021).

2-3c  Parental Involvement One of the themes that the courts strongly endorse is the importance of parents playing a key role in the FAPE their children with disabilities receive. For example, parents are to be involved in the development of the Individual Education Program (IEP) for the child. In one case (Drobnicki v. Poway United School District, 2009), the school district scheduled an IEP meeting on a date when the student’s parents could not attend; the district held the meeting anyway and told the parents they could attend via speakerphone. The U.S. Court of Appeals declared that this was a denial of the student receiving a FAPE.

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Addressing Systemic Racism and Creating Culturally Responsive Learning Environments Parents of a child with autism were granted a tuition reimbursement for their child’s attendance of a special program because the school district failed to provide sufficient information about the school’s program, thus preventing the parents from the opportunity to fully participate in the IEP process. This was deemed a “fatal” procedural flaw (Montgomery County Intermediate Unit 23 v. A.F, 2020). In another case (Winkleman v. Parma City School District, 2007), the Supreme Court unanimously ruled that parental participation in the special education process is crucial to ensuring that children with disabilities receive a FAPE. The importance of parental participation in educational planning for their child should be clear to everyone. Just as laws have to be enforced and money has to be appropriated, so court decisions have to be executed. The court decisions noted in the previous list created the expectation that something would be done, but they did not guarantee it. Students with disabilities have a legally protected right to a free and appropriate education and the courts have been grappling for years with the definitions of “appropriate,” but it is up to the schools to safeguard these rights in the implementation of programs. In the coming years we may see more cases brought before the courts that question the appropriateness of educational services that have disparate outcomes for some groups of children. Special education decisions are made within a larger system, which influences how we determine eligibility, placement, and services. You will remember from Chapter 1 that the problems of significant disproportionality show that students who are Black, Indigenous, and Persons of Color (BIPOC) have often been impacted in harmful ways by these decisions. If we hope to improve this for future students with and without exceptionalities, we must address the root causes that perpetuate these problems: systemic racism and individual biases.

2-4  Addressing Systemic Racism and Creating Culturally Responsive Learning Environments The “American Dream” is a strong belief that through hard work, any member of society can aspire to and reach even the loftiest goals. This national ethos, that freedom includes the opportunity for prosperity and success for all, is rooted in the Declaration of Independence’s proclamations that “all men are created equal” with the right to “life, liberty, and the pursuit of happiness.” A fundamental part of this dream is that one’s children will do better than oneself; that the next generation will outshine their parents. The hope for the future is what gives the American Dream its power. The American Dream has compelled countless immigrants to seek asylum in the United States. It anchored the call for the civil rights movement, with Martin Luther King, Jr.’s letter from a Birmingham jail in 1963 reminding us that the fight for equality is but an echo of our founding fathers’ vision of democracy. It inspired a generation of “audacity and hope” as former president Barack Obama challenged us to live up to the dream. The American Dream is powerful, but achieving the American Dream assumes equal access to opportunity. In this section we will take a hard look at the role of education in supporting and/or inhibiting an individual’s ability to actualize the American Dream. Schools in large measure are a mirror reflecting our society as a whole. Most of the values taught or demonstrated in schools reflect the values of the dominant sectors of society. Many of the problems encountered in the schools are part of the larger societal fabric. Schools, however, can either perpetuate these social problems or work to be part of their solution (Starck et al., 2020).

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools

2-4a  Examining Systemic Racism What is systemic racism? Systemic racism exists when institutional policies, procedures, rules, regulations, or formal and informal practices advantage one racial, ethnic, or cultural group over another. In America, systemic racism most often provides advantages for individuals from White, middle-class backgrounds while simultaneously generating barriers for individuals who are BIPOC. Systemic racism stems from the same root as individual racism: a belief in the inherent superiority of one racial, ethnic, or cultural group and the inferiority of other groups. It occurs because institutions—like courts and schools—were designed by advantaged people and cater to those people. It differs from individual racism in its scope and its power for harm. Systemic racism is most easily recognized by the disparate impacts across groups that can be seen when outcomes differ dramatically for groups who are supposedly receiving the same “treatment.” In Chapter 1, we discussed significant disproportionality within special and gifted education. You will recall that Black, Hispanic, and Indigenous students are far more likely than their White peers to be identified for most special education services, and that once identified they are often placed in more restrictive learning environments and receive harsher disciplinary interventions. These same groups of students are less likely to be identified as gifted and talented. These disparate outcomes indicate the presence of systemic racism. Dr. Kristina Collins addresses the impacts of systemic racism in the Ask the Experts (Box 2.1). As you read her thoughts, reflect on your own experiences as you moved through school.

Box 2.1

Ask the Experts:

Addressing the Impact of Systemic Racism on Students with Exceptionalities

Samuel A. Kirk

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Dr. Kristina Henry Collins, Core Faculty for Talent Development, Texas State University, San Marcos Our students are complex; multiple exceptionalities impact their lived experiences as they navigate

through school and life. Each student has unique set of personal and social challenges, and these include how they are treated and how they experience their environments. Jon (pseudonym), a gifted Black student with dyslexia presents as thrice exceptional (3e) (intersectionality of being gifted, dyslexic, and racially underrepresented in gifted programming). As a 3e student, Jon may face microaggression from peers and teachers who have stereotypes about giftedness, disability, or racial identity, further exposing him to stereotype threat, which can create high cognitive load and reduce academic focus and performance. He may feel misunderstood by others who do not share his experiences and perspectives. Jon may also be impacted by broader policy issues that surround school decisions and limit his opportunities. Policy issues impact identification, placement, and support received to help students with exceptionalities meet with success. The policies of gifted, special, and general education all have a history of pervasive disproportionality that negatively impacts students of color. This is this legacy of systemic racism that Jon faces as a student who is 3e.

(Continued)

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Addressing Systemic Racism and Creating Culturally Responsive Learning Environments

Box 2.1

Ask the Experts:

Addressing the Impact of Systemic Racism on Students with Exceptionalities  (Continued)

Racism is dehumanizing. It burdens everyone involved. The perpetrator, the victim/recipient, the witnesses, and bystanders are all negatively impacted by racist acts. Because of this, it is essential to address racism with all persons involved. The question, then, becomes, if systemic racism and barriers occur in school for students of color with and without exceptionalities, what can be done to change this? We can all be advocates for change. We can begin by understanding the historical progression of racism and its consequences, equipping ourselves with talking points and data to inform stakeholders about its impact, and having a shared understanding of best practices; all are necessary and critical tools for advocacy. But, these tools are not sufficient. It is imperative that advocates have the skillset to organize politically in order to drive change at all levels of government, policy, and schools. Driving this change requires building relationships with potential allies. To be effective in addressing and lessening the impact of systemic racism and biases, you must understand the advocate’s role in recruiting, cultivating, and sustaining a network of policy and advocacy experts.

Foster Value-Added Relationships at All Levels of Government, Policy, and Schools Recruitment, for the purpose of influencing change, involves identifying the key people needed for change and building relationships with them over time. Through this process of continual engagement, you are cultivating your relationship and building understanding and trust. Essential to recruiting and cultivating advocacy-allies, you must genuinely want to know people and explore opportunities for reciprocal collaboration—support their work if it is in line with your values and priorities. These relationships become mutually respected, strong, sustainable networks of advocacy experts with an ability to positively influence policy. These relationships will be critical when the time is right for change. Efforts to lessen the impact of systemic racism are often met with various reactions from different

TeachSource Digital Download

stakeholders. Is it important to note, however, that every person, no matter where they are in their journey of understanding their own inherent bias and/ or systemic racism, adds value to the work. I have found that most reactions, especially in grassroot efforts, fall into five categories and all can be used to advance the work: ●









The Complainant (Conflicted/ Contradict) – those who do not agree with the work or vision. Their conflict with the vision can offer perspectives that reveal potential gaps in planning; use their resistance-points to firm up your planning and communications. The Compliant – those who appear to be neutral, but compliant. At minimum, they will forward the work and remind others—directly and indirectly— of the “policy”; these stakeholders can offer perspective for alignment of practice to policy. The Cooperator – those who are on board, but will not necessarily volunteer to advance the work. When solicited for assistance, however, they can serve as dependable allies to do the work needed. The Collaborator – those who are fully on board and will volunteer and/or speak up with visionary ideas and perspective. These stakeholders will communicate and defend the work to others. The Committed – those who are fully engaged, even on a volunteer basis and sometimes will go the extra mile to help achieve the goals. Offer these individuals leadership positions in the work.

It is time to answer the call to action, becoming an advocate, to eliminate unjust acts of racism and discrimination in America, and in education. We must be upstanders in confronting structural barriers, inequitable policies, and unwritten practices that negatively impact the lived and educational experiences of students of color and those with exceptionalities.

Reflection: ●

How might YOU RECRUIT, CULTIVATE, AND SUSTAIN relationships toward efforts to address and lessen the impact of systemic racism, particularly for students and youth with exceptionalities?

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools Systemic racism codifies the process by which some groups are disenfranchised, marginalized, and even criminalized. Systemic racism is a structural problem, but we need to remember that systems are made up of people. So, when we talk about a “school system” for example, we are talking about the collective of professionals who work together to educate the students under their care. And while it is essential to examine the problem of systemic racism, we must also look closely at the individuals within the system if we hope to address the problem.

2-4b  Implicit Bias in the Classroom A bias is a predisposition, either positive or negative, toward someone or something. We all have biases, and these biases influence our choices, our feelings, and our behaviors every day. Racial biases are broadly applied attitudinal judgments based on racial or ethnic group membership; racial biases impact how we view, treat, and value others. Racial biases can be directed by any racial group toward any racial group, but they are most damaging when the dominant social group directs their biases toward racial and ethnic groups with less power. In America, the dominant cultural group is White middle class, and many of our current societal norms and institutions are influenced by the biases of this group. Our racial biases can be either explicit or implicit. An explicit bias is one that we are self-aware of; we know about it, and we are willing to share and talk about it. Implicit bias, on the other hand is more subtle; implicit biases are subconscious or automatic cognitive associations that we may not even be aware we are making (Starck et al., 2020). Given the subconscious, or automatic, nature of our implicit biases, it is more difficult for us to identify and change them to avoid causing harm. Implicit bias is most likely to be activated when we are tired, stressed, or hurried; when we do not have time to “think” we default to our automatic assumptions even when these do not reflect our best selves. Because biases impact how we treat others, it is, however, essential that, as teachers, we become aware of our own explicit and implicit biases. A major study looked at how teachers’ explicit and implicit biases compared with other non-teacher adults with similar characteristics (Starck et al., 2020). The title of the article, “Teachers Are People Too…” says it all. Teachers’ racial attitudes largely mirrored the broader society, and both groups are subject to explicit and implicit racial biases. Given these findings, it is critical that we support teachers’ exploration of their own racial biases to help them “…fully realize their potential when educating students from a variety of backgrounds…” (Starck et al., 2020, p. 281). Examples of how teacher bias can influence our treatment of students include inadvertently thinking of students of color as less capable and/or more aggressive than White students and offering fewer warnings to Black students when their behavior needs correcting (Wegmann & Smith, 2019). The belief that BIPOC students are less capable leads to their underrepresentation in advanced classes and programs for students who are gifted. The implicit (or explicit) belief that BIPOC students are more aggressive leads to an overrepresentation in special education. The fact that BIPOC students receive fewer warnings about their behavior leads to inappropriately harsher disciplinary actions and more suspensions. Our biases have life-changing consequences for our students. When students experience racial bias, it undermines their trust in their teachers and their schools. Yeager and colleagues (2017) examined the loss of trust in school for White, Latino, and African American adolescents. African American students were more aware of racial bias in schools, and as their awareness increased, their trust diminished. The study found that a loss of trust by the spring of seventh grade was predictive of future disciplinary infractions and that it negatively impacted the students’ college enrolment. These examples show the significant and life-changing impact teachers can have on their students. But, the fact that teachers can have a dramatic impact on their students is actually good news. This gives us hope that as

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teachers become more culturally competent, reflecting on their own explicit and implicit racial biases, we can create positive learning environments that support the success of all of our students.

2-4c  Dismantling Racism and Creating Culturally Responsive Learning Environments There is no quick fix. Building trust takes time. The first step to addressing racism and bias is self-reflection. On a personal level, it is taking an honest look at our own biases and working to become more aware of how we operationalize these in our classrooms. As part of this look, we should collect and review data. How do we discipline our students? Which students have been referred for gifted education; which for special education? Are there any patterns to our interactions with students that indicate we treat some groups of students differently? We need to identify where we are most uncomfortable, where we feel lest competent, and what our specific triggers are. Special education teachers self-reported, in a study of the state of special education (Fowler et al., 2019), that they felt least competent when working with families of students whose race/ethnicity and language was different than theirs. This offers one glimpse into where we might start in growing our comfort zones. While we can do much of this self-reflection on our own, we should also seek out professional development opportunities to learn more. On a systemic level this self-reflection must include listening to our stakeholders, the students, families, and communities we serve (Kea et al., 2006). What are their concerns, how are we addressing their needs, what is their level of trust in us? A careful and honest review of data that has been disaggregated by race, ethnicity, language, socio-economic status, and ability status is also part of a systemic self-reflection. A close examination of disciplinary practices, drop-out rates, referral patterns, class attendance, and student outcomes by classroom and school will reveal where the major problems are and will establish a baseline for growth. But, think about the advice of Dr. Collins, in the Ask the Experts box. Dr. Collins reminds us that data alone will not solve the problem of racism. She inspires us to become advocates who actively work to build relationships with others who can help us change policies and practices. In Chapter 1, Dr. Kea shared with us her ideas of how to become more culturally responsive teachers. In this chapter, Dr. Collins has shared the urgency that we take actions to address systemic racism. It is up to us to carry these ideas into action.

Implicit Association Test: Take this test developed by Harvard University to identify biases you may have. https://implicit.harvard.edu /implicit/education.html

2-5  Organizing Schools to Address the Strengths and Challenges of Students with Exceptionalities Schools are one of our most important social institutions. Understanding how they work helps us gain perspective on ways to support students’ success. Interestingly, one of the by-products of the COVID-19 pandemic has been a growing realization of just how vital schools are. School were recognized not only for the critical role in the education of students, but also for being central to the economic well-being of the country. As school districts pivoted to online learning, many children and families came to appreciate the key role that “going to school” had played in their lives; businesses likewise grasped the importance of schooling to the workforce, many of whom are parents. Most of us consider ourselves to be experts on schools; after all, haven’t we attended them for twelve or more years? But as students we only experience one side of schooling and are often unaware of the substantial infrastructure that

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools operates behind the scenes so that we can get an education. The legislation has set the expectation that children with disabilities will have a free and appropriate public education. The courts have reaffirmed these rights and specified some of the conditions under which these rights must be met. It is now up to educators to provide the framework by which benefits can flow to students. Our discussion of schools as institutions focuses on the organizational structures that affect teachers and other staff’s ability to support students with exceptionalities. The goal of schooling is not just to meet the minimum threshold of needs for students with exceptionalities—the goal is to help each student reach their potential. McNulty and Gloeckler (2011) have outlined five key elements by which schools can reach these high expectations: 1. Ownership: Understanding among all faculty and staff that students receiving special education services are the responsibility of everyone. 2. High Expectations: Understanding by administrators, faculty, and students that all students will be challenged and expected to perform to the best of their ability. 3. Intervention Systems: Policies, procedures, and protocols to ensure that struggling learners meet academic and/or behavioral expectations as measured by improved performance. 4. Inclusion/Collaborative Teaching: Teaching methodologies in which students receiving special education services are included in the general education classrooms and have access to both content and special education expertise. 5. Organizational/Professional Development: Successful programs for all struggling learners depends on a strong foundation of evidence-based curriculum and instruction, the use of appropriate student assessments, and a process for data-driven decision making; often professional development is needed to support teachers in these areas. The idea that every adult within a school plays a role in shaping the outcomes for every student is what McNulty and Gloeckler call “ownership.” This ownership is central to the success of students with exceptionalities who may otherwise become educationally marginalized if they are deemed to be the responsibility of “special education” alone. The schoolwide organizational models for supports and services, discussed next, are specifically designed to promote ownership and to support collaborative approaches to addressing students’ strengths and challenges.

2-5a  Inclusion of Students with Exceptionalities within General Education Classrooms Inclusion has been a significant movement in special education. As an educational philosophy, inclusion essentially says that children with exceptionalities should be a part of, not apart from, general education. The formation of social relationships is an overarching goal of inclusion. This goal is reflected in the position of The Association for Persons with Severe Handicaps (TASH), which advocates for inclusion. TASH’s support for full inclusion follows this path of reasoning: If we are to have, as a major goal, the social integration of persons with disabilities into adult society, then the school environment should foster the development of social skills, personal friendships, and relationships among children with and without disabilities. These skills are available to nondisabled persons in the natural course of their educational experiences. The social benefits for students with and without disabilities is a strong argument for the inclusion of students with exceptionalities. In practice inclusion ranges from full-time placement within a general education setting to partial inclusion for specific time periods or activities. Figure 2.2 shows the current placements for students with disabilities across settings.

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Settings for Students with Disabilities 2.7% 2.2%

60%+ in the specialized classroom 13.1%

18% 64%

30–59% in special education classroom 80%+ in general education classrom Separate school for disabilities Private school, homebound, other

◗ Figure 2.2  Percentage of Students Served Across Settings Source: Percentage distribution of students 6 to 21 years old served under Individuals with Disabilities Education Act (IDEA), Part B, by educational environment and type of disability: Selected years, fall 1989 through fall 2018.

ZUMA Press, Inc. /Alamy Stock Photo

You may recall from Chapter 1, however, that 68 percent of White students with disabilities spend 80 percent or more of their time in general education classrooms while only 60 percent of Black and 63 percent of Hispanic students are with their general education peers for more than 80 percent of the time. These numbers show that while inclusion is a widely accepted philosophy, its implementation has not yet fulfilled its aspirations. The success of inclusion depends on the resources available to help general education teachers meet the range of needs within their classrooms. Will special education teachers be available in the classroom with the general education teacher to help with special instruction? Will paraprofessionals be present to support children with special needs? Will general educators have the support they need to develop their knowledge and skills to with children with exceptionalities? Without adequate resources, it is difficult for any teacher to provide the support needed for students with exceptionalities to thrive. The inclusion movement began, in part, as a response to the legal requirement that students be placed in the “least restrictive environment.” The principle of least restrictive environment, however, requires that the educational setting should maximize the chances that the child with exceptionalities will be successful. The meaning of “least restrictive” could be reframed as “most optimal,” which may or may not be full time placement within the general education classroom. Inclusion has a better chance of being successful when a conInstruction can be adapted to the differences found in exceptional children tinuum of services is available and when in several ways—by varying the learning environment, the content of schoolwide structures, like those discussed lessons and the skills being taught, and by introducing technology that next, can provide support for the classcan meet special needs. room teacher.

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools

2-5b  Multitiered Systems of Support (MTSS) One educational strategy that integrates both general and special education, providing a framework for inclusion, is Multitiered Systems of Support (MTSS). The illusion of two separate groups of children (“regular” and “special”) has been created by laws designed to aid children with exceptionalities. One unintended consequence of these laws has been an overemphasis on eligibility for special education rather than a focus on meeting children’s individual needs through educational problem solving. Many children who do not qualify for special education have trouble learning in school and need additional support to meet with success. Many children who are not eligible for gifted education have strengths that should be enhanced and nurtured. MTSS is a tiered approach to supports and services that addresses the strengths and challenges of the children who fall between general and special or gifted education. MTSS hinges on greater collaboration across all faculty members to ensure that the strengths and challenges of each student are addressed. The range of students’ needs can feel overwhelming to a teacher, but the good news is that in today’s schools teachers are not expected to do the job alone! Teams of teachers can work collaboratively and in fact, this collaborative approach is supported by the MTSS approach. MTSS can be implemented in many ways, but most multitiered approaches are based on the following key components: ●  Tiered

hierarchies of supports and services; most often three tiers assessments and progress monitoring for data driven decision making about a child’s strengths and challenges and to document student growth ●  Standard protocols, drawn from evidence-based practices, for intervention when children need more support or enhancement ●  Problem-solving approaches that include parents and students to plan supports and services ●  Comprehensive

MTSS brings together important information about the child (including data on the child’s strengths and challenges) with evidence-based instructional approaches, so that teachers and related service providers can recognize and respond to students’ needs. Rather than a “one-size-fits-all” approach, MTSS is designed to strategically match supports and services with the intensity of student’s strengths and challenges. Using this framework, we can provide extra support for children who do not need the intense and full services we provide through special education. We can also provide additional enhancements for children who need them. Tiered supports and services allow us to match the child’s strengths and challenges with appropriate interventions. As you look at the MTSS triangle, shown in Figure 2.3, you will see that the shading deepens as you move from the bottom to the top. This shading indicates that the supports and services offered at each tier increase in intensity and duration—with Tier III being the most intense level of service. You may also notice, as you examine the MTSS triangle, that there are dashed lines between each tier. The dashed lines are important because as children develop and as their strengths and challenges change, our educational services should also change. In Chapter 1, we discussed intraindividual differences that reflect the unique set of strengths and challenges that any given individual will have. Because of these intraindividual differences, a student will likely require supports and services, delivered simultaneously, from across the tiers to be successful. All students will need the Tier I services with solid supported access to the general curriculum; some students will simultaneously need additional support for one or more content areas and/or enhancements in an area of

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Organizing Schools to Address the Strengths and Challenges of Students with Exceptionalities

TIER III

TIER II

TIER I

Intensive Instruction

Targeted Instruction

Core Instruction

Few Students

Some Students

All Students

◗ Figure 2.3  Multi-tiered Systems of Support TeachSource Digital Download   Access online

strengths; and a few students may require more intensive interventions delivered at Tier III to meet with success. So what kinds of support would likely be available at each tier? ●  Tier

I: Evidence-based core instruction with universal supports and services are typically provided in a general education setting for all children. This tier incorporates universal screening to detect if children need any additional support or enhancement to meet with success, and progress monitoring to ensure that the support being provided is appropriate for the child. Progress monitoring is critical because it allows educators to see very quickly when a child needs additional supports and enhancements to achieve success. For children who need more intense supports or enhancements, we can move to Tier II. ●  Tier II: Standardized interventions with targeted supports and services are provided collaboratively, drawing on general and special educational resources, and additional personnel when needed. These supports and enhancements become more focused based on the documented strengths and challenges of each child. These services may include more intensive and explicit instruction or more rigorous and challenging curriculum provided in smaller groups, and will often involve more frequent progress monitoring to make sure that learning stays on track. Some children will need even more intensive supports and/ or enhancements to meet with success. For these children, Tier III should be considered. ●  Tier III: Intensive individualized supports and services are provided to address specific student strengths and challenges. These supports and services may include the formal identification of students for special and/or gifted education. Supports and services provided at Tier III are tailored specifically to the child’s strengths and challenges and typically require individualized educational programming (IEP) or a 504 plan (these are discussed later in this chapter). Most of the students you will meet in this text will receive supports and services at the Tier III level. Key to working within a tired framework is that our educational supports and services must remain flexible, adjusting to meet the evolving requirements of each student as we monitor their progress and growth. It is also important to remember that tiered services are not hierarchical; you do not start at Tier I and progress to Tier III. Students with intense needs may be referred for the services provided at Tier III at any time from the other tiers.

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools

Box 2.2

Exceptional Lives    Exceptional Stories:

Inclusion for Cara

Cara is a 13-year-old girl who has been diagnosed with mild autism. She attends seventh grade in a midwestern suburban public school. Cara’s parents can be considered middle to upper middle class, and both have university degrees. Both she and her only sibling, a younger brother, have been identified as having autism. Both have received special education services throughout their public school education. Cara is fully included in the classroom and receives speech and language services as well as the services of a special education teacher. Her brother has more intensive needs and requires greater accommodations and services. Unlike many children with autism, Cara does not demonstrate intellectual or developmental disabilities. Testing has revealed that Cara’s intellectual ability and academic achievement are mostly in the average range; in mathematics, however, Cara is significantly above average. Her scores indicate that she is very advanced and could be accelerated by two years in math. She can be described as a solitary child who enjoys horseback riding. Cara has often told her parents, “I’m a loner. I like to be with animals more than people.” While an interest in horses can be typical for a child of her age, her range of interests is restricted, and she will “get stuck” on the topic of horses and their care.

The social requirements of family get-togethers are also difficult for her. She will greet everyone only if promised she can go to her room afterward. Cara does not seek social interactions and will often avoid situations in which she must interact with others. Until the second grade, Cara never entered the classroom nor went to her seat directly. In an effort to avoid peer interactions, she would circle the room along the wall until she reached her seat. Up until age 10 or so, she observed others and played in parallel. It has only been within the last two years that she has started to initiate social interaction with her peers.

Reflection: ●

Think about Cara’s strengths and needs. How could these be addressed in an MTSS? How could her strengths in math be met while still accounting for her delays in social development? In what ways would input from Cara’s parents be helpful in planning to meet her educational needs?

Source: Adapted and used with permission of Council for Exceptional Children, from “Strategies for increasing positive social interactions in children with autism: A case study,” by Welton et al., from Teaching Exceptional Children, 37(1) 40–41, copyright © 2004 by Council For Exceptional Children (VA); permission conveyed through Copyright Clearance Center, Inc.

The use of a collaborative planning process is a central part of MTSS. This planning process brings together a multidisciplinary problem-solving team to explore what supports and services would be needed to optimize the student’s success. The problem-solving team generally includes general, special, and gifted education teachers. It may include an MTSS coach, related service providers, counselors, or other specialty personnel when appropriate. Parents are key members of the MTSS team, and indeed one of the prominent features of most MTSS programs is the deeper engagement of parents as partners to their child’s success (Weingarten et al., 2020). Parents play a key role at each tier. Tier I focus is on getting to know the families of our students and developing multidirectional communication networks to keep in touch. At Tier I we also share information about MTSS in general and about the child’s strengths and challenges in particular. With Tier II, just as supports and services become more targeted for the student, our communications with families must be more in-depth, including sharing of progress monitoring data and seeking input on plans for interventions. Parental involvement with Tier III includes ensuring that parents understand their child’s rights and meeting to plan for their child’s needs. Communication about

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the child’s progress should be more frequent at Tier III so that supports and services can be adjusted if need be. In summary, MTSS is not a linear set of services by which a student begins in Tier I, moves to Tier II, and finally is served in Tier III. All three levels of services are often needed by the same child for different aspects of their supports and enhancements. The three tiers are designed to help teachers and service providers determine the level of the child’s needs in order to organize their responses to meet these needs. Again, remember that the greater the strengths and challenges of the child, the more intensive the services must be. Taken as a whole, the MTSS approach attempts to bring together the best of general and special education to create a bright future for children with exceptionalities.

2-5c  Positive Behavior Interventions and Supports (PBIS) Like MTSS described above, positive behavior interventions and supports (PBIS) is a three-tiered, schoolwide model that scaffolds support to match students’ needs. PBIS focuses on creating a schoolwide climate of support that encourages students to use proactive behaviors while helping them avoid behaviors that lead to negative consequences. One goal of this evidenced-based model is the reduction of disciplinary actions (Horner et al., 2010). This goal is reached by establishing a positive social climate schoolwide and providing individual behavior supports when needed to support the success of all students. Key components of PBIS include: ●  Establishing

clear, schoolwide, expectations for behavior data to establish baselines, monitor progress, and determine outcomes for the students, teachers, and the program ●  Identifying a set of early warning signs that things are not working (e.g. drop in grades, disciplinary actions, social engagements, absents) and using these to initiate appropriate interventions as soon as possible ●  Providing scaffolded interventions within and across the tiers to address behavioral concerns as they emerge ●  Identifying logical consequences for behaviors and a standardized process for matching consequences with behaviors (note: this may help to reduce the disparate impact of disciplinary actions for students who are BIPOC described in Chapter 1) ●  Using

Positive Behavior Interventions and Support www.pbis.org/

While PBIS is a general, or whole school, initiative, it was specifically mentioned in IDEA (see Chapter 1) because creating a safe and supportive learning environment is essential for students with disabilities. Box 2.3 shares some ideas on creating a calm environment within the classroom. The tiers used to deliver supports within PBIS increase in intensity as the student needs additional support for success. Tier I, the universal support for student behaviors, is the core of the program and is the foundation for student success. Tier I activities include teaching school-wide expectation, acknowledging appropriate behaviors, and correcting errors. Data are used by the PBIS team to monitor progress and identify areas where intervention is needed. Tier II, targeted interventions, are accessible to students within 72 hours of referral. These interventions align with the schoolwide expectations and support student growth in self-regulating and pro-social skills to support their behaviors. Intervention teams coordinate the delivery of Tier II services, and parents are key member of the team. When students need additional supports for success, Tier III intensive interventions are provided by a multi-disciplinary team. These interventions

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools

Box 2.3

Mindfulness Matters:

Moving from Chaos to Calm

Schools and classrooms can be hectic places with a lot going on; a busy and positive environment is often part of learning. But sometimes things move from busy to chaotic. Chaotic environments can be stressful, and this stress can undermine learning and sabotage our best thinking. Why This Matters: Everyone does better when they are calm and alert; we are better able to focus on what is important and we make better decisions. When things get hectic, we can feel stressed and we are more likely to react on auto-pilot to the situation or the person. When we feel stressed, our reactions are often not as helpful as they could be. At times like this my grandmother would say, “Take a deep breath,” “Stop and count to 10,” or “Look before you leap.” Her advice was sound! When we pause, we reestablish our ability to think more clearly, and when we are calm, we can better manage our responses. We can even recognize and reframe our implicit biases. (See the discussion in this chapter.) Operating from an alert and calm place allows us to defuse tensions rather than escalating them, and an alert and calm mind is ready for learning! Practicing Mindfulness: One strategy that can help us move our classrooms (and ourselves) from chaos to calm is S.T.O.P., which is an acronym for Stop, Take a deep breath, Observe your feelings and your environment, Proceed with thoughtfulness. How might this look in our classroom? 1. We can talk with our students about what happens when we are feeling stressed and how this

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can impact our thinking, our words, and our actions. 2. We can help our students explore times when they have felt stressed and have thought, said, or done things that they latter regretted (felt badly about). We can give them examples from our own experience. 3. We can talk about how it feels when we are calm and alert, exploring how being calm and alert can help us in our learning and in our relationships. 4. We can teach them to S.T.O.P. when they recognize that they are stressed and that they might not be able to be their best selves at that moment. Helping students observe their feelings and their environment may take time, several discussions, and practice. 5. We can discuss what it means to “proceed with thoughtfulness” and give examples of what may happen when we are able to this and what happens when we are not. 6. We can practice and model S.T.O.P. throughout the day when we need to bring some calm to our class. We can make a class STOP sign to signal that we need to move from chaos to calm. 7. Each student can make their own STOP sign, using index cards or other art supplies. These can be used as concrete reminders for ourselves and for each other that we need to stop and focus on being alert, calm, and thoughtful in our response to a situation or person. As it turns out, my grandmother was right!!

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focus on problem-solving, identifying the pattern of behaviors, examining the purpose of the behaviors (e.g., why is the student engaging in these behaviors), and exploring ways to prevent the unwanted behaviors while reinforcing appropriate behaviors. Students who receive Tier III interventions need wraparound supports, which begin with a functional behavior assessment (FBA) and often lead to a behavior intervention plan (BIP) (these will be discussed in Chapter 8). While some of the students who receive Tier III support will be formally identified with disabilities, many will not have been identified. If you see similarities between MTSS and BPIS, this is not a coincidence. These tiered approaches are often used in tandem to address academic and behavior outcomes. Academic accomplishment and behavioral adjustment are directly related, and both aspects of development must be in place for student success.

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Organizing Schools to Address the Strengths and Challenges of Students with Exceptionalities

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2-5d  Co-Teaching for Students with Exceptionalities When done well, co-teaching is one of the most effective ways to address the strengths and needs of students with exceptionalities within the general education classroom (Friend, 2008). In co-teaching, the general and special educators share instructional responsibility, resources, and accountability for all the students in the classroom. Together, teachers plan, present, and evaluate instruction and student progress. They also share equally in the classroom and behavior management. Successful co-teaching requires sufficient time to plan, positive collaborative relationships among teaching partners, and administrative support for the co-teaching arrangements (Fowler et al., 2019; Scruggs & Mastropieri, 2017).

2-5e  Continuum of Services for Students with Exceptionalities

Purestock/Jupiter Images

The organizational strategies presented above are excellent steps toward ensuring that students with exceptionalities are included as full members of the schoolwide community. The acceptance as full and valued members within the school community is a central to the well-being of all students. When students are marginalized for any reason—race, ethnicity, economic status, or exceptionalities—this disenfranchisement undermines their ability to be successful. “Belonging” to the school community supports well-being (Fowler et al., 2019). But belonging is not dependent on placement. Students may be “fully included” in the general education classroom and still be comWhen a student feels a sense of “belonging” we know that they are in the right place! pletely marginalized if that classroom cannot or will not address their needs. If the social climate of the classroom engenders ignoring, ostracizing, or bullying students who are deemed “misfits,” then the placement within this setting can be traumatizing rather than supportive. In a national survey, special educators rated the “sense of belonging” for their students (see Figure 2.4). Over half of the special education teachers (51%) surveyed indicated that their students felt a sense of belonging to the school community most of the time or always. However, the remaining 49 percent of respondents believed that their students felt a sense of belonging never (2%), sometimes (20%), or about half of the time (27%). On further analysis, the authors report significant differences of respondents’ ratings based on the setting where they taught, with higher ratings for a sense of belonging for general and resource-room teachers than for those who taught within self-contained special education classrooms (Fowler et al., 2019). Ensuring that students feel a strong sense of belonging, regardless of where they receive services, is a critical responsibility of all educators. It’s important to realize that the reason special education exists is not that regular education has failed. Even with the very best schoolwide supports and services and collaboration across general and special education, there will be students whose strengths and challenges require more intense and personalized attention. These are students with the most complex and intense needs, and it is critical that we offer educational options to support their growth. The continuum of services is designed to offer a range of options to ensure that student strengths and needs can be addressed. Some options, such as hospital-school care, may be needed for short-term support during critical periods; other placement options like special schools or summer programs may be needed to for student-specific knowledge and skills, like learning Braille or sign language. The main idea is that placement in any service must be based on the best available data showing what the student’s

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools 2% 7%

Always

20%

Most of the time About half of the time 44%

Sometimes

27%

Never

◗ Figure 2.4  Special Education Teachers’ Rating of Their Students’ Sense of Belonging Source: Fowler, S., Coleman, M.R., Bogdan, W., (2019). The State of the Special Education Profession Survey Report. Teaching Exceptional Children Sept-Oct (52)1. pp. 8–41.

strengths and challenges are at the specific time that placement decision is made. These decisions must be regularly reviewed as new data emerges and adjusted when needed. The continuum of services shown in Figure 2.5 moves from the general education classroom, where the majority of students with exceptionalities will receive services through hospital/treatment facilities. As we move up the continuum, the supports and services become more intensive to address more personalized strengths and challenges. Remember, placement in any given service option is based on the student’s strengths and challenges at that time; each placement decision must be made in order to optimize the student’s success. As we look at the continuum of services, it is also important to remember our earlier discussion of belonging to the school community. Schools that offer fulltime special classes, for example, will need to carefully think about how to ensure that these students are a full and valued part of the school community. This can be done with a variety of strategies that foster connecting with, supporting, and accepting students with differences. Table 2.4 shows some building blocks for fostering a sense of belonging for all students.

Most Intense

Hospital or Treatment Center Homebound Instruction Special Residential School Special Day School Fulltime Special Classroom Part-time Special Classroom with Part-time General Classroom (Tier II and Tier III supports) General Education Plus Resource Room or Tier II supports

Least Intense

Tier I: General Education Settings with Accommodations and Modifications

◗ Figure 2.5  Continuum of Special Education Services

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The Individualized Education Program and 504 Plans for Students with Exceptionalities

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Table 2.4  Building Blocks for Belonging Start a “Big Sister Big Brother Club” or “Circle of Friends” that match students with disabilities with other students who can provide social support in both formal and informal ways. Students may periodically have lunch together, attend school functions or events, share membership in school clubs, or just check-in with each other as friends in person and on social media. Join the Best Buddies Program (https://www.bestbuddies.org/), an organization “dedicated to ending the social, physical, and economic isolation of the 200 million people with intellectual and developmental disabilities.” Develop social events that intentionally build in inclusion and celebrate differences. These might be drumming circles, service projects (e.g., working at an animal rescue), community gardening, or landscaping a part of the school yard with a butterfly garden. Plan for family events that promote inclusion. School fairs, work projects, and celebrations can all be more fun when everyone is invited and welcomed. Use the arts, both preforming and fine, as vehicles for intentional inclusion. The Council for Exceptional Children’s Division for the Arts (https://community.cec.sped.org/darts/home) is a good place to start! Review your existing programs, clubs, and events. Are these intentionally inclusive? Who typically attends? Who seems to be left out? How could you make these more inviting and welcoming?

Programs like MTSS, PBIS, and co-teaching foster ownership, teamwork, and collaboration across the adults within the school. These approaches create an environment where differences are accepted and “normalized.” This is a first step in creating a climate of belonging, but we need to go further to ensure that differences are not just accepted but that they are honored with the deep understanding that it is our uniqueness that makes us who we are and our differences that that makes us stronger as a community.

2-6  The Individualized Education Program and 504 Plans for Students with Exceptionalities The laws and court decisions require that schools address the strengths and needs of students with exceptionalities and educators understand that often something different must be done to support their success. But what should this “something” be? There are two significant educational safeguards for students with disabilities and their families. These are the IEP and the 504 plan, and while they both outline the supports and services that eligible students will receive, there are some key differences between them (see Table 2.5). These differences hinge on the original laws—IDEA, a special education law, and the Rehabilitation Act (Section 504), a civil rights law—that stipulate the IEP and 504 plan respectively. IDEA is more specific in its requirements for who is eligible and how the IEP is developed and implemented; Section 504 allows for a broader definition of disability, so students who do not meet the IDEA criteria may qualify for support through Section 504. Both IEPs and 504 plans are key to guiding the educational supports and services that students will receive to help them be successful. As you read more about them, keep in mind how they are similar and how they differ from each other.

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools

Table 2.5  Comparison of IEPs with 504 Plans Individual Education Program

Section 504 Plans

Part of IDEA Special Education Law (2004) requiring free and appropriate education for students with disabilities; states receive additional funds for implementing.

Section of the Rehabilitation Act, Civil Rights Law (1973) protecting individuals with disabilities against discrimination; states do not receive any additional funds for implementing but may lose funds if they are not in compliance.

Who Is Eligible?

Who Is Eligible?

1. Any student who qualifies for one or more of the 13 disabilities listed in the law (see Chapter 1, Table 1.1). 2. The disability must impact the student’s learning and access to general curriculum, and they must need special education services to make progress in school.

1. A student with any disability that interferes with their ability to learn within the general education classroom. Section 504 defines disability more broadly than IDEA and includes anything that significantly limits the student’s basic life activities.

Who Develops the IEP?

Who Develops the 504 Plan?

This is specifically prescribed by IDEA as including parents/caregiver, general education teacher, special education teacher, school psychologist to interpret evaluations, district representative of special education services.

A team of people who know the student and understand the data and service options. This might include the student’s parents, general and special educators, and the school principal.

What Is in an IEP?

What Is in a 504 Plan?

While each state has its own specific forms for the IEP, it must include:

There is no specific format for the 504 plan, but it usually contains the following information:

1. The present levels of academic achievement and functional performance 2. Annual measurable goals 3. Services the student will receive 4. Accommodations and modifications needed for learning and assessments 5. How the student will be included within the general education program How are student and family rights protected? 1. Parents must be given notice of placement changes in writing and can use the “stay put rights” if they are disputing the change. 2. Parent or caregiver must consent in writing to evaluations and services. 3. Plan reviewed each year with reevaluation every three years. 4. Disputes can be resolved via mediation, due process complaint, resolution session, civil lawsuit, state complaint, or lawsuit.

1. The accommodations and modifications that the student will receive to remove their barriers to accessing the general curriculum 2. Who will be responsible for delivering each of these accommodations and modifications 3. Name of the person responsible for ensuring that the plan is implemented How are student and family rights protected? 1. Schools must notify parents about evaluations or any significant change to placement. 2. Parental or caregiver consent is required for evaluation of the student. 3. Generally, plan is reviewed each year and reevaluation is done every three years. 4. Disagreements can be resolved through mediation, alternative dispute resolutions, impartial hearing, complaint to the Office for Civil Rights, or lawsuits.

2-6a  Individual Education Program In 1972, Dr. James Gallagher, one of the authors of this text, proposed that a special education contract for each student with a disability be developed. He felt that this should have specifically stated goals to clarify the expected student outcomes and that the plan include a means to determine if these goals

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The Individualized Education Program and 504 Plans for Students with Exceptionalities had been met. He also recommended parental participation in the development of these plans. His recommendations were codified in the Education for All Handicapped Children Act (1975), which required that each child must have an individual plan to meet their needs, and the individualized education program (IEP) was born. The IEP is the heart of special education (Boothe & Hathcote, 2021). It lays out the blueprint for supporting each student’s success. It clarifies what needs to be done, and it specifies how we will know when we have done it. The IEP is also a legally binding contract that once agreed to, must be followed. Planning to address the strengths and needs of students with exceptionalities is done by a team. The IEP team must include: ●  The

child’s parent/caregiver/guardian least one of the child’s general education teachers ●  At least one of the child’s special education teachers ●  A school psychologist or other specialist who can present and interpret evaluation data ●  A district representative with the authority to make special education decisions ●  At

The IEP team may include other professionals who will be involved in support the student (see Figure 2.6). These addition team members may be related service providers (e.g., speech language therapist, occupational therapist, audiologist, physical therapist, school nurse), intervention specialists, specialty area teachers, family-school liaisons, work-school coordinators, or others who have a stake in the student’s program. Including the student on the IEP helps to promote selfadvocacy and to ensure that the student’s IEP truly reflects the student. Even young students can participate in meaningful ways to help shape their IEP, and older students need a seat at the table as the IEP will be shaping their lives. The required presence of the parent or guardian is a clear sign that the IEP is expected to incorporate the wishes and feelings of the family of the student as well as the educators involved. The supports and services for students with exceptionalities are often delivered by teams of adults across multiple settings, and coordination can be challenging. The plan helps to facilitate this coordination by ensuring that everyone has a clear understanding what is expected and who is responsible for each component.

School system representative

Special education teacher(s) or provider

General education teacher

Others with knowledge or special expertise about the child

Required team members

Parents

Student

Important additions to the team

Transition services agency representative

A person who can interpret evaluation results

◗ Figure 2.6  A Student’s IEP Team Source: Salvia, J., Ysseldyke, J. & Bolt, S. (2007). Assessment: In special and inclusive education.

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools

Box 2.4

High Leverage Practices

High Leverage Practice 1: Collaborate with professionals to increase student success. Teachers collaborate with general education teachers, paraprofessionals, and support staff to help students reach their academic and social learning goals. Effective collaboration requires sharing ideas, using active communication, and problem-solving. Planning for student success is data-based and addresses the allocation of responsibilities and resources to maximize student learning.

and measurable student outcomes and developing a plan to support reaching these goals. They develop agendas, manage the meeting times, encourage the sharing of multiple perspectives, and work to build consensus across participates.

Reflection: ●

What kinds of student data would you want to have in hand as you prepare for an initial IEP meeting?

High Leverage Practice 2: Organize and facilitate effective meetings with professionals and families. Teachers lead and participate in a range of meetings (e.g., IEP and 504) with the purpose of identifying clear

High Leverage Practices in Special Education https:// highleveragepractices.org/

Just as the members of the IEP team are specified by law, key components of the IEP are also defined. Table 2.6 shares the specific requirements of the IEP. The student’s present level of academic achievement and functional performance (PLAAFP) establishes the baseline for the student’s achievements and should include any academic or behavioral areas that will be addressed in the IEP. This is also a great place to make sure that the student’s strengths are described. All too often we get bogged down thinking about how we are going to support the student in their areas of challenge and we forget that addressing their strengths is just as important and that sometimes these strengths can be a pathway to supporting or mitigating the areas of challenge. The measurable annual goals should address the student (the who); what they will do (the behavior); at what level (the observable criterion); under what conditions (the where and circumstances); and the timeframe for accomplishing goals (length of time needed). These goals set the long-term agenda for the student, and they should be reviewed and adjusted periodically. Short-term objectives, covering 1 to 3 months, are only required for students with the most significant cognitive challenges. When short-term objectives are needed, they should follow the same format as annual goals, but of course reflect a shorter duration. In addition, the IEP must include a description of how the student’s progress toward meeting these goals and objectives will be measured. The IEP will also outline what specific special education and related or supplemental services will be provided to support the student’s achievement of the annual goals, access to the general education curriculum and extracurricular activities, and participation in other non-academic activities with their nondisabled peers. If the student will not participate in the above, then the IEP should explain why these activities are not deemed appropriate. Determining which assessments the student will take and the conditions under which the assessments will be conducted is a critical role of the IEP team. The majority of students with exceptionalities are required to participate in state assessments. These high-stakes tests are important to show how individual students are faring and to help us gage how groups of students are doing. Disaggregated data

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The Individualized Education Program and 504 Plans for Students with Exceptionalities

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Table 2.6  Individualized Education Program (IEP) The IEP is a written document that is developed for each eligible child with a disability. It includes: ●

A statement of the child’s present levels of academic achievement and functional performance, including: ●



A statement of measurable annual goals, including academic and functional goals designed to: ●

● ● ●





Meet each of the child’s other educational needs that result from the child’s disability

A statement of the special education and related services and supplementary aids and services, based on peer-reviewed research to the extent practicable, that are to be provided to the child, or on behalf of the child, and a statement of the program modifications or supports for school personnel that will be provided to enable the child: ●



Meet the child’s needs that result from the child’s disability, to enable the child to be involved in and make progress in the general education curriculum

A description of how the child’s progress toward meeting the annual goals will be measured





How the child’s disability affects the child’s involvement and progress in the general education curriculum (i.e., the same curriculum given to nondisabled children) or for preschool children

To advance appropriately toward attaining the annual goals To be involved in and make progress in the general education curriculum and to participate in extracurricular and other non-academic activities To be educated and participate with other children with disabilities and nondisabled children in extracurricular and other non-academic activities

An explanation of the extent, if any, to which the child will not participate with nondisabled children in the regular classroom and in extracurricular and other non-academic activities If the IEP team determines that the child must take an alternate assessment instead of a particular regular state or districtwide assessment of student achievement, a statement of why: ●

The child cannot participate in the regular assessment



The particular alternate assessment selected is appropriate for the child

The projected date for the beginning of the services and modifications and the anticipated frequency, location, and duration of special education and related services and supplementary aids and services and modifications and supports

Source: Office of Special Education Programs, U.S. Department of Education, 2004.

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from these tests can help us compare outcomes for groups of students to see if we are making gains in reaching equity across groups. The data also show us student accomplishment levels to help us determine if we are meeting goals of excellence for our students. In spite of their importance, these assessments are not appropriate for some students. Between 3 percent and 5 percent of students will need alternative assessments to show their growth. Most of these students will have significant cognitive challenges, and their IEPs will specify that an alternative assessment is necessary to measure the student’s growth. When the student becomes sixteen, their IEP must begin planning for their postsecondary life. Surveys have shown a number of former special education students having problems adjusting to adulthood in the community (see U.S. Department of Education, 2004). Because of these difficulties, transition planning is now included within the IEP when the child turns sixteen, or younger if determined appropriate by the IEP team, and updated annually thereafter. The transition plan must include the following: appropriate measurable postsecondary goals based upon age-appropriate transition assessments related to training, education, employment, and, where appropriate, independent living skills. The goals set in the transition plan should be the student’s. If you think about Marcus from Chapter 1, you will remember that he was interested in becoming a mechanic. As members of his IEP team, he and his parents help to develop appropriate supports and strategies to help him reach his goal.

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools For some students, getting a driver’s license becomes an imperative. Sometimes this is for social or personal self-esteem, but it a driver’s license may also be critical for employment. One student, Paul, who has reading difficulties, is worried that these may cause setbacks on the state driver’s license exam. Getting his driver’s license is one of his stated transition goals and to accomplish this, he will need support. His transition plan includes special tutoring, special practice exams to give him the confidence to pass, and a driver’s education class to help him with the actual driving skills. In this case, accountability for reaching his goal is fairly direct. If he passes the exam and gets his driver’s license, the transition plan will be successful. Box 2.5 provides a look at Paul’s IEP transition goals. For students with significant behavioral problems, the IEP may also include a functional behavioral assessment (FBA) and a behavior intervention plan (BIP) (these are discussed in detail in later chapters). These additions are required for students with disabilities who have been excluded from school for more than ten days for disciplinary reasons. The IEP becomes a legally binding contract once it has been signed by parents and school personal. Implementing the IEP is required by law; it is not optional, and as we saw earlier in the chapter there are many court cases showing the expectation that the law will be followed!

2-6b  Section 504 Plans Section 540 of the Rehabilitation Act (1972) addresses the civil rights of students who have disabilities that prevent them from accessing the general education curriculum. Because disabilities are more broadly defined as significant impacts on basic life activities (e.g., learning, reading, communicating, or thinking), students who may not be eligible under IDEA can still qualify for additional supports and services under Section 504. The disability area must significantly impact the student’s ability to learn within the general education classroom, and the purpose of the 504 plan is the removal of barriers to full participation and learning. Students who qualify under Section 504 get what is usually called a Section 504 plan that stipulates the accommodations and modifications needed. The specific requirements for the development of a 504 plan are not as stringently detailed as those for an IEP (see Table 2.5), but the 504 plan is still a legally binding document that must be followed. The 504 plan should specify what specific accommodations

Box 2.5

Case Example: Transition Planning Goals for Paul’s IEP

Paul, who has a relatively severe reading disability, has special concerns about getting a driver’s license, which is necessary to his employment. Therefore, the following transition plans will be added to his IEP: Present Level of Academic and Functional Performance (PLAAFP): Paul has been practicing driving with a learner’s permit but worries about passing both the written and driving test needed to get his license.

with disabilities and will take special instruction in map reading and route highlighting. Goal: By March 1, Paul will be given a practice exam and will score 70 percent or better. Given a city map, Paul will highlight common routes he follows to work and routes to the mall, downtown, and so forth. By March 15, Paul will take the licensing exam and the driving exam.

Special Education: Paul will seek from the Division of Motor Vehicles any accommodations made for students

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The Individualized Education Program and 504 Plans for Students with Exceptionalities and modifications a needed by the student, who will be responsible for delivering each of these, and who is responsible for ensuring that the 504 plans have been implemented. Because accommodations and modifications are critical to both the IEP and the 504 plan, we will look at these in greater detail next.

2-6c  Modification and Accommodations to Support Student Success Students who have either an IEP of a 504 plan will likely receive both accommodations and modifications to help them be successful. While it may seem like accommodations and modifications should be the same thing, in special education they have two very different meanings. An accommodation is a change in how a student learns the material while a modification is a change in what a student is taught or expected to learn. Accommodations help students learn the same content as their nondisabled peers; the curriculum does not change but the way the student accesses the material does. Students with specific reading disabilities, for example, may need audio-books to access information. If you think about the information processing model (IMP), discussed in Chapter 1, you can see that accommodations often use an alternate pathway to get the information into the student’s brain! Some accommodations simply offer more time for the student to complete a given task or assignment. Other accommodations may address the format for the task or assignment (e.g., an oral presentation vs. a written document vs. a photo-essay). If accommodations are needed for learning, they are also critical during assessments of learning and should be used for both classroom and standardized tests. Here are some common accommodations that can be made to help students access learning: ●  Large

print materials reader for the student ●  Visual presentations of content ●  Audio presentations of content ●  Witten directions for tasks ●  Digital media to access content (e.g., movies, video) ●  Altered the response formats (e.g., spoken, written, artistic, dramatic) ●  Technology (e.g., spell checkers, dictation, calculators) ●  Extended time, projects divided into smaller steps, flow-charts to manage work ●  Designated

Any of these accommodations can be added to an IEP or 504 plan if they will help the student access the general education content. When a student receives modifications, the content itself has been adjusted to better meet their learning needs. The content may be shortened, simplified, or replaced to bring it in line with the student’s learning level and needs. When modifications are made to the curriculum or content, these must be followed with alternative assessments for both classroom and standardized testing. It would be markedly unfair to test a student on curriculum or content that they were not taught! Some common modifications include: ●  Replacing

classwork or homework with more appropriate material alternative projects or assignments ●  Developing a simplified version of assignments ●  Taking alternative assessments based on the student’s individualized learning goals ●  Creating

The purpose of both the IEP and the 504 plan is to match the student’s strengths and challenges with appropriate supports and services to help them be successful. The use of accommodations and modifications is central to supporting learning.

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools Universal design for learning, described next, is one approach for incorporating many of these accommodations and modifications into the general curriculum and learning environment to support all students.

2-7  Universal Design for Learning The accommodations and modifications described above are designed to “retrofit” the curriculum and instruction to better meet the needs of the student. This retro-fit is needed to help the student access a curriculum that was designed for the “typical” learner. But what if we could design our curriculum and instruction, from the beginning, so that all students could have access? This is, in fact the goal of Universal Design for Learning (UDL)! The principles of UDL come from architectural designs that intentionally plan for accessibility. Some examples of universal design in architecture are the provision of both stairs and ramps for entrances/exits, the widening of interior doors, and using curb-cuts on sidewalks. These design features help to give individuals who are wheelchair mobile access to the spaces and places, but if you think about it a bit more carefully, you will quickly realize that these same design features also help the person delivering a load of copy-paper or catering the lunch, anyone with luggage or a bicycle, and a Dad pushing his child in a stroller! These relatively simple design adjustments in architecture have wide-ranging benefits, and we will see the same thing happen when we use UDL principles with our curriculum and instruction. UDL helps to build flexibility into the curriculum and instruction so that it is accessible to the largest possible number of students. The keys to expanding access lie in three design features: 1. Provide multiple ways or modes to represent the information (e.g., visual, auditory, kinesthetic, tactile). 2. Provide multiple methods that allow students to interact and engage with information (e.g., discussion, reading, reflecting, moving, dramatization, experimenting, drawing, writing, building, dancing, etc.). 3. Provide multiple ways to allow students to show what they know and assess learning (e.g., oral response, products, art portfolios, projects, written responses, dramas) (Coleman, 2015).

Center for Applied Special Technology (CAST) www .cast.org

In Chapter 1, you learned about the information processing model (IPM) that can help us identify areas of challenge and strength for learners. Remember that learning or processing information hinges on taking the information in (input), doing something with it (processing), and sharing it (output). You may be smiling to yourself as you make the connection between IPM and UDL. Simply put, the best curriculum and instructional designs to support learning provide multiple representations so that learners can access the information (input); multiple ways to deeply engage with the information, making it one’s own (processing); and multiple opportunities and ways to share what has been learned through a variety of means (output). The connection between IMP and UDL will be explored further in the remaining chapters. Much of the initial work on UDL was done by the Center for Applied Special Technology (CAST), whose task was to develop technology to provide diverse means of delivering information. CAST, in turn, established the National Instructional Materials Accessibility Standard (NIMAS), whose purpose was to produce alternative presentations of materials for students with a wide variety of needs. One of the major strategies was to digitize textbooks to make them accessible through text-to-speech technology, Braille, or other visual means for those who cannot learn through the standard print methods.

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Universal Design for Learning Special education has often led the way in the acceptance and use of technology in education. That achievement may well be due to the unique challenges that special educators face. Because they are educating children with special needs, they have been willing to try new devices, such as computers adapted to special needs, hearing aids, print magnifiers, Braille readers, and machines that trace eye movements as the student reads. When we use technology in these ways, it is called assistive technology because it is designed primarily to allow the child with special needs to gain access to information. Many of the subsequent chapters include examples of the uses of assistive technology. We often think of assistive technology as being sophisticated, complicated, or computer-driven, but this is not always the case. Assistive technology devices, in fact, can be classified as low-, middle, or high-tech. ●  Low-tech

devices may include nonelectronic devices like pencil grips, adaptive spoon handles, and picture boards. (These may not involve “technology” at all!) ●  Middle-tech devices include things like audiobooks, word-processing computers, sound recorders, and other uncomplicated mechanical devices or Apps on personal devices. ●  High-tech assistive devices are usually specifically designed to support an individual’s needs and may include speech recognition software, electronic communication devices, and mobility technologies for guiding wheelchairs.

Moral Dilemma:

FAPE for Students with Disabilties Who Attend Private Religious Schools Using Publicly Funded Vouchers Recently the U.S. Supreme Court ruled to allow states to publicly fund private religious education through school vouchers (Espinoza vs. Montana, 2020). This ruling calls into question how private schools that accept public funding should be held accountable for educating students with disabilities. Currently the Rehabilitation Act (1973) mandates non-discrimination, and IDEA (2004) mandates the provision of a free and appropriate public education—but the key word here is public. The Americans with Disabilities Act (1990) extended the non-discrimination mandate to private institutions, unless associated with a church. Traditionally, public and public-charter schools must comply with IDEA, but private schools need not. Private schools, for example, are not held to the “zero-rejection” policy, and so they can decline to accept any student who they feel does not fit their school’s program. Private schools also do not need to offer a continuum of services for students with disabilities. Thus, they are freed from accepting students with complex and challenging needs. How do you feel about private schools using taxpayer funds when they do not have to operate under the same set of rules as public schools? You have been asked by the parents of a student with significant disabilities whether they should send their child to a nearby private religious school. The parents plan to use a publicly funded voucher to pay for their child’s tuition. What things should you alert them to think about as they try to make this decision? What advice would you give them?

With the support of assistive technology, individuals with disabilities can often participate fully in many activities (Edyburn, Rao, & Hariharan, 2017). The National Assistive Technology Research Institute reminds us that the best device is not always the most high-tech. Sometimes a lower-tech option like a communication picture board is more useful than a sophisticated communication device. The selection of the right device also depends on the demands of the environment in combination with the developmental level of the individual (Koch, 2017). As the child grows and/or the demands change, the assistive technology support must be adapted and modified as well. When assistive technology is needed, the student’s IEP should describe what and how this is to be provided and include a plan for periodically reviewing the appropriateness of the device. The three major social institutions—legislatures, courts, and schools—play important roles in supporting students with exceptional educational needs, opening the door to a more promising future. We have made a commitment that all children will have a free and appropriate education, and we are charged with creating learning environments that address each student’s strengths and challenges. Each of the following chapters in this text will help us honor our commitment and answer this charge!

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Chapter 2  |  Children and Youth with Exceptionalities and Social Institutions: Government, Courts, and Schools

Summary ●  Until

quite recently, society didn’t include students with exceptionalities in general schooling. It wasn’t until the latter half of the twentieth century that legislation passed to require schooling for children with disabilities, and things are still changing. There is a clear trend of more children with disabilities being placed in the general education classroom now than there were 10 years ago. ●  Legislation is the vehicle for providing additional resources for children with special needs and also creates the structure that educators must use. Various laws, most important IDEA (2004), have mandated what services should be given to children with special needs so they may participate in the general classroom as much as possible. ●  Court decisions have validated the rights of children with developmental disabilities to a free appropriate public education. Courts have ruled that schools must have strong documentation and no other option before removing a child with disabilities from the general education classroom. ●  Systemic racism in our schools and must be addressed in order to serve BIPOC students with disabilities. A careful and honest review of data, that has been disaggregated by race, ethnicity, language, socio-economic status, and ability status, is a good first step to addressing systemic racism. A close examination of disciplinary practices, drop-out rates, referral patterns, class attendance and student outcomes by classroom and school will reveal where the major problems are and will establish a baseline for growth. ●  Both explicit and implicit bias can play a role in our decisions and how we treat our students. Because of this, it is important that we reflect on what our biases are and work to be mindful of how these can influence our actions. ●  Multitiered systems of support is a framework for organizing school services for children with exceptionalities. MTSS is arranged by tiered hierarchies of supports and services, chosen through comprehensive assessments and progress monitoring. Student’s growth must be reviewed regularly to know when to provide more support or step a child down for more independence. Parents must be involved in MTSS decisions so they can help make the best choices for their child. Culturally responsive practices with parents and families are needed to encourage full participation and partnership. ●  A continuum of services is needed to ensure that a range of student strengths and challenges can be met, and regardless of where a student is served, educators must work to ensure that every student feels a sense of belonging to the school community. ●  An individualized education program (IEP) is a legal contract that defines the nature of the supports and services a student will receive. It specifies the student’s current level of performance, identifies the program’s long-term goals, specifies the services (including accommodations and modifications), and establishes the criteria for evaluating outcomes. The IEP should be reviewed at least annually to determine whether growth is taking place. ●  Some students may qualify for supports and services under Section 504 of the Rehabilitation Act, and these students will receive a 504 plan. ●  Universal Design for Learning (UDL) provides multiply ways to represent content, engage the student in learning, and document that learning has taken place. Using UDL strategies, teachers think about students’ strengths and challenges as they plan their instruction, working to provide access to learning for all their students.

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Key Terms

Future Challenges 1. What is the future role of the courts in protecting the rights of BIPOC with exceptionalities? During the last part of the twentieth century, the courts played a significant role in affirming the rights of children with exceptionalities to a free and appropriate public education. But as we have seen, these rights have not necessarily been applied in equitable ways for some students. Disproportionality calls into question whether BIPOC students are receiving an appropriate education. Will civil rights cases be used to address the disparate impacts of special education decisions on BIPOC students with exceptionalities?

2. How so we support students with disabilities in their postsecondary education? One indication that the law, court decisions, and schools have had a positive impact is the growing number of students with disabilities attending post-secondary educational institutions. How can we ensure that students with disabilities receive the supports and services needed to be successful in college and university programs? TeachSource Digital Download

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Key Terms accommodations p. 67 American Recovery and Reinvestment Act p. 43 Americans with Disabilities Act p. 43 assistive technology p. 69 behavior intervention plan (BIP) p. 58 class action suits p. 45 continuum of services p. 59 co-teaching p. 59 data driven decision making p. 54 Every Student Succeeds Act p. 44 explicit bias p. 50 free and appropriate public education (FAPE) p. 45 functional behavior assessment p. 58 implicit bias p. 50 inclusion p. 45 individualized education program (IEP) p. 63 Individuals with Disabilities Education Act (IDEA) p. 41

Javits Act p. 44 least restrictive environment p. 45 measurable annual goals p. 64 modifications p. 67 Multitiered Systems of Support (MTSS) p. 54 No Child Left Behind (NCLB) p. 43 positive behavior interventions and support (PBIS) p. 57 present level of academic achievement and functional performance (PLAAFP) p. 64 progress monitoring p. 54 related service provider p. 63 Section 504 p. 42 Section 504 plan p. 66 systemic racism p. 48 transition plan p. 65 transition planning p. 42 Universal Design for Learning (UDL) p. 68

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Resources of Special Interest to Teachers Journals Special Education Research, Policy & Practice is an online, peer-reviewed journal committed to advancing the professional development of special education professionals through research, policy, and practice. www.hofstra.edu/academics/colleges/soeahs/sped/sped_special-education -research-policy-practice.html\ Journal of Special Education Technology presents current information about issues, research, policy, and practice in relation to technology use in special education. https://journals.sagepub.com/home/jst

Professional Organizations Interactive Tools from Education Modified is a collection of best practices and toolkits for special education, including co-teaching essentials. www.educationmodified.com/tools/ The Council for Exceptional Children keeps the community updated on policy changes, advocacy opportunities, and legislation on its Policy and Advocacy page. https://exceptionalchildren.org/policy-and-advocacy

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Par t 2

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High-Incidence Exceptionalities

most general education classrooms, and addressing their strengths and challenges through appropriate supports and services is critical for their success. In order to foster that success, Chapters 3 through 10 will help teachers gain a better understanding of the processing difficulties children with each exceptionality experience; explain how teachers can adjust their instruction and use technology to help students; and share ideas for connecting with families and the rest of the students’ support team for the best possible outcomes.

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he eight chapters in Part Two are devoted to children with exceptionalities who make up between 8 and 9 percent of the population of school-age children in the United States. Chapter 3 looks at the needs of young children and early intervention, while Chapters 4 through 10 focus on students identified with intellectual disabilities, autism spectrum disorders, learning disabilities, attention deficit/hyperactive disorders, emotional and behavior disorders, communication disorders, and gifts and talents. Students with these exceptionalities are found in

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Early Intervention Supports and Services

3 Ch ap te r

Standards Addressed in This Chapter All the CEC Initial Practice-Based Professional Preparation Standards for Special Educators (K–12) are addressed within this chapter. Please see the inside front book cover for the list of these standards.

Focus Questions 3-1 In what ways did research change historical beliefs about child development and set the stage for early intervention? 3-2 What is early intervention, and why is it so important for young children with disabilities? 3-3 Why is a “family-centered” approach to early intervention so critical? 3-4 How do we identify children who need early intervention shortly after birth and during their toddler years? 3-5 What are the five developmental domains that states use to define developmental delays in young children? 3-6 What educational responses are needed for young children with disabilities? 3-7 What kinds of supports are needed to help families navigate the transitions in services for young children?

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T

he birth of a child is a wondrous event. It is a time filled with expectation, anticipation, and excitement. It can also be an overwhelming time for parents as they learn how to meet the needs of their newborn child. The challenges of feeding, changing, and calming a newborn can feel daunting, especially when parents are trying to manage all of this in a sleep-deprived state. Under the best of circumstances, the anxiety of caring for a newborn can be intense. Newborns enter the world with a vast array of skills and abilities that will help them negotiate their early lives. The newborn prefers visual stimuli with clearly contrasting patterns; orients early to the mother’s face and voice, recognizing these as distinct from a stranger’s; and is biologically wired to seek social contact (Nugent, 2015; Nugent et al., 2007). These early skills and abilities help the newborn and the mother form a bond that is critical to both during the first few weeks of life. The mother, father, and other primary caregivers learn together how to communicate with and respond to the needs of the infant. During this process,

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Chapter 3  |  Early Intervention Supports and Services the mother gains confidence when her baby is happy, calm, and responsive, and the baby begins to thrive within this supportive environment. All of this takes place in the greater context of the family and the environmental circumstances within which the family lives (Carta & Snyder, 2019). The newborn and the mother, family, and environment form a set of complex relationships that are an interdependent system and that facilitate the optimal development of the child (Iruka, 2019). When challenges exist within any of these components (the child, the mother and family, or the environment), these challenges can affect the health and well-being of the baby (remember the discussion of Bronfenbrenner’s model in Chapter 1). The purpose of early intervention is to provide necessary supports and services to optimize the child’s development as early as possible. In this chapter, we explore the world of early intervention, looking at the supports and services that are available to help ensure that each family has what is needed for the optimal development of their child. We look at what it takes to support the development of physically and mentally healthy young children who can explore and learn with confidence. We review the history of early intervention, look at early childhood as a developmental period, explore the risk factors and stressors that can lead to difficulties, and examine the roles of families and professionals working together to meet the needs of young children.

3-1  History of Early Intervention Although the benefits of early intervention are widely accepted today, this has not always been the case. The prevailing opinion in the early twentieth century was that little could be done for a child with disabilities because intelligence and abilities were fixed at birth and therefore could not be changed. As a result of this belief, parents were encouraged to place children with disabilities in institutions and orphanages, where they often received only custodial care. In the 1930s, the belief that nothing could be done to improve outcomes for children with disabilities was dramatically challenged in a seminal research study by Drs. Harold Skeels and Harold Dye (Skeels & Dye, 1939). These researchers found that children who were placed in foster homes or who were adopted fared much better than did a comparable group of children who remained in an orphanage. The fostered-adopted group achieved normal intelligence, whereas many of the institutionalized children were classified as “mentally retarded” (today we use the term “intellectual disability” for children with cognitive challenges). Amazingly, these gains seemed to hold for the fostered-adopted group into adulthood (Skeels, 1966). Samuel Kirk (1950), founding author of this text, further demonstrated that preschool experience could increase the rate of mental development and the social skills of children who were classified as “mentally retarded.” The belief that children’s potential was fixed at birth was beginning to give way to the exciting idea that, with the right supports and services provided early on, we could significantly improve outcomes for children who were “at risk” (Wasik & Bryant, 2019). A major longitudinal study looking at the impact of early intervention, the High/Scope Perry Preschool Study, expanded our understanding of the need for early intervention (Schweinhart et al., 2005). In this study, 123 African American children, born in poverty and identified as at risk for school failure, were assigned at ages 3 and 4 to either an intervention or control group (these assignments were primarily random; however, some children attended their neighborhood child-care center). The intervention group received the High/Scope participatory learning

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History of Early Intervention

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The importance of early intervention was not well understood until late in the twentieth century.

approach in preschool, whereas the other half received normal preschool services. The long-term outcomes—looking at these individuals as adults at age  40— showed positive gains for the group that attended the High/Scope preschools. The reported positive gains included 19 percent fewer arrests, 20 percent more high school graduations, and 20 percent higher earnings for the group who attended the High/Scope preschools (Schweinhart et al., 2005). One of the longest running studies of the importance of early intervention is the Abecedarian Study that began in 1972 and continues through today (Ramey, 2019). The Abecedarian study randomly assigned infants (4.4 months on average) into two groups in order to examine the impact of quality early child care on children from economically disadvantaged families (Campbell, Pungello, Keyserling et al., 2012). One of the groups of children received enriched, high-quality child care through the preschool years, and included some special curricular opportunities. The second group of children received traditional child care. Both groups of children have been followed into adulthood. This seminal study showed that early intervention can have long-term positive benefits. As young adults, the enriched group earned reading scores 1.8 grade levels higher and math scores 1.3 grade levels higher than the control group. They were more than twice as likely to enroll in a four-year college or university (36 percent to 14 percent) and were less likely to have their first child at age 18 or younger (26 percent versus 45 percent) (Campbell et al., 2002; Campbell,

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Chapter 3  |  Early Intervention Supports and Services Pungello, Burchinal et al., 2012; Campbell & Ramey, 1995). A follow-up study of the groups as adults showed the experimental group was less likely to report depressive symptoms (McLauglin et al., 2007) and had more years of education, higher job prestige, and were more likely to be employed (Campbell, Pungello, Burchinal et al., 2012; Campbell, Pungello, Keyserling et al., 2012). Researchers concluded that the high-quality early childhood programming can have a long-term positive impact on cognitive development, academic performance, and later adult educational attainment and vocational success (Campbell, Pungello, Burchinal et al., 2012; Campbell, Pungello, Keyserling et al., 2012; Ramey, 2019). One of the best sources of how caregiver practices can influence child development is the Kauai Longitudinal Study, conducted from 1952 to 2000 (Werner & Smith, 1992; 2001). The study followed individuals from their prenatal care through age 40 and demonstrated that many children who were at risk for developmental delays could achieve success (Werner, 2000). The study showed that child-rearing practices such as providing a home environment of psychological warmth, low physical punishment, responsiveness, verbalness, and intentional encouragement for development can help at-risk children achieve normal milestones (Werner, 2000). These seminal studies paved the way for the acceptance of early intervention as critical for improving outcomes for children with disabilities. Legislative support would follow, setting expectations for early intervention systems to support practice (Haskins, 2019).

3-1a  Legislation on Early Intervention Legislative support for young children with disabilities began in 1968, when Congress passed the Handicapped Children’s Early Education Assistance Act (HCEEAA; Gallagher, 2000). This act set up twenty model programs, including Head Start (a preschool program that provides comprehensive early childhood education, health, nutrition, and parental involvement for low income families), across the United States to demonstrate how working with children with disabilities could improve their lives. During the 1970s and 1980s the legal rights of young children with disabilities were addressed in legislation. With the passage of PL 99-457, federal funding was extended to support children with disabilities and their families from birth on. You may want to look back at Chapter 2 as you think about the legislation for young children in the context of other laws. Today, the needs of young children are addressed in two sections of the 2004 Individuals with Disabilities Education Act (IDEA). Infants and toddlers (children from birth to age 2) with disabilities and/or developmental delays are addressed in IDEA, Part C, which encourages states to develop comprehensive, coordinated, multidisciplinary early intervention systems. Children with disabilities age 3 through 5 are addressed in Part B of IDEA, which provides funds for states to ensure that all preschool-age children with disabilities receive special education and related services. The 2004 reauthorization of IDEA further emphasized the need to provide services to all members of the family, recognizing the importance of the family in the child’s development. IDEA 2004 requires transition planning across the early years, because services for children from birth through age 2 and for children ages 3 through 5 are often overseen by different agencies, and thus families often have to navigate complex networks of agencies as their children move across the age span of early childhood. While as a nation we have made significant progress in establishing service delivery systems to meet the needs of young children, there is still much work to be done (Haskins, 2019). Questions remain regarding the quality of services and equitable access to services that are available (Bowman, 2019; Carta & Snyder, 2019; Iruka, 2019).

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What Is Early Intervention and Why Is It So Important?

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3-2  What Is Early Intervention and Why Is It So Important? Early intervention consists of sustained support to the family, to the caregivers, and to the child with or at-risk for developmental delays and/or disabilities, during their early years in order to promote the optimal development of the child. In this chapter we focus on children’s earliest years—from conception through age 5. Some of the lessons about early intervention learned through over 50 years of research by the FPG Child Development Institute include: ●  Early

intervention can make a difference, and the earlier the start the more beneficial the outcome. ●  The whole child approach to support including medical health, mental health, social and emotional needs, and cognitive/learning needs should be considered when looking at child development. ●  Proximal interventions, those that are close to the child/family, will have the most direct and powerful impact on child outcomes. ●  Positive, warm, responsive relationships support growth for the child and family. ●  Quality, intensity, and duration (i.e., dosage overtime) of support/intervention matter. ●  Wrap-around support for the family, neighborhood, and community provides the stability necessary for sustained growth. ●  Understanding the cultural context of the family and using familycentered approaches that honor the family’s strengths and wishes is critical for success. ●  A strong infrastructure that includes resources for professional development, technical assistance, workforce support, and research/development is needed to bring best practices to scale. ●  Attention must be given to the implementation process and the support needed to reduce fragmentation, increase synergy, and support fidelity with flexibility across a variety of contexts. ●  Changes across the system will have both intended and unintended ripple effects (Wasik & Odom, 2019).

3-2a  Why Is Early Intervention So Important? The first years of life are a critical developmental time, laying the foundation for all that is to come (Winton, 2019). From birth to the age of 3, the brain develops rapidly. During this period, the basic “self” emerges through a dynamic

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Throughout this text we stress that the earlier we begin to intervene on behalf of the child with exceptionalities, the more likely we are to see successful outcomes (Coleman, 2011). Early intervention has also been recognized as important through the laws, as noted above. Let’s explore further why early intervention is so important.

Early intervention with children and their families can make a positive difference in outcomes for the child.

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Chapter 3  |  Early Intervention Supports and Services relationship with caregivers and the environment, and this provides the foundation for autonomous emotional functioning. Language emerges during these early years, and during this time the child learns how to cope with the world. The infant is learning at a staggeringly fast rate, and the rapid development of the brain in these early years sets the stage for all further learning. If information is not provided through experience, the brain’s neural pathways are unused; conversely, if enriched experiences are provided, they actually help build a more efficient brain (CDC, 2020).

Neurology and Brain Development: Neonatal, in Infancy, and During Early Childhood During fetal development, the brain grows at an amazingly rapid rate, estimated to be 50,000 to 100,000 neurons per second, creating an extensive network that forms a system for learning. At birth, the infant immediately begins to use this learning system to make sense of the world (CDC, 2020). From the moment they are born, babies tend to show a preference for humans. They respond to faces, voices, and smells and have a special preference for their mother. Newborn babies get bored and look away when visual stimulus repeats too often. Very early on, infants learn to imitate the facial expressions and gestures of their caregivers. The brain is preset for learning, and each experience the infant has reinforces this predisposition. According to the Center on the Developing Child (2016) at Harvard, in the first few years of life the brain will make more than 1 million new neural connections every second! The brain seems to be hardwired for the learning of language. Language develops spontaneously and naturally for most children. With little formal instruction, a child learns to understand and imitate the sounds of the language heard each day. But language learning, like all areas of brain development, can be enhanced by favorable environments where caregivers talk with the child and offer lots of positive reinforcement to the baby. One of the reasons that early intervention to support children with disabilities is so important is that during the early years, birth though age 6, there are “windows of opportunity” or sensitive time periods where learning in a particular area is optimal. These sensitive time periods are not rigid, and the brain does have a significant amount of plasticity (that is, the ability to reorganize itself and shift learning functions from one area to another) across the lifecourse. Even though windows of opportunity can remain open throughout the lifecourse, changing behavior and building new skills becomes more difficult if early brain development is faulty (Center on the Developing Child, 2016). Early positive experiences with supportive relationships and stimulating safe environments help to shape the circuity of the developing brain (Center on the Developing Child, 2016). The first step in early intervention is finding children who need additional supports and services.

3-2b  Profiles of Two Children Who Need Early Intervention Supports and Services Children can need early intervention supports for a wide variety of reasons. We look at two children, Jennifer and Tyrus, to see how needs for early intervention can differ from child to child.

Jennifer Jennifer was born at 28 weeks’ gestation and is a preterm infant. Her parents were told that she would need to spend her first several months in the hospital’s neonatal care unit with oxygen support because her respiratory system was immature. Jennifer’s early birth and prolonged hospital stay were very stressful for her mother, Sandra, and her father, Tony. Sandra and Tony knew that the pregnancy was considered to be high risk because of Sandra’s age and health (Sandra is 38 and has type 2 diabetes), and so they had prepared early for their daughter’s birth; but no prior knowledge

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What Is Early Intervention and Why Is It So Important? could prepare them for the anxiety and worry they faced as they watched their tiny daughter fight for her life. Sandra and Tony felt helpless, knowing there was little they could do for Jennifer. They visited the hospital every day, and the neonatal care nurses encouraged them to hold and feed Jennifer on these visits. In the early weeks, Sandra often left the hospital in tears, feeling that she had let Jennifer and Tony down by not being able to carry the pregnancy to full term. When they finally were able to take Jennifer home, both parents were concerned that they would not be able to meet her needs. The family was referred to the local early intervention program, and home visits were set up through the visiting nurse’s agency. These supports were critical to building Sandra and Tony’s confidence in their parenting. We will meet Jennifer again later in the chapter to see how she is doing.

Tyrus Tyrus’s need for early intervention was not recognized until several months after his birth. He had been carried full term, and there were no complications. His early development seemed relatively normal and because Tyrus was their first child, Michael and Laura were not really sure what to expect. Laura had gone back to work when Tyrus was 3 months old, and things had settled down in the family routine. When Tyrus was 10 months old, however, Laura started to feel uneasy. Tyrus seemed different from some of the other babies in the child-care center. When Laura would go to pick him up he was fine, but he did not seem to know her in the same way the other babies recognized their mothers. She watched as other mothers called out their children’s names when they entered the room and she saw how their children’s faces brightened at the sight of their mothers. She also noticed that the other babies responded to their mothers’ voices with smiles and “baby talk.” Tyrus was calm but seemed not to realize that she was there to pick him up. At first Laura kept her worries to herself, reassuring herself that Tyrus seemed content and was just quieter than other children. Because Laura had had mixed feelings about going back to work, she also felt that maybe it was somehow her fault that Tyrus did not seem to recognize her. When she finally shared these worries with Michael, he reassured her that Tyrus seemed fine to him. But Laura continued to feel that something was not right. To reassure her, Michael agreed that they should talk with Tyrus’s pediatrician, Dr. Nolan, on their next visit, his one-year well-baby checkpoint. In preparation for this visit, Laura made a list of her concerns about Tyrus: “He does not recognize his name when I call to him; he sometimes does not seem to know me when I come to get him; unless he is upset, when his tantrums can be fierce, he’s so quiet. And he does not seem to want to play with us; he seems not to hear us when we talk to him—could he be deaf?” As she reviewed her list, she felt that maybe she was being silly, and she hoped the pediatrician would tell her not to worry. Tyrus’s health checkup went well. He had gained some weight, and everything seemed normal. Dr. Nolan was surprised when Laura burst into tears when she asked if there were any concerns. Laura was also surprised by the intensity of her feelings as she described her fears about her son’s behavior. Dr. Nolan listened carefully and jotted down notes into Tyrus’s file. When Laura had finished, Dr. Nolan shook her head and said, “Well, this is probably all normal, and Tyrus is likely just fine, but, Laura, I think we would all feel better if we looked into your concerns a bit further.” After an initial screening showed some problems, Dr. Nolan recommended that a full assessment for possible developmental delays be completed with Tyrus. One way to think about Tyrus’s needs is the information processing model (IPM). You will remember that that the IPM describes how the brain works as the child takes in information (input), works with this information (processing), and shares information through a variety of means of communication (output). Information processing also involves the executive function, or the decisionmaking role of learning. In addition, all of this takes place within the context of emotions. (See Figure 3.1, Tyrus’s Information Processing Model.)

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Chapter 3  |  Early Intervention Supports and Services

Emotional Context

Stimulus

Vision Hearing Kinesthetic Haptic Gustatory Olfactory

Thinking

Response

Memory Classification Association Reasoning Evaluation

Speaking Writing Motor Response Social Interaction

Processing

Attention

Information Output

Executive Function

Information Input

82

key Challenges Strengths

◗ Figure 3.1  Information Processing Model for Tyrus

After the meeting with Dr. Nolan, Laura left feeling both relieved that her concerns had been validated and something would be done and also more worried that something might be wrong with her son. Laura and Michael met with a multidisciplinary team to help with the assessment. The results from this assessment showed that Tyrus did in fact have some developmental delays, confirming Laura’s worst fears. If you examine Tyrus’s IPM (Figure 3.1), areas that are challenging for Tyrus are shaded in Blue color. Tyrus’s challenges include auditory processing (input), especially with language; he also takes longer to process information and this impacts his memory and overall thinking; speaking and social interactions (output) are difficult for him as well. But, you will also see some areas of the IPM shaded in Green color, kinesthetic input, classification (pattern recognition with processing), drawing, and motor responses are where Tyrus has strengths. Remember from Chapter 1, we can use our knowledge of a child’s areas of strengths to help support or bypass their areas of challenge. The family immediately began working with the multidisciplinary team to develop an individualized family service plan (IFSP) to meet Tyrus’s needs. We will learn more about the multidisciplinary team and the plan they developed for Tyrus later in the chapter. As we can see from Jennifer and Tyrus’s stories, the needs for early intervention can vary widely from child to child. The shared theme, however, is that the child and family need additional supports to help them thrive, and the sooner they receive early intervention support, the better the outcomes are likely to be (Marvin et al., 2020). Later in the chapter we will learn about these supports and how they can be delivered.

3-3  Family-Centered Support as Part of Early Intervention A critical component of early intervention is strengthening the parents’ capacity to meet their child’s needs (Bailey, Raspa, & Fox, 2012; DEC, 2014; Marvin et al., 2020, Turnbull, 2019). The family centered approach, described in Chapter 1,

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Family-Centered Support as Part of Early Intervention means working with families as partners, respecting their strengths, values, and decisions, while supporting their ability to meet their child’s needs. This is critical because the parents or caregivers are central to the well-being of the child. Supporting parents as they learn to care for their newborn and toddler is a critical part of ensuring the child’s mental health. Early responsive relationships that form positive attachments with the primary caregiver are the foundation for the infant and toddler’s social and emotional well-being and mental health (Corr & Santos, 2017; CSEFEL, 2020). The nonprofit organization Zero to Three (Osofsky & Thomas, 2012) defines infant mental health as: The developing capacity of the child from birth to age three to: experience, regulate, and express emotions; form close and secure relationships; and explore the environment and learn, all in the contexts of family, community, and cultural expectations for young children. “Infant mental health is synonymous with healthy social and emotional development” (CSEFEL, n.d., p. 1).

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Center on the Social and Emotional Foundations for Early Learning www.vanderbilt.edu/csefel

3-3a  The Family-Centered Approach and Racial, Ethnic, and Linguistic Diversity

Nuestros Niños Project http://nnrp.fpg.unc.edu TeachSource Digital Download Access online

Focus_on_Nature/E+/Getty Images

Successful early intervention must address and honor the family’s needs to be placed at the center of the work and family members’ goals and opinions (Swafford et al., 2015). When there is a cultural disconnect between the program’s goals and the parents, and when these differences are defined, by practitioners, as deficits, the program is unlikely to have long-term success (Bowman, 2019). Each family is unique and has a set of strengths, resources, and challenges that must be considered. Economically stressed families may not have access to health care, may experience food scarcity, and may lack basic resources for child care (Bowman, 2019). Many families also need support in recognizing the early warning signs for developmental delays. Gaining the family’s trust is essential as professionals work to encourage parents to accept proven practices for their child. Centering the intervention within the family is essential because the family is fundamental to the development of any child, with or without disabilities (Turnbull, 2019). The key to success is the ability of the parents or caregivers to relate to the child and to provide a responsive, caring environment. As professionals, it is our job to make sure that we get to know each family’s unique beliefs about their child and what their child needs to thrive. Cultural responsiveness is essential when working with families (Bowman, 2019). Early childhood programs are serving a growing number of dual language learners; approximately 30 percent of children in Head Start and 11 percent in school district funded pre-K programs are dual language learners (Guan & Cheatham, 2018). Understanding the family context is critical to understanding the child (Castro, Garcia, & Markos, 2013). Working with a knowledgeable and skilled interpreter is critical because if the communication between family members and professionals is not clear, deep, and dynamic, the chances for misunderstandings are great (Acar & Blasco, 2018). Through effective collaboration, families and professionals can provide optimal support for young children with disabilities and help them thrive. The Nuestros Niños website shares helpful information on working with children who are bilingual. Dr. Carrero, in Box 3.1, shares her thoughts on working with families. Working with families is critical to the success of young children and this means that we must find ways to support development in “spaces and places” where the child and family live; we call these the family’s natural environment.

Parents are key to the success of early interventions for the child.

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Chapter 3  |  Early Intervention Supports and Services

Box 3.1

Ask the Experts:

Working with Families of Young Children (with or At-Risk for Disabilities) Whose Primary Language is not English

© Dr. Kelly M. Carrero

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Dr. Kelly M. Carrero, Associate Professor of Special Education at Texas A&M University—Commerce Many young children who are identified with or are atrisk for disabilities are first referred because of delays in speech and language development. For young children who come from homes and families where English is not the primary language, it is often difficult to ascertain whether the language delay is because English is not their primary language or because they have an impairment. Furthermore, families who primarily speak a language other than English are most often—though not always—recently immigrated to the United States. Entering any formal system in a country that you are new to can be intimidating—for those who are undocumented or even in the process of establishing residency, it can be downright traumatic! Consequently, many immigrant families minimize their voice and presence when working with schools. For this reason, early childhood educators must go out of their way to cultivate a safe environment where families are encouraged to collaborate and communicate freely. When I was an early childhood special education teacher, I worked in a district where there were 96 different home languages represented in our district’s families. I taught two classes per day—English in the morning and Spanish in the afternoon. In my morning class, about half of my students came from homes where English was not the first language spoken and many of the languages represented were different from one another (i.e., there was not one dominant second language in my class). My afternoon class was a monolingual Spanish class—the children were almost exclusively exposed to Spanish throughout their school, home, and community experiences. I found that most of my Spanish-speaking families—many of whom were

from Mexico, but several were from El Salvador and Guatemala—were very eager to hear what I had to say and would do whatever I asked them to do. While I appreciated their enthusiasm, I am a trained special educator and special educators collaborate—it is one of our main superpowers! Using the collaboration strategies I had been taught, I was hoping to have the families very involved in the programming and decision-making process; however, the mothers responded in a submissive way and communicated their cultural value of “la maestra sabe todo y lo que ella dice va” (the teacher knows all and what she says goes). I found myself in an interesting position because I didn’t want to violate the cultural values of my students’ families and yet, as an early childhood special educator, I saw it as my job to empower families by teaching them how to navigate the educational system and use their voice to advocate for their child—parents will need these knowledge and skills throughout their child’s educational career! I recognized that this is my professional value, so I adopted a posture of cultural reciprocity (Kalyanpur & Harry, 2012). When educators use a posture of cultural reciprocity, they (a) identify what goals or concerns they would like to address with the student, (b) reflect on why they believe those goals or targets are important, and (c) determine if, and how, they mapped their own cultural (including professional) values onto those goals/targets. After reflecting, educators meet with the families to (a) review the goal and/or concerns, (b) acknowledge and explicitly state what their values are and why they think this goal/target is socially important for the student, and (c) ask the family what their cultural values are about this goal and/or concern. Do they think it is important? Do they even notice it as a concern? If so, why, and if not, why not? What skills or behaviors do the family value? How are you negotiating the cultural dissonance with the family and how is that reflected in the student’s educational programming? Through cultural reciprocity, we can build the trust needed to appropriately support our students and their families!

Reflections: ●



In what ways are cultural reciprocity and cultural competence (discussed in Chapter 1) similar? How can cultural reciprocity support a familycentered approach to supporting the child’s success?

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Family-Centered Support as Part of Early Intervention

3-3b  Early Intervention in “Natural Environments”

kali9/E+/Getty Images

IDEA (2004) stipulates that early interventions should be provided, to the maximum extent possible, in natural environments, or settings that are typical for children who do not have disabilities. Natural environments for young children can include the home, the neighborhood, the family’s place of worship, parks, playgrounds, grocery stores, child-care centers, and preschools. One important ripple effect of natural environments is that they are places of inclusion where individuals with and without disabilities are close proximity as their daily lives unfold. This close proximity fosters connections that allow individuals to learn to value each other, dignifying their difference (Turnbull, 2019). These settings provide an authentic context for learning and practicing the child’s targeted skills, such as self-feeding, pulling-up to walk, and vocabulary building (Keilty, 2020). Providing early intervention support within the child’s natural environments is key to family-centered approaches and is also critical to building strong family partnerships. When interventions are provided in the home, they become part of the family’s daily routines and activities (Keilty, 2020). Seven key principles for practicing within natural environments (see Table 3.1) have been identified by the Workgroup on Principles and Practices in Natural Environments (2008), sponsored by the Office for Special Education Programs Technical Assistance. The intent of natural environments is to facilitate learning through experiences in daily activities and routines (mealtimes, out-of-home shopping, and so on). Therapists, teachers, and other interventionists often provide services in the home for a number of reasons: the home is the functional setting for very young children; infants spend most of their time sleeping, and it is not practical to take them to an early intervention program; parents are going through the process of accepting their child’s disability and may be most comfortable in their own home setting (Basu, Salisbury, & Thorkildsen, 2010). The first person to visit the home may be a home health nurse who works with the caregivers to help them understand their child’s disability, child development in general, and parenting practices. The home health nurse may also help the parents coordinate other therapies and may help to identify a curriculum for the child and family (Nugent et al., 2017). In the process, the home visitor provides emotional support for and contact with the family (Tammy, a home health nurse, visited Sandra and Tony, Jennifer’s parents, during her first few months at home and provided critical supports to help Sandra and Tony meet Jennifer’s needs). The home visitor can also act as a service coordinator and help the parents apply for additional services for the child or the family. Some additional services may be provided by occupational or physical therapists, who visit the home once a week to teach the caregivers to position, carry, sit, bathe, feed, and generally care for the child. Promoting a child’s competence through family routines and community activities also facilitates their transition into child-care proEarly Intervention services support the family in caring for grams where the teacher can reinforce these routheir child. tines in the classroom, with snack time, bathroom use, entering, and leaving.

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Chapter 3  |  Early Intervention Supports and Services

Table 3.1  Seven Key Principles for Working in Natural Environments 1. Infants and toddlers learn best through everyday experiences and interactions with familiar people in familiar contexts. Key Concepts



 earning activities and opportunities must be functional, based on child and family interest L and enjoyment



Learning is relationship-based



Learning should provide opportunities to practice and build upon previously mastered skills



Learning occurs through participation in a variety of enjoyable activities

2. All families, with the necessary supports and resources, can enhance children’s learning and development. Key Concepts





 ll means ALL (income levels, racial and cultural backgrounds, educational levels, skill levels, A living with varied levels of stress and resources)  he consistent adults in a child’s life have the greatest influence on learning and development— T not early intervention providers



All families have strengths and capabilities that can be used to help their child



All families are resourceful, but all families do not have equal access to resources



 upports (informal and formal) need to build on strengths and reduce stressors so families are S able to engage with their children in mutually enjoyable interactions and activities

3. The primary role of the service provider in early intervention is to work with and support the family members and caregivers in a child’s life. Key Concepts



● ●

 arly intervention providers engage with the adults to enhance confidence and competence in E their inherent role as the people who teach and foster the child’s development Families are equal partners in the relationship with service providers  utual trust, respect, honesty, and open communication characterize the family-provider M relationship

4. The early intervention process, from initial contacts through transition, must be dynamic and individualized to reflect the child’s and family members’ preferences, learning styles, and cultural beliefs. Key Concepts

● ●









Families are active participants in all aspects of services  amilies are the ultimate decision makers in the amount and type of assistance and support F they receive  hild and family needs, interests, and skills change; the individual family service plan (IFSP) C must be fluid and revised accordingly  he adults in a child’s life each have their own preferred learning styles; interactions must be T sensitive and responsive to individuals  ach family’s culture, spiritual beliefs and activities, values, and traditions will be different from E the service provider’s (even if from a seemingly similar culture); service providers should seek to understand, not judge Family “ways” are more important than provider comfort and beliefs (short of abuse/neglect)

5. IFSP outcomes must be functional and based on children’s and families’ needs and priorities. Key Concepts

● ●





Functional outcomes improve participation in meaningful activities  unctional outcomes build on natural motivations to learn and do; fit what’s important F to families; strengthen naturally occurring routines; enhance natural learning opportunities  he family understands that strategies are worth working on because they lead to practical T improvements in child and family life  unctional outcomes keep the team focused on what’s meaningful to the family in its day-toF day activities (Continued)

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Finding Young Children Who Need Early Intervention Support

Table 3.1  Seven Key Principles for Working in Natural Environments  

87

(Continued)

6. The family’s priorities, needs, and interests are addressed most appropriately by a primary provider who represents and receives team and community support. Key Concepts



● ●



 he team can include friends, relatives, and community support people, as well as specialized T service providers Good teaming practices are used  ne consistent person needs to understand and keep abreast of the changing circumstances, O needs, interests, strengths, and demands in a family’s life  he primary provider brings in other services and supports as needed, assuring outcomes, activities, T and advice are compatible with family life and won’t overwhelm or confuse family members

7. Interventions with young children and family members must be based on explicit principles, validated practices, best available research, and relevant laws and regulations. Key Concepts



Practices must be based on and consistent with explicit principles



Providers should be able to provide a rationale for practice decisions



Research is ongoing and informs evolving practices



Practice decisions must be data-based and ongoing evaluation is essential



Practices must fit with relevant laws and regulations



As research and practice evolve, laws and regulations must be amended accordingly

Source: Workgroup on Principles and Practices in Natural Environments. (2008, March). Seven key principles: Looks like/doesn’t look like. OSEP TA Community of Practice-Part C Settings. Work group members: Susan Addision, Betsy Ayankoya, Mary Beth Bruder, Carl Dunst, Larry Edlerman, Andy Gomm, Barbara Hanft, Cori Hill, Joicey Hurth, Grace Kelley, Anne Lucase, Robin McWilliam, Stephanie Moss, Lynda Pletcher, Dathan Rush, M’Lisa Shelden, Mary Steenberg, Judy Swett, Nora Thompson, Julianne Woods, Naomie Younggern.

The age span addressed by early intervention typically includes children from birth through age 5, and, as we saw with Jennifer and Tyrus, the need for early intervention can be identified at any point during this time. Some disabilities are recognized very early on—at the birth of the child or even prenatally—whereas other needs do not become apparent until later.

3-4  Finding Young Children Who Need Early Intervention Support Can a physician or other professional tell whether an infant has a disability or is at risk for a disabling condition within the first few minutes of the child’s birth? When a child is born, the physician administers the first screening test to determine whether the infant has any identifiable problems or abnormalities. Screening tests are simple tests that are easy to administer and that separate infants without serious developmental problems from those who may have or be at risk for a disability. The first infant screening is done in the hospital at one minute and five minutes after birth is often the Apgar test, named for Virginia Apgar, who developed it in 1952. In administering the Apgar test (see Figure 3.2), the physician examines the infant’s heart rate, respiratory effort, muscle tone, and general physical state, including skin color. A blue cast to the skin, for example, may indicate breathing or heart problems. Jaundice at birth is indicated by a yellow cast to the skin and eyes. A serious disorder, jaundice reflects the failure of the liver to filter the blood adequately because of its immaturity; as a result, bilirubin can accumulate.

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Chapter 3  |  Early Intervention Supports and Services

Score Characteristic

0

1

2

Heart rate

Absent

Slow (fewer than 100 beats per minute)

Over 100 beats per minute

Respiratory effort

Absent

Slow or irregular

Good; baby is crying

Muscle tone

Flaccid, limp

Weak, some flexion

Strong, active motion

Color

Blue or pale

Body pink, extremities blue

Completely pink

Reflect irritability

No response

Frown, grimace, or weak cry

Vigorous cries, coughs, sneezes

Note: Letters in Apgar are an acronym for the test’s five criteria: A = Appearance, P = Pulse, G = Grimace, A = Activity level, R = Respiratory effort.

◗ Figure 3.2  The Apgar Test Source: From Shaffer/Kipp. Developmental Psychology, 8th ed. © 2010 Wadsworth, a part of Cengage Learning, Inc. Reproduced by permission.

Brazelton Institute for Research on Newborns www.childrenshospital .org/research/centers -departmental-programs /brazelton-institute/nbo

Many infants with jaundice recover in about a week. In more serious cases, the infant is placed under fluorescent lights for a day or two. This light treatment helps the infant process the bilirubin until the liver can function normally. An infant with a below-average Apgar score at one minute or five minutes after birth is monitored by the physician to determine whether a disability or medical problem exists and whether medical intervention is needed. Lower than average Apgar scores are not necessarily predictive of disabilities, but they do serve to alert the physician that the infant may have special needs. Because hearing loss can have a profound impact on language and social development, it should be detected as soon as possible, and universal hearing screening is recommended at birth. In 2017, 98 percent of newborns were screened for hearing loss, and approximately 6,500 of infants born in the United States that year were identified early as having a permanent hearing loss (CDC, 2020). In Chapter 11 we will learn more about Deafness and hearing loss. The newborn behavioral observations (NBO) approach helps parents and professionals understand the preferences and vulnerabilities of the newly born infant (Nugent, Keefer et al., 2007). The NBO approach can be used in a variety of settings and helps sensitize parents to the competencies and needs of their baby. This approach builds on naturalistic observations of the caregiver and infant to help create an optimal support system for both the family and the child (Nugent et al., 2017). Using the NBO, the clinician partners with the parent to understand the infant and models strategies to help the parent gain confidence and parenting skills. Through a series of observations, an understanding is formed of the infant’s unique traits and temperament, and this knowledge allows the parents to better respond to their baby’s needs. When the NBO mental health intervention was used, infants receiving the NBO showed greater gains in cognitive and adaptive function at six months than infants who received usual care, and caregivers made greater improvements in maternal depressive symptoms when compared with usual care group (McManus et al., 2020). The patterns revealed by the NBO approach can also help parents and clinicians decide whether further developmental assessments are needed (Kristensen et al., 2019). Some observations made for baby Jennifer (who we met earlier) are shown in Table 3.2.

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Children with or At-Risk for Developmental Delays

Table 3.2  Summary of Jennifer’s Newborn Behavior Observation (NBO) Findings Observation

Recommendations

Jennifer’s sleep pattern seems to be reverse, sleeping during busy day and wakeful during quiet night.

Transition her gradually by reducing daytime stimulation (e.g., light and sound) so that she becomes accustomed to sleeping in dark/quiet.

Jennifer’s muscle tone is somewhat problematic; she has difficulty with rooting, sucking, and grasping.

Use feeding cues (e.g., stroke cheek) to strengthen feeding response; use touch and contact to strengthen grasp.

Jennifer responds to voice, but does not visually track or respond to other sounds.

Use activities to support visual and auditory response and to strengthen social interactions.

Jennifer is difficult to soothe when she is crying.

Work to provide comfort while encouraging self-soothing (e.g., touch and talk to her, allowing her to calm down).

Jennifer’s activity level is low.

Support interactions and play activities.

Strengths: Jennifer recognizes mother’s voice and responds to this. She is beginning to adjust to the new environment. Challenges/Areas needing support: Continues to need support for appropriate sleep patterns, feeding and grasping, and social interactions Additional comments: Remember that Jennifer is still not full term, and she is doing really well for her age!

In addition to the services for young children with identified disabilities, early intervention may be provided for children from birth through age 2 who have developmental delays. Box 3.2 looks at one parent’s journey to accept her child’s disability.

3-5  Children with or At-Risk for Developmental Delays In the United States, developmental delays are defined by each state, and can occur in any of the five critical domains: cognitive, communicative, social-emotional, motor, and adaptive development (see Figure 3.3). The purpose of early support for children who may have developmental delays is twofold: first, to optimize early development; and, second, to prevent secondary problems from emerging (Neitzel, 2011). Infants develop at varying rates. Some sit at 6 months of age, others at 4 months, and still others at 8 months; some walk early, and some walk late. These variations are the major reason for being cautious when deciding whether an infant or toddler has developmental delays. Further, cultural beliefs about child rearing will influence when children hit certain developmental milestones. Families have differing thoughts about the child’s independence versus dependence, and these beliefs will shape expectations for walking, self-feeding, safe boundaries for independent exploration of the environment, and time needed for self-regulation before intervening when the child is distressed (Bowman, 2019). Understanding and honoring these beliefs is essential for successful culturally responsive familycentered interventions (Castro et al., 2013). Delays in development are identified by comparing a child’s development in the five key domains with the development of other same-age children. The average ages of a task’s accomplishment are put together in a developmental profile. If, for example, a child does not sit, stand, walk, or speak within the age range at which most children in their culture have acquired these skills, a disability or

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Chapter 3  |  Early Intervention Supports and Services

Box 3.2

Exceptional Lives    Exceptional Stories:

Welcome to Holland

I am often asked to describe the experience of raising a child with a disability—to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It’s like this . . . . When you’re going to have a baby, it’s like planning a fabulous vacation trip to Italy. You buy a bunch of guidebooks and make your wonderful plans. The Coliseum. Michelangelo’s David. The gondolas in Venice. You may even learn some handy phrases in Italian. It’s all very exciting. After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later the plane lands. The flight attendant comes in and says, “Welcome to Holland.” “Holland?” you say. “What do you mean Holland? I signed up for Italy. I’m supposed to be in Italy. All my life I’ve dreamed of going to Italy.” But there’s been a change in the flight plan. They’ve landed in Holland, and there you must stay. The important thing is that they haven’t taken you to a horrible, disgusting, filthy place, full of pestilence, famine, and disease. It’s just a different place.

So you must go out and buy new guidebooks. And you must learn a whole new language. And you will meet a whole new group of people you would never have met. It’s just a different place. It’s slower-paced than Italy, less flashy than Italy. But after you’ve been there for a while and you catch your breath, you look around and you begin to notice that Holland has windmills, Holland has tulips. Holland even has Rembrandts. But everyone you know is busy coming and going from Italy, and they’re all bragging about what a wonderful time they had there. And for the rest of your life, you will say “Yes, that’s where I was supposed to go. That’s what I had planned.” And the pain of that will never, ever, ever go away, because the loss of that dream is a very significant loss. But if you spend your life mourning the fact that you didn’t get to Italy, you may never be free to enjoy the very special, the very lovely things about Holland. Source: Copyright © 1987 by Emily Perl Kingsley. All Rights Reserved. Reprinted by permission of the author.

developmental delay is suspected (Neitzel, 2011). So, what are some typical developmental milestones? Figure 3.4 shows some milestones for typical development that can serve as benchmarks for concerns regarding a child’s development. Although understanding typical developmental milestones is helpful when we are learning about children with special needs, a chart such as the one in Figure 3.4 can make things seem rather simplistic and static. We must remember that the early development of a child is anything but simplistic and is certainly not static (Neitzel, 2011). The Centers for Disease Control, CDC, has revised their milestones for the first time in 30 years. This revision identifies milestones that

Cognitive

Motor

Social-emotional

Communication

Adaptive

◗ Figure 3.3  The Five Critical Domains of Development Source: a. Jordygraph/Dreamstime.com b. Brebca/Dreamstime.com c. Pavla Zakova/Dreamstime .com d. Noam Armonn/Dreamstime.com e. Orangeline/Dreamstime.com

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Children with or At-Risk for Developmental Delays

Depth perception

0

Regards own hand

1

Sleeps 20 hours Vocalizes

Turns to rattling sound

2

3

Controls eye muscles

Reaches

4

5

11

6

7

Localizes sound

Grasps bottle

8

9

Sleeps 12 hours

Scribbles

Stands alone

10

Sits without support

12

13

14

15

16

17

18

Imitates actions of others

Walks well

◗ Figure 3.4  Typical Developmental Milestones (in Months) Source: From www.brainconnection.com/topics/?main=fa/child-brain. © Posit Science Corporation. Reprinted by permission.

at least 75 percent of children will meet at the age indicated (https://www.cdc.gov /ncbddd/actearly/milestones/index.html). Children develop through a series of interactions with their family and other caregivers and with their environment (Castro et al., 2013; Hebbeler et al., 2012). As we discussed in Chapter 1, these interactions shape who the child is and influence who the child is becoming. When the early care and environment are optimal, the child’s development is enhanced. This is one reason why early intervention is family-centered and works to enhance the capacity of the family to meet the child’s needs. When stress enters the picture, the child’s development may be compromised (CSEFEL, 2021; Swafford et al., 2015). Figure 3.5 shows how stressors can affect these relationships, jeopardizing the optimal development of the child.

CDC new 2022 Developmental Milestones: https://www.cdc.gov /ncbddd/actearly /milestones/index.html

Challenges of the Child Family Dynamics and Interactions

Access to Resources

Family Well-being Child’s Development

◗ Figure 3.5  Stressors on the Family System That May Impact Child Development

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Chapter 3  |  Early Intervention Supports and Services In Figure 3.5, we can see that stressors may include inherent challenges of the child. Remember Jennifer and the challenges she faced as a preterm infant. Jennifer’s challenges were not over when she was finally discharged to go home. At home she continued to have difficulty with feeding, and her sleep patterns seemed to be reversed. She was most alert and wakeful at night when things were quiet and seemed to be drowsy and fussy during the day. Jennifer also cried a great deal and was difficult to soothe. Her mother Sandra felt like nothing she did for Jennifer seemed to be right, and this growing feeling of incompetence made her wonder whether Jennifer may have come home too soon. The visiting nurse, Tammy, was well versed in the newborn behavioral observation system (Nugent, 2015), and she was able to remind Sandra that Jennifer’s physical development was still catching up to her full-term birth date and that Jennifer was likely to become overstimulated very easily. Tammy also helped Sandra understand that during Jennifer’s earliest weeks of life she was in a busy, noisy, neonatal unit and that this activity actually helped Jennifer sleep. Sandra used this information to begin adapting the environment to gradually allow Jennifer to sleep with less external stimulation. Throughout this process, Sandra’s confidence began to grow. For Jennifer and her family, her preterm birth and early complications placed her at risk for developmental delays and added stress to the system, making the early parenting patterns more complicated. Stress can also be added to the system in other ways. Sandra and Tony are fortunate because they have good health-care benefits that cover 80 percent of most medical costs. Because of Jennifer’s prolonged hospital stay, however, the family was left with a substantial bill in spite of their insurance and with the family’s decision that Sandra would quit her job to take care of Jennifer, the family finances are very challenged. These additional stress factors create more worry for Sandra and Tony, but they have the emotional resources to cope with these difficulties and are committed to figuring things out. As the number of stress factors increases for a family, however, it can put the child at greater risk for developmental delays.

3-5a  What Puts Children at Risk for Developmental Delays? Infants are considered as being at risk for developmental delays because of low birth weight, prematurity, or the presence of serious medical complications. Preterm, low-birth-weight infants are a high-risk for developmental delays (Blasco et al., 2020). The rates of preterm births differ dramatically across racial groups, and Black women are 50 percent more likely than White women to give birth preterm (March of Dimes, 2020). Infant mortality is also significantly higher for Black (10.8 per 1,000) and Indigenous peoples (American Indian 8.2; 9.4 Native Hawaiian) than for Whites (4.9 per 1,000) (March of Dimes, 2020). Researchers have identified three general categories of conditions that put children at risk: genetic disorders, events occurring during pregnancy or birth, and environmental stressors.

Genetic Disorders The first opportunity to detect potential genetic disorders, in fact, occurs before conception, in genetic counseling. A counselor interviews the prospective parents about their families’ histories of disabilities and analyzes samples of the clients’ blood to determine whether they carry any problematic genes that might be passed on to their children. Individuals may choose to receive this counseling before a child is conceived. A genetic counselor can calculate the probability or odds of a couple’s having a child with a disabling condition or a genetic disorder

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Children with or At-Risk for Developmental Delays

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(March of Dimes, 2021), but the counselor cannot guarantee whether the child will be born with or without disabilities. Because genetic counseling is relatively new, we have yet to fully explore all the ethical issues that knowledge of genetic problems can create for individuals and for society.

Events during Pregnancy and Birth The second broad category of conditions that may put infants at risk are events that occur during pregnancy or during the birth. The health and well-being of the mother are critical to the prenatal development of the infant. Under optimal conditions the fetus will develop normally during the gestation period. If the mother becomes ill, is malnourished, or consumes harmful substances, the health of the fetus can be jeopardized. Prenatal care is critical because it alerts mothers to the potential dangers of certain drugs and diseases (March of Dimes, 2021). If the mother contracts a Zika infection from a mosquito bite, for example, this can damage the fetus. Researchers are studying the impacts of Zika, but expectant mothers who live in areas where Zika is prevalent should use extra caution to protect against mosquitoes. The most common maternal illness that causes difficulties with fetal development is diabetes. Controlling diabetes during pregnancy can prevent the occurrence of many disabilities (March of Dimes, 2021). Doctors may also limit the use of some over-thecounter and prescription medications during pregnancy to prevent complications for the fetus. Substance abuse by the mother or father can be linked to behavior problems and disabilities in children. The use of alcohol during pregnancy may result in the infant having fetal alcohol syndrome or spectrum disorder, a range of neurological disorders, and recent studies indicate that 2 to 5 percent of school age children may be impacted (Copeland et al., 2021; March of Dimes, 2021). Expectant mothers who use heroin may give birth to premature or low-birth-weight infants. These infants may exhibit severe drug withdrawal symptoms and will likely be at risk for disabilities. In addition, children whose mothers use drugs may be more emotionally vulnerable than the children of nonusers. If the expectant mother smokes two packs or more of cigarettes a day, she risks giving birth prematurely or having a low-birth-weight infant. Major national campaigns have been mounted to discourage pregnant women from smoking and using substances that may harm their fetuses (March of Dimes, 2021).

The March of Dimes Protecting the Health of Mothers and Babies marchofdimes.org

Environmental Risks Environmental risk factors, the third area for concerns, are conditions and occurrences in the life of the child and the child’s family that interfere with the child’s development. Environmental risk factors are the major cause of disabilities for young children. Two well-known environmental factors that interfere with development are poverty and child abuse (March of Dimes, 2020; Swafford et al., 2015). Poverty can increase the risk factors for a child in many ways (Swafford et al., 2015). Women who live in poverty are likely to have insufficient medical care (including prenatal care), poor housing, and inadequate nutrition. In the absence of prenatal care, potential disorders that a physician could detect and treat are missed. Single mothers are at greater risk for living in poverty because they may have the financial support of the father. If the expectant mother is a teenager living in poverty, she is at great risk of having a premature or lowbirth-weight infant, who is in turn at great risk for a variety of disabilities. Other risks occur when family resources are too limited to provide adequate nutrition, medical care, and housing (Bowman, 2019). If you think back to the interactive components that affect the child’s development (Figure 3.5), you will remember that a lack of financial resources is one of the major stressors

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Chapter 3  |  Early Intervention Supports and Services

Position Statement on Child Maltreatment www.decdocs .org/position-statement -child-maltreatme

The Early Childhood Technical Assistance Center www.ectacenter.org

that can jeopardize the family’s ability to meet the child’s needs. When the family is stressed, the caregiving relationship with the child is more likely to be fragile, and the child is more likely to be neglected or abused (Corr & Santos, 2017; CSEFEL, 2010a). Many of us may find it hard to understand the existence of child abuse. How can an adult physically harm a baby or a young child, particularly one with disabilities? Yet most of us cannot imagine the stress that parents of children with disabilities face. Imagine a child who cries constantly and is inconsolable. For hours during the night, the parents try everything they can think of to calm him. They walk him, feed him, and bounce him, but nothing works. Throw into the equation additional stress factors such as a difficult marriage, pressures at work, adult mental health issues, a history of past family violence, and no prospect that tomorrow will be any better than today, and you have the potential for child abuse (Corr & Santos, 2017). In 2011, an estimated 680,000 children were abused or neglected, and 11 percent of these children had diagnosable disorders (U.S. Department of Health and Human Services, 2012). Research suggests that children with disabilities are abused more often than other children (Corr & Santos, 2017; MacLean et al., 2017). Physical punishment is strongly associated with child abuse, and physical punishment also increases the risk of a child experiencing partner violence as an adult (Afifi et al., 2017). Early trauma has a profound and lasting impact on the child, and specific challenges often include cognitive, social, emotional, and academic impacts (Cummings & Swindell, 2019). Signs that a child has experienced trauma may include violent outbursts, withdrawal from others, or hyperarousal (e.g., oversensitivity to environmental stimulus). As a teacher you may see these things in the child’s behavior as crying, hording, passivity, avoidance of physical contact, or inability to concentrate (Cummings & Swindell, 2019). The Division for Early Childhood’s position paper on child maltreatment (e.g., abuse, neglect, and trauma) states that we, as teachers, must be vigilant in our awareness of and response to suspected maltreatment of the children under our care, taking a strength-based and family-centered approach to intervention (DEC, 2018). When the circumstances of the family are very stressful, life is a challenge. These environmental risk factors are some of the most difficult stressors for a family to cope with, and they often feel overwhelming and insurmountable. Supporting vulnerable families to help them meet the needs of their child is central to the child’s optimal development and mental health (Swafford et al., 2015). Young children’s social and emotional health is critical for school readiness and positive long-term outcomes (Hallet et al., 2019). Optimal child development is dependent on how several factors come together to create a dynamic system (remember from Chapter 1) that either supports or inhibits children’s well-being.

3-5b  Child Find for Children Who Need Early Intervention Not all disabilities can be recognized prenatally or at birth, and so Child Find, a critical component of IDEA 2004, requires that states identify, locate, and evaluate all children from birth to age 21 who need early intervention services or special education (ECTA, 2013). Some state Child Find programs involve a continuous process of building public awareness to increase the referral and identification of children and families in need of early intervention supports. While each state has its own process, most Child Find programs include the elements given in Box 3.3.

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Children with or At-Risk for Developmental Delays

Box 3.3 ●







Elements of State Child Find Initiatives

Definition of target population(s): How the state defines development delays will determine which children are eligible for services. Public awareness campaigns: Outreach to parents, caregivers, and the community is essential to finding children who may need additional support. Referral and intake processes: Each state has a system to manage this process. Screening and identification procedures: These will vary from state to state.







Eligibility determination criteria: These policies guide decision making about which children will receive services. Tracking and monitoring services: Evaluating the system of service providers is key to ensuring that it is successful. Interagency coordination: Because Child Find services often involve multiple agencies (such as Head Start, public schools, child mental health), it is essential that these organizations work together to address child and family needs.

Source: U.S. Department of Education Child Find Project, 2007

Child Find services are coordinated at the state level with services for infants and toddlers covered under Part C of IDEA and with services for preschool children who require special education covered under Part B. This means that some states must coordinate two agencies that have responsibilities for services as the child progresses from birth through preschool. Ideally every child in need of early intervention is “found.” Unfortunately, the likelihood of being found for early intervention differs by gender, race/ethnicity, and economic status: with special needs are less likely to be identified before kindergarten. ●  African American children are less likely than any other race to be identified early (while being more likely to be disproportionately overrepresented in school-age children with disabilities). ●  English language learners are less likely to be found than non-English language learners (Guardino et al., 2010). Appropriate identification for children from culturally/linguistically diverse families remains challenging as we work to balance the need for early supports and services to meet with success against the biases that may overidentify some children. Children from low-socioeconomicstatus households and those from homes where English is not the primary spoken language are also less likely to be represented in early intervention populations (Morgan et al., 2012). These data indicate that the very children who could most likely benefit from early intervention are

Jake Lyell /Alamy Stock Photo

●  Girls

Child Find programs must work harder to locate young children from households where English is not the primary language.

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Chapter 3  |  Early Intervention Supports and Services the least likely to be found, so their families are the least likely to review the support they need to help their children be ready for school success. Poverty also impacts the services that children will receive. Only 43 states guarantee that Medicaid will cover physical therapy, occupational therapy, or speechlanguage therapy, and many of those states limit the sessions per year. Thus many children are denied access to the very interventions that would help them meet with success in school. Once again, we can see the impact that poverty can have on a child’s trajectory for success. Once a child is found, the next step is to determine whether they are eligible for early intervention and determining what services should be provided. The following sections share educational responses for young children with or at risk for developmental delays and disabilities.

3-6  Educational Responses for Children Needing Early Intervention Currently, 44 states and the District of Columbia provide some type of publicly funded prekindergarten services; however, with the anticipated state budget shortfalls due to COVID-19, funds for these programs are likely to be reduced (Friedman-Krauss, 2020). Even within states that provide support for pre-K, these services do not reach all children with or at risk for developmental delays or disabilities, and the quality of programs varies widely.

3-6a  Quality of Early Childhood Services

DEC Recommended Practices www.dec-sped.org/dec -recommended-practices

The overall quality of the preschool classroom is clearly linked to successful outcomes for children (Barnett, 2019; Winton, 2019). Factors typically associated with a high-quality preschool classroom include low child-to-teacher ratios, high education levels for teachers, positive social interactions, and appropriate academic stimulation. In other words, a high-quality classroom provides a safe and nurturing emotional environment with rich and stimulating opportunities for learning. The Division for Early Childhood of the Council for Exceptional Children has established recommended practices to provide guidance to practitioners and families about the most effective ways to support young children with or at risk for developmental delays and disabilities (DEC, 2014). These practices cover seven areas of practice: assessment, environment, family, instruction, interaction, teaming and collaboration, and transition (see Table 3.3). The practices included in these guidelines can be delivered in all settings and are those that will have the greatest impact on child/family outcomes. As you read the rest of this chapter, think about how the recommended practices in Table 3.3 are used as practitioners work with Tyrus and his family. In addition to the seven practitioner practices, there is a set of leadership guidelines that help define the infrastructure needed to support best practices. Research from child-care studies suggests that the curriculum in high-quality programs is associated with cognitive and language gains, as well as gains in social and emotional development (Winton, 2019). Lower levels of aggression and fewer problem behaviors occur among children in high-quality programs. The curricula of these programs focus on children’s self-determination, choice making, and initiative taking, thereby encouraging them to interact with the environment (people and objects) in appropriate ways. The most effective programs are child-centered, include developmentally appropriate practices, and are intensive in nature; children who enter a well-planned,

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Educational Responses for Children Needing Early Intervention

Table 3.3 

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 ample Set of the Division of Early Childhood’s Seven Recommended Practices for S Special Education Practitioners Working with Young Children and Their Families

Assessment

Gathering information needed to make decisions and inform interventions: A1. Practitioners work with the family to identify family preferences for assessment processes. A4. Practitioners conduct assessments that include all areas of development and behavior to learn about the child’s strengths, needs, preferences, and interests.

Environment

The space, materials, equipment, routines, and activities that practitioners and families can intentionally alter to support the child: E1. Practitioners provide services and support in natural and inclusive environments during daily routines and activities to promote the child’s access to and participating in learning experiences. E2. Practitioners consider Universal Design for Learning principles to create accessible environments.

Family

Ongoing activities to ensure that families are engaged in planning and supporting their child: F1. Practitioners build trusting and respectful partnership with the family through interactions that are sensitive and responsive to cultural, linguistic, and socioeconomic diversity. F3. Practitioners are responsive to the family’s concerns, priorities, and changing life circumstances.

Instruction

Instructional practices are intentional and systematic strategies to inform what to teach, when to teach, and how to evaluate the effects of teaching: INS2. Practitioners, with the family, identify skills to target for instruction that help a child become adaptive, competent, socially connected, and engaged and that promote learning in natural and inclusive environments. INS5. Practitioners embed instruction within and across routines, activities, and environments to provide contextually relevant learning opportunities.

Interaction

Strategies for fostering children’s social-emotional competence, communication, cognitive development, problem-solving, autonomy, and persistence: INT3. Practitioners promote the child’s communication development by observing, interpreting, responding contingently, and providing natural consequences for the child’s verbal and non-verbal communication and by using language to label and expand on the child’s requests, needs, preferences, or interests.

Teaming and Collaboration

Practices that promote and sustain collaborative adult partnerships, relationships, and ongoing interactions to ensure that programs and services achieve the desired child and family outcomes and goals: TC1. Practitioners representing multiple disciplines and families work together as a team to plan and implement supports and services to meet the unique needs of each child and family.

Transition

The events, activities, and processes associate with key changes between environments or programs during the early childhood years (e.g., hospital to home to early intervention to kindergarten): TR2. Practitioners use a variety of planned and timely strategies with the child and family before, during, and after the transition to support successful adjustment and positive outcomes for both the child and family.

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Chapter 3  |  Early Intervention Supports and Services intensively structured program during the first five years of life and stay in that program for a long period of time make the greatest gains and suffer the least loss (Barnett, 2019).

3-6b  MTSS Approaches for Young Children

RtI Action Network Pre-K site (for MTSS Resources) www.RtInetwork.org/Pre-K

The Pyramid Model at Vanderbilt University www.vanderbilt.edu/csefel

The philosophy of early intervention is central to the Multi-Tiered Systems of Support (MTSS) (sometimes called RtI, or Response to Intervention) approaches being used with preschool children (Coleman, Roth, & West, 2009). MTSS models for pre-K focus on universal screening and progress monitoring data to look at the child’s needs, on the use of evidence-based practices to respond to these needs, and on working with the family to help the child become successful (Coleman, Buysse, & Neitzel, 2006b; Green, Robins, & Bucholz, 2019). Evidencebased practices are those that have been shown to work through research, practitioner wisdom/experience, and alignment with family values. Like their school-aged counterparts, pre-K MTSS focus on providing a high-quality learning environment, an emphasis on providing supports to children as soon as a difficulty emerges rather than waiting for a formal label, tailoring instruction to meet the child’s needs, and working with parents to provide support (Coleman et al., 2009; Coleman et al., 2006a; Green, Robins, & Bucholz, 2019; McCart & Miller, 2019). MTSS approaches for preschool children often use a three-tiered framework for meeting needs. Each tier is described in Table 3.4. As the needs of children increase and/or become more complex, the responses made to meet these needs must become more explicit and more intense. Tier I, Universal Support, focuses on high-quality learning environments; universal screening to look at all children’s strengths and needs; and periodic progress monitoring to see how each child is doing. With Targeted Support at Tier II, teachers use embedded activities and explicit instruction. In Tyrus’s case, for example, the speech-language therapist has suggested a variety of activities that can be done within the day to promote communication and enhance Tyrus’s learning. One activity, called “turn taking,” is being used during story time. The teacher gives four children two cards each. Each child’s cards are a different color. The teacher reads a story and prompts the children to take turns with their comments. After a child has talked, they place one of their cards in the center. The child must then wait until at least two other children have taken their turns to talk and have placed their cards in the center before that child can talk again. With Tyrus, the teacher also prompts him with a specific question about the story. Tier III, Intensive Support, is more personalized and directive. Because Tyrus has significant language delays, he also receives services at the Intensive level, Tier III. The speech-language therapist works with Tyrus three times per week. Sometimes she works with a small group of children in Tyrus’s class, sometimes she models strategies to enhance communication during daily routines, and sometimes she provides intensive individualized activities. Tyrus’s parents have also been given strategies to enhance his communication in the home and other naturalistic environments. Tiered approaches are also used to support the behavioral needs of the child. The Pyramid Model, much like PBIS described in Chapter 2, is a multitier approach to a positive nurturing environment for all children while providing additional support for any child whose behaviors continue to be challenging (Fox et al., 2011). A nurturing environment that fosters positive relationships combined with classroom practices that minimize or prevent the need for disruptive behaviors (that is, children feel safe and know that their needs will be

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Educational Responses for Children Needing Early Intervention

Table 3.4  Levels of Support Provided in Tiers I, II, & III within an MTSS Framework

Universal Tier I: Effective core curriculum and intentional teaching

Targeted Tier II: Small group embedded and explicit instruction

Roles of Parents and Professionals

Assessment Strategies

Provide high-quality early-childhood instruction to meet the academic and behavioral needs of all children in the classroom

Classroom teachers and staff plan and implement core curriculum and instruction, collaborating and communicating with families

Universal screening three times each year (e.g., fall, winter, spring)

Some children identified on the basis of universal and periodic screening need additional support to achieve success

Provide targeted instruction through additional supports and opportunities to practice skills within small groups, or as part of daily routines and for additional enrichment for learning

Specialists assist teachers; parents receive progress reports and engage in a collaborative problem-solving process with early childhood staff

Progress monitoring to ensure adequate progress and learning every 8–10 weeks

A few children need additional intensive support or enrichment to achieve success

Provide intensive instruction through individualized instructional strategies to support or enrich learning

Expanded team of professionals and parents develop more intensive plans for individual children and make decisions about referral for further evaluation; parents receive more frequent reports and engage in the collaborative problemsolving process with teachers and other professionals

Progress monitoring to ensure adequate process and learning every 4–6 weeks; referral for further evaluation if needed

Definition

Focus

Goals

Curriculum and instruction that is focused on all domains of learning and development, and is guided by observation and assessment

All children need a supportive and enriched learning experience

Explicit instruction: content-specific curricula (e.g., math, literacy, phonic awareness) and instructional approaches (dialogic reading) Embedded instruction: environmental arrangement, curricular modifications, peer support

Intensive Tier III: Intensive and individualized instruction

Individualized instructional strategies: prompting, modeling, physical assistance, giving a directive and waiting for a response, combined with explicit and embedded approaches

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attended to; adult–child relationships support and nurture prosocial interactions) is the foundation for all children (Edge et al., 2018) (see Box 3.4). The use of the Pyramid Model to support social/emotional well-being and behavioral health is a key to Arkansas’s plan to reduce the expulsion and suspension rates for young children. The problem of expulsion and suspension of

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Chapter 3  |  Early Intervention Supports and Services

Box 3.4

High Leverage Practices:

High Leverage Practice 7: Establish a Consistent, Organized, and Respectful Learning Environment

To build and foster positive relationships, teachers need to establish age-appropriate and culturally responsive expectations and routines in their classrooms. These expectations are positively stated and explicitly taught; positive behaviors are reinforced, and feedback for changing behaviors is given in a meaningful and caring way. Students are involved in setting and supporting respectful classroom expectations and routines.

See the High Leverage Practices in Special Education website, https://highleveragepractices .org/.

Reflection: ●

In what ways would the implementation of this high leverage practice help with reducing challenging behaviors in the classroom?

young children is critical with approximately 10 percent of pre-K teachers indicating that they had expelled at least one child over the previous year. Early expulsion is associated with later school failure, dropping out of high school, and involvement with juvenile justice; and mirroring the problems we discussed in Chapters 1 and 2 the children who are disproportionately impacted by early expulsion are Black boys (Edge et al., 2018). When children need additional support to overcome challenging behavior, teachers and parents work together to create a behavioral support plan. The key to behavioral support planning is understanding the ABCs of a child’s behavior: A, the Antecedent (e.g., event or circumstance) that triggers the child’s difficult behavior; B, the Behavior that is causing problems; and C, the Consequences of the behavior for the child, the adults, and others who are impacted by the behavior (Green, 2018). Through an analysis of the child’s behavior, the adults look at the antecedents or trigger(s) for the challenging behavior; what, when, and how the behavior is initiated (the context) and an examination of the behavior itself; the purpose for the behavior; what the child is trying to achieve or communicate; what the child needs; and why the child is acting in this way (Meadan et al., 2016). Finally, the adults look at the consequences of the child’s behavior. They identify strategies to minimize the triggers (e.g., planning for transitions and giving five-minute warnings to children so that they know what is coming next) and to teach replacement behaviors so that children have positive ways to express their needs (e.g., asking with words when they want a toy instead of grabbing it). Through the use of this careful planning, teachers and parents can structure the environment to minimize challenging behaviors and promote positive interactions (Green, 2018). Box 3.5 offers some ideas to help young children calm themselves. Because of Tyrus’s language delays, he does not use words to ask for toys and things that he wants and often just grabs these away from other children. As you can imagine, this gets him into difficulty when other children become upset! Tyrus’s teachers and parents worked together to examine this behavior so they could plan to support Tyrus as he learns to use words to ask for what he needs and wants. Tyrus also works with a speech-language therapist twice a week on his communications skills. This level of support falls within Tier III of MTSS.

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Educational Responses for Children Needing Early Intervention

Box 3.5

Mindfulness Matters:

Early Experiences with Self-Regulation

As adults we can understand and appreciate the benefits of trying to remain calm in the face of frustrations, but for a child this self-regulation may be challenging. Self-regulation, or the ability to re-frame our thinking, modulate our emotions, and modify our behaviors may not come naturally or easily for young children (indeed it can sometimes be difficult for us!). We can support the development of self-regulation with some simple and concrete strategies. Why This Matters: If we catch our thinking, emotions, and behaviors as things begin to get frustrating, we have room to identify and work with these feelings. The key to self-regulation is catching things before they get out of hand! Practicing Mindfulness: Starfish breathing (Zero to Three, www.zerotothree.org/resources/3402-starfishbreathing) gives very young children a concrete way to begin practicing self-regulation. Here is how it works: 1. When you see the frustration beginning to emerge, talk with the child about how they are feeling; give them words to use: “It seems like you are getting frustrated with…” “Are you feeling

TeachSource Digital Download

disappointed about…” “I know that it can be annoying when you are not allowed to…” 2. Shift the mood: “Let’s see if we can calm down so that we can make a better choice…” 3. Ask the child to make their hand like a starfish by spreading their fingers out wide. Show them how to trace each finger of their “starfish hand” as they breathe…breathe in as they trace up to the fingertip…breathe out as they move to the base of their finger. (Breathe in, trace up; breathe out, trace down following the fingers.) As you do this together, you can slow the breathing down. 4. Once the child has calmed down, make sure to identify the new feeling (e.g., now I feel calm/quiet/ ready for something new) and then move to something interesting and engaging. This process does three things: distracts the child from the frustrations; helps them to identify and name their feelings; and supports the child in the self-regulation needed to reframe their thinking, modulate their emotions, and monitor their behavior. It helps the child keep their thoughts, feelings, and actions in hand!

Access online

3-6c  The Individualized Family Services Plan Finding the right combination of supports and services for each child and their family is critical, and this process involves the development of an individualized family service plan (IFSP) (Boothe & Hathcote, 2021). The IFSP is similar to the individual education plan (IEP) that is developed for older children (see Chapter 2). Because infants and toddlers with disabilities can be found in different settings (private child-care centers, Head Start programs, public prekindergarten classrooms, and so forth), it can be difficult to tell who is responsible for developing and carrying out the IFSP (Gatmaitan & Brown, 2016). A service coordinator is key to helping the family access and navigate the system of support that is available. The service coordinator oversees the development and implementation of the IFSP.

IDEA, Part C: Legal Requirements of the IFSP Part C of IDEA requires that an IFSP be developed for each child from birth through 2 years of age who is diagnosed as disabled, developmentally delayed, or at risk for delays. When the child qualifies for early childhood special education services, such as Early Head Start, at 3 years of age, an IEP generally takes the place of the IFSP. IDEA, Part C requires that IFSPs be constructed to include the following: ●  A

statement of the infant’s or toddler’s present levels of physical development, cognitive development, communication development, social-emotional development, and adaptive development, based on objective criteria

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Chapter 3  |  Early Intervention Supports and Services ●  A

statement of the family’s resources, priorities, and concerns relating to enhancing the development of the family’s infant or toddler with a disability ●  A statement of the major outcomes expected to be achieved for the infant or toddler and the family, and the criteria, procedures, and timelines used to determine the degree to which progress toward achieving the outcomes is being made and whether modifications or revisions of the outcomes or services are necessary ●  A statement of specific early intervention services necessary to meet the unique needs of the infant or toddler and the family, including the frequency, intensity, and method of delivering services ●  A statement of the natural environments in which early intervention services shall appropriately be provided, including a justification of the extent, if any, to which the services will not be provided in a natural environment ●  The projected dates for initiation of services and the anticipated duration of the services ●  The identification of the service coordinator from the profession most immediately relevant to the infant’s/toddler’s or family’s needs (or who is otherwise qualified to carry out all applicable responsibilities under Part C) who will be responsible for the implementation of the plan and coordination with other agencies and persons ●  The steps to be taken to support the transition of the toddler with a disability to preschool or other appropriate services (Boothe & Hathcote, 2021)

Nebraska’s Individual Family Service Plan www.ifspweb.org

The family may need help locating, obtaining, and implementing the services specified in the IFSP; in fact, the family will need access to a multidisciplinary team of specialists who can help meet the needs of the child. Examples of family service plans can be found on Nebraska’s Family Service Planning website. You may wish to visit this site to see how these plans are created.

3-6d  Collaboration and the Multidisciplinary Team

Parents Helping Parents Resource Center www.php.com

Children who qualify for services under IDEA must have been identified, screened, and diagnosed by a multidisciplinary team as having a disability known to be associated with developmental delays or as being at risk for the occurrence of developmental delays. Under the guidance of a service coordinator, the term multidisciplinary means that we must draw from the knowledge and skills of more than one professional in working with the family and child. A multidisciplinary team might include physical therapy to improve motor function, speech-language therapy to assist control of the muscles involved in speech, and educational programming to support cognitive development. The team always includes a parent or guardian as a key member who helps inform the team of the child’s and family’s needs and helps shape the service plan so that it will meet these needs. Each team will comprise the specific individuals needed to address the child’s unique needs. In most cases the child will receive between two and four services. Ideally the team works together to gather and review information about the child’s and family’s needs so that a comprehensive and workable plan can be developed to address these needs (McCollow & Hoffman, 2020). Putting the multidisciplinary team together, however, can be challenging given the variety of child-care settings for young children (family-based, center-based, Head Start, and public schools), and the role of the service coordinator is critical. Let’s look at how this process worked for Tyrus and his family when he was first diagnosed with developmental delays. His teacher, after consultation with Tyrus’s parents, contacted the state coordinator for Child Find to initiate the formation of the team. (You may want to locate the Child Find services website for your state to see how you could secure support for a child whose needs are similar to Tyrus’s.)

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You may remember that Tyrus’s mother, Laura, was the first one to become concerned about his behavior. She was worried that he did not seem as responsive as his peers at the child-care center. Tyrus’s pediatrician, Dr. Nolan, listened to her and suggested that Tyrus have a comprehensive assessment to determine what was going on. This assessment required the involvement of a multidisciplinary team. Tyrus’s hearing and vision were tested; his motor control, self-help skills, and sensory integration were assessed; and his overall communication and social skills were reviewed. Tyrus’s parents filled out a lengthy questionnaire, and his teachers completed some observational notes documenting Tyrus’s behavior under a variety of circumstances. An early childhood developmental specialist with extensive experience working with children with developmental delays and possible autism observed Tyrus at his child-care center and at home. When all of this information had been gathered, the team met to review Tyrus’s needs. The team confirmed Laura’s worries and determined that Tyrus was indeed showing some delays; it diagnosed Tyrus with developmental delays in communication and social-emotional domains. The team agreed that his progress should be followed closely and monitored for possible autism spectrum disorders (Boyd et al., 2010). Identifying Tyrus’s needs, however, was just the first step for the team. The most important work was yet to come as the team worked to implement Tyrus’s plan.

3-6e  Curriculum and Instruction for Young Children Once Tyrus’s needs had been formally identified, the team’s next step was to determine what interventions should be put into place to meet these needs. Because Tyrus was only 1½ years old, he still qualified under part C of IDEA for an IFSP. You may remember from the information processing model (Figure 3.1) that Tyrus’s difficulties include auditory processing of language (input) and processing (he seems to need more time to think things through) and that he also has challenges with output (speaking and social interactions). His strengths included using kinesthetic input, categorization (pattern-recognition), and motor output. The team worked to create an IFSP that would meet the family’s needs, agreeing that Tyrus’s plan would focus on communication and social skills (see Figure 3.6). Tyrus’s parents met with a speech-language therapist to learn ways that they could prompt and facilitate Tyrus’s communications. Tyrus would receive support for speech and language three times per week, and his child-care teacher would make sure to focus on language and communication with Tyrus during the class activities and routines. Tyrus’s parents would set up more play times and would encourage his use of words to communicate. The team agreed to monitor Tyrus’s progress and to re-evaluate his needs within six months. Tyrus’s progress monitoring chart (Figure 3.7) shows how his teachers collected and used data on his use of words and his participation in class activities. Using the Individual Growth and Development Indicators (IGDIs), the team was able to see that Tyrus used fewer words than the other children his age. His teachers began supporting his use of language during daily routines, reminding Tyrus to “use his words” when he wanted something, and asking simple questions like “Which cracker do you like the best?” to get Tyrus to talk more. You can see that while Tyrus’s use of language increased over time, he still needs more support for this and for his participation in daily activities. The progressmonitoring and word charts will help Tyrus’s teachers and parents see how things are going so that they can plan for next steps when they meet. Tyrus’s needs, like those of most children, will best be met through inclusion in his preschool and supports in his home.

Early childhood programs are essential for kids with special needs.

Individual Growth and Development Indicators https://igdi.ku.edu/

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Qualification for Services Tyrus has been identified with significant developmental delays with possible autism; the team will reassess Tyrus within six months to determine progress and additional needs.

Family’s Concerns and Desired Priorities ●  Tyrus’s lack of recognition and greeting Mom when she picks him up from preschool ●  Tyrus’s inability to play and engage with others (adults and other children) ●  Inability to use words to communicate needs, to avoid frustrations and “melt downs” ●  Mom wants more time with Tyrus, feels she is working too much and that this is interfering with her ability to meet Tyrus’s needs ●  Dad is concerned about Tyrus’s ability to get along with others and play

Child and Family’s Strengths ●  Tyrus is a contented child who can entertain himself for long periods of time ●  Both parents enjoy Tyrus and are committed to meeting his needs. The family also includes grandparents, aunts, uncles, and

cousins who love and support the parents and Tyrus

Child’s Present Levels of Development ●  12-month

health check showed no difficulties with Tyrus’s vision, hearing, and overall health. Tyrus’s cognitive abilities also seem to be on target; however, these are more difficult to assess because of delays in communication and social engagement.

●  Tyrus shows significant delays in his expressive language (i.e., his use of words to express his thoughts, needs, and wants).

Tyrus’s receptive language (his understanding of what others say to him) is difficult to gauge because he does not engage socially with others. ●  Tyrus’s self-help skills seem to be on target; he feeds himself when finger food is prepared, he holds the sippy cup to drink,

and he can help with dressing. However, parents say they are usually in a hurry and just dress him themselves. ●  Tyrus’s fine and gross motor skills are not significantly delayed.

Goal/Outcome 1. Tyrus will engage in more social-play with parents, family, and other children (increase from baseline of 1 to 4 exchanges per-day as documented by parents and teachers). 2. Tyrus will show a 20% increase in his use of words to express thoughts, needs, and wants.

◗ Figure 3.6  Tyrus’s Individual Family Service Plan

Rate Per Minute Single Words

Baseline

Intervention

90 80 70 60 50 40 30 20 10 12

13

14

15 16 Age at Test

17

18

Peer Level of Function

19.....36

The use of embedded instruction (i.e., the use of a child’s daily activities to teach and reinforce key skills) helps us meet the needs of children with disabilities in the context of the inclusive classroom. Activity-based, embedded approaches are particularly useful in promoting and enhancing young children’s social competence (DEC 2014). Figure 3.8 shows how teachers plan to meet the needs of their children by embedding specific goals within the classroom activities. Let’s fast forward and picture Tyrus as a preschool child at age 4. We can see that language is still an area of challenge for Tyrus, but now his preschool teacher is focusing on a variety of communication strategies. She is helping Tyrus use symbols to express his thoughts and is also prompting Tyrus to use his words.

◗ Figure 3.7  Tyrus’s Progress Monitoring Chart

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Learning Goals for Tyrus Time period: September-November Curriculum Area

Tyrus’s Goal

Outcome Goal

Language (Expressive)

Uses words to ask for what he wants during play time

Communicates wants and needs

Language (Receptive)

Does what he is asked to do when following class routine

Understands simple multi-step directions (e.g., time to cleanup, put things away, and come to circle time)

Repeats rhyming poems

Understands word sounds and rhymes

Gives each child one snack item during snack time

Uses one-to-one correspondence (e.g., one child one snack item)

Self-Management

Cleans-up his materials after activities

Uses good work habits

Social and Emotional

Identifies basic feeling of the main character in the story during story time

Understands basic feelings of others (e.g., happy, sad, angry)

Climbs on Jungle Gym during outside time

Develops gross motor skills

Early Literacy Early Math

Perceptual Motor

◗ Figure 3.8  Embedding Learning Goals within Class Activities

Importance of Learning Through Play

Bob Daemmrich/Alamy Stock Photo

We have known for some time that the natural manner in which all children learn is through play (Taylor & Boyer, 2020). Play is naturally-occurring, spontaneous engagement with objects, ideas, or people (Lifter, Mason, & Barton, 2011). It is particularly crucial for young children, who are innately curious, to look at objects, manipulate (e.g., shake or rattle) them to see what they will do, and then play with them. Play is used in most early childhood programs. Play is important because it stimulates children’s thinking, their motivation, and their socialemotional development (Frey & Kaiser, 2011). Many young children with disabilities, however, tend to spend their time observing rather than interacting during playtime (Barton et al., 2019; Barton & Ledford, 2018). “Play” for young children with disabilities is often more solitary and functional, involving less imaginative activities (Barton et al., 2019). Examples of functional play include rolling a toy car or sipping from a toy cup, where the object is used as it was designed. This type of play is less complex and is less likely to stimulate higher levels of thinking and problem solving. Engaging young children in symbolic or imaginative play (e.g., making a meal in the cooking center and feeding the family) helps build abstract thinking, language, and decisionmaking (McLeod et al., 2017). In encouraging higher-level learning, the importance of toys and play activities cannot be overemphasized Children learn through play and develop through interactions with (Barton et al., 2019; Frey & Kaiser, 2011; Lifter their environment. et al., 2011).

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Chapter 3  |  Early Intervention Supports and Services

TeachSource Video Connection

Early studies have concluded that children with disabilities tend to be less active (more passive) and less curious about the world around them; they have fewer coping skills with which to respond to environmental demands; therefore, an interventionist may have to teach a child with disabilities how to play so the child can use play to learn (Frey & Kaiser, 2011). Many positive social outcomes result from providing children with toys, allowing them to choose toys, and encouraging them to play with other children, with or without disabilities (Lifter et al., 2011; Pokorski et al., 2019). Engaging children through play enhances their interactions with each other and promotes communication (Frey & Kaiser, 2011).

Assistive Technology for Young Children

Hearing Loss in Pre-K: A SpeechLanguage Therapist in a Small Group Setting

Assistive technology (AT) includes any item or device that helps the child participate in more detail and function more independently within the environment, improvWatch this video of a small group of young children ing their quality of life (More & Travers, 2013). As part of with hearing disabilities. The hearing specialist Tyrus’s support for communication, the speech patholois working with technology to help the students gist uses pictures with words on them to help him express learn new skills. Pre-K is such an important year for what he wants and needs in the classroom. His parents preparing students for success in school, and early also use these to support his communication at home. intervention for exceptionalities is key. These picture boards are an example of low-tech assistive What skills is the teacher focusing on that will technology that can support a child’s communication. help students in their future schooling? How does To increase Tyrus’s participation in circle time, for she keep them engaged in her lesson? example, his teachers created a “circle time book” (Simpson & Oh, 2013). The book had visual prompts for each circle Watch online time activity (e.g., What would little bear wear today? What is the weather? What day is it today?). During circle time Tyrus would point to the pictures to answer the questions and his teacher would prompt him to use his words. Having the circle time book kept Tyrus more engaged and encouraged him to learn even more words. With young children, no matter how well developed our assistive technology is, it can never take the place of human interactions (More & Travers, 2013).

Nandana de silva/Alamy Stock Photo

3-7  Navigating Transitions in Early Childhood

Young children often adapt quickly to the use of technology for learning, communicating, and playing.

Navigating the change of service providers for early intervention may be a daunting task for families as they work to maintain supports for their child. During the early years, families may need to shift service providers three or four times as their child moves from hospital to early intervention to preschool and eventually to kindergarten. Transitions are a time of change, and even at their best they can be stressful (DEC, 2014). For a family with a child who has disabilities, this stress is likely to be greatly intensified, as their fears about their child’s wellbeing may make changes even more worrisome (Rous & Hallam, 2006). IDEA requires the development of a transition plan to support families during these changes and

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Navigating Transitions in Early Childhood

Box 3.6

Reaching & Teaching:

Young Children with Exceptionalities in a Virtual Setting

by Jennifer Job, Ph.D. In early 2020, the world shut down. The coronavirus swept through country after country, and governments closed restaurants, stores, and schools in an effort to stop the spread of the deadly virus. Teachers, therapists, and specialists were expected to work with children through computer screens instead of in person, and this virtual teaching stayed in many places even as the pandemic began to ease. Starting with this chapter, we will be including information on how virtual instruction affects teachers of students with exceptionalities.

Administering IDGIs Remotely While schools and therapist offices closed in 2020, children still needed services, and early intervention wasn’t any less important. Many early childhood specialists adapted their work to be done online through video software.

As noted earlier in this chapter, the Individual Growth and Development Indicators (IGDIs) are used by intervention teams to determine where students have developmental delays. The IDGIs are typically evaluated in person, with an expert observing a child playing and performing certain tasks (IDGIs, 2021). But in 2020, therapists couldn’t be in the same room as the children they were evaluating. So, Kansas University developed criteria for administering the IDGIs remotely. Parents picked up the standard play sets from the assessor’s office and then had their children play with the toys in a room as free of noise as possible. The therapist was instructed to view the child playing through Internet video conference software such as Zoom or Skype, record the session, and score the session from the video after (Guidelines for Remote IDGI, 2020). This use of technology allowed these evaluations to continue taking place so children could still receive the early intervention they needed.

to ensure that children receive uninterrupted services as they move through their early years (Rous & Hallam, 2006). Providing services was challenging during the COVID-19 pivot to online (see Box 3.6). Remember when Jennifer (the preterm infant presented earlier in the chapter) was finally ready to go home from the hospital? After weeks of worry, her parents, Sandra and Tony, had mixed feelings about finally taking Jennifer home. They worried that they would be unable to meet her needs and keep her safe. The first phase of intervention, the initial medical support, was ending, and the second phase started with home visits and home-based support. This support was provided through the state’s Part C coordinator (remember that IDEA Part C is the section of the law that covers children from birth through age 2). This first transition was successful, and over the first three years of Jennifer’s life, Sandra and Tony learned to trust their home-health nurse and the members of the multidisciplinary team they worked with as they struggled to meet Jennifer’s needs. They were very comfortable with the family service plan that had guided the support they had received. So, their concerns were natural when Jennifer was about to turn 3 and they had to change her services. Fortunately, a plan was developed to help create a smooth transition from Part C to Part B services (for preschool children). Under Part B, Jennifer qualified for an IEP because she was still showing developmental delays in motor functioning and cognitive abilities. The multidisciplinary team recommended continued physical and occupational therapies and helped the family identify the inclusion prekindergarten programs close to their home. Although kindergarten is a long way off for Jennifer, her parents are already thinking about this fourth transition.

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Moral Dilemma:

Using Genetic Counseling Shelia and Shea had been married for two years and were beginning to talk about starting a family. Although they wanted to have children, both of them were concerned that they might have some complications. Shea’s family had a history of sickle cell anemia. They wondered whether they might pass this on to their own children. They decided to go for genetic counseling. During the session, the counselor asked for family histories and then reviewed the results from the blood work they had completed prior to the visit. The counselor explained that the information she would share with them could not tell them whether they would have a child with disabilities and that it could only give them an idea about the likelihood of problems. The counselor told Shelia and Shea that they both had “sickle cell trait,” which meant that they were carriers of the sickle cell gene. Because they both carried the problematic gene, the counselor told them they had a 25 percent chance of having a child with sickle cell anemia. Shea asked about the likelihood of his sister carrying the sickle cell gene, because he knew that she and her husband were also thinking about having children. The counselor said that it was possible that Shea’s sister also carried the gene. Shelia and Shea had been given a lot to think about, but the first thing Shea wanted to do when they got home was to call his sister and share their news with her. Shelia was not certain that he should let his sister know that she might also carry the sickle cell gene. Should Shea inform his sister that she might be a carrier? What problems could having this information create for her (personal, social, health insurance, and so forth)? Is it better to know or not to know? If Shea decides to tell his sister, what should he say?

The transition to formal schooling in kindergarten is recognized as a landmark event by most families. This normal developmental milestone may be more difficult for children with disabilities and their families. A smooth transition and a carefully formulated transition plan can facilitate the child’s adjustment and success in school. Successful transition requires communication among the preschool teacher, the parents, and the kindergarten teacher, preferably before the child enters the class. It should be a collaborative process in which past experiences are linked to future goals (Rous et al., 2010). The readiness of the child, as discussed earlier, is critical, but the readiness of the school to receive the child is just as important. School strategies that can facilitate this transition include sending letters home to parents, holding open-house visits, calling parents, and making home visits. One difficulty is that families who need support during this transition (those who live in poverty, those who reside in urban and rural communities, and those who have children with disabilities) may in fact receive fewer services. Transition planning for a smooth entry into school is key to ensuring that gains made by early intervention are not lost.

Summary ●  The

prevailing opinion in the early twentieth century was that little could be done for a child with disabilities because intelligence and abilities were fixed at birth and therefore could not be changed. However, research in the middle of the 1900s showed that early intervention could vastly improve a child’s abilities and outcomes. Early intervention is now widely accepted as essential to improving outcomes for children with disabilities and developmental delays. ●  Early intervention consists of sustained and systemic efforts to provide support to the family, caregivers, and child to promote optimal development for the child. Children’s brains are experiencing more growth in this early period than any other time, thus intervention at this time is critical to help prepare them for success later on. ●  Early intervention may begin before pregnancy with the mother-to-be receiving appropriate medical care and support. At birth, physicians will

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Future Challenges check for the infant’s overall functioning and health and will initiate any supports needed based on the results of the initial tests. Preschool children may undergo evaluations such as the Individual Growth and Development Indicators to identify needs. Child Find is also a critical component of the early intervention system as it helps locate children and families who need support. ●  Family-centered approaches establish strong trusting partnerships, that are culturally responsive, with parents. ●  Developmental delays are identified across five domains: cognitive, communication, social-emotional, adaptive, and motor. ●  Children can be put at risk for developmental delays by genetic disorders, events during pregnancy or birth, and/or environmental risks. ●  Inclusion and naturalistic environments (e.g., the home, neighborhood, religious setting) are key components of how and where early intervention services are provided. ●  The Multi-Tiered Systems of Support (MTSS) approach for young children focuses on the use of data to plan developmentally appropriate supports and enhancements to ensure that learning is both challenging and achievable. ●  A multidisciplinary team works together to identify the child’s strengths and challenges and develops a plan to respond to these: an IFSP for children from birth to 3 years and an IEP for children age 3 and older. ●  Family-centered approaches are key to the success of early interventions because the parent or caregiver is critical to the child’s well-being. Supports and services for children and families must address all components of the child’s needs and must be culturally responsive to the families. ●  Supporting children and families during transitions is essential to ensuring a smooth delivery of supports and services.

Future Challenges 1. What would be the impact if maternal health care were universal? Primary prevention through prenatal care is not available to all expectant mothers, particularly those who live in poverty. However, in the fall of 2010, the Obama administration’s Affordable Care Act directed all health plans, including Medicaid, to provide prenatal screening and counseling for expectant mothers. But even when it is available, some individuals do not take advantage of it. If prenatal care were provided universally, it could markedly reduce the number of premature and low-birthweight children who are at risk for disabilities. Is the new policy enough to ensure the healthiest pregnancies possible? What strategies would we need to employ to ensure access to these services for all mothers-to-be?

2. How can we provide appropriate supports and services for culturally and linguistically different families of children with disabilities? Having a child with disabilities has a profound impact on the family system, and this can be exacerbated for families whose primary language is not English. The additional stress, the challenge of locating resources, and the difficulty of navigating a complex system of services can all take a toll on the family’s ability to meet the needs of the child. How can we support the family to help them be successful? What are the health care/insurance, social support, and education needs of families? How can these be provided in ways that address families’ cultural values?

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3. How can we increase the quality of early child care in the United States? Increasing numbers of children are receiving early child care, and a number of these children require early intervention supports and services. How can we ensure that all children have access to high-quality child care and early intervention if they need additional supports? How would universal prekindergarten affect the well-being of children? TeachSource Digital Download

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Key Terms early intervention p. 76 natural environments p. 83 Apgar test p. 87 developmental delays p. 89 developmental profile p. 89 genetic counseling p. 92 fetal alcohol spectrum disorder p. 93

Child Find p. 94 evidence-based practice p. 98 behavioral support plan p. 100 individualized family service plan (IFSP) p. 101 multidisciplinary team p. 102 embedded instruction p. 104

Resources of Special Interest to Teachers Journals Young Exceptional Children is written for teachers, early care and education personnel, educational administrators, therapists, families, and others who work with or on behalf of children from birth through 8 years of age who have identified disabilities, developmental delays, are gifted/talented, or are considered at-risk for future developmental challenges. https://journals.sagepub.com/home/yec

Organizations Zero to Three provides extensive information for parents and caregivers about the early years and provides technical assistance to those in need. Zero to Three also advocates for better prenatal and early childhood supports for a better future. zerotothree.org The Center for Response to Intervention in Early Childhood provides research and support for using tiered services of intervention. The center provides information about progress monitoring, evidence-based interventions and practices, and programs for implementing these practices. www.crtiec.dept.ku.edu/ The Division for Early Childhood of the Council of Exceptional Children promotes policies and advances evidence-based practices that support families and enhance the optimal development of young children (ages 0–8) who have or are at risk for developmental delays and disabilities. DEC is an international membership organization for those who work with or on behalf of young children with disabilities and other special needs and their families. ​ www.dec-sped.org/

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Children and Youth with Intellectual Disabilities

4 Ch ap te r

Standards Addressed in This Chapter All the CEC Initial Practice-Based Professional Preparation Standards for Special Educators (K–12) are addressed within this chapter. Please see the inside front cover for the list of standards.

Focus Questions 4-1 How has the field of intellectual disabilities (ID) evolved and who were some of the pioneers in the early evolution of the field? 4-2 What are some characteristics of students with ID? 4-3 What is the definition of intellectual disability (ID) and how are children with ID identified (what role might implicit bias play in the identification process?)? 4-4 What are some of the biological and environmental factors that can cause ID? 4-5 How does the information processing model (IPM) help us understand the strengths and challenges of students with ID? 4-6 What educational responses are needed to support the success of students with ID?

Halfpoint/iStock/Getty Images

4-7 What are some of the challenges students with ID face in making the transition to adult life?

T

he range of human potential is vast, and each individual has their own unique pattern of strengths and challenges. Together we make up the human community. Individuals with intellectual disabilities (ID) are part of this community; while each individual is unique, we are united by our shared humanity—our hopes, our fears, our joys, and our sorrows. Our society’s progress can be gauged through the ways we connect with this shared humanity by supporting and including all community members.

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4-1  A Brief History of the Field of Intellectual Disabilities

Chronicle/Alamy Stock Photo

Organized attempts to educate children who need more time for learning than their peers began less than two hundred years ago, when French physician Jean Itard tried to educate a young boy who had been found living by himself in the woods—the so-called Wild Boy of Aveyron. Although Itard’s attempts to tutor the boy met with only modest success, one of his students, Edouard Seguin, later extended Itard’s approaches and became an acknowledged leader of the movement to educate children and adults with intellectual challenges. Another notable person in the field, Maria Montessori (1912), worked with young children with ID using what is now called sense training. This approach uses the visual, auditory, tactile, gustatory, and olfactory senses to help children learn about the world around them. Today, versions of Montessori’s methods are used with all children, even though her original work focused on children who had ID. The broader application of Montessori’s teaching approaches shows how education, in general, has benefited from the early work with children with ID. Since 1908, there have been ten changes in the definition for individuals with intellectual disabilities. These changes reflect both the proliferation of research, which is a strong Maria Montessori was a true pioneer in the education change agent, and the changes in how society responds to of young children. individuals with ID. The most recent change was from using the term “mental retardation” to “intellectual disabilities.” The term mental retardation is considered not only outdated, but also offensive. The change in terminology was made, in part, to eliminate the negative connotations that had been attached to “retarded,” and one driving force for this change was the feelings of individuals most impacted by the terminology. Through a concerted self-advocacy campaign “spread the word to end the word,” individuals Spread the Word to End with intellectual disabilities and their allies have changed not only our language the Word https://www about intellectual disabilities—they have also changed our thinking, our policies, .spreadtheword.global and our laws! /video-archive/self-advocates Legislation, the courts, and educational organizations all now use the termi-spread-the-word-to-end-the nology “intellectual disabilities,” as well as other person-first language. This is -word grassroots advocacy at its best!

4-2  Characteristics of Children with Intellectual Disabilities Let us meet two students who have ID. Jaylen is 12 years old. He loves baseball and plays for the Bailey Bobcats, the local hardware store’s little league team. His dad sometimes helps to coach the team, and his mom is a big fan! Jaylen struggles in school; he was retained in kindergarten to give him an additional developmental year, but he remains approximately two years behind his current grade level in reading and math. Jaylen is currently in the fifth grade, and we will learn more about his educational needs later in this chapter. Both of his parents love Jaylen, but they are facing financial and health problems, and these stressors make everything more challenging. Jaylen’s father was

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recently injured in a work-related accident, and he is receiving unemployment benefits and workers compensation to help with his medical bills. Jaylen’s mom is trying to get additional hours at the store where she works to help tide the family over. Jasmine is also 12 years old and in the fifth grade. She has Down syndrome, which falls under the umbrella of ID. Jasmine is friendly, talkative, and according to her mother, “has never met a stranger.” Her fifth-grade teacher is working to integrate her into the general classroom setting, and Jasmine’s special education teacher works with her three hours each day. Both teachers are concerned about her transition to middle school in the coming year, where the academic demands will increase. Her family has been her strongest advocates for inclusion, but her parents are also concerned about how to support Jasmine as she moves into her teenage years. There is an impressive range of behavior that can be shown by children with ID, and yet there are some areas of similarity, even in two children as different as Jaylen and Jasmine. Both Jaylen and Jasmine will need additional support as they progress through their lives, and in the remainder of this chapter we will explore how this support will help each meet with success.

4-3  Defining Intellectual Disabilities The diagnosis of intellectual disabilities includes both adaptive behaviors and cognitive abilities. The American Association for Intellectual and Developmental Delays defines and intellectual disability as: characterized by significant limitations in both intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates during the developmental period, which is defined operationally as before the individual attains age 22. (Shalock et al., 2021, bolding added) The following five assumptions are essential to the application of this definition: 1. Limitations in present functioning must be considered within the context of community environments typical of the individual’s age, peers, and culture. 2. Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor, and behavioral factors. 3. Within an individual, limitations often coexist with strengths. 4. An important purpose of describing limitations is to develop a profile of needed supports. 5. With appropriate personalized supports over a sustained period, the life functions of the person with ID generally will improve. (p. 1)

American Association on Intellectual and Developmental Disabilities https://www.aaidd.org/

Intellectual functioning refers to general mental capacity, such as learning from experience, reasoning, problem solving, planning, and speed of learning. And individual’s intellectual functioning is influenced by systems of support and the specific circumstances and tasks; thus while it is related to “intelligent,” it is broader than intelligence. For diagnostic purposes, “significant limitations in intellectual functioning” is measured using a full-scale IQ score that is approximately 2 standard deviations or more below the mean (considering the standard error of measurement) (Schalock, Luckasson, & Tasse, 2021). Adaptive behavior is the collection of conceptual, social, and practical skills that are learned and performed by people in their everyday lives:  ●  Conceptual

skills—language and literacy; money, time, and number concepts; and self-direction.

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Chapter 4  |  Children and Youth with Intellectual Disabilities ●  Social

skills—interpersonal skills, social responsibility, self-esteem, gullibility, naïveté (i.e., wariness), social problem solving, and the ability to follow rules/ obey laws and to avoid being victimized. ●  Practical skills—activities of daily living (personal care), occupational skills, healthcare, travel/transportation, schedules/routines, safety, use of money, use of the telephone. Adaptive behaviors are developmental and are expected to increase in complexity with age and the demands of particular contexts. Assessments of adaptive behaviors are based on the individual’s “typical” performance within the given context. Standardized tests can also be used to determine limitations in adaptive behavior, and “significant limitations” are defined as 2 or more standard deviations below the mean (Schalock, Luckasson, & Tasse, 2021). One component of adaptive behavior, mentioned above, is the development of social skills, including the individual’s level of social wariness and/or their gullibility. Naïveté, combined with a desire for approval, can reveal itself in situations where the person with ID, in a desire to be compliant, may confess in a police interrogation to things they haven’t done. This vulnerability may also lead a young person to fall victim to the false affection of others, which may lead to physical abuse or rape. It is precisely these characteristics (i.e., gullibility and naïveté), in Jasmine that her parents are most worried about. How will they protect her as she grows into young adulthood? How can they help her understand the potential dangers without damaging her friendly exuberance for life? The current definition of ID in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) (APA, 2013) does not use specific IQ scores as a diagnostic criterion, but does use functioning 2 or more standard deviations below the general population as a marker for ID. DSM-5 has placed more emphasis on adaptive functioning and the performance of usual daily life skills. DSM-5 defines intellectual disabilities as neurodevelopmental disorders that begin in childhood and are characterized by intellectual difficulties as well as difficulties in conceptual, social, and practical areas of living. The DSM-5 diagnosis of ID requires the satisfaction of three criteria: 1. Deficits in intellectual functioning—“reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience”—confirmed by clinical evaluation and individualized standard IQ testing; 2. Deficits in adaptive functioning that significantly hamper conforming to developmental and sociocultural standards for the individual’s independence and ability to meet their social responsibility; and 3. The onset of these deficits during childhood (APA, 2013, p. 33). The two areas included in these definitions, intellectual functioning and adaptive skills, are distinctly different constructs that are only moderately correlated (Schalock, Luckasson, & Tasse, 2021). Adaptive behaviors and intellectual functions should be given equal weight in determining if an individual has ID, understanding that challenges exist on a continuum and will impact each individual somewhat differently depending on their circumstances and the supports available to them.

4-3a  Levels of Impact and Support Needed for ID The type and intensity of support needed for an individual with ID to be successful will vary across time, tasks, and settings. Individuals with ID will likely need some support to be successful in personal, school/work-related, and social activities. The level of support will depend both on the specific circumstances and the individual’s unique combination of personal strengths and challenges; the more significant the challenges are, the more intense the support will need to be.

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Defining Intellectual Disabilities Determining what supports are needed is part of a person-centered planning processes that helps each individual identify their unique preferences, skills, and life goals; as these change over time, supports must change as well. Supports must also be developed and delivered in age-appropriate settings, with the understanding that all people should have the opportunity to engage in activities and life experience appropriate to their age, interests, and preferences (Schalock, Thompson, & Tasse, 2018). You will learn more about the development of person-centered planning later in this chapter. Classifying students with ID into subgroups can be useful for better understanding their needs and for determining what supports will help them meet with success. The emphasis of these classifications is on personal outcomes (Schalock, Luckasson, & Tasse, 2021). Human functioning is complex, and no person fits neatly into any single classification. For people with ID, this means that classifications, at best, are only indications of current needs and do not represent the wholistic picture of the individual. Classifications are not static; they reflect the pattern and intensity of an individual’s support needs and will shift over time and tasks. When classifications are made based on the intensity of support needed, the terms are: intermittent, limited, extensive, and pervasive. If we look at classifications based on the extent of an individual’s limitations in adaptive behavior and intellectual functioning, we would use the following classification bands based on standardized scores accounting for the standard error of measurement on appropriate assessments: ●  Mild

limitations in adaptive behaviors or intellectual functioning—IQ scores range from approximately 50–55 to 70–75 ●  Moderate limitations in adaptive behaviors or intellectual functioning—IQ scores range from approximately 40–45 to 50–55 ●  Severe limitations in adaptive behaviors or intellectual functioning—IQ scores range from approximately 25–30 to 40–45 ●  Profound limitations in adaptive behaviors or intellectual functioning—IQ scores range from approximately < 20–25 (Schalock, Luckasson, & Tasse, 2021). Both classification systems (levels of support needed and extent of limitations) can help us understand the needs of Jaylen and Jasmine. Jaylen has “mild” limitations in both adaptive behaviors and intellectual functioning, and depending on the task, he needs intermittent to limited supports to be successful. Jasmine’s needs fall at the “moderate” level, and she often needs more support and time across tasks, especially when new learning is involved. When we think about the levels of support that Jaylen and Jasmine will need, we can see how each set of supports will be unique to the task and context and that these will change across their life course. Both Jaylen and Jasmine will, however, need more time to develop the academic and adaptive skills required for successful transition to adult life; Jasmine will likely need additional support as she transitions to more independent living. In this chapter we focus on students who, like Jaylen and Jasmine, have mild to moderate limitations; Chapter 13 includes students with more intense and complex challenges.

4-3b  Prevalence of ID The approximately 40,000 students with ID make up around 1.14 percent of the school age population with disabilities (CDC, 2017). Figure 4.1 shows the racial distribution for students with ID. Although Black students make up only 13 percent of the student population, they are 28 percent of those identified with ID; combined with Hispanic students, children of color make up 57 percent of the students identified with ID. This pattern of identification shows the difficulties with significant disproportionality (i.e., the demographic representation of students identified does not match that of the general population), discussed in Chapter 1. As noted in Chapter 1,

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Chapter 4  |  Children and Youth with Intellectual Disabilities 3%

White Black

29% 41%

Hispanic Asian

28%

Lauren Shear/Science Source

◗ Figure 4.1  Racial Distribution of Students Identified with ID

Black students from non-low-income families were almost twice as likely to be identified with intellectual disabilities as their White non-low-income peers (Grindal, 2019). Later in the chapter we will explore the long-term education and employment implications of this disproportionality. Keep these findings in mind as you look at the role of adaptive behaviors in the identification of intellectual disabilities, discussed below, and think about how we can measure and interpret adaptive behaviors to lessen implicit bias and increase cultural sensitivity to the differing expectations across racial and ethnic groups.

4-3c  Measuring Intelligence and Adaptive Behavior

How do we measure intelligence and adaptive behavior? Unless we have adequate measures of Children with ID are children first—with some special characteristics these concepts, we still are in a difficult position that require educational attention. in identifying students with ID. We must use multiple sources of information to understand a student’s strengths and challenges (see Box 4.1). The development of intelligence measures actually can be traced back to Alfred Binet in France, who was given the task of finding children who were believed to be incapable of responding to the traditional educational program in the early twentieth century. Later individual tests of intelligence were developed by Lewis Terman (the Stanford-Binet Intelligence Scales) and David Wechsler (Wechsler Scales of Intelligence). The Stanford-Binet was originally designed to test the “g” factor, or general intelligence; it has lately branched out to test multiple abilities. The Wechsler scales generated subtests measuring verbal and performance IQs, which allowed psychologists to develop a profile of strengths and weaknesses for further planning. A third test, the Woodcock-Johnson Tests of Cognitive Ability, uses subtests to measure cognitive abilities and achievement. There are also nonverbal intelligence tests that have been developed to assess students who have language and communication difficulties. Nonverbal assessments are often used to assess students whose primary language is not English. The Peabody Picture Vocabulary Test, for example, is a nonverbal measure in which

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Defining Intellectual Disabilities

Box 4.1

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High Leverage Practices:

High Leverage Practice 4: Use Multiple Sources of Information to Develop a Comprehensive Understanding of a Student’s Strengths and Needs.

To develop a deep understanding of a student’s strengths and learning needs, special educators must use a variety of assessment measures and sources of information. These should include information from parents, general educators, the students themselves, and other knowledgeable stakeholders. Information from formal and informal observations, work samples, and curriculum-based and functional behavior assessments can all contribute to our understanding of the student.

All data collection and interpretation should be sensitive to language and cultural differences of the student and their family.

Reflection: ●

Why is it so critical that we have a culturally sensitive comprehensive profile of the student before we make a determination of ID?

the student is shown four pictures and then asked which picture most closely resembles the verbal clue (such as a train). The measurement of intelligence must always go beyond a single test, regardless of which test is selected; test results are only one piece of the data and they must be interpreted in light of other relevant information about the student when making important decisions regarding eligibility and placement (Salvia, Yesseldyke, & Witmer, 2017). Measuring adaptive behavior is a bit tricky, as it is somewhat dependent on societal expectations, which will vary across settings/contexts and will change across the individual’s life course (Salvia, Yesseldyke, & Witmer, 2017). Adaptive behaviors are developmental, and expectations for performance depend on the individual’s age and the demands of the task and context; performance can also vary depending on the level of support available (Schalock, Luckasson, & Tasse, 2021). Examples of adaptive behaviors would include selecting appropriate clothing for the weather and/or events of the day; being able to move from school/ work to home independently; or fixing lunch for yourself and a friend. Measuring the student’s adaptive skills is part of the diagnostic process for ID, but it is also essential for developing appropriate support and services that will promote growing independence (Salvia, Yesseldyke, & Witmer, 2017). One widely used assessment for adaptive behaviors is the Vineland Adaptive Behavior Scales II, designed to work with individuals from birth through age 90 (Sparrow, Cichetti, & Balla, 2006). The scale is completed by people closest to the individual who have direct knowledge of their levels of functioning. These usually include the parent or guardian, the teacher or employer, and others with direct knowledge of the target individual. The Vineland Scales cover communication, daily living skills, socialization, motor skills, and maladaptive behavior (Salvia, Yesseldyke, & Witmer, 2017). The Behavior Assessment System for Children, Third Edition (BASC-3) is an alternate measure for adaptive behaviors of students from ages 2 to 15 (Altmann et al., 2018). The BASC-3 has five main measures that allow for a multidimensional assessment of the individual’s adaptive and maladaptive behaviors: Teacher Ratings, Parent Ratings, Self-Report of Personality, Structured Developmental History, and Student Observation System. While understanding the student’s level of adaptive behaviors is critical, measurement of adaptive and maladaptive behaviors is subjective and must be interpreted with caution taking in to account the broad context of the individual’s life, including cultural norms and family

High Leverage Practices for Students with Disabilities https:// highleveragepractices.org/

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Chapter 4  |  Children and Youth with Intellectual Disabilities expectations (Salvia, Yesseldyke, & Witmer, 2017). The disproportionately high percentage (57%) of students of color identified as ID may be due to a lack of cultural sensitivity and/or the presence of implicit bias in measuring adaptive behaviors.

4-4  Biological and Environmental Causes of ID There is a wide variety of possible causes for ID, including both genetic and environmental factors. The outcomes for each individual with ID depend on both their genetic make-up and their environmental circumstances/experiences. As discussed in Chapter 2, the experiences young children have in their families and their surrounding social systems can have a significant impact on their development. It remains for educators and special educators to take this understanding and transform it to the developmental benefit of children—the earlier the better (Carta & Snyder, 2019).

4-4a  Genetic Factors and ID The question of how a tiny gene can influence the complex behavior of children and adults has puzzled scientists for many years. Genes can impact the development of anatomical systems and their functions—the nervous system, sensory systems, and musculature—influencing outcomes for the individual. Do certain patterns of genes predetermine certain types of behavior? Are we unwitting automatons driven by mysterious bursts of chemicals? Not really. No particular gene or protein forces a person to drink a glass of whiskey, for example, but some people have a genetic sensitivity to ethanol that may increase their tendency to become active drinkers. Similarly, genetics plays a special role in some types of ID.

Burger/Phanie/Age footstock

Down Syndrome

Each person with Down syndrome has their own individual set of strengths and challenges.

One of the most common and easily recognized genetic disorders is Down syndrome. In the United States, approximately 6,000 babies are born with Down syndrome each year (about 1 in 700 births) (Center for Disease Control and Prevention, 2021). Down syndrome results from a genotype that features an extra copy of chromosome 21; medically, an extra copy of a chromosome is called “trisomy” and so Down syndrome is also called trisomy 21. Trisomy 21 is generally responsible for mild or moderate ID and often includes a series of other physical attributes and medical complications as well (Center for Disease Control and Prevention, 2021). Some common physical features of individuals with Down syndrome are a flattened face and nose bridge, almond-shaped eyes, shortened neck, protruding tongue, and smaller ears, hands, and feet. Some individuals with Down syndrome may also have health problems, including hearing loss, ear infections, eye diseases, sleep apnea, and heart defects that are present at birth (Center for Disease Control and Prevention, 2021). Life expectancy for individuals with Down syndrome has increased

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Biological and Environmental Causes of ID dramatically, from 25 years in 1983 to 60 years in 2020 (Tsou et al., 2020). While individuals with Down syndrome share many physical features, each has their own unique set of cognitive and personality strengthens and challenges. Jasmine, who we met earlier in the chapter, was born with critical congenital heart defects that were diagnosed before she was born. Jasmine’s mother, because she was 37 at the time of her pregnancy, decided to have some screening tests done (the mother’s age can be a factor in Down syndrome). The screening results indicated that her chances of having a child with Down syndrome were high. Her doctor suggested diagnostic testing to confirm whether or not her baby did have Down syndrome. Jasmine’s parents decided not to do the diagnostic tests. They knew that these tests were risky and they realized that their decision would be the same regardless of the results: they wanted this child. Their doctor agreed, but said that they should monitor the development a bit more closely. Jasmine’s heart abnormality was diagnosed during an ultrasound examination at 19 weeks. Knowing that their child would likely need heart surgery within days of being born, her parents felt that they were prepared; the reality, however, was devastating. Jasmine had her first heart surgery when she was just 9 days old. Her parents watched as their tiny baby seemed to be fighting for her life. This was their first of Jasmine’s three heart surgeries before she reached seven, and it never got easier for her parents. Going through this process, however, gave them a new strength and a strong commitment to making sure that Jasmine’s life would be a happy one. This is partly why they have always been her strongest advocates!

Fragile X Syndrome Fragile X syndrome (FXS) is the leading cause of inherited developmental disability, resulting from a mutation on the long arm of the X chromosome. It affects about twice as many males as females—overall prevalence is about one in four thousand. Extensive investigation has found that the condition causes a deficiency in protein production necessary for normal brain development. The diagnosis can be determined by DNA testing. The wide range of individual differences in this condition calls for individual planning and treatment based on a child’s own profile and patterns of development. Box 4.2 describes the early identification of a child with fragile X syndrome. Children with fragile X syndrome appear to have strengths and challenges in information processing that require changes in educational planning and strategy. They often have early language delays that call for early speech and language

Box 4.2

A Child with Fragile X Syndrome: Early Identification

Amy Tyler noticed a problem with her son Max within weeks of his birth. He was not easy to comfort and always seemed to keep his hands clasped. When he was 6 weeks old, Amy tried unsuccessfully to get Max to look at her when she clapped her hands. At 15 months, Amy’s doctor expressed concern that Max’s language development was behind. She took Max to an early intervention service provider who recommended that he be tested at the local children’s hospital. At 20 months, Max was diagnosed with fragile X syndrome (FXS). Compared with most families of children with FXS, the Tylers were fortunate. Max was diagnosed with FXS earlier

than most children. According to a Frank Porter Graham Child Development Institute study, the average child with FXS is not diagnosed until nearly age 3, and many others not until much later. Had these children been identified earlier, they would have been immediately eligible for early intervention services under IDEA 2004. Source: Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill. (2004). Screening newborns for Fragile X. Early Developments, 8(2), 11–13. Reprinted by permission of Frank Porter Graham Child Development Institute.

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Chapter 4  |  Children and Youth with Intellectual Disabilities therapy, and many have ADHD (hyperactivity and lack of attention). They also may face difficulties with the memorization of facts. On the other hand, children with fragile X seem to be relatively good at object recognition and working with computers to enhance their written language. Of course, these are generalizations, and unique patterns of strengths and challenges for each individual must be documented. Children with fragile X (30 percent of whom can also be diagnosed with autism spectrum disorders) generally require substantial multidisciplinary support including medical interventions for mood instability, behavioral support to help with aggression and social adjustment, and speech and language therapy for conversational skills. Later in this chapter we will discuss the educational supports and services to help students with ID thrive.

4-4b  Toxic Agents and Causation of ID The remarkable system whereby a pregnant mother transmits nutrients through the umbilical cord to her fetus is also the highway by which many damaging substances can pass to the developing child. Drugs (including alcohol) and cigarette smoke are prime examples of teratogens, which include any agent that causes a structural abnormality following fetal exposure during pregnancy.

Fetal Alcohol Syndrome For centuries, we have been generally aware of the detrimental effects that alcohol consumption by the mother may have on her unborn child. Fetal alcohol syndrome or spectrum disorder (FAS), as discussed in Chapter 3, can include a range of neurological impacts, including cognitive functioning and intellectual delays (Copeland et al., 2021). Because of the effects that alcohol can have on fetal development, it is highly recommended that women who are pregnant do not drink (March of Dimes, 2021).

The Effects of Lead Ingesting heavy metals, such as lead, cadmium, and mercury, can result in severe consequences, including ID. Attention is currently being focused on lead pipes in our water delivery infrastructure to reduce the amount of lead exposure. This work mirrors an earlier and very effective effort to reduce lead amounts permitted in gasoline, which resulted in a lowering by one-third of the average lead levels in the blood of U.S. men, women, and children. The reduction in lead levels following the declining use of leaded gasoline, shows how public policy can have a positive impact on children.

Infections Impacting the Brain The brain begins to develop about three weeks after fertilization. Over the next several weeks, the central nervous system is highly susceptible to disease. If the mother contracts rubella during this time, her child may be born with ID and other serious birth defects. A rubella vaccine that is now available has drastically reduced the number of children with defects caused by rubella. The last major outbreak of rubella in the United States was from 1964 to 1965, when 11,000 pregnant women lost their babies and 2,100 newborns died (CDC, 2021). Rubella was considered eradicated from the United States in 2000. However, this may be changing: from January 1 to April 26, 2019, a total of 704 cases of rubella were reported in the United States. All of these cases resulted from unvaccinated U.S. residents traveling internationally (Patel et al., 2019). While this may seem like a small number, rubella is a serious disease and vaccinations are key to protecting the population. Children and adults are also at risk of brain damage from viruses that produce high fevers, which in turn destroy brain cells. Encephalitis is one virus of this type. Fortunately, it is rare, as are other viruses like it.

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The Information Processing Model and Students with ID

4-4c  Environmental Factors That Influence ID The environment and human interactions can play a major role in neurological and intellectual development. In earlier chapters, we discussed the impact of poverty on children’s development and the negative influences that chronic stressors can have on the family. Acknowledging the role of environmental challenges is important, but this also means that a supportive, enriched environment can have a positive impact on the child’s development. The influence of experience on brain development has been confirmed (CDC, 2021). We have already seen the positive results of various early intervention programs in Chapter 3. The implications are exciting. Our brains continue to change as we experience new information and acquire new knowledge (McCandliss & Toomarian, 2020).

4-5  The Information Processing Model and Students with ID Earlier we explained that a child’s ability to learn about their world happens through the processing of information. Students with ID have a wide variation in their ability to process information, and each individual will have their own unique pattern of strengths and challenges. The information processing model (IPM) (Figure 4.2) shows Jaylen’s strengths and challenges. Jaylen has difficulties with his memory, and this makes it harder to associate concepts and reason. His auditory memory is particularly challenging, so when he is simply “told” what to do and when all the information he is given is verbal, he really struggles. His strengths are with doing things, and he learns best by active engagement. Jaylen also needs repeated learning cycles to anchor the information within his longterm memory. Children with ID often have difficulty with memory, which can stem from limitations in understanding. It is hard to remember what you never understood.

Emotional Context

Thinking

Response

Memory Classification Association Reasoning Evaluation

Speaking Writing Motor Response Social Interaction

Processing

Stimulus

Vision Hearing Kinesthetic Haptic Gustatory Olfactory

Information Input

Attention

Information Output

Executive Function

key Challenges Strengths

◗ Figure 4.2  Information Processing for Jaylen TeachSource Digital Download   Access online

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Most typically developing students use “rehearsal” as a memory aid, saying a string of words or a poem to themselves until they remember it. Children with ID are less likely to use this method unless they are directly taught how to do so. The ability to classify, or organize information, is also affected for children with ID. Children in elementary school learn quickly to cluster or group items into useful classifications: chairs, sofas, and tables become furniture; apples, pears, and oranges become fruit. Children with ID tend to need direct instruction and much practice to learn classification. For example, a teacher may need to explain how a car and train are similar before a child with ID can classify them both as means of transportation. The executive function, the ability to make good A critical component of teaching students with ID decisions and make good judgments with the informain the general education classroom is implementtion available, is challenging for many students with ID. ing differentiated instruction as part of Universal Because of central processing differences, children with Design for Learning. Watch this video of how Ms. ID may have difficulty expressing themselves (output proColbath-Hess works with children with three levels cessing); Jaylen finds written expression very challenging. of ability and explains how she uses task analysis to The emotional context can have a strong impact on plan a writer’s workshop that addresses the needs students with ID, and if they meet with repeated failure of all of her students. In the video, how do you see in the classroom, then learned helplessness (the feelthe teacher use different types of technology and ing that one is powerless to cope with a challenge) may assistive devices to help with writing tasks? How do develop. In the face of learned helplessness, students the outcomes of the lesson plans match, and how with ID often give up early on tasks that they find chaldo they differ? lenging, believing that no matter what they do, they will likely fail in the end. Creating positive classroom Watch online environments that offer appropriate support for success will help all students learn, but it is essential for students with ID. This positive environment begins with recognizing each student’s strengths (see box 4.3).

Students with ID will thrive in a supportive learning environment.

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Educational Responses for Students with Intellectual Disabilities

Box 4.3

ID:

Remember Our Super Powers!!!

When asked what their super powers were, students with ID said: ● ● ● ● ● ● ●

I am a very nice person! I love to sing. My Mom says I am very brave. I am funny. If you get to know me you will like me, most people do! Sports, I am really good at sports!!! I am a person, just like you . . . you have super powers too!!

4-6  Educational Responses for Students with Intellectual Disabilities Students with ID are served in a variety of settings, but the vast majority (94%) will spend at least some of their time in a general education classroom. Figure 4.3 shows the educational setting where students with ID were served in the 2019–2020 school year (Department of Education, 2020). Less than 1 percent of school age students with ID were served in correctional facilities (0.11%), hospitals/homebound (0.51%), private schools (0.35%), and residential schools (0.27%) (Department of Education, 2021). Separate schools served 5.5 percent of students with ID. Often students with ID in public schools receive services in both general and special educational settings (e.g., resource rooms). The amount of time that students with ID are served in the general education classroom varies: approximately 49 percent of students spent less than 40 percent of their time; 28 percent of students spent between 40 and 79 percent of their time; and 17 percent of students with ID spent 80 percent or more of their time in the general classroom. Regardless of where a student is placed for services, the educational goal is the same: to create learning experiences that support the student’s areas of challenges and maximize their areas of strength so that they can meet with academic and personal success. Meeting this goal takes a team! 1.5% 5.5% 17%

More than 80% of the day in a regular classroom Inside regular classroom 40–79% of the day Inside regular classroom less than 40% of the day

49%

28%

Separate School Other Setting

◗ Figure 4.3  Educational Settings for Children with Intellectual Disabilities Source: Data Accountability Center. (2011). Part B Educational Environments 2011 [data file]. Retrieved from http://www.ideadata.org/PartBEnvironments.asp Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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4-6a  Organizational Structures to Support Students with Intellectual Disabilities Since the majority of students with ID are served, at least in part, within the general education classroom, it is a good time to revisit the requirements of IDEA and review the expectation that all students with disabilities receive a free and appropriate education (as discussed in Chapter 2). The courts have gone a long way to define what an “appropriate education” is for students with disabilities, and the 2017 Endrew F v. Douglass County Schools Supreme Court decision helped to define what kind of expectations we need to improve academic outcomes for students with disabilities (Department of Education, 2021) The Court held that in meeting the substantive obligations under the IDEA, schools must offer an IEP that is reasonably calculated to allow a child to make progress given their individual circumstances. The Court rejected the “merely more than de minimis” (i.e., more than trivial) standard in determining the scope of FAPE and reinforced the requirement that every child should have the chance to meet challenging objectives (Department of Education, 2021). As we create appropriate learning environments for children with ID to succeed in school, we should remember that our expectations for each child must include appropriately challenging learning objectives. Setting challenging learning objectives is really critical as we prepare students with ID for their lives; more and more students with ID are attending post-secondary educational programs offered in universities and colleges. Dr. Kristín Björnsdóttir talks about the impact that our expectations for our students have on how we plan for them (see Box 4.4).

Box 4.4

Ask the Experts:

Having High Hopes for the Future

Dr. Kristín Björnsdóttir

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Dr. Kristín Björnsdóttir professor of Disability Studies in Education at the University of Iceland A few years ago, while teaching sociology to a large group of undergraduate students, I became gripped with doubt. This was a mandatory course for different student groups, including those enrolled in the vocational diploma program for students with ID at

the University of Iceland (UI). The topic was social constructivism, and we were discussing the construct of race and skin color. I gazed over the lecture hall and was reminded of the diverse learning and communication abilities of my students. I thought to myself, “How on earth am I going to explain constructivism in an accessible manner? Better yet, is social theory meaningful for my students with ID?” As teachers, we take part in writing plans for our students with ID and consequently deciding, on their behalf, what meaningful knowledge is. Over the years, much emphasis has been placed on life skills, such as self-care and home economics, which are important for independence in adult life. The reason for such a strong emphasis on life skills can in part be explained by our expectations for the future of students with ID. Since most of our students will not have the opportunity to get a post-secondary education, they will transition from high school to work or to day programs for adults with disabilities. Designing an individualized education program is a big responsibility, and if we set low expectations for our students we may be limiting their choices down the road. The aim of the vocational program at UI is, in short, to give students with ID an opportunity for an inclusive

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Educational Responses for Students with Intellectual Disabilities

Box 4.4

Ask the Experts:

Having High Hopes for the Future

college education to promote their opportunities and participation in society. The students have a diverse educational background; some went to inclusive schools while others were enrolled in segregated special schools or self-contained special education classes. However, they have all experienced low expectations from teachers and “well-meaning” but sometimes belittling ideas about what is best for them. That day, when I was teaching social constructivism, I was tempted to give the students with ID a “pass” on the topic under discussion, dismissing their need to participate, instead of making the necessary adaptations to my teaching methods. When one of my students handed in his essay on social constructivism written with Blissymbolics (e.g., an ideographic writing system with hundreds of symbols, google it!), I realized how easy it is to confuse “dismissing” with “adaptation” for the student and how seductive ableism is. The importance of post-secondary opportunities for students with ID is well documented and ranges from increased self-determination and social networks to improved employment opportunities (Coleman & Shelvin, 2018). Although the post-secondary opportunities for students with ID are still few and far between, we as teachers must encourage our students to find their path to a meaningful future. And for some that will consist of post-secondary education. As teachers, we also must

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be aware of what influences our mindset and decision making when teaching students with ID. We constantly need to reflect on our practices and re-evaluate objectives and ask ourselves why we have set specific objectives for our students. How will our practices impact their future? Are we adapting the curriculum or simply giving them a “pass” on their education? There is no one size fits all method for preparing students with ID for post-secondary education. The students in the vocational program have told me stories of their favorite teachers which seem to have common threads, such as treating all students with respect and making efforts to find appropriate solutions and support. Their favorite teachers encouraged them to believe in themselves and to have high hopes for their future, which in essence is the best preparation for successful transition from high school to college.

Reflection: ●

In what ways do teacher expectations influence short- and long-term Ωoutcomes for their students? Why should we as teachers be very mindful of our beliefs about our students’ capabilities?

Reference: Coleman, M. R. and Shevlin, M. (2018). Post-secondary educational opportunities for students with special education needs. Routledge.

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4-6b  Multitiered Systems of Support for Students with ID Supports and services for students with ID are often delivered across educational settings. The general and resource/special education classrooms are the main placement options, and teamwork is needed to coordinate services for each student. Services are often organized in a three-tiered system of support to facilitate planning and coordination. Chapter 2 shared the multitiered systems of support (MTSS) approach to collaboration across general and special education, and here we will focus on its use for students with ID. To be effective for students with ID, systems of support must be person-centered, comprehensive, coordinated, and outcome oriented (Schalock, Luckasson, & Tasse, 2021).

Tier I for Students with ID At Tier I, the general education teacher is primarily responsible for successful inclusion for students with ID but often incorporates co-teaching with a special education teacher. The special education teacher supports appropriate accommodations (e.g., strategies that help the students access the curriculum) and modifications (e.g., altering the content to match the student’s present levels of academic achievement and functional performance, PLAAFP) of the curriculum. Co-teaching also supports the use of Universal Design for Learning (UDL) with both teachers planning the learning experiences for maximum access, using the Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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Chapter 4  |  Children and Youth with Intellectual Disabilities principles of multiple means of representing and presenting material, multiple means for student engagement, and multiple means for responding to learning (Wehmeyer, 2006). Table 4.1 shows how we can use the IPM to select appropriate UDL strategies support student learning.

Table 4.1  Meeting the Needs of Students with Intellectual Disabilities: Information Processing

and Universal Design for Learning Audio recordings

Input

Text-to-speech Manipulatives (e.g., math counting sticks) Video modeling Pictures Graphics/Charts Storyboards Timelines Tactile graphics Use of all senses Processing

UDL Engagement Kinesthetic/Hands-on activities Plays/Drama/Dance Music/Song Building models Role playing Simulation games Mnemonic strategies High-interest activities

Output

UDL Assessment Plays/Drama/Dance Drawing/Sculpting Music/Song Building models Real-world performance

Executive Function

INPUT

PROCESSING

OUTPUT

Graphic organizers

Thematic lessons

Concept maps

Metacognitive strategies

Advance organizers

Learning strategies

Use of non-punitive assessments that reward student growth

Study guides

Study skills

Highlighting Prompts (verbal, visual) Emotional Context

Safe and supportive environments

Choice of activities

Structured rules

Support available

Encouragement

Study buddy

Rewards vs. punishment

Breaks when frustration levels increase

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Interest-based assignments

Recognition of effort Separate grades for content and effort

Use of non-punitive assessments that reward student growth Risk-taking environment Recognition of effort Separate grades for content and form

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Tier II often involves special lessons for small groups of students based on progress monitoring data showing a need for additional support. For students with ID, this support may be in academic or social skills or support for making good choices. Both Jaylen and Jasmine receive Tier II intervention supports for reading and math lessons. Jaylen has also been reviving additional support for social skills because as a result of his increasing academic frustrations he has been “acting-out” in class and seems unhappy during recess and lunch. His teachers are concerned that there may be more going on with Jaylen and are starting to document his behaviors to look for patterns.

Intensive Tier III for Students with ID

David Grossman/Alamy Stock Photo

Targeted Tier II for Students with ID

Students with ID often receive services in both the general and Tier III offers the most intensive level of support, and special education classroom. these services are often provided by the special education teacher within a resource or separate classroom. Both Jaylen and Jasmine receive resource room support. Jasmine spends almost half her time in the special education classroom, where she works on reinforcing her academic skills in reading and math. She also works on life skills (e.g., using money, planning meals) and decision-making skills (e.g., role-playing different social situations). Jaylen spends approximately 20 percent of his time in the special education class working on reading and math and getting some support for his other subjects. His teachers are considering increasing this support as the content curriculum demands become more challenging. Coordinating supports across the general and special education classrooms takes time and planning. The student’s IEP acts as the roadmap for services, guiding the supports and services. Table 4.2 shows a sample of Jaylen’s IEP

Table 4.2  Jaylen’s Measurable Annual Goals and Specially Designed Instruction Area

Jaylen’s Goals and Instruction

Academic:

Goal: When given controlled nonfiction reading passages in science at his instructional level, Jaylen will read independently and respond orally to literal and inferential comprehension questions with 80% accuracy over three of four teacher-made reading assessments.

Reading in Science

Instruction: Direct instruction in identifying key details, new academic vocabulary (e.g., making flashcards with words and pictures), use of pictures, charts and graphs for information, and the structure of the text. Use of explicit modeling for describing the scientific processes addressed in the passages (e.g., the role of evaporation in the water cycle). The use of graphic organizers to identify main concepts and to show relationships across ideas (e.g., concept map showing interdependence of predators and prey; graphic organizer to compare and contrast types of volcanos). Using written summaries to share main ideas and connect information to real-world experiences. Social Skills

Goal: Given social skills instruction in interpersonal interactions, Jaylen will demonstrate all of three of the key steps (e.g., standing in appropriate proximity, listening without interrupting, joining conversations appropriately, and turn-taking during a conversation) of the social skills on five occasions across three consecutive weekly checkpoints. Instruction: Direct instruction on appropriate interpersonal proximity and strategies to join conversations (e.g., ask a question about the topic being considered, offer an observation from your experiences). The use of video modeling of appropriate and inappropriate social interactions with a compare/contrast graphic organizer to summarize observations. Repeated practice, with prompts (e.g., what question might you ask now to join the conversation), on entering conversations and using turn-taking skills (e.g., not speaking again until after others have spoken, not interrupting). Practice within simulated real-world context (e.g., lunch table, recess, waiting for the bus, at a sports event) followed by self-evaluation of demonstrated skills.

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Box 4.5

Reaching & Teaching:

Using Universal Design Online

By Jennifer Job, Ph.D. Universal Design for Learning does not stop when classes go online. Students with special needs still must have their needs met, and schools are still required to follow IEPs and 504 plans, even when classes go virtual. UDL depends on multiple modes of engagement, representation, and action and expression, and while that looks different at a distance than in a regular classroom, it can still be accomplished. The most essential component is establishing a relationship with your students before thinking about their academic needs. The research shows that students whose teachers focused on socialemotional connections before academic instruction see better performance along the lines of engagement and academics (Branstetter, 2020). The first step in supporting students with disabilities online is to make sure that they have caring adults who will support them, both in learning and at home. Fredrickson (2011) notes that students

with disabilities perform best when they feel seen, heard, and cared for, and this can be accomplished online as well as in person. How can we do this? First, connecting with the adults in your students’ lives and then by prioritizing face-to-face meetings with your students. In these meetings you can check in with them to see how they are progressing, both emotionally and intellectually. These personal check-ins are really essential to building and maintaining a relationship with our students when we are working online. Edutopia provides a toolkit for putting Maslow before Bloom (i.e., put the students’ basic needs for safety and belonging before working on academic tasks) online. The toolkit includes instruction on having morning meetings that make students feel heard, taking “brain breaks” that get students out of their seats, and incorporating mindfulness activities that incorporate sensory activities. You can find the toolkit at https://www.edutopia.org/article /how-maslow-bloom-all-day-long.

giving his learning goal for reading in the content area of science and the instructional supports he will receive to reach this goal. His IEP team recently revised his IEP to include a focus on social skills, and this goal is also shared in Table 4.2. Our responsibility for implementing a student’s IEP does not stop when teaching goes online—we still must work to ensure that all of our students have access to the curriculum. Box 4.5 shares some ideas as to how we can do this.

4-6c  Positive Behavior Interventions and Supports One of the most effective schoolwide intervention programs for children with ID has been positive behavior interventions and supports (PBIS), discussed in Chapter 2. Behavior problems and disruption have, unfortunately, been a major part of the lives of too many children with ID. When there is no schoolwide support network, the teacher’s response to disruptive behavior is often punitive, and this compounds the problem. The strategy of PBIS advocates that, when faced with some form of behavior disruption, the teacher should focus on human motivation, not just on human behavior. Jaylen, for example, has started to “clownaround,” distracting other students by making “burping” and “farting” sounds when the class is quietly doing independent math work. His classmates laugh, but they are clearly uncomfortable with his behavior. Why would Jaylen do such a thing, considering that it will surely get him in trouble with his teacher? What hidden benefits does Jaylen receive from his inappropriate behavior? All behavior

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Educational Responses for Students with Intellectual Disabilities communicates something; what is Jaylen trying to tell us through his actions? To answer these questions, his teachers decided that they needed more information; they decided to do a functional behavioral assessment of Jaylen’s behavior to better understand how to support him. A functional behavioral assessment includes identifying and describing the target behavior; data collection from multiple sources to explore reasons for the behavior and patterns as to when/were/and how often the behavior takes place (this can take the form an A-B-C chart showing the antecedent, the behavior, and the consequence, discussed in Chapter 3); a hypothesis statement as to why the behavior is present; and an identification of the replacement behavior that would be more appropriate. Box 4.6 shows the outline of a functional behavioral assessment for Jaylen. The goals of PBIS are to (1) improve academic performance, (2) enhance social competence, and (3) create safe learning and teaching environments (Horner et al., 2009). For Jaylen, the two-pronged approach, looking at both academic and social reasons for his behavior, helped him get back on track. The key to success for students with ID is appropriate supports. Indeed, Schalock, Luckasson, and Tasse (2021) put it this way “…the most relevant difference between people with ID and the general population is that people with ID need different types and intensities of supports to fully participate in and contribute to society…” (pp. 64–65), and we could not agree more!

Box 4.6

Jaylen’s Functional Assessment

1. Jaylen’s targeted behavior: As soon as independent work-time for math begins, Jaylen begins making loud, inappropriate noises. 2. Data collected: Jaylen’s teachers began systematic observations of Jaylen to document the frequency of his disruptions and identify precisely when these disruptions were taking place. Teachers reviewed Jaylen’s progress monitoring charts for reading and math and found that he was clearly struggling with some skills in both. They talked with Jaylen and asked him if he recognized that his behavior was causing problems for other students and for himself (he did) and asked him if he needed additional help with his work (at first he denied this, saying the work was stupid, but then acknowledged that sometimes he did not understand what he was supposed to do). His teachers countered that sometimes it seemed like he actually did understand the work and yet he still was disruptive (Jaylen said that he liked it that the other students thought he was funny). 3. A-B-C chart: Jaylen’s teachers created an A-B-C chart showing the Antecedent – Independent math work begins Behavior – Loud inappropriate noises Consequences – Students laugh and teacher reprimands Jaylen asking him to get back to work

4. Hypotheses about the motivation for Jaylen’s behavior: Jaylen’s behavior seems to serve two functions: (1) it allows him to avoid work that he finds too difficult and does not understand (an academic issue) and (2) it gets him much desired attention/recognition from his classmates. 5. Possible intervention strategies: Jaylen and his teachers decided that they would work to make sure that he understood the math lessons so that he could practice independently and that he could (1) ask for help when needed and (2) take his work to the special education room if he wanted more help. They also decided that if Jaylen continued to make inappropriate noises, he would receive a time-out during afternoon free time (which Jaylen loved because he got to use the computers to look up animal facts). Jaylen’s teachers decided to talk with the class while he was not present and let them know that laughing was not helping him or them. They also began thinking about how to support Jaylen’s need for friendships and a sense of belonging. Knowing how much Jaylen loved baseball, they talked about forming a “Lunch League” where students could talk about their favorite baseball teams.

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4-6d  Curriculum and Instruction for Students with Intellectual Disabilities

High Leverage Practices for Students with Disabilities https://highleverage practices.org/

Box 4.7

When planning for curriculum and skill development for students with ID, we must think about initial acquisition, fluency, maintenance of skills over time, and generalization of these skills to new and somewhat different situations (Shurr, Jimenez, & Bouck, 2019). Acquisition happens as we first expose our students to new ideas or skills, and in this phase of learning students will often make mistakes and will need direct support. Students with ID need deep exposure to new information that is tied as much as possible to real-life experiences. They also need time to use new skills with support and prompting. Once a student can use the new skill independently, with close to 60 percent accuracy, or can use it with 60 percent accuracy when prompted, it is time to think about fluency (Shurr, Jimenez, & Bouck, 2019). Fluency is the ability to use a skill with greater efficiency and a greater level of automaticity (e.g., ability to recognize sight words in reading across a variety of materials). Both speed and accuracy are important to fluency, and increasing fluency takes time and practice (Shurr, Jimenez, & Bouck, 2019). The importance of maintaining a skill may seem like a no brainer, but it really is something we need to think about! For students with ID, the ability to maintain a skill without being promoted or retaught is the real test of mastery; it means that the skill can be used with reliability, accuracy, and efficiency (Shurr, Jimenez, & Bouck, 2019). The goal of all learning, however, is generalizability, the ability to readily apply the skill to new and relatively different situations, circumstances, and settings (Shurr, Jimenez, & Bouck, 2019). Just like earlier phases of learning, generalizing a skill must be explicitly taught and practiced (see Box 4.7). Learning is a complex process, and for students with ID it takes more time to master new ideas and skills. At each phase of learning, the skill must be explicitly taught and practiced. As we explore how to plan for students with ID, we will apply these principles of learning to different content areas. Students with ID can learn. The learning process will, however, take more time and support. Table 4.3 shares teaching strategies that work well to promote learning for students with ID. As you review the strategies in Table 4.3, you will notice that they move from concrete toward more abstract and that the levels of support offered phase out gradually from intense to limited as the student gains more independence. The main idea is building success and mastery to anchor learning within positive outcomes (Shurr, Jimenez, & Bouck, 2019).

High Leverage Practices:

High Leverage Practice 21: Teach Students to Maintain and Generalize New Learning Across Time and Settings.

Teachers use specific techniques to teach students to maintain and generalize their knowledge and skills across a variety of settings. Educators use rein­ forcement schedules, provide multiple opportunities for review/practice, and extend application to natural environments beyond the classroom. The goal of generalization is for students to use their knowledge and skills independently in new situations.

Reflection: ●

Why is teaching for generalization of learning so critical for students with ID, and what strategies would you use to support generalization of a specific skill like using money to make purchases?

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Table 4.3  Examples of Strategies for Teaching Students with ID Strategy

Examples

Concrete to Abstract—moving instruction for real/direct experiences to more abstract ideas

The class visited a local farm to see the eggs, young chicks, and adult chickens. They talked about how the life cycle of a chicken moves from egg to adult.

Explicit Instruction—the direct teaching of information and skills

The teacher shows a diagram of the life cycle of a chicken and explains each stage of the cycle.

Demonstration or Modeling—showing how something is done

Using a magnetic board with removeable words, the teacher shows the student how to label each stage of the life cycle with the appropriate word (e.g., egg, hatchling, chick, adult)

(this includes video modeling and self-modeling) Prompting—encouraging or reminding the student of the needed response (this may be physical, verbal, or visual)

The teacher asks the student to label each stage of the life cycle of a chicken and offers verbal prompts when needed (e.g., What comes after the egg? Yes, it is the hatchling, when the chicken is just born).

Practice with Reinforcement—using the skills or information somewhat independently, but with feedback to strengthen correct responses (various reinforcement schedules can be used depending on the student’s performance)

The student works to label the diagram showing the life cycle of the chicken and the teacher offers immediate verbal feedback to verify accuracy or point out errors (e.g., Yes that is correct—it is the egg! Think again—after the hatchling the young chicken is called a ? Yes, chick is correct!).

Scaffolded Support—assistance provided to help the student successfully complete the learning task (supports are gradually withdrawn as student’s performance stabilizes)

The teacher watches as the student labels the diagram of the life cycle of a chicken and offers support only when needed.

Independent Practice—Student works alone to rehearse the skill or information; this repletion is needed to ensure fluency

Once the student has correctly labeled the diagram showing the life cycle of a chicken, they repeat the process independently. Techer reviews accuracy of the work when the student is finished.

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The current research on teaching students with ID focuses on visual supports and scaffolding. Explicit instruction in math combined with visual supports (e.g., math schemas, diagrams, and advanced organizers) has shown to be very effective for students with ID (Bouck, Long, & Park, 2021). Schemas are visual diagrams that form a picture representing, for example, a type of math problem to assist students in determining how to solve the problem. Other effective supports to teach math include modeling, graphic organizers, and math manipulates (Bowman et al., 2020); realistic scenarios for the problems; visual aids to support understanding; and prompting procedures to remind students of steps to solve the problem (Chapman et al., 2019). For students with ID, learning to read requires explicit, systematic, and intense instruction with plenty of time to practice (Allor et al., 2020). Early Literacy Skills Builder (ELSB) is a program that supports letter-sound recognition, decodable words, and high frequency words for students with limited verbal skills (Browder et al., 2012). Even with solid reading interventions, students with ID often need between 1.5 and 3.5 academic years to make the gains in oral reading fluency that their typical peers will make in half a year (Allor et al., 2020). Teaching reading in the content areas requires additional strategies like using adaptive textbooks for shared reading; pre-teaching vocabulary; using stop/think/reflect strategies to check for understanding; pairing reading with graphic organizers; and using verbal, written, or drawn summaries of understanding (Roberts et al., 2019; Roberts et al., 2020).

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Chapter 4  |  Children and Youth with Intellectual Disabilities Earlier in the chapter, we looked at how the use of Universal Design for Learning (UDL) suggests that we use a variety of ways to engage students to keep them interested in learning. Several instructional approaches that help to engage students with ID in learning are discussed below.

4-6e  Instructional Practices for Engaging Students with ID in Learning Students with ID will need more time and repetition to learn new information, and learning can begin to feel dull if “drill and practice” is the only form of engagement. The pedagogical approaches below share some ideas for engaging students in ways to motivate learning.

Reciprocal Teaching Reciprocal teaching is an educational strategy in which small groups of students and teachers take turns leading a discussion on a particular topic. This exercise features four activities: questioning, clarifying, summarizing, and predicting. In this strategy (as in scaffolding), the teacher models how to carry out the activities successfully. The students then imitate the teaching style while the teacher plays the role of the student. In this way, students become active players in a role they find enjoyable.

Role-Playing and Dramatization

Virtual Math Manipulatives for Online Instruction https:// www.didax.com/math /virtual-manipulatives.html

To strengthen comprehension during reading, teachers may make use of dramatization, acting out a story or a song, playing make-believe, and using gestures with songs, stories, and rhymes. Engaging in dramatic representations of the story this helps students understand and remember the main events. It is also fun! In math instruction, the use of money management can be role-played in “banks” and “grocery stores” to teach the use of addition and subtraction. Roleplaying in math makes the ideas more concrete and can help with generalizing skills to real-world situations.

Paula Solloway/Alamy Stock Photo

Use of Hands-on Manipulatives to Make Learning More Concrete

Hands on activities support learning, here students are using music to reinforce counting patterns.

Whenever we can make an abstract idea more hands-on, we support students with ID in building understanding. Manipulatives can be made for almost any subject being taught. We may be most familiar with math manipulatives, including things like Cuisenaire rods, multi-based arithmetic blocks, fraction bars, hands-on-algebra kits, and even the use of calculators. But there are also manipulatives that can help teach reading and writing. Word cubes give students a chance to link words to form sentences, and words are color coded so that students can learn the parts of speech that each sentence needs (e.g., nouns and verbs). Sentence strips can help students build paragraphs. Reading comprehension cubes are like dice, but they have questions on them so that students can roll them and answer the question as it comes up. Some manipulatives have even been adapted for online teaching (see margin link).

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Educational Responses for Students with Intellectual Disabilities

Cooperative Learning Interestingly, emphasis has switched from a focus on one-on-one instruction for the individual student with special needs, as represented in the policies for an IEP, to the importance of student participation in cooperative learning or teamassisted individualization (Browder et al., 2008). Group instruction may actually be more advantageous than one-on-one instruction because it can be more motivational and students also learn how to interact with and learn from peers.

4-6f  Strategies for Improving Social Skills of Students with ID Social skills are a critical component of the curriculum for students with ID, and teaching these begins in preschool. Early experiences with socialization skills such as taking turns, sharing, and working cooperatively can be intentionally embedded and reinforced within the daily routines. In preschool settings, the lunch table is an excellent location for teaching social skills. Here, children learn table manners, as well as how to pass and share food, help others (e.g., pouring juice), and wait their turn. The lunch table is also a good place to review the morning’s activities and talk about what is planned for the afternoon or the next day. As children move into elementary school, the teaching of social skills often needs to be more explicit. Because students with ID may have difficulty establishing social acceptance in the classroom and in their other social environments, we need to support them by directly teaching and practicing social skills in a wide range of environments and situations. When a child has a difficult time with social skills, it is hard to “fit in,” and school can be a frustrating place. One aspect of socialization is being able to deal appropriately with our negative emotions. Box 4.8 shares one strategy for helping students calm down in the face of frustrations. Children with ID sometimes have difficulty transferring or applying ideas from one setting to another. Jaylen, for example, often gets too close to the person he is speaking to, making the other person uncomfortable, but he was not aware of this reaction. Through role-playing a number of social situations with Jaylen and others, the teacher was able to establish that each person has a personal space and that this space is not to be invaded without permission (e.g., to kiss an aunt goodbye). These social rules may seem trivial, but their importance is magnified substantially when they are violated. Some of Jaylen’s emerging behavioral problems seemed to stem from social misunderstandings like this that escalated. The understanding of personal space becomes even more important during adolescence. Parents and other adults worry about the susceptibility of young people with ID to sexual abuse or unwanted sexual contact merely because they lack the social skills to avoid or manage sexual encounters. You may recall that this was a concern for Jasmine’s parents, as they felt that she would not recognize situations that could be harmful to her. Because of this, as students with ID become older, part of their social skills curriculum should address physical appropriateness in relationships. Some strategies to teach, reinforce, and practice social skills include peer-buddy systems, in which a classmate may help a classmate with disabilities negotiate the school day; peer support networks that help students become part of a caring community; and circles of friends, in which an adult facilitator helps potential peer buddies sensitize peers to the friendship needs of students with disabilities. Look back to Chapter 2, Table 2.4, and think about the building blocks for belonging and how these can help with developing social skills for students with ID.

Bullying and Cyberbullying Bullying is harassment of individuals that is repeated and where the aggressive behavior involves in imbalance of power between the bully and the victim

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Chapter 4  |  Children and Youth with Intellectual Disabilities

Box 4.8

Mindfulness Matters:

Calming Down in the Face of Frustrations

School can be a frustrating place and for students with ID, and it can sometimes feel overwhelming: lessons can seem too confusing, classmates can be mean, or teachers may not be available to help as soon as they are needed. All of this can lead to frustration, and students with ID can feel defeated before they even start! This is the feeling of learned helplessness described earlier in the chapter. But we are not helpless in the face of frustration; indeed students can learn to manage their feelings, calming down in the face of frustrations. As with most things for students with ID, the skills to manage frustration must be explicitly taught, practiced, and eventually generalized across situations. This takes time and intentionality. Why This Matters: Developing skills to manage frustration is a key part of growing up, and these skills become essential as we move through our life course. Learning to manage frustration is important to school, work, and personal success. Practicing Mindfulness: Glitter jars! Making glitter jars offers a concrete way for students with ID to visualize the chaotic feeling of being frustrated. A glitter jar, filled with water and glitter, is like a snowglobe—when you shake it up, you can see the wild whirlwind of glitter spinning around. Over time if the jar is still, this glitter settles down and the water becomes clear and calm. This is a concrete metaphor for helping us become calm so that our thinking becomes clearer. Making a glitter jar is a fun way to learn about dealing with frustrations. Directions for

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the glitter jars can be found at https://heartmindkids. com/how-to-make-a-glitter-jar-for-mindfulness/. What you will need: 1. Baby food or other small jars with lids that will close tightly (one per student) 2. Large Elmer’s clear school glue 3. Several colors of fine glitter 4. Food coloring (optional) 5. Warm tap water 6. Permanent marker to label jars Making the glitter jars: 1. Fill your jar about 1/8 or less full of the clear Elmer’s glue 2. Add glitter (your call as to how much  ) 3. Add warm water and a few drops of food color if using 4. Put the lid on and shake the jar to mix 5. Write student’s name on jar lid The glitter jars give students a great way to discuss how frustrations can feel; how when we are frustrated our minds feel cloudy and we can’t think well. This also provides a great way to talk about how we make better decisions when we are calm. When students become frustrated, they can shake their glitter jar up and watch as the glitter settles. This focus helps them calm their minds; just as the glitter in the jar can settle down, so can we!

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(Martinez-Cao et al., 2021). Bullying can be either indirect (e.g., spreading negative rumors) or direct (e.g., physical or verbal harassment), but it always has a negative impact on the victim, the bully, and the by-standers who observe the bullying. Cyberbullying can involve the Internet, using emails, Facebook, instant messaging, Twitter accounts, blogs, and other online platforms. Cyberbullying is a particularly vicious from of harassment because victims often cannot defend themselves, the aggressor can remain anonymous (and often avoid punishment), and electronic harassment can spread rapidly to a wide audience (Martinez-Cao et al., 2021). Cyberbullying is the act of cowards. Students with ID are more vulnerable to bullying in all its forms. Studies indicate that 15 percent of adults with ID report being victimized by cyberbullying and 9.7 percent said that the harassment was still ongoing (Martinez-Cao et al., 2021). Two protective factors against bullying for students with ID have been identified: the development of positive social skills and the creation of safe environments for learning (Martinez-Cao et al., 2021). Adults responsible for supporting students with ID must work to protect them from bullying in all its forms.

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Educational Responses for Students with Intellectual Disabilities

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Self-Determination One of the long-term goals for students with ID is self-determination, or the ability to set personal goals and to take appropriate actions to achieve them. The capability of making choices and solving problems is an often-stated IEP goal for students with ID (Wehmeyer, 2006). Practice at decision making can strengthen the executive function of the student (see the information processing model in Figure 4.2 for Jaylen). Developing the student’s capacity for self-determination is critical for adult adjustment (Wehman, 2013; Wehmeyer et al., 2007). Explicit teaching of self-determination skills and applications of these skills to real-life decisions must begin early and be sustained as life becomes more complex across the life course of students with ID. The Self-Determined Learning Model of Instruction (SDLMI) is an evidence-based practice for students with ID (Burke et al., 2019). The SDLMI focuses on helping teachers create many opportunities for students to practice setting goals and self-monitoring their progress toward their goals. Student goals can be academic, social, vocational, or behavioral; the key is that these goals are self-identified, written down, and used as the foundation for action planning (Burke et al., 2019). Self-determination will be discussed again as part of the development of personal support plans to facilitate transition to post-secondary life.

Teacher’s Guide for the Self-Determined Learning Model of Instruction https://selfdetermination .ku.edu/wp-content/uploads /2019/05/Teachers-Guide -2019-Updated-Logos.pdf

Using Technology with Students with ID

Sladic/E+/Getty Images

The critical role of technology in education became increasingly clear with the need for virtual learning in response to the COVID-19 pandemic. Access to computers and broadband Internet service became the foundations for education and showed the dramatic impact that technological disparities create when students and families do not have these basics. Technology is a valuable support for all students, but it can play a key role in the education of students with ID. The use of portable smart devices (e.g., smartphones and tablets) to teach and reinforce learning has shown success across a range of topics. Video modeling has been used with students with ID to support craft creations, grocery shopping, food preparation, work skills (e.g., cleaning tasks), and pedestrian navigation (Goo, Maurer, & Wehmeyer, 2019). After reviewing the literature on the use of smart devices, Goo and colleagues (2019) conclude that the use of personal smart devices “…appears, overall, to be an effective method for teaching various functional skills to students with ID” (p. 64). Video modeling was also used successfully to teach job interviewing skills to students with ID (Bahcali & Ozen, 2019). Computers offer many possible supports for students with ID. Speech-totext can help with writing, reading, and word recognition; software programs can offer repetitive practice with branching prompts to allow students ample time for mastery; and spell-check supports writing. When technology is combined with direct instruction and prompting, the resulting support can help students with ID maintain their engagement and monitor their progress in writing (Pennington et al., 2020). Mastering technology was also identified as a key skill set predicting Many of the readily available technologies, like google map, are useful success in post-secondary education and supports for students with ID. employment (Mazzotti et al., 2021).

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Chapter 4  |  Children and Youth with Intellectual Disabilities Things are changing in how we teach students with ID, and setting higher expectations for their K–12 education is critical for opening options for their postsecondary experiences. Tammy Day, director of Next Steps, shares her thoughts on inclusive educational opportunities for students after graduation (see Box 4.9).

Box 4.9

Ask the Experts:

Opportunity and High Expectations—Inclusive Higher Education

© Tammy Day

138

Tammy Day, M.A. – Program Director, Next Steps at Vanderbilt Pat’s high school education included a combination of inclusive learning environments and an IEP that provided her with additional educational supports, i.e., physical therapy, speech therapy, and work-based learning training. However, she also left high school knowing that she wanted to experience college like her older brother and that she did not want to spend her workdays washing bottles. She and her parents knew that she deserved what most high school graduates want, more time to grow and explore with their same-aged peers. Pat enrolled in Next Steps at Vanderbilt, an inclusive higher education certificate program for students with an intellectual disability at Peabody College, Vanderbilt University in Nashville, TN. During her time as a college co-ed, Pat blossomed as she took courses of interest, experimented with different employment fields through internships, and built a strong social network of her own. She has worked at the university since her graduation as an office assistant and continues to learn new skills while staying connected to her community through hobbies, friends, and family. The inclusive higher education movement began gaining traction in the United States in the early 2000s as families and students raised their voices and asked for college opportunities. To them and many others, this is a social justice issue. How was it that our society

didn’t see the value of people with ID continuing to grow and learn with their peers? Why would we not strive to provide educational opportunities, coupled with high expectations, to ALL our country’s students? Like most college graduates, students with ID leave college better prepared to engage in their communities, to be contributors, and to find meaningful employment. In the summer of 2021, Think College reported that there are over 295 such programs across 49 states. Students enrolled in Next Steps at Vanderbilt are supported as they complete their four-year Career and Community Studies certificate program by dedicated staff, faculty, graduate students, and most importantly by hundreds of university student volunteers. While the students are participating in rich university requirement courses like Stars and Galaxies and the Anthropology of Food, practicing employability skills through seven semesters of internships both on and off campus, or attending campus life events, they are learning to become self-reliant problem-solvers. And as they are learning to navigate a large college campus independently, planning social events with their friends, and monitoring their own schedules, they are learning to find their place in the world and advocate on their own behalf. The above description of the students’ college experiences is markedly different from what most students with significant disabilities experience in high school. But after teaching in public K–12 schools for 18 years, and then teaching and directing Next Steps for over 10 years, I’m convinced that these marked differences are not necessary. Students with significant disability need additional supports, but they do not need separate learning opportunities and nonexistent expectations. Equally important in this equation are the lived learning opportunities that neurotypical students are missing when they are not given the opportunity to be educated in inclusive learning communities. How can we expect people to develop the capacity to include others if they don’t know them? How will they learn that they are more alike than different? Because of the inclusive higher education programs across the country, we are getting to watch as thousands of college students gain these experiences. Vanderbilt students

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Transitions to Post-Secondary School, Work, and Adult Life

Box 4.9

139

Ask the Experts:

Opportunity and High Expectations—Inclusive Higher Education  (Continued)

often tell us that being involved with Next Steps was the most significant part of their whole Vanderbilt experience. Quite often majors are changed, or disability focuses are being included in their studies. Secondary teachers of students with ID can help to shape their students’ futures by keeping all options on the table. One critical option should always be inclusion at every possible opportunity, from course work opportunities to experiential opportunities like learning to turn the page for the choir pianist. Another way to keep all options on the table would include helping their students to develop a deep curiosity about their own futures and then to help them find ways to learn to satisfy their curiosity. We strive to not answer our student’s questions, but to reply, “Good question. Now how are you going to figure that out?” Students need to learn how to find answers and information at the highest levels of their ability. This might be by learning how to interview people to ask about their jobs, hobbies, and more. This could also be learning how to complete online searches to find answers, which might involve teaching them to use accessibility tools on their computers and smart devices. Many learners with differing abilities learn best by doing, so

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teachers must find creative ways to find supports for their students as they get to try out a vast number of new experiences. In order to prepare students with ID for college, or any student for college, teachers must also include others in this preparation. Parents need to learn about these new college programs very early in their child’s education so that they might also keep all options on the table. If an IEP team knows that college might be one of their student’s transition goals, the planning and supports will most likely be significantly different. General education teachers and guidance counselors also need to be educated about college opportunities and the real possibilities that are out there for this population. Lastly, teachers and students will benefit greatly when other students are given the chance to grow their skills and interests when they are asked to serve as mentors, tutors, and buddies that most likely will engender genuine friendships.

Reflection: ●

What kinds of lessons can we as K–12 teachers learn from the ways that students with ID are included in higher education programs like Next Steps?

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4-7  Transitions to Post-Secondary School, Work, and Adult Life Transition to independent adulthood can be a difficult journey for many young people; for youth with ID it is even more challenging (Mazzotti et al., 2021). Three factors are considered the foundation for determining a successful post-secondary transition: continuing education, employment, and independent living. In Box 4.10, Ryan shares his personal transition journey.

Next Steps Program, Vanderbilt University Peabody College of Education and Human Development | Vanderbilt University https:// peabody.vanderbilt.edu /departments/nextsteps/

4-7a  Outcomes for Adults with ID There are a growing number of studies on how students with ID are doing in adult life. The news is mixed. While 48 percent of students with ID graduate high school with a regular diploma, 15 percent drop out of high school (Department of Education, 2018). As we have seen from the Ask the Experts with Dr. Björnsdóttir and Ms. Day, more and more students with ID are enrolling in post-secondary educational programs through colleges and universities; 28 percent of students with ID attend some form of post-secondary education program, and there are now around 265 post-secondary programs designed for Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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Chapter 4  |  Children and Youth with Intellectual Disabilities

Box 4.10

Exceptional Lives    Exceptional Stories:

Ryan’s Readjustment

Ryan, a 22-year-old with mild ID, was referred to an occupational therapist after unsuccessful community-based job placements. Several professionals recom­ mended that he return to a sheltered day program for “work skills training.” While working with a new occupational therapist, Ryan said he’d like more jobs similar to the ones he had previously lost due to excessive absence or poor performance. Ryan was capable of doing the necessary tasks for those jobs but had seemed to lose interest in them very quickly. He took a look at some new job ideas on video and was excited about the possibility of working as a housekeeper at a motel. It wasn’t easy to find an employer who was willing to give him a try. But one motel owner agreed to give Ryan a job on a 30-day trial basis. It took only a short time for Ryan to become one of the most efficient and reliable housekeepers

National Technical Assistance Center on Transition, Post High School Predictors of Success https://www.nsttac.org /content/predictors-post -school-success/

on the motel’s staff. His employer was so impressed that she requested other people with disabilities seeking employment. Ryan had many successes at this job. He was named Employee of the Month and given a cash bonus, and later he was promoted to “second floor supervisor” and given a raise. Ryan eventually moved up to supervising a group of motel employees without disabilities.

Reflection: ●

In what ways did Ryan show self-determination and goal setting in planning for his future?

Adapted from Blair, B. (2000). Ryan’s story: From job placement challenge to employee of the month. Teaching Exceptional Children, 32(4), 47. Copyright by the Council for Exceptional Children. Reprinted with permission.

students with ID (Pacer, 2019). A smaller percentage of adults with ID, however, have found employment within five years of graduation, at just 16 percent. Students with ID are less likely than other youth to be enrolled in full-time two-year and four-year colleges (Park & Bouck, 2018) or pathways to paid employment, as noted above. Independent living are also more challenging for youth with ID (Newman et al., 2011; Sanford et al., 2011). Given the disproportionate representation of low-income students of color within students identified as ID (discussed earlier in the chapter), these challenges are likely compounded by issues of poverty, institutional racism, and personal bias. The intersectionality of these factors, and the social justice issues they raise, has yet to be fully explored for students with ID (Trainor et al., 2020). The type and quality of transition supports and services offered in high school can have a significant impact on the long-term post-school outcomes for students with ID. Table 4.4 draws from the results of a comprehensive literature review on predictors of post-high school success for students with disabilities (Mazzotti et al., 2021) showing the predictors of success for youth with ID. Predictors of success across education, employment, and independent living were ranked using the National Technical Assistance Center on Transition criteria as promising, researchbased, or evidence-based. Most of the predictors of success listed in Table 4.4 have been well established for many years, but the newest predictors of success for students with ID include psychological empowerment (a promising practice for education, employment, and independent living), self-realization (a promising practice for employment and independent living), and technology skills (a promising practice for employment) (Mazzotti, 2021). In spite of the research showing successful practices that support transition, many youths with disabilities do not have access to the transition-related supports and services needed for success (Trainor et al., 2020).

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Transitions to Post-Secondary School, Work, and Adult Life

141

Table 4.4  Here Predictors of Post-High School Success for Students with ID Across Education,

Employment, and Independent Living* Predictor of Success

Education

Employment

Career Technical Education (was Vocational Education)

X-RBP**

X-EBP

Inclusion in General Education 80% or More

X-RBP

X-RBP

Paid Work Experience

X-RBP

X-RBP

Parental Expectations

X-RBP

Program of Study

X-RBP

Psychological Empowerment

X-PP

Self-Care/Independent Living Skills Self-Determination/Self-Advocacy

Independent Living

X-PP

X-PP

X-PP X-RBP

X-RBP

X-PP

Self-Realization

X-PP

X-PP

Technology Skills

X-PP

Transition Program

X-RBP

X-PP

Youth Autonomy/Decision Making

X-RBP

X-RBP

X-PP

*Information from this table was extrapolated from Mazzotti, V. L., Rowe, D. A., Kwiatek, S., Voggt, A., Chang, W. Fowler, C. H., Poppen, M., Sinclair, J., & Test, D. W. (2021). Secondary transition predictors of postschool success: An update t the research base. Career Development and Transition for Exceptional Individuals 44(1). ** Ranking: Promising Practice (PP), Research-Based Practice (RBP), Evidence-Based Practice (EBP)

4-7b  Transition Planning for Students with ID Formal transition planning, by law, must begin by age 16 for students with disabilities, but many educators believe that planning for successful transitions should begin by middle school. A student’s transition plan is part of their IEP and should include post-secondary goals (e.g., educational, vocational, job/employment, independent living); transition services needed to reach these goals (e.g., instruction, related services, community experiences, career/ college counseling, daily living skills); and any legal considerations (e.g., transfer of rights, guardianship) (Boothe & Hathcote, 2021). Person-centered planning is the key to developing a workable transition plan. Person-centered planning means the individual with ID is the driver of the plan and their interest, desires, hopes, and aspirations for the future are the guide for planning. Self-determination plays a key role in the goal-setting for planning. According to the Office of Special Education and Rehabilitative Services (2017) PersonCentered planning approaches: ●  Include

in the planning process individuals who have a deep knowledge of the student’s academic and social history; ●  View the student as an individual and as a person, rather than as a diagnosis or disability; ●  Use everyday language in transition planning, rather than “professional jargon;” and ●  Ensure that goals are developed based on the student’s unique strengths, interests, and capacities (p. 35).

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National Parent Center on Transition and Employment https://www.pacer.org /transition/learning-center /planning/

Individuals with ID are now more involved in planning for their future and helping to determine the supports they need to be successful (Shogren et al., 2017). Developing a personal support plan is important as it describes the type and level of support needed across various domains of the individual’s life (e.g., home, employment, socialization, sports/leisure activities, medical/health needs). The supports outlined in the plan should help to bridge the person’s functional limitations and the demands of the task or situation, thus allowing the person to function at their best (Schalock et al, 2020). Successful transition to adult life is a long process, and many students with ID need sustained support beyond the school years to reach independence. This requires coordination with other agencies like Vocational Rehabilitation and supportive employment services (US Department of Education, 2017). Determining that an individual with ID has made successful transition into adulthood must also address their quality of life. Quality of life depends on meaningful connections and relationships, a sense of self-worth, and productive contributions provided through work. The community of support for individuals with ID must be broad and inclusive.

4-7c  Leisure Time and Sports

Special Olympics https://www.special olympics.org/

A goal of almost everyone is a healthy life with ample leisure time to pursue areas of interest. Areas of interest for individuals with ID are likely the same as for their same age peers. These may include music, art, drama, hiking, and involvement in sports. Community-based opportunities for inclusion are key to integrating individuals with ID. One of the most successful community-based programs for athletes with special needs is Special Olympics, was founded in 1968 by Eunice Kennedy Shriver, a sister of President John F. Kennedy. It has grown to a multifaceted international program, with several thousand participants and many thousands of spectators. Through Special Olympics, athletes with disabilities participate in competitive sports events.

4-7d  Family Support

The Arc of the United States https://www.thearc.org

Center for Parent Information and Resources: Parent-toParent Support https://www .parentcenterhub.org/parent -to-parent-support/

One of the common feelings of parents whose children have ID is loneliness. They feel different from their neighbors and often do not know how best to help their child. Parent support groups can be an important resource to help them cope. The Arc of the United States, a national organization with many chapters throughout the country, is able to provide access to resources for parents and families. Often another parent who has been through the same experience can be a valuable support to a parent who may otherwise feel isolated and overwhelmed. One of the strategies that professionals use to help families cope with the extra stress that often accompanies raising a child with disabilities is respite care. Respite care is the provision of child-care services so the parents are freed for a few days of their constant care responsibilities. Parents who may not have had a “day off” from child-care responsibilities for years greatly appreciate such assistance. Respite care is an effective way of reducing parental depression and stress and enabling parents to be more effective in their role. The National Parent-to-Parent Network matches a trained “veteran parent” (someone who has experience as a parent of a child with disabilities) and a “referred parent” (one who is dealing with the issues for the first time). Today, there are Parent-to-Parent programs serving nearly every state. An example of what such a program can mean comes from a referred parent:

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Summary Parent-to-Parent has been my lifeline. When I first heard the diagnosis, I was devastated. Well-meaning doctors and nurses, as well as friends and family, simply did not understand. It was only when I finally connected with another parent through the Parent-to-Parent program that I could begin to hope for a future for us all. My veteran parent was generally there for me whenever I needed her. (Turnbull & Turnbull, 1997, p. 181) We have tried to portray the diversity of students that fall under the category of intellectual disabilities (ID). Responding to the range of needs requires a team approach in planning— families are a critical member of this team!

Summary ●  The

Moral Dilemma:

Addressing IEPs in Virtual School When schools shut down due to COVID-19 in March of 2020, it threw teachers for a loop. Suddenly, they had to move their entire in-person curriculum online and work with students with a range of access to technology. Some students had fiber ultra-high speed Internet and state of the art laptops; others didn’t have their own devices and had spotty, lowspeed Internet at best. Students were required to be watching lessons taught on screens for hours at a time, and they had limited ways of completing and turning in assignments. Further, virtual schooling tied teachers’ hands as to how they could instruct students with disabilities. Accommodations such as separate settings, assistive technology, and quiet environments were inaccessible. Teachers were having a hard enough time teaching their general lessons, and some found modifying their curriculum for those with disabilities impossible. However, just because a pandemic was happening didn’t mean that IEPs were no longer enforced. Kids with exceptionalities needed to learn just like everyone else. Imagine you are a teacher at a school that is about to embark on a period of virtual instruction, with limited time and resources. What do you think the school’s responsibility is to students with ID? What should the school be doing to support each student’s IEP implementation? How could you plan with parents to help them in supporting their child?

field of working with students with intellectual disabilities is less than 200 years old. Pioneers such as Itard and Montessori laid the groundwork for current educational practices. ●  Students with ID have unique patterns of strengths and challenges, and they will require individualized supports to meet with success. ●  Individuals identified with intellectual disabilities have limitations in both intellectual functioning and adaptive behavior. An educational diagnosis of ID depends on the characteristics of the child and on the demands of the social environment. ●  The overrepresentation of students of color within ID may be due, in part, implicit bias and/or to a lack of cultural sensitivity in determining the adaptive behavioral component of the ID diagnosis. ●  Many factors may contribute to the development of ID. They include genetic abnormalities, toxic agents, infections, neurological damage, and negative environmental factors. ●  The IPM for children with ID shows challenges in auditory, memory, classification, and reasoning. There are also output challenges. Children with ID have often have difficulty processing information. For many, the problem lies in limited memory, perception, reasoning, classification, and the way they organize information and make decisions. Children with ID may have a general language deficit and specific problems using interpretive language. ●  Instruction for students with ID should be explicit and will generally proceed from concrete to abstract with support moving from intense to limited as students gain mastery. Learning will move through four phases: acquisition, fluency, maintenance, and generalization. ●  The IEPs of students with ID should include their strengths as well as their challenges. The Endrew Supreme Court ruling has also determined that all students must have the chance to meet challenging learning objectives.

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growing number of colleges and universities now have programs for students with ID. ●  Planning for transition helps students with ID establish their own goals for post-secondary education, employment, and independent living.

Future Challenges 1. What are the implications of a lack of cultural sensitivity when determining the level of adaptive behavior for a student? We know that implicit bias can play a role in decision making and that this can negatively impact students of color. What we do not yet fully understand is the role that intersectionality across race, ethnicity, and poverty plays in the determination of a student’s level of adaptive functioning.

2. How can the strategies and programs that are clearly predictive of success for students with ID be brought to scale? The future of students with ID depends on the level and type of support they receive in their pre-K–12 programming. Yet, in spite of all we know about the predictors of success, many students with ID do not have access to programs that implement these strategies. How can we work to ensure that all students with ID receive the supports they need for success?

3. How can we shift from a “deficit” to a “strength-based” approach to supporting students with ID? The 2017 Endrew F v. Douglass County Schools Supreme Court decision made it clear that all students should have the chance to learn a challenging curriculum, and a growing number of students with ID are going on to college and post-secondary educational opportunities. How can we ensure that we prepare students with ID through a strength-based approach to allow them to reach their potential?

Key Terms acquisition p. 132 adaptive behavior p. 115 classifications of intellectual disabilities (mild, moderate, severe, profound) p. 117 cooperative learning p. 135 Down syndrome p. 120 encephalitis p. 122 generalization p. 132 fetal alcohol syndrome or spectrum disorder (FAS) p. 122 fluency p. 132 fragile X syndrome (FXS) p. 121 functional behavioral assessment p. 131

intellectual disabilities (ID) p. 113 intellectual functioning p. 115 learned helplessness p. 124 maintenance p. 132 person-centered planning p. 141 positive behavior interventions and supports (PBIS) p. 130 respite care p. 142 rubella p. 122 schemas p. 133 self-determination p. 137 teratogen p. 122 transition plan p. 141 trisomy 21 p. 120

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Resources of Special Interest for Teachers

Resources of Special Interest for Teachers Journals American Journal on Intellectual and Developmental Disabilities  is among the top three journals in the special education and rehabilitation fields according to the latest industry impact factor rankings. The AJIDD reports current and critical research in biological, behavioral, and educational sciences. It is a singular, multidisciplinary resource in the causes, treatment, and prevention of intellectual disabilities. The AJIDD is targeted for researchers, clinicians, practitioners, students, and other professionals in intellectual disabilities and related disabilities. https://meridian.allenpress.com/ajidd Education and Training in Intellectual and Developmental Disabilities focuses on the education and welfare of persons with autism and developmental disabilities. Major emphasis is on identification and assessment, educational programming, characteristics, training of instructional personnel, habilitation, prevention, community understanding and provisions, and legislation. http://www.daddcec.com/etadd.html

Organizations Best Buddies is the world’s largest organization dedicated to helping people with intellectual disabilities live fully integrated lives. https://bestbuddies.org The Arc is a community-based organization of and for people with intellectual disabilities. It provides an array of services and support for families and individuals and includes over 140,000 members affiliated through more than 850 state and local chapters across the nation. The Arc is devoted to promoting and improving supports and services for all people with intellectual disabilities. https://www.thearc.org

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Children and Youth with Autism Spectrum Disorders

5 Ch ap te r

Standards Addressed in this Chapter All the CEC Initial Practice-Based Professional Preparation Standards for Special Education (K–12) are addressed within this chapter. Please see the inside front cover for the list of these standards.

Focus Questions 5-1 What is the history of autism spectrum disorders (ASD)? 5-2 What are some characteristics of students with ASD, and how are students with ASD identified? What role might implicit bias play in identifying culturally different students with ASD? 5-3 What is the definition for ASD? 5-4 What are some of the genetic and environmental causes of ASD? 5-5 How can the information processing model (IPM) help us understand the strengths and challenges of students with ASD? 5-6 What educational responses help to address the strengths and challenges of children with ASD? 5-7 What role do families and communities have across the lifecourse of individuals with ASD?

wavebreakmedia/Shutterstock.com

A

s we begin this chapter we want to recognize some differing views on terminology. Throughout this text we have chosen to use “person-first” language when talking about individuals with disabilities. While we will continue this practice, to maintain consistence and to respect current practice, we want to acknowledge an emerging movement within the autism community promoting “identity-first” language. Leaders of this movement prefer the language “autistic child” and the use of the term “autism” rather than “autism spectrum disorder,” which they feel better honors autism as a key part of who they are. You may have friends or family members who use this language. Of course, we encourage and support the use of language that individuals prefer and recognize that changes in language reflect changes in mindsets and understandings (we have seen this within the community of individuals with intellectual disabilities, as discussed in Chapter 4). As we write this chapter, there has not been a clear consensus in the wide acceptance of these changes…but language is important, so stay tuned!

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Chapter 5  |  Children and Youth with Autism Spectrum Disorders

5-1  History of Autism Spectrum Disorders Dr. Leo Kanner (1943), a psychiatrist at Johns Hopkins University, was among the first to use the term “autism,” which comes from the Greek “autos” or “self” to describe a group of children who seemed to be removed from social interactions. Dr. Kanner’s description indicated that the children did not relate to others, had delays in speech development, engaged in repetitive behavior, and were upset by changes in routines. His first case study was a young boy, Donald T.: In October 1938, a 5-year-old boy was brought to my clinic from Forest, Mississippi. I was struck by the uniqueness of the peculiarities which Donald exhibited. He could, since the age of 2½ years, tell the names of all the presidents and vice presidents; recite the letters of the alphabet forwards and backwards; and flawlessly, with good enunciation, rattle off the Twenty-Third Psalm. Yet he was unable to carry on an ordinary conversation. He was out of contact with people, while he could handle objects skillfully. His memory was phenomenal. The few times when he addressed someone—largely to satisfy his wants—he referred to himself as “You” and to the person addressed as “I.” He did not respond to any intelligence tests but manipulated intricate foamboards adroitly. (Kanner, 1943, p. 93) Autism Society of America www.autism-society.org

This description may feel familiar to anyone today who has worked with students who have autism (“classic” autism is part of what is now referred to as autism spectrum disorders). Over the past few decades, a growing number of parents and advocates became concerned that their children with ASD were not receiving proper education and treatment within the public schools. In 2006, this alliance of parents and professionals was able to persuade Congress to pass the Combating Autism Act of 2006 (P.L.109-416), and President George W. Bush signed it into law. This act: ●  authorizes

establishment of regional centers of excellence for autism spectrum disorders research ●  authorizes activities to increase public awareness of autism, to improve the ability of healthcare providers to use evidence-based interventions, and to increase early screening for autism ●  calls on the Interagency Autism Coordinating Committee (a state multidisciplinary group) to enhance information sharing This bill was reauthorized in 2011, showing continuing interest in Congress regarding this issue. As we have seen from earlier chapters, legislation is often a driver of change within the field of special education. We have learned a lot over the last several decades, and we now better understand the complex patterns of strengths and challenges that come with being autistic.

5-2  Characteristics of Children and Youth with Autism Spectrum Disorders Autism spectrum disorder (ASD) is a neurodevelopmental disorder and as such its basis is thought to lie within the structure and function of the brain. The brain is a complex organ, and we are just beginning to really understand how it works. Brain imaging techniques have uncovered suspected physiological differences in function and structure between children with autism and typically developing children, and the term neurodiversity is being used to capture these natural variations of the human brain. Neurodiversity implies that these variations in

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Characteristics of Children and Youth with Autism Spectrum Disorders

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Socialization Sort of Quirky

Very Self-Absorbed Communication

Very Verbal

Nonverbal Sensory Input

Hyper-Sensitive

Hypo-Sensitive Cognitive Abilities Intellectual Disabilities

Highly Intelligent Motor Skills

Poor Coordination

Adroitness Behaviors Unique Mannerisms

Self-Harming/Aggressive

◗ Figure 5.1  Continuum of Impacts Across the Spectrum of ASD

the structure and function of the brain are differences not deficits. Understanding the impacts of these differences helps us know what supports and services will be needed to promote success for students with ASD. The use of the term “spectrum” as part of the diagnosis category for autism indicates the wide variation in patterns of strengths and challenges across individuals within this group. While the characteristics that typify “autism” may include delays in language and communication, difficulties with socialization, repetitive motor movements, ritualistic behaviors, inflexibility, fixed interests, and differences in sensory perceptions, these all fall along a continuum, or spectrum. Figure 5.1 shows the variance across six domains—social, communication, sensory, cognitive, motor, and behavioral—for students who have been identified with ASD. If we look at the six domains in Figure 5.1 and realize that any individual’s strengths and challenges could fall anywhere along the continuum of each domain, it is easy to see the number of different patterns these combinations can form. So, given all of this possible variation, how would one describe the characteristics of individuals who have been identified with ASD? Dr. Stephen Shore put it this way: “If you’ve met one person with autism, you’ve met one person with autism” (Autism Speaks, 2021). You may want to visit the Autism Speaks website to read some stories of individuals who have been diagnosed with ASD. Mike Dolan’s story below offers some insight into one family’s life (see Box 5.1). Many have wondered what might be the fundamental mechanisms at the heart of the observable characteristics of children, like Mike Dolan, who have ASD. What is behind the inability to socialize or to communicate effectively with others? One explanation rests with the Theory of Mind.

Autism Speaks www .autismspeaks.org/

5-2a  Theory of Mind Theory of Mind (ToM) is the ability of human beings to understand the thinking and feelings of other people. This understanding is fundamental to socialization because it is necessary for interpreting, predicting, empathizing, and appropriately responding to the behavior of others (Harvard Medical School, 2021). To illustrate ToM, imagine that you are meeting a good friend for lunch, and when you get

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Box 5.1

Exceptional Lives    Exceptional Stories:

Mike Dolan and His Family

Mike Dolan was beautiful 2-year-old boy, but his parents were worried about him. Something was clearly different about their child. He wasn’t talking as most 2-year-olds do. He often made a series of repetitive physical motions with his hands. And, above all, he didn’t interact socially with his parents or others the way they thought he should. For example, he didn’t look directly at people when they talked to him, and he appeared not to pay attention to many of the things his parents said to him. He seemed preoccupied with his toy trucks and played with them incessantly. When he wanted something, like a glass of milk, he would drag his mother to the refrigerator and use her hand to grab a carton, rather than use words to ask for it. Finally, Mrs. Dolan decided to take him to the family pediatrician. Dr. Phinney examined Mike and found nothing physically wrong with his development, with the exception of some motor coordination difficulties. However, having seen a child with similar behavior two months before, she suggested that the Dolans take Mike to a university clinic with a multidisciplinary staff who could review Mike’s needs. Mike was evaluated by physicians, psychologists, educational specialists, and speech pathologists at the

university clinic. Then they met with the Dolans and explained that in their judgment, Mike had autism. The lack of communication, his inability to interact socially, his obsession with particular toys, and his strange motor movements all pointed in that direction. They also said that it was fortunate that the Dolans had come to them so soon because early intervention was essential, and they recommended beginning treatment right away. The Dolans had many questions. What was autism? What had caused the autism? Could their future children also have autism? Could Mike’s autism be improved, and if so, what would the treatment be? Mrs. Dolan wanted to know whether the public schools could handle a child with autism or whether Mike would need to go to a special school. These were all good questions—ones that any parent might ask in a similar situation and ones that we will work to answer in the rest of the chapter!

Reflection: ●

How do you imagine Mike’s parents felt when they received the news that Mike had autism? What kinds of support do you think would help them cope with this news?

there a few minutes late, he is waiting for you but he barely says hello because he is focused on his cell phone texting message after message. Do you assume he is just being rude to “pay you back” for being late? Or do you remember that his mother was recently hospitalized? Your ability to accurately infer the meaning of another person’s behavior, within a given context, is determined by your use of ToM and your own behavior is often dependent on how skilled you are at this. Of course, to avoid confusion, you could always just ask your friend what is going on! Most 4-year-old children have a developing ToM, but children with ASD (and those with some other neurodevelopmental disorders) do not seem to spontaneously develop these understandings. Recent neurological research has identified neurons that “…reliably encode information about others’ beliefs across richly varying scenarios and that distinguish self- from other-belief-related representations…” (p. 610), thus locating the neurological basis for ToM (Jamali et al., 2021). Identifying the basic cellular mechanisms that seem to be at the heart of the social and communication challenges faced by individuals with ASD can help us better understand the neurodiversity across all humans. One example of a test of ToM is known as the Sally and Anne Test (see Figure 5.2). In this test, the child watches while a doll named Sally puts a marble in a round box and leaves the scene. While she is away, the other doll, named Anne, moves the marble to the square box sitting beside the round box. On Sally’s return, participants are asked to predict where she will look for her ball. To answer correctly, one must be able to understand what Sally’s mental state

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Defining and Identifying Autism Spectrum Disorders

?

Typically Developing Child

Child with Autism

◗ Figure 5.2  Theory of Mind: An Illustration Source: Based on Understanding autism. Geoffrey Cowley, NewsWeek July 25, 2000.

would be—namely, that since she put the ball in the round box, she would expect to find it there. Most children as young as 4 can correctly guess where Sally will look. But children with autism have a great deal of difficulty with this test. This suggests that they are not able to get inside Sally’s thinking processes. Children with autism often do poorly on tasks that depend on understanding the feelings or thinking processes of others. We can look at the formal definitions for ASD to better understand the ways that students may be affected by their neurological differences.

5-3  Defining and Identifying Autism Spectrum Disorders Autism spectrum disorder is an umbrella term that refers to a collection of related neurological differences that affect a child’s social development, their ability to communicate, and their range of behaviors/interests. These differences also often include unusual behavioral manifestations such as repetitive motor movements called stereotypic behaviors or self-stimulation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013) has established the following diagnostic criteria for ASD: A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive): 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

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Chapter 5  |  Children and Youth with Autism Spectrum Disorders 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. B. R  estricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive): 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns, or verbal and nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest). 4. Hyper- or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life). D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently cooccur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Maskot/Maskot/Getty Images

Think about Mike Dolan and how the DSM-5 diagnostic criteria, given above, apply to his identification with ASD. Mike has difficulty with both social and communication skills; when he speaks, he often uses echolalia, repeating the last phase heard during “conversations,” and he requires that all his bedroom blinds be set at the same precise level before will go to sleep. Mike is only 2 and yet his need for a predictable routine and his difficulty with many sensory stimulations and especially with textures (e.g., the tags in clothing, tightness of seatbelts, seeds in strawberries, stickiness of peanut butter) are already creating difficulties with daily activities (Autism Speaks, 2021).

Neurodiversity means differences not deficits!

5-3a  Subtypes of ASD In addition to what is sometimes called “classic autism,” other subtypes are included in the category of ASD. These are Rett syndrome, pervasive developmental disorders–not otherwise specified (PDD–NOS), Asperger’s syndrome (observable in high-functioning

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Defining and Identifying Autism Spectrum Disorders children with autism-like symptoms), and childhood disintegrative disorders, which cause children to regress in their development (such as in a child who once had speech but is no longer using verbal communication). Individuals within these subtypes all meet the criteria, above, for ASD, but each group has some unique features discussed below. Rett syndrome is a progressive neurological disorder in which individuals reveal a loss of muscle functions, hand flapping (e.g., stereotypical behavior), and difficulty with communication and socialization. Symptoms appear in children 6 to 18 months old, and this is the only form of autism that primarily effects girls (more on this later). Pervasive developmental disorder–not otherwise specified (PDD–NOS) refers to a group of disorders characterized by delays in the development of socialization and communication skills. Individuals with PDD–NOS usually have some but not all of the full characteristics of autism and, as a result, may not be diagnosed until later on in childhood. Asperger’s syndrome (AS) has gained much public interest over the past few years due to increased interest in the general condition of autism and to its increased prevalence. Named in 1944 for Viennese physician Hans Asperger, this autism spectrum disorder is characterized by an observable developmental imbalance. On one hand, children with Asperger’s are generally of average or superior intelligence; however they can also be years behind in their social development. In addition, students with AS may have a preoccupation with certain subjects almost to the exclusion of other subjects (e.g., the solar system or computers) and can become experts in a narrow field that focuses on “things.” The difficulties faced by individuals with AS are most often seen with relationships and people. They may also show stereotypical behaviors, such as repetitive hand motions and various rituals like insisting that the objects on a shelf always be in the same place and in the same order. In addition, awkwardness in motor skills is often a part of Asperger’s syndrome.

5-3b  Levels of Support for Individuals with ASD Understanding the strengths and challenges of individuals with ASD is critical to determining the levels and types of support needed to help each student to succeed. The DSM-5 has established three levels of impact that reflect the intensity of supports required for success. Table 5.1 shares the levels of support needed and describes the social/communication and restrictive/repetitive behaviors for each level. Many of the behaviors identified in Table 5.1 are intensified when the individual is experiencing anxiety, high-stress, nervousness, or even great excitement. The emotional context must be considered as we interpret any child’s behavior, and addressing challenging behaviors must be done within a calming, non-judgmental climate of support. Understanding the impact of the emotional context is also key to supporting learning, as discussed in the information processing model (IPM) section of each chapter. With appropriate supports, individuals with ASD can be successful.

5-3c  Prevalence of Autism The prevalence of individuals with ASD has been steadily rising over the past decades from 2000 when an estimated 1 in 150 children were identified to current estimates of 1 in 54 (CDC, 2021; Maenner et al., 2020). Approximately 676,279 students with ASD are currently served in pre-K–12 grades (U.S. Department of Education, 2021). This rise in prevalence does not mean that a major epidemic of autism is striking the country. It is likely due to more accurate diagnosis of ASD and to the inclusion of children with high-functioning autism and/or Asperger’s syndrome in the numbers.

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Table 5.1  Levels of Support for Success of Students with ASD Support Needed

Social/Communication

Restricted/Repetitive Behaviors

Level I: Support

Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.

Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

Level II: Substantial Support

Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and who has markedly odd nonverbal communication.

Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.

Level III: Very Substantial Support

Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when they do, makes unusual approaches to meet needs only and responds to only very direct social approaches.

Inflexibility of behavior, extreme difficulty coping with change, or other restricted/ repetitive behaviors markedly interfere with functioning in all spheres. Great distress/ difficulty changing focus or action.

Source: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. Retrieved from https://www.autismspeaks.org /autism-diagnosis-criteria-dsm-5

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One of the puzzling aspects of ASD is the disparity in the gender and ethnic distribution of students. It is reasonably well established that there are four or five boys diagnosed with ASD for every one girl (CDC, 2020). The exception to this pattern of boys over girls is Rhett syndrome, which primarily affects girls. These distributional differences, according to gender, speak powerfully for the involvement of a genetic factor in ASD. But there is another difference in prevalence that seems to be more related to environmental factors. A recent study of prevalence in eleven states found no differences in identification patterns for Black and White 8-year-old students; however, Hispanic students were less likely to be identified by age 8 (Maenner et al., 2020). While this is encouraging, equitable identification of students with ASD remains problematic. Earlier studies by Mandell and colleagues (2007) found that Black children were 2.6 times less likely to receive an autism diagnosis than were White children and were more likely to be diagnosed as having a conduct disorder or an attention disorder; only after several reviews of their needs were they correctly identified with autism. Black children are also identified much later in the developmental sequence, having their first evaluation after age 3, and not getting the early intervention treatments that are so effective in mitigating the impacts of ASD (Maenner et al., 2020). When underrepresented students are not correctly Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Defining and Identifying Autism Spectrum Disorders identified and when critical interventions and services are delayed, the outcomes for students are undermined (Travers & Krezmien, 2018. Travers and Krezmien (2018) point out three implications stemming from under-identification of some underrepresented students for ASD: students who are not identified likely do not get access to needed supports and services; when resources are directed to White students, fewer resources are available to serve underrepresented students and in resource-limited environments this further discourages identification; and underidentification may have cultural or racial implications with behaviors and characteristics associated with autism being inaccurately attributed to racial, cultural, or linguistic differences—in other words, implicit bias. In Chapter 1 we discussed the impact that implicit bias can have on the overrepresentation of Black/African American, Indigenous, and Latino students within many categories of disabilities (e.g., ID, emotional/behavioral disorders); with ASD these biases seem to have the opposite effect, preventing some educators and diagnosticians from accurately recognizing the early signs of autism in children of color. Early and accurate identification of ASD is critical to successful interventions, and we must take a long and serious look at the role that implicit bias can play in undermining this process for Black, Latino, and Indigenous students. Dr. Jennifer Neitzel, director of the Educational Equity Institute, discusses the importance of early identification in the Ask the Experts Box 5.2.

Educational Equity Institute www.educationalequity institute.com

Ask the Experts:

Supporting Families in Accessing Early Intervention for Young Children with ASD

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Box 5.2

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Dr. Jen Neitzel, Executive Director, Educational Equity Institute Despite efforts to increase early identification of autism spectrum disorder (ASD), most young children do not receive a formal diagnosis until four to

five years of age. Over the last decade or so, a wealth of research has emerged demonstrating the stability of an ASD diagnosis when a child is two years old. Early identification of ASD is critically important because the sooner children start receiving early intervention services, the better the outcomes. Currently, there a few issues that are hindering efforts to increase early identification and intervention. First, research suggests that many parents of young children with ASD have concerns about their learning and development by 18 months of age; however, these concerns are often overlooked by pediatricians. An additional concern is the ongoing racial disparities in identification. That is, Black children and other children of color are consistently under-identified for ASD (Travers & Krezmien, 2018). As practitioners in the field, it is essential that we understand these ongoing issues and listen to and support families who have concerns about their children’s learning and development. Authentic family engagement that is built on respect, trust, and a shared humanity is critical to early identification and intervention. Removing the power dynamic between parents and professionals while also understanding culturally responsive family engagement practices is the first step in responding to parents’ concerns about their young children.

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Chapter 5  |  Children and Youth with Autism Spectrum Disorders

Box 5.2

Ask the Experts:

Supporting Families in Accessing Early Intervention for Young Children with ASD  (Continued)

However, this approach should not be limited just to early childhood professionals. Pediatricians and other healthcare providers who are responsible for diagnosing young children must shift their mindsets about how they approach parents who have very real concerns about their children. Healthcare professionals must remove the power dynamic in the relationship and begin to view parents as the experts on their children, instead of the other way around. Beginning to address implicit racial biases within healthcare is another important step. A recent study was conducted with college students who were given vignettes of students with conduct disorder (CD) and ASD, along with photos of Black and White children, and asked to sort the photos according to the likely diagnosis. White students were more likely to diagnose White children with ASD and Black children with CD, while the reverse was true for Black students (Obeid et al., 2021). These findings show the presence of implicit bias within the general population and point to the need to address how healthcare providers approach families of color and how they respond to their concerns about their children. A key task for all professionals, both early childhood and healthcare, is to support parents of young children who are concerned that their child may have ASD. Key strategies include:

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Urging families to become experts on ASD, their child, and effective intervention approaches Providing families with information about special education laws, including their rights and services available to them Helping families develop strategies for communicating clearly about ASD, their child, and their concerns so that they can be proactive, rather than reactive during appointments with other professionals Connecting families with local parent advocacy organizations, such as Autism Society and Autism Speaks

Early childhood professionals play a key role in helping families develop advocacy skills that can be used to not only acquire an initial diagnosis, but also access high-quality early intervention services now and in the future.

Reflection: ●

What are some of the long-term consequences of implicit biases that may lead to the under-identification of Black children with ASD? Thinking back on the advice from the experts in Chapters 1, 2, and 3, how can we combat the impact of implicit bias and systemic racism within our educational programming?

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5-3d  The Importance of Early Identification of Children with ASD As noted by our expert, Dr. Neitzel in Box 5.2, early identification of children with autism is one of the key elements of treatment. The development of language and social skills is critical from ages 18 months to 3 years. These skills, in addition to imitation of motor behaviors and using eye gaze to communicate, need to be fostered during this time. If we wait for the child’s autism to be discovered in kindergarten, we have lost valuable treatment time. While early intervention is optimal, progress can be made with appropriate interventions across the lifecoudes of the student. Fortunately, a number of studies have shown that diagnosticians have the ability to correctly identify children with autism at age 2 or earlier (Boyd et al., 2010; Zwaigenbaum, 2013). This ability affords an early opportunity to begin therapy in language functioning and improvements in peer relationships. It is important for parents and pediatricians to know how to access early intervention supports and services within their communities.

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Pediatricians generally use basic screening tests to identify children who may require further evaluation. Children with ASD have difficulty with pretend play (e.g., pretending to drink from a teacup), imitating adult behavior (e.g., tapping on the table), and pointing at objects on request (e.g., pointing at the dog). These difficulties are often due to weaknesses with symbolic thinking, joint attention, and nonverbal communication. In addition, pediatricians may note repetitive motor movements that have no context. If these things are noticed, it may be a sign that more comprehensive evaluation is needed. The American Academy of Pediatrics recommends that all children be screened for ASD at their 18- and 24-month well-child visits (HealthyChildren.org, 2019). The Modified-Checklist for Autism in Toddlers (M-CHAT-R), a screening tool with twenty questions for parents, can be used to identify children as young as 16 months who may be at risk for autism (Whitney et al., 2019). Early identification sets the stage for early interventions (see Chapter 3).

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Genetic and Environmental Causes of ASD

Pediatricians can play a critical role in identifying young children with ASD and listing to parent’s concerns is critical.

5-4  Genetic and Environmental Causes of ASD As discussed in earlier chapters, an intertwining of genetics and environment are involved in most areas of exceptionalities, and this is true for ASD as well.

5-4a  Genetics and ASD The genetic search for the causes of ASD has shown remarkable progress in recent years and a complex collection of genes combined with environmental interactions appear to be implicated. One line of evidence for a genetic cause for ASD lies in the observation that autism appears to run in families and that monozygotic twins (with an identical genetic makeup) are much more likely to both have autism than dizygotic twins (where the genetic makeup of the twins is different). It can be difficult to explore genetics because large samples are needed to have confidence in any findings. The SPARK (Simons Powering Autism Research) initiative is working to solve this problem by building a research base of individuals with ASD and their families. The project has thirty-one collaborating research sites, and currently over 27,000 families are enrolled (the project is hoping to eventually have 50,000 participating families). Investigators are collecting histories from these families and seeking the genetic factors that separate the family members with ASD from their relatives. This collection of families promises to be a rich supply of continuing data for the immediate future. Here is how SPARK discusses the possible genetic contribution to ASD:

Simons Powering Autism Research https:// sparkforautism.org/

Different types of genetic changes can contribute to autism. In some cases, genetic changes are passed down (inherited) from parents to their children. In other cases, a random change takes place in the sperm or egg because the process of copying DNA is not perfect. This change to the genetic code is considered a “de novo” (new) change. Studying genes can help us find changes linked to autism no matter when they take place. Based on what we know today about genes that are linked to autism, SPARK scientists expect to find a genetic difference linked to autism in as many as 10% of people in the study. (SPARK, 2021)

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Chapter 5  |  Children and Youth with Autism Spectrum Disorders Stay tuned because the important findings from the SPARK studies continue to emerge! Identifying the genetic causes of autism can help us find potential treatments as well as preventive measures for other issues that are common within subtypes of autism, like digestive issues and seizures.

5-4b  Mistaken Causes of Autism With the advance of more sophisticated diagnostic tools, several previously held ideas about the causes of ASD have been abandoned. One of these was that the mother’s coldness or lack of emotional feelings for the child had resulted in the child’s social distancing. An unfortunate term, “refrigerator mother,” had been used to describe this situation (Bettelheim, 1978). Not only was this insulting to mothers who were already stressed, but it was also totally incorrect. Another discredited theory is that thimerosal, one of the ingredients in vaccinations, might have some side effect causing the ASD. This idea has been widely circulated in the public press and has resulted in some parents fearing to get vaccinations for their child. The paper, by Andrew Wakefield, that triggered these concerns was redacted in 2010 by the Lancet (the British medical journal that published the original paper) because, “…Britain’s General Medical Council ruled [that] the children that Wakefield studied were carefully selected and some of Wakefield’s research was funded by lawyers acting for parents who were involved in lawsuits against vaccine manufacturers. The council found Wakefield had acted unethically and had shown ‘callous disregard’ for the children in his study, upon whom invasive tests were performed” (Eggerston, 2010). Thimerosal as a possible cause of ASD has now been studied extensively by scientific panels and found to be without merit (Taylor et al., 2002). Nevertheless, such ideas die hard, and parents may not heed the advice of their pediatrician that going without protection from childhood diseases is far riskier than vaccination. The pain and confusion caused by these discredited ideas underline the importance of scientific studies to keep the public informed.

5-4c  Neurology and Brain Development: Recent Findings Related to ASD ASD is considered to be a neurodevelopmental disorder and as such it often occurs with other disorders that result from differences in the brain’s structure or function. When two disorders co-exist, the term used is comorbidity. Thirtythree percent of students identified with ASD were also classified as having intellectual disabilities (discussed in Chapter 4) (Maenner et al., 2020). Other common neurological comorbidities with ASD include motor impairments, sleep disorders, and epilepsy (Jeste, 2011). Motor impairments can include both gross and fine motor delays and deficits, which may also affect other cognitive and behavioral domains. Sleep disorders occur in 83 percent of children with ASD, and up to a third of child with ASD also have epilepsy (Jeste, 2011). Epilepsy and sleep disorders can be treated, and doing so may significantly improve outcomes for individuals with ASD. Findings from a recent study looking at early brain development suggest that disruptions occurring very early on when the cerebral cortex is beginning to organize may have implications for individuals with ASD (Nakagawa et al., 2019). In this study researchers found that mutations in the gene, Memo1, which is needed to organize brain cells as the brain is developing, seem to create disorganizations of the cerebral cortex. In humans, the cerebral cortex is responsible for speech, long-term memory, consciousness, and perception,

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The Information Processing Model all of which have implications for individuals with ASD. Understanding the brain differences across human development will eventually help us establish better therapeutic interventions.

In each chapter we use the information processing model (IMP) to describe the impacts that strengths and challenges can have on learning. We may think of learning as primarily academic; however, social skills are also learned and social learning is an area where students with ASD often need more support. Figure 5.3 provides a portrait of the various elements of information processing that are likely to be affected in children with ASD. In this case we will start with the sensory or receptive abilities, input, which help to moderate incoming experiences.

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5-5  The Information Processing Model

Children with ASD may show little emotion when engaging with others.

5-5a  Input: Hyper- and Hyposensitivity to Sensory Stimuli With ASD, each of the modes for sensory input can be either a strength or a challenge depending on the specific pattern for the individual student. Having an atypical response to sensory stimulation, however, is one of the characteristics of ASD.

Emotional Context

Thinking

Response

Memory Classification Association Reasoning Evaluation

Speaking Writing Motor Response Social Interaction

Processing

Stimulus

Vision Hearing Kinesthetic Haptic Gustatory Olfactory

Information Input

Attention

Information Output

Executive Function

key Challenges Strengths

◗ Figure 5.3  Information Processing Model for Children with Autism Spectrum Disorder TeachSource Digital Download   Access online

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Chapter 5  |  Children and Youth with Autism Spectrum Disorders Responses to stimulation can take two, opposite forms: hyper- and hyposensitivity. One form of hypersensitivity can be to noises in the environment, and sounds may seem to come through with terrifying impact. The following quote from Temple Grandin, an adult with autism, illustrates this: Loud, sudden noises still startle me. My reaction to them is more intense than other people’s. I still hate balloons, because I never know when one will pop and make me jump. Sustained high-pitched motor noises, such as hair dryers and bathroom vent fans, still bother me, lower frequency motor noises do not. (Cowley, 2000, p. 53) In addition to sound sensitivity, hypersensitivity to stimuli can extend to touch or tactile input. Some children with autism are hypersensitive to specific textures of things; at its extreme this is known as tactile defensiveness. Examples of tactile defensiveness include sensitivity to tags in clothing, seams in socks, scratchy woolen sweaters, or too tight pants. This can make dressing a toddler challenging! Other indications of tactile defensives may include a dislike of certain foods because of their texture (e.g., sticky, chunky, seedy). And some children with a hypersensitivity to touch will shy away from relatives hugging them or from being touched by others. Hypersensitivity can impact other sensory systems as well: visual (avoiding visual stimulation), oral (excessive chewing or mouthing of objects), and olfactory (sensitivity to smells). While hypersensitivity is common for individuals with ASD, hyposensitivity may also be present. When individuals have hyposensitivity, their reactions to sensory input are dampened or muted; they have the opposite reaction to those shared above. In the case of hyposensitivities, individuals may not react to loud sounds, visual stimulation, or touch. In either case, hyper- or hyposensitivity can easily be misinterpreted and can compound the social difficulties children with ASD often face.

5-5b  Central Processing: Thinking Because the patterns of strengths and challenges for students identified with ASD are so varied, it is difficult to depict these with any single model. In this case, we have identified the most likely areas of impact and seen within the information processing model, many individuals with ASD have trouble with important thinking skills reflected in the executive function, and the more complex mental processes of reasoning, transforming, and evaluation. However, the memory and classification areas seem less involved, and with Asperger’s syndrome these can be areas of strength.

5-5c  Output: Response Mode Children on the autism spectrum also have difficulty with a range of motor skills such as gross motor skills (e.g., running and jumping), fine motor skills, and motor planning (e.g., moving one’s body in space). Although children with ASD may meet motor milestones on time, their movements may appear stiff or awkward. Some students with ASD, however, show a remarkable strength in drawing pictures or with building complex structures out of Legos or blocks. The key thing is to identify the unique patterns of strengths and challenges for each student and to use this information to help you plan to support their success.

5-5d  Emotional Context: The Climate of the Classroom The emotional climate for learning is critical to optimizing student’s success. If the learning environment is stressful, anxiety provoking, or in complete disarray, it is difficult for most students to function at their best and students will cope as well

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The Information Processing Model

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as they can. Everyone responds to high-stress differently. Think about how you respond to extreme stress. Do you “shut-down” drawing into yourself for comfort? Do you see others to talk with? Do you focus on something else to distract you from the situation? Do you become flustered and upset and perhaps lash out? Do you eat ice cream or other comfort foods? Do you go for a run or use other physical releases to find balance? For many students with ASD who crave quiet, orderly, predictable environments, even the typical classroom can feel overwhelming and chaotic. Their coping behaviors, while seemingly different and perhaps more extreme, are actually fairly similar to most people’s. Students with ASD may withdraw, even to the extent of hiding under a desk; they may have a meltdown or a tantrum, lashing out in their frustration; they may focus on manipulating an object to the exclusion of all other stimuli; or they may use repetitive physical movement (e.g., rocking, hand motions) to sooth themselves and help them calm down. When students with ASD use any of the behaviors above, they are coping with their stress. The use of repetitive physical movement, unless they are hurting themselves or others, should be treated as an acceptable way to release tension and self-regulate (it is like taking a short run to decompress). Remember that many students with ASD find verbal communication challenging, and this can exacerbate their reactions to stress because it is difficult for them to tell people how they feel and what they need. We can support coping in a variety of ways. First, we can work to create a calmer emotional tone within our classrooms (see the Mindfulness Matters discussions in Chapters 2, 3, and 4). We can also designate a “safe space,” creating a place that functions as the “eye of the storm” where students can retreat if they need to regroup (e.g., a quiet corner, a nook, or a pass to the library). By thinking creatively about what our students need to thrive, we can structure our classrooms to better meet their needs. More strategies for supporting learning will be discussed in the next section on educational responses. As we review the puzzling behavior of Mike Dolan noted earlier in this chapter, we need to consider what is happening in his information processing system. As shown in Figure 5.3, he seems to have challenges with executive function. He has difficulty focusing attention, is unable to organize his thinking to address problems, and has difficulty communicating his needs with words. It is also important to note what functions well in his information processing system. Mike has no problem hearing or seeing, and his memory for the things he likes or wants (“Where are the cookies and milk?”) is excellent. His motor skills appear typical, if somewhat uncoordinated. We can focus on his strengths as a foundation for instructional planning. Although there are great individual differences in youngsters with an ASD diagnosis, the challenges described here are found at the heart of many of their difficulties with learning. A major focus of special education supports and services should address supporting emotional regulation, focusing attention, and enhancing communication skills in children with ASD. While ASD is generally accepted to be a part of an individual’s neurological makeup across their lifecourse, the language and social challenges faced by children with ASD can improve with educational and therapeutic interventions. Sustained support for children with ASD is essential to help them When these interventions include attention to the develop skills needs for success. student’s strengths they can be even more effective (see Box 5.3).

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Chapter 5  |  Children and Youth with Autism Spectrum Disorders

Box 5.3

ASD:

Remember Our Super Powers!!!

Neurodiversity means our brains are different not that we have deficits, we are really good at a lot of things…here are some of our super powers: ● ● ● ● ● ● ●

I am honest, I tell the truth. I am loyal. I like to know why things happen and will investigate things I am interested in. I am really good at puzzles and math!! I love computers and can probably help you with yours if you need me too. I draw really cool 3D pictures and can turn them into stuff with my 3D printer. Animals really love me.

5-6  Educational Responses for Students with Autism Spectrum Disorders The majority of students, around 91 percent, with ASD will spend at least some of their time learning within the general classroom. Figure 5.4 shares the breakdown of the educational settings where students with ASD are served: less than 1 percent are served within correctional facilities, homebound, or hospital settings; approximately 33 percent spend less than 40 percent of their time within the general classroom; while 18 percent spend between 40 and 79 percent of their time there. Close to 40 percent of all students with ASD are primarily served within the general classroom for 80 percent of their time or more. Other settings where students with ASD are served include parental placement in private schools (1 percent), residential schools (less than 1 percent), and separate schools (6 percent). Schools provide a range of supports and services to help students with ASD thrive, and these are organized across general and special education programs.

1% 7%

More than 80% of the day in a regular classroom Inside regular classroom 40–79% of the day

33%

40%

Inside regular classroom less than 40% of the day Separate School Other

18%

◗ Figure 5.4  Educational Settings for Children with ASD Source: Data Accountability Center. (2011). Part B Educational Environments 2011 [data file]. Retrieved from http://www.ideadata.org/PartBEnvironments.asp

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Educational Responses for Students with Autism Spectrum Disorders

5-6a  Organizational Structures to Support Students with ASD One of the themes of this text is that education is a team game. In other words, no individual teacher should be expected to meet the needs of students alone. This is especially true in cases involving children with ASD, because the patterns of students’ strengths and challenges can be so varied. To address the needs of students with ASD it takes a team of multidisciplinary personnel working together from diagnosis to interventions and educational supports and services. Because students with ASD are served across educational settings, coordination among programs is essential. In earlier chapters we have discussed the use of multi-tiered services to facilitate the coordination between general and special education across three tiers. We looked at academic services and at services that support social and behavioral success (positive behavioral interventions and supports). While these were discussed separately, they are actually both part of the MTSS (multi-tiered systems of support) approach. For students to thrive we must provide both academic and social/emotional/behavioral supports. Academic learning and social/emotional well-being are intricately intertwined and no group of students illustrates this as poignantly as students with ASD. So, in this discussion we will weave the two sides of this coin (i.e., academic and social/emotion supports) into the single framework of MTSS.

MTSS Approaches for Students with ASD The range and the intensity of ASD in individual children make it likely that all three tiers of support will be needed to help students succeed.

Tier I: Universal Support for Students with ASD As we have noted before, Tier I is not merely the general education class without any additions. The general education teacher works with the special education teacher to plan for their students’ academic and social/emotional needs. Universal Design for Learning (UDL) strategies can help with the academic learning by capitalizing on the student’s strengths. For example, if the child has a strong visual memory, information can be presented using charts, graphics, and pictures as well as with words. The class schedule can be depicted with pictures, and expectations for behaviors in the class can also be reinforced with infographics. These visual supports will likely help other students as well. Lessons can also be designed around students’ interests; remember that many students with the Asperger’s syndrome have very strong and intense interest areas (e.g., marine biology, astronomy, computer science). A number of skills can be taught or reinforced while students are focused on learning within their area of interest. For example, students can learn and practice the writing process as they draft reports, design infographics, or develop news stories highlighting their topical expertise. Tier I, the general classroom, is also a wonderful place to support social development for students with ASD. Structuring the room so that it is organized and expectations for student behavior are clearly and explicitly shared is a place to start. Carefully pairing students for mutual support can allow students with ASD to practice social skills such as turn taking during conversations. Some social skills may need to be explicitly taught in Tier II before they are practiced in Tier I (see Box 5.4).

Tier II: Targeted Support for Students with ASD Greenspan and Wieder (2006) make an important observation about teaching to the strengths of the child. The key point is that the treatment has to be based on the top of the range of a child’s skillset. If the child can walk sometimes, then he can walk. If the child can relate with others sometimes, then she can relate, and

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Box 5.4

High Leverage Practices:

High Leverage Practice 9: Teach Social Behaviors.

Teachers should explicitly teach appropriate interpersonal skills, including communication, and selfmanagement, aligning lessons with classroom and school-wide expectations for student behavior. Prior to teaching, teachers should determine the nature of the social skills challenge and should target social

High Leverage Practice in Special Education https:// highleveragepractices.org/

skills instruction accordingly, teaching and reteaching as needed to promote mastery.

Reflection: ●

How is teaching social skills similar to teaching other academic skills?

we can help her relate more often (p. 25). So, when we say that children with ASD have difficulties in creating social relationships, it does not mean that the ability to do so is totally absent. It means that we have to support and nurture these skills (the same is true of motor skills or language). Tier II targeted interventions are designed to explicitly teach and reinforce skills that are needed. Academic skills will likely need to be explicitly taught using direct instruction, modeling, prompting, and reinforcement. Several evidence-based practices are presented later in this section and these can form the base for planning targeted interventions. Most students learn social skills by observation and/or incidental learning (i.e., learning that occurs but is not explicitly taught), but students with ASD often need to be directly taught many social skills like turn taking for reciprocal conversations, making eye contact with a speaker, or appropriate ways for greeting and departing. Learning these skills can go a long way to smoothing out social interactions for students with ASD. When the academic or social challenges of the student are more intense, or when the comorbidities (i.e., other issues that exist along with the ASD) make the needs of the student more complex, more intense supports are likely needed; these can be provided within Tier III.

Tier III: Intensive for Students with ASD High Leverage Practice in Special Education https:// highleveragepractices.org/

Box 5.5

Tier III offers the student individualized supports that are often time-intensive. These supports are generally designed and implemented by a special education teacher, and they may be offered within a small-group or individual setting (see Box 5.5). Academic and social skills taught within Tier III generally align with the long-term goals of the student’s IEP.

High Leverage Practices:

High Leverage Practice 20: Provide Intensive Instruction.

Teachers match the intensity of instruction to the intensity of the student’s learning and behavioral challenges. Intensive instruction involves focusing on high-priority, clearly defined skills or concepts that are critical to academic or behavioral success. With intensive instruction students have many

opportunities to respond and receive immediate, corrective feedback.

Reflection: ●

What aspects of intensive instruction make this approach a good fit for students with ASD?

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Educational Responses for Students with Autism Spectrum Disorders Several approaches to intensive supports for students with ASD have been developed into programs, or models, which are widely used (see Box 5.6).

5-6b  Comprehensive Treatment Models for Students with ASD Several broad-based approaches to working with ASD have been developed by researchers and practitioners at major universities. These programs are often called comprehensive treatment models (CTMs) because they encompass a range of strategies aimed at addressing the major features of ASD (Odom, Boyd et al., 2010). A few of the most well-known models are described below.

UCLA Young Autism Project This program uses the principles of applied behavior analysis (ABA) or operant conditioning to directly provide positive rewards for appropriate behavior. In this way, the child learns to pay attention to adults, to imitate, and to use language for social purposes. This one-on-one interaction, with trained students or parents, is often an intensive and painstaking process. Lovaas, the original director of the UCLA Center on Autism, contends that 40 hours a week should be spent on working directly with children with ASD to ensure that they can be ready for first grade with typically developing children. The approach requires teaching many discrete skills, which are then chained into functional routines.

Box 5.6

Reaching & Teaching:

Teaching Children with ASD Online

By Jennifer G. Job, Ph.D. When the coronavirus pandemic pushed students into virtual learning, it was especially difficult for students with ASD who thrive on routine and consistency. The Autism Training and Technical Assistance Project provides strategies for working with children with ASD virtually. Here are some to work with:



Use concrete language and terms as much as possible. One significant difference between online instruction and in-person teaching is the lack of context available. Children with ASD often have difficulty understanding abstract phrasing and without students around them and a consistent classroom setting, that difficulty is compounded. So be sure to use specific, detailed language, especially when describing assignments. Provide multiple means of participation in class and completion of assignments. In stressful situations, including having to transfer from in-person instruction to virtual, children with ASD often regress in verbal ability and communicate through other expressions. Give students digital pictures that they can submit during online instruction to express their







emotions, and allow students to use multiple modes, such as videotaping, writing, and drawing, to answer assignments. Establish a daily schedule and routines your class can count on. Students with ASD thrive on routine, but when schools were closed for the coronavirus pandemic, daily schedules went out the window. Whether you are teaching asynchronously or synchronously online, have a specific schedule that is printed and easy for students to access, and try to keep it the same daily. Give students advance warning when you are going to switch tasks (e.g., if you are about to end an online direct instruction period and move to individual practice). Support behavior online. Provide positive reinforcement when children are exhibiting appropriate behavior, such as keeping their attention on the screen or answering questions. Provide visual rule cards that depict the behavior you want to see. And model coping skills and self-talk that you want to see from the students. Reinforce good behavior with rewards, even from a distance, e.g., extra breaks or outdoor periods.

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UCLA Young Autism Project www.semel.ucla.edu/autism

The applied behavior analysis (ABA) approach that has been a central part of the Lovaas method has been utilized by many others in the field who have adopted it and established treatment programs of their own. The ABA approach is based upon the behavioral model of B.F. Skinner (from 1938), which presents the antecedent-behavior-consequences sequence. Once the behavior to be changed is identified (e.g., Bob putting his materials away), the teacher can try to modify the antecedents through prompting (e.g., handing the books to Bob) and introducing differential reinforcement (e.g., praising Bob for doing a good job or withholding praise if he performs poorly). Although it is widely used, applied behavior analysis is not without controversy. Some adults and teens with ASD feel that the highly structured and demanding approach to changing behaviors (e.g., repetitive motor movements) can create more anxiety and lead to an increase in rigidity if therapists try to adhere to a prescribed program without first working to connect with the individual (Child Mind, 2021).

TEACCH—University of North Carolina at Chapel Hill

TEACCH University of NC at Chapel Hill ww.teacch.com

LEAP—University of Denver This program, at its base, attempts to improve the social behavior of children with autism. The curriculum emphasizes independent play and social interaction in naturally occurring routines. Social skills are taught as discrete skills such as “play initiation.” Applying the program in an integrative setting with typically developing children allows opportunities for practicing social skills. LEAP has used peer-mediation skills intervention, training typically developing peers to enhance social interaction with children with ASD. DON CAMPBELL/The Herald-Palladium/ASSOCIATED PRESS

LEAP, University of Denver https://morgridge.du.edu /pele-center/leap/

TEACCH is a statewide program in North Carolina with seven regional centers where intensive work is done with parents to help them become teachers of their own child with autism. Pictures and other visual symbols are used extensively to help communicate with the child. The communication curriculum is based on behavioral principles but is applied in more naturalistic settings (e.g., home, child care centers, classrooms). TEACCH has also developed an extensive curriculum that includes domestic skills, such as cleaning, cooking, and putting things away, and independent living skills, such as using calendars, hygiene, handling money, and so on. TEACCH includes parental counseling to help parents cope with daily stressors and with concerns about what their child is going to do in adulthood and how they can support them on this path. Individual counseling for children and youth with high-functioning ASD is also available.

Social skills are an important component of the program for children with ASD.

Pivotal Response Model—University of California at Santa Barbara This program often starts with discrete trial behavior analysis, similar to the UCLA model, but then moves on to a goal of social and educational proficiency in natural settings. The goal is to achieve change in pivotal areas that have broad generalizations. The emphasis is placed on self-management, motivation, self-initiation, and other abilities that can be transferred from one situation to another. There is also a specific curricula with an emphasis on parental involvement.

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Educational Responses for Students with Autism Spectrum Disorders These four comprehensive approaches are only some of the widening professional efforts to support students with ASD and their families. These initiatives are encouraging because of the reports of successful gains in each (Odom, Rogers, McDougle, Hume, & McGee, 2007). These comprehensive programs stress the differences between their programs and others providing similar services, but we should also consider their similarities. In a typical preschool program, all children face the daily greeting of teacher and peers, a morning snack, reinforcement of the classroom rules, a lunch break (a fine time for natural lessons of conversation and social skills), nap time, and leaving for the day. These events are roughly similar from one program to another, even with the differences in therapeutic approaches noted by their program leaders. This may be one reason they all report favorable outcomes with little to distinguish them from one another.

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Pivotal Response Treatment, UC-Santa Barbara https:// education.ucsb.edu/autism /pivotal-response-treatment

5-6c  Curriculum and Instruction for Students with ASD Most states have a set of content standards that identify the knowledge and skills required for students in English and mathematics at each grade level. These standards are designed for students in general and as such they are meant to be a “one-size-fitsall,” for students in each grade level, but similarly to clothes that make this same claim, one-size does not really fit everyone! Earlier we quoted Dr. Stephen Shore who said, “If you’ve met one person with autism, you’ve met one person with autism” (Autism Speaks, 2021). Remembering this is pretty important as we think about the kinds of supports and services each student will need to be successful. What we are aiming to do is create a “one-size-fits-each” approach that tailors our supports and services to the specific strengths and challenges of each student. Let’s look at how two content standards, which are representative of the kinds of standards many states have adopted, will impact students with ASD. The two standards chosen for this example reflect areas that many students with ASD may find challenging: perspective taking and social communication. The first is a writing standard for fifth grade: Write opinion pieces on topics or texts supporting two different points of view giving reasons and relevant evidence for both. Here the student is forced to take more than one perspective and address the idea that different people may have different ideas, thoughts, and beliefs. This can be challenging for many students with ASD who often see the world through a fixed lens. Teachers may have to help students with ASD understand how to take the perspective of others (e.g., Theory of Mind) to do this task. Content standards for speaking and listening, for K–2 students, are another example of possible difficulty for students who have challenges with social communication: Participate in collaborative conversations with diverse partners about grade level topics and texts with peers and adults in small or larger groups. Follow agreed upon rules for discussions (e.g., listening to others and taking turns speaking about the topics and texts under discussion). Meeting content standards like these may be difficult for students with ASD and will often require more direct/explicit instruction with additional time for acquisition, fluency, maintenance, and generalization (as discussed in Chapter 4) to master. Table 5.2 provides some additional examples of how learning content standards may need to be supported for students with ASD. Several instructional strategies have been developed to support learning for students with ASD, and many of these are now considered to be evidence-based because they have a proven track record of success.

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Table 5.2  Content Standards, Classroom Behaviors, and Evidence-Based Strategies

Sampling of Content Standards Ask and answer questions to seek help, obtain information, or clarify something that is not understood. K.3 Speaking and Listening Describe how characters in a story respond to major events and challenges. 2.3 Reading Literature Write narratives to develop real or imagined experiences or events using effective technique, descriptive details, and clear event sequences.

Classroom Behaviors for Students with ASD

Evidence-Based Strategies to Support Success*

Student may not be able to initiate asking for help or clarification. May sit and do nothing. May try to escape or avoid the task.

Naturalistic Intervention (i.e., embedded support with prompts and encouragement); Peer-Mediated Instruction and Intervention (i.e., peers prompt and provide support)

Student may struggle to answer correctly in response to questions about character perspective and responses.

Social Narratives of Social Stories (i.e., descriptions of social situations)

Student may have difficulty separating fact from fantasy.

Prompting (i.e., use verbal or visual cues to engage the learner)

Comic Strip Conversations (i.e., use a visual display that simplifies characters’ responses)

Visual Supports (i.e., use pictures or diagrams to support learning)

5.3 Writing Analyze how particular lines of dialogues or incidents in a story or drama propel the actions, reveal aspects of a character, or provoke a decision.

Students have difficulty determining how dialogue or incidents in a story propel a character’s actions.

Social Narratives of Social Stories (i.e., descriptions of social situations)

Student may have great difficulty organizing writing with wellstructured event sequences and instead may focus on unimportant details.

Visual Supports (i.e., graphic organizers, infographics, idea webs, pictographs)

Comic Strip Conversations (i.e., use a visual display that simplifies characters’ responses)

8.3 Reading: Literature Write narratives to develop real or imagined experiences or events using effective technique, well-chosen details, and well-structured event sequences. 11-12.3 Writing Adapted from: Constable, S., Grossi, B., Moniz, A., & Ryan, L. (2013). Meeting the Common Core State Standards for students with autism: The challenge for educators. Teaching Exceptional Children, 45(3), 6–13. *Additional evidence-based practices will be discussed later in this chapter.

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National Clearinghouse on Autism Evidence and Practice At the FPG Child Development Center, University of North Carolina – Chapel Hill https://fpg.unc.edu/projects /national-clearinghouse -autism-evidence-and -practice

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5-6d  Evidence-Based Practices for Students with ASD Evidence-based practices (EBP) are those practices which have demonstrated efficacy through a sufficient number of high-quality, peer-reviewed journal articles with findings that have been replicated by independent research groups (Steinbrenner et al., 2020). A recent comprehensive study by the National Clearing House on Autism Evidence and Practice Review Team at the FPG Child Development Institute shares the evidence-based findings for practices used to support children, youth, and adults with ASD (Steinbrenner et al., 2020). According to Steinbrenner and colleagues, “The purpose of the current review is to identify focused intervention practices that have evidence of efficacy in promoting positive outcomes for learners with autism. . . .[so that] teachers and other service providers may select these practices when designing an individualized education or intervention program because of the evidence that they produce outcomes similar to the goals established for children and youth with autism” (p. 11). Focused intervention practices target a single skill or goal and tend to occur over a short

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period of time (i.e., until the skill is mastered or goal is reached). Examples include discrete trial teaching, visual supports, prompting, and video modeling. According to the research team, focused intervention practices can be considered the building blocks of educational programs for children and youth with autism, and they are highly salient features of the comprehensive treatment models (CTM) described earlier in the chapter; for example, peer-based intervention (Odom, 2019) is a key feature of the LEAP CTM (Strain & Bovey, 2011). Table 5.3 shares the full list of focused intervention practices identified as evidence-based by the research team (Steinbrenner et al., 2020). The practices listed in this table can be implemented in a variety of settings by teachers, therapists, and family members. The particular practices used will depend on the individual’s specific strengths and challenges and the support objectives being addressed.

Table 5.3  Evidence-Based Practices, Definitions, and Number

of Articles Across Review Periods Empirical Support 1990– 2011 (n)

2012– 2017 (n)

1990– 2017 (n)

Arrangement of events or circumstances that precede an activity or demand in order to increase the occurrence of a behavior or lead to the reduction of the challenging/interfering behaviors.

29

20

49

Augmentative and Alternative Communication (AAC)

Interventions using and/or teaching the use of a system of communication that is not verbal/vocal which can be aided (e.g., device, communication book) or unaided (e.g., sign language)

9

35

44

Behavioral Momentum Intervention (BMI)

The organization of behavior expectations in a sequence in which low probability, or more difficult, responses are embedded in a series of high probability, or less effortful, responses to increase persistence and the occurrence of the low probability responses.

8

4

12

Cognitive Behavioral/ Instructional Strategies (CBIS)

Instruction on management or control of cognitive processes that lead to changes in behavioral, social, or academic behavior.

7

43

50

Differential Reinforcement of Alternative, Incompatible, or Other Behavior (DR)

A systematic process that increases desirable behavior or the absence of an undesirable behavior by providing positive consequences for demonstration/nondemonstration of such behavior. These consequences may be provided when the learner is: (a) engaging in a specific desired behavior other than the undesirable behavior (DRA), (b) engaging in a behavior that is physically impossible to do while exhibiting the undesirable behavior (DRI), or (c) not engaging in the undesirable behavior (DRO).

27

31

58

Direct Instruction (DI)

A systematic approach to teaching using a sequenced instructional package with scripted protocols or lessons. It emphasizes teacher and student dialogue through choral and independent student responses and employs systematic and explicit error corrections to promote mastery and generalization.

2

6

8

Evidence-Based Practice

Definition

Antecedent-Based Interventions (ABI)

(Continued)

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Table 5.3  Evidence-Based Practices, Definitions, and Number of Articles Across Review Periods  (Continued) Empirical Support 1990– 2011 (n)

2012– 2017 (n)

1990– 2017 (n)

Instructional approach with massed or repeated trials with each trial consisting of the teacher’s instruction/ presentation, the child’s response, a carefully planned consequence, and a pause prior to presenting the next instruction.

16

22

38

Exercise and Movement (EXM)

Interventions that use physical exertion, specific motor skills/techniques, or mindful movement to target a variety of skills and behaviors.

6

11

17

Extinction (EXT)

The removal of reinforcing consequences of a challenging behavior in order to reduce the future occurrence of that behavior.

13

12

25

Functional Behavioral Assessment (FBA)

A systematic way of determining the underlying function or purpose of a behavior so that an effective intervention plan can be developed.

11

10

21

Functional Communication Training (FCT)

A set of practices that replace a challenging behavior that has a communication function with more appropriate and effective communication behaviors or skills.

12

19

31

Modeling (MD)

Demonstration of a desired target behavior that results in use of the behavior by the learner and that leads to the acquisition of the target behavior.

10

18

28

Music-Mediated Intervention (MMI)

Intervention that incorporates songs, melodic intonation, and/or rhythm to support learning or performance of skills/behaviors. It includes music therapy, as well as other interventions that incorporate music to address target skills.

3

4

7

Naturalistic Intervention (NI)

A collection of techniques and strategies that are embedded in typical activities and/or routines in which the learner participates to naturally promote, support, and encourage target skills/behaviors.

26

49

75

Parent-Implemented Intervention (PII)

Parent delivery of an intervention to their child that promotes their social communication or other skills or decreases their challenging behavior.

13

42

55

Peer-Based Instruction and Intervention (PBII)

Intervention in which peers directly promote autistic children’s social interactions and/or other individual learning goals, or the teacher/other adult organizes the social context (e.g. play groups, social network groups, recess) and when necessary provides support (e.g., prompts, reinforcement) to the autistic children and their peer to engage in social interactions.

19

25

44

Prompting (PP)

Verbal, gestural, or physical assistance given to learners to support them in acquiring or engaging in a targeted behavior or skill.

55

85

140

Reinforcement (R)

The application of a consequence following a learner’s use of a response or skills that increases the likelihood that the learner will use the response/skills in the future.

53

53

106

Evidence-Based Practice

Definition

Discrete Trial Training (DTT)

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Table 5.3  Evidence-Based Practices, Definitions, and Number of Articles Across Review Periods  (Continued) Empirical Support 1990– 2011 (n)

2012– 2017 (n)

1990– 2017 (n)

The introduction of a prompt, comment, or other distractors when an interfering behavior is occurring that is designed to divert the learner’s attention away from the interfering behavior and results in its reduction.

13

16

29

Self-Management (SM)

Instruction focusing on learners discriminating between appropriate and inappropriate behaviors, accurately monitoring and recording their own behaviors, and rewarding themselves for behaving appropriately.

14

12

26

Sensory Integration® (SI)

Interventions that target a person’s ability to integrate sensory information (visual, auditory, tactile, proprioceptive, and vestibular) from their body and environment in order to respond using organized and adaptive behavior.

1

2

3

Social Narratives (SN)

Interventions that describe social situations in order to highlight relevant features of a target behavior or skill and offer examples of appropriate responding.

15

6

21

Social Skills Training (SST)

Group or individual instruction designed to teach learners ways to appropriately and successfully participate in their interactions with others.

18

56

74

Task Analysis (TA)

A process in which an activity or behavior is divided into small, manageable steps in order to assess and teach the skill. Other practices, such as reinforcement, video modeling, or time delay, are often used to facilitate acquisition of the smaller steps.

9

4

13

Technology-Aided Instruction and Intervention (TAII)

Instruction or intervention in which technology is the central feature and the technology is specifically designed or employed to support the learning or performance of a behavior or skill for the learner.

10

30

40

Time Delay (TD)

A practice used to systematically fade the use of prompts during instructional activities by using a brief delay between the initial instruction and any additional instructions or prompts.

16

15

31

Video Modeling (VM)

A video-recorded demonstration of the targeted behavior or skill shown to the learner to assist learning in or engaging in a desired behavior or skill.

35

62

97

Visual Supports (VS)

A visual display that supports the learner engaging in a desired behavior or skills independent of additional prompts.

34

31

65

Evidence-Based Practice

Definition

Response Interruption/ Redirection (RIR)

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Looking at the list of evidence-based practices given in Table 5.3, it would be easy to feel overwhelmed! How can any teacher be expected to know all of these, let alone use them all in their classroom? Well the good news is that no single teacher is expected to do either of these things! Remember, it takes a team. The IEP team will have a special educator who is knowledge about the strengths and challenges of students with ASD, and the parents of the student (and the student themselves if appropriate) will work together to identify the most effective practices. Most students with ASD will also have a speech language pathologist to work on communication and social skills and an occupational therapist to support sensory integration, emotional regulation, and fine motor skills. These practices will also be implemented by the team. Some focused interventions will be the primary Parents are often critical team members in reinforcing skill development with their child. responsibility of the classroom teacher, others may be led by the special education teacher or therapist, and many will be reinforced at home by the family. The National Professional Development Center on Autism, at the FPG Child Development The National Professional Institute, University of North Carolina – Chapel Hill, has developed a series of Development Center on professional development modules to support educators and families in the Autism, at the FPG Child use of evidence-based practices. AFIRM (Autism Focused Intervention Resource Development Institute, Modules) supports the planning, using, and monitoring of each of the twentyUniversity of North Carolina – seven evidence-based practices listed in Table 5.3. You may want to visit the Chapel Hill https://autismpdc Nation Professional Development Center on Autism website and check-out this .fpg.unc.edu/ wonderful resource!

5-6e  Creating a Structured Environment Many students with ASD benefit from a predictable routine with visual supports to minimize anxiety surrounding transitions and to reduce communication demands in the learning environment. One approach to providing this support is called “structured teaching” (TEACCH, 2014). The desire for structure among children with ASD can be met by visual representations for the day ahead. Figure 5.5 shows two types of schedules that can bring structure and security to the student. In Paul’s case, he is given a sequence of tasks he needs to complete to get to morning circle time. The visual schedule is a reference he can use if he’s confused about what comes next. For other students like Jordan, a visual representation of the day provides the structure needed. Jordan has a card with a large checkmark on it, and as each event occurs, he moves the checkmark next to the action and can see what is coming next. Such scheduling can bring necessary routines to the child’s attention and allow them to live in a predictable world. Of course, it is up to the teacher to see to it that these sequences are honored in practice, or the student with ASD will be plunged into a chaotic world again. Creating a consistent physical environment around the child (everything is in the same place from one day to another) can be another source of security. A daily schedule and a consistent environment are critical for a child with autism to feel secure. Many students with ASD benefit from a predictable routine with visual supports to minimize anxiety surrounding transitions and to reduce communication demands in the environment.

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5-6f  Behavior Issues for Students with ASD

Fellers Photography/Shutterstock.com

One of the consequences of a limited ability to communicate, common among children and youth with autism, is frustration. Without the use of words, this frustration may be expressed through acting out or aggressive behavior. Such behaviors complicate the instructional program for children with autism and even result in burnout or emotional exhaustion for teachers. In many cases, the high rate of aggressive behavior exhibited by students with ASD may be linked to self-injurious behavior, repetitive behaviors, and increased levels of frustration due to social and communication weaknesses. This aggression often seems to be spontaneous and not planned. Reports of children with ASD being involved in criminal behavior or assaults often turn out to be cases of comorbidity (more than one disorder—in this case a combination of autism and emotional disturbance), where the aggression stems from the emotional disturbance rather than the autism side of the comorbidity. However, teachers and IEP teams need to be alert to aggressive behaviors so that appropriate support can be offered. Teaching students to identify their own feelings and to appropriately recognize the feeling of others can help them deal with negative emotions that may lead to inappropriate behaviors. The Mindfulness Matters in Box 5.7 shares one strategy to support students in understanding emotions. The teacher can also use social narratives (one of the evidence-based practices in Table 5.3) or stories, which involve the child and/or the teacher writing a very short story that describes a specific social situation with which the child struggles. These social stories are designed to teach the cues and behaviors for specific social situations. Dr. Carol Gray has developed over 150 Social Stories (these are copyrighted) to support social and life skills development for students with ASD. ◗ Figure 5.5  Visual Schedules to Support Students with ASD One way to support appropriate behavior for students with ASD is to help their classmates understand their strengths and challenges (see Box 5.3 earlier, Remember Our Super Powers). Teachers can use children’s literature as a starting point to help build awareness, understanding, and empathy within the class. Some books that teachers can use with their classes have been identified by the Council for Exceptional Children’s Division on Autism and Developmental Delays through the Dolly Gray Children’s Literature Award. This award recognizes authors, illustrators, and publishers that offer high-quality portrayals of individuals with developmental disabilities and ASD. The award-winning book for 2020 was Scarlet Ibis by Gill Lewis, a book that shares the story of 12-year-old Scarlet and her younger brother Red who has autism. Helping students better understand their classmates with autism was deemed so important by the When students have difficulty expressing their feelings and directors of the beloved children’s show Sesame Street needs with words, they can become frustrated and may resort to aggressive behaviors. that they developed a new character who is autistic: Julia!! Julia and Elmo become friends and like to do lots

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Box 5.7

Mindfulness Matters:

Recognizing My Feelings

A big part of mindfulness is our ability to recognize our own feelings and the feelings of others. Feelings set our inner emotional tone and our inner emotional tone permeates all that we think, say, and do. Why This Matters: Being able to recognize how we are feeling is the first step to understanding and regulating our emotions (i.e., choosing to shift our feelings toward more positive ones). Recognizing how others are feeling helps us know how to interpret and respond to their actions. We all get along better when we understand our own feelings and the feelings of other people. Practicing Mindfulness: Feeling Faces! In this activity students will identify some of the major feelings that they and others experience and will create a “Pictionary of Feeling Faces.” 1. Identify and discuss some of the major feelings/ emotions that we and others experience (e.g., happy, sad, excited, calm, joyful, angry, worried, scared). Tell a story: Have you ever felt X? When and why? Do you know someone else who has had the same feelings? Who? When? Why? (Note: Depending on the student, teachers may need to take the lead in story development.) 2. Use facial expressions, gestures, and body language to convey the feeling and “show” the emotion.

TeachSource Digital Download

Social Stories https:// carolgraysocialstories.com /social-stories/ Council for Exceptional Children Division on Autism and Developmental Delays, Dolly Gray Literature Award https://www.dollygrayaward .com/home Sesame Street and Autism http://autism.sesamestreet .org/

3. Create a Pictionary of Feeling Faces; using construction paper, make a multi-page booklet (remember that new feelings will be added as the year goes on so leave plenty of blank pages). (Note: This may be done electronically if students have access to technology and can use this as a medium.) 4. At the top of the page write the feeling word. 5. Cut-out pictures from magazines and other sources, or draw your own pictures of people who are feeling this emotion. (Note: Again may be done electronically with a search for appropriate images.) 6. Add to your Pictionary as new or more nuanced emotions (e.g., nervousness, anxiety, concern, puzzlement, surprise, exasperation, annoyance, frustration, contentment, cheerful, pleased, grateful) are identified and discussed throughout the year. 7. Use your Pictionary to discuss emotions of characters in the books you are reading, to share feelings you experience, or to write stories of your own. Pictionary books are a great way to build an understanding of how people feel and this can be used to discuss ways that we interpret and respond to the feelings of others. Feelings are important!

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of the same things…but when Elmo introduces Julia to Abby, Julia does not respond and Abby thinks that Julia does not like her. Elmo explains that sometimes Julia does things a little differently but they can all be friends; resources to help build awareness and understanding can be found on the Sesame Street and Autism website. Building awareness and understanding of older students can be done with discussions of characters portrayed on TV shows or in movies. Sheldon Cooper in The Big Bang Theory and Gil Grissom in CSI: Crime Scene Investigation may be good starting characterizations of individuals with ASD. Some people have also wondered if Sherlock Holmes, portrayed by Benedict Cumberbatch in the BBC TV series is “on the spectrum”! Helping students accept the differences of their classmates will go a long way to creating a social environment where all students can thrive. Functional behavioral assessments (discussed in Chapters 3 and 4) can be helpful for targeting, understanding, and developing appropriate behaviors. You may remember that this has been referred to as the “ABC” approach: ●  Antecedents—What preceded the student’s behavior or triggered the difficulties ●  Behavior—The

nature of the event or what the student actually did currently happens as a result of the student’s behavior

●  Consequences—What

Understanding what the behavior is communicating and helping the student shift to more positive ways of accomplishing their goals is critical to supporting their success. Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

The Role of Families and Communities in Supporting Individuals with ASD

5-6g  Assistive Technology to Support Communication for Students with ASD

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TeachSource Video Connection

The importance of supporting communication for students with ASD is universally agreed upon. At the extreme end of communication challenges are students who are nonverbal (some estimates indicate that as many as 40% of students with ASD are nonverbal). When language is not used, we need to give students other ways to communicate this is often called Augmentative and Alternative Communication (AAC). According to the American Speech-LanguageHearing Associations (ASHA, 2021), AAC includes any form of sharing feelings or ideas without talking! This would Watch this video telling the story of Imani, who include body language, facial expressions, and gestures as is a young adult with autism. Students who have well as the more formal communication support systems difficulty communicating struggle with making described next; the main point is to increase the student’s their basic needs known and making choices. ability to communicate (ASHA, 2021). What strengths does Imani have, and what The speech language pathologist on the student’s IEP challenges is she facing? How does she answer team will be primarily responsible for selecting and supher teacher’s questions and assignments? As you porting whichever ACC approach is determined to be the see her go throughout her day, what strategies best fit for the student. This may be very low-tech support do you see her teachers using that you could use like the use of picture boards to show key ideas (e.g., choice in your own classroom? How do these teachers of foods, favorite toys, desired activities) or may be quite improve her communication skills? sophisticated with computer/personal electronic devices set up to support communication. An online search for “apps for autism” will lead to a wide variety of apps that Watch online can help support communication and social skills development for students with ASD. Many of these apps are free or low cost. On occasion, teaching the student some elements of American Sign Language (e.g., stop, more, tired, happy) will give them another method for communication. In Chapter 8, we will discuss AAC approaches more fully. When communication abilities are improved, behavior often improves as well because when a person can ask for what they need, share their feelings, and connect with others in positive ways; this helps reduce their stress and frustration.

5-7  The Role of Families and Communities in Supporting Individuals with ASD Families are the keystone for supporting children and youth with ASD. It is often the parents who first notice that something is different for their child and often it is their persistent advocacy that leads to diagnosis, treatment, and support for their child’s success. In earlier chapters we have discussed the need for family-centered practices that form trusting partnerships with parents and siblings; professional supports, when done with this kind of partnership, always stand a better chance of success.

5-7a  Family Involvement To provide an appropriate support for their child, parents of children with ASD often need more information and a new set of skills. They need to know special education laws and regulations and how to negotiate these on behalf of their child. Parents also need an understanding of the nature of autism and how it influences their child’s learning patterns and behavior. One of approach to supporting children and families is the Developmental, Individual Difference, Relationship-Based Model (DIR) developed by Drs. Stanley Greenspan and Serena Wielder in the 1970s is one approach for supporting children and their families. This relationship-based Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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Profectum: Developmental, Individual Differences, Relationship-based Model https://profectum.org /about/dir/

Susan Senator www .susansenator.com

Box 5.8

approach to engaging children’s strengths draws on brain science to activate social and emotional competencies of the child (Profectum, 2021). By building on the foundational capacities for development—comfort, competence, confidence, control, and communication—relationship-based models support parents in their pivotal role in optimizing their child’s development. Recognizing that each family is different, specific strategies can be adapted to meet the family’s unique characteristics. In addition, some parents need help coping with the emotional stress that can follow from having a child with a significant developmental disorder. Many parents of children with ASD have become autism experts in their own right and create their own books, websites, and blogs in order to share information and support with other parents. Visit the website of author Susan Senator for an example of a high-quality website and blog authored by a parent of a child with ASD. It is extremely important that the parents be encouraged, or they may give up attempts to communicate with the child following initial frustrations and challenges. Parents also need practical help like that offered in Box 5.8, “Holiday Tips for Families Living with Autism.”

Holiday Tips for Families Living with Autism

The holiday period can be a stressful time for those on the autism spectrum, because it is a breach in their daily routine. However, if we anticipate the holidays and what they entail before they arrive, the person with autism can be made more comfortable and at ease—ensuring joy for all throughout the holidays.

“Everyone in the Car!”: Starting Off on Successful Outings ●

● ●

To help day trips run more smoothly, travel in two cars so that one person can return home with your loved one on the autism spectrum if they get distressed. Eat before leaving home or bring food with you. Bring a quiet toy or books to a restaurant, religious service, or other social activity.

“We Are Going to Grandma’s!”: Tips for Social Gatherings ●











When going to large social gatherings, arrive early to let the person on the autism spectrum get accustomed to the growing number of people. If the child becomes distressed during a social gathering, pick a quiet place to go or take them out for a walk. When visiting someone’s home, ask for breakables to be removed from reach; think carefully about visiting those who refuse to accommodate your request. Bring a preferred item, favorite toys, or stuffed animals to a family gathering or other social event. Before going to a family event, look at individual pictures of family members and teach your child their names. Before going to a social event, use “social stories” and practice simple courtesy phrases and responses to questions,





either verbally, with pictures, or with gestures. (“How are you?”“I am fine.”“How is school?”“Good.”) Let trusted others spend time with your child if they volunteer. Ask for help if you need it. Families and friends are often eager to participate.

“Do We Have to Go to the Mall?”: Shopping Without Stress ●









To help your loved one with autism get used to malls, go early before the stores open. Walk around, get familiar with the building, buy a snack when the stores open, and leave. Extend the amount of time at the mall each time you go. When shopping, be positive and give small rewards, such as a piece of candy, for staying with you. To teach your child not to touch things when shopping, visit a clothing store or another store with unbreakable objects; this gives them an opportunity to practice following the rules while minimizing risk. When shopping, bring a helper to have an extra set of eyes and hands until you are confident of a safe experience. Provide headphones or earplugs to the person with autism spectrum disorder to moderate the noise and activity around them.

Reflection: ●

How might these tips help support any family as they prepare for a hectic holiday?

Source: National Standards Project. (2009). Randolph, MA: National Autism Center.

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Summary

5-7b  Transition to the Teen Years and Young Adulthood

Vladimir Vladimirov/E+/Getty Images

What happens to children with ASD when they become young adults? Approximately 72 percent of students with ASD graduate with a regular diploma while only 6.4 percent drop out of high school (Department of Education, 2018). Thirty-four percent attend some form of postsecondary school after graduation while 55 percent move directly to employment. The recent study of predictors for postschool success identified seven variables that predict education and employment success for students with ASD (Mazzotti et al., 2021). The predictors for postschool education and employment success were: goal setting, inclusion in general education, program Families are the keystone for supporting children with ASD. of study, self-care/independent living skills, social skills, transition program, and youth autonomy/ decision making. Do you remember the first case description of a child with autism, Donald T., presented by Dr. Leo Kanner in 1943 (shared in the beginning of this chapter)? Well let’s take a look at what happened to Donald as he grew up. Donald attended his local high school, where his disabilities were largely accepted, and in 1958 he received a Moral Dilemma: bachelor’s degree in French from Millsaps College in Jackson, Mississippi. After this Addressing IEPs in Virtual he worked at the bank owned by his School family. Though retaining many features autism throughout his life, Donald was able to learn to drive and he traveled extensively When schools shut down due to COVID-19 in March of 2020, (Donvan & Zucker, 2010). While outcomes for it threw teachers for a loop. Suddenly, they had to move their individuals with ASD vary, as we learn more about entire in-person curriculum online and work with students their strengths and challenges we can create the with a range of access to technology. Some students had supports and services needed for success. fiber ultra-high-speed Internet and state of the art laptops;

Summary ●  In

the 1940s, Dr. Leo Kanner was one of the first psychiatrist to use the term “autism,” which described a group of children who did not relate to others, had delays in speech development, engaged in repetitive behaviors, and were upset by changes in routines. In the past few decades, a growing number of parents and advocates have been working to better education for children with ASD, and in 2006, Congress passed the Combating Autism Act. ●  ASD is a neurological disorder affecting communication and social development and causing, at times, a variety of restrictive and repetitive behaviors and unusual reactions to sensory stimulation. Brain imaging techniques have shown differences in structure and function between typically developing

others didn’t have their own devices and had spotty lowspeed Internet at best. Students were required to be watching lessons taught on screens for hours at a time, and they had limited ways of completing and turning in assignments.      Further, virtual schooling tied teachers’ hands as to how they could instruct students with disabilities. Accommodations such as separate setting, assistive technology, and quiet environments were inaccessible. Teachers were having a hard enough time teaching their general lessons, and some found modifying their curriculum for those with disabilities impossible. However, just because a pandemic was happening didn’t mean that IEPs were no longer enforced. Kids with exceptionalities needed to learn just like everyone else.       Imagine you are a teacher at a school that is about to embark on a period of virtual instruction,  with limited time and resources. What do you think the school’s responsibility is to students with exceptionalities? What should the school be doing to support each students IEP implementation? How could you plan with parents to help them in supporting their child? [Note: you may wish to look back at the Reaching and Teaching Box in this chapter as you think about your response!]

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Chapter 5  |  Children and Youth with Autism Spectrum Disorders children and children with ASD. In addition to “classic autism,” subtypes of ASD include: Rett syndrome, pervasive developmental disorders, Asperger’s syndrome, and child disintegrative disorders. ●  The term “neurodiversity” is often used to indicate that the differences in the brain structure and function of individuals with ASD represent the range of neural development and are differences, not deficits. ●  The spectrum of ASD includes a range of social, communication, cognitive, motor, behavior, and sensory patterns which are unique to each individual. Children with ASD also show restricted, repetitive patterns of behavior, and their difficulties are not better explained by intellectual disability. Children with ASD may not show a grasp of Theory of the Mind like typically developing children. ●  Children of color are less likely to be diagnosed with ASD than their White counterparts, and instead are often given a diagnosis of conduct disorder. When children of color are identified with ASD, this diagnosis often happens at a later age and so they are less likely to receive the early intervention which are so critical to optimism outcomes. ●  Causes of ASD include both neurological (differences in the brain’s structure and function) and genetic factors. ASD runs in families and in sets of identical twins. ●  The information processing model can be used to understand how hyperand hyposensitivity to stimuli can affect how students respond to situations. The emotional context for learning, the climate of the classroom, can either support functioning or make things more challenging for the student. Students with ASD often have difficulty with output, including verbal expressions and motor skills. ●  Children as young as 2 years of age can be identified with ASD and can begin intensive interventions for language development and social skills. ●  Twenty-seven evidence-based practices have been identified to support the success of students with ASD. The specific practices used will depend on the IEP team’s determination of the best match with the student’s strengths and challenges. ●  Applied behavior analysis is one approach to social and cognitive learning, and relation-based therapies are a second widely used method. ●  Improvements in communication are often carried out in natural environments, both home and school, using the child’s interests in play to develop and expand their communication. ●  For children who are nonverbal, augmentative and alternative methods of communication are needed, these may include pictures, sign language, communication apps, an or technology specifically designed to support communication. ●  Many programs of treatment for ASD exist that report clinical successes in terms of improving social and academic skills, but we still need careful research to document these treatments and their long-term effects. ●  Despite the variety of approaches, most major treatment programs include common elements: similar curriculum content, structured teaching environments, predictable routines, functional approaches to problem behavior, and the teaching of transition skills to prepare children for kindergarten. ●  Families are the keystone to supporting students with ASD, and working in partnership with families is paramount to their success.

Future Challenges 1. Will there be enough trained personnel? The education of children with autism requires very special preparation. Few teachers, whether in general or special education, have mastered the

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Key Terms methods of applied behavior analysis or the other instructional strategies designed to enhance the social development and communication skills of children with autism. How will the requirement for trained personnel be met?

2. How can we ensure that individuals with ASD have a voice in the decisions that impact them? Individuals with ASD want a lot more self-determination, both on small and larger scale decisions. How can we ensure that their voices are included on organizational and foundation boards and in policy decisions that will impact their lives? Inclusivity means respecting the perspectives and including the voices of individuals with the lived experience needed to inform decisions and practices. How can we make sure that this happens for individuals with ASD?

3. Who will pay for expensive educational treatments? One of the issues that has not yet been solved, or even confronted, is where the funding for these projects will come from. If one takes the clinical advice that children with autism should have 25 to 40 hours of special instruction weekly, and 1 in 54 children have ASD, how do we pay for all the trained personnel needed? There are simply not that many specially prepared personnel to meet the demand, and schools and special educators need to adapt their programs to take this into account. Similarly, budgets at local and state levels for general and special education are already seriously stretched. The demand for extensive clinical services would likely be met with skepticism, if not opposition.

4. Where is the special programming for adolescents with ASD? While we are developing impressive adaptations for early childhood and elementary age children with ASD, the literature is just emerging about adaptations for older students with ASD. This is a major problem, as the environments in secondary education are so different, with the emphasis on content specialists and even movement between classes (including the social milieu that secondary school creates). One big thrust in special education has to be in programming for these adolescents and in planning for their transition into further schooling or the world of work. TeachSource Digital Download

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Key Terms applied behavior analysis (ABA) p. 165 Asperger’s syndrome p. 153 childhood disintegrative disorder p. 153 comorbidity p. 158 comprehensive treatment models p. 165 Developmental, Individual Difference, Relationship-Based Model p. 175 echolalia p. 152 focused intervention practice p. 168 functional behavioral assessment (FBA) p. 174

hypersensitivity p. 160 hyposensitivity p. 160 incidental learning p. 164 neurodiversity p. 148 pervasive developmental disorders– not otherwise specified (PDD–NOS) p. 153 Rett syndrome p. 153 stereotypic behaviors p. 151 self-stimulation p. 151 tactile defensiveness p. 160 Theory of Mind (ToM) p. 149

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Resources of Special Interest to Teachers Grandin, T. (2011). The way I see it (2nd ed.). Arlington, TX: Future Horizons. A unique perspective on autism by a successful businesswoman who has autism and now wishes to share with others her experiences growing up, including the difficulties she had fitting into the cultural environment that was unaware of or unsympathetic to her condition. Padiyar, K. (2009). Targeted, taunted, tormented: The bullying of children with autism spectrum disorders. Boston, MA: Massachusetts Advocates for Children. A report focusing on a special problem faced by children with ASD. These children are especially vulnerable to bullying, as they have few psychological and physical defenses. These interviews with parents leave little doubt that their children have suffered serious bullying, and the parents expose the issues with the educators’ responses to these events. Teaching Students with Autism: A Guide for Educators This guide helps K–12 educators create a great school experience for students with autism with tips to capitalize on students’ strengths, strategies to address their challenges, and resources for providing individualized support. www.nea.org/resource-library/teaching-students-autism-guide-educators

Journals Journal of Autism and Developmental Disorders The leading peer-reviewed, scholarly periodical focusing on all aspects of autism spectrum disorders and related developmental disabilities. Published monthly, JADD is committed to advancing the understanding of autism, including potential causes and prevalence (e.g., genetic, immunological, environmental); diagnosis advancements; and effective clinical care, education, and treatment for all individuals. JADD also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families. http://link.springer.com/journal/10803

Organizations Autism Society of America The Autism Society of America has been improving the lives of all affected by autism for over 50 years and envisions a world where individuals and families living with autism are able to maximize their quality of life, are treated with the highest level of dignity, and live in a society in which their talents and skills are appreciated and valued. The society provides advocacy, education, information and referral, support, and community at national, state, and local levels through a strong nationwide network of affiliates. www.autism-society.org/ TEACCH Autism Program TEACCH® provides clinical services that are tailored to meet the unique needs of each individual with an autism spectrum disorder (ASD) and their family. Services available include diagnostic evaluations to determine whether or not an individual has ASD. Support services are offered for individuals with ASD and their families through individual intervention services and support groups, parent mentors, and parent teaching sessions. TEACCH provides education and training such as workshops for parents, teachers, and other professionals focusing on characteristics of autism and intervention strategies. TEACCH offers consultation services to programs such as schools or residential communities serving individuals with autism. https://teacch.com/clinical-services/ Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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Children and Youth with Learning Disabilities

6 Ch ap te r

Standards Addressed in This Chapter All the CEC Initial Practice-Based Professional Preparation Standards for Special Education (K–12) are addressed within this chapter. Please see the inside front cover for the list of these standards.

Focus Questions 6-1 What is the history of the learning disabilities field? 6-2 What are some characteristics of children with learning disabilities? 6-3 How are learning disabilities defined and identified, and what are some of their causes? 6-4 What challenges do we face in identifying students whose primary language is not English, those whose families are within the poverty level, and students from Black, Indigenous, and Latino families? 6-5 How does the information processing model help us understand the strengths and challenges of students with learning disabilities? 6-6 What educational responses are needed to help students with learning disabilities meet with success in school and beyond? 6-7 How can having a child with learning disabilities impact the family? 6-8 What kinds of support will students with learning disabilities need to be successful in college, in the workplace, and in adult life?

insta_photos/iStock/Getty Images

C

hildren with learning disabilities are both puzzling and paradoxical. In spite of near-average or higher-than-average intelligence, students with learning disabilities often find school to be very difficult. Just as the term learning disabilities implies, these children struggle to learn and often need additional supports to help them succeed in school. Andrew, for example, is a bright and talkative third grader who loves to socialize with his friends. When books are read to him, he understands and remembers all the details and often asks intriguing questions. His teacher notices this and feels that Andrew should be a very capable student, yet his independent reading level is barely at the first grade. At first his teacher assumes that he is just being lazy, but when she sees how frustrated he becomes with reading, she decides there might be more to it, and indeed there is: Andrew has a learning disability (we will meet Andrew again later in the chapter and look at how to address his strengths and challenges).

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Chapter 6  |  Children and Youth with Learning Disabilities The ways that children with learning disabilities struggle in school have fascinated and baffled researchers and practitioners in the fields of reading, cognition, speech and hearing, neurology, learning, vision, audition, and education. Not all children with learning disabilities have the same set of challenges. Some have difficulty learning to read, spell, and write. Others have trouble with math or with attending to information and completing tasks. Some have difficulty with all academic areas. The pattern of strengths also varies for students with learning disabilities, making each student unique. In this chapter, we look briefly at the history of learning disabilities, how learning disabilities are defined, and how the school and family can work together to create a climate of success for individuals with learning disabilities.

6-1  A Brief Historical Overview of Learning Disabilities The term learning disability was coined in 1962 by Samuel Kirk, the first author of this text, but it came to life during discussions at a 1963 conference with concerned parents and professionals that focused on students who, in spite of average or above-average intelligence, seemed to be encountering substantial difficulties in school. Prior to 1962, these students had been labeled with terms such as minimal brain dysfunction, Strauss syndrome, and brain injured (Lerner & Johns, 2015). From Dr. Kirk’s perspective, students with learning disabilities were a heterogeneous group who shared one commonality: All had a neurologically based problem that affected learning in various ways (Kirk, 1962; note: this was the first edition of Educating Exceptional Children—the book you are reading now in the fifteenth edition!). The assumption that a learning disability has a neurological basis is sound (more about this later in the chapter), but it is hard for teachers to use “neurological anomalies” as evidence when they are trying to decide whether or not a student has a learning disability. There may come a time in the not-too-distant future when brain studies will be part of the identification process, but currently we must rely on a student’s behavior and performance to help us determine the presence of a learning disability (Black et al., 2015). The students we currently identify as having learning disabilities include those with assumed neurologically based learning problems (the group that Dr. Kirk was focused on) and students who are not performing well for other reasons. We explore this further when we discuss how we define learning disabilities.

6-2  Characteristics of Children with Learning Disabilities While all children have unique patterns of strengths and challenges, children with learning disabilities often face more dramatic combinations. They are like crystals; each has their own unique structure, combining their strengths and challenges to form an individual pattern. Children with specific learning disabilities vary in their academic, personal, and social characteristics, and the descriptions of Tonya and Ray below show some of the variation that children with learning disabilities can exhibit.

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Characteristics of Children with Learning Disabilities

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Both Tonya and Ray have learning disabilities, and yet each has a unique combination of strengths and challenges. Because of these differences, each student with a learning disability will need specialized supports to be successful in school. These supports are often described in either their individualized educational program (IEP) or their 504 plan, as discussed in Chapter 2. Later in this chapter, we will explore how teachers and parents can work together with the child to promote success, but first we take a look at how learning disabilities are defined by law, how students are identified, and what some of the causes of learning disabilities are.

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Tonya: Tonya is a fifth grader with a measured IQ score of 135. Although this score places her in the gifted range intellectually, she still struggles with many academic tasks. Tonya is a twice-exceptional (2e) learner. She is a solid, albeit slow, reader but a very poor speller. Tonya also has difficulty with handwriting, and so, although she can talk in great detail about subjects of interest, she has a very hard time writing about them. Tonya also struggles with organizing her thoughts, and her written products are messy and very hard to follow. Even when she seems to be committed to a writing project, like her report on the NASA space program (Tonya would like to be an astronaut), she refuses to revise her work to strengthen it. Because of these challenges, she often tries to distract the class with off-topic discussions and refuses to complete work that she claims is “boring” when she becomes frustrated. This disruptive behavior has led to some social isolation, as Tonya’s classmates distance themselves from her because they do not want to get into trouble. Tonya’s teacher is frustrated with her; she sees how bright she is when she is participating in discussions and wonders why she can’t apply herself more diligently when she is writing. She is also puzzled by Tonya’s refusal to complete work that should be relatively easy for her and feels that she might need more discipline—both at school and at home. Later in the chapter we explore how specific writing strategies, computers, and assistive technology can be used to help Tonya become more successful. Ray: Ray, also a fifth grader, has a very different pattern of strengths and challenges from Tonya’s. Ray has average intelligence but encounters extreme problems with reading, spelling, and writing (sometimes called dyslexia). He has a hard time organizing his ideas and is frequently distracted. His reading problems are so severe that he is almost a non-reader. Because of his poor academic performance, some of his classmates believe he is “stupid.” In spite of these academic problems, Ray excels in one area: art. Ray is very creative and loves hands-on building projects. In fact, he happily volunteers for all art projects. His teacher feels that he needs a great deal of support for learning and is grateful for the resource teacher’s help with Ray. The resource teacher works with Ray and a small group of students with similar needs for an hour each day. She also helps Ray’s general classroom teacher adapt her lessons to provide more support for Ray, and sometimes they co-teach during lessons that may be more challenging for him and his classmates. Together, both of Ray’s teachers are looking for ways to use his strength in art to bolster his self-esteem and build more social support for him with his peers.

Most classrooms will have at least one student with learning disabilities and often special and general education teachers will team-up to meet their needs.

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6-3  Defining and Identifying Learning Disabilities and Looking at Causes More than fifty years have passed since Dr. Samuel Kirk used the term learning disabilities to describe children who, despite average or above average intelligence, seemed to be encountering problems with school (Coleman et al., 2006a). The DSM-5 lists specific learning disorders (i.e., poor writing, reading, and numeric skills) as neurodevelopmental disorders that are not caused by intellectual disabilities, specific sensory deficits, or other extraneous factors (APA, 2013). At the time that he conceptualized learning disabilities, Dr. Kirk believed that children with learning disabilities would likely be a very small subset of children with exceptionalities. Little did he know that children with learning disabilities would become the largest group of students served by our special education programs. Current estimations indicate that 37 percent of the school-age children who receive special education are categorized as learning disabled (U.S. Department of Education, 2020). The numbers of children identified as learning disabled is the largest category within special education. One possible explanation for the high numbers is the way we have defined learning disabilities. The U.S. Department of Education (2004) gives us the following definition: SEC. 602. DEFINITIONS. (29) SPECIFIC LEARNING DISABILITY. (A) IN GENERAL. The term “specific learning disability” means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in the imperfect ability to listen, think, speak, write, spell, or do mathematical calculations. (B) DISORDERS INCLUDE. Such term includes such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. . . . (C) DISORDERS NOT INCLUDED. Such term does not include a learning problem that is primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage. This is a theoretical definition and must be “operationalized” to help us actually identify students with learning disabilities. To operationalize this definition, states use a range of different practices. Some use formulas that hinge on the discrepancies between intellectual abilities (IQ) and achievement and/or performance to indicate the degree of underlying disability affecting a child’s psychological processing. Each state set up its own formulas for determining the degree of the discrepancy. Tonya, for example, is a bright girl who is doing poorly in school. Her poor performance may be due to a learning disability, or it could be due to any number of other things (e.g., a lack of interest in school, teachers who are inexperienced, challenges due to poverty, or even problems with home and family). Some educators believe that the use of discrepancy models to identify students with learning disabilities has broadened the category to include any child who experiences problems with learning. Students have also been labeled as learning disabled because they are underachieving in school with no apparent reason for their lack of success (Fletcher et al., 2019). Partly because of this, the category has remained large, as the learning disability label may be given to students who teachers feel would benefit from some level of systematic support. Because of these concerns about the discrepancy model, a few states have moved away from this approach entirely (Schultz & Stephens, 2021). An alternative approach to identifying students with learning disabilities is called response to

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Defining and Identifying Learning Disabilities and Looking at Causes intervention (RtI) (NASDSE, 2005; Thomas et al., 2020). It can be a bit confusing, because while RtI was originally designed as a multi-tiered framework to help identify students with learning disabilities (e.g., students who did not show an adequate response to evidenced-based interventions), the tiered approach has been expanded as a service delivery model that promotes greater collaboration across general and special education. Now RtI is generally called Multi-tiered Systems of Support (MTSS), the tiered approach to learning described in earlier chapters. While MTSS is primarily used as a service delivery model, student progress monitoring can still be used to identify learning disabilities. The use of progress monitoring data to inform identification decision-making is helpful because it shows student performance in response to high-quality evidence-based interventions (Fien et al., 2021). The reauthorization of the Individuals with Disabilities Education Act (IDEA, 2004) reflects this change in thinking about how we define and serve students with learning disabilities. IDEA 2004 includes the response to intervention approach as one option that schools can use to identify students with learning disabilities. The new language is part of Section 614, the section that addresses evaluations, eligibility determinations, individualized education programs, and educational placements: (b) EVALUATION PROCEDURES. (6) SPECIFIC LEARNING DISABILITIES. (A) IN GENERAL. Notwithstanding section 607 (b0, . . . when determining whether a child has a specific learning disability as defined in section 602 (29), a local educational agency shall not be required to take into consideration whether a child has a severe discrepancy between achievement and intellectual ability in oral expression, listening comprehension, written expression, basic reading skill, reading comprehension, mathematical calculation, or mathematical reasoning. . . . (B) ADDITIONAL AUTHORITY. In determining whether a child has a specific learning disability, a local educational agency may use a process that determines if the child responds to evidence-based intervention as a part of the evaluation procedures described in paragraphs (2) and (3) (IDEA, 2004). It is important to note that the language of the law does not preclude a review of the student’s strengths and challenges as part of a comprehensive educational evaluation of the student’s needs; it allows the use of information that shows how a child has responded to evidence-based interventions as one part of a comprehensive evaluation of students’ needs (Kame’enui, 2007). The need for comprehensive evaluations to assess students’ needs is even more important when using this approach, because understanding why children are unable to learn is key to reshaping our educational supports to help them succeed. In addition to being comprehensive, a Supreme Court decision emphasizes that the evaluation of the student’s needs must be done in a timely manner to ensure that supports and services can be put in place as early as possible (Forest Grove School District v. T.A., 08-305, 2009). The majority of states now allow for both the use of discrepancy models and RtI approaches for identifying students with learning disabilities (Lerner & Johns, 2015). The MTSS model, as noted in previous chapters, focuses on prereferral prevention and intervention within Tiers I and II and on recognizing the strengths and challenges of students so that we can deliver appropriate supports and services through a collaborative approach. So, while MTSS began as an alternative route for identifying students with learning disabilities, it has grown into a school improvement movement focused on building collaborative approaches to meeting students’ academic and behavioral needs! The third grade often seems to be the critical year for students with learning disabilities, since during this year students are expected to make the shift from “learning to read” to “reading to learn.” This means that classroom activities usually become more complex and students are expected to function with more autonomy, putting additional pressure on students with learning disabilities.

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If we think about Ray’s experience in school, we can see how an MTSS approach would have been useful early on. Ray, as you may recall, is a fifth grader who is struggling in school; he has severe problems with reading, spelling, and writing. In the early grades, Ray’s teachers hoped that he would catch up to grade level if he worked a little harder. They did not refer Ray for an educational assessment to initiate special education services because, although he was falling behind, his teachers did not yet see an acute discrepancy between his abilities (which were average) and his performance (somewhat below average). It was not until Ray was in the third grade that he qualified for learning disabilities services, at which point he was failing. Within an MTSS approach, Ray’s teachers would have been able to activate supports with Tier II interventions as soon as they noticed that he was encountering difficulties; they would not The MTSS team works together to plan interventions and have had to wait for a formal label of learning supports for each student. disabilities. Ray would have had more intensive instruction provided in small groups early on, and his teachers would have initiated formal assessments and progress monitoring as soon as they realized that he was continuing to fall behind. Ray’s learning disability likely would have been identified before he encountered severe problems in third grade. To help us get a fuller picture of Ray’s learning disabilities, let’s look at the related area called dyslexia.

6-3a  Dyslexia Currently, dyslexia is accepted as a disorder within the learning disability population, defined by the International Dyslexia Association as follows: Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge. (International Dyslexia Association, 2021)

International Dyslexia Association https://dyslexiaida.org/

Similar to the findings for students with autism, as discussed in Chapter 5, the major conclusion is that children with dyslexia have brains that operate differently from the brains of children without dyslexia (Black et al., 2017). Although persons with dyslexia have difficulties in language-based tasks (i.e., reading, spelling, writing, and phonological awareness), many have well-developed abilities in visual, spatial, motor, and nonverbal problem solving. Ray’s problems with learning could be called dyslexia because his specific learning disabilities are in the language area with great difficulty learning to read. It is important to remember that not all children with learning disabilities have dyslexia and that dyslexia is often considered a medical term, whereas specific learning disability is used in educational settings. Ray also has a great deal of difficulty with paying attention in school, and his mind often seems to wander, which causes problems for him and is a source of frustration to his teachers. Ray’s difficulties

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Defining and Identifying Learning Disabilities and Looking at Causes

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6-3b  Importance of Early Recognition of Children with Learning Disabilities

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are extreme enough that his teachers feel he may also have an attention-deficit disorder, discussed in Chapter 7. Many individuals with learning difficulties also have attention-deficit disorders (Silver, 2010).

Recognizing young children who may show early indications of learning disabilities is important so that support can be provided for their development (Coleman et al., 2009; Neitzel, 2011). And systematic observations of a child’s behavior and abilities over time is an important way to document possible early learning disabilities. Many students with dyslexia do very well with hands-on-learning. One clinical observation tool to help with this is the Early Learning Observation Early Learning & Rating Scale (ELORS) (Coleman et al., 2011; Coleman et al., 2010). The ELORS Observation Rating Scale is a concerns-based observation tool that helps teachers and parents gather and http://getreadytoread share information about young children who may have learning disabilities (Gillis .org/screening-tools/early et al., 2010a). Using the ELORS, teachers and parents can systematically rate their -learning-observation concerns from 1 (little or no concern) to 4 (great concern) across seven devel-rating-scale opmental domains. The seven areas of development are perceptual and motor, self-management, social and emotional, early math, early literacy, receptive language, and expressive language. Ten examples of typical developmental tasks are provided for each domain, and teachers and parents use these to rate their levels of concern (Get Ready to Read, 2021). Table 6.1 shows a sample of the items for each domain. Significant difficulties for a young child within any of these seven areas should be followed up with additional parent and teacher discussions during the collaborative problem-solving process within the MTSS framework (Gillis et al., 2010b; West, 2011).

6-3c  Causes of Learning Disabilities There is not a single cause of learning disabilities; as with most areas of disability, there are often multiple factors at play. Studies that focus on subgroups within the larger population of children with learning disabilities have identified some neurological differences associated with their learning problems (Black et al., 2017; Ma et al., 2014; Richards et al., 2014). Although no one is quite sure what causes learning disabilities, some evidence indicates also that learning disabilities may be genetic, as they seem to “run in families.”

Genetics of Learning Disabilities Over the last 50 years, research on the genetic links for learning disabilities has focused on family and twin studies (looking at outcomes for identical and fraternal twins has long been a way to explore genetic patterns). Genetic patterns for children with learning disabilities have been noted in family relationships, and chances are good that their parents, grandparents, aunts and

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Table 6.1  Sample: Early Learning Observation and Rating Scale (ELORS) Teacher-Individual Child Form

4 (great concern) 1 (little or no concern)

Domain of Learning: Perceptual and Motor Eye-hand coordination Large muscle coordination Drawing simple shapes (such as circle, square) Dressing skills (zippers, buttons, shoes, socks)

1   2    3    4 1   2    3    4 1   2    3    4 1   2    3    4

Domain of Learning: Self-Management Adjusting to changes in routine Transitioning from one activity to another Understanding the consequences of behaviors Using words to solve problems with peers

1   2    3    4 1   2    3    4 1   2    3    4 1   2    3    4

Domain of Learning: Social and Emotional Playing cooperatively with other children Expressing frustration appropriately Maintaining friendships Showing a range of emotions (e.g., happy, worried, sad)

1   2    3    4 1   2    3    4 1   2    3    4 1   2    3    4

Domain of Learning: Early Math Naming numbers Showing understanding of one-to-one correspondence Determining which of two groups of objects has more Showing understanding of basic time sequences

1   2    3    4 1   2    3    4 1   2    3    4 1   2    3    4

Domain of Learning: Early Literacy Interest in reading activities Identifying words (such as “STOP” on a stop sign) Remembering names of letters Learning letter sounds

1   2    3    4 1   2    3    4 1   2    3    4 1   2    3    4

Domain of Learning: Receptive Language Paying attention to speech in the presence of background noise Responding to verbal requests Following simple three-step directions Requiring modeling or demonstration

1   2    3    4 1   2    3    4 1   2    3    4 1   2    3    4

Domain of Learning: Expressive Language Expressing wants, needs, and thoughts verbally Size of vocabulary Length of typical sentences Retelling details of a story

1   2    3    4 1   2    3    4 1   2    3    4 1   2    3    4

Source: Coleman, M. R., West, T., & Gillis, M. Early learning observation and rating scale (ELORS): Teacher-individual child form. © 2011 National Center for Learning Disabilities, Inc. All rights reserved. Adapted with permission. For more information, visit LD.org.

uncles, or other relatives will also have learning difficulties. Today’s research has shifted toward a more nuanced look at comorbidities across areas of learning disabilities and targeting specific performance-based skills for the student (Fletcher & Grigorenko, 2017). Researchers are currently working to establish

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Defining and Identifying Learning Disabilities and Looking at Causes the genetic patterns across specific types of learning disabilities (i.e., reading, writing, math), and twin studies show that shared genetic influences contribute to all aspects of reading and math and that both genetic and environmental factors contribute to each academic domain (Willcutt et al., 2019). Some researchers have proposed that genetic information be used to help plan educational instruction, sometimes termed “precision teaching” (Erbeli, 2019). However, this idea remains controversial with concerns about how to protect student and family rights and privacy (Sabatello et al., 2021). All learning disabilities cannot be attributed to genetic causes, and some may stem from environmental factors and/or from inadequate prenatal health care, which may influence brain development.

The Brain and Learning Disabilities The brain is hardwired for learning, so what happens when an individual has a learning disability? Neurologists have shown that the organization of the brain and how it functions when doing given tasks is different when a learning disability is present (Black et al., 2017; Richard et al., 2015). Using functional magnetic resonance imaging (fMRI), neurologists are studying not only the structure of the brain, but how it functions when engaged in a given task (Morin, 2021). Remember that while the brain works as a whole, each area of the brain takes on specialized tasks, and studies using fMRI technology have found differences in the brain functions for students who have reading problems (Ma et al., 2014) and writing difficulties (Richard et al., 2014) compared with their nondisabled peers. We are still working to understand how these anomalies affect information processing and learning as a whole. One encouraging finding is the emerging evidence that when children are given explicit and intense instruction on reading skills (e.g., phonological awareness, decoding), their brain scans show similarities to the scans of their peers without disabilities in how their brains process information (McCandliss & Noble, 2003). Neuroimaging studies have a way to go to offer practical educational support; however, they do provide critical information that someday may lead to better diagnostic criteria for early identification of students with learning disabilities (Black et al., 2015). Dr. Susan Boutilier, a pediatric neurologist, offers her thoughts on what we, as teachers, should know about the brain and students with learning disabilities (see Box 6.1).

6-3d  Prevalence of Learning Disabilities Although learning disabilities have an impact at all ages, we focus our discussion of prevalence on school-age individuals from 6 to 21 years old. The U.S. Department of Education (2020) reports that 37 percent of individuals ages 6 to 21 who are receiving special education and/or related services have specific learning disabilities. Learning disabilities remain the largest category of disability among all racial and ethnic groups. Within the LD student population, 43 percent are White, 20 percent are Black, 36 percent are Hispanic, and 5 percent are Asian. The 42nd Annual Report to Congress indicates that students who are American Indian or Alaska Native, Black or African American, Latino/Hispanic, and Native Hawaiian or Other Pacific Islanders were more likely to be identified as having learning disabilities than their White peers. These patterns continue to remind us that the identification process we use must be fair and equitable so that we do not inadvertently overidentify students from some racial and ethnic groups. In earlier chapters, we discussed the role that systemic racism and implicit bias have on undermining the trust that racial minority students have in teachers and schools (Yeager et al., 2017). Banks (2017) interviewed seven Black college students with learning disabilities about their experiences. The students in this

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Box 6.1

Ask the Experts:

Learning Disabilities from a Neurologist Viewpoint

Dr. Susan B. Boutilier is a pediatric neurologist in Greenville, North Carolina, and is affiliated with East Carolina University School of Medicine. She received her medical degree from the University of California Davis School of Medicine and has been in practice for more than 20 years. Dr. Susan B. Boutilier

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I treat a lot of children with a range of neurodevelopmental problems in my child neurology practice. Many of my patients have severe disabilities. In the case of children with severe disabilities, we often know the cause because it shows up on MRI scans and we can “see” where the problem is. However, in the case of children with mild physical and/or cognitive difficulties, the cause is less clear. Most issues with learning are a neural connectivity issue: how the brain works as opposed to the structure of the brain. Neural connectivity is how your brain cells “talk” with each other; it is the way you “think.” These connectivity differences will not show up on an MRI; this is simply the way the child’s brain works. Everyone has a unique way of taking in information and using it to negotiate the world. When we talk about a “learning disability,” we need to remember that it is only a disability in a particular context or subject. We all have strengths and weaknesses. When a child has difficulty with schoolwork, it is clearly important to help them with that difficulty. Understanding how the child is processing information and what educational interventions can best help is important. Equally

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important is understanding a child’s innate strengths and giving them opportunities for success on a regular basis. The child that struggles to read may be excellent in art or mathematics, or they may be good with animals or skilled at building things. When much of their time in school is spent remediating, or focusing on the difficulty, it can be frustrating and discouraging for the child. We all need to make sure they have ample time in a day for enjoyable educational experiences. As teachers you can make a big difference in the life of a child. You can notice where and when the child has problems, you can help them see their strengths, you can make sure they have opportunities for success on a regular basis, and you can help them with their frustrations. Children can often tell you what stresses them and what makes them feel good. We need to remember to ask them and to listen to their answers! Each child needs to understand that their strengths are valued and that their weaknesses do not define them. In order for a child to understand this, it is necessary to communicate this to the parents. When parents hear that their child has a learning difficulty or disability, they may also feel a sense of failure or sadness. Helping them identify their child’s strengths and see the child as a whole, not as being less than perfect, is essential. Children will often find their own path to success based on their interests and capabilities. Adults in their lives can either help or hinder this process. Appreciating the child and helping them understand their strengths is essential.

Reflection: ●

Why is it so important to listen to our students; what steps should we take to ensure that students can share their strengths and challenges with us?

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study were all “success stories,” having graduated high school and enrolled in a four-year university—yet as we examine what they have to say, we learn that their journey was far from smooth. Each of the young men described times when they experienced microaggressions, lowered expectations from teachers, marginalization, and “othering” by peers and teachers. They talk about needing help and about resenting having to prove themselves in order to invalidate derogatory views of their academic abilities. The additional burdens they faced due to their race and learning disabilities taxed their spiritual and emotional well-being and

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Appropriate Identification of Bilingual Children their academic progress. The fact that all of them “made it” is a credit to their selfdetermination, hard work, family support, and to the teachers who did speak up for them (Banks, 2017). We are just beginning to understand how the intersectionality of race, gender, and disability impact our students.

6-4  Appropriate Identification of Bilingual Children With the demographic shift in the United States, Hispanics are currently the largest minority group at 18 percent of the population (Census.gov, 2021). Approximately 23 percent of school-age children come from homes where a language other than English is spoken (KidsCount, 2021). Appropriate identification of children with learning disabilities whose first language is not English presents a special challenge (Huddle et al., 2017; Przymus & Alvarado, 2019). As noted earlier, 36 percent of students identified with learning disabilities are Hispanic, and this may reflect the demands faced by students who must communicate in two or more languages (Capin et al., 2020). The difficulties faced by students whose first language is not English are exacerbated by the ways that we think about bilingualism. In many cases, educators view emergent English language and bilingualism as a problem to be remediated; this negative view reflects and perpetuates deficit thinking and it is a red flag for deep-seated issues of status and power (Trainor & Robertson, 2020). Przymus and Alvarado (2019) point out that terms like “English Language Learner” and “code-switching” may foster the view that bilingualism is a problem to be solved and not an asset to be nurtured. They recommend using “emerging bilingual” and “translanguaging” to reframe this “language as a problem” thinking and to help break the implicit biases that arise with this mindset. Translanguaging is the use of multiple languages to capitalize on the full linguistic repertoire during communication (Przymus & Alvarado, 2019). Because mastering more than one language is difficult in and of itself, appropriate assessments of the child’s abilities and skills are critical to understanding if learning disabilities are present (Capin et al., 2020; Banks, 2012). When bilingual students are assessed in only one language (or even in both languages separately) we do not gain a full picture of their linguistic strengths. Language usage is linked to thinking, and students who speak more than one language often “think” more completely when they are able to use all of their language skills to express ideas. The idea of dynamic bilingualism and dynamic assessment encourages students to draw on their full linguistic repertoire for self-expression and may better reflect the student’s actual language competencies, helping to reduce overrepresentation of emergent bilingual youth in special education (Przymus & Alvarado, 2019). The dual language demands faced by children who are bilingual will be examined in-depth in Chapter 9, but the following example of Juan illustrates some of the ideas we have been discussing. Juan is a high school student whose primary language is Spanish. While he is a hard worker and seems to like school, he is struggling with the demands of reading in the academic subjects. His teachers are concerned about this and feel that he may have a learning disability. They are reluctant to refer him for special education because they also feel that his reading problems may stem from his bilingualism. More and more students like Juan are being supported by being taught specific strategies for reading in the content areas within Tier II of the MTSS model to help them meet with success (Cartledge et al., 2016). Juan’s teachers decide to intensify support for him using the following evidence-based practices: embedded vocabulary development opportunities to practice new words with intensive focus on high-utility words with academic content, building background knowledge before reading text and specific guidance on paraphrasing key readings to build understanding, the use of graphic organizers

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Chapter 6  |  Children and Youth with Learning Disabilities to show main ideas with supporting details, and instruction on writing using selfreflection (such as reading aloud what you have written to check the meaning) and guided outlines to model the writing process (Capin et al., 2020). The decision to provide this extra support for Juan was made by a team of teachers, including the bilingual specialist, the special education teacher, and his general education teachers. In the meeting, Juan requested additional support with his homework, and the team agreed that he should participate in the student support program offered either before school, during lunch hours, or after school, through the MTSS services. Because Juan relies on the school bus and has after-school responsibilities to his family, Juan decided to attend the lunch hour support session. He also planned to talk a few of his friends into going with him so he would have a small group to eat with during the lessons. Identification practices for students whose first language is not English go beyond simply making sure that the specific assessments are valid and reliable. We also must make sure that these assessments are fair (Banks, 2012; Capin et al., 2020). Fairness comes into play in ensuring that the primary language is used within the assessment process and that the individuals conducting the assessments are culturally competent (Banks, 2012). Our goal is to make sure that the assessments reflect the student’s actual abilities and that we capture strengths as well as areas of concern (Przymus & Alvarado, 2019).

6-5  Using the Information Processing Model to Understand Learning Disabilities Students with learning disabilities have difficulties with processing information, and this can lead to problems across several areas including language development, academic learning, motor coordination, social and emotional self-regulation, and focusing attention. Because learning disabilities can impact any area of processing, it is difficult to portray a “typical” child with learning disabilities. Figure 6.1 shows us that Ray has difficulties involving executive processing, understanding auditory input (hearing letter sounds, following directions given orally, and so forth), memory (especially for things he hears), and both speaking and writing as

Emotional Context

Stimulus

Vision Hearing Kinesthetic Haptic Gustatory Olfactory

Thinking

Response

Memory Classification Association Reasoning Evaluation

Speaking Writing Motor Response Social Interaction

Processing

Attention

Information Output

Executive Function

Information Input

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key Challenges Strengths

◗ Figure 6.1  Ray’s Information Processing Model TeachSource Digital Download   Access online

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Using the Information Processing Model to Understand Learning Disabilities ways to share his ideas. The secondary areas that cause difficulties for Ray are more generalized. Because of his challenges with both memory and focus or attending, he struggles with all of the deeper processing areas (e.g., classification, association, reasoning, and evaluation). He also has had difficulties with social interactions that require processing a lot of auditory information (e.g., tone of voice, inferential intent of words, and emotional content of the message). Ray’s areas of strength include using kinesthetic and visual input, drawing, and motor responses. As you can see in Figure 6.1, Ray’s challenges are pretty pervasive. The good news is that he has strong visual and kinesthetic skills, and these are what help him with his art. Remembering that Ray, and other students with LD have strengths is critical to providing the encouragement and support they need (see Box 6.2). Each component of the IPM performs an important function related to learning, and optimum learning takes place when the components function smoothly as one system. A learning disability can be explained as a glitch in this system. Let’s look at each component and explore what the glitches mean for students.

6-5a  Problems with Input When the learning difficulty occurs because of input glitches, a sensory perceptual problem exists. Unlike sensory acuity problems, perceptual problems cannot be corrected with glasses or hearing aids. Those with visual perception problems can experience figure-ground (seeing an object against the background), closure (completion of a figure), and spatial relationship problems. Any one of these problems can make learning very difficult. If they are combined with auditory perceptual difficulties—figure-ground auditory problems (hearing speech against background noise) or difficulties in sound discriminations and/or sound recognition—then learning becomes even more difficult (Lerner & Johns, 2015). Andrew, the first child we met in this chapter, has visual perceptual problems that make reading very difficult. His auditory perception, however, is strong, so he can understand information that is read to him. Ray, as noted earlier, has the opposite pattern: strong visual perception with weak auditory perception. In addition to perceptual problems, some individuals with learning disabilities experience sensory integration difficulties. Sensory integration involves the ability to use two or more senses simultaneously and smoothly (Lerner & Johns, 2015).

Box 6.2

LD:

Remember Our Super Powers!!!

Having a learning disability can be challenging sometimes – but it can also be pretty good. Here are some of the super powers that can come with a LD: ● ● ● ● ● ● ●

I am funny and can make people laugh! Creativity is my super power; I am really good at building things with Legos! I am a dancer. Solving problems. I am really good at this – especially if the problem is not my own!! I am a leader; someday I may be president. I am very empathetic. I tell great stories and I want to be a writer – even though I have a learning disability and can’t spell – I guess that’s what spell check is for!!

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Chapter 6  |  Children and Youth with Learning Disabilities A student’s inability to listen and take notes during class is an example of a sensory integration dysfunction because this task requires blending auditory perception and tactile or proprioceptive (an awareness of where your body is in relation to the space around it) actions. A final area of concern with this component is oversensitivity to sensory input; this may mirror the difficulties faced by some children with autism (see Chapter 5). Lights, sounds, smells, and tastes may become overwhelming. When this heightened sensitivity affects the sense of touch, it is called tactile defensiveness, in which touch can trigger acute discomfort. For individuals who are tactually defensive, a light or soft touch seems to be more uncomfortable than firm contact. In a typical busy classroom, it is easy to see how a student with these sensory sensitivities would experience difficulties.

6-5b  Problems with Processing or Thinking When problems with learning primarily affect processing or thinking, we see difficulties with memory and with organizing ideas or thoughts in meaningful ways. Problems in these areas can be especially frustrating for students and their teachers. Although Ray’s problems occur in several areas, the most difficult of them involves his inability to organize his thoughts and ideas. This inability creates great challenges across most school tasks, and it is only when he can be creative in the arts that he feels truly at home. Tonya, on the other hand, excels in her thinking; she seems to thrive in the world of ideas, and she has a great long-term memory. Her struggle comes when she must write her ideas down. Let’s look at glitches that affect memory and information retrieval and then at the problems with organizing thoughts. The division of memory into sensory, short-term, and long-term memory helps us understand how students process different tasks. See Figure 6.2 to see how our memory works. Our sensory memory can hold large amounts of information for a very short period of time (2 to 3 seconds). We use short-term memory to remember the directions and steps for solving a math problem while simultaneously doing the calculations. Long-term memory stores information that we have made our own to draw on for future use. Problems with any of these forms of memory lead to major learning difficulties. However, the greatest impact occurs when students struggle with long-term memory storage and retrieval. Another way to view memory is to consider how the information is stored. We typically store information in three kinds of memory: semantic, episodic, and physical/motor (Lerner & Johns, 2015). ●  Semantic

memory stores concepts, words, symbols, and generalizations. This is the most frequently used form of memory in school. hears Re a

l

Sensory input

Sensory memory

Short-term memory

Large capacity Lasts up to 1 or 2 seconds

Small (5–9 items) capacity Lasts up to 15–18 seconds

Fo rg

Attention

ett

ing

Storage

Fo rg

Retrieval

Long-term memory Unlimited capacity Lasts indefinitely

ett

ing

◗ Figure 6.2  The Atkinson-Shiffrin Model of Memory Source: From FREBERG. Discovering Biological Psychology, 1E. © 2006 Wadsworth, a part of Cengage Learning, Inc. Reproduced by permission.

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●  Episodic

memory is our ability to recall whole scenes or episodes from our past. When we experience episodic memory, we feel we are “right back there” with all senses engaged. Often episodic memories are triggered by smells, like when you smell baking cookies and you are immediately transported back to the times you spent with your grandmother in the kitchen. Episodic memories are often associated with strong emotions that can be either positive or negative. ●  Motor memory is our ability to program our body movements. Our bodies learn patterns and retain them for future use. We learn to ride a bicycle, play the piano, or write our names. Some motor memories seem to last after we no longer use them—thus the expression, “It’s like riding a bike.” When an individual has a learning disability that affects memory in any form, school can be a challenging place. In addition to memory, the processing component includes thinking. Students work with the information to interpret and combine it with prior knowledge as they create meaning for themselves by constructing their own understandings. Original ideas are born in this stage that allow the learner to move beyond the known into new areas of thought. It is in this component of the IPM that real learning takes place. When problems occur in thinking, they are likely to stem from an inability to organize thoughts in meaningful ways (classifying, forming associations, using reasoning abilities, and so forth). In other words, ideas remain fragmented and disconnected so that patterns TeachSource Video Connection and relationships across ideas never jell into useful concepts. Interestingly, when information is stored in memory as isolated bits and pieces, it is much more difficult to retrieve and is less useful for thinking. Framing teaching around concepts and big ideas and using visual supports to structure these in meaningful ways is useful in helping our students reduce retrieval problems (Ellis et al., 2011). This is discussed further later in the chapter. Learning, according to the IPM, is a function of how well an individual processes the information. Deep processing is necessary to understanding information so that it can be used in meaningful ways. Deep processing occurs when we transform the information to make it ours. Such processing might include forming categories Watch the video “Universal Design for Learning: Prinwhere new information is linked with existing informaciples and Practice in a Middle School Classroom.” In tion. It also includes analytical and evaluative thinking. this video, Assistant Principal Adam Deleidi describes The ultimate transformation occurs when we use the how his teachers implement the principles and pracinformation to create new ways of thinking and share tices of UDL with a group of students with diverse these new understandings with others. Ray, for examneeds and learning styles. Their methods illustrate ple, has a hard time getting new information to “stick.” how employing the principles of UDL can increase In preparation for an upcoming social studies test, his students’ level of engagement and critical thinking mother spent several nights helping him study by quizskills. The teachers in this video use a variety of stratzing him on vocabulary and dates. During the study egies to teach a vocabulary lesson to their students. sessions, he seemed to be getting the information, and everyone was discouraged when he failed the actual test. Reflection: Ray had not processed the information deeply during his ● What are some of the strategies that the general classroom study time, and so he was not able to apply his learnteacher and special educator use or recommend to ing when it came to the test. On the other hand, after other teachers who work with students with learning he completed his social studies project—a topographical disabilities? How might some of these strategies help map of his state showing its different regions, populatarget potential problems with information processing? tions, and products—he was able to remember and discuss everything he had learned in great detail. For Ray, Watch online this hands-on art-related project helped him process the

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Chapter 6  |  Children and Youth with Learning Disabilities

Box 6.3

Reaching & Teaching:

Input for Children with Reading Disabilities

By Jennifer G. Job, Ph.D. For children with dyslexia and other reading disabilities, reading a book can be challenging, and reading text to keep up with online classes can be even more so. Teaching strategies for children with input difficulties rely on multisensory, individualized learning, which is much harder when teaching from a distance. But that does not mean it cannot be done! First, you can ensure that parents are included in the plans for lessons and materials. Share strategies for helping children to read and do schoolwork from home, and write encouraging notes emphasizing students’ strengths. Also, be flexible with deadlines and how children turn in materials. If a child has difficulty following complicated systems for submitting work, perhaps parents can email you photos instead.

Consider multiple ways that students can show you they have learned the material. Offer options in reading, writing, and creating to let them fulfill the standards. Be sure to work with parents to help children reach their goals—they may have ideas of how to work within the child’s home situation and interests that you are not aware of. If a student has a particular disability like dyslexia, it may help if you translate reading assignments or worksheets into a font that makes it easier for the child to read. For example, Dyslexie (dyslexiefont.com) is a typeface specifically designed to enhance the ease of reading, learning, and working. Resource: How to make distance learning work for teachers and students, April 6, 2020, The Dyslexia Resource.

information more deeply so that he could remember and use what he had learned. Sharing information, or using what you have learned, is represented in the output component of the IPM.

6-5c  Problems with Output For some individuals with learning disabilities, the problem is primarily output, or the expression of ideas and thoughts, which can take several forms. When output problems affect speech, they may be called developmental aphasia, because the symptoms mirror those of a stroke patient with speech difficulties. These problems include word retrieval and speech fluency, which can make communication difficult. A second form of output glitch involves the motor mechanics of handwriting. The easiest way to understand this is to imagine that the connection between the brain and the hand is not efficient. There is “static on the line,” which makes it difficult for the hand to know what to do and for the brain to understand what the hand has done. If you think back to Tonya’s profile, you will remember that this was one of her challenges. Difficulties with handwriting are sometimes called dysgraphia, which literally means bad writing. To produce legible products, these students have to “draw” their letters and form them into words. This process is very taxing and cannot be sustained for general work. When dysgraphia is combined with visual and auditory perceptual problems or sensory integration difficulties, note taking during lectures and copying from the board are virtually impossible. Another form that output learning disabilities can take is an inability to both understand and produce gestures and facial expressions that correspond with feelings and emotions. In this case, individuals have difficulty interpreting emotional nuances that are communicated through facial expressions and body language.

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Using the Information Processing Model to Understand Learning Disabilities Because a tremendous amount of information is communicated nonverbally through looks and body positions, an individual who does not “read” these clues is at a distinct disadvantage when communication is required (see Box 6.3). Individuals with these problems may also have a flat affect (an absence of expression on the face) that can limit their ability to express needs and wants, thus making communication more problematic. Social situations can be quite painful for these individuals, creating an early pattern of social avoidance.

6-5d  Problems with Executive Functions As we discussed earlier, the executive function, or metacognition, is the decisionmaking component of this model. Decisions are made as to: ●  What

input to notice or screen out; strategies to use to store information or whether the information needs to be stored; ●  How useful the information is; and ●  How ideas and understandings will be expressed. ●  What

Metacognition also includes self-regulatory skills (Hidi & Ainley, 2008; Wery & Nietfeld, 2010). We monitor ourselves so that we can continuously adapt our thoughts, speech, and actions to accomplish our goals (Zimmerman & Schunk, 2008). Self-regulation implies that individuals are in control of and responsible for their own actions. In addition to its importance for learning, self-control is also a key ingredient in social success. Impulsivity can lead to disastrous results: essentially leaping before looking. In learning, self-regulation allows us to monitor our understanding. Good readers, for example, continuously monitor their comprehension and work to make sense of their reading (Pierangelo & Giuliani, 2006). When something is not clear, good readers loop back and reread the passage. Poor readers, on the other hand, often fail to recognize that something does not make sense. Even when they do recognize the problem, they often fail to initiate a strategy such as rereading to help them make sense of the text (Wery & Nietfeld, 2010). In addition to problems with self-regulation, difficulties with the executive function can show up as attention deficit/hyperactivity disorder (ADHD), as will be discussed in Chapter 7, and it is not unusual for students with learning disabilities to also have ADHD.

6-5e  Emotional Context of Information Processing Emotional context is critical to our understanding of how students learn (Immordino-Yang & Damasio, 2007). The IPM usually describes learning as a purely cognitive activity, but this is not how learning really takes place. Both one’s emotional environment and one’s internal emotional state have a dramatic impact on our ability to learn (Shattell et al., 2008; Willis, 2008). When the emotional environment is harsh or we perceive it as dangerous, our internal emotional states become acutely stressed and defensive. Neither this environment nor the internal state it produces is optimal for learning. In fact, strong negative emotions have an impact on all aspects of our ability to process information, coloring our perceptions, scrambling our thinking, interrupting our ability to communicate, and, perhaps most importantly, clouding our judgment or executive functioning. As our understanding of neurology develops, we see that emotions and cognition are interwoven and cannot be viewed separately (Zimmerman & Schunk, 2008). The high leverage practice in Box 6.4 shares the importance of positive and constructive feedback to students’ academic and behavioral learning.

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Chapter 6  |  Children and Youth with Learning Disabilities

Box 6.4

High Leverage Practices:

High Leverage Practice 8: Provide Positive and Constructive Feedback to Guide Students’ Learning and Behavior.

The purpose of feedback is to increase motivation, engagement, and independence in learning and behavior. Effective feedback must be strategic, goal directed, timely, positive, and constructive. Providing positive and constructive feedback is an essential component of both academic instruction and social/ emotional/behavioral guidance.

Reflection: ●

In what ways can positive, constructive feedback help to create a positive climate for student learning?

Individuals with learning disabilities may be even more vulnerable to toxic emotional environments than other students because their internal emotional states are often less secure (Shattell et al., 2008). Repeated experiences of failure and frustration can lead to anticipatory anxiety in the face of new situations, even when the situation is not particularly stressful. This anticipatory anxiety can sabotage success by undermining self-confidence at the start of a new experience. Anticipatory anxiety can also lead to heightened sensitivity and defensiveness, which further erode an individual’s ability to respond to new situations and opportunities. Thus far we have discussed the impact of the emotional context on cognition, but the emotional context also affects social situations. When an individual has a learning disability that affects their ability to read and understand social cues, social situations can feel threatening because people are often very unpredictable. In a classroom, students’ success is directly related to their skills in understanding and interpreting the teacher’s expectations. Most students know when they are about to “cross the line” with a teacher and pull back enough to prevent negative consequences. Students who have learning disabilities that affect their understanding of social cues and who have difficulty with self-regulation may often find themselves in trouble. This tendency further exacerbates the anxiety response in the face of similar situations. When you are fairly certain that you will get in trouble and you don’t know how to prevent it, you can become anxious when anticipating the future. Put yourself in the shoes of Tonya, Juan, or Ray for a moment and think about how their frustrations, fears, and anxieties compound their difficulties and make learning even harder for them. The importance of a positive emotional climate for learning is discussed later in the chapter. Box 6.5 shares some strategies to help students manage their internal Many students with learning disabilities are puzzled when they get into trouble in the classroom and are not sure what they did. emotional climate so that they can practice self-regulation. BearFotos/Shutterstock.com

High Leverage Practices https://highleveragepractices .org

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Using the Information Processing Model to Understand Learning Disabilities

Box 6.5

Mindfulness Matters:

Managing Impulsivity: The Secret Signal

Many students with learning disabilities have a hard time managing their impulsivity—it often seems like they leap before they look—and this can get them into some pretty difficult situations! Why This Matters: Learning self-management, or self-regulation, is pretty important to our overall success. Self-regulation means that we are able to choose our actions and direct them toward accomplishing things we feel are important. This is key to accomplishing both long- and short-term goals. Practicing Mindfulness: Teachers can help students develop the self-awareness needed to build more selfregulation by using a secret signal to indicate to the student when they need to stop what they are doing and shift to behaviors that will lead to more positive outcomes. The secret signal is an early warning that the student is approaching trouble. Here’s how this works: 1. Identify with the student behaviors that often seem to lead to difficulties within the classroom (e.g., interrupting others during discussions, not allowing other students to take their turns during project work, being a distraction to others). 2. Discuss with the student what these behaviors look like and why they seem to lead to problems. Also

TeachSource Digital Download

discuss alternative behaviors that would lead to more positive outcomes. 3. Select a “secret signal” (pulling your ear or placing one hand on your hip—think “third-base coach” as you figure out your secret signal) that you can use when the student is either engaged in one of the problematic behaviors or is about to start one of the behaviors that has traditionally caused problems. 4. Practice using the signal with the student and asking them what they should do when they see the signal. 5. Use the signal during class when you need to help the student shift from problematic behaviors to more positive ones! Remember, for the secret signal to work, the student must see you giving it; this may mean that you will first need to get their attention. You can do this by walking toward them and even placing a hand on their desk if you need to. Most students will like having this secret communication with you and will learn to watch you for the signal. Using a secret signal helps students stay out of trouble because they pause and look before they leap!

Access online

6-5f  The Information Processing Model as a System Although each part of the IPM has been discussed separately, the components work together as a system. Each component influences and is influenced by others in a continuous feedback loop. An anomaly or problem in one area will have an impact on other components. For example, a student with a visual processing problem that affects closure will have a difficult time recognizing the differences between the letter pairs a/u, n/h, a/d, h/b, a/g, c/o, a/q, c/d, t/f, i/l, i/j, o/p, r/n, and v/y. If the student has a problem with visual rotations and mirror images, then the following letter pairs will become difficult: b/d, q/p, q/g, u/n, h/y, m/w, and g/p. With these moderate perceptual difficulties, reading becomes a struggle. The individual spends the majority of their time and energy sorting the letters and decoding the words. This leaves little room for understanding meaning, which is essential for moving information into shortterm memory (see Figure  6.2). Moderate problems with input will also hamper processing and thinking, making it difficult to learn. This will inhibit output (the ability to share what has been learned), because the information has not been deeply processed and stored in long-term memory. In contrast, for good readers, the decoding becomes automatic. This automaticity means that while they are reading, they can also process the information;

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Chapter 6  |  Children and Youth with Learning Disabilities they can think about what they are learning. When all the components work together, this facilitates understanding and keeps the IPM operating smoothly. In addition to the influences of each IPM component on the others, learning disabilities are further complicated because of the multiplicity of possible problems. Remember that when we use the term learning disability, we are referring to a wide range of learning challenges that coexist with a variety of learning strengths. Therefore, each student with a learning disability will have a unique profile and will need an educational environment that can address these differences. It is not unusual, for example, for a student to have problems with visual perception, short-term memory, sequencing information, organizing thoughts, and handwriting. This same individual might be strong in auditory perception, creative insights, and talking. In fact, this combination reflects Andrew’s learning profile; we will see how we can address Andrew’s needs in the next section, which shares educational responses for students with learning disabilities.

6-6  Educational Responses for Students with Learning Disabilities Throughout this chapter, we have looked at the multiple ways that a learning disability can affect a student’s ability to learn. We have noted that the category of learning disabilities includes individuals with widely different strengths and challenges. Box 6.6 shares the experience of one student with learning disabilities and the important role that school programs and a great teacher can have in making a difference.

Box 6.6

Exceptional Lives    Exceptional Stories:

A Painful Situation

A bad year Without bad people really No one exactly to blame Just a sequence of events A class that didn’t belong to me And I not belonging to it The round peg in the square whole [sic] So slowly I faded out At first just the field trips and their ilk Then for part of the day And finally completely As words sprang and papers vanished I became more and more lost and confused And most of all sad So the round peg Found a round whole And so the story ends At least it was without villains (unpublished poem by Shane Wilder, 2004)

Shane was born in 1992 and has lived in Albuquerque his whole life. He began writing in the second grade, when he won the New Mexico PTA Reflections Fair. Years later one of his stories, “To Top It All Off,” about his experience of having a learning disability, was placed in the Library of Congress. In 2005 and 2006, Shane was recognized as an All-American Scholar. But in spite of these academic successes, Shane’s early life was filled with struggles in school. His parents captured Shane’s dilemma this way: “In the early elementary school grades, Shane experienced profound failure and, in our view, a lack of understanding that a student could have a substantial learning disability and also be

Marci Laurel

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(Continued)

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  Educational Responses for Students with Learning Disabilities

Box 6.6

Exceptional Lives    Exceptional Stories:

A Painful Situation  (Continued)

intellectually gifted. This was especially confusing for some teachers because his primary area of disability identified was in reading and written language, and yet these are also the primary areas of his giftedness.” Like other students who are twice-exceptional, Shane is gifted in several areas, but these strengths are combined with areas of great challenge. In Shane’s case, he has a specific learning disability that affects reading. In fact, through fourth grade, Shane was essentially a nonreader, and he describes his difficulties this way: “It all began in the second grade. That was when I realized that I couldn’t read, write, or keep track of things like other kids could. Thus, I sort of fell out of regular education, first into a special education class at my school and eventually into Mr. Higgins’s twice-exceptional class.” Shane kept his love of language and learning alive by getting his books on tape. According to his parents, “Shane continued to be a motivated learner, but he became very discouraged about his daily failure at school. At home he discovered audiobooks, which greatly helped his mental state as he was able to read the books he loved independently and continue to learn new words and ideas that were so important to him.” One of Shane’s teachers in middle school said, “Shane’s passion for language would be remarkable in any teenager but is astounding when coupled with the severe learning disability that made reading ‘with his eyes’ a struggle at best and, for most of his elementary years, an impossibility. How could a boy who faced years of failure—and at times stinging humiliation—maintain his love of books? Thank heavens for audiobooks!” The audiobooks allowed Shane to use his strong listening comprehension, his outstanding ability to think, and his natural curiosity about life to continue learning. Shane was also fortunate because the Albuquerque Public Schools had one of the finest programs for students who are twice-exceptional. As Shane’s struggles in school increased, his parents sought out ways to help him: We were so very fortunate at that time to meet Dr. Dennis Higgins. Shane was eventually transferred to the school where Dr. Higgins was teaching a model elementary school classroom for students who were identified as both gifted and having an area of disability. Shane felt “at home” from

the moment he stepped into this classroom and, with the love and guidance, became willing to try again to be a “successful” student. Shane talks about his journey back to school success this way: It began with learning to accept school again once I got to Mr. Higgins’s class. This occurred by beginning my time in Mr. Higgins’s class with very little work and a lot of support for those few things. In Mr. Higgins’s class I slowly learned, one, to catch up in skills that I have missed and, two, to persist in things that were hard. As well, I had a series of reading teachers who had varying levels of success, until the final one who taught the Wilson Program, which was exceedingly dull and boring, but it had its desired effect. By working two hours a week one-on-one with the teacher, I finally learned to read in the fifth grade. I am currently doing well in the ninth grade, where I take honors English, analytical biology, and a “gifted” health class but also study skills (a.k.a. resource room special education support). The most important support for being successful in challenging academic classes at this point are my IEP modifications, especially those that allow a teacher to accept my work based on content that might otherwise be disqualified because of spelling and/or conventions of writing. Audiobooks are and always will be the most important adaptation for me because, even though I can now read at an expected level, it is still slow and less effective; therefore, I rely on audiobooks for most of my reading. The final modification of great relevance is the ability to either use voice activation software (which is new to me) or dictation for long written work. He added that although he does not have any “sage” advice, he would suggest that others who struggle with twice exceptionalities should “find Dr. Higgins or his clone!”

Reflection: ●

What does Shane’s experience tell us about the importance of the school program and the teacher?

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Chapter 6  |  Children and Youth with Learning Disabilities Because of the unique needs of students with learning disabilities, an IEP or 504 plan that links educational interventions and supports to the specific needs of each student is required by law. The following section on educational responses shares organizational structures or supports and instructional strategies for meeting the needs of students with learning disabilities.

6-6a  Organizational Structures and Support for Students with Learning Disabilities Where Are Students with Learning Disabilities Served? Figure 6.3 shows how the services for students with learning disabilities are provided across both general and special educational settings. The majority of students with learning disabilities (73 percent) spend most of their time (80 percent or more) in general education classes. Twenty percent of students with learning disabilities receive services in the regular classroom for 40 to 79 percent of the day. A much smaller percentage of students with learning disabilities (4 percent) spend over half of their school day in settings other than the general classroom, and less than 1 percent receive services in correctional facilities, hospitals, residential schools, and separate schools (U.S. Department of Education, 2020). As you can see from Figure 6.3, the vast majority of students with learning disabilities receive all or most of their education within the general education setting. Students with learning disabilities typically participate in the same learning activities, focus on the same content standards, and take the same assessments alongside their nondisabled peers; however, skilled teachers use a variety of strategies to support students successfully (Learner & Johns, 2015). Vaughan and Fuchs (2003) suggest positive outcomes for students with learning disabilities are not seen unless a well-organized set of supports is put into place, and McLesky and Waldron (2011) concluded that the inclusive classroom is not the only setting needed for students with learning disabilities. They state that “most elementary students with learning disabilities require intensive high-quality instruction in a part-time special education setting that is delivered by a teacher with specialized skills to make adequate academic progress in basic skill areas” (p. 53). So, while the general inclusive classroom can provide positive support and social skills experience for students with learning disabilities, it takes a team to implement the targeted supports to ensure student success (Lemons et al., 2018).

1% 4% Most of the day in general classroom

20%

Inside regular classroom 40–79% of the day Most of the day outside the general classroom 73%

Receive services in other environments

◗ Figure 6.3  Educational Settings for Children with Learning Disabilities Source: Data Accountability Center. (2011). Part B Educational Environments 2011 [data file]. Retrieved from http://www.ideadata.org/PartBEnvironments.asp

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MTSS Approaches for Students with Learning Disabilities One thing that is different about MTSS for students with learning disabilities is that their response to intervention provided through Tiers I and II can now be used as part of the identification process for learning disabilities (discussed earlier in the chapter). Documenting how a student responds to evidence-based interventions can provide helpful information when used as part of comprehensive evaluation to formally identify the student’s learning disability. Earlier chapters have discussed MTSS at length and so here we will take one student, Andrew, who is struggling in third grade because his reading skills are weak and he is now failing to make his grade. His teachers are exploring whether to have him tested for learning disabilities so that they can provide additional support and help him get back on track. If his teachers had been able to recognize his needs and respond to them earlier using an MTSS approach, Andrew might have had a better chance of success and might not have had to fail the third grade. Let’s look at what would have happened for Andrew if he had attended a school where an MTSS approach was used.

Universal Tier I for Students with Learning Disabilities We will start with what Andrew’s kindergarten classroom could have looked like. Ms. Brown, Andrew’s kindergarten teacher, uses a guided reading approach to help all her students get ready to learn to read. This approach focuses on early reading skills, including print awareness, phonemic awareness, phonics, vocabulary building, word recognition, reading fluency, and text comprehension. At the beginning of the year, as part of the schoolwide screening, Ms. Brown assessed all of her students on letter naming, letter sound recognition (phonemic awareness), word recognition, story retelling (retelling the story from memory after it had been read aloud), and story sequencing (placing pictures in order to show the story as it was told). Andrew had a very difficult time with most of these skills, but he was very good at story retelling and picture sequencing. Ms. Brown noted Andrew’s initial skill levels in each area and began her instruction with Andrew. She also sent a note home to Andrew’s parents asking them to read with and to Andrew as often as possible. She included two books that she thought might interest Andrew, with a list of questions to be used in discussion of the books. Andrew was placed with a group of his classmates who all needed to strengthen their early reading skills. For six weeks Ms. Brown collected weekly progress monitoring data on letter naming, letter-sound matches, and word recognition. At the end of this period she used this information to review what her students had mastered. At this point, she realized that Andrew was not making appropriate gains in his phonemic awareness and that he was falling further behind his classmates in word recognition. Ms. Brown decided that Andrew’s needs required even more intensive instruction, so she brought Andrew’s file to the kindergarten team meeting. In addition to the kindergarten teachers, the team meeting included the school’s reading specialist and special education teacher. At the team meeting, it was decided that Andrew would benefit from short-term intensive instruction on letter recognition and phonics and that Andrew would receive reading support with Tier II “targeted” services.

Council for Exceptional Children Division on Learning Disabilities Teaching LD Resources for Teachers www.teachingLD.org

Targeted Tier II for Students with Learning Disabilities  Andrew and two other students worked three times a week with the reading specialist on mastering letter-sound matches (phonemic awareness) and word recognition. An evidencebased curriculum was selected to teach these skills, and this support was provided in addition to all the early reading instruction that Andrew received in his general classroom. Andrew’s progress on both skills was monitored three times per week, and records were kept to show his slope of improvement (see Figure 6.4). A meeting was held with Andrew’s parents to share Andrew’s progress and discuss his needs. Andrew’s parents suggested that they could help more with word recognition and wondered whether there might be any computer software that they could use for this. They also asked his teachers to remember his outstanding

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Chapter 6  |  Children and Youth with Learning Disabilities Tier 1

35

Tier 2

30

Initial Sounds per Minute

206

25

20

15

10

5

0

0

1

2

3

Class average

4

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8 9 10 11 12 13 14 15 16 17 18 19 20 Assessment Number

Andrew

◗ Figure 6.4  Andrew’s Progress Monitoring Chart

memory for stories that were read to him, and together they decided to use this strength to help him develop a word bank of his favorite words from the stories he heard. Andrew created a notebook with pages for each letter and began adding words the next afternoon after story time. In addition, his teacher helped him write a sentence using each word, and Andrew drew a picture in his word bank showing the part of the story in which this word occurred (see Figure 6.5). Andrew’s teaching team met again with his parents to review his progress at the end of nine weeks. It was decided that, although Andrew had made substantial progress in both his phonemic awareness and his word recognition, he still needed the intense support to be successful. The team also agreed that more information about Andrew’s learning needs should be gathered through a comprehensive evaluation. The planned evaluation included individual assessments of Andrew’s listening, thinking, speaking, reading, writing, spelling, and math—the seven domains identified in the legal definition of specific learning disabilities. An occupational therapist was brought onto Andrew’s team to assess his handwriting, sensory integration,

SNAKE

SPIDER

The snake was fast and sneaky.

The spider sat on her web.

◗ Figure 6.5  Sample Page from Andrew’s Word Bank

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and motor skills. The team also did a full cognitive evaluation. These assessments, in combination with the progress monitoring data showing how Andrew has responded to the interventions, gave a comprehensive picture of Andrew’s strengths and challenges to help the team determine how to meet his needs. The assessment would also be used to decide whether Andrew would need the more intensive services provided through the school’s special education program.

Intensive Tier III for Students with Learning Disabilities  When the results of Andrew’s assessments had been compiled, the team met again. This time the team members reviewed all of the assessment information and discussed Andrew’s eligibility for special educational services. Andrew’s assessment corroborated the observations that his teachers and parents had made and helped them understand the complexity of his needs. Andrew’s strengths and challenges placed him in the above average range and also showed that he was eligible for learning disabilities services. The psychological report indicated that “Andrew’s reading and writing deficits will impact all academic areas. But in spite of these problems, he understands concepts easily, has an advanced spoken vocabulary, and demonstrates superior verbal abilities. Andrew’s listening comprehension is advanced, and his critical thinking is strong.” High leverage practice five shared in Box 6.7, reminds us of the importance of communicating assessment results in ways that all stakeholders can understand. The areas of difficulty included significant delays Giving students with learning disabilities lots of choices can help in visual-motor integration, early reading skills, and them find books that they want to read. writing, and moderate difficulties with early math achievement. This information, along with the progress monitoring data, indicated that Andrew should High Leverage Practices be identified for special education services for learning disabilities. The team https://highleveragepractices agreed that an IEP would be needed for Andrew to help him with the transition .org to first grade.

Box 6.7

High Leverage Practices:

High Leverage Practice 5: Interpret and Communicate Assessment Information with Stakeholders to Collaboratively Design and Implement Educational Programs.

Teachers share and interpret assessment information for all stakeholders, including colleagues and families, to help them understand and use the data collaboratively in planning for the student.

Reflection: ●

Why is it so important to share assessment findings with families in clear and jargon-free-ways?

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Chapter 6  |  Children and Youth with Learning Disabilities

6-6b  Curriculum and Instruction for Students with Learning Disabilities Students with learning disabilities can be successful in school. Often the curricular adaptations and instructional modifications that help students with learning disabilities meet with success are also helpful to other students. As you read through the next section, think about Andrew, Tonya, Ray, and Juan, students you have met in this chapter, but also think about other students you have worked with. How might the strategies suggested here be useful in helping any student meet with greater success in school?

Strategies That Work to Support Students with Learning Disabilities Earlier in this chapter we looked at the information processing model (IPM) as a way to think about the impact that a learning disability can have. Table 6.2 shows strategies that can help address difficulties with each component of the IPM system. These strategies have been organized to show how the Universal Design for Learning (UDL) can be integrated with the IPM. UDL, as you recall, includes multiple ways to represent information, multiple ways to engage the learner, and multiple ways to assess learning. UDL corresponds directly with the information processing model’s input (representation of information), processing (engagement of the learner), and output (assessment of learning). Each of the strategies chosen for inclusion in Table 6.2 has been shown to be effective, and together, these strategies form a set of options that can be matched to the student’s strengths and challenges. Table 6.2 shows strategies to help with input difficulties. Remember that students with learning disabilities have problems with perception, or how the brain interprets the information, not with acuity or the ability of the sensory organ to take in stimuli. Ray, for example, has severe auditory processing difficulties. This means that it is very hard for him to take in information when he is reading or listening; but remember that Ray is very good with visual information and handson projects. The strategies that will support Ray need to focus on using multiple pathways for processing the information. Some students with learning disabilities have problems with processing information, or thinking. Processing problems make it difficult for students to organize their thoughts and ideas and to retrieve information that they have learned. Ray has a very hard time with memory, and he often finds organizing his ideas to be a daunting task. What strategies given in Table 6.2 do you think would help Ray with his memory and organization of ideas? Problems with output often create difficulties such as those faced by Tonya, who struggles with handwriting. Her behavior is becoming increasingly more disruptive as her frustration escalates. Reviewing Table 6.2, what kinds of things might be put in place to reduce Tonya’s frustration with output difficulties, while supporting her strengths in thinking or processing? Some of the most challenging difficulties faced by students with learning disabilities are those that affect the executive function abilities. Ray has difficulty with maintaining attention and is impulsive. What strategies in Table 6.2 might help Ray develop better selfregulatory skills? The emotional context within which individuals learn is also key to understanding the IPM. Thinking about Juan, how can his teachers create the emotionally supportive environment he will need to thrive in school? Often, when we begin to look at how we can support students with special learning needs, we find that the same strategies would benefit many of our other students. How would all of our students’ learning be enhanced if some of the strategies you have identified for Andrew, Ray, Tonya, or Juan were more broadly implemented in general education classrooms?

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Table 6.2  Meeting the Needs of Students with Learning Disabilities: Information Processing

and Universal Design for Learning KEY: UDL Representation. UDL Engagement. UDL Assessment Input

Books on tape Video/Pictures Manipulatives Graphics/Charts Story boards Timelines Matrixes Highlighting Large font/bold Color coding Audio files Tactile graphics Use of all senses

Processing

Kinaesthetic Activities Discussions Debates Plays/Drama/Dance Building models Music/Song Writing activities Simulation Games (Journals, Poetry, Stories, Creative Thinking Reports, Plays, Essays) Data Collection Role Playing Critical Thinking Research Skills Data Analysis

Output

Discussions Debates Plays/Drama/Dance Drawing/Sculpting Music/Song Building models Experimentation Charts/Graphs Writing activities (Journals, Poetry, Stories, Reports, Plays, Essays) Pictures/Photos

Executive Function

Graphic organizers Thinking maps Concept maps Learning frames Outlines Chapter headings Advance organizers Syllabi Study guides Highlighting Prompts (verbal, visual)

Thematic lessons Big ideas Concept-based learning Metacognitive strategies Learning strategies Study skills

Rubrics (with open areas of student choice) Self-assessments Self-selected products

Emotional Context

Safe environment Structured rules Encouragement Rewards vs. punishment

Choice of activities Interest-based assignments Support available Study buddy Breaks for movement

Use of non-punitive assessments that reward student growth Risk-taking environment Recognition of effort Separate grades for content and form

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Chapter 6  |  Children and Youth with Learning Disabilities

Access to the Content Standards Students with learning disabilities will often need accommodations and/or modifications to help them learn. You may remember from Chapter 2 that accommodations are changes in how a student gains access to the curriculum and modifications are changes in what the student learns, the actual curriculum or learning objectives. The purpose of making accommodations and modifications is to limit the impact of the disability area while simultaneously supporting opportunities for learning and supporting student autonomy in learning. While each specific set of accommodations and modifications must be matched to the individual student’s strengths, challenges, and preferences, there are some widely used options that offer a starting point for consideration. Possible Accommodations: 1. Offering preferential seating (e.g., up front, on a ball-chair, away from distractions, beside a study buddy) 2. Using technology (e.g., computers, tablets, calculators, cell phones, audiobooks, CDs, videos) 3. Using specific software support (e.g., spell checker, speech-to-text, bliss symbols, inspiration for writing) 4. Using learning supports (e.g., graphic organizers, outlines, thinking maps, color coded visual aids, charts/graphs, advance organizers, summaries, focus questions, study guides, outlines, lecture notes, PowerPoint slides, vocabulary lists) 5. Using tactile materials and manipulatives (e.g., multi-based arithmetic blocks, hands-on algebra, sentence cubes, hands-on science) 6. Offering alternative ways to assess learning (e.g., projects, photo journals, videos/films, models, art creations, songs, performances, role-plying, debate) 7. Offering additional supports (e.g., task analysis for large projects, checkpoints for progress, review of drafts, editorial assistance, study sessions, mentoring, peer-support groups, prompts) 8. Providing additional time for completion of assignments, projects, and assessments (e.g., allow extra time for reading complex materials, use summer reading to get ahead of reading for advanced classes, allow students to take breaks when needed) Possible Modifications: 1. Reducing “busy-work” to focus on work that is essential to learning or to demonstrating mastery (e.g., assign fewer math problems with a focus on the more challenging ones, reduce copying from the board or from one paper to another, use curriculum compacting and pre-assessments to document mastery, credit by exam) 2. Pre-determining timeframes for work that show appropriate effort (e.g., expected time spent on homework) and accept work done within that frame of time 3. Offering choices so students can select topics of interest for projects and reports 4. Providing alternative readings on similar topics/themes to match students’ independent reading levels 5. Substituting coursework if needed (e.g., computer languages vs. foreign language, off-grade-level classes) 6. Offering partial credit for work, grade only work that has been completed and do not deduct for unfinished work, and offer differential grades for work (e.g., a grade for content and a grade for writing mechanics, rewards for effort, extra credit opportunities) 7. Offering self-assessment opportunities and choice of some areas to be assessed (e.g., students may ask that “humor” be a category of assessment as part of their grade for a science project)

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Asking students what they need to be successful is a really good way to promote self-advocacy. Remember that the goal is to keep the content level challenging while giving the students the support they need to be successful. Table 6.3 shares examples of universal design for learning strategies that can be used to support students’ access to content standards.

Summary of Evidence-Based Practices for Students with Learning Disabilities While each student is unique, there are some instructional approaches that we know help students with learning disabilities to master new content. Modeling is an effective way to introduce new skills to students with LD. Using

Table 6.3  Using Universal Design Principles to Give Students with Learning Disabilities

Access to Content Standards Content Standards Reading Integration of Knowledge and Ideas, Grade 4 Integrate information from two texts on the same topic in order to write or speak about the subject knowledgeably.

Multiple Representations

Multiple Engagements

Multiple Assessments

Advance Organizers

Direct Instruction on Content and Strategies

Written Products (including note cards, outlines, concept webs, and drafts)

Text/Narrative Graphic Organizers Charts, Pictures, Tables Web-based Text Audiobooks Bold/Large Font Color-Coded Text for Main Ideas

Reading using SQ3R (Survey, Question, Read, Recite, Review)

Oral Presentations

Note Taking (outline headings)

Charts, Graphs, Pictures

Discussions Small Group Applications

Compare/Contrast Graphic Organizers

Seminars

Blogs

Debates

Threaded Discussions Online

Develop Graphic Organizers: compare/contrast, concept webs, pros and cons, timelines, visual representations of information Writing Activities

Documentary Film Letter to the Editor Mock Briefing for Decision Makers

Prepare Presentations (PowerPoint, etc.) Operations and Algebraic Thinking, Grade 4

Hands-on Materials

Multiply or divide to solve word problems involving multiplicative comparison, e.g. by using drawings and equations with symbol for the unknown number to represent the problem, distinguishing multiplicative comparison from additive comparison.

Drawings

Charts, Graphs, Pictures Real-World Application Highlighted Problems (key words in color) Flash cards: Words to Math Symbol or Operations

Direct Instruction on Concepts with Modeling of ProblemSolving Strategies (I do, you all do, you do!) Use Hands-on Manipulatives Create Side-by-Side Comparing Multiplication and Addition Create Flash Cards Draw Pictures Representing Process Use Calculators for Checking Create word problems based on real-world data collection Math talks on when to multiply rather than add

Traditional Written Assessment of Problem Solving Student developed word problems on concepts Drawings, Pictures, Charts, Graphs Math Talks Students find realworld examples of when multiplication would be more efficient than addition

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Chapter 6  |  Children and Youth with Learning Disabilities modeling, teachers demonstrate the skills or tasks that students are learning. As they move through the steps to complete the task, they may use “think aloud” to share the processes that they are using to be successful with the task. Students have clear strategies for documenting steps to task completing (e.g., advanced organizers, outlines, flowcharts) that they can use for further reference, and as students gain skills and confidence they can take over steps of the task and build independence for similar tasks. When modeling is done well it incorporates teaching that is explicit, strategic, scaffolded, and metacognitive (Beach et al., 2021). ●  Explicit

teaching involves using language that is both precise and concise, giving clear examples of what is to be learned (avoiding vague, disorganized, and cluttered presentations of information), and providing schemas that show the organization of ideas to be learned (Berkeley et al., 2010; Fuchs et al., 2004; Gersten et al., 2009; Maccini et al., 2007; Scheuermann et al., 2009). ●  Strategic teaching includes mnemonics, organizational strategies (such as graphic organizers, advance organizers, and outlines), and specific approaches that facilitate memory, making connections across information being learned, and the ability to apply information within new contexts (Berkeley et al., 2010; Deshler et al., 2009; Gersten et al., 2009; Gildroy & Deshler, 2008; Wolgemuth et al., 2008). ●  Scaffolding of instruction includes moving from concrete to abstract, from simple to complex, and from supported to independent (Coleman, 2005; Deshler et al., 2009; Ellis et al., 2005). ●  The metacognitive approach to teaching means helping students understand how to “think about their thinking” as they work to solve problems, activate or select strategies to use, and anchor learning in their memory. It also helps students with self-regulatory skills that facilitate learning (Coleman, 2005; Ellis et al., 2005; Deshler et al., 2001; Faggella-Luby & Deshler, 2008; Graham & Harris, 2009; Maccini et al., 2007; Wery & Nietfeld, 2010; Wolgemuth et al., 2008). Technology and Media Division of Council for Exceptional Children www.isetcec.org/

How does teaching that is explicit, strategic, scaffolded, and metacognitive fit with what you know about learning as information processing? Teachers can structure their curriculum and pedagogy to provide the support students need so that they can thrive.

Jim West / PhotoEdit

Assistive Technology for Students with Learning Disabilities

Technology can be used to support children’s learning when they have visual or auditory perception difficulties.

Assistive technologies play a key role in supporting students with learning disabilities by minimizing the impact of their disability. Students with learning disabilities can benefit from an array of assistive technologies including text-to-voice readers, audiobooks, calculators, voice-activated software, voice recorders, and electronic spellers. Many of the same technologies that are commonly used by most people are very helpful for students with learning disabilities (McMahon et al., 2021). Tonya, for example, uses the computer with spell check for her writing so that she can revise more easily and so that her spelling difficulties will be less likely to limit her written expression. Each child’s IEP or 504 plan should specify the assistive technology needed. The role of assistive technology is to help learners become more autonomous in learning so that they can function more independently.

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Families of Children with Learning Disabilities

6-7  Families of Children with Learning Disabilities

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Families are a critical part of the support system for individuals with learning disabilities. Because a learning disability is often not identified until the child reaches school age, the adjustment of the family to the child’s needs comes later than it will in some other areas of disability. Families of children with learning disabilities are at risk themselves if they lack social support and are undergoing stress in coping with their child’s disability. Because learning disabilities seem to run in families, parents may feel that they have genetically passed this on to their child. Parents may also be struggling with some of the same problems that their child is experiencing, and so they may feel ill-equipped to help. However, families are unique, and often they display amazing strengths when faced with the need to support a child with disabilities. Many recognize that their child with learning disabilities needs to be taught strategies for learning, in addition to the information and facts. Families are also key in convincing their children with learning disabilities that they are not “stupid” or “lazy,” and families can play a major role in challenging their children to persist in the face of academic challenges. Families know their child the best, so they are uniquely positioned to help teachers know what their child may need. Strong partnerships with parents help both the teacher and the parents understand the child’s needs. The parents play two key roles for their child with learning disabilities. The first is as an advocate for the child, working to ensure that the school addresses their child’s needs. As teachers, it can sometimes be difficult when parents ask us to change our practices to better meet the needs of their child. But it is critical that we listen. If we have formed a strong partnership with the parents, we can work together, and the parents’ knowledge of their child can help us meet the child’s needs. The second key role of parents is to create a support system at home to provide a safe and loving environment with the necessary structures for the child’s success. Table 6.4 shows a few things parents can do to support their child with learning disabilities. Although the suggestions in Table 6.4 may seem like solid ideas for any family, the consistency, organization, and positive tones are even more critical for the healthy development of children with learning disabilities.

Families provide support to help their child find success.

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Chapter 6  |  Children and Youth with Learning Disabilities Table 6.4  Ideas for Parental Support for Students

with Learning Disabilities ●







● ●

● ●

As much as possible, create a consistent household schedule for daily routines (bedtimes, wake-up times, dressing, leaving for school, meals, room cleaning, TV time, chores, and so forth). Develop clear guidelines for expected behavior framed from the positive (what you want, rather than what you don’t want), and place these in a chart or contract if needed for a reminder. Consistently reinforce expectations from a positive point of view and, if necessary, develop consequences for inappropriate behavior. Consequences should be naturally linked to behavior. For example, if a child breaks a toy out of anger, the consequences may be to clean up the mess and to give one toy away to a child who does not have many toys. For a teenager who stays out too late and does not call, the consequence may be grounding for a week with no phone privileges. Use prompts and checklists for normal chores if needed (prepare a get-ready-forschool checklist to use the night before). Organize, organize, organize! Set up things you need for the next day the night before (put clothes out, make lunch, gather everything by the door, etc.). Provide a quiet study place and time. Check to see that homework has been done and verify that the agreed-on amount of time has been spent working on assignments.



If needed, seek out the help of a tutor or study coach.



Help your child regulate blood sugar with healthy snacks and foods.



Help your child get appropriate exercise to regulate mood and stress.



If medications are needed, monitor these and their impact.



Monitor TV time, programs watched, computer time, and Internet access.





Communicate your love and appreciation of your child often and in very concrete ways. If there are other siblings in the family, make sure that their needs are also addressed, and do not set siblings in competition for your approval.

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The major task of every family with children is to prepare them for a meaningful life. This is no different for families who have a child who has learning disabilities. Parenting is a full-time job, and it continues as the child moves through adolescence and young adulthood. For students with learning disabilities, family support during these transitions is critical.

6-8  Transitions to Postsecondary Life for Individuals with Learning Disabilities The transition from adolescence to young adulthood can be a difficult time for anyone (Coleman & Shevlin, 2018). The normal struggles with independence, identity formation, and lifestyle choices are compounded when a disability is added. The challenges of transition to adult life can be even more daunting for Black, impoverished, and Latino youth with learning disabilities who often face barriers due to language, citizenship status, and lack of community resources, and culturally

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Transitions to Postsecondary Life for Individuals with Learning Disabilities

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competent transition planning is a must (Coleman et al., 2021; Ruiz & Scott, 2021). Studies of risk-taking behaviors indicate that compared with their peers without learning disabilities, adolescents with learning disabilities engage more frequently in risk-taking behaviors such as smoking, using marijuana, acts of delinquency, aggression, and gambling (McNamara & Willoughby, 2010). Students with learning disabilities may also use passive coping strategies (ignoring the problem and hoping it will just go away) (Firth et al., 2010). Given the increased likelihood of risk-taking behaviors in combination with limited coping strategies, counseling support may be important for adolescents with learning disabilities when they face difficult life choices. High school dropout rates are significantly higher for Learning disabilities will impact the individual across their life time and students will need sustained support to individuals with learning disabilities than for their nondismeet with success. abled peers (Zablocki & Krezminen, 2013). In 2018, 78 percent of students with LD graduated with a regular diploma and 15 percent dropped out of high school (U.S. Department of Education, 2020). Dropping out of high school can have significant negative impact on life outcomes, limiting job opportunities and reducing income, while increasing unemployment and the risk of incarceration or arrest. Two factors associated with high dropout rates were disciplinary exclusions (being expelled from school or placed in suspension) and lower than average grades. When we reflect on the challenges of students like Ray and Juan, we can understand how staying in school can sometimes feel overwhelming. Our responsibility as educators is to find ways to support the student’s success through appropriate accommodations. The development of solid transition plans during middle school helps increase the likelihood that the student will graduate (Mazzotti et al., 2021). Other predictors of successful transition to postsecondary education, employment, and independent living for students with LD include career technical education, inclusion in general education, paid work/employment experience during high school, parental expectations, program of study, psychological empowerment, self-determination/ self-advocacy, self-realization, student support, work-study, and youth autonomy/ decision making (Mazzotti et al., 2021). Moral Dilemma: Transition plans must consider the Classroom Modifications student’s current levels of academic and functional performance, interests and aptitudes, postsecondary goals, and transiStudents with learning disabilities often need modifications tion activities. These plans must also address in their assignments in order to minimize the impact of their who is responsible for implementing the plan disabilities and to facilitate their success. Kevin’s IEP, for and how the plan will be reviewed (Boothe & example, includes extended time on exams, no penalty for Hathcote, 2021). The plan may focus on transispelling errors on essays written in class, and the ability to tion to work or on postsecondary educational use the computer for extensive written work. You are Kevin’s opportunities. Plans must also consider the stuhigh school English teacher, and one of your students has dent’s cultural context and needs (Ruiz & Scott, protested that giving these accommodations to Kevin is not 2021). Unfortunately, the quality of the transifair. The protest is growing, and now several students have tion plan seems to differ for groups of students. voiced their resentment of “Kevin’s special treatment.” Landmark and Zhang (2013) found that the How will you handle this? What are your personal student’s ethnicity influenced the level of combeliefs about this issue, and how will your beliefs affect pliance with best practices evidenced in the stuyour professional decisions? What does “fair” mean in the dent’s transition plan. They found that plans for educational context for individuals with special learning African-American students were less likely to be needs? compliant on family involvement and employment preparation, and the plans for Hispanic

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Chapter 6  |  Children and Youth with Learning Disabilities students lacked compliance with annual goals. Thus, we see that students who will likely need the highest level of quality support for success both in high school and in their transition to adult life often receive less appropriate support (Balcazar et al., 2012; Lo et al., 2011; Shumate et al., 2012). For many students with learning disabilities, school has been a place where they have struggled. Therefore, decisions about postsecondary options are filled with mixed emotions (Coleman & Shevlin, 2018). Yet in spite of these challenges, students with learning disabilities are attending college in growing numbers (National Center for Education Statistics, 2021). Colleges and universities that receive any federal funds may not discriminate against students with disabilities in their admissions policies; they are also legally required to provide support for students with disabilities if they are accepted. In spite of this requirement, supports and services vary widely from campus to campus and graduation rates for students with learning disabilities continue to lag behind those of their nondisabled peers (Coleman & Shevlin, 2018). A solid support system at the college level is important for students with learning disabilities, because college is different from high school. Think of the many things that you, as a college student, are expected to do that were never part of your high school experiences. Now imagine the impact these differences would have on you if you were also coping with a learning disability. Not all students with learning disabilities will go to college; many will choose other options. The most important thing is that during their early educational years we have prepared them for the many opportunities that will come their way in life, so that they can make sound personal decisions and meaningful contributions to those around them.

Summary ●  The

field of learning disabilities has evolved over many years as we come to understand more about learning and brain development. ●  Individuals with learning disabilities are a heterogeneous group, and they each have their own unique set of strengths and challenges. These strengths and challenges can present through input, output, or processing of information. Although the origins of learning disabilities are largely unknown, the most commonly accepted cause is a problem related to how individuals process information at the neurological level. ●  The DSM-5 lists specific learning disorders (i.e., poor writing, reading, and numeric skills) as a neurodevelopmental disorder that is not caused by intellectual disabilities, specific sensory deficits, or other extraneous factors. Studies that focus on subgroups within the larger population of children with learning disabilities have identified some neurological differences associated with their learning problems. Causes can be both genetic and environmental. ●  A comprehensive evaluation that includes overall cognitive abilities and academic achievements in combination with progress monitoring data is essential to accurately diagnose and plan services for students with learning disabilities. This is particularly difficult with children from homes in lower income brackets or those that speak a language other than English. Because mastering more than one language is difficult in and of itself, appropriate assessments of the child’s abilities and skills are critical to understanding if learning disabilities are present. When bilingual students are assessed in only one language (or even in both languages separately), we do not gain a full picture of their linguistic strengths. ●  Students identified with learning disabilities are the largest group within special education. Within the LD student population, 43 percent are White, 20 percent are Black, 36 percent are Hispanic, and 5 percent are Asian. The 42nd Annual Report to Congress indicates that students who are American

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Future Challenges Indian or Alaska Native, Black or African American, Latino/Hispanic, and Native Hawaiian or Other Pacific Islanders were more likely to be identified as having learning disabilities. These patterns continue to remind us that the identification process we use must be fair and equitable so that we do not inadvertently overidentify students from some racial and ethnic groups. ●  The information processing model (IPM) can be used to help understand learning disabilities and to help us plan interventions and supports to help students overcome their challenges. Students with learning disabilities have difficulties with processing information, and this can lead to problems across several areas including language development, academic learning, motor coordination, social and emotional self-regulation, and focusing attention. Because learning disabilities can impact any area of processing, it is difficult to portray a “typical” child with learning disabilities. ●  The MTSS approach promotes the collaboration between general and special educators needed to fully support students with learning disabilities. Most students with learning disabilities are served in general education classrooms with appropriate modifications outlined in their IEPs or 504 plans to help them be successful. ●  Universal Design for Learning strategies can be matched to the students strengths and needs to modify the curriculum and support student learning. ●  Evidence-based teaching approaches include the use of explicit, strategic, scaffolded, and metacognitive strategies to support learning. Instructional and assistive technologies can greatly minimize the impact of a learning disability. ●  Families of students with learning disabilities are critical both in their advocacy role and in the home support they provide for their child. Because adolescents with learning disabilities often show poor judgment and engage in risk-taking behavior to a greater extent than their nondisabled peers, counseling support may be needed. ●  More and more students with learning disabilities are attending college and finding ways to use their strengths in meaningful and productive lives.

Future Challenges 1. Increasing numbers of students with learning disabilities are attending colleges. What should be done to ensure smooth transitions and comprehensive services in the postsecondary setting? The wonderful news is that more and more students with disabilities are attending colleges. The difficulty is that institutions of higher education may not be fully prepared to meet the needs of these students. Additionally, most students do not want to self-identify as having a disability, which makes reaching them even more difficult. Questions that will need to be answered include: How can we make sure that colleges and universities are equipped to meet the needs of students with disabilities? What changes are needed in institutional policies (e.g., admissions, drop-add periods, support services, housing, full-time student criteria, and so forth) in light of this changing student population?

2. How can the needs of twice-exceptional students be addressed? As more students are recognized as being twice-exceptional—that is, gifted and with disabilities—supports and services need to be developed to address their complex needs. We need to ensure that we nurture and address the strengths of twice-exceptional students through challenging learning experiences while providing appropriate supports for the areas of disability at the same time. How can collaborative teams work to include specialists in the education of students with special gifts or talents, to address the needs of twice-exceptional students?

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3. If genetic information linked to learning disabilities progresses to the point that it can be used to plan “precision teaching,” what would some of the challenges be for educators, families, and students? We are already seeing the impact of gene therapies, gene replacements, and the use of genetic information to tailor medical treatments. If the use of genetic information becomes an option to help with identification and planning instruction for students with learning disabilities, what would some of the problems be? How would we protect student privacy? How would this impact families? How would this change expectations for who is needed on the multidisciplinary team responsible for the student? TeachSource Digital Download

Access online

Key Terms auditory perception p. 195 automaticity p. 201 collaborative problem-solving p. 189 developmental aphasia p. 198 dysgraphia p. 198 dyslexia p. 185 episodic memory p. 197 evidence-based interventions p. 187 explicit teaching p. 212 heightened sensitivity p. 196 long-term memory p. 196 metacognitive approach p. 212 modeling p. 211 motor memory p. 197

progress monitoring p. 188 proprioceptive p. 196 scaffolding p. 212 self-regulatory skills p. 199 semantic memory p. 196 sensory integration p. 195 sensory memory p. 196 short-term memory p. 196 slope of improvement p. 205 strategic teaching p. 212 tactile defensiveness p. 196 twice-exceptional p. 185 visual perception p. 195

Resources of Special Interest to Teachers Teaching LD is the online center from the Division for Learning Disabilities (DLD) and is one of seventeen special interest groups of the Council for Exceptional Children (CEC), the largest international professional organization dedicated to improving educational outcomes for individuals with exceptionalities, including both students with disabilities and the gifted.  www.teachingld.org/ Support and Resources for Parents from the Learning Disabilities Association of America helps caregivers navigate the education system and give assistance to their children with LD. https://ldaamerica.org/parents/?audience=Parents LD Resources Foundation, Inc. is a non-profit organization that helps find solutions to those who are affected by specific learning disability, dyslexia, and ADHD. The website provides resources to these adults, teenagers, and children, as well as their parents and educators, with a special focus on the needs of low-income households. www.ldrfa.org/

Journals Learning Disabilities Research and Practice publishes articles addressing the nature and characteristics of children and adults with learning disabilities, program development, assessment practices, and instruction. In so doing, LDRP provides valuable information to professionals involved in a variety of different disciplines including special education, school psychology, counseling, reading, and medicine.  https://onlinelibrary.wiley.com/journal/15405826 Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD)

7 Ch ap te r

Standards Addressed in This Chapter All the CEC Initial Practice-Based Professional Preparation Standards for Special Educators (K–12) are addressed within this chapter. Please see the inside front cover for the list of these standards.

Focus Questions 7-1 How has the field of education for students with attention deficit/hyperactive disorder (ADHD) evolved? 7-2 What characteristics of students with ADHD can impact their learning and life success? 7-3 What is the definition of ADHD, how are students identified, and what are some causes of ADHD? 7-4 How is ADHD related to other areas of disabilities (e.g., learning disabilities, emotional and behavior disorders, communication difficulties)? 7-5 What are some of the pros and cons of using medication to address the challenges of ADHD? 7-6 What educational responses are needed to address the needs of students with ADHD? 7-7 How can families help support children with ADHD? 7-8 What challenges do youth with ADHD face in their transition from school to work and adult life?

Fuse/Corbis/Getty Images

“H

e is in constant motion, his energy is non-stop, and his exuberance is sometimes overwhelming!” “She seems to be in a world of her own… it is hard to get her to focus, and, even though she is bright, tasks often remain half done.” You probably have met a child like this already, as nearly 10 percent of all children have received an attention-related diagnosis (CDC, 2021). Children with attention deficit/hyperactive disorder (ADHD) can find life, and especially school, a bit daunting. For some it is hard because their energy is difficult to harness,

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Chapter 7  |  Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD) while others have a hard time maintaining focus or focusing on something that needs to take priority. Some struggle with both of these challenges. The major symptoms of ADHD—inattention, impulsivity, and hyperactivity—can lead to inner chaos that manifests in fidgety, loud, disorganized, disruptive, off-task, or daydreaming behaviors, and missing or incomplete work. Children with ADHD form one of the largest groups of exceptional learners, and teaching them can test our stamina and our patience! But children with ADHD also can exhibit incredible creativity and out-of-the-box thinking; their energy can be fun and exciting, and they often bring a sweet empathy to others who struggle. In this chapter we will explore the history of ADHD, learn about the nature and causes of the disorder, identify the strengths and challenges of students with ADHD, and explore how these needs can be met to support their success in school and life.

7-1  History of the Field of ADHD The field of ADHD largely evolved through the medical community, beginning as early as 1798, with physicians taking the lead in describing patients who seemed unusually fidgety, inattentive, and/or unruly (Rooney, 2011). After a 1917–1918 epidemic of encephalitis (acute inflammation of the brain), physicians saw an increase in patients with these symptoms and the term “minimum brain damage” came into use to describe this cluster of symptoms (Patterson & Spence, 1921). Dr. Kurt Goldstein (1936, 1939) noted that soldiers who had experienced traumatic brain injuries during World War II suffered from disorganization, perseveration, hyperactivity, and problems with figure-ground focus (discerning the foreground object from the background of a picture). Educators began to describe children with similar behaviors in the 1930s and 1940s. Dr. Alfred Strauss studied children who were thought to have brain damage, and the term “Strauss Syndrome” was used to describe the cluster of characteristics shown in Figure 7.1 (Strauss & Lehtinen, 1947). William Cruickshank worked to identify educational strategies for children who were hyperactive and distractible, and his work helped lay the foundation for interventions we see in use today (Cruickshank et al., 1961). The term minimal brain damage or dysfunction was replaced in the 1960s as the focus shifted to the child’s hyperactivity. Today we recognize two forms of difficulties within the cluster we call attention deficit/hyperactivity disorders (ADHD): inattention (the inability to attend and focus) and hyperactivity (problems with impulsivity and self-regulation). Some individuals have a combination of challenges that include both inattention and hyperactivity/ impulsivity. Educators are involved in the identification of children with ADHD and with providing supports and services needed for their success. Physicians, however, are still taking the lead in looking at causes for ADHD, studying the brain and genetic links, helping parents and teachers identify children, and exploring the use of medications to help treat the symptoms. As with all children with exceptionalities, it takes a team!

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Characteristics of Children with ADHD

Erratic and inappropriate behavior on mild provocation

Increased motor activity

Distractibility of more than ordinary degree under ordinary conditions

Poor organization of behavior

Persistent faulty perceptions

Persistent hyperactivity

Awkwardness and consistently poor motor performance

◗ Figure 7.1  Strauss Syndrome, Early Description of Children with ADHD Source: Baum, S., Olenchak, R., & Owen, S. (1998). Gifted student with attention deficits: Fact and/or fiction? Or can we see the forest for the trees? Gifted Child Quarterly, 12(2). 96–104.

7-2  Characteristics of Children with ADHD ADHD presents in a variety of ways depending on the specific combinations of challenges and strengths for each child. Some children struggle most with attention and focus but do not seem to be hyperactive or to have excess energy. Other children are little dynamos whose energy seems to be impossible to contain. Some children like Angelina, below, struggle with both inattention and hyperactivity, making routine activities very challenging. Although many children encounter periodic problems with attention and follow-through, individuals with ADHD face lifelong challenges and need a variety of supports to help them be successful. The characteristics of children with ADHD are given in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) (see Box 7.1). According to the American Psychiatric Association (APA, 2013), “ADHD is characterized by a pattern of behavior, present in multiple settings (e.g., school and home), that can result in performance issues in social, educational, or work settings.” ADHD symptoms, which must present prior to age 12, fall into two categories: inattention and hyperactive/impulsive (see Box 7.1). Children must have at least six symptoms, while older adolescents and adults must have five or more symptoms (APA, 2013). In reviewing these symptoms, it is easy to see why school would be difficult for a student with ADHD.

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Box 7.1

Symptoms of Attention-Deficit/Hyperactivity Disorder: DSM-5

Note: Symptoms of inattention, hyperactivity, and impulsivity must have persisted for at least six months and occur in multiple settings (such as home, school, work) to a degree that is maladaptive and inconsistent with the developmental level of the individual.

● ●

Hyperactivity ● ●

Inattention ●

● ● ●

● ●



Fails to give close attention to the details or makes careless mistakes in schoolwork, work, or other activities Has difficulty sustaining attention in tasks or play activities Does not seem to listen when spoken to directly Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) Has difficulty organizing tasks and activities Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) Loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)

Is easily distracted by extraneous stimuli Is forgetful in daily activities





● ●

Fidgets with hands or feet or squirms in the seat Leaves seat in classroom or in other situations in which remaining seated is expected Runs about or climbs excessively in situations in which it is inappropriate Has difficulty playing or engaging in leisure activities quietly Is often “on the go” or acts as if “driven by a motor” Talks excessively

Impulsivity ● ● ●

Blurts out answers before questions have been completed Has difficulty awaiting turn Interrupts or intrudes on others (e.g., butts into conversations or games)

Source: From Diagnostic and Statistical Manual of Mental Disorders 5th ed., TR

7-2a  Let’s Meet Angelina Angelina, who is 6 years old, has ADHD. She is easily distracted and often distracts other students. Angelina makes “careless” mistakes in her work and seems to daydream much of the time. She is often out of her chair, sharpening a pencil, going to the supply table, or just wandering around the room. It is hard for her to concentrate in school, and her teacher refers to her as a “wiggle worm” and a “day dreamer.” Angelina’s parents feel that she is impetuous, and they find it frustrating that she cannot follow through with simple household chores, like feeding Binx, her cat (who she loves dearly), unless she is prompted several times. Her parents feel that they have become “nags” and that Angelina is changing from their fun-loving little girl into an anxious and unhappy child. If you review the indicators of ADHD in Box 7.1, you will see that Angelina has several of the symptoms. Angelina’s symptoms include failing to give close attention to details and making careless mistakes, having difficulty sustaining attention, not following through on instructions, avoiding tasks that require sustained mental effort, leaving her seat, being easily distracted, having difficulty playing quietly, and not waiting her turn. Her ADHD symptoms include both inattention and hyperactive/ impulsive challenges, and Angelina’s difficulties impact her functioning at home and school. To better understand the way ADHD impacts learning, we can look at the information processing model (shown in Figure 7.2) for Angelina.

7-2b  Information Processing Model and ADHD The primary difficulties for children with ADHD are related to executive function (Boyle & Scanlon, 2019; Silverstein et al., 2020). Some of the tasks that are managed by our executive function include making plans, keeping track of time,

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Characteristics of Children with ADHD

Emotional Context

Thinking

Response

Memory Classification Association Reasoning Evaluation

Speaking Writing Motor Response Social Interaction

Processing

Stimulus

Vision Hearing Kinesthetic Haptic Gustatory Olfactory

Information Input

Attention

Information Output

Executive Function

Key Challenges Strengths

◗ Figure 7.2  Information Processing Model for Angelina, a Child with ADHD TeachSource Digital Download   Access online

keeping track of more than one thing at a time, integrating past knowledge into current decision-making, evaluating ourselves and our work, knowing when we need to ask for help, and regulating our behaviors. Since the executive function oversees attention, decision making, and self-regulation, all other areas of information processing are also impacted by ADHD. It is as though the child’s ADHD throws a blanket over their ability to process information, and sometimes medications can lift this blanket. Figure 7.2 shares the information processing model for Angelina, who we met earlier. Angelina has the combined form of ADHD with inattentiveness and hyperactivity, and we can see that several areas of information processing are impacted, including all of the central processing areas and also written expression. Her strengths include using kinesthetic input, speaking, motor responses, and social interactions. For children with ADHD, distractibility occurs because they are unable to screen out stimuli that are irrelevant to the present task. Therefore, all input seems to be given equal weight, and the information-processing system can be overwhelmed. Imagine being in a store with 45 televisions tuned to 45 different channels. Trying to watch only one program would be difficult because all the TVs are producing sound and visual images that are competing for your attention. This is similar to the experience that individuals with ADHD have when environmental stimulation is abundant. For an individual with ADHD, like Angelina, a typical busy classroom may be challenging with its numerous distractions. This is the world as she knows it, and it is no wonder that she finds it overwhelming at times. But there is a flip side to ADHD that is often overlooked. When Angelina is working on something she enjoys, like learning a new dance move, she will hyperfocus—lock in on the activity like a laser beam and lose all track of time (see Box 7.2). Her parents may think, “How can my child have ADHD? She spends hours at a time on mastering a routine for just one song.” It’s not that children with ADHD do not have the ability to focus at all, but rather that it is difficult for them to focus on something that does not stimulate them in some way. Children with ADHD can also exhibit exceptional creative energy, especially when diving into a new project. But the executive function required to see all of the steps of the project, and how long everything will take, may falter, and often teachers

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Chapter 7  |  Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD)

Box 7.2

ADHD:

Remember Our Super Powers!!!

If you ask anyone with ADHD, they will likely tell you it is not all bad—here are some of their super powers: ● ● ● ● ●

When I like doing something, I can work on it for hours and never notice how much time has gone by! I love building things with Legos—I made an entire space city once and kept it for over a year! People say I am a lot of fun to be with because I have lots of energy and like to do stuff! I am really good at sports. Currently I play baseball, but I love all sports! I think my super power is kindness—I do not like to see anyone hurt or unhappy!

will describe students with ADHD as “biting off more they can chew” and having a lot of half-finished work.

7-3  ADHD Definition, Identification, and Causes

shapecharge/E+/Getty Images

The definition of ADHD has undergone several changes as our understanding of how children learn and our knowledge of neuroscience has increased (Silverstein et al., 2020). The federal regulations for special education, the Individuals with Disabilities Education Act of 2004 (IDEA 2004), include attention deficit disorder or attention deficit/ hyperactivity disorder within the category of “Other Health Impairment,” shown in Box 7.3. Each area included within other health impairments is medically related, with diagnosis and treatment under the care of a physician, but they also have educational repercussions. Doctors and mental health workers rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to guide their identification of ADHD (see Box 7.1). The DSM-5 (APA, 2013) places ADHD within the cluster of neurodevelopmental disorders which also includes learning disabilities, separating ADHD conceptually from oppositional defiant and conduct disorders. This organization emphasizes the relationship between the difficulties children experience with attention and impulsivity, which are behavioral concerns, and problems with learning or academic outcomes (Tannock, 2013). Ability to attend (i.e., to pay attention) overlaps with the ability to learn; children with ADHD may find learning more difficult, while children with learning disabilities may also have problems attending and/or controlling their impulses. Throughout this chapter we will explore the comorbidity of ADHD with other areas of exceptionality, examining the relationships and overlap across areas of concern. Comorbidity is the coexistence of other areas of disability or other mental health concerns along with the primary disorder, making diagnosis and treatment more complicated. Comorbidity is particularly important, as ADHD may exist with several other disabilities and disorders, including learning disabilities, emotional and behavior disorders, communiBecause of their impulsivity, it is sometimes difficult for children with ADHD to play with others. cation disorders, and other mental health challenges (Boyle & Scanlon, 2019).

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ADHD Definition, Identification, and Causes

Box 7.3

227

Federal Regulations for Other Health Impairments

(9) Other Health Impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that:

disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and (ii) Adversely affects a child’s educational performance

(i) Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention-deficit/hyperactivity

Source: Individuals with Disabilities Education Improvement Act of 2004, PL 108-446, U.S. Department of Education, Washington, DC.

7-3a  Identification of Students with ADHD

Fuse /Getty Images

Students with ADHD can legally qualify for services through the Other Health Impaired category (see Box 7.3) of IDEA 2004 or they can be found eligible for services through Section 504 of the Rehabilitation Act (1973). You will likely recall from Chapter 2 that under IDEA, students receive an individualized education plan (IEP), while under the Rehabilitation Act students get a 504 plan for support, and that students who do not qualify under the requirements for IDEA may still be eligible for support through 504. The American Academy of Pediatrics does not recommend a general diagnosis of ADHD before the age of 6 and provides special guidelines for children 4 and 5 years old (Wolraich et al., 2019). Identifying a student Parents often seek help from their pediatrician when they first as having ADHD should be a team effort, with input suspect that their child may have ADHD. from key individuals who know the child well and can document behavioral, social, emotional, and academic impacts of the disability across a variety of settings. Parents and teachers often provide information through an observational checklist showing how the student performs and indicating areas of concern. Parent reports have been shown to be very reliable (Ramtekkar et al., 2010). Student input can also be key to helping with identification because students themselves can share information directly related to their experiences. Table 7.1 shares some sample items from the Conners-3 Scale (Conners, 2014), a rating scale for identifying ADHD. Many of the checklists have parent and teacher versions, with a few also having a student version to gather input. All of the scales help establish patterns of behavior. In looking specifically at the intensity and duration of this behavior, we can determine if the child has ADHD. Identifying students through checklists and rating scales can be challenging, however, because perceptions can sometimes be biased. One area where potential bias may influence referrals for ADHD is gender. In school- or community-based settings, boys are identified two to three times more often than girls, and the girls who are identified often have higher levels of impairment (Coles et al., 2012). Coles et al. (2012) found that teachers’ interpretations of student needs were different for boys and girls. Fifty teachers were given eight matching vignettes, four girls and four boys, depicting students with ADHD.

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Chapter 7  |  Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD)

Table 7.1  Sample Items from the Conners Scale (Conners-3) Conners-3 ADHD Rating Scale: The following are sample items from the Conners-3 Teacher Rating Scale, used for students ages 6–18. The full scale contains 113 items. Respondents consider the student’s behavior for the last month and select 0 for not true at all, 1 for just a little true, 2 for pretty much true, and 3 for very much true. A separate scale is used for parents’ responses; students ages 8–18 may also complete a self-report form. In addition to ADHD, the Conners-3 also addresses comorbid disorders such as oppositional defiant disorder and conduct disorder. Category

Sample Item

Inattention

3. Has a short attention span. 37. Doesn’t pay attention to details; makes careless mistakes. 44. Is sidetracked easily. 60. Avoids or dislikes things that take a lot of effort and are not fun. 86. Gets bored easily.

Hyperactivity/Impulsivity

1. Leaves seat when he/she should stay seated. 4. Fidgets or squirms in seat. 9. Blurts out answers before the question has been completed. 26. Talks out of turn. 83. Talks nonstop.

Source: Conners, C. K. (2008). Conners-3 teacher assessment report. North Tonawanda, NY: Multi-Health Systems, Inc.

They were asked to rank how likely they would be to refer each child for treatment and to indicate their treatment preferences. Teachers in the study rated girls as having more severe impairments than boys when hyperactivity and opposition defiant disorders were included in both vignettes. This is an indication that the teachers saw behaviors associated with ADHD as more “abnormal” for girls than for boys. This is an example of how implicit biases impact gender decisions. The authors concluded that hyperactive and impulsive behaviors were more likely to lead to teacher referrals in general and that when these were displayed by girls, the impairments were perceived as more serious (Coles et al., 2012). They also indicate that girls with ADHD more often show symptoms of inattention-without-hyperactivity—a less classroomdisrupting behavior—and that perhaps this is why girls may be overlooked by teachers.

7-3b  Families from Culturally/Linguistically Diverse Backgrounds Another area of potential bias is with the identification of children from culturally/linguistically diverse and/or economically disadvantaged families (Gerdes et al., 2013). Using some rating scales, African-American students are twice as likely to be identified with ADHD (Flowers & McDougle, 2010). The concerns for identification patterns of ethnic minority and poor children are complex: ●  Are

we over identifying some students because the rating scales are primarily designed for and normed on white, middle-class students?

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ADHD Definition, Identification, and Causes ●  Do

additional risk factors for children whose families live in poverty increase the number of children with ADHD? ●  How do the family’s cultural expectations of child behaviors impact their view of what is “appropriate” (e.g., interrupting during a discussion, or asserting one’s point of view)? Researchers are exploring these questions to help us understand how ADHD identification interacts with the family’s culture and economic status. Basch (2011) looked at the impact of ADHD identification on urban poor students, noting the increased likelihood of identification for ADHD as well as higher absenteeism and dropout rates for these students. The students also experienced more social rejection and greater difficulties with peer relationships than students without ADHD. The difficulties of urban poor students with ADHD are compounded because while there is a higher likelihood that they will be identified as ADHD, they are less likely than white, middle-class students with ADHD to receive consistent pharmacological therapy to help them manage their symptoms (Basch, 2011; Pastor & Reuben, 2005). Flowers and McDougle (2010) reviewed rating scales to look at their use with African-American children. Data supported the use of the Vanderbilt Attention-Deficit/Hyperactivity Disorder scales for diagnosing African-American students with ADHD. The authors call for greater cultural sensitivity, more representative normative samples, and an increased awareness of the need for culturally appropriate assessment tools for use in the identification process of students with ADHD. Gerdes et al. (2013) looked at culturally appropriate assessments for Latino children and found that there were potential problems with the use of rating scales primarily designed for White families. They looked at the Disruptive Behavior Disorders Rating Scale Spanish version (DBD-S) and found that while both subscales (Inattentive and Hyperactive/Impulsive) were psychometrically sound, the Hyperactive/Impulsive scale may not be culturally appropriate for some Latino families. While the family’s degree of acculturation must be considered, Latino families, relative to Caucasian families, may hold different beliefs regarding mental health problems. Latino families may hold more collectivist values, may emphasize spiritual origins for mental health difficulties, and may believe in an external locus of control (that is, the problems are not intrinsic to the child) (Skinner et al., 2001). This combination of beliefs and values may predispose Latino families to be more accepting of the child’s behaviors. Gerdes et al. (2013) alert us to the fact that just because an instrument is technically sound does not mean that it is a culturally appropriate assessment. They call for a combination of diagnostic approaches, including a focus on the child’s functional behaviors (e.g., how they relate to their peers, academic achievements) in addition to the current focus on the ADHD symptoms (e.g., such as failing to give close attention to the details).

Going Beyond Checklists In addition to observational checklists and rating scales, intelligence and achievement tests are often used to show patterns of performance that are associated with ADHD. Box 7.4, Ask the Experts, shares Dr. Emily King’s thoughts on what psychologists can look for during their assessments of children for ADHD. There are many facets to a comprehensive assessment used to determine if a child has ADHD. Parents, teachers, and other adults provide observational documentation of the child’s behavior across different settings, and input may also be included from the child. Assessments will often include measures of cognitive abilities and achievement, like those described by Dr. King. Taken together this information is used to establish the intensity and duration of the behaviors to determine if a child has ADHD.

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Chapter 7  |  Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD)

Box 7.4

Ask the Experts:

What Do Psychologists Look for When Assessing a Child for ADHD? 3. Wechsler Adult Intelligence Scale, 4th ed. (WAIS-IV) — for ages 16 years, 0 months to 90 years, 11 months I generally use the WISC-V for school-age children. The WISC-V provides five index scores, which together determine a full-scale intelligence score. Here is a summary paragraph I include in all of my reports describing the WISC-V:

© Emily King

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Dr. Emily King is a licensed psychologist and the owner of an independent private practice in Raleigh, North Carolina, where she provides psychological evaluation, therapy, and consultation services for children, adolescents, and families. She also conducts cognitive and memory assessments as part of a multidisciplinary team at the Diagnostic Teaching Clinic at North Carolina State University. You can contact Dr. King through her website at www.dremilyking.com. What assessments do you typically use for intelligence and achievement when diagnosing a child’s ADHD? The most common evaluation instruments for intelligence, or cognitive ability, are the Wechsler scales (WPPSI-IV, WISC-V, WAIS-IV) and the WoodcockJohnson Tests of Cognitive Abilities, 4th edition (WJ-IV Cog). Other cognitive batteries include the Differential Ability Scale, 2nd edition (DAS-II) and the Stanford-Binet Intelligence Scales, 5th edition (SB-5). Let’s look at the Wechsler scales to see how they can be used in the assessments of children with ADHD. The Wechsler scales include the following: 1. Wechsler Preschool and Primary Scale of Intelligence, 4th ed. (WPPSI–IV) — for ages 2 years, 6 months to 7 years, 7 months 2. Wechsler Intelligence Scale for Children, 5th ed. (WISC-V) — for ages 6 years, 0 months to 16 years, 11 months

The WISC-V measures an individual’s ability using ten core and five optional subtests which are grouped into the following four global areas: Verbal Comprehension Index, which evaluates a child’s ability to respond orally to questions, Perceptual Reasoning Index, which assesses a child’s ability to manipulate concrete materials or process visual stimuli to problem solve non-verbally, Working Memory Index, which measures a child’s shortterm memory, and Processing Speed Index, which assesses the efficiency of a child’s cognitive processing. These four areas then yield a Full-Scale score indicating a child’s overall ability. The most commonly used achievement instruments are the Wechsler Individual Achievement Test, 4th edition (WIAT-IV) and the Woodcock-Johnson Tests of Achievement, 4th edition (WJ-IV). Another commonly used achievement instrument in the public schools is the Kaufman Test of Educational Achievement, 3rd edition (KTEA-3). Each of these tests yields standard scores related to reading, mathematics, written expression, and oral language. What patterns are you looking for within these assessments that indicate the child might have difficulties with attending or impulse control? A test examiner most often uses clinical observations of behavior during the administration of these tests to determine impulse control or attention concerns. In regards to impulse control, for instance, children may impulsively grab test materials or be extremely eager to begin testing before having received the directions or test prompt. Some individuals may have an impulsive response style where they quickly give a response, then change their response after looking at all the options on the page of a visual task, for instance. At times, an individual’s struggle with impulsivity or inattention may be exacerbated when presented with a challenging academic task, such as writing, and they may need verbal prompts repeated in order to ensure they have heard the directions. (Continued)

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ADHD Definition, Identification, and Causes

Box 7.4

Ask the Experts:

What Do Psychologists Look for When Assessing a Child for ADHD?  (Continued)

In regards to inattention, examiners also use clinical observations during testing sessions to determine if the individual is overly distracted by extraneous noises in the environment, needs directions repeated, or needs support to remain on task. For instance, some children become easily distracted by testing materials on the table or other items in the testing room and begin talking about those items rather than the task at hand. Using the WISC-V as an example, examiners who are concerned about attention issues often look for weaknesses on the Working Memory Index, which contains two auditory short-term memory tasks. If a child has difficulty focusing or maintaining a steady work pace due to distractibility while completing the Processing Speed tasks (both timed pencil and paper tasks), his or her score may be impacted by this behavior, which would be noted through the examiner’s clinical observation. Additionally, a memory test can be used to help determine attention/concentration. Commonly used memory scales include the Wide Range Assessment of Memory and Learning, 2nd edition (WRAML2) and the Children’s Memory Scale (CMS). Both tests ask an individual to complete visual and verbal memory tasks, some presented within a context, such as a story or a picture, or without a context, such as a word list or visual design. The WRAML2 also has two specific tasks, one presented visually and one verbally, measuring attention and concentration. Each task requires

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attention and allows the examiner to observe an individual’s behavior and approach to these tasks. An additional test often given to identify attention concerns is the Conners’ Continuous Performance Test 3 (CPT3; Conners, 2014). The CPT3 involves an individual responding to a series of target letters presented on a computer screen. Results indicate the likelihood of an individual having attention difficulties and can be used in conjunction with parent and teacher rating scales when investigating characteristics of an attention disorder. The CPT3 can also be used to learn more about individuals with impulsivity or activity control concerns. Children with attention deficit/hyperactivity disorder (ADHD) often perform lower than expected on working memory tasks, given their performance in other areas. While a low score on working memory tasks does not directly indicate a diagnosis of ADHD (observations and teacher/parent report across settings must be gathered), children with ADHD often benefit from having memory testing in order to determine any strengths or weaknesses in their learning profile so that teachers can best plan how to teach them new information.

Reflection: ●

How can findings from a comprehensive evaluation of the student’s academic achievement and learning profiles help teachers plan for appropriate instruction?

Access online

Prevalence of ADHD It is difficult to establish with any precision the actual prevalence rates for students with ADHD (Wolraich et al., 2014). Some of the factors that make it difficult include: ●  Students

who are diagnosed in private or clinical settings may receive medication/support and may not be included in school special education counts. ●  ADHD is part of the Other Health Impaired category and counts for this category include several other areas of concern, making it hard to parse out the specific count for ADHD. ●  Many students with ADHD receive supports through 504 plans, or targeted support at Tier II within an MTSS approach, and so they do not appear in the school counts for special education (Rooney, 2011). ●  Comorbidity of ADHD with other impairments, when it is the secondary area of disability, further complicates the count.

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Chapter 7  |  Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD)

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Because of these challenges, we see a wide variance in reported numbers of students with ADHD; estimates suggest 9.4 percent of schoolage children, or approximately 6 million children ages 2 to 17, have been diagnosed with ADHD (CDC, 2021). Boys (close to 13 percent) are more than twice as likely to be identified as girls (5 percent) (CDC, 2021). Students from families with higher educational levels (Merikangas et al., 2010) and those receiving Medicaid health insurance (Centers for Disease Control and Prevention, 2010) are more likely to be identified. Research shows that the prevalence for students with ADHD differs by race and Hispanic origin (Zablotsky & Alford, 2020). Data from the National Health Interview Survey showed that for ADHD and learning disabilities combined, non-Hispanic Black children ADHD is highly heritable and will be found throughout families. (close to 17 percent) were more likely than nonHispanic-White children (14 percent) or Hispanic children (almost 12 percent) to be identified (Zablotsky & Alford, 2020). Children living in families at less than 100 percent of the federal poverty level were more likely to be diagnosed with ADHD or learning disabilities when compared with children above this poverty threshold, and non-Hispanic White (13 percent) and non-Hispanic Black (15 percent) were more likely to be identified than Hispanic children (10 percent). These data show that there are differences across groups of children with regards to the identification of ADHD and learning disabilities (Zablotsky & Alford, 2020).

7-3c  Neurological, Genetic, and Environmental Causes of ADHD ADHD is a complex disability with possible neurological, genetic, and/or environmental causes (CDC, 2021). These causes often overlap, influencing the degree and specific manifestation of the dysfunction. While it is impossible to completely untangle the causes of ADHD, we can look at each area separately to get a sense of why some individuals have ADHD and how the specific manifestation of the problems can differ from one person to another (Zacharek et al., 2021). We can also begin to see how genetics and environment may influence identification patterns, leading to higher rates for boys and for children living in poverty (Morelli et al., 2021).

Neurological Causes of ADHD Several studies examining differences in brain size, structure, development, and function have established a clear neurological basis for ADHD. In their metaanalysis of 55 studies, Cortese et al. (2012) found that when compared with typically developing children, the brains of individuals with ADHD seem to develop more slowly, reaching key maturation points somewhat later, and that the size of some brain areas is smaller. These findings were replicated in additional studies by Shaw et al. (2011) and Qui et al. (2011). Studies with MRI (magnetic resonance imaging) show differences in brain structure and function that seem to be linked to problems with executive functioning including off-task behaviors, attention, planning, sequencing for problem-solving, time management, and the ability to keep future consequences of present actions in mind (Mostofsky et al., 2010; Qui et al., 2011; Woodburn et al., 2021). ADHD-related

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dysfunctions are impacted by multiple neurological systems. These systems include higher-level cognitive functioning, sensorimotor processing, and use of the “default network” involved in mental focus (Cortese et al., 2012; Konrad & Eickhoff, 2010). As the brain develops, the areas of dysfunction change, showing differing patterns of impact for children and adults (Frodl & Skokauskas, 2012). Gender differences must also be kept in mind; because most of the neurological studies have been done with males, we need to remember that we may see somewhat different patterns for females with ADHD (Frodl & Skokauskas, 2012). Remember our expert, Dr. Boutilier, in Chapter 6, shared that many of the challenges students face with learning are differences in “neuro-connectivity” or how the brain cells talk to each other. She reminded us that these are just differences and that they are not “bad.” Like students with LD, students with ADHD also have differences in how their brains function.

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Comorbidity: ADHD and Other Areas of Disability or Concern

Because of genetic factors, it is not unusual for both fathers and sons to have ADHD.

Genetic Causes for ADHD ADHD runs in families; approximately one-third of the fathers who were diagnosed in childhood have a child who is also diagnosed (Rooney, 2011). Twin and family studies have shown that ADHD is highly heritable and work is underway to establish the genetic factors involved (NIMH, 2008). According to Durston (2010), genetic factors can account for up to 80 percent of phenotypic variance. Phenotype, the set of observable characteristics of an organism, includes physical form, development, and biochemical make-up. Because clear phenotypical differences have been established for the brains of individuals with ADHD, mapping these differences to genetic factors should be possible. While multiple genes may contribute to the phenotype of ADHD, no genome-wide significant associations have been firmly established (Neale et al., 2010; U.S. Department of Education, 2008a). Our genes, however, only provide a blueprint for our development, and genes alone do not determine our specific outcomes. The environment also contributes to how our personal strengths and weaknesses will evolve.

Environmental Causes for ADHD Environmental factors that are potentially linked with ADHD include cigarette and alcohol use by the mother during pregnancy, premature birth, high levels of exposure to lead or other environmental toxins, and brain damage or injury (Martin et al., 2019; NIMH, 2021). Environmental factors linked to poverty and family stress may also contribute to a student’s inability to concentrate in school (Morelli et al., 2021).

7-4  Comorbidity: ADHD and Other Areas of Disability or Concern As we have discussed earlier in this chapter, the condition of ADHD often coexists with other categories of disability and other mental health disorders. Approximately 64 percent of children with ADHD may have an additional area

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Chapter 7  |  Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD)

Children and Adults with Attention-Deficit Hyperactivity Disorder www.chadd.org

of concern (CDC, 2021). Almost one-third of all children with ADHD have learning disabilities, and many experience difficulties with reading, math, and written communications. Other commonly occurring areas of disability include emotional and behavioral disorders, autism spectrum disorders, and communication disorders (CDC, 2021). Mental health concerns are also frequently associated with ADHD; these include conduct disorders, oppositional defiant disorders, mood disorders, anxiety, depression, bipolar disorder, sleep disorders, bed-wetting, substance abuse, tics, and Tourette syndrome (Rooney, 2011; Tan & Teng, 2020). There also seems to be a linkage between aggressive behavior and ADHD, putting children at increased risk for social difficulties and school failure (Rooney, 2011; Tan & Teng, 2020). The challenge of the mental health worker or clinician is to determine what symptoms belong to the ADHD, which ones reflect any associated disorders, and which ones may be associated with both ADHD and the secondary condition. Children with comorbid disorders seem to have poorer overall function than children with ADHD alone (Booster et al., 2012; Ricketts et al., 2021; Tan & Teng, 2020). Different patterns for social and academic performance are associated with internalizing disorders (i.e., mood or anxiety disorders) and externalizing disorders (i.e., oppositional defiant and conduct disorders). Children with comorbid externalizing disorders have more difficulties with social interactions, and children with both externalizing and internalizing disorders have greater problems with homework and academics (Booster et al., 2012). Self-regulation problems and emotional liability are also associated with ADHD and these may lead to the secondary problems we see with internalizing disorders (Anastopoulos et al., 2011). Not surprisingly, children with any other condition comorbid with their ADHD show increased academic difficulties (Barnard-Brak et al., 2011). As the number of comorbidities increases, the need for cross-sector coordinated care also increases. This care must be tailored to the specific pattern of strengths and challenges faced by the individual child and family (Larson et al., 2011; Morelli et al., 2021).

7-5  Using Medication for ADHD Symptoms Rasheed, an 8-year-old, has been diagnosed with ADHD with some aspects of EBD (emotional behavioral disorders) as well. The most frequent description of Rasheed is that he is “out of control.” His constant activity seems almost “driven,” according to his mother. Rasheed’s doctor, impressed by the intensity of his behavior, has prescribed Ritalin as a way to calm Rasheed and help him control his behavior so that he has an opportunity to learn. The Ritalin seems to help Rasheed control his impulsive behaviors, but his mother worries about possible side effects from taking medicine. Many individuals with ADHD may benefit from medications to help them focus and sustain their attention; however, there may also be some drawbacks, and Rasheed’s mother is correct to be concerned. Rasheed’s teachers are aware that he is taking Ritalin, and they are helping his parents keep track of any changes in his behaviors to monitor the impact of the medications. Pharmacological interventions for ADHD are one of the most common treatments. While medication will not make them learn, for some children it may give them an opportunity to learn. An estimated 69 percent of children with ADHD receive medication as at least part of their treatment. Children between ages 11 and 17 showed the highest prevalence of taking medication, and boys are almost 3 times more likely to take medication than girls

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Using Medication for ADHD Symptoms (Centers for Disease Control and Prevention, 2011). The most typical medications prescribed for children with ADHD are stimulants, which may seem counterintuitive; why would you give stimulant medication to a child who is already hyperactive, impulsive, or who has difficulty controlling their behavior? Stimulant medications, used with children with ADHD, are believed to affect the portion of the brain that produces neurotransmitters, the chemical agents at the nerve endings that help move electrical impulses among nerve cells (NIMH, 2021). The boost that stimulants give in neurotransmitter production increases the child’s capacity for attending, controlling their impulses, and reducing their hyperactivity. Nonstimulant medications that are sometimes used with children with ADHD include anti-depressant, antipsychotic, anti-anxiety, and mood-stabilizing drugs. While medications seem to have a beneficial effect for many children with ADHD, they are not without problems. All drugs will have some side effects. The most common side effects of stimulant medications include decreased appetite/weight loss, insomnia and sleep problems, nervousness, mild headaches, and stomachaches (NIMH, 2021). Less common, but more serious, side effects can include slowed physical growth, tic disorders, problems with thinking or social interactions, and increased suicidal thoughts (NIMH, 2021). When we read the list of possible side effects, we can understand why some parents, like Rasheed’s mother, are concerned about medications. Side effects can often be avoided or minimized. Adjustments can be made in the type of medication, the dosage levels, and the time and manner the drug is taken. The determination of medication protocols is the responsibility of medical personnel and is not done by educators. Educators, however, do have a clear role in helping to monitor the effects of medication. The feedback teachers give helps doctors ensure that the child is taking the proper dosage, at the most effective times, and in the most efficient ways. Still, parents and children have to weigh the pros and cons of medication as they make their decisions. The story in Box 7.5 shows one child’s path to identification as ADHD; in Michael’s case pharmacological support is a key part of the intervention plan that will help him meet with success. While medication is considered a key part of multimodal treatment for ADHD, it is prescribed less often for Latino and African-American children (Pastor & Reuben, 2005). As noted earlier, children from African-American, Latino, and poor families remain underserved even when identified (Basch, 2011; Gerdes et al., 2013; Pastor & Reuben, 2005). Gerdes and colleagues (2013) identified several barriers to services for Latino families: ●  lack

of health insurance of reliable transportation ●  inability to pay for child care ●  immigrant status ●  difficulties with proficient use of English ●  lack of trust for mental health providers ●  lack of bilingual/bicultural mental health providers ●  lack

Some of these barriers are likely to impact African-American children and children from impoverished families as well. Thus, we find that the very children who are most at risk for identification as ADHD are also most likely to receive the lowest levels of supportive interventions once they have been identified (Gerdes et al., 2013). It is important to remember that medication does not cure ADHD, and it is only effective while it is being used. In addition to medication, it is critical for children with ADHD to receive appropriate educational, behavioral, and emotional support to help them thrive.

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Chapter 7  |  Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD)

Box 7.5

Exceptional Lives    Exceptional Stories:

Meet Michael

Michael is in the third grade at Southside Elementary School. His teachers and parents are concerned about his high activity level, distractibility, and impulsivity. While his parents had noticed these concerns dating back to his early development, they always viewed him as just being “all boy,” and while it was often exhausting, they appreciated his active engagement with the world. These symptoms, however, were now impacting his learning, especially in writing.

Wechsler Intelligence Scale for Children, 4th ed. (WISC-IV): Michael’s Chart Scales/Subtests

Index/Scaled Score*

Percentile Rank

Descriptive  Category

Verbal Comprehension

114

82

High Average

Perceptual Reasoning

121

92

Superior

Working Memory

99

46

Average

Processing Speed

85

16

Low Average

109

73

Average

Full Scale

*Index and IQ scores between 85 and 115 are considered average.

How was Michael identified? Michael is the middle child with an older brother and younger sister. His family history is significant for ADHD and learning concerns. Michael’s parents reported that he has always been an active boy, jumping and climbing off things when he was a toddler and sometimes being a safety concern when running from his parents in public as a young child. Michael’s sunny personality kept everyone engaged but his parents worried that his fearlessness of strangers could lead to trouble, and they tried to keep a close eye on their little boy. Michael was able to follow routines in preschool and kindergarten but had some difficulty sharing due to his impulsivity with grabbing toys from others. He also had difficulty remaining still during circle time. While Michael appeared to be a smart child, in the first and second grades he had difficulty remaining focused to complete tasks and often needed to get up and move around for frequent breaks. By third grade, however, the demands of school seemed to be overwhelming him. He was becoming easily frustrated, unhappy, and had alarmed his parents by saying on several occasions that he “hated school!” His parents and teachers were concerned and wanted to know more about his needs; they referred him for additional assessments. The school psychologist prepared a learning profile of Michael, showing the following results. Based on cognitive testing, Michael showed some strengths and challenges within his profile. He has strong verbal and visual reasoning abilities, yet his

working memory is relatively weaker and there is some concern with his processing speed score, which indicates that Michael works slower than others his age on timed pencil and paper tasks. These results are commensurate with concerns regarding Michael’s writing, which seems to be a struggle for him. While standardized achievement testing ruled out a writing disability, concerns remain regarding Michael’s writing as he is below grade level in this area. Parent and teacher rating scale results indicated significantly elevated scores in the areas of inattention and hyperactivity/impulsivity on the Conners-3, indicating that Michael is exhibiting more frequent behaviors in these areas than others his age. Based on his reported history, rating scale results, and examiner observations, Michael was diagnosed with attention deficit/hyperactivity disorder, combined type (ADHD). The school-based IEP team met to discuss these results and Michael’s needs. The IEP team included Michael’s parents, his classroom teacher, a special education teacher, the school psychologist, and a school administrator. The school psychologist reviewed Michael’s cognitive testing, rating scale results, and the resulting ADHD diagnosis, and the team began thinking about Michael’s needs. While Michael’s test results did not indicate a specific writing disability, he continued to struggle in this area. His IEP team discussed that Michael is often disorganized and distracted during writing tasks and also appears to have difficulty with handwriting, all concerns that frustrate

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Using Medication for ADHD Symptoms

Box 7.5

Exceptional Lives    Exceptional Stories:

Meet Michael  (Continued)

Michael during writing tasks. Based on his belowlevel performance and poor grades in writing, the IEP team concluded that Michael’s diagnosis of ADHD appeared to be significantly impacting his academic performance in writing, and therefore he qualified to receive special education services as a student with an Other Health Impairment.

What are Michael’s strengths and challenges? Strengths: ● Visual processing skills ● Reading and math skills ● Energetic social personality ● A leader in athletics Michael’s challenges include: ● ●









Difficulty remaining seated during class Easily distracted by others around him and extraneous noises in the hallway Difficulty getting organized and started on tasks, especially writing Difficulty completing work due to talking to others and playing with items in his desk Often impulsively calls out in class or bumps into others in line when having trouble standing still Difficulty remembering to bring completed homework back to school

What supports might be helpful for Michael? Several modifications were put in place by the IEP team to support Michael’s academic and behavioral success, including the following: ●













Preferential seating away from distractions and close to the teacher Frequent reminders to remain on task either provided by the teacher or by a timer on his desk A basket of fidget toys he can play with while sitting on the floor listening to the teacher One-on-one assistance from a special education teacher as needed to support his writing needs Permission to dictate writing assignments into a recorder or voice-activated computer The opportunity to use the computer for writing assignments to keep him engaged and on task Shortened assignments, such as one writing prompt at a time, to encourage his compliance with getting started on tasks







Permission to take frequent breaks to get a drink of water or complete a job, like running an errand for the teacher Consultation with the school’s occupational therapist to determine handwriting needs Home-school chart to provide positive reinforcement for writing down homework assignments and returning completed work to school

The IEP team recommended that Michael receive direct instruction from the special education teacher to support his organization and writing skills. The special education teacher worked with his classroom teacher to set a time for Michael to join a small group of students for focused work on how to be organized for success. She also provided one-on-one support for Michael’s writing, teaching him to use Inspiration software to organize his ideas in prewriting and word processing to draft his papers for easier revision. Michael learned the revision process and began to take pride in his written work. Michael’s parents continue to work with him during homework tasks and other multistep activities, such as chores at home. He benefits from using visual supports such as lists to remember his routines in the morning and evening, and he also benefits from the use of timers at home. Michael also benefited from pharmacological management of his ADHD symptoms under the care of his pediatrician. His medicines helped him remain focused, lowered his energy level, and decreased instances of impulsivity during the school day. Michael said that he felt like “his brain was his own” when he took his medicine and that he “could decide what it was going to do!” His teachers and parents also saw the difference. With his medicine Michael was better able to sustain his focus and self-regulate his behavior. This in turn seemed to reduce his anxiety and frustration. Michael was going back to the happy-go-lucky boy his parents had known him to be! With careful planning and support Michael is learning to manage his ADHD and it looks like he will have a successful year.

Reflection: ●

How do Michael’s teacher and parents work together to support his success?

Source: Provided by Dr. Emily King, Licensed Psychologist, Wake County, NC. Reprinted by permission.

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Chapter 7  |  Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD)

7-6  Educational Responses for Children with ADHD

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Two federal laws guarantee a “free and appropriate public education” (FAPE) for students with ADHD (see Chapter 2): the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973. Students with ADHD may qualify for supports and services under either one. There are some different requirements, however, depending on whether service eligibility is through IDEA or Section 504. Look back at Chapter 2 for a comparison of the requirements of IEPs and 504 plans. Section 504 eligibility is often a good choice for students who can be successful in school with minor changes and accommodations, while eligibility through IDEA 2004 may be better for individuals with more intense or wider-ranging needs for support. In addition to considerPlanning the supports and services need for students with ing the level of support needed for the student’s success, ADHD takes a team! parents and teachers should also understand that specific requirements for implementing 504 plans can vary from school to school and that parental rights are not guaranteed under Section 504. Disciplinary infractions are handled differently within IEPs and 504 plans. With the IEP, even if suspended or expelled, a student is guaranteed FAPE, and they may only be expelled up to 10 school days, meeting (manifestation determination) to establish relationship of behavior to disability. (Note: any student who brings a weapon or engages in buying, selling, or carrying illegal drugs may be suspended for up to 10 days.) With the 504 plan, requirements for disciplinary action include: the student may be suspended or expelled for up to 10 days; after 10 days (consecutive or not) a “manifestation determination” meeting must be held to determine if child’s disciplinary behavior is related to their disability; if yes, alternative placement must be found. Exceptions: (1) use of illegal drugs or alcohol relinquishes all 504 rights; (2) use of firearms means removal immediately to an alternative setting and a follow-up meeting must be held after ten days of alternative placement. Both IDEA 2004 and Section 504 require that schools provide students with appropriate supports and services. The vast majority of students with ADHD will be served within general education classrooms with consultation support from special education teachers and/or related service providers.

7-6a  Organizational Structures to Support Students with ADHD Placing students with ADHD on a trajectory for success requires intense, engaging, and sustained multimodal support (Bussing et al., 2012). Multimodal support is a three-pronged approach using pharmacological/medical support, behavior therapies, and academic interventions (Fabiano et al., 2010). It takes a team to provide supports needed; for students with ADHD this team may include medical and mental health specialists in addition to educators and parents.

MTSS Approaches for Students with ADHD The difficulties faced by students with ADHD impact both academic success and behavioral/social outcomes. Students with ADHD experience significantly lower academic achievement, levels of class placement (more remedial classes), and rates of homework completion, while simultaneously showing higher absence and tardy rates, class failure, and dropout rates (Kent et al., 2011). Peer and social relationships are also challenging for individuals with ADHD (Tan & Teng, 2020). Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Educational Responses for Children with ADHD Academic and behavioral successes seem to be directly related. When a student is meaningfully engaged in learning and is meeting with academic success, the student is less likely to act out. By the same token, when a student is able to selfregulate their behavior, make friends, and feel socially accepted, the student is better able to meet with academic success. Many schools are working to support academic and behavioral outcomes for students with ADHD using Multitiered Systems of Support (MTSS). The use of multitiered approaches has been shown to reduce suspension, expulsion, and dropout rates for students with ADHD, and these approaches can facilitate the home/school partnerships so important to the success of students with ADHD (U.S. Commission on Civil Rights, 2019). We can see the importance of this for Rasheed, now in middle school, who is facing some serious academic and social challenges. Rasheed will need both academic and behavioral support at all three tiers (Universal, Targeted, and Intensive) to be successful. Let’s see what that support might look like.

Universal Tier I for Students with ADHD Rasheed’s middle school team, whose motto is “We are a winning team!” has worked together to establish “The Team Rules” (see Figure 7.3) that share expectations. These are consistently used across classrooms, and all students know the consequences for inappropriate behaviors. Having a consistent set of expectations that are clearly and explicitly shared is a starting place for all students. Rasheed’s teachers have also structured their classrooms into “zones” for various activities. The students know that the red zone is for small group activities and the expectations are posted for small-group work. The blue zone is for quiet individual work, and the green zone is for whole class time. Teachers also alert the students when specific behaviors are expected; for example, during a seminar discussion, students are not expected to raise their hand before they speak, but they are expected to use courtesy with their peers. For Rasheed, this new way of interacting was actually disconcerting, and his behavior began to deteriorate without having the clear rule of “raise your hand and wait to be called on before you speak.” Even after a whole-class lesson on this with several reminders, Rasheed was unable to adjust to the new procedures during seminar time and he had also stopped raising his hand to speak during whole-class time. Because of this, his teachers decided to offer some targeted support, Tier II, for some students, including Rasheed.

The Team Rules Show Respect for Others By: ●

Not Interrupting, raising your hand to speak in class, and being courteous

Be Prepared By: ●

Completing work on time, having your materials ready, and keeping track of your assignments

Be a Good Citizen By: ●

Helping others when you can, asking for help when you need it, and working to get along with others

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Targeted Tier II for Students with ADHD His teachers designed a set of lessons on how to participate in a seminar discussion versus a whole-class general discussion. In a seminar discussion the expectations include: no raised hands, free flow of ideas, and courtesy when others are talking. For a whole-class general discussion the expectations are: raise your hand before you talk, wait for the teacher to call on you, and listen to others. For some students who have learned more formal “rules,” it can be difficult to understand situations where the rules do not apply. Rasheed’s teachers modeled the appropriate behavior for the seminar, gave students practice time with immediate feedback, and developed a set of discussion guidelines for the students so that they would be able to participate in the classroom seminars more comfortably. After practicing these skills in a small group with direct support, Rasheed was better able to participate in the seminar with his classmates.

Intensive Tier III for Students with ADHD Rasheed also receives more intensive support for his behavioral needs at Tier III. The school counselor has been working with a group of students on appropriate social skills, particularly those needed for friendships within mixed gender groups. The group meets during lunch on Tuesdays and Thursdays. The counseling group offers a safe place for the students to talk about concerns and to practice their social skills. They use role play to experience different points of view, a technique that has been really helpful. The group has even taken field-trips to local restaurants and movie theaters, which has been really fun for Rasheed and his peers. Rasheed is learning how to interact with others in appropriate ways, which has given him more confidence. A wonderful by-product of this group work is that a friendship has evolved between Rasheed and another student, Collin!

Special Programs: After School, Saturdays, and Summer

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The Incredible Years www.incredibleyears.com

Support provided during the school day to help students with ADHD may need to be augmented with more intense interventions after school, on Saturdays, or through summer camps. Special programs offer a structured context to address learning strategies and/or behavioral needs like peer relationships. Interventions delivered within special programs can be strictly controlled to maintain consistency and a high degree of fidelity of implementation (i.e., using interventions specifically as they are designed). Because these programs do not take place during the school day, they can focus on increasing the intensity of instruction, providing time for scaffolded practice of new skills, and monitoring the effectiveness of the intervention. Group size can be adjusted using small groups for instruction to improve on task behaviors (Hart et al., 2011). Parent support classes can be integrated with these special programs to promote consistent support for the child. Special programs can also be used to support teachers’ professional development, giving classroom teachers a chance to observe and participate in structured interventions to help them learn how to implement similar strategies with their students.

For many students with ADHD, meeting daily classroom expectations can be challenging.

7-6b  Curriculum and Instruction for Children with ADHD Planning to address the instructional needs of students with ADHD begins with an assessment of their strengths and challenges (McLaughlin, 2012).

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For students with ADHD, “instructional needs” will usually include academic interventions and behavioral therapies; assessment information will be needed from both areas. This information lays the foundation for accommodations to help the student meet with success. While some information from the identification process may be useful, often additional information is needed to help us understand the student’s needs in the classroom. This means that we may have to collect our own data for planning instruction. Each student with ADHD will have strengths as well as challenges, and Table 7.2 shares the steps we can follow to get a planning process started if we have to support their success. Table 7.2  Steps for Instructional Planning for Students with ADHD What to do…

Why do this?

How to use this…

Advice

Get to know the student, review the student’s file (IEP or 504 plan) looking for patterns of strengths and challenges, talk with the student, observe the student in class.

This helps us see the big picture so we can understand what the student is facing and how we can best support their learning.

Think about how the student’s strengths can be used to help them learn and what specific difficulties the student’s challenges might create in your class.

Try to put yourself in the student’s place and picture what would help them to be successful in your class.

Identify the ideas offered in the IEP or 504 plan that could help the student meet with success in your class; ask the student what has worked before.

Ideas that have been successful in the past may be the best starting place.

Think about which ideas or strategies will be most effective with your content areas and style of teaching and start with these.

Remember that IEPs and 504 plans are legal documents designed to help us meet the student’s needs, and we must implement these.

Identify the BIG ideas you want your students to understand; these themes or concepts are the most important overarching ones that guide your instruction.

Knowing the BIG ideas that you are teaching will help you and your students organize the facts and skills into meaningful wholes and will reduce fragmentation and isolated ideas.

Structure your lessons around these BIG ideas and share this structure with your students to show them how ideas are related (use graphic organizers to explicitly show this structure).

When we use BIG ideas to organize our teaching, it helps make learning more meaningful and it facilitates memory because information is organized around a central theme.

Consider what additional information about the student you will need to plan your instruction of specific content knowledge and skills.

While the IEP and 504 plans are a good starting place, they often will not have the specific data you need on skills levels to plan your instruction.

Look at your specific teaching/learning goals and design curriculumbased assessments of the skills needed for success. Use these as checkpoints for progress monitoring.

Don’t make this harder than need be—remember you are checking readiness skills for the lesson. If you are teaching reading, use vocabulary words and/or a read-a-loud; for math use a few problems; for writing use prompts to check skills.

At this point focus on skills and check on the student’s baseline readiness.

Plan for supported instruction using UDL ideas (see Table 7.3). Plan for the student’s specific supports and enhancements.

TeachSource Digital Download

You are looking for error patterns that will show you where to start. If you plan ahead to address the student’s needs, your class time is less hectic, more productive, and students are more engaged in learning.

Think about how you can use multiple ways to (a) represent the content, (b) engage the learner, and (c) assess learning. Also think about the FUN factor: will learning be active and enjoyable?

(These may already be part of your curriculum.) When students are actively engaged, they learn more and their behavior improves.

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Chapter 7  |  Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD) The key to helping students with ADHD learn is threefold: identifying the strengths and challenges of the child, selecting appropriate instructional approaches, and implementing these consistently to support the child’s learning (U.S. Department of Education, 2017). Instruction for students with ADHD must be explicit, clearly organized, and clearly presented; contextual, embedded within a meaningful sequence of learning that activates prior experience and knowledge; and strategic, supporting learning with specific approaches that are directly taught (mnemonics for memory, for instance) and other metacognitive approaches. Dr. Edwin Ellis and his colleagues suggest that we use a scaffolded approach that starts with modeling instruction for students with ADHD and builds to increasing levels of autonomy for the learning (Ellis et al., 2011). He characterizes this as three phases: “I do it,” the students watch and the teacher explains both the process and the thinking; “Y’all do it,” pairs or small groups of students engage in helping each other practice the new skill or information; and finally, “You do it,” the student reaches a confidence level to work independently. This approach is highly engaging and allows the student to work toward mastery with a feeling of confidence. While these instructional guidelines are excellent for all children, they are essential for students with ADHD who can easily get lost if our instruction is vague, disorganized, or boring.

Strategies: Four Variables for Success

High Leverage Practices https://highleveragepractices .org

Box 7.6

Learning strategies that promote success can be organized under four variables: time, structure, support, and complexity (Coleman, 2005). These variables can be modified to match the student’s strengths and needs. Some students, for example, just need a little more time to meet with success; others need more structure or support. All students deserve content that is complex, meaningful, and appropriately challenging. The goal is to keep the complexity level of the concepts as high as possible while providing the time, structure, and support the student needs to be successful (Coleman, 2005). Figure 7.4 shows how these variables are related and gives examples of how each can be modified to help students with ADHD be successful in our classrooms.

High Leverage Practices:

High Leverage Practices: 14 Teach Cognitive and Metacognitive Strategies to Support Learning and Independence and 16 Use Explicit Instruction.

High Leverage Practice 14: Teach cognitive and metacognitive strategies to support learning and independence. Teachers explicitly teach cognitive and metacognitive strategies to support memory, attention, and self-regulation of learning. Self-regulation and metacognitive strategies are integrated into lessons through modeling and explicit instruction.

Reflection: ●

Why are metacognitive strategies so important for students with ADHD?

High Leverage Practice 16: Use explicit instruction.

while solving problems, enacting strategies, completing tasks, and classifying concepts. Strategically choosing examples and non-examples to facilitate student understanding, anticipating common misconceptions, highlighting essential content, and removing distracting information. They model and scaffold the steps or processes needed to complete tasks.

Reflection: ●

Explicit instruction has also been mentioned as a key strategy in Chapters 4, 5, and 6; why is this such an important tool to help students learn?

Teachers make content, skills, and concepts explicit by showing and telling students what to do or think

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Educational Responses for Children with ADHD Time is our most flexible resource and it is the easiest one to change, yet in schools we often use time very rigidly. With a little planning, however, we can adjust the time we use for direct instruction, guided practice, and independent practice to better match the needs of our students (McLaughlin, 2012). We can offer additional time for students who need it while shortening the time for others who have already mastered the content. To do this we must, of course, know our students’ strengths and challenges, and this is why our first step in planning is assessment (the data collection outlined in Table 7.2). We also need a classroom that is set up for differentiated instruction so that students can be working on modified assignments when needed. Structure encompasses the content, the process, and the learning environment. Structuring the content helps to make it more explicit for our students (See High Leverage Practices). We can add more structure to the content by organizing it around big ideas, using focus questions, and graphic organizers (see other strategies in Figure 7.4). These strategies help our students see

Time ● ● ● ●

Structure

Content ● BIG ideas ● focus ● advanced organizers ● syllabi ● graphic organizers ● thinking maps ● outlines ● scope and sequence flow ● multiple prompts Process ● task analysis ● timelines ● check-points ● organizational skills ● study strategies Environment ● reduce distractions ● arrange physical environment to match instructional goals ● facilitate autonomy ● allow movement and physical activity

● ●

Extended time on assignments Study sessions and practice time Short breaks for movement Untimed or extended time on tests/assessments After school and/or special programs Use of summer school to focus on one class at a time

Support SUCCESS

Peer Groups ● cooperative learning ● study buddy ● teams for learning ● ask three before me ● think-pair-share Assistive Technology

Complexity ● ●

● ●



use BIG ideas to organize information divide work into smaller units of mastery hands on active learning by doing higher order thinking (critical and creative) teach strategies for analyzing, evaluating, and drawing reasoned conclusions.

◗ Figure 7.4  Four Variables for Success Source: Coleman, M. R., Four Variables for Success. Gifted Child Today, 26(1), 22–24. TeachSource Digital Download   Access online

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TeachSource Video Connection

concretely what the information is and how it is connected with other information they have learned or are learning. We can add more structure to the process of learning by helping our students use task analysis, breaking large complex tasks into the smaller steps needed to complete them. Imagine the panic that students with ADHD feel when assigned a ten-page research paper. Without support, they will likely feel so overwhelmed that they will give up. We can use task analysis to help them identify the steps needed to complete the assignment: ●  Selecting

an approved topic appropriate sources ●   Reading, annotating, and making notes from these sources ●  Developing a thesis statement or main theme ●  Identifying evidence that supports and or refutes this theme ●  Outlining or using a web to organize the paper ●  Drafting the paper ●  Getting feedback on the first draft ●   Revising the paper (perhaps going back through the feedback/revision process) ●  Completing the final draft. ●  Compiling

Watch the video “Edward: Instructional Modifications for a Gifted Student with Attention Deficit Hyperactivity Disorder.” This video is a good depiction of how we can use task analysis (breaking large tasks into manageable chunks) and how graphic organizers support learning for students with ADHD. After watching the Video Case, reflect on how these strategies might also help other students in Edward’s class. What other strategies would you suggest Edward’s teachers use to help him be successful? How might his teachers also nurture Edward’s giftedness? Watch online

We may also need to structure the process by teaching study skills and developing a timeline with checkpoints to help students stay on target. The great news is that while explicitly developing and teaching these strategies to support students with ADHD, many other students in our class are likely to be more successful! Finally, we can structure the learning environment to help students with ADHD focus. We can reduce distractions (e.g., tennis balls on chair feet to minimize noise, use of headphones with soft music, reduced clutter, and visual stimuli in the classroom). We can also set up the physical environment to facilitate whole-group, small-group, and individual activities. By structuring the classroom environment we help all of our students work more productively. The third variable for success is support. Support can be provided in several ways. We can provide more direct instruction, targeted interventions (Tier II), and intensive interventions (Tier III). Peer support can also be helpful through activities like cooperative learning groups or study buddies. There are, however, some pitfalls to peer support that we need to keep in mind: some students really prefer to work alone and will do much better on their own, while some students are easily distracted and may need to work in pairs, not groups. Also, peer support should allow all students to be meaningfully engaged in learning, and remember, peer support does not take the place of our teaching. Additional support can also be provided through assistive technology, discussed later in this section. The fourth variable for success is complexity. More complex content requires that our students think about what they are learning rather than just memorizing isolated facts. With complex thinking, students are asked to identify meaningful patterns and relationships across ideas. Students analyze and evaluate information and learn to draw reasonable conclusions based on evidence. Complexity also involves the use of creative thinking as students

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Educational Responses for Children with ADHD combine ideas in new ways. The content standards discussed next are complex standards that set high expectations for learning. When a student is struggling to meet high standards, we often tend to reduce the level of content complexity in an effort to make things easier (McLaughlin, 2012). Instead of making the content easier, we can provide more time, structure, and support to help the student be successful while maintaining higher expectations (Coleman, 2005). Figure 7.4 is a graphic organizer showing how the four variables are related. As you look at it you will notice that time is at the top: it is the first and easiest variable to modify. Structure and support are directly across from each other and are directly related. If we have not provided the structure a student needs, then we will have to provide additional support (or help) for the student to be successful. On the other hand, if we have provided appropriate structure in the content, process, and environment, then the student is more likely to be able to complete the work independently. Complexity is at the bottom of the figure; it is the foundation that we are strengthening through the other variables. By providing the time, structure, and support needed we can keep the complexity level higher. Our job is to adjust each variable to allow for the right level of student autonomy.

Access to Content Standards: Universal Design for Learning Content standards often present complex outcomes that students are expected to master. For students with ADHD this can be challenging but not impossible. Skills needed for complex learning tasks, like understanding causal relationships within a narrative, differ from tasks like word decoding or memorizing vocabulary. Bailey et al. (2009) describes the following deep processing steps needed for the complex learning task “understanding causal relationships in a narrative”: 1. Strategically allocate attention. 2. Select, encode, and interpret important information. 3. Use story structure to build understanding. 4. Retrieve relevant background information. 5. Generate inferences for interpreting information. 6. Monitor comprehension. These processing skills for understanding causal relationships can be generalized to other complex tasks like understanding and interpreting social cues (Bailey et al., 2009). The difficulty that students with ADHD have is that while they can do deeper processing, they must be sufficiently engaged with the task to maintain adequate attention. Because understanding complex ideas requires deeper, more effortful processing, students with ADHD are not likely to engage in this without specific support and prompting. Direct and explicit instruction on how to make the meaningful connections necessary for building coherent understanding are also needed. Table 7.3 shows how we can use Universal Design for Learning (UDL) with the content standards, helping students with ADHD engage and sustain the attention needed for deeper processing of information. Keeping students with ADHD engaged and on task is the first order of business, and the UDL principles help us with this. Sometimes, however, students with ADHD will be off task. In fact, we can expect off-task behavior if the tasks are too long, too hard, too boring, too repetitive, too vague, or if they require more skill than the student has. We should closely examine the tasks we assign our students to make sure that they are worthy of students being “on.”

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Table 7.3       Using Universal Design Principles to Give Students with ADHD Access

to Content Standards Content Standards Writing Standard Research to Build and Present Knowledge, Grades 9–10 Conduct short as well as more substantive research projects to answer a question (including a selfgenerated question) or solve a problem: narrow or broaden the inquiry when appropriate; synthesize multiple sources on the subject, demonstrating understanding of the subject under investigation.

Multiple Representations ●











Provide several examples of well-written papers as models Develop timelines, checkpoints, and research strategies Use graphic organizers to show relationships among ideas (e.g., hierarchies, compare/ contrast, main idea and supporting details) Develop graphics to show ideas and data Create pictorial outlines showing the flow of ideas Discuss relationships among ideas and examples of support/ evidence for conclusions

Multiple Engagements ●





● ●









Math Standard, High School Geometry: Congruence, Experiment with transformations in the plane Know precise definitions… Represent transformations…

● ●





Describe rotations… Develop definitions of rotations, reflections, and translations…



Written definitions



Pictures showing definitions Use solid shapes and graph paper



Use mirrors to show reflections Find examples of transformations in real life



Draw transformations…







TeachSource Digital Download

Do a task-analysis to outline steps for the project Use software programs to help organize work (e.g., Inspiration) Web-based research to locate reliable sources

Multiple Assessments Written product Oral presentation of main ideas and supporting evidence Debate for students who have drawn different conclusions Photo essay or documentary film on topic

Interview experts Use color-coding for organizing notes and sources Dictate ideas to capture thoughts Use drama to portray ideas Partner with another student to review work and get feedback Draft, get feedback, revise Use flash cards with concepts, definitions, pictures Use manipulatives to explore transformations (e.g., shapes on graph paper, overhead projector) Use movement to show the principles of congruence with a partner (e.g., playing shape charades) Use computer software to experiment with and depict transformations Draw transformations (use graph paper, tracing paper, software) Work with a partner challenging each other to identify and replicate the sequence of transformations made to carry a given figure onto another

Use knowledge of congruence to build something (e.g., picture frame) Assess for knowledge of definitions (e.g., short answer or matching test) Create a piece of art showing congruence or a lack of congruence, incorporating rotations, reflections, and translations if possible Create a photo essay of examples of congruence in real life (e.g., rotations, reflections, or translations) Assess for applications of knowledge of congruence (problemsolving)

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Many apps available for general use can help students with ADHD get organized.

Assistive Technology for Students with ADHD Students with ADHD can benefit from a variety of assistive technologies to help them stay focused and organized. Computer tutorials can be useful for practicing specific skills, because they give the student immediate feedback, use branching programs to redirect based on outcomes, and often use engaging game-like features to keep the students’ attention (see Box 7.7). Another benefit to computer tutorials is that the student’s “failures” are private and can be self-corrected. If the computer tracks progress, the teacher can use this record to monitor the student’s learning.

Box 7.7

Reaching & Teaching:

Using the Pomodoro Technique Online for Students with ADHD

by Jennifer G. Job, Ph.D. Students with even the most dedicated attention spans had difficulty paying attention to their classes when they went virtual during the coronavirus pandemic. For students with ADHD, the situation became untenable: they lost their peer support group, and they were required to sit still in front of a computer screen for hours at a time. The Centers for Disease Control and Prevention (2021) recommends keeping in mind during virtual instruction that students with ADHD need predictable schedules in order to develop a routine, and that teachers should find ways to have children interact with their peers as much as possible while online. Also recommended is encouraging parents to set up a separate, dedicated at-home learning space for their child so they aren’t distracted by the day-to-day activities in the household.

One technique teachers can try, especially with older kids doing more lengthy tasks, is implementing the Pomodoro method for online work sessions. At its core, the Pomodoro technique has students work for 25 minutes on a task, and then take a 5-minute break, and it is a common system used by those with ADHD. Teachers can put a virtual timer up on their screen so that students know they have a set amount of time to get something done. The clock helps take away the “overwhelmed” feeling students with ADHD have when facing a task that seems endless. After doing this a few times, students can reflect on the 25-minute time period. Is it enough? Do they feel like they are accomplishing more? Teachers can adjust the timer to what seems to work best for their classes.

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Chapter 7  |  Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD) Technology that helps with organization is especially useful for students with ADHD. Many apps for life are available that have calendars, daily schedules, to do lists, reminder prompts, pictures of work or exam schedules, and information files that can all be stored on smartphones or tablet computers. Tools like spreadsheets, PowerPoint presentations, and word processing are also helpful for organizing, analyzing, and communicating ideas. In this ever-changing digital age, technology should be much more than just study tutorials or organizational tools. Technology, at its best, should be integrated into the curriculum to support learning, enhance critical and creative thinking, and allow for authentic product development. Today’s students use the Internet to access information on any topic at any time. Apps exist that allow them to compare prices of shoes, track sports teams, and follow key news events. Social networking media allows them to connect with others across the room and around the world. This high-tech environment offers fast ready access to, well, just about everything. But do these technologies keep students more engaged, or are they creating greater distractions? Perhaps the students themselves will teach us how to help them thrive in this rich, interactive digital world.

Behavioral Interventions for Students with ADHD Behavior interventions are a key part of the educational support needed for students with ADHD. The goal of behavior interventions is to help students increase their positive behaviors while reducing behaviors that interfere with learning. School-wide programs like Positive Behavioral Interventions and Supports (PBIS), described earlier, are ideal because they provide consistent expectations for students. There are, however, strategies that classroom teachers can use to support students’ positive behaviors. Table 7.4 shares a list of evidence-based strategies for behavioral interventions that teachers can use with their students. When the student’s behavior is more problematic, specific behavioral intervention plans must be developed. Rasheed, the student discussed earlier in the chapter, not only struggles with ADHD, he also deals with emotional challenges and aggressive behaviors. In elementary school, Rasheed needed a comprehensive and consistently implemented behavior intervention plan which began with a functional behavioral assessment to determine what was motivating his inappropriate behaviors (see Chapters 4, 5, and 6). Rasheed often used inappropriate behaviors to get attention from his teacher and to avoid tasks that he disliked. He was a master at getting the teacher to focus on him until she became so exasperated that she placed him in “time-out”; therefore, he achieved both his goals with his disruptions (attention from the teacher and avoidance of his work). His teacher’s challenge was to find ways to shift this pattern by giving him attention for appropriate behavior and replacing “time-out” with “work-out” where Rasheed was placed in semi-isolation while he completed the expected work. All students can benefit from strategies that help them stay calm and focused. Box 7.8 shares some strategies you can use with students to help calm their minds. Rasheed’s elementary teachers helped him learn how to get attention through appropriate behaviors and taught him specific strategies to ask for help with his work. They also incorporated strategies like the ones in Table 7.4 and in Box 7.8 in his intervention plan. One of the most important things they did, however, was nurturing positive relationships with Rasheed to make sure that he felt strongly connected to his teacher and classmates (Basch, 2011). Involving Rasheed and his parents in developing these plans helped make them stronger. By the time Rasheed was in middle school, his behavioral support focused on making and keeping friends.

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Table 7.4  Evidence-Based Behavior Intervention Strategies Behavior Modification Strategies ●

Premack Principle: “Eat your spinach before you get your cake”—rewards come after completion of required work.



Positive Reinforcement: Recognition, praise, and/or reward for appropriate behaviors



Token Systems: Rewarding specific targeted behavior (e.g., raising your hand before talking)



Behavioral contract with clear expectations, rewards, and consequences



Extinction/Replacement: Ignoring inappropriate behaviors while concentrating on appropriate replacement behaviors



Use of “time-out” to intervene when behaviors are destructive or distracting



Explicitly teach and reinforce prosocial skills (e.g., how to join a play group)

Instructional Management Strategies ●







● ●

● ●

Arrange the physical space to accommodate students (e.g., small-group work, individual work, whole-group work, movement area, flow-pattern for walking, time-out area). Explicitly worded, visible, statements of positive behavior expectations (Show respect for others by raising your hand before talking in discussions. Contribute to the classroom community by helping others when you can. Take care of the classroom environment by keeping it clean and neat.) Give clear directions for tasks, activities, and participation (post these visually as well as presenting orally): Give prompts for moving from one direction to the next, and allow for students to remind each other of next steps when appropriate (“ask three before me”). Provide clear structure and explanations of assignments, process for completion, time expectations, benefits for completion, and consequences for incomplete work (the use of rubrics can be very helpful with this). Use individual, small-group, and computer-assisted learning to support students while building greater autonomy. Provide timely feedback on performance and monitor progress (both academic and behavior): Use encouragement to keep students on task, error analysis to understand and correct mistakes, and praise for work well done. Use movement, active hands-on, multisensory, and participatory lesson formats whenever appropriate. Establish regular communication with parents/guardians regarding academics and behavior, recognizing positive/ appropriate performance and alerting parents/guardians of any concerns (use daily feedback when needed, move to weekly when possible).

Organizational Strategies ●







Teach time management skills beginning with daily schedules, weekly plans in elementary school, and progressing to three-week, marking period, and semester plans at middle and high school. Use color coding on plans to indicate what “must” be done, what “should” be done, and what students would “like” to do. Develop systems to organize school supplies, papers, homework, sports/music/drama, or extracurricular materials. Put in place a daily/weekly checkpoint to keep these things organized and use rewards when this is done. Create organized work spaces (desk and locker at school, work area at home) and monitor these to make sure they are kept “work ready” with supplies needed. Develop routines and checklists for accomplishing daily/weekly activities (at home: check for papers that need to be reviewed and signed, set clothes out the night before, gather all school materials and place them by the door; at school: enter class, place homework in box, take seat, and begin morning work).

Procedures That Foster Self-Regulation, Self-Monitoring, and Self-Directed Learning ● ●









Offer choices in topics, activities, and work groups when appropriate. Use private signals to cue students that their behavior is becoming inappropriate (e.g., hand signals like a third base coach would use, to communicate that the student is bothering others). Allow students to use movement when needed to release excess energy. Set a space in the room for this and clear expectations on how it is to be used so as not to distract others. Teach strategies like count to ten if you are getting upset, jot your idea down instead of blurting it out if you are worried you will forget it, and use courteous language when you need something. Provide opportunities for self-evaluation both on academic work and behavior. Discuss these self-evaluations, offering feedback on how they compare with your own assessment. Plan instruction that will connect in meaningful ways with student interests, and work to show the relevancy of learning to the students’ lives.

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Chapter 7  |  Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD)

Box 7.8

Mindfulness Matters:

Calming My “Monkey Mind”

When we are distracted or distraught, our minds often race around, and it feels like thoughts are just bouncing off the walls so we can’t focus on what we need or want to do. This feeling is often present for individuals who have ADHD. It feels like our mind is a busy little monkey just doing its own thing and we have no control over what it is doing! Why This Matters: “Monkey mind” is a pretty good description of the feeling when our mind is jumping around from thought to thought and/or is distracted by everything in our environment. When this is our state of mind it is impossible to learn because we cannot stay focused long enough to take new information in, let alone process it. Calming the monkey mind is the foundation of mindfulness. Practicing Mindfulness: Calming the monkey mind is one purpose of meditation, and it begins with a simple process of observing the mind as it is—busy, restless, bored, or distracted. Here is how to get started. Talk with your students about how difficult learning is when our minds are busy and distracted, and label this “monkey mind.” Let your students know that you will be practicing some strategies to help calm the monkey mind down so that it can learn! With your students: 1. Find a quiet place where the distractions are naturally minimized (close the classroom blinds, dim the lights). 2. Find a comfortable chair with support for your back so that you can sit up straight (most school chairs will be fine for this) with your feet flat on the floor. 3. Place your hands on your knees, resting them gently. 4. Close your eyes gently (later on eyes can be kept open if distractions are minimal). 5. Breath normally through your nose, follow the breath with your mind, and count “1” as you inhale

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and exhale; continue counting until you reach “11” and then begin again with “1” (with more practice you can count to 21). 6. Guide your students with quiet instructions to “breathe in and feel the breath fill your lungs… breathe out and feel the breath leaving your body…count one; breathe in and feel the breath fill your lungs…breathe out and feel the breath leaving your body…count two…” 7. During the breathing, different thoughts may enter your mind; this is monkey mind trying to get your You may think attention and interrupting you. “Oh, I have to remember to take my library book back” or “I am hungry—when is lunch?” or even “This is really boring, when is recess?” Calmly tell little monkey mind that you are breathing and ignore its interruption. Don’t worry about how many times it interrupts you—just remind it you are breathing and go back to counting. Eventually little monkey mind will settle down. 8. Ask your students how this felt—what did little monkey mind do? Did it interrupt you? Were you able to calmly go back to counting your breathing? Sometimes when we are just starting to practice, monkey mind gets nervous that we are ignoring it and it can get really active. That is OK; just remind monkey mind that you are learning to count your breath and it does not need to worry! This practice can be useful for the whole class or it may be a technique that you want to share with only some of your students. It works best if you set aside at least 5 minutes for practice, and if you can model this for your students, it will inspire them to try it. The more you practice this the calmer little monkey mind becomes!

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7-7  Families of Children with ADHD Families of children with ADHD play a critical role in helping the child learn to cope with difficulties, learn positive behaviors, and develop the self-regulation needed for success. This can, however, be challenging, especially if parents face some of the same difficulties as their child; remember ADHD has been shown to be highly heritable! By definition, ADHD symptoms must manifest in more than one setting, with dysfunctional behaviors present in both school and home. Parenting becomes more difficult as the complexity of the child’s needs increases. The parents of children with opposition defiant or conduct disorders in addition Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Families of Children with ADHD

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to ADHD, for example, report higher levels of stress, anxiety, depression, feelings of inadequacy, and conflict within the family than those whose children have only ADHD (Deault, 2010). Deault (2010) also found a strong interaction between a parent’s level of functioning and the intensity of a child’s disability. In her systematic review of the literature, she noted that longitudinal studies showed that over time, parenting behaviors seem to be shaped by the child’s behavior. Parents of children with ADHD and opposition defiant disorders gradually become more reluctant to discipline their child, while parents of children with ADHD and conduct disorders reported increasing levels of distress as their children reached the teenage years (Deault, 2010). The interactions between genetic predispositions for ADHD (and other mental health challenges) and environmental circumstances show that some environmental factors seem to add risk to the outcomes. Not surprisingly, All family members are impacted by a child’s ADHD, and everyone can help be supportive. when families faced negative life events (e.g., poverty, unsafe neighborhoods, limited healthcare) Rydell (2010) found that their children’s symptoms of ADHD seemed to increase. The overall quality of life was reported as lower by parents of children with ADHD, and the continued presence of challenges seems to take a serious toll on the family’s well-being (Danckaerts et al., 2010; Sciberras et al., 2011). Since the role of the family, and especially parents, is so important, Gerdes et al. (2012) strongly advise family and parent interventions in addition to working with the child with ADHD. They found positive results for parents who participated in an 8- to 12-week training program focused on behavioral therapies and specific parenting skills. Participating mothers reported reduced stress levels, fathers reported greater involvement with their child, and both sets of parents indicated a use of more consistent discipline (Gerdes et al., 2012). The National Resource Center on AHDH offers parent workshops on the following topics: ●  Establishing ●  Learning

house rules and structure to praise appropriate behaviors while ignoring mild inappropriate

behaviors appropriate commands ●  Using “when…then” contingencies (such as when your room is clean, then you can play baseball) ●  Planning ahead for public outings and practicing appropriate behaviors ●  Using “time-out” as a consequence for inappropriate behavior ●  Using charts, points, and token systems to reward appropriate behaviors ●  Using a school-home note system to communicate and track academic and behavioral accomplishments (CHADD, 2004) ●  Using

One system for establishing home-school communication is the daily report card (DRC). Benefits of the DRC have been described as (a) increasing timely communications between school and home, (b) helping teachers and parents maintain the focus on IEP goals, (c) enhancing the use of data to monitor the child’s progress, (d) increasing the likelihood of consistent rewards and consequences for behaviors, and (e) providing timely feedback to students on their progress. The daily report card’s main value seems to be enhancing the home-school relationship and monitoring the child’s progress. Helping children learn to stay organized, follow a schedule, and control their impulses can be difficult. Parents are often juggling multiple family needs with work and other demands. Setting home routines and consistent expectations is a foundation for the child. Box 7.9 offers advice for families on supporting their child’s organization. Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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Chapter 7  |  Children and Youth with Attention Deficit/Hyperactive Disorders (ADHD)

Box 7.9

Tips to Help Kids Stay Organized and Follow Directions

Schedule. Keep the same routine every day, from wake-up time to bedtime. Include time for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible. Organize everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys. Use homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the

importance of writing down assignments and bringing home the necessary books. Be clear and consistent. Children with ADHD need consistent rules they can understand and follow. Give praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it. Source: National Institute of Mental Health. (2008). Attention Deficit Hyperactivity Disorder (ADHD). Bethesda, MD: Author.

One of the primary responsibilities parents face is the decision about medications for their child. Meeting with physicians is critical, and weighing the pros and cons of medicines can be difficult. Parents will also be the ones who must monitor the impact of medications, with input from teachers. Keeping a behavior log is a useful way to track the impact of medications; parents and teachers make note of the child’s eating, sleeping, and mood patterns as well as specific behaviors. This information is especially helpful when new medication is prescribed or there has been a change in medications. As with all children, being a parent of a child with ADHD is a full-time job that continues throughout the child’s life.

7-8  Transition to Post-secondary and Adult Life for Individuals with ADHD The difficulties experienced by children with ADHD may change as they grow up; however, the challenges do not seem to diminish (Boyle & Scanlon, 2019; Frodl & Skokauskas, 2012). Academic problems persist and may even increase (Gerber, 2012), social difficulties with peers may worsen (Wehmeier et al., 2010; Willoughby & Evans, 2019), abuse of alcohol, drugs, and nicotine may emerge (Charach et al., 2011), and individuals may be a greater risk for involvement with the juvenile justice system (Bussing et al., 2010). Biederman et al. (2010) studied the persistence of ADHD symptoms in a sample of 110 boys as they moved from childhood to young adulthood. Kuriyan et al. (2013) found that young adults with ADHD are 11 times more likely to be unemployed, much less likely to complete a 4-year degree, and earned less per hour than other adults. A disappointing trajectory for students with ADHD, however, is not written in stone. Protective factors for youth include early intervention and support (Bussing et al., 2012), strong parenting (CHADD, 2008), and intensive educational support including strategies for coping and learning (Kent et al., 2011). An estimated 2–8 percent of college students have ADHD, many of them report that they struggle more than their peers without ADHD, and fewer complete their postsecondary educational programs (Boyle & Scanlon, 2019; Rooney, 2011; Willoughby & Evans, 2019). Students who seem to be successful in college

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Summary report strong time management, organization, study skills, and self-regulation strategies; the good news is that all of Moral Dilemma: these skills can be taught (Rooney, 2011; Austin’s Behavior Willoughby & Evans, 2019). Gifted students with ADHD seem to have educational outcomes that are more similar to their gifted peers than to their ADHD peers Austin, a child in your fifth-grade class, is struggling. He has been identified with ADHD and his constant motion, impul(Bussing et al., 2012). While teens and adults sive outbursts, and disorganization are causing him difficulare often more likely to stop taking medicines ties and disrupting the learning of others. Austin’s parents (Kent et al., 2011), studies have shown that do not believe in medication and expect you to modify your continued use of medication as part of a mulclassroom for Austin. While you have made several accomtimodal approach to regulate ADHD symptoms modations, Austin’s behavior continues to create problems. may be helpful (Wehmeier et al., 2010). You feel that he will not be successful in middle school given A strong transition from the childhood home his current functioning. You have a conference coming up to postsecondary education or employment is with his parents and are wondering how to share your conkey to success. Incoming college students need cerns. What will you say? to be connected with student disability offices on campus, and many schools offer the ability to continue the accommodations that made students successful in K–12. Student health services must be utilized to ensure consistent and ongoing access to medications. Employers must be made aware of accommodations that will help their employees with ADHD confidently and competently complete their tasks. To place a child with ADHD on the pathway toward a successful life it takes a concerted team effort. Early intervention, consistent and continued support for the child and family, and multimodal approaches that combine medicine, behavioral therapies, and educational interventions are needed to help children with ADHD grow into happy, productive adults.

Summary ●  ADHD

involves a combination of challenges that impact the individual’s ability to sustain attention, restrain impulsivity, and control activity levels. ●  Although ADHD is a relatively recent term, educators and medical professionals have long recognized its symptoms. ●  ADHD presents in a variety of ways, although it typically results in executive function deficits of some sort. Some students will suffer from inattention, others hyperactivity, and others from both. The DSM-5 is used by clinicians to make an ADHD diagnosis. ●  Clinicians often use rating scales to make an ADHD diagnosis in addition to clinical observation and other diagnostics, including intelligence tests. Input from parents and teachers is vital to correctly identifying students with ADHD, because the diagnosis cannot be made without confirmation that the ADHD behaviors are present in multiple settings (home and school). ●  Students from culturally/linguistically diverse backgrounds are more likely to be misidentified as having ADHD. Girls are also more likely to be overlooked as having ADHD. ●  It is difficult to accurately count the number of students with ADHD due to the wide range of symptoms and the fact that ADHD is often comorbid with other disorders. ●  ADHD is thought to have both neurological and genetic causes. Environmental factors also play an important role in the manifestation and management of ADHD symptoms.

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multimodal treatment including medication, behavior therapies, and educational interventions is the most effective way to address the needs of students with ADHD. ●  Students with ADHD may qualify for supports and services under IDEA 2004 or Section 504; some students may not qualify for services, but educators can still adapt instruction to meet their needs. ●  Multitiered Systems of Support can provide the academic and behavioral support students with ADHD need to be successful. ●  Instructional planning for students with ADHD should consider the supports and services offered under IDEA 2004 or Section 504. Teachers should also work with other professionals such as the school psychologist or special education teachers to develop appropriate instructional strategies. ●  Universal Design for Learning offers one way to make the curriculum accessible for students with ADHD. Time, structure, support, and complexity should all be considered as elements of effective instructional planning. ●  Assistive technology can be used to help students with ADHD stay organized and on top of tasks. ●  Modifications to the learning environment and evidenced-based behavioral modification techniques are also vital components of a successful strategy that meets the needs of students with ADHD. ●  Families play a vital role in the success of students with ADHD. Schools can work with parents to support students’ learning. The importance of support for parents of children with ADHD should not be overlooked. ●  Students with ADHD can have productive, happy lives with support and a strong educational foundation.

Future Challenges 1. Families are critical to the success of children with ADHD. How can we better support families in the development of strong parenting skills? A substantial body of research shows that enhancing parenting skills is an evidence-based practice to help children with ADHD be more successful. Parent training programs exist; however, few parents participate in these. How can we make parent support and training programs more accessible so that more parents can participate in them?

2. Although Latino, African-American, and children living in poverty are at a higher risk for being identified with ADHD, they are also less likely to receive appropriate supports and services, especially medication as part of a multimodal approach. How can we ensure that we are not inadvertently overidentifying children from culturally and linguistically diverse families because of biases in the identification process or assessment tools? And how can we simultaneously ensure that all children who do have ADHD have equal access to the interventions that will help them be successful?

3. As we learn more about the interaction of genetic predispositions and environmental risk versus protective factors, how can we improve outcomes for students with ADHD? Although there is a strong indication of genetic predispositions for ADHD, we also know that factors in the environment can act as either protective agents or risk enhancers. How can we identify these factors so that we can increase children’s protective factors to minimize the impact of their ADHD? TeachSource Digital Download

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Resources of Special Interest for Teachers

Key Terms attention deficit/hyperactive disorder (ADHD) p. 221 comorbidity p. 226 contextual p. 242 differentiated instruction p. 243 explicit p. 242 fidelity of implementation p. 240

metacognitive p. 242 multimodal support p. 238 neurotransmitters p. 235 phenotype p. 233 strategic p. 242 task analysis p. 244

Resources of Special Interest for Teachers Hallowell, E. M. & Ratey, J. J. (2011). Driven to Distraction. New York, NY: Touchstone. This classic book is one of the first to describe what having an attention deficit disorder is like. The authors, who both have ADHD, share their experiences, challenges, and pathways to success. The case studies present excellent snapshots of individuals with ADHD and help the reader build an understanding of what ADHD is and how it can be addressed. For teachers and parents, this book remains a must-read. Journal of Attention Disorders focuses on basic and applied science concerning attention and related functions in children, adolescents, and adults. JAD publishes articles on diagnosis, comorbidity, neuropsychological functioning, psychopharmacology, and psychosocial issues. The journal also addresses practice, policy, and theory, as well as review articles, commentaries, indepth analyses, empirical research articles, and case presentations or program evaluations.  http://jad.sagepub.com/ American Academy of Child & Adolescent Psychiatry ADHD Resource Center is a hub for families to find professionals to help with diagnosis and treatment. There is also a library of resources for helping families understand and navigate the disorder. www.aacap.org/aacap/Families_and_Youth/Resource_Centers/ADHD_Resource _Center/Home.aspx Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD) serves as a clearinghouse for evidence-based practices to work with students with ADHD. The organization also hosts support groups for families and individuals and advocates for better public policies to respond to the needs of those with ADHD. www.chadd.org/ ADDitude is a magazine dedicated to dealing with ADHD issues, including parenting and teaching. Readers can find articles on everything from teaching students with ADHD to helping someone with ADHD keep a clean and organized room to dating with ADHD. https://additudemag.com

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High-Incidence Exceptionalities

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Children and Youth with Emotional and Behavior Disorders

8 Ch ap te r

Standards Addressed in This Chapter All of the CEC Initial Practice-Based Professional Preparation Standards for Special Educators (K–12) are addressed within this Chapter. Please see the inside book cover for a list of these standards.

Focus Questions 8-1 What are the early roots of the field of education for children with emotional and behavioral disorders (EBD), and how has the field evolved? 8-2 What are some characteristics of students with EBD? 8-3 How is EDB defined, and what role might systemic racism and implicit bias play in the identification of students with EBD? 8-4 What are some possible causes and correlated constraints related to EBD? 8-5 How can the Information Processing Model (IPM) help us understand the strengths and challenges of students with EBD? 8-6 What educational responses are needed to help address the strengths and challenges of students with EBD? What does “wrap-around support” look like? 8-7 What roles can family and community play in supporting children and youth with EBD across their lifecourse?

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A

person’s behavior is one form of communication. Behavior is observable; how we act and what we do at any given time, within any specific context, is an indicator of how we feel, what we need, and what we want. For students with emotional and behavioral difficulties, we need to try and understand what their behaviors are telling us, because in many cases their actions really do speak louder than their words! In this chapter, we will take a deep look at the strengths and challenges of children and youth who have emotional and behavior disorders. We will look at the disruptions that emotional and behavioral problems can cause for the student, their classrooms, and their family. And we will examine ways in which we can provide wrap-around support to enhance the student’s social and academic success.

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders

8-1  History of the Field of Emotional and Behavior Disorders Our understanding of the field of emotional and behavior challenges has changed dramatically over the years. Three centuries ago, children with behavior problems were often believed to be possessed by the devil or morally deficient. When anyone paid attention to them at all, they were shut away in large institutions with very little effort directed toward their education. The professionals who dealt with them were largely physicians or clergy. Beginning in the late 1800s, children who were considered to be significantly different from their age-mates were put into special ungraded classes, with little attention paid to their individual or special needs. Jean Itard and Edward Seguin, both physicians, became important figures in treating children with behavior problems (as they did with children with intellectual disabilities as discussed in Chapter 4). After World War II, the responsibility for children with exceptionalities gradually shifted from the medical professionals to educators. As schools assumed greater responsibility, the focus became increasingly behavioral and educational. Psychologists and educators took the lead in examining human development and behavior. The psychologist Abraham Maslow (1908–1970), was influential in understanding maladaptive behaviors, but he took a slightly different approach. He was interested in the factors that made people “mentally healthy.” He studied successful individuals, rather than those who suffered from mental illnesses (Bergin & Bergin, 2019). Through his work, he developed a hierarchy of needs that he believed an individual must address to reach what he considered the highest outcome, self-actualization, or the fulfillment of one’s potential in ways that contributed to the society. Maslow’s hierarchy of needs (see Figure 8.1) moves from basic physical needs (e.g., food, sleep, exercise) to more complex psychological

SelfActualization Aesthetic Needs

Need to Know and Understand

Self-Esteem Needs

Belongingness and Love Needs

Safety and Security Needs Physiological Needs (Nutrition, Sleep, Exercise) ◗ Figure 8.1  Maslow’s Hierarchy of needs Source: Bergin and Bergin, 2019 Child and Adolescent Development in your Classroom, Cengage page 162.

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Characteristics of Students with EBD human needs, including safety and security; belonging and love; self-esteem; the need to know and understand; aesthetic needs (e.g., for beauty and balance); and, finally, to the pinnacle of the pyramid, self-actualization. Maslow believed that unmet needs were the root of many behavioral and emotional problems (Bergin & Bergin, 2019). According to his theories, it is not possible to move up the developmental hierarchy until the lower needs are satisfied; in other words, if a person’s basic physical needs are not met, the person will prioritize those needs and will be unable to develop further until those needs are met. For instance, if a child does not have safety and security, or, if the need for belonging is not addressed, then they will not be able to focus on the need to understand or self-actualize. In Chapter 2, we looked at the need for belonging, and we will examine this idea further within this chapter as we explore ways to provide the intense support that students with emotional and behavioral problems (EBD) require to be successful. Today we are aware of the bioecological and social factors that influence children’s development (see Bronfenbrenner in Chapter 1), and we know that interventions must also include changing and improving the child’s social and educational environments. In this chapter, we explore our current understandings of human development, and we look at the bioecological and behavioral supports and services needed for each student’s success.

8-2  Characteristics of Students with EBD Children and youth who have emotional and/or behavioral problems form a varied group, and they can be found in every economic stratum, across all racial and ethnic groups, and within all types of families. What they share are difficulties adjusting to the social and behavioral expectations that are the norm for most school settings. Students may have challenges in social situations with making friends or engaging in appropriate play activities, coping with typical social difficulties (e.g., not being selected to participate in a game), or responding appropriately to adult authority. Other problems may include difficulties with self-regulation, depression, managing frustration, and anger, or handling disappointments. Students with EBD often face academic challenges, and they may struggle with schoolwork. It is not unusual for students with EBD to have comorbid learning disabilities, intellectual disabilities, or attention deficits; or they may have an autism spectrum disorder that compound their challenges and make learning and social adjustment even harder. Let’s meet two students who have been identified as having EBD. Pete is an eighth grader attending a large urban middle school. He currently lives with his mother, grandmother, and younger sister, Nadria. He is very protective of Nadria and walks her to elementary school each day before he goes to school. Pete has a great sense of humor, but he sometimes uses his gift for getting laughs inappropriately. He is well known for acting “too cool for school,” and he seems to take pride in his reputation for distaining authority. He is a member of a local gang known as the Griffins that, on occasion, terrorizes other students in the school. Gang members are suspected of stealing from local stores and delivering drugs. Pete is a good example of a student who has both academic and behavior problems that interfere with his school performance. When he finds an assignment difficult, he will loudly protest that the work is stupid or boring, and he says that his teachers “can’t make him do it!” His teachers have started to believe that he is right, they can’t make him do it, and they are about to give up on him. Pete does not appear to be depressed or anxious, but his acting-out behavior is becoming more and more difficult to handle. Kendall is also in the eighth grade. She is an only child and lives with her parents in a large home within a gated community. She attends a private school in

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders which students must wear uniforms and participate in at least two extracurricular activities (e.g., sports, debate, key club). Kendall has refused to select her extracurricular activities, giving lots of reasons why she will not participate (e.g., she won’t wear the athletic uniform for sports; she does not like to speak in public, etc.). Kendall has worked with younger students as a study-buddy and seems to like this role, but being a study-buddy is not on the list of approved extracurricular activities. She also has two dogs and is good at training them; however, animal-related options are not on the approved list, either. Kendall has always been shy, but she has become so withdrawn that it is challenging to get her to attend school at all. She has also begun refusing to eat, and her parents suspect she is vomiting after her meals because she has lost a considerable amount of weight. Kendall used to bring a friend home on occasion, but she now claims that she has no friends and is not interested in making any. Her grades are slipping from A’s and B’s to C’s & Incompletes. Her teachers and parents are worried. Throughout the chapter, we will continue to check in on Pete and Kendall to learn about the kinds of support they are getting to help them cope with their challenges and to see how they are doing.

8-2a  Strength-based Approaches to Support Positive Identity Formation When we encounter students having EBD, we often focus almost exclusively on their problems, because these tend to feel overwhelming and can even be life threatening. But if we overlook the child’s positive identity—the strengths of students with EBD—our attempts to help them may actually fail. Focusing only on a student’s difficulties reinforces a negative identity and promotes a belief that the student is just “problematic.” When we hold a negative one-dimensional view of the student, we trap everyone—the student, the teacher, and the parents—in a downward spiral that may become a self-fulfilling prophecy. By recognizing and reinforcing a student’s strengths, we can ensure that we are looking at the whole child (Yeager et al., 2021). Through focusing on the student’s strengths, we also help students redefine themselves more positively and develop a more positive identity. Because students with EBD often have a negative view of themselves, supporting their positive identify formation is critical (Coleman et al., 2021). We can address three interrelated components within positive identity formation: selfconcept (i.e., how I define who I am); self-esteem (i.e., how I feel about and value myself); and self-efficacy (i.e., my belief in my ability to be successful at a given task). A person’s self-concept is significantly influenced by how others whose opinions the child deems significant see and define them. Who is included in the “significant” group will change over time; the group starts with parents and family members, followed by teachers and peers. For Pete, who we met above, the Griffins are key, and it is important to him that gang members see him as cool. Self-esteem is the value or sense of self-worth that a person holds. This value is based in part on the individual’s self-concept. Kendall’s self-esteem is very low; she does not feel much self-worth in part because she has a negative self-concept. Self-efficacy, a belief in one’s ability to accomplish a given task, incorporates not just self-concept and self-esteem, but also the individual’s prior experiences with similar tasks and/or their observations of similar people performing similar tasks. Both Pete and Kendall suffer from low self-efficacy. Pete is quickly losing his confidence in his ability to be successful in school, and his self-efficacy for schoolrelated tasks is really low. Kendall struggles with her shyness, and she feels that no one likes her; her self-efficacy for making friends and fitting in is very low. These three areas are interconnected: the more positive the individual’s selfconcept, the higher their self-esteem will be; the more successful they (or their role models) have been with prior tasks, the more confidence they will have in their

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Emotional and Behavior Disorders: A Slippery Definition

Box 8.1

EBD:

Remember Our Super Powers!

When we focus only on students’ problems, we come to see students as one-sided, and in doing this, we may forget that they also have strengths. We may have to remind ourselves (and our students) that their strengths are important parts of who they are. Here are some strengths that students with EBD say they have: ● ● ●

● ●

“I am really good at ‘reading’ people and situations—like, I know right away when you are getting mad.” “Being funny, I make people laugh and I like to do that.” “It is hard to say what I am good at; sometimes I think that there is nothing that I can do, but then my dog licks my face, and I guess if she loves me, I must be ok.” “I am good at knowing when someone is sad and empathizing with them.” “Building things like cars; I have a car that I re-built, and I can drive it.”

ability to perform similar tasks (i.e., the stronger their self-efficacy). Self-concept, self-esteem, and self-efficacy all influence the individual’s identity formation in either positive or negative ways. When we remember that our students have strengths that we can build on, we can help influence their identity formation in positive ways (Collins et al., 2022). Strength-based approaches scaffold supports around the strengths of the individual and the assets of the family, neighborhood, and community (Yeager et al., 2021; Coleman, 2016). If we do not incorporate a strengths-based approach to supporting students, they may spiral downward into learned helplessness, the belief that nothing they can do will stop bad things from happening and that they are doomed to fail no matter what they do (discussed in Chapter 4). Learned helplessness results in students giving up without really trying. They quit early when faced with new or different tasks that they find challenging; why should they try—they will only fail. The student’s academic performance may be much worse than they are capable of, as a result of being so pessimistic about their ability to succeed. Children who have reached the point of “learned helplessness” often have such low selfconcepts that failure in a school task or a social setting only confirms for them their worthlessness. Kendal’s withdrawal from all school-related challenges and her marginal effort to complete schoolwork is quickly becoming learned helplessness: she claims that it just doesn’t matter what she does; she will never be accepted in school and is always going to be a failure, so why bother?

8-3  Emotional and Behavior Disorders: A Slippery Definition The legal definition of EBD as found in the Individuals with Disabilities Education Act (IDEA) of 2004 is given in Table 8.1. As you review this definition, you may find that you recognize yourself. After all, who among us has not been concerned about interpersonal relationships or experienced periods of depression or engaged in inappropriate behavior at one time or another? What separates children with EBD from most of their peers is not the kind of behavior shown but the intensity and duration of that behavior. Concerns for the student arise when the intensity of their feelings or behaviors are extreme and persistent across most environmental contexts. If our concerns are strong enough, we may refer the student for possible identification of EBD so that they can get the support they need.

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders

Table 8.1  Federal Definition of Emotional and Behavior Disorders (i) Emotional disturbance means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance: (A)  An inability to learn that cannot be explained by intellectual, sensory, or health factors. (B)  An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. (C)  Inappropriate types of behavior or feelings under normal circumstances. (D)  A general pervasive mood of unhappiness or depression. (E)  A tendency to develop physical symptoms or fears associated with personal or school problems. (ii) Emotional disturbance includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance under paragraph (c)(4)(i) of this section. Source: Individuals with Disabilities Education Improvement Act of 2004, Pub. L. 108–446, U.S. Department of Education, Washington, D.C.)

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One problem with the definition of EBD is how to determine whether students are experiencing a “normal” amount of unhappiness or if their intense unhappiness threatens to swallow them up and destroy their ability to perform academically. Furthermore, we must decide what should be considered a “satisfactory” relationship and how one defines a “marked degree” or “inappropriate” feelings (Sullivan, 2017). The vague nature of the definition allows for a wide range of interpretations and begs the question: “Where are the dividing points?” The definition’s wide latitude for professional judgment is a double-edged sword. When wielded appropriately, with cultural competence, the EBD definition can help identify students who need services; but it can also open the door to implicit bias in the identification process (Sullivan, 2017). Another problem with this definition is in the final statement in Table 8.1, which says that the term “does not apply to children who are socially maladjusted unless it is determined that they have an emotional disturbance.” Few professionals agree with this statement; most believe that we should be trying to treat both emotionally disturbed and socially maladjusted children. The schools have, by and large, handled this problem by assuming that any child showing serious behavior problems can automatically be assumed to be emotionally disturbed and thus eligible for support. The definition of emotional disturbance has yet another serious shortcoming. Several observers have pointed out that the federal definition places all responsibility for the problem on the child and none on the environment in which the child exists, making it the responsibility of the special education program to change the child but not the learning environment, which may itself be considerably flawed. Focusing exclusively on the child as the challenge also fails to consider the critical interactions between the child and their extended environmental context of family, neighborhood, school, and community (Farmer et al., 2020). This extended context, as we saw in Chapter 1, can have a profound influence on human development and can A child’s behavior is telling us something about their needs. play a central role in providing the wrap-around

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Emotional and Behavior Disorders: A Slippery Definition support students with EBD need (Farmer et al., 2022a). It is not easy to determine emotional and behavior disorders in children, and the current IDEA definition of EBD, which relies heavily on individual perspectives and clinical judgment, likely contributes to many of the barriers faced by this special field.

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Council for Exceptional Children’s Division for Emotional and Behavior Health https://debh .exceptionalchildren.org/

8-3a  DSM-5 Clinical Areas Related to Emotional and Behavioral Disorders Identifying, or diagnosing, these disorders is the purview of psychologist and medical teams, not the responsibility of educators. But an understanding of the medical community’s definition of mental health, while outside the educational arena, may help us understand the extent of the challenges some students with EBD face. The Diagnostic and Statistical Manual of Mental Disorders: DSM-V (American Psychiatric Association, 2013) lists several areas, or “conditions” that may pertain to students with EBD. Table 8.2 list some of these disorders to exhibit the range of challenges that students with EBD may face. The areas of challenge described in Table 8.2 are very real for some students, and students dealing with these challenges often have great difficulty with daily life tasks, including learning in school. Think back to Pete and Kendall: which of the areas given in Table 8.2 might be challenges for each of them? Understanding

Table 8.2  DSM-5 Disorders Related to Students with Emotional and/or Behavioral Challenges Examples of DSM-5 Disorders Related to Students with Emotional and/or Behavioral Challenges Disruptive, Impulse Control, and Conduct Disorders

Oppositional Defiant Disorder—repeated displays of anger, argumentation, vindictive behaviors.

Involve difficulties with selfregulation which impact other people in social and learning settings and may focus on those in authority.

Intermittent Explosive Disorders—Discrete episodes of aggressive behaviors that result in serious assaults or property damage.

Anxiety Disorders

Generalized Anxiety Disorder—inordinate worry and rumination about a variety of scenarios which leads to agitation, loss of energy, difficulty focusing, irritability, and problems with sleep.

Involve disproportionate levels of fear relative to the actual danger and maladaptive behaviors to avoid anxietyprovoking entities or situations.

Conduct Disorders—aggression toward people or animals, destruction of property, deceitfulness, theft, serious transgression of rules

Social Anxiety Disorder—fear of being negatively evaluated by others in social situations (e.g., meetings, encounters with unknown people, public speaking) which leads to inappropriate avoidance. Selective Mutism—reticence to speak in normal situations where speech is expected which is not due to lack of ability to speak.

Trauma and Stress Related Disorders Result from experiences of trauma or intense stress.

Feeding and Eating Disorders Involve persistent difficulties with food and inappropriate, sometimes life threatening, eating behaviors.

Reactive Attachment Disorder—chronic pattern of emotional withdrawal and lack of seeking comfort when dis-tressed; minimal social responsiveness and positive affect, periods of prolonged sadness. Post-traumatic Stress Disorder—reoccurring distressing memories/flashbacks, reactive distress, nightmares resulting from direct or vicarious experiences of trauma (e.g., violence, assault, life threatening events). Anorexia Nervosa—refusal to maintain a minimal normal body weight, significantly distorted perception of body shape and size. Binge-Eating Disorder—rapid and abnormal consumption of large quantities of food while unable to control this behavior.

Adapted from the American Psychiatric Association, & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA.

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders the levels of challenges that our students with EBD face can help us respond with the intense and compassionate support required to help them be successful.

8-3b  Classifications of EBD: Internalizing and Externalizing Behaviors As you look at the challenges described in Table 8.2, you may notice that these problems seem to manifest in two distinct ways: some students seem to externalize their difficulties, or behavior disorders, while other students internalize them as emotional disorders. Externalizing behaviors are directed outward, focusing on others (e.g., people, animals, or things) and may include behaviors that are disruptive, hyperactive, destructive, and/or, aggressive. Pete’s behavior tends to be externalizing, using distractions to avoid tasks he does not feel he can do. His behavior is becoming more disruptive, and on occasion, his humor is verbally aggressive. With internalizing behavior, the behaviors are directed inward, at the self, and may include depression, withdrawal, anxiety, shyness, unhealthy eating or restriction of food, suicidal ideation, or phobias. Kendall’s behavior is internalizing and includes her determined withdrawal from school, peers, and family. The acceptability of a wide range of behaviors, however, depends on the attitude of the perceiver and can be influenced by implicit bias, as we have seen in earlier chapters. We noted earlier that the federal definition focuses on the child and not on the child’s environment, but we cannot take the child and their behavior out of context. We need to remember that the home and neighborhood environment, as well as the learning environment we provide at school, may exacerbate difficulties for some students (Farmer et al., 2022a).

8-3c  Possible Role of Implicit Bias and Systemic Racism in the Identification of Students with EBD Earlier in this chapter, we discussed both the DSM-V and the IDEA definition of EBD and raised concerns that the very nature of the definition’s ambiguity opens the door to implicit bias. This bias can also lead to possible systemic racism. Everyone agrees on this one fact: even though Black children only make up 13 percent of the population, they make up 25 percent of children referred for EBD services, suggesting a significant racial bias in identification (U.S. Department of Education, 2021). The question is, why? While Sameroff (1990) reported risk factors for child development derived from the family and the social surroundings, Hart (2009) added another risk factor—the school setting itself. Hart (2009) reported on four case studies of minority children in programs for emotional development. In one, Kanita, a student in a school serving primarily low-income Black students, was referred for disruptive and noncompliant behavior. Below is a description of Kanita’s classroom by the observer: There is little student involvement. Some are looking at what their classmates are doing at the computer. At least one student is cutting paper while others look aimlessly around the room…. The boy sitting next to me keeps talking to Kanita, who is at the computer. Someone tells the teacher that Kanita is doing Math Corner on the computer and the teacher tells her not to. Kanita replies she is going to do it anyway. (p. 155) The question is whether Kanita’s “troubling” behavior represents “troubled” behavior, as in emotional disturbance. School personnel believed that Kanita’s problems stem from her mother’s months-long incarceration. In fact, observations in the home itself revealed Kanita was in a warm and supportive environment with

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Causation of Emotional and Behavior Disorders

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8-4  Causation of Emotional and Behavior Disorders As we have learned more about human development, we have come to realize that while our genetics can have much to do with our behavior (e.g., characteristics such as impulsiveness), the influences of our environment are also paramount in shaping outcomes (Farmer et al., 2022a). Bronfenbrenner (1995) focused on the family as a child-rearing

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other relatives. When Kanita was referred to a program for children with EBD, the EBD teacher remarked that her behavior was actually acceptable. Rather, it was the environment that Kanita was in that contributed to her behavior, as she was continually frustrated in her attempts to learn. Kanita was mainstreamed and then later was placed in a program for gifted students. This is an example of the role implicit bias plays in the referral process for students. How many minority students like Kanita are wrongly referred to programs for emotionally disturbed children? When we consider that student behavior is influenced by the context and practices that take place within the school and classroom, we must also consider the ways that these environments may contribute to a student’s supposed EBD (Farmer et al., 2022b). Culturally and linguistically diverse students often attend urban, low-socioeconomic status schools where the contextual factors (e.g., less close relationships with teachers, few resources for learning, inappropriate discipline) may contribute to inappropriate behaviors (Sullivan, 2017). Teacher implicit bias may also contribute to over-referrals of Black students for special education (Stark et al., 2020; Farmer et al., 2022b). There is also reason to believe that schools react differently to offenses students from various ethnic backgrounds commit. For example, a teacher may consider a White student who talks back to be “joking” but a Black student to be “rude” (Wegmann & Smith, 2019; NCLD, 2020; Farmer et al., 2022b). Recent data indicates that disciplinary practices are harsher and more restrictive for students who are Black, Indigenous, or Latino than for those who are White (Wegmann & Smith, 2019; NCLD, 2020) (see Chapter 1). In our pluralistic society, a definition of “acceptable” behavior must allow for cultural differences. The conflict between the values of those in authority in society (and in the school) and the values of their culture can create tension (Harry & Klingner, 2006). Even more serious in its impact is the situation in which the peer group devalues education or pressures the individual to use drugs or violence (Farmer et al., 2022b). Pete’s membership in the Griffins is problematic in part because of the gang’s distain for authority figures, including teachers. So far, Pete has been walking a fine line between gang affiliation and school commitments, but this line is becoming more and more blurred, and his teachers worry what will happen to him as he moves toward high school. Cultural competence, the ability to appreciate and honor the cultural differences of our students and their families, is critical for avoiding cultural clashes and/or preventing these from escalating (remember the advice of Dr. Kea, from “Ask the Experts” in Chapter 1). Supporting the family is a critical part of the wrap-around support for the child, and this support must be culturally responsive to the needs of the family. We will learn more about culturally competent wrap-around support later in this chapter.

Families are key to providing the wrap-around support that students need to be successful.

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders system, on society’s support or lack of support for that system, and on the effects of that support or lack of support on children (Chapter 1), but he also recognized the impact the child has on their own environment. The interactions between the child and their immediate, or proximal, contacts (e.g., individuals within the home, school, neighborhood) provide the strongest influence on development, and these interactions are also key to providing the child the support they need (Rosa & Tudge, 2013). Bronfenbrenner maintained that the alienation of children reflects a breakdown in the interconnected segments of a child’s life across the family, peer group, school, neighborhood, and work world. The question is not “What is wrong with children with emotional or behavior disorders?” but “What is wrong with the dynamics within the child’s environmental context and social system?”

8-4a  Environmental Factors Influencing EBD: Correlated Constraints Understanding why a person behaves as they do is complicated. Our behavior is the result of the interactions across many contributing factors that are both personal (e.g., cognitive abilities, physical attributes, academic accomplishments, personality, racial identity) and, as Bronfenbrenner (2005) pointed out, ecological (e.g., family, peers, neighborhood, schools, social/political). These factors form a dynamic system in which each factor contributes, either positively or negatively, to the overall system (Farmer et al., 2022a). Because the factors operate within a system, and not in isolation, they may be seen as correlated constraints that affect how any individual reacts within any given situation at any time. When multiple factors of strength occur across the system (e.g., high levels of resources, warm and trusting relationships, a sense of belonging in school, strong academic performance), these factors can mitigate, or, constrain, problems that arise in other factors (e.g., loss of a parent, being bullied, difficulty with an academic assignment, substance abuse, conflicts with a teacher). However, given the aggregation of many negative factors, when multiple risk factors stack up (e.g., unstable home environment, low-resourced school, challenges with learning, exposure to violence) the difficulties in one factor are more likely to promote problems across other factors (Farmer et al., 2020). On the positive side, good academic performance, good relationships with peers, the presence of supportive adults, and athletic competence all tend to interrelate with one another and operate as a brake on aggressive behaviors; on the other hand, a combination of academic problems, attention difficulties, coercive family relations, and poor parental monitoring all can operate as a dynamic system contributing to aggressive behavior (Farmer et al., 2020; Farmer et al., 2007). When we realize that we are dealing with a dynamic system of factors related to EBD, we can see the limited impact a single intervention (e.g., improving social skills) may have in the face of this system of negative correlated constraints. This dynamic system defies easy modification and yet, because it is a system, the factors are interrelated and, to some extent, interdependent. This means that when one factor is significantly changed, it can influence the entire system, and this potential for change gives us hope (Farmer et al., 2022b). However, for interventions to work well, they must address supports across the entire system (e.g., family, neighborhood, peers, school, classroom), working together to enhance the positive constrains while minimizing the negative ones. This is the essence of wrap-around support.

8-4b  Role of Maltreatment and Trauma in EBD One of the environmental factors clearly related to EBD is child maltreatment and trauma (CEC, 2018). The physical and psychological maltreatment of children, often by individuals known to the child—including family members, neighbors,

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Causation of Emotional and Behavior Disorders

Box 8.2

Impact of the COVID-19 Pandemic on Child Maltreatment

The impact of the COVID-19 pandemic, with increased isolation of families, higher rates of alcohol use by parents, the added stress of health concerns, and financial insecurity, may have had a significant impact on childhood maltreatment and abuse (Shen, 2020). Studies show that parents experienced increased stress because of the pandemic, which may place their children at a higher risk for abuse if interventions and support are not available (Brown et al., 2020). Parents reported decreases in their own and their child’s mental health and increases in conflicts with children, thoughts of suicide, worries about physical safety, and use of alcohol or drugs to relieve stress (Gadermann et al., 2021). All these factors contribute to the vulnerability of families and to an increased likelihood of abuse and neglect.

The specific impacts of the pandemic on child neglect and abuse, however, may be difficult to trace since the mechanisms for tracking and tracing abuse have been impacted by the pandemic as well (Rodrieguez et al., 2021). Teachers, police officers, lawyers, medical workers, and social service staff, are the most likely to see and report cases of possible child abuse, with educators making the largest number of referrals (21 percent) (U.S. Department of HHS, 2021). With schools pivoting to online instruction, the teacher’s ability to recognize the signs of maltreatment were likely diminished. It may be years before we truly understand the full impact that the COVID-19 pandemic has had on the mental health of students, families, and the professionals who support them.

and members of the child’s custodial-care community (e.g., religious leaders, teachers, coaches, youth leaders)—has a profound impact on the child’s wellbeing (CDC, 2021). The U.S. Department of Health and Human Services report “Child Maltreatment 2019” (2021) estimated that 4.4 million referrals were made to child protective services alleging maltreatment, and approximately 656,000 children were victimized. The Child Maltreatment 2019 report indicates that children in their first year of life suffer the highest rate of abuse and neglect (25.7 out of 1,000); girls are victimized at 9.4 per 1,000, while boys’ rates of victimization are slightly lower at 8.4 out of 1,000. The report further indicates that children suffered the following types of maltreatment: 74.5 percent suffer from neglect, 17.5 percent experience physical abuse, 9.3 percent are sexually abused, and 11 percent suffer from other types of abuse, including emotional threats and lack of supervision (U.S. Department HHS, 2021). Finkelhor and colleagues (2013) reported that the true occurrence of children in the United States who have experienced some form of maltreatment may be as high as one in four children. In 2019, 1,840 children died of abuse or neglect (CDC, 2021). Child maltreatment rates differ across racial groups, with American-Indian or Alaska Native children experiencing the highest rates of victimizations (14.8 per 1,000 children); African-American children have the second highest rate at 13.7 per 1,000 (U.S. Department HHS, 2021). The stress experienced by families living in poverty may also contribute to higher rates of abuse and neglect. Rates of neglect and abuse are five times higher for children living in low-socioeconomic families as compared with children in higher socioeconomic families (CDC, 2021). The impact of poverty is compounded, as many children living in low-socioeconomic families also attend low-resourced schools.

8-4c  School Risk Factors School is a critical part of the lives of most children; most students will spend 6.5 hours a day in school, 180 days a year. That means that students spend approximately 1,170 hours a year in school! Ideally, schools should be a safe and positive place for learning really cool and relevant stuff, and where students are part of a community that includes their peers, teachers, and families.

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders Sometimes, however, as in the case of Kanita’s school discussed above, school does not seem to be a good fit for some students, and in the worst cases, school may actually contribute to the student’s social, emotional, and behavioral problems (Farmer et al., 2022b).

Violence in the Schools We have made the point that the schools are a mirror of our society, reflecting both the good and the bad. We need to remind ourselves that more than 56 million students, or about one in every five citizens of this country, are in school right now. Since we see a great deal of violence in our communities, we should not be surprised to also see it reverberating within our schools. Here are recent statistics on the kind and rate of violence in our schools: the 2019–2020 school year, 75 school shootings occurred, nearly seven times more than a decade prior. There were 1,346 homicides among youth ages 5–18 in 2019; 56 of those occurred in school during the 2019–2020 school year. In 2019, there were 2,756 suicides among youth ages 5–18; nine of those occurred at school. ●  In the first six months of 2019, 2 percent (down from 4 percent in the previous decade) of students ages 12–18 reported being victimized at school, 2 percent (down from 3 percent in the previous decade) reported theft, and 1 percent reported violent victimization. ●  In 2019, about 7 percent of students in grades 9–12 reported being threatened or injured with a weapon on school property. ●  During the 2015–2016 school year, 10 percent of public school teachers reported being threatened with an injury. Six percent of school teachers reported being physically attacked. ●  During the 2017–2018 school year, 14 percent (down from 23 percent in the previous decade) of public schools reported daily or weekly bullying among students; 9 percent reported widespread disorder on a daily or weekly basis. ●  In 2019, 22 percent (down from 23 percent in the previous decade) of students in grades 9–12 reported that drugs were offered, sold, or given to them. ●  During the 2019–2020 school year, 35 percent of schools took serious disciplinary actions for student offenses, including suspensions of five or more days and expulsions. (IES, 2021; Office of Justice Programs, 2021; Kids Data, 2021)

Constantinis/E+/Getty Images

●  During

When a person is bullied everyone is negatively impacted… the bully, the victim, and the observers.

In almost every case, the statistics on violence reported were much higher in the community at large than in schools, but these statistics do remind us that violence is a part of many students’, teachers’, and administrators’ lives in the school setting. And, while these statistics on school violence remain alarming, the slight decline in some areas (e.g., students being victimized, student thefts, bullying) may be a direct result of anti-bullying and empathy-development programs to support students. The implementation of schoolwide positive support programs that focus on creating a positive school climate and culture while reducing the emphasis on punitive interventions may also be having a positive impact.

School and Cyber Bullying There is little doubt that bullying has been a part of schools since the beginning of education. Only recently has it been a source of study and part of the special education programming.

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Causation of Emotional and Behavior Disorders

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Farmer et al. (2007) identified three actors in bullying: 1. Bullies: Youth identified as bullies repeatedly perpetrate physical and social harm against their peers but are not bullied by their peers. 2. Victims: Youth who are identified as victims are routinely bullied by peers but do not bully peers. 3. Bully-Victims: Youth who are identified as bully-victims perpetrate bullying against peers and are also bullied by peers. Each of these behaviors has different motivations and reasons for appearing in the classroom or school environment, and each is often involved in the social status and interactions of individual students. Children with intellectual disabilities, physical and sensory limitations, and emotional problems are at a higher risk for being bullied, and sometimes children with disabilities bully other marginalized peers as a way of deflecting social assaults against themselves (Stopbullying.gov, 2022).

Stop Bullying stopbullying.gov

Kids Who are Bullied Kids who are bullied can experience negative physical, social, emotional, academic, and mental health issues. Stopbullying.gov identifies the following impacts of bullying: ●  Depression

and anxiety, increased feelings of sadness and loneliness, changes in sleep and eating patterns, and loss of interest in activities they used to enjoy. These issues may persist into adulthood. ●  Health complaints. ●  Decreased academic achievement—including GPA and standardized test scores—and school participation. These students are more likely to miss, skip, or drop out of school. A very small number of bullied children might retaliate through extremely violent measures. In 12 of 15 school shooting cases in the 1990s, the shooters had a history of being bullied.

Kids Who Bully Others Kids who bully others can also engage in violent and other risky behaviors into adulthood. Kids who bully are more likely to: ●  Abuse

alcohol and other drugs in adolescence and as adults. into fights, vandalize property, and drop out of school. ●  Engage in early sexual activity. ●  Have criminal convictions and traffic citations as adults.  ●  Be abusive toward their romantic partners, spouses, or children as adults. ●  Get

Bystanders Bullying does not just impact the victim; bystanders who observe the bullying can also be traumatized (Grantham & Biddle, 2013). Kids who witness bullying are more likely to: ●  Have

increased use of tobacco, alcohol, or other drugs. increased mental health problems, including depression and anxiety. ●  Miss or skip school. ●  Have

Because each of these groups—the victim, the bully, and the bystander—are negatively impacted by the act of bullying, each group needs supportive interventions that prevent further bullying. Bullying prevention interventions must focus on the needs of all three groups to be successful. It is hard to calculate the damage done when children who go to school don’t learn, but instead worry about how to avoid the bully or bullies who physically threaten, extort money, or write hurtful or threatening e-mails. The size of this problem can be seen in Figure 8.2, which shows that in the sixth grade, more than

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29.5

25

25.3

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20

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18.9

15 10

14.7 8.2

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6th Bullied

7th Injured

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8th

5.4 9th Grade

3.7 10th

3.3 11th

0.7 12th

◗ Figure 8.2  Percentage of Students Bullied and Injured from Bullying Source: Data from Table 10.2 in Indicators of School Crime and Safety: 2019; National Center for Education Statistics, U.S. Department of Education. Retrieved from https://nces.ed.gov.

one in four report incidences of bullying; even in the twelfth grade, one out of 10 report such behavior. There is a gender difference, with boys experiencing physical bullying and girls receiving more psychological intimidation. While face-to-face bullying may take place on or near the school grounds, bullying may also be done at a distance through the use of technology.

Cyberbullying Cyberbullying uses technology (e.g., cell phones, computers, and tablets) to bully others. Cyberbullies harass others by sending, posting, or sharing negative, harmful, false, or mean content about others with the intent of being hurtful. This may include sharing personal or private information about someone else causing embarrassment or humiliation. According to Stopbullying.gov, cyberbullying is particularly problematic because it is: Persistent—Digital devices offer an ability to immediately and continuously communicate 24 hours a day, so it can be difficult for children experiencing cyberbullying to find relief. Permanent—Most information communicated electronically is permanent and public if not reported and removed. A negative online reputation, including for those who bully, can impact college admissions, employment, and other areas of life. Hard to Notice—Because teachers and parents may not overhear or see cyberbullying taking place, it is harder to recognize. Furthermore, cyberbullies operate at a distance “safe” from retaliation and often remain anonymous, and this distance makes it much more difficult to prevent and intervene with support for the victim, the bully, and the by-standers. The CDC report, “The 2019 Youth Risk Behavior Surveillance System” (2021), found that an estimated 15.7 percent of high school students reported being electronically bullied in the 12 months prior to the survey. Kendall and Pete have both been involved in bullying. Pete was initially bullied into joining the Griffins; older gang members who lived in his neighborhood threatened to hurt him and his sister Nadria if he did not join the group. (This intimidation is one reason that Pete walks his sister to school every day.) In addition to using threats to influence Pete, gang members also offered rewards. They promised safety, money, and access to other incentives like drugs. But, ultimately

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Causation of Emotional and Behavior Disorders what convinced Pete to join was the “brotherhood” he thought that he saw among the Griffin members; when you are a Griffin, you belong, and someone always has your back. What Pete is now learning is that he is expected to be the bully, and his role models for this, within the Griffins, are very instructive. Kendall’s bullying took a different form. It started as subtle isolation from the girls who had once been her friends: conversations would end abruptly when she approached the group in the hall between class, some of the girls would intentionally turn away and avoid her, she was no longer invited to sit with her friends at lunch, and gatherings were held (e.g., going to the mall, a swim party) and she was not included. Then the comments started to appear on social media: “Did you see K’s hair today? UGH! What is she thinking?” Initially, these comments reached only a few girls, but soon the circle grew as both boys and girls were involved, and the harassment escalated. Kendall was rated the least kissable in the class…she was deemed to be the least likely to ever be cool…she was called repugnant and told to use more deodorant. Eventually, she became completely ostracized by the very group of students she had been friends with for most of her elementary school years.

Substance Abuse Risk Factors While substance abuse cannot be said to cause emotional or behavioral problems, it is clearly part of the syndrome of behaviors linked to early problems and later delinquency. Think about the characteristics of drug users: low self-esteem, depression, inability to handle social experiences, and stress. These same characteristics

Box 8.3

Reaching & Teaching:

Stopping Cyberbullying while Distance Teaching

By Jennifer Job, Ph.D. As noted in this chapter, cyberbullying is an especially difficult issue to address. The problem became even more pervasive when most schools went virtual during the pandemic. Teachers were instructing solely through the computer for the first time and the only way students were communicating with each other was across online platforms, giving children multiple opportunities for cyberbullying. The result: At least one in three students have experienced bullying online (DoSomething, 2021). The best defense against cyberbullying while teaching virtually is a good offense; in other words, prepare against cyberbullying and work with students to recognize the signs to stop it. Virtual classes should always begin with instruction on online etiquette and

how to treat one another. EdTech magazine (2020) recommends that schools use platforms like Google Classroom or Lightspeed Systems that have safety and anti-bullying software built in. Many systems also let teachers limit the amount of conversation outside the class that can take place online. If a teacher has an assistant, it helps to have someone monitoring classroom chats. Also recommended is teaching students to recognize and report cyberbullying, either of themselves or other students, to keep a safe learning environment. Teachers also should easily recognize the signs of cyberbullying, even when they are only working with students online. Here are some warning signals to look out for; they may be indicators of cyberbullying, according to the Cyberbullying Research Center (2018):

A child might be the victim of cyberbullying if they: A child might be cyberbullying others if they: ●







Stop using their camera while in online classes or refuse to log on Appear frustrated, nervous, or angry while using their devices Become withdrawn or stop participating while in class Let grades slip







Quickly switches screens or hides screens if observed or if called on by the teacher Exhibits emotions disconnected from the classroom activity (e.g., laughing excessively during a lecture) Won’t discuss what they are doing online or what they are spending their time on

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Ilene MacDonald/Alamy Stock Photo

often mark children with behavior disorders. The public’s attention is often directed to the use of exotic drugs, but the use and abuse of alcohol and tobacco are much more common. Substance abuse is a growing problem in U.S. schools, and there is evidence that children with behavior problems may have rates of substance abuse higher than the rates of their peers in special education or in general education. In addition to the general teen culture that can encourage substance abuse in some communities, children or teenagers with behavioral and emotional problems often are influenced by a series of additional factors that may predispose them to substance abuse. These factors may include prescribed medication, chronic medical problems, social isolation, depression, and a higher risk of being in a dysfunctional family. Thus, special educators must know the signs of chemical dependency, what to do when they suspect drug abuse in their students, and how to work with It takes a team to provide the interventions needed to help drug treatment programs. Long-range treatment may students with emotional and behavioral needs be successful. demand services from community and mental health agencies, and teachers should be aware of good referral sources. The coordination with community services is a central part of providing the wrap-around-support that students with EBD need (discussed further in this chapter).

8-5  Information Processing Model for Students with EBD The two students, Pete and Kendall, whom we have been following in this chapter have information-processing patterns that appear similar in spite of their very different problems (see Figure 8.3). Pete tends to externalize his negative emotions,

Emotional Context

Thinking

Response

Memory Classification Association Reasoning Evaluation

Speaking Writing Motor Response Social Interaction

Processing

Stimulus

Vision Hearing Kinesthetic Haptic Gustatory Olfactory

Information Input

Attention

Information Output

Executive Function

key Challenges Strengths

◗ Figure 8.3  Information Processing Model for Students with Emotional and Behavior Disorders TeachSource Digital Download

Access online

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Information Processing Model for Students with EBD turning them outward through aggressive humor, challenging the teachers’ authority, and now, bullying younger students within his neighborhood (he worries about doing this, but feels at a loss to know what to do because he does not want to lose his emerging status within the Griffins). Kendall is turning her emotional turmoil inward, and she is now showing more acute signs of depression, anxiety, and disordered eating. Her withdrawal from school life has extended to her home, and her parents have a hard time getting her to leave her bed—let alone her room. As a result of their difficulties, both Pete and Kendall struggle with learning. They are unable to process information easily, and this impacts their memory, reasoning, evaluation, and decision making (i.e., executive function). They also find it hard to concentrate within the classroom; their minds often wander toward their problems and so they miss critical information, especially when it is presented verbally. Central-processing problems (e.g., thinking about things) combined with attention and decision-making challenges ultimately undermine output. Both Pete and Kendall have a hard time with writing and speaking; Kendall has a hard time with peer social interactions, and Pete struggles with adults in authority roles. The challenges that Pete and Kendall face are made worse when the emotional context of the classroom, school, or school yard are intensified. Kendall has come to dread walking the halls between classes; she now refuses to go to the cafeteria and will not change clothes in the locker room for gym. She feels relatively safe within the classroom when the teacher is present, but her anxiety remains high since she worries about what comes next. Pete’s hostility comes out within the classroom when his teachers try to make him do work that he feels unprepared for. Pete is very aware of his power status and reacts strongly when actions and words of others threaten him and his status. One teacher, Ms. Broughton, has taken to “mocking” him in an attempt to get him to comply. When he claims that the work is “stupid,” she uses phrases like, “you should have learned this in elementary school—maybe it’s not the work that’s stupid!” She also rolls her eyes and shakes her head when he does not turn in a paper. The disrespect that this teacher shows through her words and actions is the worst thing possible for a student like Pete, whose sense of well-being hinges on his status within his peer group. The only place where he currently finds any positive reinforcement is within the Griffins. Pete and Ms. Broughton are on a collision course headed for a major crash. Although the challenges faced by Pete and Kendall are daunting and negatively impact their ability to process information (i.e., learn), they both also share some strengths. Their strengths with input are kinaesthetic and haptic; motor responses and the arts are strengths for them in output. Pete is also acutely aware of the emotional tone of his environment and the people within it. This sensitivity has been long-honed because of his violence-prone neighborhood. In Pete’s neighborhood, survival requires a heightened awareness of emotions to detect, deter, and defuse interactions that could have deadly consequences (this is where he learned to use humor to deflect danger). Pete’s heightened sensitivity could be considered a hidden asset of growing up within an adverse situation (Ellis et al., 2020). At this point, however, no one in his school environment has supported a positive use of this ability. As indicated in Figure 8.3, emotional and behavioral disorders often impact all aspects of information processing. Anxiety and stress can influence all the centralprocessing mechanisms from memory to evaluation. The child’s attempt to communicate through speaking and writing is clouded by either external conflicts or internal concerns, and these also impact their social relationships. Students’ decision making (i.e., executive function) is at the mercy of the emotional forces working on them at any given time. In short, a child with emotional and behavioral disorders has serious problems in every major aspect of information processing, and this makes learning in school challenging.

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Box 8.4

Mindfulness Matters:

Dealing with Anger

Anger is a strong emotion, and when it washes over us, we can feel so overwhelmed that we are helplessly carried forward on its wave. The consequences of being carried away by the wave of our anger, however, can be very problematic. While anger feels like a powerful primary emotion, it is actually a secondary emotion. Anger is a response to an underlying emotional state: we feel frustrated—we get angry; we feel hurt— we get angry; we feel left out—we get angry; we feel disrespected—we get angry; we feel afraid—we get angry; we feel disappointed—we get angry; we feel dismissed—we get angry; we feel humiliated—we get angry; we feel helpless—we get angry. Why this Matters: Understanding that anger is a secondary response to an underlying feeling is critical because if we can identify the underlying feeling, we may be able to shift our response from “anger” to something more proactive. At the very least, we can begin to deal with the underlying triggers for our anger so that we can avoid being mindlessly carried away by it. Practicing Mindfulness: STOP! When we find ourselves immersed by a wave of anger, we need to STOP: Stop—Become like a stone that is too big, too heavy, and too still for the wave of anger to carry it forward. (Feel yourself anchored to the floor, and become very still as the wave of your anger washes over you.) Think—Reflect on why you are feeling angry. (What just happened? What is the underlying feeling that you are responding to? What event triggered your anger?) Observe—Scan your body. (What is happening to your breathing, your heart rate, your muscles?) Breathe deeply, relax your muscles, and your heart rate will slow down.

TeachSource Digital Download

Proceed—Choose your next action carefully to more positively respond to the situation, person, or event. (Take a deep breath, and decide what to do.) We often think of anger as outwardly directed wrath or fury, but anger can also be directed inward, manifesting as depression or intense self-loathing. In both cases, outer and inner anger can be very selfdestructive. When we use the STOP method to deal with our anger, we move from “reacting” to “responding” in difficult situations and this places us in control of our actions. When we are responding, we can choose to use words to express what we feel, want, or need. We can choose to ignore the person or situation, deciding that it is beneath our worry. We can choose to get help to deal with the situation. We can choose to walk away. When we use STOP, we get a better understanding of our own feelings and what has triggered our anger. This self-awareness can lead to better decision making, and it supports our development of self-determination. Teaching our students the STOP method helps them gain more control over their anger. When we discuss the underlying feeling that can lead to anger, we can help each student identify their own triggers (i.e., which feelings usually lead to their anger). We can also share alternative responses to these triggers that can have more positive outcomes. Helping students gain control over their anger through building self-awareness is critical to supporting their capacity for self-determination (i.e., their ability to choose an alternative path). Placing the student in control of their choices helps to keep them from being swept into a sea of suffering by the waves of their anger.

Access online

8-6  Educational Responses for Students with Emotional and Behavior Disorders Early in the chapter, we noted that students spend over 1,000 hours a year in school. This is a substantial amount of time, and the hope is that the time is well spent on preparing students for success in their lives. Outcomes for students identified with EBD, however, are concerning: 32 percent of students labeled as EBD drop out of school, the highest rate of all disability areas; only 61 percent of students labeled EBD earn a regular high school diploma, ranking them third to the bottom within the populations of students with disabilities (48 percent of students

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Educational Responses for Students with Emotional and Behavior Disorders with intellectual and/or developmental disabilities, or IDD, and 47 percent of students with multiple disabilities receive regular diplomas) (U.S. Department of Education, 2018). Youth with EBD are three times as likely as all other students to be arrested before leaving school, and they are twice as likely than other students with disabilities to live in a correctional facility, halfway home, drug treatment center, or to be homeless once they leave school (Read, 2014). Six times more youth who have been incarcerated have EBD than other children (Read, 2014). We have chosen to lead off this section with these grim statistics to drive home the seriousness of the challenges we face in rethinking how we support students who have or who are at risk for having emotional and behavioral problems. Given these outcomes for students with EBD, we must ask ourselves why our educational programs seem to be failing this group of students. Do we start too late in the student’s life? Would earlier intervention be more helpful? Do we have the right organizational structures and instructional strategies in place? Do we provide our supports and services with sufficient intensity? Do we partner with families and community members to provide wrap-around support? All these questions must be considered as we work to improve outcomes for students with EBD because the truth is that we can likely do better across all these areas.

8-6a  Early Intervention and Support for Children at risk for EBD Social and emotional well-being is foundational to all other areas of human development and is critical for learning. Look back at Maslow’s hierarchy of needs presented earlier in this chapter and you will see that the needs for love and belonging come just after the physical needs for food, sleep, and safety. The need for love, belonging, and safety begin at birth, and when these needs are not met, the child is at a higher risk for developing emotional and behavioral problems (Farmer et al., 2022b). We have also already discussed that children under the age of one have the highest rates of experiencing trauma and maltreatment. The Centers for Disease Control (CDC) identifies the first risk factor for victimization as being a child younger than age 4, and the second risk factor as being a child with special needs (CDC, 2021). Given these factors are so prevalent, it should not be surprising that signs of emotional and behavioral problems may begin very early in life. Current estimations suggest that between 8 and 10 percent of children aged 3 to 5 who attend preschool may display challenging behaviors or have special socialemotional needs (Markelz, Riden, & Hooks, 2021). Cumulative stress in early childhood has also been shown to have negative impacts across the lifecourse of the child, due in part to changes in the brain structure and neural processing resulting from chronic stress (Nicholas et al., 2021). Anxiety disorders that are evidenced in childhood often persist into adulthood, and persistent anxiety may result in both structural and functional changes as the brain matures (Zacharek et al., 2021). The most common social-emotional exceptionalities found in preschool-aged children are ADHD, oppositional defiant and conduct disorders, anxiety disorders, and depressive disorders. Are these young children getting the support they need? The answer is, probably not. Indeed, one study found that children in Pre-K are expelled at higher rates than their K–12 peers (Gilliam, 2005)! Moreover, behavior problems that begin in preschool are associated with academic and social problems later in school as well as an increased risk for being identified with EBD and of dropping out prior to graduation (Markelz, Riden, & Hooks, 2021). Early and intensive support for young children who show indications of emotional and behavioral problems is critical to mitigate or prevent later problems. Early intervention is also likely to have a greater impact because social skills tend to be more malleable, responsive to change, during early childhood. Yet, many

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High Leverage Practices https:// highleveragepractices.org

Box 8.5

early childhood teachers report that they are not prepared to deal with challenging behaviors (Hemmeter et al., 2008; Lang et al., 2017). Early childhood teachers often react to children’s challenging behaviors in negative and punitive ways that tend to lead to increased negative interactions and to intensified challenging behaviors from the child (Farmer et al., 2022b). When teachers react with negative comments or punitive responses, this reaction impacts the social climate of the classroom. For example, Mrs. Moore, after a morning of chastising Darius for “misbehaving” (e.g., running, being loud, snatching toys from other children) in class, will finally relax and turn her attention elsewhere when Darius is quiet while building in the block center—not understanding that this is the very time she should be interacting with him in a positive way! She might engage with Darius by showing interest in his project and asking him about it: “Darius, that is a really interesting building; tell me about it.” She might smile and say something like, “Darius it looks like you have a great building project going on. You are really good at creating cool structures.” The natural response to children’s challenging behavior seems to be trying to control the child through punishments or verbal sanctions. Since the “natural” response (e.g., punishment and criticism) turns out to be ineffective, we must switch gears and encourage a positive classroom and home environment. Because behaviors are shaped through an ongoing series of interactions between the child and their environment, the more positive our interactions and classroom environments are, the better we can expect the child’s behavior to be! Preventing challenging behaviors in early childhood from escalating hinges in part on the creation of a positive environment where teachers use effective classroom management skills, engage children in meaningful activities, and use behavior-specific praise to encourage and reinforce appropriate behaviors. Behavior-specific praise shifts from general positive statements like “nice job!” to task- or situation-specific praise, such as, “you did a really nice job in preparing the cookie plates for snack!” (Markelz, Riden, & Hooks, 2021). The suggestions provided above for how Mrs. Moore could engage with Darius focus on the use of specific praise and encouragement. When teachers use behavior-specific praise, they focus the child’s attention on specific behaviors, and this focus helps the child develop a positive self-concept (e.g., I am good a setting up snack time!). As we learned early in the chapter, a positive self-concept, along with high self-esteem and a strong self-efficacy for learning, are the foundation of emotional health. It is particularly important to identify young children who have or may be at risk for having EBD because often the problems exhibited in preschool do not go away; the problems often persist and become more serious in later grades unless action is taken early (Farmer et al., 2022b; Egger & Angold, 2006). However, while early childhood intervention is optimal for children with EBD, we must remember

High Leverage Practices:

High Leverage Practice 22: Provide Positive and Constructive Feedback to Guide Students’ Learning and Behavior.

The purpose of feedback is to improve student learning and behavior while increasing their motivation, engagement, and independence. Positive and constructive feedback is clear, specific, goal directed, and focuses on the task or process. It is also given in a timely fashion and focuses on helping to build the student’s understanding.

Reflection: ●

In what ways can positive and constructive feedback support a student’s development of self-efficacy for success in school related tasks?

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Educational Responses for Students with Emotional and Behavior Disorders that it is never too late to provide the supports needed for each student’s success (Farmer et al., 2022b). The following educational responses are divided by organizational strategies and instructional strategies to clarify what the system can do and what the teacher can do.

8-6b  Organizational Structures to Support Students with EBD Supports and services for students with EBD often do not start until the child is in the second or third grade, and even then, schoolwide coordinated services may not be available. When schoolwide services are in place, the interventions provided for students with EBD may still not be intensive enough to make a positive impact (Farmer et al., 2020). Many general education teachers feel ill prepared to provide the support that students with EBD need to be successful (Lloyd et al., 2019), and yet, as seen in Figure 8.4, most children with EBD spend most of their school day in the general education classroom. The intensive and coordinated supports students with EBD need will likely require going beyond the general classroom and even beyond the services currently available in most schools.

8-6c  MTSS Approaches for Students with Emotional and Behavior Disorders When the multi-tiered system of supports (MTSS) framework is implemented schoolwide, all students are taught social, emotional, and behavioral competencies, just as they are supported in their academic achievements. Educators work to create a positive, predictable, and safe environment that promotes strong interpersonal relationships with students through teaching, modeling, and encouragement (NWPBIS, 2021). The combined schoolwide support for academic and social/emotional success of students within the MTSS structure is a good starting place for meeting the needs of students with EBD (Gage et al., 2020). However, supports and services provided across the MTSS framework need to be intensified and tailored to individual students to significantly impact outcomes for students with EBD (Farmer et al., 2020). Let’s look at what intensive and tailored

4% 12%

More than 80% of the day in a regular classroom Inside regular classroom 40–79% of the day 50%

17%

Inside regular classroom less than 40% of the day Separate School

17%

Other Setting

◗ Figure 8.4  Educational Settings for Students with Emotional and Behavior Disorders Source: Data Accountability Center. (2018). Part B Educational Environments 2011 [data file]. Retrieved from http://www.ideadata.org/PartBEnvironments.asp

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Northwest PBIS https:// pbisnetwork.org/

supports for students with EBD might be needed across each tier of the MTSS service framework.

Universal Tier I for Students with EBD Tier I services usually occur within the general education classroom, supporting all students in developing academic and social competence. The classroom support for social/emotional/behavioral development within Tier I aligns with the schoolwide procedures for expected behaviors and consequences for students. Classroom support for developing social and behavioral competencies may include the explicit teaching of appropriate behaviors, establishing a set of consistent school-wide expectations, creating a behavioral matrix to share behavior norms across school settings (see Table 8.3), and using positive strategies to reinforce and reward desired social behavior (NWPBIS, 2021). You may notice that behaviors in the matrix (Table 8.3) are all stated in the positive—what the student will do—as opposed to what they will not do. This positive approach is very intentional and sets the tone for positive expectations rather than punitive responses. While Tier I is called the “universal” tier, it does not mean that every child in the classroom receives the same thing, at the same time, delivered in the same way. Far from it! Universal means that all the students within Tier I have access to evidence-based practices and the teacher differentiates these practices, adjusting them to the strengths and challenges of each child (Coleman, 2014; Coleman & Shah-Coltrane, 2013). Differentiated instruction often uses the principals of Universal Design for Learning (UDL), presenting information in a variety of ways, offering multiple ways to engage the students, and giving students a range of possible ways to show what they know (earlier chapters have discussed the use of UDL). Farmer and colleagues (2020) call this approach “tailored” instruction because it responds to the individual student’s strengths and challenges.

Table 8.3  Sample Behavior Matrix for Schoolwide Positive Behavior Intervention and Supports Setting

Be Kind

Hallways

1. Help others 2. Be respectful 3. Be mindful of “personal space”

Cafeteria

1. Invite others to sit together

2.  Be polite (e.g., use please and thank you) 3. Talk with people at your table

Restrooms

1. Give each person privacy

2.  Model appropriate behavior for younger students

3. Wait your turn to use facilities Classroom

1. Offer to help others

2. Listen to others respectfully

3.  Encourage others to do their best

Be Responsible 1. Go where you need to go

2. Walk quietly

Do Your Best 1.  Take care of your personal belongings

3. Keep the space clean

2. Follow the bells to be on time

1. Take care of your own trash

1. Be on time

3. Help to keep the area clean

3. Wait your turn

2. Speak with your inside voice

2. Follow adult directions

1. Dispose of your own trash

1. Wash your hands

3.  Report any problems to an adult

3.  Leave when you have finished

2. Keep the area clean

2. Keep the space clean

1. Take care of your own things

1. Ask for help when you need it

3.  Follow directions of your teacher

3. Complete assignments

2. Use your inside voice

2. Be prepared for each activity

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Educational Responses for Students with Emotional and Behavior Disorders An example of how differentiated instruction can be applied to evidence-based practices to address student’s strengths and challenges can be seen with support for reading. Children who experience problems with learning to read in grades K-1 are more susceptible to developing behavior problems that can persist in later years (Garwood et al., 2017). When children struggle with reading, they often feel frustrated and may try to avoid reading tasks; they may also become anxious and depressed. When reading is a problem for young students, they may come to define themselves as “stupid,” leaving them vulnerable to a poor self-concept and low self-esteem, which may undermine their self-efficacy for school-related tasks (Garwood et al., 2017). These feelings form the basis of emotional instability, which can lead to behavior problems. Because of the link between academic success and emotional well-being, Tier I must include a strong core academic program that is adaptable for students currently doing poorly (Garwood et al., 2017). Tier I reading support, for example, may start with an evidence-based approach, but within this approach, teachers adjust instruction to the student’s specific strengths, interests, and challenges (Lane, 2014). Typically, formal reading begins with a focus on the development of phonemic awareness, decoding and word recognition skills, and reading fluency, but instruction must go beyond these basic skills to include the meanings of words in text, strategies for accessing the author’s meaning, and vocabulary knowledge (Lane, 2014). Reading comprehension—understanding what has been read—is the goal, and critical to reaching this goal is understanding the student’s background knowledge and selecting reading materials that are relevant to students’ lives, which can enhance their motivation to read (Garwood et al., 2017). Starting with an evidence-based core reading program offers a foundation for differentiated or tailored instruction. Strategies to match reading instruction to the student’s strengths and challenges might include: ●  Selecting

reading materials that are within the student’s instructional and independent reading levels. ●  Using a variety of print-based materials (e.g., comic books, magazines, webbased materials, how-to manuals) to enhance motivation to read. ●  Enhancing motivation by selecting materials of high interest for each student. ●  Ensuring that reading materials are culturally appropriate and responsive. ●  Supporting reading comprehension through strategies that promote active processing of the information (e.g., acting out the story, drawing picture frames for the progression of the narrative, creating charts or graphics for the information, discussing the information with others). ●  Building background knowledge so that students can connect with the information. Pete has been a struggling reader since first grade, and now that he is heading to high school, getting him to even touch a book is hard. Unfortunately, his learning disabilities were never diagnosed, so he did not receive the early and intense reading support he needed. Pete also has some underlying ADHD issues, and he really struggles to attend to solitary tasks, which he finds difficult or boring. Without the support for his learning problems, Pete has concluded that he must be stupid if he can’t read (i.e., his self-concept, or, definition of himself); because of this conclusion, his self-esteem gets lower each time he fails at a school task and his self-efficacy for academic tasks has reached an all-time low. There is nothing in school that he feels good at and no one that he feels connected too. Pete has reached a point where school does little but undermine his already fragile self-concept, self-esteem, and self-efficacy. He no longer believes that he “belongs” in school. If this does not change when he goes to high school, he is at high risk for dropping out. Academic support in Tier I often used the principles of UDL since these can be applied to any content area to support student learning. In earlier chapters, we

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders shared a range of UDL strategies that can be used to support students in Tier I. These strategies address multiple ways to represent, engage with, and share information (also see Table 8.5 in this chapter). However, even with strong core curriculum and support for developing social competencies that are tailored to the individual student and intensive to meet their needs, some students will need additional support that targets their specific areas of challenge.

Targeted Tier II for Students with EBD Supports offered at Tier II are matched to the student’s strengths and challenges and may include both academic and social/emotional/behavioral interventions. Key to supporting the student is knowing what they need! The use of data-driven decision making is the foundation of interventions in Tier II (Coleman & Job, 2013). While we often think that “data” is synonymous with numerical and quantitative summaries, Coleman and Job (2013) remind us that “data” are much more than then numbers. In addition to numerical metrics, data can include observations of behaviors, work-samples, surveys used to establish student interests and learning preferences, interviews, and environmental/ecological information that places observations within a context. Table 8.4 shares types of data that can be used for decision making. Data collected from multiple sources shows a pattern of strengths and challenges for each student. Using data in decision making is key to matching the student’s strengths and challenges with appropriate supports. The data guides decision making about both the kind and the intensity of the support needed to help the student be successful. When students experience great difficulties, the intensity of support must be increased. While data is key to good decision making, we must also remember that more data does not always lead to better decisions. The strategic use of data includes being clear about why you are collecting the data (i.e., know your purpose), collecting the data you need for the decision you are making, using existing data when you can rather than creating more data, and remembering that the best data-collection method may often be the simplest (e.g., if you want to know if the student is having difficulties, ask them!) (Coleman & Job, 2013). When the data indicate that a student needs additional support to achieve success, it is time for Tier III interventions.

Intensive Tier III for Students with EBD While Tier III interventions will often include support for improving both academic and social/behavioral competences, we will focus on social and behavioral support in this section. Remember that all behavior is a form of communication. Individuals behave in certain ways because they either get something “good” (access) or avoid something “bad” (escape). If we can figure out why a student is behaving a certain way, or what the function of a challenging behavior is, we can also figure out the effective interventions. Gresham (2007) describes five major ways in which challenging behavior may be accomplishing the goals of the student. The student’s behavior may be trying to: 1. Gain social attention (positive social reinforcement). 2. Gain access to tangibles or preferred activities (material or activity reinforcement). 3. Escape, delay, reduce, or avoid aversive tasks or activities (negative reinforcement). 4. Escape or avoid other individuals (negative social reinforcement). 5. Gain internal satisfaction (automatic or sensory reinforcement or control). Figuring out the “function” of the behavior is done through a Functional Behavior Assessment (FBA). The FBA begins with gathering information—data— about the student’s behavior to answer the question, “Why did they do that?” The

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Table 8.4  Types of Data Useful for Data-Driven Decision Making Assessment Type

Definition

Purpose for Decision Making

General outcome measure (formative)

Standardized indicators of basic success that have multiple equivalent items to allow for progress monitoring

Assess growth in the mastery of basic skills needed for a given area of learning

Curriculum-based measure (formative)

General outcome measures that are established for specific content areas to assess student mastery of the given curriculum and monitor progress

Inform instructional decision making that is tied to the curriculum and that reflects a student’s achievements and learning gaps

Formal state or district assessment (summative)

Standardized tests that are given periodically to determine achievement levels within a given curriculum or domain

Evaluate student performance and mastery within a given curriculum or domain

Observational measure (formative)

Systematic tools that allow observes to document student behaviors within the context of their natural environments or activities

Inform instructional planning for students given their actual performance in the learning context

Benchmark assessment (formative and summative)

Checkpoints of accomplishments on skills within a given domain or curriculum

Document proficiency in skills within a given domain or curriculum and identify more needed supports

Work samples/portfolios (formative or summative)

Student generated artifacts that show actual work and accomplishments

Provide evidence of performance or accomplishments

Student interest and learning performance surveys

Profile of a student’s interests and learning preferences

Inform instructional planning and differentiation

Environmental/ecological information

Contextual information about a student’s family, culture, language, areas of strength, and areas of challenge

Support appropriate planning for family engagement and student success

Student interviews

Get input directly from the student to learn about interests, preferences, and concerns

Guides decision making on topics and types of activities

Student career interest surveys

Formal survey to identify student’s strengths and interest areas

Guides course selection and transition planning

*Adapted from Coleman, M.R. & Job, J. (2013). Using data-driven decision making. In M.R. Coleman & S. Johnsen (Eds.) Implementing RtI with Gifted students: Service models, trends, and issues Prufrock Press (pp 83–100)

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intervention team collects a variety of data that looks at both the student’s behavior and the environmental context, as well as the conditions where the behavior is seen. If you go back to Table 8.4, you can see the kinds of data that can be used as part of the assessment. In addition to the problem behavior, the data collection focuses on the antecedents to the behavior and the consequences following it; this method is sometimes referred to as the A-B-C approach (antecedents–behavior– consequences; discussed in Chapter 3). By modifying the antecedent behavior and the consequences that follow, we can often modify the behavior itself. Gage, Lewis, and Stichter (2012) completed a meta-analysis of over 69 studies of functional behavior assessments and concluded that using a functional behavior assessment led to a 70 percent reduction in problem behaviors across all student characteristics. Once a hypothesis has been developed about why a student is engaging in the problematic behaviors, the team can develop a Behavior Support Plan (BSP). A BSP generally addresses (a) pro-social replacement behaviors and (b) changes to

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders

Box 8.6

High Leverage Practices:

High Leverage Practice 10: Conduct Functional Behavioral Assessments to Develop Individual Student Behavior Support Plans.

When a student’s problematic behavior is chronic, intense, or impedes learning, we must plan appropriate supports. The key to planning successful interventions is a functional behavioral assessment that helps to determine why the student is engaging in the problematic behavior. In addition to the problematic behavior, the assessment reviews the environmental context in which the behavior takes place, looking

High Leverage Practices https:// highleveragepractices.org

at the antecedents and consequences. Based on our hypothesis about the function of the student’s behavior, an intervention plan can be developed.

Reflection: ●

In what ways can a functional behavior assessment lead to a greater understanding of the student’s needs?

the environment that make the replacement behavior more effective, (c) changes to the environment that make the problematic behavior less effective, and (d) a data-collection process to monitor the student’s progress. Students with EBD have some of the most intense challenges of any group of students, and while the MTSS framework is a starting place for addressing their needs, services must often go beyond the school to support the student’s success.

8-6d  Wraparound Support for Students with EBD The wraparound approach makes extensive use of agencies outside the school program in coordination with school personnel in the planning. Using a multidisciplinary approach, professionals from education, psychology, psychiatry, social work, and other related fields can form an intervention team to provide a “system of support.” The family is a critical part of this system, and family involvement is critical to the support provided. Systems of support call on the assets of the family, the neighborhood, and the community and can include Boys and Girls Clubs, religious centers (e.g., churches, temples, synagogues, mosques), libraries, parks and recreation programs, and youth support programs, which can all become part of the system of care for students with EBD. Wraparound support might include counseling for the student and their family. Kendall and her family are already in counseling, and Kendall has begun taking anti-anxiety medication to deal with her stress and help her regain healthy eating habits. During family counseling, her parents learned about the bullying behaviors of her classmates, and they have approached the school to see if changes can be made. Kendall’s parents have personal resources, live in an asset-rich neighborhood, and they can leverage the supports Kendall needs. This situation is not the case for Pete. Pete’s mother, who has become very worried about his increased truancy and her inability to handle his behavior, needs Wraparound support includes family, friends, and neighbors. support herself. Because of Pete’s attendance record, the school has referred him to social services, and the Ariel Skelley/DigitalVision/Getty Images

Boys and Girls Clubs of America https://www.bgca .org/

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family will begin counseling soon; however, Pete’s mother is very concerned that social services will take Pete away from her. Her level of trust in many government agencies is very low because she has seen first-hand how some interventions can do more harm than good. For students with the most extreme emotional and/or behavioral difficulties, medication may also be part of the wraparound support. The neural chemistry of the child’s brain may need to be adjusted, and medication may be considered as part of the treatment and support (National Institute of Mental Health [NIMH], 2016). When medication is considered for a child, the multidisciplinary team will need to include a physician (psychiatrist, neurologist, or pediatrician), and may often include a psychologist, a psychiatric nurse, and/or a behavioral therapist as well. As our understanding of brain development increases, we are better able to recognize and treat early stages of mental illness and emotional disturbances in children. The use of psychotropic (affecting the neurosystem) medication with young children, however, must evaluate the related risks (NIMH, 2016). Some risks associated with medications include side effects like nausea, decreased appetite, excessive sweating, confusion, and dizziness (Qato et al., 2018). For children who are trying to manage extreme anxiety disorders, depression, obsessive-compulsive disorders, post-traumatic stress disorders, attention deficits, eating disorders, and schizophrenia, the benefits of medication may outweigh the risks. While the specific medication needed for an individual child will, of course, be identified by the child’s physician, medications may include antidepressants, mood stabilizers, antipsychotics, and stimulants to support attention (Qato et al., 2018). Young children respond to medications differently than older children and adults because their brains are developing so rapidly. As a result, they may metabolize medications at a different rate (NIMH, 2016). Since psychotropic medications affect the brain chemicals TeachSource Video Connection related to mood and behavior, children taking these medications must be closely monitored. Teachers also need to be aware of the child’s medication and its potential side effects so that they can provide appropriate accommodation within the school setting. While wraparound care often focuses on the student and their family, we must also consider the needs of the teachers. Working with students who have EBD can be exhausting, and the daily stress of trying to meet their needs can feel overwhelming. Administrators often talk about the importance of “teacher-self-care,” but rarely are the time and resources provided to ensure that teachers can take care of their students and their students’ families, let alone take care of themselves (Fowler et al., 2019). Watch the video “Brittany and Trisha: Teaching StratWhen teachers do not receive the support that they need, egies for Students with Emotional and Behavioral their job becomes even more difficult and their motivaDisorders.” This video describes the experiences of tion to continue teaching is undermined. As we look at two students, Brittany and Trisha, and the teaching wraparound support, we must consider strengthening the strategies their teachers have used to help them school-based infrastructure for teachers so that they can meet with success. After watching the Video Case, be successful (Fowler et al., 2019). reflect on the strategies described in the video.

8-6e  Curriculum and Instruction for Students with EBD While organizational structures are important, their influence is diminished unless they are accompanied by effective instructional strategies. Once the teacher and the student are face to face, how does the teacher

Reflection: ●

How might you incorporate these strategies into your own teaching? What questions or concerns might you have about working with students with EBD in the classroom?

Watch online

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders adapt the lessons to fit the special needs that the exceptional child brings to the classroom?

Access to Content Standards: Universal Design for Learning

Division for the Arts (DARTS) a part of the Council for Exceptional Children https:// darts.exceptionalchildren.org/

Children with EBD are expected to meet the same learning objectives, as identified by content standards, as other children in spite of the challenges they face. Table 8.5 shows how UDL can be used to provide access to content standards for students with EBD. We typically think of content standards and academic success in terms of the core curriculum areas of reading, math, science, and social studies, and we often leave out the arts. The arts can be an especially important area of the curriculum for students with EBD because they provide an open-ended opportunity for nurturing the student’s natural creativity. Box 8.7 shares the view of our expert, Dr. Beverly Gerber, on why the arts are such an essential part of the curriculum for students with exceptionalities and especially for a student with, or at risk for, EBD. While access to the curriculum is critical for academic success, students with EBD also need intensive support to develop social competencies.

Table 8.5  Using Universal Design Principles to Give Students with EBD

Access to Content Standards Content Standard

Multiple Representations

Multiple Engagements

Multiple Assessments

Reading Standard for Literature, #6, Craft and Structure, Grade 7

Text-based materials Movies, TV shows

Direct instruction on points of view analysis

Written product on points of view

Cartoons

Readings

Compare/Contrast Chart

Pictures

Identify words/phrases that show characters’ points of view

Dramatic presentation

Analyze how an author develops and contrasts the points of view of different characters or narrators in a text.

Graphic organizers (characters’ points of view) Highlighted text (colors for points of view) Story boards showing development of points of view

Role plays/Drama

Write editorials giving contrasting characters’ points of view

Write poem or song sharing points of view

Poem or song presenting evolving points of view

Compare/Contrast Charts

Debates Discussions/Seminars Draw pictures depicting evolving points of view Application to real life, where people have different points of view

Math Standard Statistics and Probability, #6 Investigating Chance process and develop, use, and evaluate probability models, Grade 7

Hand-on Models

Direct instruction on probability

Traditional assessments of problem solving

Real-world examples

Dice roll predictions and charts

Software for probability

Develop a model for predicting the likelihood of being dealt an ace in a five-card deal for five people using a standard deck of cards

Computer generated models of Probability

Charts, Graphs, Pictures

Approximate the probability of a chance event by collecting data…

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Develop real-world scenarios where knowing the probability of an event should help with decision making

Given a specific real-world scenario using probability, students can offer advice on the best choice or decision Discuss the ethics of games of chance

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Educational Responses for Students with Emotional and Behavior Disorders

Ask the Experts:

Why Art Education? A Special Way to Reach and Teach Our Students

© Beverly Levett Gerber

Box 8.7

285

Beverly Levett Gerber, Ed.D. is Professor Emerita of Special Education, Southern Connecticut State University A typical school curriculum is built on an escalating spiral of skills and demands. More subject mastery is required of students each year, and, to add more stress, most school subjects have right or wrong answers. Words read in class are either right or wrong, answers to math problems are right or wrong, spelling is right or wrong. For a student with learning difficulties and/or behavior problems, a lesson that requires following a strict series of directions can result in frustration and behavior problems. As an art teacher observing a third-grade reading class, I had trouble absorbing what I was seeing. There was Taylor, one of my art students, covering his work sheet with drawings of fences, hitting his neighbor, and making buzzing noises during the reading lesson. Taylor’s classroom behavior was disruptive. His attention span was short, and his schoolwork was of mediocre quality. In the art room, Taylor’s artwork and behavior were in sharp contrast to his behavior during the reading lesson. Taylor used perspective drawing. He thrived on building assemblage sculptures and consistently contributed original ideas to the class (Joynes, 2006). Classroom problems can be upsetting and embarrassing. But the art room can be a refuge for students with learning difficulties, a room where they can demonstrate their skills and abilities. The art studio curriculum can offer students open-ended art lessons that do not have a “right” or “wrong” way to solve them. If a student does not excel in drawing, a two-dimensional medium, then clay, a three-dimensional medium, may

provide success. And, there is no escalating spiral of demands. Students can complete one project and begin another as a new challenge. There are many ways to be creative and to solve problems. Success can be empowering and can help to break a “cycle of failure.” Stories about art teachers “saving” students with learning and/or behavioral difficulties are not unusual. Chuck Close (1940–2021) was an artist well-known for his enormous photorealistic portraits. However, his own school career was filled with many learning and many, many behavioral difficulties. Luckily, he was mentored by his high school art teacher, who recognized Close’s talents and helped him get into Yale Art School. Close has said that for him, “It was either Yale or jail.” Classroom Teachers + Art Teachers = Enriched Curriculum. When classroom teachers and art teachers work together, lessons are enhanced. Adrienne D. Hunter, now a retired art teacher in Pittsburgh, collaborated with many classroom teachers. Math lessons were enriched with tessellation and quiltmaking designs. A mural of the New York skyline and a life-size Statue of Liberty enhanced both the school’s 9/11 studies and the school’s entrance. Studies of WPA projects during the Depression generated collaboration between the school’s history, art, and language arts teachers, senior citizens, and students from a nearby university, receiving city-wide recognition and acclaim. But collaboration is not as easy as it may seem. A lack of time is often the primary concern. Many art teachers teach in more than one school and may have hundreds of students to teach each week. We know that art teachers need information about our students. These teachers are seldom included in PPT meetings and often have no access to information in a student’s individualized educational plan (IEP). How do we carve out time to share that information? To develop lessons together? To shine a positive light on our students? As Joynes suggests above, art teachers have different information to share, but they need time to exchange that information with the classroom teacher. Teachers need time to share IEP information and to understand a student’s educational and behavioral needs; they need to know whether a student is having a good day or bad day, they need information about which students are good seating partners and which

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders

Box 8.7

Ask the Experts:

Why Art Education? A Special Way to Reach and Teach Our Students  (Continued)

students to separate, if there are allergies, favorite topics and special interests, etc. Finding time to meet and share information tests our own creativity. Working Together. Art teachers, classroom teachers and resource teachers can share how each teaches a student, including information about their learning and behavioral strategies, adaptive equipment, and modifications created for that student (what works and doesn’t work). Teachers must update each other about issues, problems, and/or successes the student may be experiencing that day. They should share information about a student’s special skills and interests— and not simply assume those talents/interests show up in other classrooms. Don’t underestimate what can be accomplished when we work together. Together, we helped create CEC’s Division of Visual and Performing Arts Education (DARTS) and the Special Needs in Art Education Interest Group (SNAE/NAEA) at the National

Association of Art Educators. Both organizations bring art educators and special educators together. Please share your own stories in workshops, through local and state conferences, and online at https:// darts.exceptionalchildren.org and https://www .arteducators.org/community. Reach out to other teachers. Don’t assume they already know your successful special education and art education collaborative teaching approaches. Thank you for your interest in art education.

Reflection: ●

In what ways can you use the arts in your teaching to support the well-being of students with EBD and help them develop a more positive self-concept?

Reference: Lokerson, J. E., & Joynes, A. C. (2006). Students with learning disabilities. In Gerber, B. L., & Guay, D. M. (Eds.) Reaching and teaching students with special needs in art (p.83). Reston, VA: National Art Education Association.

8-6f  Building Social Competency

SDI Productions/E+/Getty Images

One of the clear goals of support for students with emotional and behavior disorders is to develop the student’s social competency; in other words, we want to increase behaviors such as cooperation, responsibility, empathy, and self-control. The combination of these social skills can be seen in the student’s ability to take charge of themselves and their destiny, their self-determination. Dr. Dennis Cavitt shares the importance of helping students with EBD develop selfdetermination skills as a key part of their social competence (Box 8.8). Building social competency means increasing students’ awareness, ability, and commitment to eliminating their negative behaviors and to encourage the acquisition of constructive ones. For Pete, this process means that the teacher works with him to improve Social competency is critical for success in life. self-awareness skills that will enable him to increase his own control over his hyperactivity or distractibility. Dr. Cavitt, our expert, shared how Dylan’s participation in his IEP meeting helped him to develop self-determination (Box 8.8). How might using this strategy help Pete as he transitions to high school?

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Educational Responses for Students with Emotional and Behavior Disorders

Ask the Experts:

The Importance of Self-Determination Skills

© Dr. Dennis Cavitt

Box 8.8

287

Dr. Dennis Cavitt, Assistant Professor of Special Education, Midwestern State University, Wichita Falls, TX. Dylan, a 17-year-old 11th grade student, was diagnosed with emotional disturbance in 3rd grade. When Dylan found school frustrating, he would explode, yell out and throw things. His behavior alarmed his teacher and scared the other students. While his teachers understood that he was behaving this way to get what he wanted (e.g., attention, preferred materials, to do or not to do certain activities), they also knew that he needed help to learn how to express his needs more proactively and to manage his behavior. Students identified with emotional and behavioral disorders (EBD) as a group are more often placed in the most restrictive educational settings in schools, and these segregated environments will often impact students when they leave the K–12 environment. Students who have been identified with EBD tend to experience significant issues making the transition into adulthood; they have the worst graduation rates of all students identified with disabilities, they experience high unemployment, they struggle with socialcompetence, and thus, their behaviors often end up getting them in trouble with the law, and they often end up incarcerated. They are three times as likely as other students to be arrested before leaving school. They are twice as likely as other students with disabilities to be living in a correctional facility, halfway house, drug treatment center, or on the street after leaving K–12 environment. But these outcomes are not written in stone. It is our responsibility as educators to help change the trajectory for our students, and this responsibility requires helping them develop positive self-determination-skills.

A primary goal of education is to produce selfdetermined adults. Ultimately, this means that as an adult, our students are prepared for further education, employment, and independent living. Self-determination involves many essential life skills needed for planning and carrying out a plan of action and helping an individual behave in a responsible way. These skills include: choice-making; decision-making; problem-solving; goal-setting and attainment; independence, risk-taking, safety; self-observation, evaluation, and reinforcement; self-instruction; self-advocacy and leadership. A self-determined individual will exhibit positive attributions of efficacy (i.e., belief in their ability to be successful) and outcome expectancy, self-awareness, and self-knowledge. When an individual struggles with the discreet skills necessary for self-determination, they tend to be seen as “out of control” and they may engage in destructive behaviors, like Dylan did. The development of self-determination skills does not just happen; these critical skills must be specifically, directly taught and practiced and generalized into novel environments. The development and use of self-determination skills are essential for an individual to become the causal agent for their lives. For Dylan, this meant adopting a behavior management program that focused on teaching strategies to help him take responsibility for his own behaviors. Over time, Dylan learned to use self-monitoring strategies where he would earn opportunities to engage in appropriate behaviors to obtain a preferred item/ activity. This particular strategy was successful. Prior to Dylan learning these self-monitoring strategies, he relied on people external to himself to control his behavior. However, now he can make appropriate choices for himself. He moved from external locus of control to an internal locus of control (e.g., understanding that his actions were his to regulate). Historically, we have seen that individuals who engage in self-determined behaviors tend to live a more fulfilling life. Since the development of selfdetermination skills is a lifelong process, an educational program needs to incorporate self-determination strategies as early as possible. So, what happened to Dylan? When he was leaving the middle school and heading to high school, Dylan asked to attend his IEP meeting. He wanted to be engaged in the decisions that were being made for his high school classes. He was provided training

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders

Box 8.8

Ask the Experts:

The Importance of Self-Determination Skills (Continued)

on how to lead his IEP meeting. During his meeting, the team began talking about various accommodations and, at one point, the team specifically began talking about notetaking and using an assistive technology device to help with notetaking. The team was recommending an AlphaSmart™ for him. Dylan told the team that his keyboarding skills were very slow and that he would rather use paper and pencil to take notes, but also obtain a copy of a classmates notes to fill in the gaps. The team was impressed with his discussion of accommodations that would work for him, and they agreed and adopted his suggestions. Fast forward to the next school year, and Dylan was successful in all his classes with the support decisions the team made with his input. Dylan’s behavior during the school year was much more appropriate than when he was in middle school. Dylan was fully included in all general education

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classes and was highly successful. In his 11th grade year, he was engaged in a vocational class in which he worked at the local zoo’s herpetarium. He told his supervisor that he would be an excellent employee if they would provide him with a visual schedule regarding the activities he needs to complete each day. Reports from his supervisor indicated that he indeed was very successful at his job. With the support of a dedicated team of educators, Dylan is successfully using self-determination skills in his life and changing outcomes!

Reflections: ●



What are the benefits of including self-determination skills training early in a student’s education? What are the possible outcomes if you do not teach self-determination skills with student identified with an EBD?

8-6g  Assistive Technology for Students with EBD

SDI Productions/E+/Getty Images

Several technological aids can provide some supportive help for those working with children who have behavior or emotional difficulties. Some take the form of board games that enhance social skills development with topics such as social greetings, handling anger at school and work, appropriate and inappropriate touching, good sportsmanship, and so on. In another classroom behavior game, students move around the board and are exposed to 10 strategies that are positive solutions for managing anger. They include taking responsibility for one’s own actions, encouraging self-control, and dealing with the acting-out behavior of others. A computer can be an especially useful learning tool for a student with a behavior disorder because it provides an objective and neutral response to their efforts. Students with long histories of problems may respond poorly to teacher feedback, particularly when criticism or correction is involved. If they are adept at manipulating others, it can quickly change the focus of a discussion from their academic struggles to the teacher or the content. This is what Pete often does with comments like “This is really stupid” and “Why are you always picking on me?” With a computer, however, the student has the privacy to try again when their first attempt is not successful. Assistive technology support can help by Technology can be a useful tool to support learning. increasing success and reducing stress for children with emotional difficulties (Edyburn, 2006).

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The Role of Family and Community Earlier in the chapter, we posed several questions about why outcomes for students with EBD continue to be problematic: Have we started too late? Would earlier intervention be more helpful? Do we have the right organizational structures and instructional strategies in place? Do we provide our supports and services with sufficient intensity? Do we partner with families and community members to provide wrap-around support? After reading this section, it should be apparent that the answer to each question indicates that we can do better across the board to ensure that students with EBD receive the early, comprehensive, intense, and tailored supports they need to be successful. In the next section, we will further explore how we can build stronger partnerships with families and community resources to offer the wraparound support that students need.

8-7  The Role of Family and Community The importance of the family has long been recognized for children with EBD. This is one of the reasons parents play a significant role in the IDEA 2004 legislation. Table 8.6 summarizes the various interactions the family will have with the school. As you can see in Table 8.6, parents must be fully informed about activities related to their child. Sopko and Reder (2007) provide detailed statements from the law itself that leave little doubt about the intentions of the lawmakers. The parents are experts on their own children and on their child’s feelings and behaviors and strong partnerships with families is a key aspect of wraparound support (Turnbull, 2019). Cultural competence is critical to building strong relationships with families (Kea et al., 2006). It might be a good time to re-read the message from Dr. Cathy Kea, our expert in Chapter 1. Dr. Kea shared with us a series of questions that we can use to build an understanding of our students and their families. This understanding is the starting point for creating the meaningful partnership with families needed to support positive outcomes for students with EBD. As you re-read the “Ask the Experts” from Chapter 1, keep Pete’s family in mind!

Table 8.6  Parental Involvement in IDEA 2004 ●













Understand what consent is and provide informed consent for services under IDEA 2004. Be notified in advance about any proposed changes to a child’s evaluation, IEP/IFSP, or educational placement, to ensure the opportunity to participate in meetings regarding the education of their child. Be informed about the process used to assess the child’s response to scientific, research-based intervention, appropriate strategies for improved achievement, and the right to request an evaluation. Learn about disciplinary processes and disciplinary actions regarding their child. Receive a copy of the procedural safeguards, the evaluation report, the documentation of determination of eligibility, and a copy of the child’s IEP at no cost. Be informed about the state procedures for filing a complaint and the right to records of hearings, findings of fact, and decisions. Permission to inspect and review all education records related to their child, and request that information be amended.

Source: Sopko, K. and Reder, N. (2007). Public and parent reporting requirements: NCLB and IDEA regulations. Alexandria, VA: National Association of State Directors of Special Education.

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders

Moral Dilemma:

Supporting Hakeem

8-7a  Transition and the Lifecourse of Students with EBD

The U.S. Department of Education (2018) reported that only about 61 percent of students with EBD graduate from high Hakeem, a student in your algebra class has started to act out. school. These findings suggest that stuHe has begun slouching in his chair, answering with sarcasm dents with EBD often face (1) the diffiwhen call on in class, and not turning in his homework. You culty of entering a labor market with low have asked his other teachers if they are noticing any proband uncertain wages, (2) the possibility of lems and they all agree that his behavior has “fallen off.” You trouble with the law, and (3) the unlikelidecide to talk with him, and he confides, in confidence, that hood of their seeking additional training he is being harassed by gang members and that he is really on their own. If we hope to change the worried about his safety. He warns you not to tell anyone or current trajectory for many students with he will be called a “snitch” and will have to “pay for it.” What EBD, we need to rethink the supports and do you do? services we provide for them and their families (Farmer et al., 2022a). We must commit resources to strengthen the bridges from school to family and to community for children with EBD (Farmer et al., 2022a).

Summary ●  After

World War II, the responsibilities for children with EBD shifted from the medical world to educators and psychologists. Dr. Abraham Maslow (1908– 1970) contributed to our understanding of what can be done to support mental health with his “hierarchy of needs” model. ●  Children with EBD have difficulties adjusting to the social and behavioral expectations that are the norm for most school settings. They often have negative self-concepts, low self-esteem, and diminished self-efficacy for school related tasks. A “strength-based” approach to students can help with this. ●  Many students with EBD also have other challenges that may include learning disabilities, autism, and other areas of disability. ●  The definition of emotional and behavior disorder considers the intensity and duration of age-inappropriate behavior, the situation in which the behavior is exhibited, and the individual who considers the behavior a problem. Some consider the federal definition to be problematic because it focuses exclusively on the student as the problem and does not address the importance of the student’s environmental context. ●  Implicit biases can play a role in the identification of students with EBD, and as educators, we must become aware of our own biases to ensure that these do not negatively impact the students under our care. ●  EBD has many contributing causes, including both genic and environmental factors. Correlated constraints can play role in both mitigating and exacerbating challenging behaviors. Trauma, maltreatment, and school-based bullying or violence can all play a role in the student’s well-being. ●  The Information Processing Model shows that for students with EBD, many areas of processing are challenging. It also is essential to remember that the emotional context can have a dramatic impact on the student’s ability to learn. ●  Early intervention and support for young children can play a critical role in preventing and/or limiting the impact of emotional and behavioral challenges. If problems are not addressed in early childhood, they often persist and intensify.

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Key Terms ●  The

MTSS model’s three-tier approach to academic and social/behavioral support provides the opportunity for students to receive support across the tiers. Many educators of students with EBD, however, believe that traditional schoolwide MTSS models are not intensive enough and that the supports must be tailored to address the challenges of each student with EBD. ●  Culturally responsive practices are essential for supporting students with EBD and helping them develop the social and behavioral competencies. ●  Functional behavior assessments to determine what is motivating the student’s behavior are critical to developing a support plan. The wraparound approach, which features a multidisciplinary system of care, is critical for full support of the student. ●  Building social competency and supporting academic success are critical aspects of support. ●  The parents are experts on their own children and on their child’s feelings and behaviors and strong partnerships with families is a key aspect of wraparound support.

Future Challenges 1. What are the environmental conditions needed for emotional and behavioral health? We well know the impact of trauma, neglect, and abuse on the well-being of children, yet some individuals can achieve success in spite of early and prolonged adversity. What are the protective factors for these children? How can we ensure that each child has access to the positive “constraints” that will help to mitigate the effects of adversity?

2. How can we ensure that the supports and services students and their families receive are intense enough to make a difference? One serious condition limiting the delivery of quality educational services to children with behavior problems is the need for highly qualified personnel. Another concern is the lack of time and resources to allow even the most qualified personal to provide the intensive supports students with the greatest challenges need. How can we strengthen family, neighborhood, and community partnerships to offer wraparound support for student with or at risk for EBD?

3. How early should we begin? Research increasingly indicates the advantages to beginning education and therapy early in the child’s life—and that includes family counseling. For children with emotional and behavior disorders, this would mean starting well before the school years. Ideally, early intervention for children with EBD and their families should begin by ages 2 or 3. How can we build the infrastructure needed for this early support? TeachSource Digital Download

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Key Terms Behavior-specific praise p. 276 behavior disorders p. 264 Behavior Support Plan (BSP) p. 281 correlated constraints p. 266

emotional disorders p. 264 externalizing behaviors p. 264 functional behavior assessment (FBA) p. 280

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Chapter 8  |  Children and Youth with Emotional and Behavior Disorders internalizing behaviors p. 264 learned helplessness p. 261 psychotropic p. 283 self-actualization p. 258

self-concept p. 260 self-efficacy p. 260 self-esteem p. 260 wraparound approach p. 282

Resources of Special Interest to Teachers StopBullying.gov provides information from various government agencies on what bullying is, what cyberbullying is, who is at risk, and how you can prevent and respond to bullying.  Stopbullying.gov The Center for Parent Information and Resources on emotional disturbance provides a hub of links and groups for supporting parents and other adults in working with children with EBD. https://www.parentcenterhub.org/emotionaldisturbance/

Journals Behavioral Disorders addresses compelling issues related to individuals with behavioral challenges. Regular features include Research-based articles which discuss evidence-based practices for use with challenging behaviors. Published by the Hammill Institute on Disabilities and SAGE in association with the Council for Children with Behavioral Disorders. www.ccbd.net Beyond Behavior addresses compelling issues related to individuals with behavioral challenges. Regular features include Practitioner friendly articles which discuss evidence-based practices for use with challenging behaviors. www.ccbd.net Journal of Emotional and Behavior Disorders offers interdisciplinary research, practice, and commentary related to individuals with emotional and behavioral disabilities. Each issue explores critical and diverse topics such as youth violence, functional assessment, school-wide discipline, mental health services, positive behavior supports, and educational strategies. https://journals.sagepub.com/home/ebx

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Children and Youth with Communication, Language, and Speech Disorders

9 Ch ap te r

Standards Addressed in This Chapter All of the CEC Initial Practice-Based Professional Preparation Standards for Special Educators (K-12) are addressed within this chapter. Please see the inside book cover for a list of these standards.

Focus Questions 9-1 How did the field of speech and language disorders evolve? 9-2 What are some characteristics of children with speech and language disorders, and how can the Information Processing Model (IPM) help us understand their strengths and challenges? 9-3 How does typical language develop, and what kinds of difficulties and/or disorders can affect communication, language, and speech? 9-4 Why must a child’s culture and linguistic background be factored in when assessments and services are determined? 9-5 How do other disability areas impact communication, language, and speech disorders? 9-6 What educational responses are needed to support children with speech, language, and communication disorders?

Stephanie S. Cordle/St. Louis Post-Dispatch/ ASSOCIATED PRESS

9-7 What family and lifecourse issues are important for individuals with speech, language, and/or communication disorders?

T

he desire to communicate seems as basic a human need as food. Communi­ cation begins as infants work to make their needs known to parents. Initially, the infant uses cries, grunts, gestures, and facial expressions to get their message across. At 3 to 6 months of age, the baby begins cooing, and babbling begins between 6 and 12 months. Infants generally focus on using sounds that approxi­ mate speech and imitating the language they have been listening to from birth (Morgan & Wren, 2018). Finally, at around 1 year, the first “words” appear. These first words are usually repetitions of sounds, such as ma-ma, da-da, or pa-pa.

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders So, is it any wonder that in many languages, these words mean “mother” and/or “father”? Nothing is more exciting to parents than their infant’s amazing ability to acquire speech and language in the first year of life. But in some cases, that language development is delayed, or it doesn’t appear at all. When children show delays in language development or have difficulty producing speech sounds, early intervention is essential for improving their abil­ ity to communicate (Morgan & Wren, 2018). In this chapter, we look at commu­ nication, language, and speech, examining the ways that children develop and the difficulties they encounter when they have challenges in these areas. We look briefly at the history of the speech-language field; reflect on how we define com­ munication, language, and speech; examine typical human development of lan­ guage; explore the impact of being a bilingual child on language development; review the disorders and disabilities that can affect these areas; and present strate­ gies that can be used to support children and youths who have disorders in com­ munication, language, and/or speech. Throughout this chapter, we discuss the impact that specific disabilities may have on a child’s ability to communicate, use language, and speak.

9-1  History of Communication, Language, and Speech Disorders

American Speech and Hearing Association www.asha.org

The formation of the American Speech and Hearing Association (ASHA) in 1925 marked a significant point in the emerging field of speech-language pathology, but attempts to correct speech patterns and to enhance communication date back at least to the early Greeks in the fifth century B.C. (Coufal, 2007). In the United States during the 1800s, a focus developed on elocution, or the ability to speak with elegance and propriety (Moore, 1802, as cited in Duchan, 2008). With the emergence of public schools, curricula for teaching elocution were developed, and some attention was given to helping students who had speech impediments. Alexander Graham Bell founded the School of Vocal Physiology in 1872 to help improve the speech of children who were deaf or who suffered from stuttering and/or articulation problems (Duchan, 2008). By the advent of the twentieth century, the emerging science of speech and communication began to influence practice. Early studies connecting areas of the brain to speech and language began to emerge with the work of Paul Broca and Carl Wernicke. As Figure 9.1 shows, parts of the brain were named after Broca and Wernicke because of their pioneering work in this area. By the middle of the twentieth century, the concept of speech-language disorders began to move beyond the production of sounds to include the “inner language,” or thoughts that underlie communication. Key contributors to our ideas of sym­ bol formation were Karl Goldstein, Helmur Myklebust, and Charles Osgood. Goldstein worked with aphasics, individuals who had lost or failed to develop language, whereas Myklebust concentrated on individuals with auditory pro­ cessing difficulties. Osgood added the idea of a mental component to com­ munication. Their combined work began to show that communication was complex, involving interactions among speech production, language develop­ ment, and thought (Duchan, 2008).

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History of Communication, Language, and Speech Disorders

Motor control of mouth and lips

Broca’s area

Motor cortex

Wernicke’s area

Primary auditory cortex

Angular gyrus

◗ Figure 9.1  The Major Brain Structures Participating in Language Source: Freberg, L. (2006). Discovering Biological Psychology, p. 392. Used by permission of Houghton Miffin Harcourt Publishing Company.

9-1a  Studying Brain Injury to Understand Language Neurologists often try to determine the specific function of various areas of the brain by examining the impact of brain injury or damage. The generalized notion that language is largely associated with the brain’s left hemisphere (see Broca and Wernicke’s areas in Figure 9.1) is supported by the language disruption that occurs when a lesion or injury to that hemisphere occurs (Lansing et al., 2004). This pattern of hemispheric specialization, however, seems to be better defined for adults than for children (Bates et al., 2001). For young children, when the brain is still developing, there seems to be far more plasticity, which is the ability of the brain to compensate for and reorganize functions to draw on the nondamaged areas, than there is for adults (Bates et al., 2001). In their comparison of the effects of left-hemispheric brain lesions on language for children and adults, Bates and her colleagues (2001) found that while adults showed the classic signs of aphasia (language loss) after injuries to the left hemisphere, children did not seem to be impacted in the same way. In their study, they saw no differences in the language development of children ages 5 to  8 who had either left- or right-hemisphere lesions. The language of children and adults with bilateral brain injuries, however, was severely impaired. These findings support the hypothesis that language outcomes, because of brain injury, differ for children and adults and depend on the extent of damage to both hemispheres.

9-1b  Study of Linguistics During the 1960s and 1970s, the speech-language field emphasized linguistics. Noam Chomsky led the way by examining the rules and sequences governing the acquisition of language (Chomsky, 1965). Over the past 30 years, the area of language pragmatics—ways that language is used to communicate in a variety of contexts—has emerged as a critical area of study (Duchan, 2008; Hyter, 2007). The social aspects of communication in everyday life also play a central role in our cur­ rent thinking about speech and language disorders (Burton et al. 2019; Duchan, 2008). Current research additionally focuses on the role of cognition in language development and the importance of learning as part of language acquisition

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders (Hoff, 2004, 2009). Researchers have discovered that language acquisition, from the cognitive perspective, depends to a large extent on the child’s exposure to language (Slobin, 2006). The more language a child hears, and the greater the complexity of this language, the more likely the child will learn the structural properties of language. From this perspective, providing language-rich environ­ ments is critical for young children. The impact of learning two languages for chil­ dren growing up in bilingual or multilingual families or communities is also an emerging area of study (Bruton et al., 2019; Maguire et al., 2010). We will explore this issue in greater detail later in this chapter. Since communication is so vital to being a member of society, life can be dif­ ficult for children who have speech and/or language disorders.

9-2  Characteristics of Students with and Definitions of Communication, Language, and Speech Disorders Communication is central to our ability to fit into society successfully, and when difficulties with language and/or speech interfere with communication, children often experience difficulties (Brinton & Fujiki, 2006). These challenges can affect the formation of a child’s friendships, school success, and self-esteem (Daughrity, 2019; Grace & Raghavendra, 2019; Girolametto & Weitzman, 2007). While there are many different patterns of impact for challenges with communication, lan­ guage, and speech, we can begin to understand some of the difficulties if we get to know two students: Johnny and Michelle.

Meet Johnny and Michelle, Two Students with Speech Disorders Johnny is a 10-year-old boy who has a moderate articulation and phonology disor­ der (he mispronounces specific sounds, such as saying “woad” instead of “road”). A speech disorder may signal an underlying language problem, and a comprehensive assessment indicated that Johnny also has a language-related learning disability. Academically, he is performing below grade level on skills that require language mediation, like repeating back written instructions. Johnny also demonstrates a range of intraindividual differences with both strengths and challenges. At this point, his sound substitutions and omissions are not very severe, and he can usu­ ally be understood, but his speech still sometimes sets him apart from his peers. Johnny’s speech is characterized by consistent sound substitutions (w/r, as in wabbit for rabbit; t/k, as in tome for come; and l/y, as in lellow for yellow). He also sometimes omits sounds at the ends of words, including the sounds that represent verb tense and noun number (e.g., the final /s/ in looks and cats). When he was younger, his expressive language was delayed, and he spoke very few words until he was 2 years old. When he did begin to talk, his speech was almost unintelli­ gible, and nonfamily members had difficulty understanding him. Johnny’s recep­ tive language, however, was excellent, and his understanding of language spoken to him allowed him to be an active member of a busy family with three older siblings. Careful listening to his conversational language reveals that he still omits articles, and his sentence structure is not as elaborate as that of most 10-year-olds. Johnny is in a general classroom, MTSS Tier I, but he sometimes seems reluctant to participate in class. It has not been determined whether this reluctance stems from his sensitivity to others’ reactions, an inability to formulate speech and com­ plex language to express his ideas, or both. When we look at Johnny’s strengths, we note that he is bright and has strong athletic abilities, and he gets along well with other children. A sensitive teacher can do much to help Johnny feel comfortable despite his speech disorder and can help him develop a positive self-concept.

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Characteristics of Students with and Definitions of Communication, Language, and Speech Disorders Michelle, who is also 10 years old, has different difficulties with speech. Her problems, however, are not with articulation—that is, the pronunciation of words. Michelle has difficulty with speech fluency, and she often stutters when she is talking. Michelle’s speech is characterized by sound repetitions (e.g., “W-W-WWhat do you need?”), sound prolongations (e.g., “Ssshhhhould I go, too?”), and a series of interjections that insert pause words into the sentence (e.g., “I can-umum-you know-do this”). Sometimes when Michelle opens her mouth to speak, nothing comes out. Michelle is a shy child by nature, and her difficulties with speaking have made her very hesitant to interact with others. When Michelle was in the second grade, she had a teacher who made the situation even worse. Michelle remembers Mrs. Cooke forcing her to stand before the class and give her book report. Mrs. Cooke said loudly in front of the class, “Now, Michelle, just take a deep breath and talk slowly and you will be fine.” When Michelle did begin to stutter, Mrs. Cooke interrupted her and said, “Just start from the beginning and you can get it right.” Michelle was mortified by her continued difficulties in front of the whole class, and the more nervous she became, the worse her stuttering became. Finally, she was allowed to slink back to her seat and try to make herself invisible; she has tried hard to maintain her invisibility ever since. One of Michelle’s strengths is written language, and she has won several awards for her poetry. Michelle is comfortable talking at home, and her stuttering does not seem to be a major problem when she is with her family. In school and other settings, Michelle finds it very difficult to participate in conversations involving more than a few people. The information-processing model for Michelle indicates the areas that cause her the most difficulties, but it also shows her strengths (see Figure 9.2). While Michelle has difficulties with speech (output), and these difficulties can cause problems with social interactions, her ability to receive information (input) and to process information (thinking) is just fine; she also has strengths in written out­ put. It is important to remember that students who have challenges with speech, language, and communication also have many strengths. Box 9.1 shares some of

Emotional Context

Thinking

Response

Memory Classification Association Reasoning Evaluation

Speaking Writing Motor Response Social Interaction

Processing

Stimulus

Vision Hearing Kinesthetic Haptic Gustatory Olfactory

Information Input

Attention

Information Output

Executive Function

key Challenges Strengths

◗ Figure 9.2  Michelle’s Information Processing Model TeachSource Digital Download

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders

Box 9.1

Speech, Language, and Communication Disorders:

Remember Our Super Powers!

Even though we sometimes have difficulty sharing our thoughts, we also have some great strengths. Here are some of our super powers: ● ● ● ● ●

“I am really good at figuring things out. I think and think, and then I know what to do!” “I am a good listener.” “I am good at writing poetry and have won some awards for it.” “I am an athlete. I pitch in baseball, am a forward in basketball, and also play tennis!” “I am a photographer—they say a picture is worth a thousand words—so this is really important for me!!”

the strengths that students with speech, language, and communications difficul­ ties have. Both Johnny and Michelle have speech disorders, and both receive support from a speech-language pathologist. Later in the chapter, we discuss the supports and services these children need to be successful, and we return to Johnny and Michelle to check their progress.

9-2a  Definitions of Communication, Language, and Speech Although we sometimes use the terms communication, language, and speech inter­ changeably, each term means something different. The following definitions clar­ ify how these terms are being used in this chapter and give us a shared platform for looking at the kinds of problems that can emerge with each of these areas.

Communication The ability to communicate is essential to our participation in society. It is what links us to others and helps us form a shared sense of belonging. Communication is the exchange of thoughts, information, feelings, and ideas, and it requires three things: a sender, a message, and a receiver (see Figure 9.3). This statement may seem like common sense, but it is important to note that communication has not taken place unless all three elements are in place and are working (Loncke, 2011). The sender initiates the communication and determines the message, and the receiver gets the message and must interpret it to understand what it means, thus completing the communication loop. If you think about the infor­ mation-processing model (IPM), you can see how communication involves input (hearing or seeing), central processing (thinking about and understanding), and output (speaking, signing, writing, etc.). Communication also involves the use of the executive function (decision making), and all of this takes place within an emotional context that must be factored in to correctly understand the message (Loncke, 2011). Communication problems can emerge when difficulties occur with any one of these elements. We communicate in many ways. Messages can be transmitted through writing, symbols, and pictures; as humans, we also communicate through drama, dance, music, and all the fine arts. Communication can be nonverbal, through gestures

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Characteristics of Students with and Definitions of Communication, Language, and Speech Disorders

What does he mean? Is he asking me to study with him? Or is he just curious?

Hi! Do you have a study partner for ED250 yet?

Message Sender Pragmatics: Meaning in context Semantics: Meaning

Receiver How many ways can this be interpreted? “Aren’t you in my ED 250 class?”

Syntax: Sentence /Grammar Morphology: Words Phonology: Sounds Building Blocks of Language ◗ Figure 9.3  Has Communication Taken Place?

and facial expressions. Think of all the things you can express with just a look. Sign language uses an ordered form of gestures to convey meaning. The primary vehicle that humans use for communication, however, is spoken language.

Language Lahey’s classic definition of language as “a code whereby ideas about the world are represented through a conventional system of arbitrary signals for communication” is still viable today (Lahey & Bloom, 1988, p. 3). Through this definition, we see that language, as a code, represents ideas, or mental con­ structs, and that these are separate from actual objects and events. These mental constructs are inherent to the person and not to the word, object, or event. Further, Lahey’s definition reminds us that language is symbolic; it relies on signals, sounds, and signs to represent objects and events and is an abstrac­ tion. And finally, through this definition, we see that the primary function of language is to communicate. Two kinds of language are involved in communication: receptive language and expressive language (ASHA, 2021a). Receptive language involves the abil­ ity to take in the message and understand it (that is, listening with under­ standing to oral language and reading written language with comprehension; in other words, input and central processing). Expressive language is the abil­ ity to produce a message to send; this ability typically involves speaking and writing (output) but also includes sign language (discussed in Chapter 11). So, as part of communication, language is an organized system of symbols that humans use to express and receive meaning. Language systems evolved over time and largely replaced the innate communication system of gestures and facial expressions, which convey a more limited range of meaning. The key elements that help define a language can be thought of as belonging to three categories: form, content, and function.

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders

Box 9.2

Mindfulness Matters:

Understanding Body-Language to Build Better Communications Skills

Communication is about sending and receiving a “message,” and for the message to be transmitted successfully, it must be understood. This idea may sound simplistic, but it is the critical aspect of communication. For a message to be correctly understood, we must go beyond the words and interpret the body language of the sender. Body language, or the nonverbal signals and signs we send, often supersedes the actual verbal content of the message (e.g., when we glare at a student with our hand on our hips while saying, “Are you being smart?”) Why this Matters: During any communication, understanding the meaning of the message is critical. Misunderstandings can lead to hurt feelings, confusion, and “drama.” Attending to body language (e.g., posture, gestures, movements, eye gaze, facial expressions) is key to correctly understanding the message. Practicing Mindfulness: Mindful Attention to Body Language begins with understanding how our own bodies communicate. Paying attention to nonverbal signals can help our students become better communicators. We can start with thinking about how we walk, stand, sit, and move when we have different kinds of feelings. We can play “Body Language Charades” with our students to help them learn more about how our bodies communicate nonverbally. Here is how it works: 1. With the students, create a set of feelings cards (i.e., write one feeling on each index card) to include the major and minor emotional states we may find ourselves experiencing (e.g., frustration, anger, joy, fear, amazement, happiness, boredom, sadness, puzzlement).

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2. Create another deck of cards, using a different color, with the kinds of body language we can use (e.g., posture/stance, sitting, walking, running, hand gestures, arm gestures, head position, facial expressions, eye gaze, breath). 3. As you build the decks of cards, discuss what the feelings are and how these are communicated through different kinds of body language. This step would also be a good time to explore how differences in cultural norms can impact nonverbal communication and how these differences may contribute to misunderstandings. 4. To Play: (a) students draw one card from each deck, giving them a feelings card and a body-language card (e.g., happiness & walking; frustration & sitting; fear & eye gaze). (b)  the student then tries to communicate the feeling using only the allowed body-language to express it. [Note: This action is harder than it sounds—we all tend to use facial expressions, breathing, and eye-gaze spontaneously when we are expressing emotions. It is hard to isolate just one aspect of nonverbal communication, but have your students try to use body language this way.] (c)  The remaining students work to guess the feeling that the student is communicating. (d) Points can be scored for both “sending” and “receiving” the message correctly. [Note: You can also split your class into teams who work together to identify the feelings.] Discussing with your students the importance of nonverbal communication can help them avoid misunderstandings, confusion, and drama!

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Language Form  The form that a language takes can be seen in the sounds, words, and grammar that underlie the language (ASHA, 2021a). Each language has its own individual form, or structure, but languages that share a common origin may be resemble each other in form (Gleason, 2005). Language form includes the following areas: 1. Phonology is the study of sounds (i.e., phonemes) and how they combine to form speech (e.g., the phoneme “d” in dog; or “c” in cat).

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Characteristics of Students with and Definitions of Communication, Language, and Speech Disorders 2. Morphology is the study of how words are formed and the rules that address the structure of words by adding prefixes and suffixes to modify the words meaning (e.g., “chase” becomes “chasing”). 3. Syntax is the set of rules that guide how words are combined to form sentences and the relationships of components within the sentence (e.g., the basic sentence structure in English is a “subject,” a “verb,” and a “direct object,” as in the sentence: “The dog is chasing the cat.”) (ASHA, 2021a). A language’s grammar is the combination of its morphology and syntax. The structure of a language helps to convey the content. For example, in English, we often use the sentence form article/noun/verb: “The cat pounced.” When we see a sentence like this one, but with a word we do not know (in this case, a made-up word): “The cat zupped” we understand that “zupped” is an action.

Language Content The content of a language is the information being communicated. This information is an essential element of language because the meaning of the symbols used is the heart of the message. Language content, or semantics, is the meaning of words and sentences. You may have heard someone say, when arguing a point, that something is “just semantics,” dismissing a point of difference by implying that the ideas are the same regardless of the words used. This argument is incorrect, however. Meaning is semantics, and meaning may be the most essential aspect of language. Meaning, however, must be interpreted within the context of the communication.

Language Function  Language function, or use, addresses language as appropri­ ate communication within a given society and a specific context. For a message to be correctly understood, the entire context of the message must be considered, and this means going well beyond just the words (see Mindfulness Matters, Box 9.2). To understand the meaning of the message, we must also consider the setting, the individuals involved, the history of individuals, the cultural perspectives of the individuals, the tone of voice, and even the body language of the sender (Gibbs & Colston, 2020). The two concepts critical to how language is used are language pragmatics and supralinguistics. Language pragmatics address the social context in which the communication occurs (Gibbs & Colston, 2020). The social context is important because it helps clarify the meaning of the communication. Thus, the sentence “Can you feed the dog?” may mean one of the following: Please feed the dog. Are you physically able to feed the dog? or, Do you have the resources needed to feed the dog? The meanings depend on the circumstances and the understanding of the person to whom the question is addressed. Pragmatics also addresses the different expecta­ tions for communication in different settings and contexts (Gibbs & Colston, 2020). Children are asked to use very different rules when they communicate in the class­ room versus on the playground, and sometimes expectations for communication are different for the home and the school. To be successful, we must learn to adapt our communications to the specific expectations in a variety of settings. Supralinguistics is the sophisticated analysis of meaning when the literal mean­ ing of the word or phrase is not the intended meaning (WPS, 2017). Being good at supralinguistics means that one can understand sarcasm, indirect requests, subtle inferences, and figures of speech. This skill is also important for understanding puns, wordplay, and verbal humor. Because people often communicate with indi­ rect language, individuals who have difficulty with this idea may be at a loss to interpret meaning and understand needs. For example, a teacher may say, while rolling her eyes, “Well, of course I expect you to talk out in class,” when she means

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders the opposite. A youngster who has difficulty understanding social cues and inter­ preting nonliteral language (such as sarcasm) will be very confused by this state­ ment. This is one of the challenges faced by children with Asperger’s syndrome and other students with ASD (see Chapter 5) (Krupa et al. 2019; Hughes-Lynch, 2010). Next, we discuss speech. When a given community selects a series of sounds to convey meaning, it creates speech. Spoken language can be used to convey abstract meanings and to address the past and future, as well as the present.

Speech Speech is the systematic oral production of the words of a given language. Sounds become speech only when they produce words that have meaning. Speech has a rhythmic flow, with stress and intonation, and it uses words with stressed and unstressed syllables. We think of speech as combining articulation, fluency, and voice. Articulation is the clear pronunciation of words, speech fluency refers to the appropriate flow of the words, and voice is the intonation and quality of the production (pitch, loudness, and resonance). Figure 9.4 presents a simplified over­ view of the production of speech. A thought occurs in the brain; it is translated into symbols and sent to the larynx area for phonation and resonation, which takes place in the vocal tract; air is sent to be modified by movements of the tongue and passage over the teeth and lips, which combine to form the sounds, words, and sentences of a particular language (articulation). The thought transformed into words is received by a listener through hearing, in a process called audition. The following four processes are involved in the production of speech: ●  Respiration

(breathing) generates the energy that produces sound. is the production of sound by the vibration of the vocal cords. ●  Resonation gives the voice a unique characteristic that identifies the speaker (it is the product of sound traveling through the speaker’s head and neck). ●  Articulation is the movement of the mouth and tongue that shapes sound into phonemes (the smallest unit of sound), which combine to make speech. ●  Phonation

Figure 9.4 displays where each of these processes occur in the human body. Both Johnny and Michelle have speech disorders, but it is important to remember that a failure to appropriately interpret the context or setting can also lead to prob­ lems with communication and the pragmatics of language use (Loncke, 2011). Communication disorders often involve both language and speech disorders.

Thought

Articulation

Audition Resonation Phonation

Respiration

◗ Figure 9.4  Processes Involved in the Production of Speech

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Typical and Atypical Language Development

9-3  Typical and Atypical Language Development

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An infant is innately programmed to communicate through smiles, eye contact, sounds, and gestures (the prelinguistic system). Most infants are very social beings and are motivated to relate to persons in their environment. The language system uses these talents. Parents and caregivers teach the child that people and objects have names and particular sounds to identify them. Early challenges with these prelingual behaviors can signal risks for later difficulties with language develop­ ment (Morgan & Wren, 2018; Loncke, 2011). Although the specific language that each child learns will depend on the language spoken in the home, the pattern of language development seems to be similar across languages. The aforemen­ tioned two aspects of language, receptive language and expressive language, are critical to a child’s development. Understanding typical language development is essential to understanding when and how problems with language can manifest themselves. Typically, expressive language emerges in sequence from pleasurable sounds (such as cooing) and cries to babbling (e.g., da-da-da), and by around 1 year of age, most children have one or two words (e.g., mama; bye-bye). From ages 1–5, language begins to take off with simple sentences (such as “where kitty?” or “more cookie”); until at age 5, the child can communicate easily using the same grammar other family members use (“I like ice cream. It be good!”). Receptive language—the child’s ability to understand spoken words—also fol­ lows a sequence from simple to complex. Infants enjoy eye contact and games like “peekaboo”; toddlers begin to recognize that spoken words stand for objects (shoe, cup, ball), and they can often follow simple commands (such as “Get your shoes so we can go to the park”). Preschool children can usually follow two-step directions (“Sit on the rug and get ready for story time”), and they can listen to stories and respond to basic who, what, and where questions. By the time children start kindergarten (age 5), they should be ready to understand most of what is said in home and school settings. For many reasons, however, a child’s individual language progression may dif­ fer somewhat from this typical sequence. A bilingual child, for example, who is learning two languages at the same time may have fewer words in each language and so may appear to be delayed in vocabulary or language acquisition when only

Language development begins at birth and as the infant hears and responds to the sounds made by the people in their environment.

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders one language is assessed (Perez et al. 2019; Hoff, 2004; Hart, 2009; Brice & Brice, 2009). When words in both of the child’s languages are considered, however, we get a more accurate understanding of the child’s true vocabulary and abilities (Holt, 2005, Brice & Brice, 2009). Children who are bilingual may also be some­ what delayed in their phonemic awareness (the relationship between letters and sounds), and they may need additional time and support in early reading (Burton et al., 2019; Brice & Brice, 2009; Brice, Carson, & O’Brien, 2009). The ability to communicate in more than one language is a strength that will ulti­ mately be an asset to the individual (Castro et al., 2021; Barac & Bialystok, 2012). In fact, studies have shown that bilingual children often outperform monolingual coun­ terparts in executive control and literacy examinations (Fielding & Harbon, 2020). However, because bilingualism may impact the early development of language, chil­ dren can be misidentified as having language delays when they are actually on target, given the demands of learning two languages (­Kay-Raining Bird, Genesee, and Verhoeven, 2016). During assessments, we must make sure that we understand the child’s language and cultural context as we look at the child’s needs (Guiberson & Ferris, 2019; Hart, 2009; Hoff & Elledge, 2005). With the growing numbers of children from culturally and linguistically diverse families in today’s schools, we must be extremely careful that we consider the child’s language background as we look at pos­ sible areas of concern (Perez et al., 2019; Marinova-Todd et al., 2016; Guiberson et al., 2006; Salvia et al., 2007; Brice et al., 2009).

Box 9.3

Ask the Experts:

Equitable Speech/Language Services for Bilingual and Bicultural Children Bilingualism as a Child Characteristic

© Dr. Dina C. Castro

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Dr. Dina C. Castro is the Director of the Boston University Institute for Early Childhood WellBeing at the Wheelock College of Education and Human Development In this commentary, I highlight some of the ideas the authors present on why and how professionals in the field of speech, language, and communication sciences can ensure that services are equitable for the bilingual and bicultural children they serve. Also, I discuss the most common challenges encountered in the implementation of the effective practices described in the chapter to serve this population of children.

As has been mentioned in this chapter, communication, language, and speech are related to brain development and socialization. Neuroscience research has now demonstrated that the brain of a bilingual child not only functions differently but is also organized differently than the brain of a monolingual child (Conboy, 2013). As noted by Barac et al. (2014, p. 13), “The experience with two linguistic systems, no matter how short and regardless of the language pairs involved, changes the way in which language is organized in the brain. Furthermore, these functional brain changes are present very early on, after only limited bilingual experience, suggesting that setting up representations in two linguistic systems through exposure to two languages, and not only language production, drives functional plasticity in bilingual children.” Based on these findings, it is accurate to conclude that bilingualism is a child’s characteristic, not a problem that needs to be fixed. It is known as well that socialization (Vigotsky, 1978) and culture (Rogoff, 2003) play a pivotal role in language development and in development and learning in general. As bilingual children operate in the world with their two languages, they learn from interactions with people and the physical environment, at home, their school, and community in the language that is involved in those

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Typical and Atypical Language Development

Box 9.3

Ask the Experts:

Equitable Speech/Language Services for Bilingual and Bicultural Children  (Continued)

interactions. Thus, they use two languages to make meaning of their experiences (Castro et al., 2021). These ideas are very important for professionals to have in mind when planning and implementing services for bilingual children. Interventions should support the child’s development and maintenance of their home language in addition to the majoritized language, preventing the harmful consequences of arrested development or loss of the child’s first or home language during cognitive, language and socioemotional development (Fillmore, 2020). This includes, for example, not telling parents of bilingual children with communication, speech, or language disorders to talk to their children only in English, a practice that unfortunately is still common among professionals, because there is a misconception that bilingualism can delay progress in a child with a disorder (Marinova-Todd et al., 2016). In fact, there is research evidence that demonstrates that bilingual children with developmental disabilities (including those with specific language disorders and children with autism) are capable of becoming bilingual, although there will be differences based on time and amount of exposure to each language. These studies conclude that bilingualism is not detrimental to development and learning (Kay-Raining Bird et al., 2016). Deficit perspectives about bilingual children’s language development Holding monolingualism as the norm when providing services to bilingual children with communication, speech, and language disorders reflects a deficit perspective that disadvantages bilingual children. The monolingualism as norm perspective assumes that bilingual children are facing a “language barrier,” and thus support policies and practices intended to eliminate the “barrier” by eliminating the child’s first or home language replacing it with the majoritized language (Castro & Meek, in press). Using monolingual language development as the norm in referral, assessment, and intervention practices has resulted in the over or underrepresentation of bilingual children referred to speech and language pathology and special education services (Artiles et al., 2010). Practices such as assessing bilingual children only in English, or with translated standardized instruments normed with monolingual English-speaking samples, ignore what children may have learned through their other language. Furthermore, the instruments’ cultural

biases may lead to inappropriately identifying a bilingual child as having a communication, language, or speech disorder. For these reasons, choosing the adequate assessment instrument (available in the child’s home language and normed in that language) is necessary to prevent misidentification. However, the limited availability of culturally valid assessment instruments in languages other than English is still a big challenge. Although, there are some instruments available for Spanish-speaking bilingual children (Barrueco et al., 2012), instruments in other languages are extremely limited. To avoid making assumptions based on deficit perspectives, professionals also need to gather information about the various contexts of bilingual children’s language development including their home, school, and community. This will help them gain an understanding of the beliefs, practices and behaviors that are particular to these children’s and families’ lives and recognize their strengths to use them in planning culturally and linguistically responsive interventions (Castro et al., 2020). Implications for professional preparation With the changing demographics in the country, speech pathologists and other professionals serving children with communication, language and speech disorders are very likely to have bilingual children among their clients. Thus, programs preparing these professionals should include coursework and field experiences that will prepare them to offer services that are grounded in children’s culture and linguistic diversity. Also, increasing the cultural, linguistic, racial, and ethnic diversity among professionals in the field of communication, speech, and language sciences would facilitate the provision of linguistically and culturally sustaining practices to bilingual children and their families. Finally, an interdisciplinary approach is critical when serving bilingual children with communication, speech, or language disorders, with the speech pathologist working closely with the bilingual and special education teachers, in partnership with the families. References cited in this feature can be found in the references at the end of the text.

Reflection: ●

What types of supports do bilingual children need in the classroom? How can teachers work with bilingual families with children with communication disorders?

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders

9-3a  Disorders in Communication, Language, and Speech It is important to distinguish among disorders in communication, language, and speech because they have different origins and require different interventions. Table 9.1 gives the American Speech-Language-Hearing Association’s (ASHA) defi­ nitions of these disorders. Communication disorders are often related to other areas of disability (ASHA, 2021b). Those related to hearing are discussed in Chap­ ter 11. Communication difficulties also impact children with autism (Chapter 5), learning disabilities (Chapter 6), visual impairments (Chapter 12), and physical disabilities (Chapter 13). We will explore these relationships in greater detail later in this chapter.

Communication Disorders Communication is often used as a general term to include pragmatics, speech, and language. Communication disorders disrupt the individual’s ability to send, receive, and process information. If you think about the information-processing model (Figure 9.2), you can see how problems with input could undermine an individual’s ability to take in messages. Difficulties with processing can make understanding or interpreting the message hard, and output problems can make it hard to send a message. In some cases, the processing difficulties affect a child’s ability to understand nonliteral meanings of words, and so the child misses the nuances of the communication. The brain’s executive function system also over­ sees and monitors communication; so, if there are problems with attending, com­ munication will be difficult. The emotional context of communication can also contribute to an individual’s inability to send, receive, and/or understand the message. Strong emotions, such as anger and high levels of anxiety, can make communication difficult. Remember Michelle, the girl we met at the beginning of the chapter, and how painful speaking in front of the class was for her because of her speech disorder? Speaking in front of the class became even more difficult as

 merican Speech-Language-Hearing Association’s Definitions of Communication Table 9.1  A Disorders Including Language and Speech

Communication Disorders

A communication disorder involves difficulties with receiving, sending, processing, and comprehending verbal, nonverbal, and graphic symbolic information. Communications disorders may be mild or severe and may co-exist with other areas of disabilities. A. A speech disorder involves the articulation of speech sounds, fluency, and/or voice. 1. An articulation disorder speech sounds are distorted and may be unintelligible due to substitutions, omissions, or additions of phonemes. 2. A fluency disorder the flow of speech is characterized by differences in rate or rhythm and the reputation of speech sounds, syllables, words, or phrases. 3. A voice disorder the quality of voice is atypical given the speakers gender and age; pitch may be too high or low, volume may be inappropriate, and differences may include resonance and duration of sound. B. A language disorder involves difficulties with any combination of spoken, written, and or symbol systems used to share ideas and messages. Language disorders may impact understanding and use of (a) language form (phonology, morphology, syntax) (b) language content (semantics), or (c) language function (pragmatics).

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Typical and Atypical Language Development

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her anxiety increased when her teacher put pressure on her. Michelle’s early expe­ rience with public speaking related to strong negative emotions that stayed with her and inhibited her desire to communicate for years to come.

Language Disorders As explained earlier, culturally determined rules govern the form, content, and function of language. Table 9.1 shows that each element of language—phonology, morphology, syntax, semantics, and pragmatics—is a potential source of language disorders. For example, some children can express age-appropriate ideas in cor­ rect sentence structures but are not able to use accepted rules of morphology; they might have difficulty with pluralization (foot-feet), verb tenses (run-ran, walkwalked), or the use of prefixes (pre-, anti-). Language involves both reception (taking in information) and expression (giving out verbal information and producing written language). In some manner, lan­ guage is processed internally during both reception and expression, but language production and language comprehension do not always proceed at the same pace. Some children will speak but do not seem to understand the meaning of the sen­ tence (Slobin, 2006). And remember from our discussion of the information-pro­ cessing model that processing challenges can interfere with all types of learning, including language learning. The stages and sequences of normal language acquisition give clues to lan­ guage disorders. But it is often difficult to determine a specific cause for a child’s language disorder. Speech problems, developmental disorders, or other disabilities may all influence the child’s ability to use language. Speech disorders are a specific form of language disorders that affect a child’s ability to produce oral language.

Speech Disorders Speech disorders may include problems with articulation and phonological pro­ cessing, voice, and/or fluency, and they may be due to physical anomalies, such as a cleft palate.

Cleft Palate  One cause of speech disorders is a cleft palate, which is a congenital

Jean-Marc Giboux/Hulton Archive/Getty Images

abnormality that occurs when the roof of the mouth has not closed completely during prenatal development (ASHA, 2021c; Lee, Law, & Gibbon, 2009). The incidence of cleft palate ranges is about 1 in 700 (CDC, 2020). The cleft may be only on one side (unilateral) or on both sides (bilateral) and is usually closed by Smile Train surgery during the first 18 months of the child’s life (Henningson et al., 2008; www.smiletrain.org Priester & Goorhuis-Brouwer, 2008). While early surgery can repair the cleft, an estimated 50 to 75 percent of children born with a cleft palate will require speech intervention at some point in their life (Lee et al., 2009). Studies looking at the development of speech for children born with a cleft palate indicate differences in pronunciation, word usage, and vocabulary for children at age 2.5 to 3 years (Scherer, Williams, & Proctor-Williams, 2008; Scherer, D’Antonio, McGahey, 2008). Scherer, Williams et al. (2008) compared the early language development of children born with and without cleft palates and found persistent difficulties in vocalization and vocabulary for children even after their cleft palate had been repaired surgically. While the two groups of children (those born with and without a cleft palate) were similar in their frequency of early babbling, the complexity of the child’s early babbling was significantly lower for children with cleft palates. The authors conclude, in part, that the children with cleft palates use fewer and less complex sounds and receive more limited motoric feed­ Repair of the child’s cleft palate is essential to the back from their babbling practice, and this limits their spoken child’s language development. word acquisition at 3 years of age.

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders Early intervention with a multidisciplinary team (including surgery, dentistry, audiology, and speech-language pathology professionals, as well as parents) can help support speech acquisition (ASHA, 2021d; Henningson et al., 2008). Parents can also be taught to provide early intervention support to help their child’s speech development (Scherer, D’Antonio et al., 2008; Priester & GoorhuisBrouwer, 2008). The areas of speech therapy that are often needed for children born with cleft palates include disorders of articulation, phonological processing, and voice.

Articulation and Phonological Processing Disorders  Articulation disorders may range from a mild frontal lisp or a fleeting hesitation in words to mispro­ nunciations of speech sounds that are so severe that speakers are unintelligible to listeners in their own community. Imprecise phoneme (sound) production or articulation errors include substitutions, distortions, omissions, and, infrequently, the addition of extra sounds. When the intended phoneme is replaced by another phoneme, the error is one of substitution. Common examples are w for r (wight for right), t for k (toat for coat), and w for l (wove for love). The influence of multiple substitutions on intel­ ligibility becomes apparent when like becomes wite. In other instances, a mispro­ duction makes a phoneme sound different but not different enough to change the production into a phoneme with a different meaning. These productions are known as distortions (e.g., bwu for blue). When a disorder involves omissions, cer­ tain sounds are omitted entirely (pay for play, ka for cat or cap). Johnny, the boy discussed earlier in the chapter, had difficulties primarily with articulation. Even with intense early speech therapy, his speech was almost unintelligible until he was 8 years old.

Lots of practice on speech sounds maybe needed to help children with articulation disorders.

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Disorders of Voice  Voice is the production of sound in the larynx and the selective transmission and modification of that sound through resonance and loudness (you may want to look back at Figure 9.4 to remind yourself how speech is produced). When we talk about voice, we usually think of three characteristics: quality, pitch, and loudness (ASHA, 2008). We evaluate these characteristics in terms of the speaker’s age, sex, and cultural. A voice disorder

Typical and Atypical Language Development is an inappropriate variation in one of these. Disorders of voice quality, generally called dysphonia, can be related to phonation, resonation, or both. Breathiness, hoarseness, and harshness are disorders of phonation. Problems with resonation include hypernasality (excessively nasal-sounding speech) and hyponasality (speech that sounds as if the speaker has a bad cold). For children born with a cleft palate, voice disorders often include hypernasality, hyponasality, audible nasal air emissions, and/or turbulence and difficulties with controlling voice quality (Henningson et al., 2008). Often phonation and resonation disorders are present in the same person, but they can be separate disorders. Pitch indicates whether the speaker is male or female, young or old. Pitch breaks, a common problem, occur in adolescents and affect boys particularly when their voices are maturing.

Disorders of Speech Fluency: Stuttering  Fluency is the flow of speech. The most common fluency disorder is stuttering, which is characterized by repetitions and prolongations of sound, syllables, or words; tension; and extraneous movement (ASHA, 2021e). Stuttering is a complex speech disorder with a variety of assumed causes. Speech patterns often include: ●  repetitions

of words or word parts (“W-W-W- Where are we eating?”) of speech sounds (“Ssssave me a chair.”) ●  interjections of sounds (“We can meet at um, um, you know, like, six o’clock.”) ●  stopped or blocked speech where the sounds will not come out (ASHA, 2021e). ●  prolongations

Stuttering is diagnosed when these disfluencies stand out and disrupt the per­ son’s ability to communicate. A skilled speech-language pathologist is needed to assess the speech patterns and develop and implement a support program to help individuals cope with their speech challenges. Treatment programs for people who stutter often focus on teaching behaviors to help them monitor and control speech rate, control breathing, and reduce tension during speaking (ASHA, 2021e). Some researchers believe that there may be a genetic component to stuttering because more boys than girls have persistent disfluencies in their speech (Singer et al., 2020; Dworzynski et al., 2007). Children who stutter may show spontaneous recovery by school age (Ward, 2008), but others, like Michelle, continue to have difficulties. If not addressed, the long-term consequences of fluency disorders can be life changing with psychological, emotional, social, and functional impacts (Blood & Blood, 2016). As with most disabilities, early intervention (begun by the age of 3) with family involvement, can be very effective in reducing stuttering (Kelman & Nicholas, 2020).

9-3b  Prevalence of Communication, Language, and Speech Disorders Because of the complexity of communication problems, it is difficult to get an accurate picture of how many communication disorders are speech disorders and how many are language disorders. Speech and language disorders affected over 1.3 million children in 2019, approximately 2.7 percent of all schoolchildren (IES, 2020). Determining prevalence figures can be difficult, however, because younger children, in kindergarten through second grade, may be overidentified due to mild speech delays. Prevalence figures also tend to be distorted because intel­ lectual and developmental delays, cerebral palsy, autism spectrum disorders, hearing loss, and many other disabilities affect communication. Although a communication disorder may be secondary to another disability, it still requires treatment and therapy as part of a total special education program (Briley & Ellis, 2018).

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders

9-4  Importance of the Child’s Cultural and Linguistic Context Children learn to speak the language that is spoken in their homes and neighbor­ hoods. They tend to use language to express their needs and thoughts in the same way that their parents or caregivers do (Perez et al., 2019).

9-4a  Bilingual Learners For children who are bilingual, the increased language demands may cause delays in vocabulary acquisition in each of the languages used. As noted earlier in the chap­ ter, these delays are a normal byproduct of learning more than one language. To accurately assess vocabulary development for bilingual children, we must include word counts for both languages used by the child (Brice & Brice, 2009). The words ball and bola, for example, despite having the same meaning, must be counted as two words for the bilingual child, and thus, the actual vocabulary for bilingual chil­ dren is often greater than that for the monolingual child. Assessments that do not fully explore the language abilities of dual language learners may disadvantage stu­ dents from culturally and linguistically diverse families (Wofford & Wood, 2019). Evidence also suggests that learning and using two languages may enhance the child’s executive function (Bialystok & Viswanathan, 2009). Barac and Bialystok (2012) examined executive functioning for three sets of bilingual children, Spanish-English (n = 20), French-English (n = 28), and Chinese-English (n = 30), as compared with monolingual English speakers (n = 26). The nonverbal execu­ tive control task involved selecting the matching color or shape for a computerpresented stimulus, monitoring both the speed and accuracy with which the child could complete the task. This task measures the child’s ability to maintain focus and task-switch from color to shape depending on the stimulus presented. The bilingual students outperformed the monolingual students on this nonverbal executive control task (Barac & Bialystok, 2012). Brice et al. (2009) studied articulation and phonology for preschool bilingual (Spanish-and-English-speaking) children and noted differences in pronunciations for some phonemes. In these cases, the use of two languages may cause interfer­ ence patterns to emerge, when one language structure is imposed onto the other language. These differences may lead to the misdiagnoses of some children as hav­ ing speech disorders. The articulation differences were further complicated by the various Spanish dialects the child used (see discussion of dialect in a later section). The study highlights the need for speech-language pathologists with bilingual and bicultural experience to appropriately assess children who are dual-language learners (Wofford & Wood, 2019).

9-4b  Language Differences The development of oral language skills is influenced by differences in socioeco­ nomic, cultural, and linguistic background of the student (Wood et al., 2019). In some homes, parents use language in ways that are different from the language some teachers expect students to use. For example, teachers may demand explic­ itness in language (Justice et al., 2008). Although the two sentences “He took it” and “Arthur took my truck” convey the same meaning, the listener must be in the immediate environment to understand the former, less explicit communica­ tion. Children who have not been exposed to explicit communication in the home may have difficulty when they encounter a teacher who expects it. Teachers must be aware that differences in language usage, such as this one, are not considered disorders. These differences can be addressed by teaching rather than by therapy. Comparing the child’s communication skills with the skills of peers from the same

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Importance of the Child’s Cultural and Linguistic Context

DisobeyArt/Shutterstock.com

The child’s primary language must be considered when evaluating his or her pronunciation of English for speech articulation.

cultural background helps us to avoid labeling the child as language impaired rather than language different (McCabe & Champion, 2010; Hart, 2009).

9-4c  Dialects The picture can be further complicated by differences in a child’s language due to family, community, or regional accents and dialects. Variations in word usage, pro­ nunciation (phonology), word order (syntax), and meaning (semantics) influence the child’s use of language (pragmatics). A dialect is a variation of language that dif­ fers in pronunciation, vocabulary, or syntax from the literary form of the language. It is used and understood by a group within a larger community. Dialects reflect regional, social, occupational, and other differences: “He done sold his car”; “We be there”; “She be sick to her stomach.” The use of a dialect is not a sign of a speech disorder but is part of the linguistic diversity of society (HwaFroelich, Kasambira, & Moleski, 2007). The following ASHA definition for communication differences and dialects reminds us that these are not considered to be speech or language disorders: Communication difference/dialect is a variation of a symbol system used by a group of individuals that reflects and is determined by shared regional, social, or cultural/ethnic factors. A regional, social, or cultural/ethnic variation of a symbol system should not be considered a disorder of speech or language. (ASHA, 2013a). A dialect is very much a part of a child’s self-concept, and teachers must react to it carefully. Teachers should model standard literary usage when speaking and encourage children to use it when reading aloud and writing, but they should allow children to use dialect in their informal speech if the intent of their com­ munication is clear. Language assessment tools, however, are based on an average child’s use of lan­ guage, which is not necessarily the way language is used, taught, and encouraged in all families and communities; this can be problematic (McCabe & Champion, 2010). Speech-language pathologists and teachers need to learn what a specific community considers accurate pronunciation and usage, and then they can teach children the expectations for communication in different settings (Wofford & Wood, 2019; Brice & Brice, 2009).

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders

9-5  Disability Areas and Problems with Communication, Language, and Speech Throughout this text, we look at the ways that a disability can affect a person’s life. The impact that a disability can have on an individual’s ability to communicate with others is perhaps one of the most poignant of these effects. Table 9.2 shows the possible problems with communication, language, and speech that can coex­ ist with other areas of disability. Since problems with communication, language, and/or speech are often pres­ ent along with other disabilities, the law requires that speech-language therapy be available as a related service for children with disabilities, if needed (Center for Parent Information & Resources, 2017). Related services are defined as support services that are required to assist the child in benefiting from special education (Center for Parent Information & Resources, 2017) In most cases, a speech-language pathologist will be part of the multidisciplinary team that helps in assessing the child’s needs, planning to address these needs, and carrying out

Table 9.2  Possible Problems with Communication, Language, and Speech

That May Accompany Disability Areas Disability Area

Possible Communication, Language, and Speech Problems

Intellectual and Developmental Delays

Delayed language is a universal characteristic; disorders may be present in all aspects of speech production and with both expressive and receptive language.

Cerebral Palsy

Poor muscle control and difficulty breathing may result in communication difficulties ranging from speech disorders of articulation and voice to the inability to speak; may need augmented communication support. For many individuals, language delays will also be present.

Learning Disabilities

Language difficulties can cause major problems in learning to read, write, spell, and do arithmetic. Problems with communication include understanding social cues, contextual needs, and interpreting nonliteral language.

Severe and Profound Multiple Disabilities

Difficulties with speech production. May experience delays in language development; may need augmented communication support.

Autism

Communication difficulties can stem from an inability to read and interpret social cues, facial expressions, and gestures; a lack of interest in communication; difficulties with interpreting nonliteral language and language delays may be present.

Deaf/Hard of Hearing

Generalized language delays, alternative communication needs (such as sign language, cued speech, lip reading); may have articulation difficulties, voice problems, and limited use of speech.

Visual Impairments

Difficulties with language reception in reading; can require use of Braille or audio augmentation. Communication difficulties may be present if an individual is unable to see social cues, facial expressions, and gestures. Abstract ideas (e.g., colors) may be hard to communicate if a child has no vision.

Emotional and Behavioral Problems

Communication difficulties can arise from the inability to appropriately read social cues and from impulsivity related to difficulties with self-regulation. Language delays lead to further frustration and can exacerbate existing problems.

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the services required to support the child. The early detection of problems related to communication, language, and speech is essential because early inter­ vention can make a significant difference in the out­ comes for children with problems in these areas and for preventing secondary problems from emerging (Loncke, 2011). Box 9.4 shares the story of a young girl’s experi­ ence prior to being able to communicate her needs. You may remember that our “Ask the Experts” author in Chapter 4, Dr. Kristín Björnsdóttir, shared that one of her students had used Blissymbols to respond to an assignment on social constructivism and the con­ struct of race and skin color. (If you have forgotten this story, you may want to go back to Chapter 4 and re-read the “Ask the Experts” feature.)

Box 9.4

Fotosearch/Fotosearch/Getty Images

Disability Areas and Problems with Communication, Language, and Speech

Augmentative communication systems must be individualized for each student.

Exceptional Lives    Exceptional Stories:

Have You Ever Wondered What it Would be Like Not to be Able to Communicate? It’s Very Frustrating. It’s Very Lonely. It Hurts.

Think about it. You feel, you think, you know and understand the words, and yet you cannot speak them. You hear everyone around you in an interesting conversation, but you cannot join in. You cannot express any of the feelings or emotions that are just as deep inside of you as they are inside anyone else. You are furiously angry, and you have to hold it in; or you are extremely happy, and you can’t show it. Your heart is so full of love you could just burst, but you can’t share it. I know what it is like because for years, I could not communicate or express myself. I am a 19-year-old girl. I have cerebral palsy and cannot talk. I do not have coordination in my hands to write or use sign language. Even a typewriter was out of the question when I was younger. I know what it is like to be fed potatoes all my life. After all, potatoes are a good basic food for every day, easy to fix in many different ways. I hate potatoes! But then, who knew that but me? I know what it is like to be dressed in reds and blues when my favorite colors are mint greens, lemon yellows, and pinks. I mean, really, can you imagine? Finally, help came! I was introduced to Blissymbols. My life changed! Blissymbols were originally developed for a universal language, but they have been a miracle for me and others like me. Blissymbols are a combination of the written word and a symbolized picture that anyone can learn, which are displayed in a way that can be easily used. There was a

tray strapped to my wheelchair. It was covered with a sheet of paper, which was divided into little blocks of words to form sentences. At last, I could communicate! Naturally, one board could not hold all the words needed. I had to learn to make up my own, combining two or more words to mean another. As in “story sleep” for dream or “bad night horse” for nightmare. My teachers started me on ten words a day to see if I could learn them. I learned as fast as they could give me new words. I was ready to communicate! I could even stutter! That’s what my uncle calls it when it takes three or four tries to point to one word. Once I mastered Blissymbols, I left the symbols behind and changed to words and sentences. I got my first computer. It was an AutocomTM. I programmed my Bliss board into it and much more. It also had a printer. Finally, I could write! Communicating for me has opened a lot of doors. It even let me act in a play. I have been a guest speaker at a Kiwanis Club meeting. It has done a lot more, too. There’s help out there, just don’t give up.

Reflection: ●

How does the ability to communicate change how others see that person? What assumptions are often made about individuals who have difficulty communicating?

Source: “Sara’s Story” from Keyhole Communique, 3(3), May 1989.

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders

9-5a  Assessment and Identification of Problems with Communication, Language, and Speech A comprehensive evaluation of a child’s ability to communicate will include an assessment of both receptive and expressive-language strengths and needs. Because the demands of communication are complex, it is essential to assess each element of language to establish areas in which difficulties are encountered. Table 9.3 shows the language element that should be assessed and what it will look like for both receptive and expressive language. A comprehensive evaluation will likely include both formal and informal assess­ ments, combining standardized tests with systematic observations and recordings of spontaneous uses of language across multiple settings (Wofford & Wood, 2019; Wood et al., 2019; Hyter, 2007; Olswang et al., 2007; Salvia et al., 2007). Formal assessments rely on diagnostic tests and clinical evaluations done by a speech-lan­ guage pathologist. As part of the informal assessment, teachers can make a key con­ tribution to understanding the child’s needs through their systematic observations of the child. The observations that a teacher makes of the child’s language behavior during typical classroom activities help the team gain a comprehensive portrait of the child’s typical verbal and nonverbal communication patterns (Olswang et al., 2007). Teachers can further use their observations to shape the kinds of supports that will help strengthen the child’s communication skills. The speech-language pathologist is primarily responsible for the identifi­ cation, diagnosis, and design of the treatment plan or curriculum, as well as the implementation of this plan for children with language and speech dis­ orders. In implementing the plan, the speech-language pathologist works as part of a multidisciplinary team. Coming together as a team is important; the special educator and the speech-language pathologist bring different expertise and experiences to the table. But, because they have been trained in separate programs, it may take extra effort to combine their understandings of how to support the student’s success. The team must consider several things as they evaluate the child’s communication strengths and needs. The child’s age, gen­ eral cognitive abilities, sensory acumen, experiences, and the family’s primary language will all have an impact on the child’s communication. When English is not the primary language of the child and/or the child’s family, the assess­ ment for possible problems with language is more complex (Perez et al., 2019; Santhanam et al., 2019).

Table 9.3  Language Elements for a Comprehensive Assessment of Communication Difficulties Language Elements

Receptive Language

Expressive Language

Phonology

Child has difficulties hearing different speech sounds.

Child’s articulation of speech sounds is impaired.

Morphology and Syntax

Child has difficulty understanding grammar or language structure (not based on cultural dialect or linguistic differences).

Child uses inappropriate grammar or language structure (not based on cultural dialect or linguistic differences).

Semantics

Child has difficulty understanding needs, ideas, wants, feelings, and thoughts of others.

Child has difficulty expressing needs, ideas, wants, feelings, and thoughts through language.

Pragmatics and Supralinguistics

Child has difficulty interpreting the speaker’s motivations.

Child has difficulty adjusting communication to the social context and demands.

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Educational Responses for Children with Communication, Speech, and Language Disorders

9-5b  Assessment of Children from Culturally or Linguistically Diverse Backgrounds Children from homes in which English is not the primary language are more likely to encounter difficulty in using English in school. When a language or speech dis­ order is suspected, children from cultures and communities that speak a language other than English need to be assessed by speech-language pathologists who are skilled in the child’s primary language when possible, and when this assessment is not possible, a skilled interpreter must be available (Santhanam, 2019; Guiberson & Ferris, 2019). Assessments of children who are bilingual should involve a specialist who is bilingual and bicultural. A speech-language pathologist who speaks the lan­ guage of the child’s home and who understands the child’s cultural background can more appropriately interpret the child’s assessment results; this should help prevent misdiagnosis of communication, language, and speech disorders (Perez et al., 2019; Brice & Brice, 2009). Great care must be taken that children from different cultures who speak a dif­ ferent language receive an accurate assessment by a person well versed in the chil­ dren’s language and cultural mores. For example, Spanish-speaking children who speak a Puerto Rican dialect use several phonological sounds that are consistent with their dialect, but they may be considered “errors” by other Spanish-speakers. If the dialect of these children is not considered, lower scores will be obtained on their language assessments (Wofford & Wood, 2019; Goldstein & Iglesias, 2001; Brice & Brice, 2009). When a native speaker of the child’s language is not available to conduct the assessment, an interpreter who speaks the child’s language can be hired to assist the evaluator and help communicate with the family. During the evaluation, the interpreter can relieve the family’s stress by keeping the family informed about what is taking place. Interpreters may be either professionals or ad hoc volunteers, but in either case, the speech-language pathologies should be mindful of using “jargon,” which may be difficult to translate (Santhanam et al., 2019).

9-6  Educational Responses for Children with Communication, Speech, and Language Disorders Students with communication, speech, and language disorders form a heteroge­ neous group with a wide variety of strengths and needs. They may be identified primarily for their challenges with speech, or they may have another primary area of disability and therefore receive speech/language support as a related service. In either case, a multidisciplinary team will likely be involved in planning and deliv­ ering supports and services.

9-6a  Organizational Structures to Support Students with Communication, Speech, and Language Disorders Not all children with speech-language disorders are in special education classes. In fact, as shown in Figure 9.5, 88 percent of children with speech and language disorders spend the majority of their day in general-education classes (80 per­ cent of their time or more); 4.4 percent are served in the general classroom for 40 to 79 percent of the day; only 3.7 percent spend about half their day outside of

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders

Placement of Children with Communication Disorders 3.7% 3.9% 4.4% General classroom 80% of the day General classroom 40–79% of the day General classroom 40% of the day Separate settings 88%

◗ Figure 9.5  Educational Setting for Children with Communication Disorders Source: U.S. Department of Education, Office of Special Education Programs, Data Analysis System (DANS). (2020). Children with disabilities receiving special education under part B of the Individuals with Disabilities Education Act. Washington, D.C.: Author.

the general classroom, and close to 4 percent are served in separate settings (U.S. Department of Education, 2020). Children with speech and language disorders are more likely than children with other disabilities to be served in the general classroom. With most children with communication, speech, and language disorders served within the general education program, multitiered approaches like MTSS become very important in addressing the child’s needs.

MTSS Approaches for Students with Communication, Speech, and Language Disorders The three levels of intervention that typically constitute the Multi-tiered Systems of Support (MTSS) approach, when they are working well, provide a collabora­ tive framework for meeting the needs of students with communication, language, and speech disorders (Sanger, Mohling, & Stremlau, 2012). The speech-language pathologist is central to the multidisciplinary team planning and implementing the interventions within an MTSS system. The speech-language pathologist can help with screening, progress-monitoring, assessments, and interventions to pre­ vent continued failure (Sanger et al., 2012). Collaboration among the multidisci­ plinary team across all three tiers is essential in helping the child meet with success.

Universal Tier I for Students with Communication, Speech, and Language Disorders  As previously mentioned, most children whose primary area of identification is speech and language are served in the general classroom. Inclusion is the typical option for the child with communication disorders, because most children with primary speech disorders respond well to the general education program if they receive additional support for their special communication needs (Leonard et al., 2019). The general-education classroom and inclusion with typically developing peers provide a rich language environment that can enhance the communication of all children. You may recall that both Johnny and Michelle, the children presented early in this chapter, were students in a general classroom. You may also remember that Michelle’s second-grade teacher’s insensitivity led to a painful situation in which Michelle’s stuttering caused her significant embarrassment. Michelle’s

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Educational Responses for Children with Communication, Speech, and Language Disorders current teacher in fifth grade, Ms. Boone, is much more aware of the difficulty that Michelle faces and has worked hard to make the classroom comfortable, engaging, and nonthreatening. Ms. Boone has modeled active listening for her students, and she praises them when they listen respectfully and patiently to each other with­ out interrupting. This approach is particularly helpful to Michelle, because it has allowed her to feel more at ease talking. In addition, the children in the class, with Michelle’s permission, have learned about the difficulties that she faces, and they have been asked to show courtesy to her when she is speaking. All the students have been asked to practice the following guidelines for being a good communicator: ●  Disregard

short pauses or slow speech. acceptance of what has been expressed rather than how it was said. ●  Treat Michelle like any other member of the class. ●  Acknowledge Michelle’s speech difficulties without labeling her. ●  Help Michelle feel in control of her speech. ●  Show

Not surprisingly, because of the open, honest, and compassionate way that Michelle’s needs have been addressed, the class is very supportive, and Michelle is making leaps and bounds with her class participation. Box 9.5 shares some of the strategies that Ms. Boone has used in her class to help every student feel like they belong. Ms. Boone also uses a variety of cooperative-learning strategies to promote student-to-student communication (Timler et al., 2007). The classroom environ­ ment is set up with engaging materials and small-group arrangements that pro­ mote conversations about what is being learned. Ms. Boone believes that learning is facilitated by social interaction, and so she has structured her classroom envi­ ronment and routine to facilitate communication (Timler et al., 2007). Even with this language-rich environment in which the children’s communication is inten­ tionally enhanced, Ms. Boone knows that some of her students will need more support. She works closely with the school’s speech-language pathologist, Mrs. Henley, to help her students with more intense needs.

Targeted Tier II for Students with Communication, Speech, and Language Disorders  In addition to Michelle, Ms. Boone’s fifth-grade class has three students who have language-related learning disabilities: two students who are

Box 9.5

Ms. Boone’s Strategies to Build Community in Her Classroom

Ms. Boone has a typical fifth-grade class with lots of students who have special learning needs, but, Ms. Boone believes that each of her students is special, whether they have been identified or not! She has designed several activities to help her students understand their own strengths and challenges and be more empathetic with others in their class. Here is one of her activities: 1. Students create a collage showing the things that they are good at and the things that are hard for them. 2. Students share their collage and talk about what they are good at and what they may need extra support with.

3. The class discusses how everyone has strengths and everyone has challenges. 4. The class builds a class collage showing their combined strengths and areas where some members may need extra support. 5. Using the class collage as a focal point, they discuss how they can support each other so that everyone can be successful. After the class completes this activity, they commit to (a) use their strengths to help others and (b) ask for help themselves when they need it!

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders English-language learners, Pedro and Gyanna, and one student with Asperger’s syndrome, Drew. These children often seem reluctant to participate in the literature seminars that the class holds every other week. To help with this situation, Mrs. Henley, the speech-language pathologist, works with the four children, giving them explicit instruction on the “language routines” Ms. Boone uses during literacy seminars (Ritzman, Sanger, & Coufal, 2006). She teaches them the rules of participation, and the students practice their new participation skills until they can use them comfortably (Timler et al., 2007). During the seminars, Mrs. Henley prompts the students to remember their “participation rules” when they want to contribute. Eventually, students can participate without explicit prompting. Pedro and Gyanna also work with the English-language learners’ (ELL) teacher prior to each seminar to review key vocabulary that will be used and to explore answers to the questions that will be discussed. These preliminary activities help both children feel more confident in participating during the seminars. The provision of scaffolded supports to help students reach success is very important (see High Leverage Practice in Box 9.6). To help Michelle become more comfortable participating in the classroom, Mrs. Henley and Ms. Boone use a similar approach called “planned participa­ tion,” which gives Michelle information about what they will ask in advance to give her time to prepare and practice what she wants to say. This scaffolded support helps Michelle feel more confident when it is time to participate. They also focus on Michelle’s strength in poetry writing by creating a “Friday Poets Corner,” in which students can share their poems. Classroom teachers can be particularly helpful to the child who stutters by working with the speech-lan­ guage pathologist to create planned opportunities for the child to participate in speaking activities that are appropriate for practicing newly acquired fluency skills at increasing levels of complexity. While collaboration between the SLP and the teacher within the general class­ room is important for supporting students in a natural environment (Krupa et al., 2019), for some children, more individualized support is needed; for these chil­ dren, Tier III services must be provided to help them succeed.

Intensive Tier III for Students with Communication, Speech, and Language Disorders  At Tier III, the services are specifically designed to meet the student’s High Leverage Practices https://highleveragepractices .org

Box 9.6

individual needs. In most cases, the child’s individualized education program (IEP) will specify the services needed and will determine the related services that are essential to his or her success. Because the needs of each child are unique, a speechlanguage pathologist must be prepared to deal with a broad range of disorders.

High Leverage Practices:

High Leverage Practice 15: Provide Scaffolded Supports

Scaffolded supports offer temporary assistance to students so that they can be successful with tasks they cannot yet do independently. These supports may be visual, verbal, or written and are carefully matched to the student’s performance and understanding of the learning task. Supports are gradually removed as the student gains more competence and the supports are no longer needed for success.

Reflection: ●

In what ways does scaffolded support help a student develop the self-confidence needed to be successful in both academic and social contexts?

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Educational Responses for Children with Communication, Speech, and Language Disorders The speech-language pathologist provides support for students who may have primary articulation, fluency, voice, and/or language disorders. The pathologist must also be able to address the problems found among children with cleft palate, intellectual and developmental delays, cerebral palsy, learning disabilities, and emotional disturbances; students who are deaf must also be supported (Hanks & Velaski, 2003). To address the wide variety of needs, the speech-language pathologist must be able to manage multiple roles (Ritzman et al., 2006). The oneon-one support that a child with communication and language challenges gets from a caring and competent speech-language pathologist can be life changing. In Box 9.7, Liz Parrot shares the impact that working with a speech-language pathologist had on her life. A Summary of MTSS Approaches for Students with Communication Disorders can be accessed online.

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Ask the Experts:

Speech-Language Therapist ~ The Value of One-on-One Connections with Each Child

© Liz Parrot

Box 9.7

Liz Parrot is a tutor who had a speech disorder herself as a child. I was born in the late 1950s with a cleft lip and palate. In my worldview, I was ugly and I didn’t talk correctly. I knew that almost all the people I had contact with as a child noticed the ugliness and speech impairment. Kids teased me. My grandmother often told me to remember that you can’t judge a book by its cover. I knew this meant that while I wasn’t beautiful on the outside, I was (or might be) on the inside. I started speech therapy at three years old and continued through sixth grade. We moved a lot, so I attended five elementary schools. And at each elementary school, I had a new speech therapist. Unlike other people, speech therapists never treated me like there was something wrong with me. Of course, there was, otherwise I wouldn’t have needed speech therapy. But in the context of my relationship with my speech therapist, my speech

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wasn’t a problem, it was just what we were there to work on. The one-on-one relationships I had with speech therapists were very important to me. The therapists listened to me as if what I said mattered. And I talked with them about things that mattered to me. Once, when I was in preschool, half of one of my fingernails fell off. In my recollection, the space where the nail had been looked like pizza without the cheese. I asked my speech therapist what to do about it. She told me to tell my mother. My mother was angry. She didn’t understand why I’d talked to the speech therapist about my finger rather than her. That was an easy question to answer: the speech therapist listened to me, so I felt like I could ask her what I should do about my finger. I spoke with a speech therapist on the phone recently and mentioned that I’d had a lot of speech therapy as a kid because I was born with a cleft lip and palate. She was surprised. She said she couldn’t tell at all from the way I talked. The way I speak now indicates that the therapeutic relationships I had with speech therapists were very effective. Besides that, the speech therapists valued me. In a world in which you feel like an ugly little girl who talks funny, to have an adult treat you as though you are of value is a huge thing!

Reflection: ●

321

Why is it so essential for every child to have at least one adult who values them? What impact did the speech-language pathologist have on Liz when she was a small child?

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders

Box 9.8

Reaching & Teaching:

Working Online with Students Who Have Speech and Language Disorders

Jennifer Job, Ph.D. Working with students who have speech and language disorders can present challenges under the best of circumstances; separating the student and teacher into different buildings and only giving them a computer screen to communicate through makes things exponentially more difficult. The American Speech-Language-Hearing Association names some of the following issues that teachers may encounter in teaching children with speech and language disorders virtually (ASHA, 2020b): 1. Being understood. A child with communication issues may have difficulty with pronouncing certain sounds, or words may be harder to hear over a computer screen. Additionally, if a child is used to communicating with an assistive device, the device may be hard to see over the screen. 2. Understanding. As noted earlier in the chapter, students with communication disorders may have difficulty interpreting body language or verbal cues, and these students may miss those cues while trying to watch the screen. 3. Limited social practice. The chapter discussed earlier how critical it is for children with communication disorders to interact with other children and adults as much as possible to help facilitate their language development, and remote

learning, especially asynchronous learning (e.g., watching videos and doing offline tasks) doesn’t provide that practice. Several accommodations may be made for students to overcome remote-learning challenges. The most important tactic the teacher must use is to build and maintain open communication lines with the family members. Find out if the child has access to a quiet, low-distraction space to connect to online learning, and if you, as the teacher, can provide materials to make it easier to communicate, such as a small white board and dry-erase markers for students who have trouble making themselves understood through speech. You can also be sure to provide instructions and notes in writing as much as possible so that you are not misunderstood when giving spoken directions. And ask the family if you can facilitate interactions between the student and other children in the class to give them as much opportunity as possible to improve their communication skills.

Reflection: ●

What challenges do virtual and remote learning present for students with communication, speech, and language disorders? How can you as a teacher help to mitigate these challenges?

9-6b  Curriculum and Instruction for Students with Communication, Speech, and Language Disorders In addition to providing one-on-one support, speech-language pathologists may work directly with children in the general-education classroom, supporting the aca­ demic program (Sanger et al., 2012). They may alert students to pay attention to verbal or written instructions, encourage them to ask pertinent questions and to participate in discussions, and assist them in responding in a culture- and classroomappropriate fashion. Speech-language pathologists also use many techniques to pro­ mote the carryover of newly acquired communication skills into the classroom and everyday conversation. These techniques include providing children’s notebooks prepared by therapists that are kept in the classroom for the teacher’s regular review, weekly conferences with teachers regarding specific objectives, the use of devices and props as reminders, and carefully planned in-class “talking” activities. A major task of the communication specialist is to help the classroom teacher use these tools effectively, because the teacher’s help is vital to the student’s success. The speech-language pathologist helps by suggesting strategies that encourage talk, expand talk, and model correct forms and usage. She may help the teacher set up effective peer-mediated social supports (Goldstein et al., 2007) and may

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help teach students self-advocacy skills so that they can communicate their needs (Ritzman et al., 2006). But, it is critical to remember that when any specialist, including the speech-language pathologist, joins the classroom support process for a child, this support must be offered in a way that protects the child’s privacy and guards their right to fully belong in the general-education classroom. It is also essential that the child’s one-on-one support continues in addition to their support within the classroom. If you think back to our expert, Liz Parrot, you’ll remember she shared the importance of her relationships with the speech-language patholo­ gist, and this relationship is what made the most difference in her life. The teacher’s creativity in adapting classroom opportunities to foster ways of talking will help the student to generalize these new skills. The classroom is often the most appropriate setting for incidental and interactive functional teaching of communication skills.

Content Standards for Students with Communication, Speech, and Language Disorders Students whose primary area of concern is with speech or language disorders are most often served within the general-education classroom and are expected to master the curriculum content standards alongside their peers. Mastering the curriculum can be challenging for children who have language disorders that impact listening, talking, reading, and writing. Table 9.4 shares universal design for learning approaches that can support children with communication, speech, and language disorders in mastery of the content standards. The table can also be accessed online. Children who receive speech-language support as a related service because they have another primary area of disability will often have communication goals on their IEPs. When a student’s IEP includes a communication goal, the services the speech-language pathologist provides will support the child and their teacher.

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Specific Strategies to Support English-Language Learners Understanding the linguistic competencies of children whose primary language is not English can be tricky (Salvia et al., 2017). Earlier in the chapter, we looked at a variety of things that make it more challenging to recognize language delays and disorders in children who are English-language learners, and so it should come as no surprise that meeting the needs of bilingual children can also be challenging. The strategies given here are meant to be a starting place for teachers and can pro­ vide a foundation for interventions at Tiers I and II. These strategies address the two areas of language competency that ELL ­students need: (1) basic interpersonal communication skills and (2) cognitive/aca­ demic language proficiency (Bunce, 2003). In other words, children must be able to communicate with others socially, and they need the more specialized language skills required for success in school. Brice et al. (2006) offer the following ideas for teachers to help English-language learners strengthen their communication: 1. Build lessons around the child’s background knowledge, and bridge this knowledge to new learning. 2. Provide written copies of directions and key instructions, and use pictures to show what is expected. 3. Ask open-ended prediction questions to allow children to contribute a vari­ ety of knowledge (e.g., “What do you think . . . ?”). 4. Teach study skills (such as note-taking, organization, and test-taking strategies). 5. Encourage students to ask questions and participate in discussions. 6. Model correct language forms, and employ appropriate wait times (be patient and give 3 to 5 seconds or more to let students think) to allow students to respond.

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders

Table 9.4  U  sing Universal Design Principals to Give Student with Communication,

Speech, and Language Disorders Access Content Standards Content Standard

Multiples Representations

Multiple Engagements

Multiple Assessments

Reading Standard Literacy, Integration of knowledge and ideas, Grade 6

Advance organizers

Direct instruction on content, vocabulary, and strategies

Written products (concept webs, drafts)

Reading text material with guided prompts for noting what you “see” and “hear”

Oral presentations

Listening to reading (with guided prompts)

Compare/contrast Graphic organizers

Web-based text

Watching dramatization or video (with guided prompts)

Audiobooks

Discussions

Documentary film showing differences in perceptions

Vocabulary builders

Small group applications

Use picture or iconic prompts for material (e.g., an eye for narrative descriptions that promote visual images, and ear for words that evoke sounds)

Debates

Compare and contrast the experience of reading a story, drama, or poem to listening to or viewing an audio, video, or live version of the text. Including contrasting what they “see” and “hear” when reading the text to what they perceive when they listen or watch.

Text/narrative Graphic organizers for compare and contrast Pictures Video Dramatization

Develop graphic organizers: compare/contrast

Pictures of images seen

Essay on the pros and cons of “reading” vs. “watching the video”

Create visual representations of information or images Writing activities Prepare presentations (PowerPoint, etc.)

Math Standard, Geometry, Solve real-world and mathematical problems involving area, surface area, and volume, Grade 6

Hands-on materials

Find the area of right triangles, other triangles, special quadrilaterals, and polygons by composing into rectangles or decomposing into triangles and other shapes; apply these techniques in the context of solving realworld and mathematical problems.

Highlighted problems (key words in color)

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Charts, Graphs, Pictures Drawings Real-world application

Flash cards: words to math symbol or operations

Direct instruction on concepts with meta-cognitive or “think-aloud” explanations of process Use hands-on manipulatives Create flash cards for formulas of area, surface area, and volume

Traditional written assessment of problem solving Student developed word problems on concept Drawings, Pictures, Charts, Graphs

Draw pictures representing

Math talks

Use tangram forms to practice using triangles, squares, and rectangles to compose and decompose larger shapes

Students find realworld examples of when an area, surface area, or volume can be found by composing or decomposing the space into other shapes

Use calculators for checking Create word problems based on real-world data collection

Access online

7. Teach language routines to help the children in typical situations (e.g., asking questions, getting what they need, and providing information). 8. Use grammar drills and direct instruction to support skill development. 9. Practice formalized or structured speaking, and allow students to “rehearse.” 10. Allow for code switching and code mixing (the use of the primary language interspersed with English is natural as the second language emerges). 11. When students have reached a higher level of proficiency with English, use more complex sentences. 12. Explicitly teach vocabulary that is needed in the learning context.

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9-6c  Assistive Technology for Augmentative and Alternative Communication

BRIAN MITCHELL/Corbis/Getty Images

Perhaps most importantly, in working to meet the needs of ELL children who have communication disorders, we must establish a collaborative team that includes the ­ classroom teacher, the bilingual-education specialist, the special-­ education teacher, the speech-language pathologist, and the child’s parents.

When speech disorders are severe enough to make oral ­communication difficult, students may need additional assis­ tive-technology supports to help them communicate (Tsai, 2019). Assistive technology includes approaches and devices that support communication and help people express their thoughts, needs, wants, and ideas (Leech & Cress, 2011). The primary forms of assistive technology for children with com­ munication, language, and speech disorders are a ­ ugmentative Communication can be facilitated with access to the and alternative communication (AAC) devices or approaches right assistive technology. (ASHA, 2021f). Augmentative communication strategies are often used to prompt or promote the development of speech by helping the child use words to communicate. Individuals with severe speech Technology and Media difficulties, however, can use augmentative or alternative communication to sup­ Division of the Council plement or replace talking. Some communication systems do not provide voice for Exceptional Children output, so the person who is receiving the message must be physically present www.tamcec.org to understand what is being communicated. In other words, the communication must be seen—such as through gestures, body language, sign language, and com­ munication boards. Because of this need, these com­ munication approaches are not useful with telephones TeachSource Video Connection or for communication from room to room. American Sign Language (ASL), an alternative communication system of gestures that contain meaning, is an exam­ ple of a nonspeech communication system that is dis­ cussed in more detail in Chapter 11. Other augmentative communication devices simu­ late or enhance speech. Assistive technology for com­ munication varies in its level of sophistication. One device for supporting communication is the communi­ cation board. Communication boards vary in complex­ ity from a set of simple pictures (e.g., pictures of a glass of milk and a glass of juice) to sophisticated groups of letters, words, pictures, and special symbols (Hart & Banda, 2010). More sophisticated communication Watch the video “Assistive Technology in the Incluboards produce speech when they are used (Tsai, 2019). sive Classroom: Best Practices.” As you watch this Blissymbolics is a computerized communication Video Case, reflect on how the teacher uses both system that uses graphic symbols or “blisswords” to high- and low-tech resources to help Jamie, a child help the child communicate. Figure 9.6 shows some with cerebral palsy, communicate. How are Jamie’s sample blisswords that might be used for communica­ strengths highlighted and her challenges suption. Using Blissymbolics, children point to or touch ported? What kind of communication tools is Jamie the words they want and form sentences to express able to use, and how does she show understanding thoughts. This process allows a child with severely lim­ of what is going on in the classroom? ited speech to “talk.” This is the system that Sara, who you met in the Exceptional Lives, Exceptional Stories Watch online section of this chapter, used to communicate. You may

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders

HOUSE

MEDICAL

KNOWLEDGE

Spiderman BLISSNAME + MAN + SPIDER

MONEY

PLANT

BOOK

Harry Potter BLISSNAME + BOY + LIGHTNING

1 I, me (first person) PERSON + 1

(to) like

◗ Figure 9.6  Sample Blisswords Blissymbolics is a computerized communication system that uses graphic symbols or “blisswords” to help the child communicate. Almost any word in the English language can be described using a combination of blisswords.

Blissymbolics www.blissymbolics.org

want to revisit her story to think about how assistive technology can change someone’s life. The picture-exchange communication system is another way to augment communication, helping students increase their vocabulary and expand their communication. Communication for a person using augmentative devices takes more time, energy, and skill; it also requires the listener to be an active, patient, and recep­ tive communicator (Solomon-Rice & Soto, 2011). Adolescent students who used augmentative communication systems described “good” communicators as those who: ●  treat

me as a person who has things to say me like a teenager, not a baby ●  give me time ●  listen properly ●  give me the option of saying “it is none of those” ●  tell me if they do not understand me ●  check with me to make sure they got my message ●  do not finish my sentences for me ●  are not afraid of me or my voice ●  can use signs, my communication book, or other ways to communicate with me (Wickenden, 2011) ●  treat

The students in this study also said that they could tell very quickly if the person they were talking with was going to be a good communicator or not (Wickenden, 2011). The principles these teenagers articulated are a solid foundation for good communication in general and offer excellent advice to anyone who wants to be a good communicator! With the advent of mobile devices (e.g., iPads, phones, tablets) augmentative communication strategies have become more accessible and cost effective (Grace & Raghavendra, 2019). Social media has also expanded the capacity for students with communication difficulties to network with others. In their work with crossage e-mentoring, Grace and Raghavendra (2019) found that older students who used AAC could mentor younger students through online social media. Through these relationships, the students’ social networks were extended, their changes for

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Family and Lifecourse Issues interactions were increased, and they gained a sense of control in their ability to communicate with others. The most important thing to remember about the use of augmentative and alternative communication supports is that the more the child communicates, the stronger their ability to communicate becomes. This result means that we should support communication through a variety of means to enhance children’s development.

9-7  Family and Lifecourse Issues Parents are the child’s first teachers, and in no area is this truer than in the lan­ guage a child develops (Nelson et al., 2019). The child makes amazing progress in language during the first few years of life (Morgan & Wren, 2018; Loncke, 2011). The parent or primary caregiver can do a lot to support and shape early language development (Guiberson & Ferris, 2019). In the first few years of life, talking with the child is essential. Talking about colors, counting, identifying the names of objects, playing word repetition games, and sharing nursery rhymes are all part of the early language stimulation of young children. The parent can also help the child become more aware of sounds by reinforcing the familiar sounds of the environment (e.g., “The clock goes tick-tick-tick”; “The car goes vroom!”; “What does the cat say?”). Reading with young children further extends their understanding of language and can be the perfect time for discussions of pic­ tures, ideas, and actions in the story. As the child grows, it is important that early attempts to communicate are taken seriously. Children thrive when adults listen to them and seem interested in what they have to say (Loncke, 2011). Often grandparents play a special role in the child’s life, because they take the time to listen to the child.

9-7a  How Parents Can Support Their Child’s Communication If the child says, “Wa doo,” the parent may say, “I don’t understand; tell me again.” The child repeats, “Wa doo,” looking at the refrigerator. The parent then says, “Oh, you want some juice” and gives it to the child. The parent can also be taught to use recasting, or modeling the correct pronunciation without cor­ recting the child’s speech. For example, in response to the question “What do we call that big cat?” the child says “a wion,” and the parent says, “yes, that big cat is a lion.” At no time does the parent interrupt the child and tell them, “Say lion.” Responses by the adult that build on what the child is communicating are also referred to as following directives, and they have been shown to facili­ tate the child’s language development (McCathren et al., 1995). When adults follow the child’s lead, talking about what the child is interested in, the child is likely to be more engaged in the conversation and will use and learn more words (Southern California Comprehensive Assistance Center, 2005; Justice et al., 2008). Siblings also play a critical role in supporting the language development of a child with communication, language, or speech disorders (Douglas et al., 2018). With support and training, typically siblings can learn to be good communica­ tion partners, developing skill around asking open-ended questions, using patient wait-time for responses, and building communication around the child’s natural interest and activities (Douglas et al., 2018). When we focus on the social use of language (pragmatics) and stress functional communication, we can support language development in natural environments.

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders

AzmanJaka/E+/Getty Images

Communication can be enhanced within the natural environment of the home as the family takes time to play and talk together.

Using an interactive approach, the interventionist—a parent, a sibling, the spe­ cial education teacher, or speech-language pathologist—capitalizes on the natural inclination of children to talk about what they are doing, plan to do, or want to do. To encourage correct word and language use, the communication partner provides support while the child is eating, playing, or visiting community settings such as a grocery store (Douglas et al., 2018; Hyter, 2007). Working in settings in which talking and listening occur naturally helps to increase the child’s amount of talk. And the more the child talks, the more they will gradually gain accuracy and increase their vocabulary.

9-7b  Transitions for Students with Communication Disorders What lies ahead for the child who has a communication disorder? The answer to this question depends on the nature and severity of the disorder (Loncke, 2011). Children who have primary articulation disorders (that is, a speech or language disorder not associated with other disabilities) seem to have few related prob­ lems as adults. In contrast, follow-up studies of children with more complex and severe disabilities in addition to language disorders continue to have prob­ lems in academics, interpersonal relationships, and work (Durkin et al., 2012). What is clear, however, is that early support can help to minimize secondary problems, and, in some cases, it can help a child overcome the speech and lan­ guage disorders. Important changes have come about in helping students with communication disorders make transitions from high school to college and the workplace. Many colleges and universities have support services and special programs for students with disabilities. Special clinics and help sessions are staffed by speech-language pathologists, learning-disabilities specialists, and psychologists. Supports offered may include individualized techniques for note-taking, class participation, and writing. Job coaches can help individuals with the pragmatics of work-related communication to allow individuals to be successful in employment settings (Montgomery, 2006). Augmentative and alternative communication systems can be developed to meet work-related needs, and assistive technologies can be used to support communication. Because communication is so critical to an individual’s

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Summary successes, every effort must be made to support effective and appropriate com­ munication. Appropriate supports and interventions that are provided early and continued for as long as necessary can help individuals develop their com­ munication skills.

Summary ●  The

Moral Dilemma:

Children with Communication Disorders Collaboration among classroom teachers, special-education teachers, and speech-language pathologists is essential to providing the full support that a child with communication disorders needs across all three tiers of intervention. A good example of collaboration was presented in the Educational Responses section of this chapter (see pages 318–321). But collaboration is not always easy to accomplish. What can you do if one of the professionals who is key to the child’s success will not work as part of a team? What are some of the personal and professional obstacles to collaboration, and how can you help a colleague overcome these? What should you do if you feel a child is being harmed by a colleague’s resistance to collaboration?

formation of the American Speech and Hearing Association in 1925 was critical to the development of the field of speech and language disorders. ●  Children with communication, language, and speech disorders have a wide range of strengths and needs that impact their learn­ ing. The Information Processing Model can help us identify each individual student’s area of strength and challenge. ●  Communication is an essential part of being human, and it requires a sender, a message, and a receiver. ●  Language is a code in which signs, sounds, and symbols represent feelings, ideas, and information. Language is both receptive and expressive and can be described as having form, content, and function. Language form includes phonology, morphology, and syntax; semantics refers to content; and func­ tion includes pragmatics and supralinguistics. ●  Speech is the systematic oral production of the words of a given language. Processes needed to produce speech are respiration, phonation, resonation, articulation, audition, and symbolization/organization. ●  Typically, language development follows a pattern of emerging complexity moving from sounds to words and sentences that convey meaning. ●  A language disorder is impaired comprehension or use of spoken, written, and/or other symbol systems. ●  Speech disorders include problems with articulation, fluency, and voice. ●  Understanding normal patterns of language acquisition is an important part of identifying children with language disorders. A comprehensive and cultur­ ally competent assessment is essential to identifying communication, lan­ guage, and speech disorders. ●  Since communication, language, and speech disorders often co-exist with other areas of disability, it is difficult to determine their prevalence in children. ●  Understanding a child’s cultural and linguistic background is necessary to cor­ rectly identify and support children with language disorders. Recognizing com­ munication disorders in children whose primary language is not English can be challenging and may require a specialist who is both bilingual and bicultural. ●  Being bilingual or multilingual is a strength and not a deficit. Using more than one language promotes cognitive growth. When assessing the vocabu­ lary of students who are bilingual or multilingual, we need to count words they know in all their languages! ●  Individuals with disabilities may also have communication disorders. ●  The role of the speech-language pathologist has expanded in the schools to include coteaching children within the general-education classroom. ●  Assistive technologies including augmentative or alternative communication devices, and approaches may be needed for individuals with limited speech.

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Chapter 9  |  Children and Youth with Communication, Language, and Speech Disorders ●  Parents

and families can provide essential support for a child’s development of language. Grandparents and siblings can be wonderful communication partners for the child.

Future Challenges 1. How can schools provide the time and resources needed to allow teachers to collaborate as they work to meet the needs of their students? Collaboration between general-education teachers and specialists is essen­ tial to supporting children with communication, language, and speech disorders, yet teachers often find this collaboration difficult to accomplish. Barriers to collaboration include a lack of time, limited shared resources, and difficulties with caseloads or class size. If we truly believe that collaboration is necessary, how can we find ways to support teachers and related service providers so that they can work together meaningfully?

2. How can early intervention materials be made more available to parents and physicians? Most speech disorders are not identifiable until a child reaches 2 years of age, when verbal-language ability usually appears. Unfortunately, parents frequently do not recognize early signs of potential speech disorders in the prelinguistic stage. How can we make information on prelingual indicators of potential difficulty more available to both pediatricians and parents?

3. How can we provide appropriate services for children with communication, language, and speech problems who are also Englishlanguage learners? Our schools are serving increasing numbers of children whose primary language is not English. When communication, language, and speech prob­ lems exist in children who are bilingual, it can be more difficult for school personnel to recognize, identify, and meet the child’s needs. How can we address the communication, language, and speech needs of bilingual chil­ dren and their families? TeachSource Digital Download

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Key Terms American Sign Language (ASL) p. 325 articulation p. 296 articulation disorders p. 310 audition p. 304 augmentative and alternative communication p. 325 cleft palate p. 309 communication p. 300 communication disorders p. 308 dialect p. 313 dysphonia p. 311 expressive language p. 301 language p. 302 language content p. 303 language form p. 302

language function p. 303 language pragmatics p. 297 morphology p. 303 phonation p. 304 phonology p. 302 receptive language p. 301 related services p. 314 resonation p. 304 respiration p. 304 speech fluency p. 304 stuttering p. 311 supralinguistics p. 303 syntax p. 303 voice p. 304

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Resources of Special Interest to Teachers

Resources of Special Interest to Teachers Journals American Journal of Speech-Language Pathology publishes peer-reviewed research and other scholarly articles on all aspects of clinical practice in speech-language pathology. The journal is an international outlet for clinical research pertaining to screening, detection, diagnosis, management, and outcomes of communica­ tion and swallowing disorders across the lifespan as well as the etiologies and characteristics of these disorders. Because of its clinical orientation, the journal disseminates research findings applicable to diverse aspects of clinical practice in speech-language pathology. https://pubs.asha.org/journal/ajslp Communication Disorders Quarterly presents cutting edge information on typical and atypical communication—from oral language development to literacy. The journal also offers assessment of and interventions for communicative disorders across the lifespan. It includes research reports, a clinical forum that reports theo­ retical applications in clinical and educational settings, short tutorials on specific topics or clinical procedures, and media reviews. https://journals.sagepub.com/home/cdq http://www.topicsinlanguagedisorders.com Language, Speech, and Hearing Services in Schools publishes peer-reviewed research and other scholarly articles pertaining to the practice of audiology and speechlanguage pathology in the schools, focusing on children and adolescents. The journal is an international outlet for clinical research and is designed to promote development and analysis of approaches concerning the delivery of services to the school-aged population.  https://pubs.asha.org/journal/lshss

Professional Organizations American Speech-Language-Hearing Association (ASHA) is the national profes­ sional, scientific, and credentialing association for 218,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hear­ ing scientists; audiology and speech-language pathology support personnel; and students. www.asha.org/

Resources for Families Speech Pathways Foundation provides a treasure trove of resources, including a list of state and national organizations, advocacy groups, funding sources, and other sites of interest for parents. http://www.speechpathways.net/resources/resources.htm The Center for Parent Information & Resources Parent Hub is a central spot for information and research for families. The Hub also includes trainings, workspaces for parents to coordinate with one another, and learning materials. https://www.parentcenterhub.org/whatiscpir/

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Children and Youth with Gifts and Talents

10 CH AP T E R

Standards Addressed in This Chapter All of the CEC Initial Practice-Based Professional Preparation Standards for Special Educators (K-12) are addressed within this chapter. Please see the inside book cover for a list of these standards.

Focus Questions 10-1 How did the field of gifted education evolve, and why is it important for giftedness to be recognized as an exceptionality? 10-2 What are some characteristics of students with gifts and talents, and how can the information processing model help us understand their needs? 10-3 How do we define “gifts and talents,” and how are students identified? 10-5 Why do students from culturally and linguistically different or socioeconomically disadvantaged homes and twice exceptional (i.e., twice exceptions, or 2e—gifted students with disabilities) students continue to be underidentified for gifted-educational supports and services? 10-6 What educational responses are needed to address the strengths and ­challenges of students with gifts and talents? 10-7 What lifecourse considerations are important for students with gifts and talents?

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W

e all can picture the two or three most intelligent people we have ever met. We may have been impressed by the breadth of their knowledge and skills or a bit envious of how effortlessly they learn or play an instrument. We may have even wondered where their abilities came from. Was it merely a lucky roll of the genetic dice, or did their parents and teachers have something to do with the flowering of their talent? Were they always so advanced in development? When we see individuals with outstanding abilities, we may also wonder if others in our society have great talent that has not been recognized or enhanced. In this chapter, we describe students with gifts and talents, reflect on how we identify their abilities, and explore why we miss many students from culturally and linguistically different families as well as students who are both gifted and have a disability (i.e., twice exceptions, 2e). We also explore the educational responses needed to support students in reaching their potential.

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Chapter 10  |  Children and Youth with Gifts and Talents

10-1  How the Field of Gifted and Talented Education Evolved and Why It Is Important The term gifted traditionally has been used to refer to people with intellectual gifts, and each culture defines giftedness in its own image, in terms of the abilities that it values. Ancient Greeks honored the philosopher and the orator, and Romans valued the engineer and the soldier. From a society’s definition of giftedness, we learn something about the values and lifestyles of that culture. We also learn that the exceptional person often is defined by both individual ability and societal needs. In the formative years of gifted education in the United States, the IQ score was often the sole measure of “giftedness.” The Stanford-Binet Intelligence test, developed by Lewis Terman during and after World War I, was often used as the sole indicator of giftedness (Terman & Ogden, 1947). This narrow conception of intelligence as unitary (e.g., one thing), stable (e.g., fixed), and measurable (e.g., easily assessed) laid the early foundation of the field (Coleman et al., 2021). This restricted view of intelligence has left a legacy of misconceptions that we continue to struggle with today (Terman & Oden, 1947). These problematic misconceptions include that: 1. giftedness is global, and that to be “gifted,” an individual must be exemplary across all domains; 2. giftedness is fixed vs. developmental; it is either there or not there; 3. giftedness will manifest on its own, regardless of contextual support; and 4. we can measure the existence of giftedness fairly easily through an IQ test or by looking at outstanding school achievement, with these measurements being accurate assessments of individual giftedness that will hold over time (Coleman et al., 2021). As part of this legacy, we see continued debates about who is “truly” gifted, and we often fail to recognize, nurture, and support students with potential giftedness. Thus, we further marginalize gifted students from non-White, middle-class backgrounds, as well as gifted students with disabilities. We now understand that Lewis Terman, through his identification process of using only the IQ test to select his sample, eliminated many potentially bright youngsters from culturally diverse and socioeconomically disadvantaged families. We also know that Terman’s belief in the eugenics movement (e.g., improving the human race through intentional breeding programs designed to weed out “inferiority”) shaped his views of giftedness; those assumptions about human development are now being challenged (Dai, 2020). In acknowledgment of the role that this legacy has had on the field of gifted education, the National Association of Gifted Children recently released the following statement: We acknowledge the injustices of structural and systemic racism and recognize the field of gifted education has historically been part of the problem by promoting these injustices, even if inadvertently. Some early researchers and thought leaders who influenced the field were involved with the eugenics movement, and early gifted identification and programming practices often became vehicles for de facto segregation. The field has made tremendous strides in addressing these historical injustices in recent years, but we have not made sufficient progress. (NAGC Board of Directors, 2020) National Association for Gifted Children https://www.nagc .org

What we have learned is that how we conceptualize giftedness determines who we identify as gifted and how we serve the students we identify (Baldwin, 1985; Frasier, 1997). We will discuss this idea further as we explore gifted education’s current policies, programs, and practices. More recently, the National Academy of Sciences assembled a distinguished panel composed of Nobel Prize winners, university presidents, and CEOs of

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Students with Gifts and Talents and the IPM major corporations to produce a report on the status of students with gifts and talents in American society, with particular focus on math and science. This panel concluded with some serious concerns in a report, Rising Above the Gathering Storm (2007). Following are some of the concerns the panel members raised: ●  U.S.

Students in the twelfth grade performed below average for 21 countries on a test of general knowledge in mathematics and science. ●  In 2004, China graduated about 500,000 engineers and India graduated 200,000, as compared with 70,000 in America. ●  In 2001, U.S. industry spent more on tort litigation than on research and development, showing a lack of investment in innovation. Here are a few of the many recommendations this panel made: ●  Create

10,000 four-year scholarships in math and science to develop the best minds in our society. ●  Increase teacher preparation to support the development of students’ innovation and creativity. ●  Increase funds for research for several federal agencies, such as the National Science Foundation and NASA. The National Academy of Sciences report was one of many efforts over the years that focused on the importance of educating students with gifts and talents. Other reports and studies include: ●  The

Marland Report (Marland, 1972) Excellence (Ross, 1993) ●  Rising above the Gathering Storm (Committee on Prospering, 2007) ●  Preparing the Next Generation of STEM Innovators (Bruer, 2010) ●  National

Yet, despite these reports and the concerns they raise, there is no federal mandate for gifted education. (This topic was also discussed in Chapter 2.) Because there is no federal requirement, gifted education remains a patchwork quilt and access to programming depends, to a large extent, on where you live (NAGC & CSDPG, 2020). One thing is certain: As educators, we need to do more than stand in awe of high abilities. We need to find ways to help students with special gifts and talents develop. As educators, it is our responsibility to nurture students because no matter how intelligent they are, they are unlikely to discover algebra on their own, nor learn how to write a sonnet, nor play a saxophone or violin. Special abilities need to be nurtured. We will discuss the definitions of gifted and talented and the identification practices based on them later in the chapter, but first, let’s get to know a few gifted and talented students.

10-2  Characteristics of Students with Special Gifts and Talents and How the Information Processing Model Helps to Understand their Needs Let’s meet three children: Cranshaw, Zelda, and Sebastian. They are all 10 years old and in the fifth grade. Cranshaw meets the criteria for intellectual, creative, and leadership giftedness; Zelda has intellectual gifts; both Cranshaw’s and Zelda’s abilities were recognized in kindergarten. For our third student, Sebastian, his teachers failed to notice his intellectual and artistic gifts until his current fifthgrade English Language Learning (ELL) teacher saw his outstanding abilities and recommended him for gifted-education services.

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Chapter 10  |  Children and Youth with Gifts and Talents

10-2a  The Information Processing Model In this case, we will look at the information processing model for Zelda. As shown in Figure 10.1, Zelda shares the major strengths of most students with gifts and talents, which are within the processing, or thinking, areas of memory, classifying, associating, reasoning, transforming, and evaluating information. Because of these cognitive strengths, the output, or response area of the model, shows her strengths in speaking and writing. Many students with gifts and talents, like Zelda, also have strengths in their executive function. As you can likely predict, Zelda’s areas of challenge are within motor response and social interactions found in information output, and she also has some visual challenges that require glasses to correct. The information processing model helps us understand that students with gifts and talents will need learning experiences that allow them to think with more complexity and to move through basic tasks with greater speed to reflect their ability to learn more rapidly in their areas of strength.

Cranshaw Cranshaw is a big, athletic, happy-go-lucky youngster who enthusiastically embraces his academic and social life in school. He seems to be a natural leader, and he has a wide range of interests that shift from week to week. One week he can be fascinated with astronomy, the next week with football formations, and the following week with the study of Africa and all its many cultures. His teachers tend to have two very distinct reactions to his abilities. One is that he is a joy to have in the classroom. He is a cooperative and responsible boy who not only performs his own tasks well but is also a good influence in helping the other youngsters to perform effectively. On the other hand, Cranshaw’s high abilities and ever-changing intense interest can also be challenging for his teachers, who worry that they may not be able to meet his academic needs. Cranshaw’s family is a close-knit, reasonably happy one. His father is a businessman, his mother is an elementary school teacher, and he has one sister who is in the second grade. The family is moderately active in the community. They anticipate that Cranshaw will go on to higher education, but they do not seem

Emotional Context

Stimulus

Vision Hearing Kinesthetic Haptic Gustatory Olfactory

Thinking

Response

Memory Classification Association Reasoning Evaluation

Speaking Writing Motor Response Social Interaction

Processing

Attention

Information Output

Executive Function

Information Input

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key Challenges Strengths

◗ Figure 10.1  Information Processing Model for Students with Gifts and Talents TeachSource Digital Download

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to be future-oriented and are perfectly happy to have him as the enthusiastic and well-adjusted youngster that he appears to be today.

Zelda Zelda’s high scores on intelligence tests are similar to Cranshaw’s. Zelda is a passionate reader who always has a book in her hand. She seems most comfortable in the world of ideas. She loves to discuss and debate, though sometimes her “debates” can become confrontational when she is convinced that she is right (as she often is!). Socially, she has one or two girlfriends, but she is not a member of the wider social circle of girls in her class and, indeed, she seems to reject most socialization as being “trivial.” Teachers respond to Zelda with two generally different feelings. They are pleased with the enthusiasm with which Zelda attacks her schoolwork and the good grades that she gets. At the same time, they are concerned about Zelda’s undisguised feeling of superiority toward classmates who are not as bright as she is. They worry that her obvious disdain for students who she believes are not as smart as she is will alienate her classmates. They are already seeing signs of social isolation, and they are sure that Zelda will have even more difficulties when she moves on to middle school. Zelda’s parents are college professors—her father in history and her mother in English literature. They value academic achievement and intellectual performance, almost to the exclusion of all other things. They love the fact that their daughter gets all A’s, and they take great pride in her ability to assimilate large amounts of information relatively quickly. Zelda is very aware of what makes her parents happy, and this knowledge further motivates her to do well in school. The family’s social evenings are often made up of intellectual discussions of politics, religion, or the current burning issue on the campus. These discussions are definitely adult oriented, and Zelda is intelligent enough to occasionally join such conversations. Her parents encourage her participation and enjoy their daughter’s ability to defend her ideas using facts to support her position.

Sebastian

Jim West/Alamy Stock Photo

Sebastian came to this country with his parents three years ago from Central America, and he speaks two languages, English and Spanish. His father works long hours on construction projects, and his mother works part-time cleaning homes. Sebastian has two sisters and one brother who all go to his school. His parents were somewhat surprised this year when the school system told them Sebastian was eligible for the program for students with gifts and talents, but they are very proud and want to help Sebastian succeed in his new role. Sebastian’s abilities were not seen during his earlier years in school. He did well, he was quiet in class, and his achievement scores only showed slightly above average in math. Because achievement scores were used as a screening point for gifted programming, his teachers never nominated him for consideration. Sebastian’s teachers were unaware that his achievement scores were not a reliable indicator of his true abilities because the assessments were done in English only. (See Chapter 9 for a discussion of bilingual and bicultural assessments.) It was not until the English Language Learning teacher brought him forward during a grade-level meeting that his teachers began to realize that he had been overlooked. His teachers began completing observations within their classes Supporting the strengths of students with gifts and talents and collecting work samples that showed his problemcan take many forms. These students are planting trees as solving and critical thinking. Based on this evidence, they part of a study on the impact of deforestation. referred him for further evaluation. The school psychologist

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Chapter 10  |  Children and Youth with Gifts and Talents told them that Sebastian’s IQ was 121 and that this likely was an underestimation of his true potential since this assessment was also given in English. You may recall from earlier chapters that bilingual and bicultural assessments are recommended for students when English is not their primary language, but as is often the case, the school district did not have the resources to ensure that this type of assessment was done for Sebastian. Despite this limitation, Sebastian was formally identified as gifted and began participating in the gifted-education program in October of his fifth-grade year. Sebastian’s teachers, however, still plan to be careful with his assignments, supporting his language skills while stressing his artistic contributions, which are considerable, and nurturing his math abilities. His gifted-education teacher is also aware that Sebastian may need some additional support within her class, and she is committed to ensuring that he feels welcome in his new class. When we look at Cranshaw, Zelda, and Sebastian, we are reminded that individuals within any category of exceptional children are first and foremost i­ndividuals. Each has his or her own pattern of strengths and areas of need. Indeed, within any category of exceptional children, the intraindividual differences of a single child can seem more important than the interindividual differences across the group. Nevertheless, we need to remember that what students with gifts and talents have in common is an advanced cognitive ability; this ability will require teachers to provide a more challenging learning experience in the children’s areas of strength, recognizing that these strengths may not always show up in school (see Box 10.1).

10-2b  Neurology and Brain Development: What We Know about Students with Gifts and Talents One of the original ideas from neurology was that the frontal lobes were linked to intellectual ability and executive function. Such functions as control processing, strategy formulation, and monitoring the contents of working memory fit into this category. But more recent evidence from a variety of MRI studies suggests that the neural basis of giftedness is distributed throughout the brain, and it is the “interconnectiveness” of the brain that determine high efficiency (Solé-Casals et al., 2019). While certain areas within the brain have specialized functions, it is the ability of these areas to work together in synergy that contributes to giftedness.

Box 10.1

Students with Gifts and Talents:

Remember Our Super Powers!

Students who have been identified with gifts and talents are often pretty good at academic things, but let’s review what some students consider to be their “superpowers,” which might not show up in school. ●







“Well, I speak three languages, English, Italian, and Spanish, but I think my superpower is that I also speak ‘Cat’—I’m a cat whisperer!” (age 7) “A lot of children in my town do not have warm coats, and it can get pretty cold here. So, I started a coat drive where people could donate the coats they didn’t need or had outgrown…we have given lots of coats to children who need them…is that a superpower?” (age 10) “Trees are really important. They help to reduce carbon in the air, and we need that! I started a club with my friends to plant trees in our community. We planted over 100 trees. We got permission from the city council, and we now have a budget for even more trees! I guess my superpower is being a Dendrophile!” (age 12) “When COVID hit and there were not enough face shields for medical personnel, my friends and I began making them with our 3D printers. I guess trying to fill a need like this one would be my superpower.” (age 15)

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10-2c  Social and Emotional Development of Students with Gifts and Talents Giftedness does not provide an inoculation against social and emotional problems (Cross et al., 2018). The question is whether it provides a buffer against them because of these students’ cognitive abilities to solve problems and to examine their own feelings. One characteristic that seems to be a part of the emotional and social lives of some students with gifts and talents is perfectionism. Perfectionism is the combination of thoughts and behaviors associated with extremely high standards or high expectations for one’s own performance. While perfectionism can be a strength because it sets a high standard for performance, it can also be problematic if it becomes maladaptive (Cross et al., 2018). If perfectionistic tendencies get out of hand, they can cause paralysis and students can become “failure avoidant.” And “failure” is often defined differently by students who have perfectionistic tendencies! Perfectionist students may become depressed if they receive a 95 on a paper instead of the usual 100. Zelda is highly perfectionistic, and because she (and her parents) sees grades as the primary measure of achievement, she becomes very upset if her work receives a less-than-perfect score. For most of her elementary years, Zelda could make 100s on all her work with very little effort. Because the work has not been difficult for years, she has become complacent and very accustomed to her “easy A’s.” Recently, her gifted-education teacher has been offering Zelda more challenging work to help her stretch her abilities. Within the gifted program, Zelda’s assignments often require deep thinking and creativity instead of rote memorization, and she is finding this work uncomfortable because she cannot be certain that she will “make the grade.” Her teacher is trying to help her focus on learning instead of the grade and on the importance of tackling new and challenging tasks. She would like Zelda to be willing to take some risks by pushing herself academically. On her last assignment, instead of earning her typical A, Zelda was asked to rewrite her essay to include additional points of view. Zelda’s initial reaction to all this feedback has been to rebel; her parents became alarmed when she told them that the gifted program was stupid because it does not really count for anything and that she was going to quit! In addition to maladaptive perfectionism, other areas of concern for some students who are gifted are related to stress, mental health challenges, and suicide. Students who take advanced courses with more demanding workloads report feeling higher levels of stress around academics than do their peers who take general education classes (Suldo & Shaunessy-Dedrick, 2013; Shaunessy-Dedrick et al., 2015). This stress can be even more intense for students who live in poverty and may also be impacted by additional environmental stressors (we will discuss this issue later in the chapter) (Szymanski, 2021). Students who are taking demanding class and caseloads indicate that these factors contribute to higher stress levels: increased workload and homework, time needed for practice and study, diminished time with family and friends, and worry over grades (which need to remain high for college admissions and scholarships) (Szymanski, 2021). Chronic and acute stress can take a severe toll on the students’ mental and physical well-being (see Box 10.2, Mindfulness Matters). When stress becomes overwhelming, it can lead to a downward spiral of negative thoughts that may include suicidal ideation (Cross & Cross, 2019). Cross (2013) pointed out that an increasing incidence of suicide among adolescents in general would seem to mean that the incidence would likely be increasing in the gifted population as well. Cross, Cassady, and Miller (2006) explored suicidal ideation in 153 teenagers applying to a residential school for advanced mathematics and science and found no higher rates of suicide in this group than in the normal population. However, in a more recent study looking at honors college students, the risk factors of high perfectionism and suicidal ideation were found within the

William and Mary Center for Research on Suicide of Gifted Students https://education .wm.edu/centers/cfge /suicide_institute/index.php

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Chapter 10  |  Children and Youth with Gifts and Talents

Box 10.2

Mindfulness Matters:

Stress Reduction with Meditation

Meditation has been practiced in Eastern countries for thousands of years; compared with this history, meditation is relatively new here in the Western world, and we are just beginning to understand its benefits. While there are many forms of meditation, most involve bringing the mind to a focus on an object (e.g., the breath, a sound, a visual image, or a mantra). This focus helps to slow the mind down, a process sometimes called resting the mind or placing it in “calm abiding.” Why this Matters: When we engage in some form of meditation, we reduce stress and build cognitive focus. Acute and/or chronic stress can have a negative impact on our mental, emotional, and physical well-being. Increased levels of cortisol, a hormone associated with stress, leads to inflammation, which can cause damage throughout the body. Meditation has been shown to lower heart rates and blood pressure. So, by helping to reduce stress, meditation may have a positive impact on long-term mental and physical health! Practicing Mindfulness: Conduct a student research project to learn more about the benefits of practicing meditation on health and well-being: 1. Discuss the impact of stress on mental and physical well-being; students may give examples from their own life about how stress impacts them. 2. Have students research the impact that chronic and acute stress can have on mental and physical wellbeing. Create a visual product (e.g., photo collage, bulletin board, webpage, sculpture) showing this impact. 3. List ways that students currently try to reduce their stress. Have students talk with others about how they reduce their stress. [Note: Stressrelieving strategies can either be proactive toward supporting overall health (e.g., working out, socializing with friends, taking a walk in the woods) or detrimental to overall health (e.g., binge eating, using alcohol/substance abuse, fighting). Both types of stress relief may come up in these discussions.]

TeachSource Digital Download

4. Discuss the use of meditation as one way to reduce stress. 5. The benefits of meditation have been studied at several major medical schools. Provide students with a list of sites where they can learn more about the impact of meditation on mental and physical well-being. (See the list at the end of this box.) 6. Have students share what they have learned about the role of meditation in stress reduction and its impact on mental and physical well-being. 7. Invite students to do their own mini-study on the impact of meditation by trying one of the meditation techniques they have learned about and documenting their experience. [Note: Students should select a straightforward technique like following the breath, a walking meditation, or using a sound to focus the mind. As they try this practice, they can keep a journal to share their experience. To track the impact, students may want to try doing a daily practice session of 10–20 minutes for three weeks.] While the practice of nonreligious meditation is widely seen as being beneficial, it is not without possible controversy. You may want to send a letter to your students’ parents sharing your plans for these activities prior to starting them; then, of course, respect the wishes of parents who prefer that their child not participate.

Suggested University Medical Schools That Study Meditation: Harvard Health: Harvard Medical School https://www.health.harvard.edu/staying-healthy/what -meditation-can-do-for-your-mind-mood-and-healthUC Davis Medical School: https://health.ucdavis.edu/health-news/newsroom /10-health-benefits-of-meditation/2019/06 Mayo Clinic: https://www.mayoclinic.org/tests-procedures /meditation/about/pac-20385120

Access online

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Students with Gifts and Talents and the IPM profiles of many students (Cross et al., 2018). The authors recommend having counseling available to all honors students since there may be a greater need for this support than in the general college population.

10-2d  Creativity Creativity is a process that has fascinated educators and philosophers for centuries. How does one create something novel that was not there before? How did da Vinci, Picasso, the Brontë sisters, Einstein, DuBois, Curie, Fanon, Mozart, Suzuki, Shankar, and many thousands of others accomplish their outstanding works? Can we as educators discover and enhance these talents that seem to be at the apex of human endeavor? One researcher defined creativity as the ability to generate ideas, products, or solutions that are considered novel and useful for a given problem, situation, or context (Beghetto, 2008). (Note the emphasis on usefulness; many people produce “novel” thoughts, but with little utility.) We are beginning to understand that creativity is not so much a personal characteristic as it is a process that blends thinking, working, and personality. Treffinger, Young, Selby, and Shepardson (2002) present four different dimensions of the creative process: generating ideas, digging deeper into ideas, courage to explore ideas, and listening to one’s inner voice. Generating ideas requires cognitive flexibility, whereas digging deeper into ideas requires more synthesis and reasoning power. Personality becomes more central to the courage to explore ideas, requiring risk taking and openness to experience (Subotnik et al., 2019). The final stage, listening to one’s inner voice, deals with clearly envisioning what you wish to accomplish and determining to overcome obstacles—again, personality characteristics. There seems to be substantial evidence from the literature of many cultures that people are most creative when they are motivated primarily by the interest, enjoyment, satisfaction, and challenge of the work itself (i.e., “intrinsic motivation”) (Lee et al., 2021). Given that creativity is fostered when learning is fun, challenging, and driven by student interests, it is logical to ask “what happens to the development of creativity in an educational environment that focuses on the results of high-stakes testing?” High-stakes tests, whose results can substantially change a student’s future, often measure the acquisition of factual information rather than the application of this information to creative problem solving. Hodges and Lamb (2019) completed a historical review of the impact of No Child Left Behind (see Chapter 2) on gifted programs in Washington state. You may recall that this law required the use of high-stakes tests to determine adequate yearly progress of students. What they found was that the number of school districts in the state reporting that they had a gifted program declined from 77 percent to 62 percent between 2006 and 2007 and 2012 and 2013. Furthermore, districts that did not make adequate yearly progress were more likely to no longer report having a gifted education program (Hodges & Lamb, 2019). While it is not conclusive, this decline does seem to be a by-product of the high-stakes testing movement. By redirecting resources to high-stakes testing, we may also be depriving students of the search for new ideas and intellectual adventures leading to creativity. Hennessey & Amabile (2010), in an extensive review of creativity literature, commented: One possibility is that with America’s newfound emphasis on “high stakes testing” and other manifestations of the accountability movement has come a general de-emphasis on creative behavior in favor of the more easily quantified and assessed mastery of reading, writing, and arithmetic. (p. 587) So, what are the positive traits and environments that can enhance creative production?

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Oleksandr Rupeta/Alamy Stock Photo

Chess is one game that can reveal special gifts and talents in young children.

Renzulli (2002) suggests that three intersecting rings of above-average ability, creativity, and task commitment need to be nurtured to support creative productivity. He asked the question, “What causes some people to mobilize their interpersonal, political, ethical, and moral realms of being in such ways that they place human concerns and the common good above materialism, ego enhancement, and self-indulgence?” (Renzulli & Reed, 2008). He also proposed that the following combination leads to intellectual productivity: optimism (positive feelings from hard work), courage (moral conviction), romance with a topic (passion), sensitivity to human concerns (empathy), physical/mental energy (curiosity), and sense of destiny (power to change). There is little doubt that such a combination should promote productivity. What remains is how educators can recognize and develop these traits within their students with gifts and talents (Lee et al., 2021).

10-3  How Do We Define “Gifts and Talents” and Identify Students In the United States, definitions of giftedness are often tied to performance; the focus is not so much what the child is doing as when, developmentally, they are doing it. A child playing chess is not a phenomenon, but a child playing chess seriously at age 5 is. Many children write poetry, but not at age 6, when most children are just learning to read. Early rapid development is one of the clear indicators of high ability. As noted earlier in the chapter, there is no federal mandate for gifted education in the United States, and so each state has its own definition of gifted and talented (NAGC & CSDPG, 2020). Many of the state definitions, however, are based on the definition developed in the National Excellence (1993) report, and this definition is given in Table 10.1. Let’s unpack this definition to look at the key ideas it contains. In this definition, the phrase “show the potential for performing” means that we accept the idea that children can have gifts or talents without showing them through excellent performance. We see that potential may be manifest, or it may be latent, and we may have to nurture this potential if we wish to see it. “Compared with others of

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Table 10.1  Federal Definition of Students Who Are Gifted Children and youth with outstanding talent perform, or show the potential for performing, at remarkably high levels of accomplishment when compared with others of their age, experience, or environment. These children and youth exhibit high-performance capability in intellectual, creative, and/ or artistic areas; possess an unusual leadership capacity; or excel in specific academic fields. They require services or activities not ordinarily provided by the schools. Outstanding talents are present in children and youth from all cultural groups, across all economic strata, and in all areas of human endeavor. Source: Ross, P. (Ed.). (1993). National excellence. Washington, D.C.: U.S. Department of Education.

their age, experience, or environment” means that we accept the important role of experiences and environmental context in developing students with gifts. If we think of a student who is 2e (e.g., twice exceptional, in other words, gifted but also possessing a disability), the lived experiences for this student will be very different than those of his hearing peers. We must consider this difference as we work to recognize his gifts and talents. When looking at a child’s potential giftedness, we also must consider the environmental context of the child. This context, as seen in Bronfenbrenner’s model (and as noted throughout earlier chapters) includes the family, the neighborhood, the community, the school, and the broader societal forces at play during any given period; all these impact how a child will manifest their potential (Szymanski, 2021). The phrase “require services . . . not ordinarily provided” means that we expect school systems to modify their services and programs to address the different levels of development of students with, or, who show potential for having gifts and talents. “Outstanding talents are present in children . . . from all cultural groups, across all economic strata” means that we expect to find gifted abilities and talents in all racial and ethnic groups and across all socioeconomic levels. While this diverse scope is clearly part of the definition, we have fallen short of actualizing it and children from racially, ethnically, and socioeconomically different families remain disproportionately underrepresented within gifted education programs nationwide (Coleman & Shah-Coltrane, 2015). We now know that intelligence is not fixed for an individual, but it can be improved with education and experience. We are not limited in the number of highly intelligent students we can produce, but we have as prospects a gradually increasing number of highly intelligent people—if we are wise enough to create the conditions for their development of their potential. As psychologist Howard Gardner (2020) states, “…how much one achieves within or across intelligences is a joint product of how important the capacity is in the society where one happens to live, how highly motivated one is to develop that capacity, and how skilled are the teachers and the technologies of education available in one’s culture…” (p. 16). As we think about nurturing students’ giftedness, the idea of the individual’s “potential” is critical, but added to this factor are others determining the outcome, such as motivation and personality. As discussed by Subotnik, Olszewski-Kubilius, and Worrell (2011) when referring to the “talent development” viewpoint:

The Association for the Gifted (TAG) http://www .cectag.org/

General ability is necessary but not sufficient to explain optimal performance or creative productivity. It remains a component of talent development along with domain-specific abilities, psychosocial skills, motivation, and opportunity. (p. 14).

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Chapter 10  |  Children and Youth with Gifts and Talents This combination of forces is referred to as talent development, with the end goal of helping each student reach their potential (Subotnik et al., 2011). The assumptions posited by this definition are important, and we will explore their impact throughout the chapter as we look at identification practices and the supports and services needed to help students with gifts and talents thrive in our schools.

10-3a  One Gift or Many? Should giftedness be regarded as one overriding general mental ability or as a series of special abilities? Howard Gardner views giftedness as being made up of multiple special abilities (Gardner, 2020; Gardner, 2017; Ramos & Gardner, 2003). He has proposed a list of nine distinct and separate abilities called multiple intelligences that need specific educational attention: verbal-linguistic, logical-mathematical, musical-rhythmic, visual-spatial, bodily-kinesthetic, interpersonal, intrapersonal, naturalist, and existential intelligences (Gardner, 2020; Davis et al., 2011). Everyone knows someone who is particularly good at one or two of the abilities listed by Gardner, but it would be rare for someone to be outstanding in them all. Think of a student who is a math whiz but who is not an expert in linguistic or interpersonal intelligence. Consequently, the educational issue becomes not only how to plan one overall program for students with gifts and talents in many of these areas, but also how we meet the needs of students who have specialized talents in a single area such as mathematics, music, visual perception, or interpersonal relationships. Because students can be gifted in only one or in more domains, identification should be domain specific, matching students’ strengths with specific program options.

10-3b  Children of Extraordinary Ability What happens to the rare students who are seven or eight years ahead of their age group in intellectual development, the 1 in 100,000 at the level of an Einstein? Lubinski (2009) reported on the adult outcomes for over 2,000 students drawn from the Study of Mathematically Precocious Youth project (SMPY). These students represented the top 1  percent of ability, as measured by their IQ scores. When this top one percent of students was further divided into quartiles, differences were seen in their outcomes as adults. The top quartile of this 1 percent was enormously more productive than the bottom. The top quartile received many more doctoral degrees, wrote more scientific articles, were named on more patents, had higher income, and had more literary publications than did the lowest quartile. Box 10.3 shares the stories of two students with outstanding abilities.

10-3c  Identification of Students with Gifts and Talents Before we can provide students who have gifts and talents with the supports and services they need, we must find these students. Identifying gifts and talents is not always an easy task. In every generation, many children pass through school unidentified; their talents go unrecognized and their gifts unaddressed (Coleman & Shah-Coltrane, 2015; Johnsen, 2004). Identification is a means and not an end. Identification helps us match students’ strengths with appropriate supports and services so that the student can thrive. Identifying students requires an understanding of the program requirements or services under consideration. If, for example, we want to choose a group of students for an advanced mathematics class, we must use different criteria than we would if we were looking for students for a creative writing program

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How Do We Define “Gifts and Talents” and Identify Students

Box 10.3

Exceptional Lives    Exceptional Stories:

Terry and Lenny

Thanks to Dr. Julian Stanley, who began the Study of Mathematically Precocious Youth (SMPY) in 1971, we have gathered a picture of children of outstanding ability over time. Two of the most outstanding are Terry and Lenny, whose mathematical abilities flourished early. These boys had schools and parents who were flexible enough to adapt to the special abilities of these boys. Terry: Terry, who grew up in Australia, taught himself to read by watching Sesame Street at age 2. By age 3, he had learned to read, type, and solve mathematical puzzles designed for 8-year-olds. At age 5, he was placed in a split first- and second-grade class but took math with fifth graders. In three years, he had mastered the elementary curriculum and was placed in eleventhgrade mathematics. He finished undergraduate work at age 15 and received a PhD in mathematics from Princeton University at age 21. His parents and mentors took care that he had social interaction with his peers and was not distracted by the notoriety that accompanied his obviously unusual development. Terry’s father commented on his friendly personality. When he was little, he was liked by his classmates and teachers, and now he is equally liked by his colleagues, peers, and students. He is now a parent himself and a professor of mathematics at UCLA. When asked what advice he would give to other talented students, he said: Well, don’t be afraid to explore and be prepared to learn new things continually. . . . I remember in high school thinking I understand what mathematics and physics were all about only to discover so many wonderful things about these subjects in college that I had no idea existed in high school. (p. 313) Lenny: Lenny grew up in a university town in North Carolina. Lenny came to the attention of many people when, as a 10-year-old, he earned a perfect score on the SAT mathematics test. During his participation in SMPY, he was referred to as “the smartest kid in the United States,” yet he was a friendly and gregarious boy interested in music and sports, interests he has carried into adulthood. He excelled on various tests, obtaining a perfect score on the College Board Test of Standard English at age 11 and also on all three parts of the Graduate

Record Examination. He led the United States team in the International Mathematical Olympiad and helped the team win two gold medals and one silver medal, the first time the United States was able to do so. He also won distinction in the National Spelling Bee and the Westinghouse Science Competition. Unlike Terry, Lenny was not moved through the school program so rapidly, skipping only the third grade. His parents discouraged rapid acceleration in favor of good social and emotional development, although he took many university classes while in high school and eventually went to Harvard University at age 16. He now has his PhD from the Massachusetts Institute of Technology and is a professor at Duke University. Despite growing up on different continents, Terry and Lenny both had intelligent and well-educated parents who wished for their boys’ good achievement but also happy social and emotional development. They will likely make major contributions to mathematics and to our country’s scientific advancement. Not all stories of outstanding talent have such happy endings. One counterexample is provided by the early life of Norbert Wiener, another famous mathematics prodigy, or child who shows extraordinary development in his or her early years, who coined the word cybernetics. His unhappy childhood is detailed in his autobiography, Ex-Prodigy: My Childhood and Youth (Wiener, 1953). What is clear is that such unusual talent must be guided in an intelligent way with the education system remaining flexible and adaptive to these students’ needs. If this adaptation occurs, there is no reason not to expect other happy stories such as those of Terry and Lenny.

Reflections: ●



In what ways did the parental decisions help to shape the lives of Terry and Lenny? What factors do you think parents should consider when making decisions about the lifecourse of children who are extremely advanced for their age?

Source: Muratori, M. et al. (2006). Insights from SMPY’s greatest child prodigies: Drs. Terrence (Terry) Tao and Lenhard (Lenny) Ng reflect on their talent development. Gifted Child Quarterly 50(4), 307–324.

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© iStockphoto.com/skynesher

Small group work helps develop planning and explorative skills.

or for a jazz-band in the music program. Specific program requirements must shape the identification process and criteria (Coleman, 2012). To best connect with this broad audience, policies for identifying children who have gifts and talents should allow for multiple types of information, multiple sources of information, and multiple time periods for collecting and reviewing this information. Figure 10.2 shares the types of information that can be useful in looking for students’ gifts and talents. Let’s look more closely at each area within Figure 10.2 to see what types of information we could use to help us identify a student’s gifts or talents. Student achievement is an indicator of the student’s knowledge level, and this level may be shown through standardized achievement tests or reflected in classroom

Multiple Areas Can Be Used as Evidence of Giftedness Giftedness is the manifestation of ability to learn well beyond the expected level of one’s age-mates. It can be discovered through outstanding student performance, high test scores, or through observation. These abilities are sometimes muted in students by unfavorable environmental circumstances and needs to be actively sought.

Student Achievement Observable Student Behaviors

Student Interest

Student Performance

Student Motivation To Learn Student Aptitude

• Within any area, a single indicator may reveal a need for services. However, no single indicator should eliminate a student from consideration. • Information from any (and all) areas may be used in matching students with appropriate service options. • Information from each area should be directly related to the service option considered. • Information from specific areas may be given priority for specific service options (e.g., math achievement/performance; advanced math class).

◗ Figure 10.2  Multiple Areas of Giftedness Source: Coleman, M. R., Gallagher, J., Harrison, A., & Robinson, L. (1996). Planning components for the education of gifted students: Suggested guidelines for plan development. Chapel Hill: University of North Carolina, Frank Porter Graham Child Development Center.

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How Do We Define “Gifts and Talents” and Identify Students criterion reference and progress-monitoring assessments. Student interests are an indicator of a student’s focus areas, areas of expertise, and their curiosity levels. Interest can be documented through formal interest inventories or surveys, student interviews, or by documenting areas that students are passionate about (e.g., what books do they check out?). Interests can also be demonstrated through a student’s participation in extracurricular activities both in and outside of school. You may recall that Cranshaw, the student we met earlier in the chapter, was known to have intense interests that often shifted from week to week. Cranshaw’s interests had not yet settled on any one area, but the intensity of his attention to topics during any given week shows his level of curiosity. Related to interest is student motivation, or their commitment to pursue a learning experience. Motivation, like interest, may be shown either within school or outside of school, and it has come to be seen by how persistently a student tackles a given task. Motivation, however, is a tricky indicator for giftedness. When we see high levels of motivation, we learn something about the student, but when motivation is not present, we learn more about the environment than about the student. When motivation is not present in students who are capable, what we learn is that the environment and or the experiences being offered are likely not a good match for that student. We must remember that a lack of motivation does not mean a lack of ability. Student aptitude, or their capacity to learn, is one indicator of giftedness. Aptitude generally involves reasoning, problem solving, and memory (you may recognize the central processing components of the information processing model), and these are often measured with an IQ (e.g., intelligence quotient) or through demonstrated abilities. Student performance is an indicator of a student’s demonstrated mastery and is often shown through work samples, portfolios, grades, and authentic assessments of learning, and, like interest and motivation, performance may be demonstrated outside of school. Products such as superior essays and term projects can be kept in a student portfolio and serve as an indication of special gifts. In the visual and performing arts, talent usually is determined by the consensus of expert judges, often in an audition setting. Experts in the arts are not enthusiastic about tests of artistic ability or musical aptitude. They trust their own judgment more; although their judgment may be susceptible to bias, it is possible to judge the quality of a series of products or a portfolio of drawings or compositions that students produce over time. The final type of information in Figure 10.2 is student behaviors, which may be seen within the classroom/school setting or in the home/community. Although isolated behaviors (e.g., an amazing question the student asks during a lesson) may help us understand a student’s strengths, patterns of behavior give us a more comprehensive view. To recognize patterns of behavior, we need to document behaviors through systematic observations of students over time and in multiple settings and circumstances. A student’s classroom behavior, for example, can often show us their ability to organize and use materials and their persistence with problem solving, or reveal their creative potential better than can a test. Think back to Sebastian, who we met earlier; his ELL teacher saw his strengths, and his teachers began documenting his accomplishment through observations and work samples; he was finally nominated and identified for gifted-educational services. When his teachers relied solely on his achievement scores, they were unable to see his gifts. Box 10.4 shares one program’s approach to supporting teachers in recognizing students, like Sebastian, whose gifts have gone unnoticed. When using multiple types of information to help us identify a student’s gifts and talents, we must remember that within any area, a single indicator may reveal a need for services. However, no single indicator should eliminate a student from consideration for gifted-educational services. Information from any areas may be used in matching students with appropriate services; the information used should match the services under consideration (e.g., if it is a math program, then math

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Box 10.4

U-STARS~PLUS (Using Science Talents and Abilities to Recognize Students, Promoting Learning for Underrepresented Students)

Project U-STARS~PLUS capitalizes on the teachers’ knowledge of their students to help them recognize young children with outstanding potential from culturally and linguistically different and socioeconomically disadvantaged families (Coleman, 2016; Coleman & ShahColtrane, 2011). The U-STARS approach relies on three key elements: 1. teachers who know what to look for (how to recognize potential); 2. teachers who know how to structure their classrooms so that children will be engaged; and 3. teachers who know how to provide a psychologically safe environment in which students can show their best abilities (Coleman & Shah-Coltrane, 2010).

teachers examples of specific student-behaviors to look for. Teachers use structured observations to recognize patterns behaviors that indicate student’s strengths across nine domains. These domains are: learns easily, shows advanced skills, displays curiosity and creativity, has strong interests, shows advanced reasoning and problem solving, displays spatial abilities, shows motivation, shows social perceptiveness, and displays leadership. The basic belief underlying this approach and similar ones is that we must go beyond the use of IQ scores and standardized measures of achievement if we hope to identify “hidden giftedness.”

Reflection: ●

The structured observation approach used by U-STARS includes an observational note-taking system that gives

United African Alliance Community Center: The Future Leaders of Tomorrow Children’s Home in Tanzania www.uaacc.net

Box 10.5

In what ways would a teacher’s observations of a student’s strengths be useful in planning learning experiences for the student?

ability, performance, and achievement should be used). It is also important to use local norms (e.g., the pattern of scores on assessment found for the population of students within the same school or district) for establishing guidelines for assessment thresholds (Peters et al., 2021). By using local norms, we are comparing students with others within the same context to establish which students will need access to a more advanced curriculum than their peers. Getting identification policies and practices right is critical if we are going to address the persistent underrepresentation of Black, Indigenous, Latino, socioeconomically disadvantaged, and 2e students.

Special Photos by Latrell Broughton

Three images used in this chapter were taken by photographer Latrell Broughton during a 2019 visit to the United African Alliance Community Center (UAACC) in 2019. UAACC is managed by former Black Panthers Pete and Charlotte O’Neal, and is based in Imbaseni Village, Tanzania. UAACC provides a variety of community services, including providing free filtered water, free education to local youth, housing international travelers and study-abroad groups, and taking year-round care of twenty-three children as part of their “Future Leaders of Tomorrow Children’s Home.”

More information about the organization’s activities can be found at the website in the margin note. The images taken by Latrell are identified as such, and their original titles have been used as their captions.

Reflections: ●



In what ways can visual images help us understand the needs of our students? How can positive visual images reshape our thinking about student’s strengths?

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Continued Underrepresentation of Gifted Students from Racially, Ethnically

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10-4  Continued Underrepresentation of Gifted Students from Racially, Ethnically, Socioeconomically Disadvantaged, and 2e Populations © Latrell Broughton

The pernicious and persistent underrepresentation and inadequate services for marginalized students is the most pressing challenge faced in gifted education (Coleman et al., 2021; Ford et al., 2021; Rinn, Mun, & Hodges, 2020). It is difficult to document the full extent of the underrepresentation of Black, Latinx, Indigenous, socioeconomically disadvantaged, and 2e students because with Future Leaders of Tomorrow: High ability has been found in no federal mandate for gifted education, data collection every ethnic and cultural group and so we need to search is left to states and/or districts and data is not ­compiled for it. nationally (see Chapter 1). You may, however, recall from Chapter 1 that the “risk ratio” for Black, Latinx, and Native American students being identified for gifted education is 0.34. In other words, if you are a Black, Hispanic, or Native American student, you are about one-third as likely to be identified for gifted education McFadden v. Board of Education than if you are a White or an Asian student (Hodge et al., 2018); disproportionfor Il S. Dist. U-46 https://www ate underrepresentation within gifted-education services is seen across all states .casemine.com/judgement/us (NAGC & CSDPG, 2020). Our expert, Dr. Tarek Grantham, discusses the educa/591469e6add7b049342e06a8 tional challenges faced by gifted Black male students (see Box 10.6).

Box 10.6

Ask the Experts:

Upstanders Confront Anti-Black Racism and Close Excellence Gaps for Gifted Black Males

Dr. Tarek C. Grantham

specializing in the underrepresentation of Black students in gifted education

Dr. Tarek C. Grantham, is a professor of education psychology at the University of Georgia

Black males with creative gifts and talents are plentiful, capable, and necessary for family, community, societal growth, and prosperity. They are not an anomaly and can be found everywhere if we have the will to identify and serve them. Many educators have deficit mindsets toward Black males. Their deficit thinking is, in large part, due to systemic racism, institutional racism, structural racism, implicit racial bias, hatred, white supremacy, white privilege, and, perhaps most basically, ignorance and fear of Black males. A national call for anti-racist leadership aims to replace bystanders with upstanders and to close excellence gaps for Black male students.  (Continues)

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Box 10.6

Ask the Experts:

Upstanders Confront Anti-Black Racism and Close Excellence Gaps for Gifted Black Males  (Continued)

National Leadership for Anti-racist Gifted Education The National Association for Gifted Children’s (NAGC) Championing Equity and Supporting Social Justice for Black Students in Gifted Education Statement responded to the murder of George Floyd and the anti-Black racism that targets Black males in society. Their statement sparked important attention to Black males in gifted and advanced programs. “We acknowledge the injustices of structural and systemic racism and recognize the field of gifted education has historically been part of the problem by promoting these injustices, even if inadvertently” (NAGC, 2020). Current researchers, practitioners, and other advocates should take note that gifted-education leaders in a predominantly white professional field of education were not silent or vague regarding racial inequity and promoting equity for Black males. Following their lead, educators can advance racial equity and move beyond bystander attitudes and behaviors that perpetuate Black male excellence gaps.

Replacing Bystanders with Upstanders Bystanders to Black males’ underrepresentation in gifted and advanced programs and overrepresentation in special education are individuals with awareness of the educational crisis; they may say Black male excellence gaps matter, and yet they do nothing to close them. Conversely, upstander educators proactively confront anti-Black racism and work to close excellence gaps among Black males. We need upstanders for gifted Black males. Our role as upstander educators can and should include intentional efforts that empower Black males to understand and embrace their racial and cultural identity, to identify and develop their gifts and talents, and to close excellence gaps by using their academic and creative potential for individual, group, and community uplift. Black males need to know who they are, to whom they belong, and how their racial heritage and present reality are connected (or not connected) to the real excellence gaps. Upstander educators need to intentionally expose gifted Black males to exceling gifted Black males and nurturing people who understand the negative impact of antiBlack racism on Black males and the systems that oppress their potential and perpetuate excellence gaps in creative achievements. Racial and cultural pride in excellence among gifted Black males can and should be a priority in schools with gifted and

advanced programs, regardless of school geographic context or economic status.

Black Male Excellence Whether being educated in predominantly Black, mixed-race, or predominantly white rural, urban, or suburban schools, Black males need culturally responsive teaching and learning experiences and content that explains, affirms, and extends their sense of self as a part of the racial heritage and present landscape of Black excellence. To close excellence gaps in creative achievements, race and racism cannot be ignored or overlooked when educating gifted Black males; many are not comfortable in gifted and advanced programs because they are alienated and have internalize the trauma that results from educational, emotional, psychological, and physical neglect. For example, too often, Black males silently experience trauma that builds over time because of oppressive content and teaching practices, and, as a result, they end up feeling disconnected, devalued, unvalidated, and outraged. These feelings can come from excessive whiteness in language arts textbooks and English literature, assaultive and unapologetic white supremacy in psychology, sociology, and history courses, and distorted or misguided research in science courses that feature studies by white scientists marginalizing and “inferiorizing” blackness and the Black experience for personal or professional gain. We need upstander educators and researchers who notice and question the use and infusion of research-based practices and educational policies derived from scientific racism that lead to overrepresentation of Black males in special education and underrepresentation in gifted and advanced programs. Upstander educators move beyond fear and proactively dismantle racism and systemic forms of anti-Black racism (whether it is intentional or unintentional) supporting and advocating for the experience of Black males’ rights to the educational opportunities afforded by gifted or advanced programs.

Supporting Upstanders for Gifted Black Males Upstander educators can model for others how to check their racial biases and plug in with scholars, practitioners, and other advocates who are proactively advancing racial equity and access for gifted, creative, or talented Black males in advanced educational PreK-20 programs. Legal actions in local

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Continued Underrepresentation of Gifted Students from Racially, Ethnically

Box 10.6

Ask the Experts:

Upstanders Confront Anti-Black Racism and Close Excellence Gaps for Gifted Black Males  (Continued)

schools and innovative higher education initiatives support emerging upstanders, encouraging them to be proactive and promote culturally responsive antiracist gifted and advanced programs.

Landmark Case McFADDEN v. BOARD OF EDUCATION FOR IL S. DIST. U-46 case: Discrimination in Gifted Education A federal judge found that racial disparity in the giftededucation program of the U-46 Illinois school district was a function of intentional discrimination. An equity formula presented in the case gave the field of gifted education a way to quantify equity for Black males in gifted and advanced programs. What does equity mean in terms of percentage of Black males in gifted and advanced programs? What are appropriate goals to improve the status-quo of underrepresentation for gifted Black males? The U-46 case set a legal precedent that empowers upstander educators in school districts to address these questions and to determine if policies and practices are in fact discriminatory against Black males.

Black Male Initiatives in Higher Education Many public universities across the country have recognized that systemic racism in PreK-12 impacts their capacity to recruit and retain gifted and talented students in higher education. For example, the University System of Georgia (USG) recognized

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the urgency to address barriers impacting African American males and implemented a state-wide African American Male Initiative (AAMI, www.usg .edu/aami/) because they discovered a major gender gap among college-aged African American students. Colleges and universities in the USG receive support to proactively develop programs that recruit and retain African American males.

Some Final Thoughts Although bystanders to racial inequity exist, an increasing number of upstander educators, administrators, policy makers, and other advocates are stepping up to say no to anti-Black racism. These upstanders are part of the solution for Black males to gain access to gifted and advanced programs, and I believe that if you are reading this text, you get to decide how you will stand on racial equity for gifted Black males—stand by and watch, or stand up and act. This is a call for upstanders and an affirmation that you can make a difference if you dare to join the personal and professional anti-racist work in gifted and talented education.

Reflection: ●

In what ways has Dr. Grantham’s message changed your views on your role in influencing outcomes for your students (and specifically for the Black male students you will teach)?

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Supporting all our student’s strengths is the best way to ensure that student’s potential gets recognized.

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10-4a  Twice Exceptional, 2e, Students with Disabilities Who Are Also Gifted A student’s inability to see, hear, get along with others, read fluently, or walk independently does not mean that he or she is not gifted and talented; it only means that there is a good chance that their special talents will be overlooked (Hua & Coleman, 2002). Recognizing twice exceptional (2e) students can be difficult (Amend, 2018). Students who are 2e have both areas of giftedness where they excel and areas of significant challenge where they often struggle (Coleman & Roberts, 2015). The patterns of strengths vary from person to person, and the areas of challenge can include sensory impairments, physical limitations, emotional difficulties, problems with communication or socialization, and challenges with attention and learning disabilities. While areas of strength are those often associated with students who are gifted (e.g., curiosity, strong interests, insights, advanced reasoning, and creativity), these may be masked by the student’s areas of difficulty (Baum & Schader, 2018). Because of their unique patterns of strengths and challenges, it takes a team of educators in partnership with families to address the needs of students who are 2e (Besnoy, 2018; Coleman et al., 2018). You may want to reread the “Exceptional Lives Exceptional Stories” in Chapter 6 that shares the story of Shane, who is 2e.

10-4b  Summary Thoughts on Underrepresented Students with Gifts and Talents Gifted students from culturally and linguistically different, economically disadvantaged families and/or students who also have disabilities often have more complex needs than their middle-class white nondisabled peers (Coleman et al., 2021). The intersectionality between race, language, and ability status often creates challenges that go beyond those that we typically associate with the “gifted student.” Because of these challenges, we may fail to recognize the strengths of these students, more often focusing on their deficits. Coleman and colleagues (2021) point out that the challenges marginalized students face often hinge on the way that our society’s expectations are mirrored within our educational systems. They posit that gifted students from culturally/linguistically different, economically disadvantaged environments and/or those students with disabilities often face the following challenges: 1. Being seen through a deficit lens where they are viewed as “at risk” vs. as “at potential” 2. Having their gifts and talents ignored or misinterpreted 3. Being a “misfit” in existing programs for gifted or advanced learners 4. Having to navigate mixed messages across their home, school, and community environments 5. Being questioned for wanting to excel and/or for not living up to expectations of others 6. Having their abilities undermined by individuals who sell them short 7. Being told to settle for less than they can achieve 8. Having their identity questioned by peers and adults 9. Being rejected because of characteristics that are beyond their control 10. Having to live in a world where being true to themselves is difficult. The needs of culturally/linguistically different, socioeconomically disadvantaged, and twice exceptional students who are gifted are complex, and each student’s strengths and challenges must be considered individually. We often see district and/or school mission statements that declare a commitment to “all” students’ success, believing that through this mission statement, we are showing

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clear support for the range of students who we serve (Dickson, 2015). Yet, given the clearly disparate impact our policies and practices have on some students, the position that “all” are adequately covered by these statements can be disingenuous. Dickson (2015) puts it this way, “The term all is too broad…the generic concept of all is an egalitarian notion the embraces equality…the term each embraces equity and connotes fairness…and individual attention” (p 234). As we reconceptualize how we address the educational and developmental needs of students with gifts and talents, we must focus on the strengths and challenges of each student, understanding the multifaceted and dynamic cultural influences that shape their development, across the course of their life, and building equitable supports and services to enhance their success (Collins et al., 2021).

10-5  Educational Responses for Students with Gifts and Talents Throughout earlier chapters, we have made the case that we must provide appropriate strength-based educational opportunities to support each student. We have stressed the importance of these supports and services as central to ensuring the student’s success. Our responsibility, as educators, is the same for students with gifts and talents; however, in this case, our adaptations require that we go beyond and above the traditional curriculum to address students’ advanced academic needs in their areas of strength. We will look at how the MTSS model can be used to structure these learning opportunities and how we can adjust the curriculum through enrichment, acceleration, sophistication, and novelty to address the learning needs of students with gifts and talents.

10-5a  Organizational Structures to Support Students with Special Gifts and Talents MTSS Approaches for Students with Gifts and Talents

Tier I is characterized by a high-quality curriculum for all learners and the use of periodic assessments to monitor a student’s progress. Tier I is the ideal place to nurture the strengths of all students so that we can better recognize students who have gifts and talents (Coleman, 2018). As part of a strength-based focus, our classrooms should include high-end differentiation of the curriculum for all students. In differentiating our curriculum, we will also be addressing the foundational needs of students with gifts and talents. Strategies for Tier I differentiation within the general education classroom often include the following: 1. The use of high-level questioning: Using Bloom’s Taxonomy as a guide, this measure would mean asking questions that require students to analyze, synthesize, and ­evaluate information in addition to ­remembering,

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Universal Tier I for Students with Gifts and Talents

Hands-on activities help many children realize their special talents.

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Table 10.2  Adapting Content Standards for Advanced Learners: Example from ELA Standards

for Speaking and Learning; Strand 1, Comprehension and Collaboration Grade-Level Outcomes in Knowledge and Skills: Prepare for and participate effectively in a range of conversations and collaborations with diverse partners, building on others’ ideas and expressing one’s own clearly and persuasively. Grade

Typical Learners

Advanced Learners

Grades 3–8

Students will participate in literature circles on grade-level topics.

Using Socratic seminars, advanced students will initiate and participate effectively in discussions on relevant real-world issues and reading key texts.

Students will participate in face-to-face and virtual discussion groups on grade-level topics in language arts.

Advanced students will initiate virtual discussion groups on texts and topics of interest, posting and commenting regularly regarding text and ideas supported by textual evidence.

Engage effectively in a range of collaborative discussions (one-on-one, in groups, and teacherled) with diverse partners on grade-level topics and texts, building on others’ ideas and expressing their own clearly. Grades 9–12 Initiate and participate effectively in a range of collaborative discussions (one-on-one, in groups, and teacher-led) with diverse partners on grades 9–10 (and 11–12) topics, texts, and issues, building on others’ ideas and expressing their own clearly and persuasively.

Source: VanTassel-Baska, J. (Ed). (2013). Using the Common Core State Standards for English language arts with gifted and advanced learners. Waco, TX: Prufrock Press.

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understanding, and applying it (see Table 10.2, presented later in this chapter). 2. The use of leveled assignments: While the assignments target the same curriculum topics, they are leveled to reflect their degree of complexity. The first level is mastery, or the basic understanding of the content covered. The second level is enrichment, an extension of the basic content to include interesting and/or fun information that is often more engaging for students. The third level is more challenging and often extends the topic beyond what is typical expected for students, requiring more advanced learning skills. Within Tier I, all students would be expected to successfully show mastery, and all would have access to enrichment assignments. The challenge-level assignments are designed to move beyond this level for students who easily show mastery and complete enrichment. 3. The use of student choice: Differentiation in Tier I can also include allowing students to choose specific topics within each area of study. For example, if elementary students are learning about animal-survival strategies, students can select the specific animal they wish to learn about and complete their project with this animal. The basic framework for the study would be the questions students are asked to answer (e.g., Where does your animal live? What does your animal eat? What other animals are predators for your animal? What dangers does your animal face? What are the key survival techniques your animal uses?). The student’s choice and their response to the prompts will self-differentiate, depending on their levels of interest and ability. In addition to differentiated instruction, Tier I strategies also include the use of Universal Design for Learning (UDL). A Summary of UDL Supports for Students with gifts and talents can be accessed online. When students require more targeted support to address their gifts and talents, we can use strategies offered at Tier II.

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Educational Responses for Students with Gifts and Talents

Targeted Tier II for Students with Gifts and Talents The focus at Tier II is on offering more targeted support for students based on their strengths and challenges. One strategy to help gifted students avoid the chronic boredom of having to “learn” things they already know is curriculum ­compacting. The basic principle of compacting is that if students already know something and have the basic skills to apply the knowledge, they should be allowed to move on to other areas of learning (Reis, 2008). The critical point of compacting is that students are allowed to show their knowledge when they are ready; they do not have to wait until the whole class has mastered the content (Renzulli & Reis, 1997). Once students have shown mastery of the basics, they can be released from further direct instruction, guided practice (class work), and independent practice (homework) on this set of knowledge and skills. Essentially, curriculum ­compacting allows students to “buy time” for other, more appropriate learning experiences. How can this time be used? Strategies for Tier II support, when students have shown mastery of the general curriculum, may include: 1. The use of contracts for learning: Student-learning contracts can be used to specify enrichment or extended-learning activities that the student will undertake to replace the direct instruction, guided practice, and independent practice that they do not need because they have mastered the content (see curriculum compacting, above). The scope of the contract depends on how much time is being covered (e.g., one chapter in math, a unit of social studies, one week of TeachSource Video Connection direct instruction in science). The learning activities in the contract should reflect both student and teacher input and should result in a specified product that can be used to document student’s completion of the contract. 2. The use of small group and/or independent s­ tudies: This strategy builds on the use of choice (shared in Tier I) and contracts, but it extends this choice to a larger set of work. The student, or group of students, undertakes an investigation to answer research questions that they generate. The investigation may be a spin-off from the general curriculum or may be an area of student interests not typically covered Watch the video “Middle School Science Instrucwithin the curriculum. These investigations tion: Inquiry Learning.” In this video, you’ll see are supported and monitored by the classroom how a middle school science teacher uses inquiry teacher, often with some support from the learning in teaching a lesson on the geology of the gifted-education specialist; as with the conGrand Canyon. As you watch students construct tract, they often involve the development of a knowledge through experimentation, you’ll also product to document completion. This product hear the teacher’s views on the benefits of inquiry can also be shared with others. learning, as well as the challenges it presents, such With Tier II, the goal is to follow the lead of the student in establishing the new and extended content that they will pursue. The work should be engaging and, to a large extent, self-directed. Sebastian, the student we met earlier, has a strong interest in immigration laws and the plight of children and families who are trying to enter the United States by crossing the southern border. His area of strength is math, and he is well ahead of

as extra planning and general “messiness.” Why does the teacher feel that inquiry learning is beneficial? What might be some unique benefits or challenges in using this method with students with gifts and talents? What are some ways that you could use inquiry learning in other subjects, such as English or mathematics? Watch online

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Chapter 10  |  Children and Youth with Gifts and Talents his classmates in mastering the math concepts for his grade. Given this mastery, he has been “compacted out” of the next two chapters in math, thus, buying him close to three weeks of math time where he will not need direct instruction, guided practice, and independent practice. He would like to use this time to pursue his interest in immigration law. His gifted-education, bilingual education, and general education teachers worked with him to develop an independent study plan, and they agreed to work together to support him. In addition to his written summary of the challenges faced by immigrants and the current laws regarding immigration, the culminating product he chose for showing his work was a mural depicting the plight of migrants at the border (you may remember that Sebastian is an artist in addition to having strengths in mathematics). His mural will be shared both within his school and at the public library, which houses a community center to support English language learning for immigrant families.

Intensive Tier III for Students with Gifts and Talents Tier III represents a major difference from the general education program to address the advanced-learning needs of students with gifts and talents. The strategies used at Tier III will often be delivered outside of the general education classroom and may involve some type of content or grade acceleration. Types of acceleration may include: school admission: The intellectually and socially mature child is allowed to enter kindergarten at a younger-than-normal age. ●  Content/subject acceleration: Students are allowed to “test out of” portions of the curriculum (e.g., chapters or units in math) and/or whole classes (e.g., Spanish One, Algebra). ●  Grade-level acceleration: The student can accelerate by eliminating one semester or grade in school. The primary concern here is the potential for temporary social-adjustment problems for the student. ●  Telescoping the curriculum: The child covers the standard material, but in less time. For example, a three-year middle school math program is taught over two years to an advanced group. ●  Advanced placement: The student takes courses for college credit while still in high school, shortening the college program. ●  Dual enrollment in high school and college: The student is enrolled in college while finishing high school. ●  Early college admission: An extraordinarily advanced student may enter college as young as 13 years of age. ●  Early

The research shows that acceleration generally has a positive effect on students both academically and socially (Jett & Rinn, 2019). Yet despite this positive outcome, many school districts are reluctant to use acceleration as a strategy to address the needs of students with gifts and talents (Assouline et al., 2015). Some ideas about why schools hold back from acceleration may include: ●  Schools’

lack of familiarity with the research on acceleration belief that children must be kept with their age peers ●  A belief that acceleration “hurries” children out of childhood ●  A concern that acceleration could hurt students socially ●  Political concerns about “equality” for all ●  The concern that other students will be offended (Colangelo et al., 2004) ●  A

As more longitudinal studies are completed, it becomes possible to learn what actually happened to students who were accelerated, instead of what people hoped or feared would happen. In a seminal study, Lubinski et al. (2001) conducted a ten-year follow-up of 320 students with profound gifts who scored high enough

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on the SAT to qualify as the top students among 10,000. Of these 320 students, 95 percent had taken advantage of various forms of acceleration (grade skipping, taking college courses while in high school, taking exams for college credit, entering college early, and so forth). The perceptions of these students regarding their acceleration were highly favorable. They saw the procedures as an advantage in their academic progress and in maintaining their interest in learning. They found little or no effect of such acceleration on their social lives or peer relationships. By their early 20s, twenty-three had already attained PhDs, nine had law degrees, and seven were doctors of medicine. Another 150 or so of this sample continued to work toward advanced degrees. These results are even more positive than those of similar studies and clearly suggest that the fears of educators and parents that such acceleration would harm the students socially are largely unfounded (Colangelo et al., 2004). A Summary of MTSS Approaches for Students with gifts and talents can be accessed online. TeachSource Digital Download

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10-5b  Other Organizational Strategies to Meet the Needs of Students with Gifts and Talents Going beyond the use of MTSS, schools may use a range of options to deliver services to students with gifts and talents. This range may include some of the following: 1. Flexible grouping: encouraging teachers to use flexible grouping and ­regrouping of their students based on learning objectives, social needs, and student ability. (Note: Flexible grouping is also a high-leverage practice, see Box 10.7.) 2. Cluster grouping: placing small groups of similar high-ability students within a given classroom 3. Consultation support: providing collaborative and/or co-teaching support for the classroom teacher to meet the needs of high-ability students 4. Resource rooms: providing a part-time support system where a speciality teacher can address student needs

Box 10.7

High Leverage Practices for Students with Disabilities https://highleveragepractices .org/

High Leverage Practices 17:

Use Flexible Grouping

Teachers assign students to homogeneous and heterogeneous groups based on explicit learning goals, monitor peer interactions, and provide positive and corrective feedback to support learning. Teachers use small learning groups to accommodate learning differences, promote in-depth academic interactions, and teach students to work collaboratively.

Reflection: ●

How can the use of flexible grouping help to address the academic and social needs of students with gifts and talents?

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Chapter 10  |  Children and Youth with Gifts and Talents Changing the learning environments in these ways helps to: ●  provide

students with gifts and talent time to interact with one another to learn with and from their intellectual peers. ●  reduce the range of abilities and performance levels within the classroom making it more likely that the teacher can provide appropriate instruction matched to the student’s needs. ●  place students who have gifts and talents with a specialty-area teacher who has the knowledge and skills to address their needs. When student needs go beyond the school, other educational options are available.

10-5c  Residential and Special Schools for Students with Gifts and Talents

North Carolina School of Science and Mathematics https://www.ncssm.edu Illinois Mathematics and Science Academy https://www.imsa.edu/

Another type of educational setting for students with gifts and talents is the residential school. Currently, eighteen public residential schools for gifted high school students operate in sixteen states: Alabama, Arkansas, Georgia, Illinois, Indiana, Louisiana, Maine, Mississippi, Missouri, New York, North Carolina, Oklahoma, South Carolina, Texas, Virginia, and Wisconsin. Most residential schools have a strong focus on mathematics and science, but they also offer a strong curriculum in the arts and humanities. Residential high schools often serve students in grades 11 and 12, but some enroll students in grades 9 and 10. These schools often bring together highly talented students for their last two or three years of high school; they are given a rigorous introduction to higher-level thinking and study. The North Carolina School of Science and Math and the Illinois Math and Science Academy are two examples of this type of residential school. In addition to full-time residential schools, many states offer “Governors Schools,” which are summer programs of several weeks that offer challenging and enriched learning experiences on a wide range of topics. No matter what the service setting is, students with gifts and talents need access to appropriately challenging and enriched curriculum that matches their areas of strengths.

10-5d  Curriculum and Instruction for Students with Gifts and Talents The emphasis on curriculum and instruction for students with gifts and talents is on both advanced content and the higher-level thinking processes that allow the students to problem solve, find problems, and be creative. This approach should come as no surprise because when we look at the information processing model (see Figure 10.1), we see that these are the areas of strength shared by students with gifts and talents. Joyce VanTassel-Baska (2008) developed the integrated curriculum model, which is composed of three interrelated dimensions that are responsive to the learner with special gifts and talents: 1. Emphasizing advanced content knowledge that frames disciplines of study 2. Providing higher order thinking and processing Focusing learning experiences on major issues, themes, and ideas that define both real-world applications and theoretical modeling within and across areas of study (VanTassel-Baska, 2008). This approach to curriculum honors the academic needs of students with gifts and talents. Two curriculum adaptations that incorporate these ideas are Advanced Placement and International Baccalaureate Program.

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Educational Responses for Students with Gifts and Talents Advanced Placement (AP) consists of more than thirty courses and exams the college board offers to provide the opportunity for high school students to take college-level courses while they are preparing to graduate. If the students score high enough on the exam for the course, they may earn credit with the college they choose to attend. Chances are that you took an AP course in high school since over 1.2 million students took one in 2020 alone. An effort is now being made to ensure that as many students as possible have access to AP classes. The International Baccalaureate Program (IB) was designed to provide a rigorous pre-university course of study focusing on active learning, citizenship, internationalism, and respect for other cultures. IB begins as early as elementary school in some areas. A special Theory of Knowledge course is provided for all IB candidates, and each candidate must write an extended essay on an independent study topic, as well as report on a service activity he or she has performed. The informal reports from students and teachers have been favorable because the content is seen as challenging and relevant for students seeking higher education. Curriculum often needs to be adapted for students with gifts and talents because the general content standards most states use provide only a baseline for what students need to know at each grade level. These standards, however, are not necessarily challenging material for advanced students. One example of adapting the content standards for advanced learners is provided in Table 10.2. Table 10.2 shows examples of language arts expectations for typical learners and for advanced learners (VanTassel-Baska, 2013). To adapt their own curriculum, teachers can use the Bloom’s Taxonomy to help them address higher levels of thinking. Table 10.3 shares the levels of Bloom’s moving up the “thinking scale” from Knowledge/Remember to Evaluation/ Evaluate. As teachers review their lessons, they can use the key words in Table 10.3 to see the levels of thinking they are targeting, and they can also use the suggested assessment strategies to ensure that students also have a chance to show their higher-level thinking.

Table 10.3  Taxonomy of Cognitive Thinking Domain

Definition

Keywords

Assessment

Knowledge/ Remember

Ability to remember something previously learned/ recall information

Tell, recite, list, memorize, remember, define, locate, state, who, when, where, how, what, identify, select from Iist

Workbooks, quizzes, tests, vocabulary, timelines, fact cards, recitations, lists, matching, multiple choice, T/F

Restate, give examples, explain, summarize, translate, show, symbols, predict, define, describe, illustrate, paraphrase, categorize, extrapolate, predict, map-match

Drawing, diagram, response to question, revision, basic project report, sequencing, translate, define, establish categories, make predictions based on Information given

Retrieve/Identify

Comprehension/ Understand

Demonstrate basic understanding of concepts/ curriculum Translate to other words/retell in own words Construct meaning

(Continued)

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Table 10.3  Taxonomy of Cognitive Thinking (Continued) Domain

Definition

Keywords

Assessment

Application/ Apply

Transfer knowledge learned in one situation to another, applying information

Demonstrate, use guides/maps/ charts, make/cook, interpret, predict, relate, simulate, organize, develop

Model, display, collect, written product, recipe/ cooked product, artwork/crafts, demonstration, hands-on demonstration, use information in context or real world situation

Investigate, classify, outline, categorize, review, compare, contracts, solve, survey, diagram, infer, prioritize, discriminate, select, focus on main ideas, deconstruct

Survey, editorial, questionnaire, plan, solution, report, review prospectus, hypothesis, model, create an outline, compare and contrast chart

Compose, design, invent, create, conclude, construct, propose, forecast, coIIect, rearrange parts, imagine, extend, hypothesize, construct

Lesson plan, song, poem, story, advertisement, invention, expert project, experiment with scientific process, present new ideas

Judge, evaluate, give opinion, viewpoint, rate, prioritize, choose, recommend, critique, support, challenge, discuss, monitor, test, set criteria

Decisions, rank, rating/grades, editorial, debate, critique, defense/ verdict, build criteria

Use information

AnaIysis/ Analyze

Understand how parts relate to a whole Understand structure and motive Note fallacies Identify structure and purpose

Synthesis/ Create

Re-form individual parts to make a new whole Create something new

Evaluation/ Evaluate

Judge the value of something vis-á-vis criteria, support judgment

See: Bloom, B. S. (1956). Taxonomy of educational objeclives, handbook I: The cognitive domain, New York: McKay. Anderson, L. W. & Krathwohl, D. R. (et al.) (2001). A Taxonomy for Learning, Teaching, and Assessing, New York: Longman.

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Problem-Based Learning is another approach to curriculum that focuses on teaching students the process of problem solving. The essence of problem-based learning (PBL) is as follows: 1. The students are presented with a problem for which the solution is not stated. For example, a student has suddenly become ill with several odd symptoms. The cause of this condition is not evident. 2. The students are made stakeholders in the problem. They are asked to play the role of medical detectives tracking down the diagnosis for the condition, and they must use a variety of search techniques, including the Internet,

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Educational Responses for Students with Gifts and Talents interviews with doctors and medical personal, and researching medical texts, to reach an answer. 3. The instructor plays the role of metacognitive coach, not information giver. The teacher may point out possible sources of information or ways of accessing various sources, perhaps even suggesting that students interview community medical personnel, but will not provide the answer. SDI Productions/E+/Getty Images

Using a combination of small-group and individual work, the students try to arrive at the answer. (In the preceding problem, the students finally decided that the cause was the West Nile virus. They recommended controlling mosquitoes but not closing the school since the disease is not contagious.) Teachers receive special training for the role of coach in the PBL model. These PBL methods have Problem-based learning builds on the creative and analytical strengths of student with gifts and talents. been used to teach economics, social studies, language arts, science, and even medical school subjects. The observations from diverse PBL programs are remarkably similar: The students are energized by the nature of the problems presented, play an active and enthusiastic role in seeking new knowledge to solve each problem, and report excitement and increased interest as a by-product of the PBL approach (Barrows, 1988; Doig & Werner, 2000; Gallagher & Stepien, 1996; Gallagher & Gallagher, 2013; Maxwell, Bellisimo, & Mergendoller, 2001). Another example of differentiated curriculum for young children is offered in Table 10.4. In this case, the lesson is designed as a take-home project, science investigation. When you think of science, you may envision large laboratories filled with sophisticated equipment, but science is really about careful observation, collecting data, and drawing inferences from that data. These activities are well within the range of children at an early age; they are the building blocks for higher-level thinking. Take, for example, Table 10.4. It focuses on weather, an activity that can easily be done with a young child and a cooperating family member. In this activity, the child is making observations, collecting data, and drawing inferences, activities well within her capabilities, that capture the essence of science (Coleman & ShahColtrane, 2010).

10-5e  Culturally Responsive Curriculum and Instruction for Students with Gifts and Talents Earlier in the chapter, we discussed the challenge of underrepresentation of students of color within gifted education. This challenge does not stop with equitable identification practices; indeed, equitable identification is only the first step. Ford (2007) has repeatedly raised concerns about retaining Black/AfricanAmerican students in programs for students with gifts and talents. Placing students in a special program does not guarantee that they will be happy to be there or will want to stay (Ford, Moore, & Milner, 2005). Ford (2002) and Ford and Grantham (2003) mention as reasons for dropping out of a special program irrelevant curriculum; social, racial, and cultural backgrounds that are incompatible with those of most of the students; and, sometimes, a lack of support from parents who find themselves being torn between the culture of the school and the culture of the home.

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Table 10.4  Family Science: Weather Project Day 1 1. Before you start, predict the weather for the week. Use today’s weather to guide you. Record your predictions on your Observation Record.* 2. On Day 1, pay close attention to the weather and the sky outside. After school, pick a weather symbol that best describes the weather you experienced this day. Circle the weather symbol for Day 1 on your Observation Record. 3. Notice the wind. How windy is it? Circle the set of words that best describes the wind for Day 1 on your Observation Record. 4. Notice the sky. Describe how the sky looked in the morning and now in the evening for Day 1 on your Observation Record. Days 2–4 1. Repeat Steps 2–4 for the next three days. 2. Finish your Observation Record and discuss the Family Time Questions that follow. 3. Return your Observation Record and packet to school by the date due. Family Time Questions 1. Did you have days when you could have used more than one symbol? Why do you think this happened? 2. How many days were windy? What kinds of weather did you have these days? How did the wind relate to the other weather? 3. Looking back at your morning sky drawings across the week, what was the same and what was different about the sky in the morning? 4. Looking back at your night sky drawings across the week, what was the same and what was different about the sky at night? Source: Coleman, M. R., & Shah-Coltrane, S. (2010). U-STARS~PLUS Family Science Packets. Arlington, VA: Council for Exceptional Children. *The observation record can be found online with resources for this chapter.

Culturally responsive curriculum and instruction can play a critical role in ensuring that students feel both welcome and supported within gifted-education programs. Dr. Kea, our expert in Chapter 1, discussed the development of cultural competence (you may want to go back and re-read this discussion). As part of her discussion, she stated that, “…our cultural competence is reflected in our ability to create culturally responsive learning environments. Culturally responsive curriculum and pedagogy honors our students and their families. The curriculum we select reflects the cultural backgrounds of our students but also introduces them to other cultures. We design our learning activities to be inclusive and reflect different points of view. We present student generated products and work to showcase their accomplishments. Our classroom is colorful, inviting, and respectful. We invite families to partner with us in ensuring their child is successful and we create a welcoming classroom where students and families feel valued.” If we wish to ensure that our gifted students of color feel that they belong within our giftededucation programs, we need to develop our cultural competence as educators and adopt the culturally responsive practices recommended by Dr. Kea.

10-5f  Assistive Technology for Students with Gifts and Talents The rapid development of technology has opened many doors for students with gifts and talents, and for their teachers! From computers to smartphones and iPads, an entire virtual reality has opened up for learners, and we are just

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Educational Responses for Students with Gifts and Talents beginning to understand what life with the metaverse will mean for education. Living within this virtual realm comes as second nature to students today, and they may spend as much as six hours a day engaging with technology (Siegle & Mitchell, 2011). If we are wise, we will use these technologies to enhance educational options. If our goal is the stimulation of higher thought processes, this media provides us with many different opportunities. With the pivot to online learning during the COVID pandemic, we began to see some of the benefits that this learning method could offer students. While online learning will not likely, nor should it, replace face-to-face learning, evidence suggests that students with gifts and talents may perform better in online instruction (Potts, 2019). The metaverse is here to stay, and many of our gifted and talented students will be leading the way into the future.

Box 10.8

Reaching & Teaching:

Media Literacy for Students with Gifts and Talents

Jennifer Job, Ph.D. While teaching online is difficult in many ways, the technology access does give teachers many opportunities for students with gifts and talents to tackle complex and high-level assignments that are oriented to their interests. Teachers may want to assign GT students research projects or assignments that have them address real-world problems, and with the Internet at their fingertips, students have access to a world of information. But much of that information isn’t trustworthy or unbiased. How can we ensure that our students find good sources for their research? The Newseum (newseumed.org), an organization dedicated to supporting sound journalism and media literacy, has a wealth of lesson plans to teach students about differentiating trustworthy sources from junk. Here are a few suggestions to get started. 1. Explain the difference among newspapers, research journals, and commercial websites. Google Scholar (scholar.google.com) only shows results from research journals. The “news” section of Google only returns results from media sources.  2. Show students how to get the most complete results from a Google search. A search of “global warming” will return much different results than will “industry contributions to global warming.” Google also has lessons on refining web searches, such as using quotes to find an exact match or using “and” or “or” to include or exclude certain results. 3. Teach the E.S.C.A.P.E method for trusting sources. When students find an article on a subject,

ask them to read the website’s mission statement or “About” section. Then have them answer the following questions: Evidence: Are there statistics or data included, and can they be verified? What is the source of the data that is given? Source: Who is behind the article? Can I find an author? Is the website run by a company or a special-interest group? Context: How does this article fit in with current events? What motivation might the site have for publishing the story? Audience: Is there a specific audience for this story? Does it have a political bias? A cultural bias? Purpose: Why did the site publish the story? Is it simply to inform or persuade to a particular point of view? Is it to make money? Is there a call to action? Execution: What style is the article written in? What is the tone? What images are included?  Having students think critically about the information that they use in forming their arguments is a skill that will last them a lifetime. 

Reflection: ●

Why is it important to teach students media literacy? How will media literacy skills expand and deepen assignments teachers can give?

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Chapter 10  |  Children and Youth with Gifts and Talents

10-6  Family and Lifecourse Issues

© Latrell Broughton

It may seem like having a child with gifts and talents would be every parent’s dream, but raising a child who has advanced needs can sometimes be challenging! Let’s revisit the three children we met at the beginning of this chapter to see some of the challenges these families may face. Cranshaw’s family seems to take his abilities in stride. They are supportive of his interests but do not put much pressure on him around his grades (they don’t need to since he does well without any pressure). His mother did become concerned, however, when he transferred to middle school and there was no advanced math offered for sixth graders. She knew that he would be really bored in general math and wanted him to start algebra instead. When she met with the middle school personnel to express her concerns, no one took her seriously. Although she was a teacher, they dismissed her as a “pushy parent” and told her she was worrying about nothing. They said that sixth grade was about learning to socialize and that she should just let her son be a kid for a while longer! She told her husband that the school personnel dismissed her concerns as trivial and that they were treating her as though she was “complaining that she could not gain enough weight!” She decided to fight back and took her concerns to the school board with a group of like-minded parents. While this action did result in the formation of a sixthgrade algebra class for twenty students, including Cranshaw, his mother was not sure she had done him any favors. The teacher assigned to teach the class seemed intent on making it onerous for the students, perhaps to prove a point that the students should not be taking algebra yet. Zelda’s parents faced their first real challenge when she came home declaring that the gifted program was stupid, and she wanted to drop out. Their first reaction was distress at what it would mean for them if their daughter were not in the gifted program. Much of their family pride was tied up in their intellectual abilities and having a daughter who was gifted supported this family view. Quickly, however, they realized that they needed to get to the bottom of the problem…why was Zelda unhappy? They suspected bullying, and they wondered if she was being picked on by others. They set up a meeting with her teacher and the gifted-education specialist to see what was going on. What they heard surprised them. After much discussion, they decided that they needed to shift gears with Zelda—they would encourage her to take risks, they would back down from their focus on straight A’s, and they would work with her to feel more comfortable in open-ended and creative activities. Interestingly, both her parents decided that these might be good goals for the whole family, and so they signed up for a family art program where they could “get creative” together. They also told Zelda that staying in the gifted program was important and that they would support her in this goal. The teachers concern about Zelda’s social skills were also heard. Her parents decided that counseling in socialization would be helpful, and they found a family therapist who specialized in supporting social development. Likewise, the family did this therapy together! Zelda’s challenges became the family’s challenges, and her successes in overcoming them became the rewarded outcomes. For Sebastian and his family, the major challenge Quality time with Babu (Grandfather) across the generations, was thinking about his future education. They knew is important for all children. that he would go to college, and they were concerned

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Summary about how they would afford this expense. When he said he wanted to become a Moral Dilemma: lawyer so that he could help other immiSupporting Students Who grant families make the transition to citizenship, his parents were both proud and Experience Micro-Aggressions worried. How could they pay for college and law school? The expenses of advanced One of your students, Travon, was once a happy and active education and the time that such an educamember of the class who contributed lively and thoughtful tion takes both seemed daunting to his parent. comments to each discussion, but lately, he has been reserved They realized that they were facing expenses of if not disconnected. Your sixth-grade language arts class has up to a quarter of a million dollars over a sevenalways been a safe haven for students in the urban middle year period, when considering the combination school, but it does not seem to be working for Travon. When college and law school. Even with scholarships you ask him what is going on, he reluctantly tells you that and grants, Sebastian is likely to leave school in some of his friends are accusing him of “acting white” and serious debt. In addition, the family has three that others in the class have told him that he is “not as smart other bright children and wonders how they can as he thinks he is.” Travon also says he does not want you to afford to encourage them all. This is not merely do anything and that he will have to work it out himself. What an issue for Sebastian’s family; it is a challenge can you do to support him? faced by society at large. We need highly trained scientists, economists, lawyers, engineers, and we don’t want training for these professionals to be left solely to the wealthy who can afford it. In addition to expense, time is also a factor for our three students. If Sebastian follows the typical school trajectory, he will be twenty-two when he graduates from college and twenty-five when he finishes law school and can begin practice; he will also be deeply in debt. Zelda, not surprisingly, has decided that she wants to be a professor. She will likely be thirty when she finishes her Ph.D., and she may also be in debt. How can we, as a society, help Sebastian and Zelda? If we truly value education, we should be able to find ways to support students as they strive for excellence.

Summary ●  Until

recently, giftedness for educational purposes was identified primarily through IQ tests. Now we know that gifts and talents may present through many domains. ●  Children with special gifts and talents may show outstanding abilities in a variety of areas, including intellect, academic aptitude, creative thinking, leadership, and the visual and performing arts. Intellectual giftedness appears to be created by a strong combination of heredity and environment, with a close and continuing interaction between these two forces. ●  The information processing model shows major strengths of most students with gifts and talents that are within the processing, or thinking, areas of memory, classifying, associating, reasoning, transforming, and evaluating information. Many students with gifts and talents also have strengths in their executive function. ●  Underrepresentation and inadequate services for marginalized students is the most pressing challenge faced in gifted education. The “risk ratio” for Black, Latinx, and Native American students being identified for gifted education is 0.34—if you are a Black, Hispanic, or Native American student, you are about one-third as likely to be identified for gifted education than if you are a white or an Asian student. ●  Ability grouping, combined with a differentiated program, has been demonstrated to be an effective strategy that results in improved performance by students with gifts and challenges. Cognitive strategies—problem finding,

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Chapter 10  |  Children and Youth with Gifts and Talents problem solving, and creativity—are the focus of many special programs for gifted students. Acceleration, the more rapid movement of students with gifts and talents through their long educational span, has shown positive results. ●  Parents have many challenges in raising gifted students, including knowing what the right services are for them and preparing to help them through higher education.

Future Challenges 1. Are there programs for young children who are gifted? The early years are increasingly seen as fundamental to a developing intellect. Prekindergarten programs are blossoming across the country and will need to provide for their students having gifts and talents who already can read and do basic arithmetic. This is an early challenge for educators to develop a differentiated curriculum for the preschool years.

2. How can we ensure that gifted and talented students from culturally and linguistically diverse and/or economically disadvantaged families are recognized and served appropriately? We continue to face the challenge of underrepresentation of some groups of children in our programs for students with gifts and talents. Given the rapidly changing demographics across the country, this disproportionate representation will likely increase unless we take proactive steps to address it. We need to look to models that help teachers recognize and nurture potential, using structured observations of students engaged in meaningful and dynamic lessons.

3. How can we help the public see the national need to educate students with gifts and talents? Professionals in this field of gifted education have had little impact when trying to communicate to the public about the key significance of these students to the nation’s future well-being. How do we communicate this idea? TeachSource Digital Download

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Key Terms acceleration p. 356 advanced placement p. 359 curriculum compacting p. 355 high-stakes testing p. 341 integrated curriculum p. 358 International Baccalaureate Program (IB)p. 359 multiple intelligences p. 344 perfectionism p. 339 problem-based learning (PBL) p. 360

prodigy p. 345 residential schools p. 358 student achievement. p. 346 student aptitude p. 347 student behaviors p. 347 student interests p. 347 student motivation p. 347 student performance p. 347 talent development p. 344 twice-exceptional (2e) students p. 352

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Resources of Special Interest to Teachers

Resources of Special Interest to Teachers Gifted Child Quarterly publishes original research and new and creative insights about giftedness and talent development in the context of the school, the home, and the wider society. Each issue offers quantitative and qualitative research studies that explore the characteristics of gifted students, program models, curriculum and other important areas that maximize the development and education of gifted students.  www.nagc.org Journal for the Education of the Gifted offers information and research on the educational and psychological needs of gifted and talented children. Devoted to excellence in educational research and scholarship, the journal acts as a forum for diverse ideas and points of view on gifted education, counseling, and parenting. https://journals.sagepub.com/home/jeg Parenting for High Potential is the quarterly magazine designed for parents and others working to support and guide their gifted children at home and at school. https://www.nagc.org/parenting-high-potential-1 National Association for Gifted Children’s mission is to support those who enhance the growth and development of gifted and talented children through education, advocacy, community building, and research. The organization aims to help parents and families, K-12 education professionals including support service personnel, and members of the research and higher education community who work to help gifted and talented children as they strive to achieve their personal best and contribute to their communities. www.nagc.org

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Par t 3

T

Low-Incidence Exceptionalities

he three chapters in Part 3 describe the educational needs of exceptional children who constitute less than 1 percent of the students in our schools. Although there are few students within these areas, their special educational needs are often complex and significant support is required to ensure their success. Special planning and individualized programming are important to support

children who are deaf or hard of hearing, children with visual impairments, and children with physical or multiple and severe disabilities. In Chapters 11 through 13, we highlight how these exceptionalities affect students, their families and the educators who serve them. We discuss the supports and services needed to help students with these exceptionalities meet with success.

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Children and Youth Who Are Deaf or Hard of Hearing

11 Ch ap te r

Standards Addressed in This Chapter All of the CEC Initial Practice-Based Professional Preparation Standards for Special Educators (K–12) are addressed within this Chapter. Please see the inside book cover for a list of these standards.

Focus Questions 11-1 How did the field of deaf education evolve, and what is the history of the debate between oral and manual communication? 11-2 How are the terms deaf and hard of hearing defined? What are some characteristics of children with hearing difficulties, and why must we consider the degree, type, and age of onset of the hearing loss? 11-3 What are some causes of hearing loss? How is hearing loss detected, and why is early intervention so critical? 11-4 How can varying hearing levels affect a student’s cognitive, academic, social, and language development, and what can be done to maximize a student’s communication potential? 11-5 What is the Deaf culture, and why are bilingual and bicultural approaches to understanding the needs of individuals who are deaf and hard of hearing important? 11-6 What kinds of educational responses are needed for students who are deaf and hard of hearing? 11-7 Why is family involvement so important for the child’s communication and transition planning?

C

ommunication is critical to our sense of belonging; being able to exchange thoughts, feelings, and desires is key to establishing a bond with others. Building and maintaining strong connections within the hearing world can be challenging when sensory input is reduced, and it can feel very isolating. Belonging to a social group where you are accepted and understood is critical. For many individuals who are deaf or hard of hearing, that sense of belonging is found within the Deaf community (the capitalized term Deaf is discussed later in the chapter). Deaf identity is a large part of their lives, and within the Deaf culture, many individuals prefer deaf-first language rather than person-first language;

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Chapter 11  |  Children and Youth Who Are Deaf or Hard of Hearing they use the term “hearing levels” rather than “hearing loss” (you may recall a similar discussion within the Autism community in Chapter 5). We have tried to honor these preferences where we can; however, for consistency and clarity, we sometimes also use person-first language and the term “hearing loss.” In this chapter, we use the term deaf to refer to individuals who have little to no ability to process spoken sound and the term hard of hearing to refer to all other hearing levels. We also use a capital D when referring to the Deaf culture or community because all deaf and hard-of-hearing children have a birth right to the Deaf culture, its language (American Sign Language), and to learning about their “deafhood” (Miller, 2015) (discussed later in this chapter). On occasion, we also use the term hearing losses to describe these challenges. Because hearing losses can differ in degree, type, and age of onset, their impact on children can vary widely. Throughout this chapter, we continue to explore the role of communication and language in learning and in social relationships. We discuss the history of education for individuals who are deaf or hard of hearing, review definitions of what it means to have a hearing loss, and consider the educational supports and services that individuals and their families need to help them thrive.

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11-1  History of Education for Individuals Who Are Deaf or Hard of Hearing

Marlee Matlin, a famous actress who is deaf, has led the way in advocating for individuals who are deaf and hard of hearing.

Over the past three decades, we have seen a growing acceptance within the hearing society of individuals who are deaf or hard of hearing. This growing acceptance has come about in part because several individuals who are deaf or hard of hearing have achieved prominence in their fields. Phyllis Frelich, an actor who is deaf, won a Tony award for her performance in the Broadway play Children of a Lesser God. Marlee Matlin, also deaf, received an Oscar for her performance in the motion picture based on the same play, starred in the television dramatic series Reasonable Doubts as a deaf lawyer, and played Jackie Rossi in the movie CODA (which stands for Children Of Deaf Adults). Miss America 1995, Heather Whitestone McCallum, is deaf. Following in the footsteps of deaf athlete Luther Taylor, who played baseball from 1900 to 1908, Kenny Walker played professional football in the 1990s and now coaches for the Iowa School for the Deaf. During the 2000 Olympics, Terrence Parkin, a swimmer who is deaf, won a silver medal. The Riverside Cubs football team, for the California School for the Deaf, had an undefeated 2021 season; what did they say their strength was? Being deaf! Today there are doctors, lawyers, directors of government agencies, and professionals in every walk of life who are deaf. The president of Gallaudet University, Roberta J. Cordano, who is deaf, is fluent in American Sign Language and English. Her parents are both Gallaudet alumni, and three generations of her family have attended or are attending Gallaudet. Many students who are deaf or hard of hearing attend regular schools, and more and more adults who are deaf or hard of hearing prosper in the workplace. But the hearing society has not always accepted individuals who are deaf or hard of hearing. The acceptance of individuals who are deaf or hard of hearing has been greatly assisted by government mandates, regulations, and continued advocacy for the rights of all people. Commissions established by Congress in 1986 and 1988 led to the establishment of the National Information Center on Deafness and the Helen Keller National Center for Technical Assistance. Rules and regulations in 1990 that required state-wide telephone-relay systems helped ensure phone access for individuals with hearing loss; stipulations in 1993 that all television sets with

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History of Education for Individuals Who Are Deaf or Hard of Hearing

Signs and Sounds for Sammy

Sammy, now 8 months old, was born deaf. Because of an infant hearing screening, this condition was detected shortly after his birth. Sammy has some residual hearing, so he was fitted with hearing aids by 3 months, when he began to respond to the sounds around him. Sammy also needed intense language interventions, focusing on interaction with his environment and the development of words and concepts. His family began working with an interdisciplinary team composed of an audiologist, a speech-language therapist, and an early interventionist, who was also deaf. The team decided that a total communication approach using both manual and oral communication would be the best approach for Sammy. Based on this decision, the family began learning ASL so that they could teach Sammy. The deaf early interventionist also introduced the family to other members of the Deaf community, and the family was relieved to meet other

families with deaf children. They wanted to ensure that Sammy’s early communication skills would flourish. They are also aware that if his residual hearing was not sufficient for language development, a cochlear implant could be an option. The team decided to re-evaluate their decisions when Sammy was 9 months old. Sammy’s family felt that they were learning a lot from the Deaf community members they had met, but they also realized that their journey had just begun and that it would be a lifelong process of finding the right combination of supports and services to help Sammy develop to his fullest.

Reflections: ●



Were you surprised that an infant could be fitted with hearing aids? Why is it important to begin communications interventions early for children who are deaf or hard of hearing?

screens 13 inches or larger sold in the United States must be equipped to receive captioned broadcasts have expanded media access. Technological advances have radically altered accessibility with voice-to-print and print-to-voice capacity on most computers and devices. Through legislation, court actions, growing societal awareness, and technological advances, the world is becoming more accessible to individuals who are deaf or hard of hearing (see Chapter 2). Yet, despite these gains, challenges still remain. Although many deaf people use a manual language called American Sign Language (ASL) to replace or augment spoken English, our society is still very speech-language-oriented (Kite, 2020). A lack of understanding can still cause barriers in the acceptance of individuals with differences (Warner-Czyz et al., 2018). Since we are a speech-dominated society, some medical personnel and educators strongly advocate the use of oral-speech language for individuals who are deaf or hard of hearing (Kite, 2020). Others, however, take a more balanced approach, advocating the use of sign language to support early communication (National Association of the Deaf NDA, 2021). The dispute over how to teach communication skills to a child with a hearing loss is not new; it began in Europe with Samuel Heinicke in Germany stressing oralism (speech) and Abbé de l’Épée in France stressing manualism (gestures). An early conference held in Milan in 1880 stressed oralism and claimed that sign language impeded language development (Paul & Quigley, 1994). The debate was intense, with firm believers on both sides. In the United States, the sign-language approach was spearheaded by Thomas Hopkins Gallaudet, who, with Laurent Clerc, founded the first school for the deaf in Hartford, Connecticut, in 1817. Gallaudet College was founded in Washington, D.C., in 1884, and its patron, Abraham Lincoln, signed the school’s charter. During the next 100 years, from 1817 to 1917, schools for the deaf were founded in most of the states. The oral approach to instruction was advocated by Alexander Graham Bell, inventor of the telephone and audiometer, and the founder of the School of Vocal Physiology in 1872. Interestingly, both Gallaudet and Bell had mothers with severe hearing losses, and each man was firmly convinced of the correctness of his approach.

National Deaf Education Center http://clerccenter .gallaudet.edu

Georgios Kollidas/Alamy Stock Photo

Box 11.1

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While best known as the inventor of the telephone, Alexander Graham Bell was also an advocate of the oral approach.

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Chapter 11  |  Children and Youth Who Are Deaf or Hard of Hearing Not until the 1970s did Bob Holcomb (Gannon, 1981), a college graduate with a severe hearing loss, advocated the use of both manual and oral communication and coined the term total communication method to describe this approach. In total communication, some type of manual communication is used simultaneously with speech. Because our hearing culture seems to prefer that people learn to speak, medical personnel and educators may stress oral language within the total communication approach, giving less emphasis to the importance of learning sign language (Kite, 2020; Lynas, 2000). The most important thing, however, is to teach the child a communication system that the child can master, regardless of whether it is manual, oral, or a combination of both, so that the child grows up with a clear identity and acceptance of themselves and their hearing levels (NAD, 2021b). Today, total communications approaches can start at a very early age, as we see in Box 11.1, Signs and Sounds for Sammy. As use of the total communication method increases, the recognition of American Sign Language as a legitimate language allows individuals whose primary language is ASL to receive the same protection and support services as English-as-a-second-language users covered under the Bilingual Education Act (Reading Rockets, 2021; Johnson & McIntosh, 2009; Simms & Thumann, 2007). Recent technological and medical advances in hearing aids and cochlear implants have greatly increased the ability to capitalize on an individual’s residual hearing and, through this, to expand their ability to communicate. We will learn more about these technological and medical advances later in the chapter, but first let’s meet some students!

11-2  Characteristics of Children and Definitions of Deaf/Hard of Hearing Many factors influence the impact of a hearing loss. The individual patterns of children with hearing loss can vary widely, as we can see in the cases of three children, Kiesha, Carlos, and Ethan, who have hearing levels that will affect their learning and possibly also their social skills.

11-2a  Meet Three Children Who Are Deaf or Hard of Hearing Kiesha is hard of hearing. Carlos has a postlingual hearing loss (developed after he learned to speak), and his situation is complicated by the fact that his first language is Spanish. Ethan was born deaf, and both his parents are also deaf. The intraindividual differences among these children show the heterogeneous nature of children who have hearing losses.

Kiesha Kiesha, who is 10 years old, has a moderate hearing level of 50 decibels. (The decibel (dB), a unit used to measure the intensity of a sound, will be explained more in the next section.) Kiesha’s level of hearing means that, without her hearing aids, she will miss most typical-volume conversations. Kiesha’s motor coordination, cognitive abilities, and social maturity are on target for her age. Her language development is slightly delayed. She has some difficulty with articulation, and she receives speech therapy. The language delays have affected Kiesha’s reading and spelling skills, but her achievement in math is at her grade level (fifth).

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Characteristics of Children and Definitions of Deaf/Hard of Hearing Kiesha was first fitted with hearing aids when she was a toddler; as she has grown, she has received new hearing aids each year. Kiesha goes to the audiologist annually for a full evaluation, and the special education teacher and the speech-language pathologist work with her to make sure that her hearing aids are functioning well in the school environment. Kiesha receives support from the speech-language pathologist once a week, and she works with the special education teacher periodically when she needs some extra help with school tasks. Even though Kiesha’s development and educational achievement are close to those of her peers, she does need some additional support from the classroom teacher. Her hearing aids and slight speech differences sometimes make her feel different from her friends, and this situation may become more of a challenge as she moves into middle school. Kiesha’s hearing also fluctuates somewhat when the weather changes or when she has a cold. Teachers who are not aware of this fluctuation may not realize that, in some circumstances, Kiesha may miss key information if she is not encouraged and supported to participate fully in the learning activity. Both Kiesha’s parents are hearing, and before Kiesha was born, neither parent had ever met a deaf person. When Kiesha’s hearing difficulties were identified, the pediatrician provided her parents with a list of resources; one of these was a parent group for parents with children who were deaf or hard of hearing. This group was very supportive, and through this connection, Kiesha’s parents met other parents, some who were deaf. Kiesha’s Information Processing Model (IPM), showing the areas that are impacted by her hearing level, is shown in Figure 11.1. When you look at the IPM, you can see Kiesha’s challenges with auditory input and speaking as output. She also has some difficulty with social interactions. Her areas of strength include visual input, memory (especially for visual information), reasoning, and writing. She has also learned to focus her attention and concentrate when needed.

Emotional Context

Thinking

Response

Memory Classification Association Reasoning Evaluation

Speaking Writing Motor Response Social Interaction

Processing

Stimulus

Vision Hearing Kinesthetic Haptic Gustatory Olfactory

Information Input

Attention

Information Output

Executive Function

key Challenges Strengths

◗ Figure 11.1  Kiesha’s Information Processing Model TeachSource Digital Download

Access online

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Carlos Carlos, who is now 11 years old, was born with normal hearing but suffered a severe hearing loss in both ears at age 4 due to an infection and high fever. His family moved from Mexico to the United States when he was 5, and his first hearing aids were fitted when he began kindergarten. Because he was already speaking when he lost his hearing, he is classified as having postlingual hearing loss. Carlos’s support needs are complicated by the fact that his first language is Spanish, and so, although his hearing loss is postlingual, he still has difficulties with English. Carlos is an intelligent young man, but because of his hearing challenges and his language differences, his academic development has lagged behind. Because of his social maturity and excellent physical abilities, he is a leader on the playground, where the game of choice is soccer. The one area of academics in which he performs at grade level is science, where handson experimentation is stressed. On audiometric testing, Carlos shows a hearing level of 75 decibels with the amplification provided by his hearing aids; this level indicates a severe hearing loss. Since Carlos learned to talk before his loss of hearing, he can draw on his early language foundation for learning, and with hearing aids, speech therapy, and other special education services, he is moving ahead. For his first three years of schooling, Carlos attended a bilingual special education class for two hours each day. In this class, he received academic support in both Spanish and English. His team made the decision to focus on oral communication and decided not to introduce Carlos to American Sign Language. He is now receiving weekly speech language support and special education services in reading. Carlos relies a good deal on his lipreading skills, and he sits at the front of the classroom, facing the teacher. He still needs extra help in developing his academic skills. The audiologist and speech-language pathologist have suggested that Carlos would be an ideal candidate for a cochlear implant. They are working to set up a meeting with his parents to share information on this option for Carlos (we will learn more about this later in the chapter).

Ethan Ethan was born deaf. His hearing loss is profound, testing at a loss of more than 95 decibels. He has never heard a spoken word. Both his parents are also deaf, and as active members of the Deaf community, they welcomed Ethan into their family. Because Ethan was their first child, they felt somewhat overwhelmed. But the issue for them was not Ethan’s hearing level—it was their own learning curve as new parents! His parents did, however, struggle with a major dilemma. Ethan was likely to be a candidate for a cochlear implant when he turned one year old. His pediatrician was an advocate for this implant because it would give Ethan access to sound and facilitate his use of oral communication. The struggle his parents faced was their loyalty to their Deaf community and their clear belief in Deaf identity as a positive and not a “defect” to be “fixed.” Ultimately, they opted for the cochlear implant, but continued to use American Sign Language. They also worked hard to support Ethan within the Deaf community and within his hearing community. Ethan is now 10 years old, and while he attends the neighborhood public school, his parents augment this with Saturday and summer programs for deaf children. Ethan’s connection and communication with his family and deaf peers is solid with the use of American Sign Language. With hearing peers and teachers, he uses lip-reading, oral communication facilitated with his cochlear implant. These three students show the wide range of possibilities for individuals who are deaf or hard of hearing; Each individual child will show a unique pattern of strengths and challenges, and this pattern will change over time. Remembering that all students have strengths is an important part of planning to meet their needs (see Box 11.2).

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Characteristics of Children and Definitions of Deaf/Hard of Hearing

Box 11.2

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Students Who Are Deaf or Hard of Hearing: Remember Our Super Powers!

Education is the process of supporting learning and helping students reach their potential. To do this, we need to focus on our students’ strengths. Here are some of the superpowers that deaf students say they have: ● ● ● ● ● ●

I have a really great visual memory—if I see it, I can remember it, period. Dancing—I am really graceful and love to dance! I was Clara in the Nutcracker. My superpower would be computers. I can fix them, build them, and program them. Reading lips! Be careful what you say because I can read your lips from across the room—it comes in handy! Concentration! When I want to focus on something, I can just lock in and everything else disappears. Football! I am the quarterback for my team!

The impact of a hearing loss can vary widely depending on the degree of loss, the type of loss, and the age of onset at which the loss occurs.

11-2b  Definitions of Deaf, Hard of Hearing, and Central Auditory Processing Disorders A hearing level is defined by the degree of loss, the type of loss, and the age at which the loss occurred. The Individuals with Disabilities Education Act (IDEA, 2004) defines deafness as a hearing impairment that is severe enough that the child cannot process linguistic information through hearing, even when using amplification or hearing aids. This hearing loss adversely affects the child’s educational performance. Being “hard of hearing” is defined as an impairment in hearing that may be permanent or fluctuating and that adversely affects a child’s educational performance, but that is not included under the definition of deaf. What we see in both definitions is that the hearing level can adversely affect the child’s education and that special educational adaptations are needed to support the student. An individual’s hearing level is determined by the individual’s reception of sound as measured in decibels (dB). A loss of between 16 and 25 dB is considered slight; increasing degrees of loss range from mild (26–40 dBs) to moderate (41–55 dBs) to moderately severe (56–70 dBs) to severe (71–90 dBs) and profound (more than 91 dBs) hearing loss or, to use a more common term, deaf (American Speech-LanguageHearing Association [ASHA], 2021). Table 11.1 presents the range of degrees of hearing levels, their descriptive classification, and their possible causes. Individuals classified as hard of hearing may be able to hear and understand speech, or they can be helped to do so with hearing aids. Only a small percentage (less than 1 percent) of persons who are deaf are unable to hear speech under any conditions.

Huntstock/DisabilityImages/Getty Images

Degree of Hearing Level

It is critical that all family members learn to communicate effectively with the child who is deaf or hard of hearing.

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Table 11.1  Levels of Hearing Level of Hearing (Measured in Decibels)

Description

Possible Causes

Sounds Heard

16–25 dB

Slight hearing loss

Otitis media, or fluid build-up in the middle ear due to ear infections; damage to the ear through injury, illness, or noise exposure

Hears vowel sounds clearly; may miss unvoiced consonant sounds (f, s, sh)

26–40 dB

Mild hearing loss

Otitis media; prenatal exposure to infections (e.g., rubella, cytomegalovirus/CMV, herpes simplex virus); damage to the ear through illness, injury, or noise exposure

Hears only some louder-voiced speech sounds

41–55 dB

Moderate hearing loss

Chronic otitis media; middle ear anomalies; sensorineural damage; prenatal exposure to infections; genetic factors; and damage to the ear through illness, injury, or noise exposure

Misses most speech sounds at normal conversational level

56–70 dB

Moderately severe hearing loss

Middle ear anomalies; sensorineural damage; prenatal exposure to infections; genetic factors; and damage to the ear through illness, injury, or noise exposure

Hears no speech sounds at normal conversational level

71–90 dB

Severe hearing loss

Same as moderately severe hearing loss

Hears no speech or other sounds

91 1 dB

Profound hearing loss

Same as severe

Hears no speech or other sounds

Source: Adapted from the American Speech-Language-Hearing Association (ASHA) website, https://www.asha.org/public/hearing/degree-of-hearing-loss/ Retrieved December 17, 2021.

Types of Hearing Loss The ear is a complicated structure (Figure 11.2), and it functions in a complex way. The outer ear is composed of the pinna, the temporal bone, and the auditory canal, or external auditory meatus. The middle ear is composed of the tympanic membrane, or eardrum, and the three ear bones: the malleus, the incus, and the stapes. The stapes lies next to the oval window, called the gateway to the inner ear. The inner ear contains the cochlea, which contains part of the hearing organs, the vestibular apparatus, which includes the vestibule and three semicircular canals of the inner ear, and the cochlear nerve, or auditory nerve. Problems with hearing can be due to either the structure or the function of the ear. Hearing losses can be classified into four categories: conductive losses, sensorineural losses, mixed hearing losses, and central auditory processing losses. The first three types of hearing loss are considered to be caused by problems with auditory acuity, or the ability to take in sounds and transfer them to the brain successfully. The fourth type of hearing loss is an auditory processing difficulty, which means that the individual can sense the sounds but has problems understanding them. Within the informationprocessing model, the first three types of hearing loss are related to problems with input—getting the information to the brain—whereas the fourth type is due to difficulties in processing the input once it is received. A conductive hearing loss occurs when something blocks the sound passing through the outer or middle ear (ASHA, 2021b). The blockage can be caused by wax, ear infections (otitis media), or any type of malformation of the ear canal. Conductive hearing losses make hearing faint sounds more difficult. This type of

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Characteristics of Children and Definitions of Deaf/Hard of Hearing

Outer ear

Middle ear

Bone

Inner ear

Ossicles

Oval window

Auditory nerve Cochlea

Pinna

Auditory canal

Tympanic membrane

Eustacian tube

Oval window

Cochlea (cut to show canals)

Incus Malleus Tensor tympani muscle Stapes Stapedius muscle Round window

◗ Figure 11.2  Anatomy and Structure of Ear Source: Freberg, L. (2006). Discovering Biological Psychology, p. 392. Used by permission of Houghton Mifflin Harcourt Publishing Company.

loss is usually temporary and can often be corrected by surgery or medication, but children will also need educational supports to help them with language development and may need speech-language support to help overcome articulation problems (ASHA, 2021b; Herter, Knightly, & Steinberg, 2002). Sensorineural hearing losses are caused by damage to the inner ear (cochlea) or to the auditory nerve, particularly in the delicate sensory hairs of the inner ear or in the nerves that supply them. Sensorineural hearing losses affect both the ability to hear faint sounds and the ability to hear clearly, and this deficiency can make understanding speech sounds difficult. Hearing aids will likely be useful for most individuals with sensorineural hearing loss, and cochlear implants can be considered for individuals with profound hearing loss in both ears who cannot benefit from hearing aids (ASHA, 2021b).

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TeachSource Video Connection

Watch the video “Amy: Accommodating a Gifted Student with Hearing and Visual Impairments in a Middle School Classroom.” This video clip shows Amy in the classroom with her peers. Amy’s teacher also discusses her experiences working with a student with hearing loss. What are some of Amy’s unique challenges discussed in the video? What additional strategies might help support Amy’s learning? Watch online

Mixed hearing losses result from problems in the outer ear, as well as in the middle or inner ear, combining both conductive and sensorineural difficulties (ASHA, 2021b). Persons with this type of loss may hear distorted sounds and have difficulty with sound levels. Depending on the specific site of the difficulty, a combination of medical treatment and amplification with hearing aids can be used to increase hearing. As with sensorineural hearing losses, some individuals may benefit from cochlear implants (a surgically implanted device that directly stimulates the auditory nerve), and all will need educational and related service supports. In addition to the loss of hearing due to auditory acuity problems, an individual may have difficulties processing auditory information. Central auditory processing difficulties are considered a type of hearing loss because they limit the individual’s ability to use auditory information (ASHA, 2021c Salvia et al., 2012). An individual with a central auditory processing disorder (CAPD) may have difficulties with sound localization, auditory discrimination, understanding speech sounds against a noisy background, auditory sequencing, memory, pattern recognition, sounding out words, and reading comprehension (ASHA, 2021c; Salvia et al., 2012). Like individuals with other hearing losses, individuals with CAPDs will need a multidisciplinary team to provide appropriate supports and services. We will discuss these supports and services later in this chapter.

Age of Onset of Hearing Loss A hearing loss can be either congenital, meaning present at birth (as with Ethan), or acquired, meaning that it has occurred in either childhood or adulthood (as with Carlos). A hearing loss that occurs before the child’s language has developed is a prelingual or prelinguistic hearing loss, and one that occurs after the child has acquired some speech and language is called a postlingual or postlinguistic hearing loss. The timing of an acquired hearing loss will have a critical impact on the child’s oral language and speech because it shapes the child’s early communication, language, and speech development. If the loss occurs before the child has acquired speech, the oral language delay is likely to be greater than it would be if the child had already developed a solid language and speech foundation. The stronger the child’s speech and language foundation is prior to the loss of hearing, the more the child can draw on it to support their oral communication. For the child with prelingual deafness, the early introduction of sign language is critical to facilitating overall communication. The specific impact of any hearing loss will depend in part on how early the loss is detected, on whether the child is provided amplification or a cochlear implant, and on the supports and services the child and family receive.

11-2c  Prevalence of Hearing Loss An estimated 3 in 1,000 infants are born with detectable hearing losses. As infant screening increases, this number could prove to be a low estimate (NIHD, 2021). During the 2018–2019 school year, 60,669 students were listed as deaf or hard of hearing (U.S. Department of Education, 2020). Although students with hearing loss reportedly account for 1 percent of students with disabilities, this figure is likely to be a low estimate because many students with hearing losses have other disabilities as well (Department of Education, 2020; Jones, Jones, & Ewing, 2006).

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Causes and Detection of Hearing Loss in Children and the Importance of Early Intervention

11-3  Causes and Detection of Hearing Loss in Children and the Importance of Early Intervention Understanding the causes of hearing losses and knowing how we can detect this loss allows us to begin interventions as early as possible to help the child meet with success. With hearing loss, the earlier we start interventions, the better the outcomes for the child.

11-3a  Causes of Hearing Loss Many factors may produce hearing loss in children. The causes are genetic, neurological, environmental or acquired, or of unknown origin (Herter, Knightly, & Steinberg, 2002).

Genetic Causes of Hearing Loss Genetic factors are likely to be involved in more than half of all the incidents of congenital hearing losses (losses present at birth). The Joint Committee on Infant Hearing (JCIH; 2007) position paper states that there are nearly 600 syndromes and 125 genes associated with hearing that have been currently identified, and genetic research on deafness continues (Kurima et al., 2002). Genetically caused hearing losses are inherited from one or both parents and can be inherited from either a hearing parent or a nonhearing parent (ASHA, 2013b). Because many forms of deafness are at least partially related to genetic factors, it is now possible to test individuals for various genes associated with deafness (Sparrow, 2010). The use of genetic testing to help determine the probability of conceiving a child who is deaf has become quite controversial; some members of the Deaf community are concerned that this information may perpetuate the deficit view of deafness (Sparrow, 2010). Approximately 20 to 40 percent of children with hearing losses have associated disabilities that must be considered as part of their treatment (Cupplies et al., 2013). Chapter 13 looks at the needs of children with multiple areas of disability, including children who are both deaf and blind. Children with other genetically related disabilities may also have associated hearing problems. For example, children with Down syndrome (a genetic disorder associated with intellectual and developmental delays) often have narrow ear canals and are prone to middle-ear infections, which may cause hearing losses. Individuals with cleft palates (an opening in the lip and aboral ridge) also may have repeated middle-ear infections, which can result in conductive hearing losses (Herter et al., 2002).

Neurology and Brain Development Related to Children Who Are Deaf or Hard of Hearing The brain is a complex organ that plays an essential role in all our functions. Here is a simplified version of normal hearing: Sound comes in through the ear canal, vibrations move from the cochlea along the auditory nerve, and these vibrations are processed in the auditory cortex (within the left hemisphere) (Sakai, 2005). For young children, the sounds of most importance are related to language. So, what happens when a child is deaf, and the brain receives no input from sound? Early work by Helen Neville and her colleagues (1997) using brain-imaging technology showed that for children born congenitally deaf, their “visual language,” American Sign Language, is processed in the auditory cortex. Sakai (2005) had similar findings in a study of children whose first language was Japanese Sign Language. Other studies, however, found bilateral cortical activity (both hemispheres working) for processing both ASL and British Sign Language (BSL) (Sakai, 2005). The brain’s plasticity, or ability to reorganize itself when needed, seems to be at work here (Pennington, 2009).

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The result of studies done with children who have received cochlear implants show that the younger the children are when they receive the implants, the more benefit there is for speech and vocabulary outcomes (Connor et al., 2006; Fagan & Pisoni, 2010; Geers et al., 2008; Hayes et al., 2009). The critical age for the maximum benefit seems to be prior to 2.5 years. While cochlear implants have now been approved for infants (National Institute on Deafness and Other Communication Disorders [NIDCD], 2010), more research looking at the role of the brain in processing language (both oral and visual/manual) will help us understand these relationships better (Pennington, 2009).

Environmental Causes of Hearing Loss

Environmental causes include exposure to bacteria, viruses, toxins, and trauma, as well as infection during pregnancy or in the birth process Communication is important for development (Herter et al., 2002). The environmental effects that begin before birth and this can be oral and visual/manual. are associated with illness or infections the mother may have had during pregnancy. For example, uncontrolled diabetes in the mother may cause a hearing loss in her child. A group of infections that affect the mother and that can also cause severe hearing losses in the fetus has been labeled TORCHS (de Jong et al., 2010) (see Table 11.2). The most common cause of hearing loss for young children in their preschool years is otitis media. A middle-ear infection very common in children of preschool age, otitis media, can lead to hearing loss and language difficulties. Figure  11.2 (shown earlier) shows an area called the middle ear, where the malleus, the incus, and the stapes are located. When a child has otitis media, this area fills with a fluid that decreases the child’s ability to hear. Depending on the frequency and severity of infections, the hearing loss may be mild or even moderate (ASHA, 2021). Children are susceptible to ear infections because their eustachian tubes are small and often more horizontal than those of adults, so fluids do not drain as effectively (ASHA, 2021). The most important thing is to detect the hearing loss as early as possible.

11-3b  Assessing Hearing Levels in Children Hearing losses can be detected at birth, and 45 states require a hearing screening for newborns (National Conference of State Legislatures, 2021). The Centers for Disease Contral and Prevention reported, based on data from 50 states and 3 territories, that 98.4 percent of infants under the age of 1 month had been screened for hearing losses in 2019 (CDC, 2019). Because 20 to 30 percent of hearing losses occur during early childhood, further screenings should be conducted at regular intervals. If a hearing loss is identified at birth, a comprehensive auditory evaluation can be conducted by 3 months of age, and the infant may be fitted with a Table 11.2  Maternal Infections That May Cause Hearing Loss to

the Fetus: TORCHS TO

Toxoplasmosis—a parasitic disease

R

Rubella (German measles)—mostly controlled within the United States by vaccines

C

Cytomegalovirus (CMV)—an infection in the mother’s uterus which can go undiagnosed

HS

Herpes simplex virus—can cause neurological problems as well as deafness

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Causes and Detection of Hearing Loss in Children and the Importance of Early Intervention

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hearing aid or may receive a cochlear implant. Early diagnosis can also alert the parents if the child is deaf and may need to learn sign language or an alternate communication system to facilitate optimum development and to mitigate any developmental delays (Lillo-Martin D., 2021; Cruz et al., 2013). Testing for a hearing loss will take somewhat different forms depending on the age of the child.

Measuring Hearing Levels To assess hearing in an infant, we must first determine whether the ear is functioning appropriately and whether the brain is receiving the sound signal. Three methods for assessing hearing in infants are: otoacoustic auditory emissions (OAE), auditory brainstem response (ABR), and auditory steady state response (ASSR) (JCIH, 2007). Both OAE and ABR techniques measure the underlying physical activity for hearing. A bone-conductor test can assess hearing in infants and preschool children younger than 3 years of age by measuring the movement of sound through the bone and the hearing system to the brain, bypassing the ear (Salvia et al., 2012). A bone-conductor test should not be done in a school setting, because a special environment is needed. Play audiometry can be used with very young children. Toys are used to elicit responses, such as eye blinks and changes in respiration or heartbeat (slower heartbeats indicate attention). An examiner distracts the child with an attractive toy. Sounds are piped into the room. A change in sound indicates that a curtain will be raised to reveal a more attractive toy. After a few experiences of this process, children without hearing losses hear the change of sound and turn to look at the hidden toy before the curtain is lifted to reveal it. If the child does not turn when the sound is changed, hearing losses are suspected (Herter et al., 2002). The most frequently used hearing assessment is pure-tone audiometry. Pure-tone audiometry can be used with children about 3 years of age and older. The audiometer—an instrument for testing hearing acuity—presents pure tones (not speech) to the individual, who receives the tones in a headset (BrennanJones et al., 2018). The audiometer presents a range of sounds and measures the frequency (vibrations) and intensity (pitch) at which the individual hears these sounds. The individual being tested responds to the sounds by raising a hand (or speaking into a microphone) if he or she can hear the tone; using the results, an audiologist can determine the degree and range of hearing loss.

National Center for Hearing Assessment Management: www.infanthearing.org

11-3c  The Importance of Early Intervention for Children with Hearing Losses Early intervention is critical for children with hearing losses. The Joint Committee on Infant Hearing (2007) found that infants and children with mild to profound hearing loss who are identified in the first 6 months of life and are provided with immediate and appropriate intervention have significantly better outcomes in vocabulary development, receptive and expressive language, understanding of syntax, speech production, and social and emotional adjustment. The impact and importance of early intervention for children with a hearing loss cannot be overstated. Early and intense intervention using a communication system that the child can master which incorporates visual cues (Fitzpatrick et al., 2011; Harrington et al., 2010; National Association for the Deaf [NAD], 2010) is essential. Once a child’s hearing level has been determined, parents are faced with several decisions. Based on the type and severity of the hearing loss, parents must evaluate the use of amplification (hearing aids to maximize the child’s residual hearing); communication systems (oral and/or manual); and the possibility of a cochlear implant (NAD, 2021b; Duncan, 2009; Hardonk et al., 2011; JCIH, 2007; NIDCD, 2010). These decisions are not easy; there are pros and cons associated with each option. Because each child’s situation is unique, professionals and parents must carefully review these pros and cons as they work to plan the most beneficial

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Chapter 11  |  Children and Youth Who Are Deaf or Hard of Hearing interventions for the child. During this decision-making process, parents may feel torn between the urgency of choosing and starting the intervention and the need to think through the options so that they make the best decision (Duncan, 2009; Hardonk et al., 2011). For hearing parents, with a child who is born deaf, these decisions can be even more challenging since they may have limited knowledge about, and experience with, being deaf. Dr. Elaine Gale shares the importance of including a Deaf adult as part of the early intervention support team for parents.

Box 11.3

Ask the Experts:

Infusing Deaf Adults in Early Intervention Support for Families

Dr. Elaine Gale

384

Dr. Elaine Gale is an Associate Professor in the Special Education Department and Lea­der of Deaf and Hard of Hearing Programs, Hunter College, CUNY https://education.hunter.cuny. edu/about/faculty-staff/elaine-gale/ Alex was born deaf. His mother Madison was hearing, and she had never even met a deaf person . . . she was concerned. What would happen to Alex? What would his life be like? How could she support him when she did not even know where to start? Over 90 percent of deaf children are born to hearing parents who have little to no experience with deafness and often, like Alex’s mom, have never met a deaf person prior to the birth of their child! The early years of any child are important to their development, but for a deaf child, these years are critical because it is essential for children to have full and frequent access to language early to avoid developmental delays. Parents of deaf children face many decisions, and they need support as they navigate the deluge of information and myriad possible pathways. Fortunately, early intervention programs are available to help parents during this time, but sometimes one critical piece of this early support is missing. Parents who have little to no experience with raising a deaf child need the support and perspective of someone who is deaf. They need to meet others who are deaf and to learn about the Deaf community and culture.

When new parents are connected with deaf adults, they often feel less isolated—and through these contacts, they can build their confidence as they learn more about their child’s needs. Deaf adults can serve as role models for the parents and child as well as help them access the Deaf community to build even more connections for support. Deaf adults who are part of the early intervention support network can also educate medical staff and other professionals who see being deaf through a deficit lens. Well-meaning professionals often approach being deaf with the lens of “something is wrong with the child and this needs to be fixed as soon as possible.” This medical perspective may even extend to the use of ASL (American Sign Language) as part of the family’s communication plan. This adverse pressure on parents may make it difficult for them to fully embrace their deaf child while seeking wrap-around support for their child’s strengths. The presence of a deaf adult as a member of the professional support team can broaden perspectives of other professionals and parents by instilling a social cultural lens. Deaf adults help normalize being deaf by sharing their own experiences, by teaching a range of visual communication strategies, and by showing the variety of positive possibilities for the family. Simply by being a part of the team, the presence of a deaf adult can ground other professionals and parents’ experiences within a more positive frame of reference. While the inclusion of a deaf adult within the early intervention team is ideal, it can sometimes be challenging because there may not be any deaf professionals available (deafness is a low-incidence exceptionality, so the numbers of deaf adults with early intervention expertise and experience are limited). This should not, however, stop the team, or the parents, from seeking ways to include deaf adults in the process. The Deaf Leadership International Alliance (www.dliaconnect.org) has

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Causes and Detection of Hearing Loss in Children and the Importance of Early Intervention

Box 11.3

385

Ask the Experts:

Infusing Deaf Adults in Early Intervention Support for Families  (Continued)

tips to collaborate with deaf adults in early intervention programs, including: (a)  infusing deaf adults throughout the early intervention system to ensure inclusion of experiences, (b) including deaf adults with diverse experiences to reflect diverse experiences and backgrounds, (c) involving deaf communities and organizations for resources and social opportunities, immersing in Deaf culture to learn sign (d)  language and cultural living solutions, (e)  implementing training for professional qualifications, and (f ) identifying funds to support and sustain services for families (https://dliaconnect.huntersoe.org /welcome/dlia-collaborate). Deaf-led organizations to connect with include National Association of the Deaf (www.nad.org), National Black Deaf Advocates (www.nbda.org), and Council de Manos (www.councildemaos.org). Another strategy for connecting with deaf adults is to contact local deaf schools. There are also programs that can teach parents about the life experiences of deaf adults. The SKI-HI Institute Deaf Mentor Program (see website in margin note) gives families access to trained and skilled deaf adults who can teach the families about visual communication, ASL, and the Deaf culture. What does this mean for you as you join the special education professional community? You will need to decide this for yourself. When faced with a new situation, like the need to support a hearing parent with their deaf newborn child, what will you do? How will you take a positive approach to ensure that the child’s family gains the knowledge and support they

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need to build their confidence? How will you be an advocate for the child while connecting the family with the Deaf community? When we, as professionals, are asked to support families in areas where we may not feel competent to help, we must seek this expertise from others, learning from the Deaf community with an openness and a sense of cultural humility. Cultural humility entails a commitment to self-evaluation and selfcritique. It means fixing power imbalances when they exist to ensure that family members and deaf adults are included in all decisions. It means developing partnerships with others who bring different and important perspectives, experiences, and knowledge. It also means being an advocate for policies and practices which lead to the infusion of deaf adults in the early intervention system so that children and their families receive the support they need. Cultural humility is about openness to new approaches, ideas, and solutions. It is about seeing strengths where others may see deficits. As you enter the field of special education, I wish you well and encourage you to learn as much as you can so that you can be of benefit to the children and families you serve—but also to remember that your education is never complete…there is always more to learn, and understanding this takes cultural humility!

Reflections: ●





What are some of the benefits of having a deaf adult on the early intervention support team? In what ways does the presence of this adult benefit the family? How might their presence benefit other professional members of the team?

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The following guidelines can help professionals provide appropriate support for parents during the decision-making process: ●  Remember

that parents of young children with hearing loss need time to deal with their feelings. ●  Engage parents in discussing and determining their ambitions, aspirations, and desires for their child.

The SKI-HI Institute Deaf Mentor Program http:// deaf-mentor.skihi.org

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Chapter 11  |  Children and Youth Who Are Deaf or Hard of Hearing

Box 11.4

Exceptional Lives    Exceptional Stories:

A Gifted Eye: A Story of Mathew

When I met him, Mathew was traveling with his family—Mom, Dad, and elder brother, Michael. The tour took five days, circling all of Ireland with amazing views of the coastline, castles, and countryside! Sitting with his face pressed against the bus window— Mathew was taking it all in! An interesting boy with a sparkle in his eye, Mathew communicated in many ways: sign-langue with some speech and lip reading, lots of smiles, and a dramatic flair for the important information like battles on the castle parapets. He seemed curious about my camera and watched as I struggled to figure out how to use it. I handed it to him, and we became instant friends. Mathew had an eye for the shot. He framed the elements, he took multiple angles, and he often captured the spirit of his subject. His humor showed in his work. One series of photos showed the backsides of several beautiful horses. These were paired with photos taken while tailing members of our tour…the twinkle in his eye as he shared the pictures with me said it all! After Mathew had taken several photos, he discovered the video function of the camera and began producing a miniseries. First, a restaurant walk-through complete with a signed narrative about the food. Next, a castle walk-about with, of course, a battle scene. Finally, a general day on tour with the morning bus loading; people riding, sleeping, talking, and watching the scenery pass by; and the end of the day departure from the bus with happy, tired, tourists

laden with small purchases acquired as reminders of the sights seen. Mathew attended a school for the deaf where American Sign Language was the primary mode of communication. He had received cochlear implants and was struggling to learn to use them and to incorporate speech. On the trip, he was wrestling to fit in with a hearing world, a complicated communication challenge. With only a father who understood sign language, surrounded by ambient noise that interfered with the sound quality of the implant, embedded in a group of adults who had limited patience to understand a boy’s difficult speech, and only a few individuals who understood the importance of facing Mathew as they spoke (so he could read their lips)…communication did not seem to be worth his effort. The photography seemed to help. Several people took an interest in his work. He shared generously and often took people’s pictures in return for their interest. In this way, Mathew connected with many of the tour group members. He became the trips eyes— documenting all we saw. On the last day, Mathew gave me back the camera and I promised to send him his work. We parted with a hug. While we have not been in touch for several years, my hope is that this charming, bright, energetic young boy has continued to use photography to communicate and connect. Mathew’s gift: his eye for photographic detail… with this he captured and shared the essence of the world around him.

●  Display

clear, open, and harmonious beliefs, expectations, and assumptions. parents with impartial, comprehensive, written, and spoken information presented free of jargon and in a judicious manner. ●  Include Deaf adults and/or individuals with bicultural/bilingual experiences to support decision making. ●  Recognize common emotions, beliefs, and knowledge needed to make the decision-making process work (Gale, 2021; Duncan, 2009). ●  Provide

Early and intense communication with children, particularly in infancy and the preschool years when the child’s central nervous system is ready to learn language, is critical (Gale, 2021; Boons et al., 2012; Cruz et al., 2012; Fitzpatrick et al., 2011). Adults must provide the language of the child, whether in manual or oral form, if the child is to learn to communicate. Box 11.4 reminds us that a child should be given multiple ways to communicate, including the arts!

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Communication, Cognitive, Academic, and Social Development of Children Who Are Deaf or Hard of Hearing

While we cannot predict any specific outcomes for individuals based on their hearing level, we can look at overall patterns of development for communication, cognitive abilities, academic achievement, and social adjustment.

11-4a  Impact of Hearing Levels on Language, Speech, and Communication

choja/iStock/Getty Images

11-4  Communication, Cognitive, Academic, and Social Development of Children Who Are Deaf or Hard of Hearing

Early efforts to communicate must be reinforced by caregivers to support the child’s development.

During the first year of life, or the prelinguistic period (meaning before or without speech), infants with hearing losses will exhibit the same behaviors as hearing infants: crying, making comfort sounds, and babbling to parents. In babbling, children produce their first sounds that resemble words (baba, dada), and the parents reinforce these sounds and transform them into words (as we learned in Chapter 9). What many parents do not realize is that these language behaviors are innately programmed and will appear whether infants can hear or not (Knight, 2003). Infants who can hear typically produce their first word around 12 months of age. For the infant who is deaf, babbling does not develop into words. However, in a seminal study, Petitto and Marentette (1991) found that children with severe hearing losses gesture at about the same developmental age at which hearing children babble. They concluded that infants are innately predisposed to learn language and that they do so by stimulating the environment with babbling; if they cannot hear, they use babbling-like hand movements that are sign equivalents of speech sounds. These signs are not words, but they are like the babbling sounds. Parents who are deaf recognize these signs and begin teaching a manual form of communication; often this is American Sign Language. Each language, spoken or manual, proceeds in similar fashion. If the parents do not help the child form signs into a language, the child may develop her own sign system, called home sign. One difficulty is that 90 percent of children who are deaf or hard of hearing are born into homes with hearing parents who do not recognize the child’s early attempts at a manual communication system, so these attempts are not reinforced, and the child’s language development is delayed (Gale, 2021).

11-4b  Cognitive Development of Children with Hearing Losses Children who are deaf or hard of hearing have the capacity for normal intelligence, and some may be intellectually gifted (Powers, 2011). However, because they cannot hear as well as children with normal hearing, they may experience some developmental delays. Intelligence depends on the interaction between a person’s innate capacity and his or her environmental experiences (see Chapter 10). As children with hearing losses mature, they will have different background experiences, communication histories, and access to information, and so they will need specialized instruction to

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Chapter 11  |  Children and Youth Who Are Deaf or Hard of Hearing reach the same cognitive and developmental milestones as children who can hear. A hearing loss may, however, be accompanied by disabilities that impact the child’s cognitive abilities (Gallaudet Research Institute [GRI], 2008; Jones et al., 2006). An estimated 40 percent of students with hearing loss also have an additional area of disability (Hartman et al., 2019). One area of special concern is children who are both deaf and blind. Deafblindness will be discussed in-depth in Chapter 13. It can be difficult to determine the intellectual level of children with hearing losses in part because intelligence tests used to measure cognitive abilities are not designed for or normed with children with hearing losses. Orally (speech) administered intelligence tests that are heavily based on language often greatly underestimate the abilities of a child whose primary language is manual (Salvia et al., 2012). To assess children who are deaf or hard of hearing in written English is also problematic if the child’s primary language is American Sign Language; the vocabulary, syntax, and grammar of ASL are significantly different from those of English. A child whose first language is ASL should receive the same assessment accommodations that any child whose primary language is not English receives. This means that the assessment should be conducted in the child’s primary language (ASL) and that the assessor should be bilingual and, if possible, bicultural (Johnson & McIntosh, 2009; Simms & Thumann, 2007). Furthermore, appropriate assessments must address both the child’s access to the stimulus (spoken or printed words) and their ability to respond to the test prompts by either speaking or writing (Salvia et al., 2012; Cawthon & Wurtz, 2008). When nonverbal tests are used with a sign language or manual communication system familiar to children, the children often perform well within the normal range. One reason that we get a more accurate assessment of abilities with nonverbal assessments may be that these better capture the student’s strengths. Hamilton (2011) found that students who were deaf showed strengths in visuospatial recall (that is, with items presented in visual format); imagery (such as the ability to create, maintain, and manipulate visual images); and dual encoding (using both speech and sign language). When specifically taught these strategies, students who were deaf also showed strengths in phonological encoding (using speech sounds) and rehearsal (repeating information to be recalled). Teachers may capitalize on these strengths to support the student’s learning (Hamilton, 2011).

11-4c  Academic Development in Reading for Children with Hearing Losses Reading levels of many children who are deaf or hard of hearing tend to be lower than those of their hearing peers, but we may be closing this gap (Mayberry et al., 2011; Antia, 2007; Antia, Jones et al., 2009; Luckner & Handley, 2008; McGough & Schirmer, 2005; Reed et al., 2008; Schirmer & Schaffer, 2010; Trezek & Wang, 2006). In an important study, Mayer and colleagues (2016) looked at the vocabulary, reading and writing skills of 33 young people, aged 9 to 16 years, who had cochlear implants. The participants included 26 students who were born deaf. Most participants were educated in mainstream classrooms, with 85 percent using oral communication in school. The group was cognitively able, all scoring within or above the normal range. The study found that, “Using the Single Word Reading Test, 55 percent were within the average range, and 21 percent above. As measured by the York Assessment of Reading Comprehension, 72 percent were commensurate with hearing peers, and 9 percent above on reading rate, and 75 percent within the average range, and 13 percent above on comprehension. Free writing samples indicated that 25 percent were performing at the expected level for their age, 19 percent above, and 56 percent below. Influences on outcomes were age at implantation, bilateral implantation, and age at testing. Overall, this

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Communication, Cognitive, Academic, and Social Development of Children Who Are Deaf or Hard of Hearing

Box 1.5 ● ●



● ●





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Promising Elements of Reading Instruction for Children Who Are Deaf or Hard of Hearing

Rehearsal of information Direct teaching of sight words and morphological rules (how sounds are combined to make words) Explicit vocabulary instruction and practice with short passages Use of high-interest reading materials Instruction in the grammatical principles of ASL and how these translate to written English Teacher-modeled discussions of stories and explicit instruction in reading comprehension strategies Interaction with text and peers in learning

● ● ● ● ●



Reading to young children Use of captions Intensified instruction Use of word processing Use of simple stories and word recognition practice with young readers Use of general curriculum for reading reinforcement

Source: Information was drawn from Luckner et al. (2005/2006). An examination of the evidence-based literacy research in deaf education. American Annals of the Deaf, 150 (5), 443–456.

Image Source/Corbis

group demonstrated good use of their technology, and much stronger outcomes in vocabulary and reading than evidenced in the deaf population prior to implantation. Writing outcomes were not as strong as in reading but were not showing the use of non-standard English as in the past, and were showing writing strategies such as invented spelling, common in hearing children.” (p.71) New methods for reading instruction for students with hearing loss also hold great promise (Moores, 2013; Smith & Wang, 2010). Children who have not heard the sounds of the language will struggle to decode print if they are taught in the usual method of matching speech sounds (e.g., phonemes) to print. Since phonemic awareness, or the ability to use speech sounds, may be limited for children who are deaf or hard of hearing, alternative methods must be used to teach reading (Strassman et al., 2019; Luckner & Handley, 2008; McGough & Schirmer, 2005; Schirmer & Schaffer, 2010; Smith & Wang, 2010 Trezek & Wang, 2006). Smith & Wang (2010) found that the use of “Visual Phonics” significantly increased phonological awareness for students who were deaf. Visual phonics is a multisensory tool that combines hand cues with written symbols that represent phonemes (speech sounds), allowing students who are deaf to manipulate phonemes without hearing the sound. The use of visual phonics to increase speech production and reading abilities for students who are deaf is a promising practice (Smith & Wang, 2010). When reading is taught visually or by a manual method (such as American Sign Language or finger spelling), children who are deaf or hard of hearing are able to learn how to read, write, Supporting enriched social interactions between students is an and use appropriate language forms, such as past important step in developing social competence. tense, questions, and logical propositions such as

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Chapter 11  |  Children and Youth Who Are Deaf or Hard of Hearing if-then and either-or (Smith & Wang, 2010; Trezek & Wang, 2006; Trezek et al., 2007). In summary, through improved teaching strategies, earlier intervention, new technology, and medical treatments (cochlear implants), children who are deaf or hard of hearing are making solid gains in learning to read (Strassman et al., 2019; Luckner & Cooke, 2010; Luckner et al., 2005/2006).

11-4d  Social and Personal Adjustment of Children with Hearing Loss Many youngsters who are deaf or hard of hearing will make friends with both their hearing and nonhearing peers. The explicit teaching of strategies for social and emotional well-being is critical for students who are deaf (Luckner & Movahedazarhouligh, 2019). Luckner and Muir (2001) conducted interviews with 20 successful students who are deaf and who were receiving most of their education in general educational settings. They found that many of the students attributed their success to working hard, studying, paying attention, advocating for themselves, getting involved in sports, and making friends. Most students acknowledged the importance of their families and the help and support they received from teachers, interpreters, and notetakers, but all of them spoke about the importance of their friends (Luckner & Muir, 2001). The study identified several factors that support the social adjustment of children who are deaf and hard of hearing: ●  Early

identification and intervention that markedly improve the child’s overall functioning and increase feelings of self-esteem ●  Family support and acceptance of the child ●  Sophisticated technological aids, such as the Internet, which provide access to information and social contacts ●  Participation in extracurricular activities (sports, Scouts, service clubs) ●  Skilled and caring professionals who work with the child and family. Promoting Alternative Thinking Strategies (PATHS) is a curriculum designed to improve social competence and to reduce behavioral problems for children who are deaf. It teaches self-esteem and interpersonal competencies (Kam et al., 2004) and aims to assist students in achieving self-control, emotional understanding, and problem-solving skills (Greenberg & Kusche, 1998). The PATHS curriculum has undergone many revisions over time (Novack et al., 2017) and new research on its efficacy is likely needed (Luckner & Movahedazarhouligh, 2019). Social adjustment for students who are deaf may be made more difficult if they experience bullying (see Chapter 8). Warner-Czyz and colleagues (2018) looked at patterns of bullying experienced by 87 students with hearing losses (aged 7–18 years). All the students wore auditory technology, communicated orally, and participated in mainstream education. Results showed that students with hearing loss endured significantly higher incidence of bullying, particularly exclusion and coercion, then the general population. Clearly more needs to be done to support full inclusion and social integration for students with hearing loss (Warner-Czyz, 2018). Finding positive ways for students to connect with each other is one way to build better relationships. (See Box 11.6.) Being able to communicate is an interactive process that enables persons with hearing loss to participate fully in their environment. Hearing is not the issue; communication is (Antia, Sabers, & Stinson, 2007). Recall that approximately 90 percent of the parents of children who are deaf or hard of hearing are not able to communicate fully with their children through speech. Therefore, parents will have to master a communication system that is appropriate for their child. When expressing frustration over inadequate communication in their homes, five young adult deaf students mentioned family members with limited signing

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The Deaf Culture or Community and Bilingual Approaches to Deafness

Box 11.6

Mindfulness Matters:

Building Connections Through Mindful Movement

Mindfulness is “being-in-the-moment,” and it is often practiced through concentration or focus on something that can anchor the mind in the present. Body movement is an ideal focus, and it brings the body and mind together. In this activity it also helps build connections with others. Why this Matters: Centering the body and mind in the present moment has a calming effect. It is calming because when your body and mind are centered in the present moment, you get a small break from worrying about the past and from being anxious about the future. If we spend a lot of time worrying about things that have happened in the past, or, feeling anxious about what the future holds for us—we may miss the present moment altogether. And it is the present moment that is the most important! We can only act in the present moment; the actions that we take in the present moment become our past and lay the groundwork for our future. We really do need to take act mindfully! Practicing Mindfulness: Mindfulness with Mirror Movement In this activity we connect with a partner to bring the body and the mind together in practicing mindful movement: 1. Form pairs, designating partner “A” and partner “B.” 2. Have partners face each other a foot apart, with clear contact established.

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3. Partner “A” takes the first lead making slow movements while partner “B” works to follow these movements as a mirror image. [Note: no talking and no physical contact is allowed but partners do need to maintain eye contact.] 4. After the first 5 minutes, switch partners so that partner “B” is the lead and partner “A” follows. [Note: you can signal the switch by blinking the lights.] 5. After the practice, discuss the activity with the students: — How did it feel to be in the lead? How did it feel to be the mirror image? — Were you able to concentrate? What were your distractors? — Could you feel your body and mind coming together as you concentrated on following the movements? What did this feel like? 6. As students debrief, ask them to share any additional through or feelings that they experienced during this activity. The concentration used during the Mirror Movement activity keeps the body and mind anchored in the present moment and it helps us to remember that each moment is a gift—that is why it is called the “present!”

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skills, attending gatherings with numerous untrained relatives, and watching television with family members who would summarize the program but not give the details (Bodner-Johnson & Sass-Lehrer, 2003). These students’ main complaint was that communication issues prevented them from participating fully in family life. It is rare for all the hearing members of a family to learn a sign language. It is not surprising that some children with severe hearing losses prefer to be with children like themselves, with whom they can feel socially accepted and comfortable. This desire extends into adulthood and has led to the formation of the Deaf culture or community.

11-5  The Deaf Culture or Community and Bilingual Approaches to Deafness The Deaf community exists as a separate cultural group within our society and has exhibited considerable cohesiveness for more than a century (Ladd & Lane, 2013; MSM Productions, 2008). The community is a very diverse group whose

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Chapter 11  |  Children and Youth Who Are Deaf or Hard of Hearing

World Federation of the Deaf www.wfdeaf.org

membership is composed of people of many different religious, social, and ethnic backgrounds. The shared bonds, however, are similar values and traditions, a common language (ASL), and specific behavioral protocols that are known to and practiced by group members. Membership in the Deaf community is a part of an individual’s identity, and allegiance to the group is often strong (Miller, 2015). Parents who are deaf often teach ASL to their children who are deaf, and many adults who are deaf learned ASL from their peers in residential schools, where they established close, long-lasting friendships (Stinson & Foster, 2000). When considering cochlear implantation for their child, parents who were deaf may give priority to Deaf identity, the use of sign language, and ethical issues related to the decision for their child (Hardonk et al., 2011). The Deaf community has state and local networks, holds world games for the deaf, hosts a Deaf Miss America Pageant, publishes a newspaper, and produces other material. The community is strongly bonded, and many adults who are deaf in the United States move toward membership and involvement in it. The Deaf community has the status of a minority group within the mainstream culture. Its members are bilingual and use ASL (or another form of sign language) for communication with others and American English for reading and writing. The use of a shared language, American Sign Language, is a key part of the identity within the Deaf community and is one of the reasons that bilingual-bicultural approaches to deafness are so important. Members of the Deaf community have a sense of belonging and pride, and they help one another overcome possible isolation from mainstream society. The Deaf community provides a sense of Deaf identity for its members. Deaf identity is not static; it is an ongoing quest for belonging and acceptance within the Deaf community while maintaining a voice within the hearing community (McIlroy & Storbeck, 2011).

11-5a  The Bilingual-Bicultural Approach to Deafness National Association for the Deaf https://www.nad.org

National Black Deaf Advocates https://www.nbda.org

The bilingual-bicultural approach asserts that persons who are deaf are bicultural in that they belong to the Deaf culture, as well as to the broader culture of the society in which they live (NAD, 2010). Many are also bilingual because they use a sign language system (usually ASL) to communicate, as well as use the spoken or written language of their culture (Crowe et al., 2012). In the United States, the primary language is English, and Deaf individuals who speak a different first language would be considered trilingual if they use two oral and written languages in addition to ASL (Crowe et al., 2012; Easterbrooks, 1999; Moores, 2000). The child’s family cultural background must also be considered, as we see in Box 11.7, which presents information on African-American families with children who are deaf or hard of hearing. Latino children who are deaf make up 35 percent of the deaf and hearing loss population in schools (Department of Education, 2020). Think back to Carlos, one of the children we met at the beginning of the chapter. Carlos would be a trilingual child, with Spanish, ASL, and English. Clearly, he needs support in all three languages to achieve success. Carlos is also a candidate for a cochlear implant, and his parents have decided to pursue this option in hopes that he will be better able to fit in with other children in his school and neighborhood community. Gale (2010) also found that families whose child had cochlear implants still favored a bilingual approach to communication. A bilingual-bicultural approach for students who are deaf is likely to provide the support needed for students to meet with success both within their Deaf and hearing communities (Gale, 2010).

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Educational Responses for Children Who Are Deaf or Hard of Hearing

Box 11.7

African-American Hearing Parents with Deaf/Hard of Hearing Children

While African-American children make up 14 percent of all children with profound hearing loss, little attention has been given to cultural needs of these families in research and practice (Department of Education, 2020; Borum, 2012). The perspectives of African-American parents regarding choices for their children’s language and communication pathways have largely been overlooked. Borum (2012) completed in-depth two-hour interviews with 14 AfricanAmerican hearing parents (12 female, and 2 male) about communication and language decisions they had made for their child with hearing loss. Central themes that emerged for these parents included the importance of an oral tradition and the child’s ability to participate in this, the need for the child to be able to talk with both hands and voice, the importance of written language and literacy, and the importance of maintaining a cultural identity as “Black” in addition to developing a Deaf identity. The families who participated in the interviews felt that their children would need to operate in a complex world where being deaf and

Black was going to present challenges. They wanted their children to be prepared to navigate both hearing and Deaf cultures, and they wanted their children to be prepared to be successful within a hearing world. All the families wanted total communication approaches with both speech and manual communication (such as ASL, English Sing, Cued Speech, finger spelling) for their child. They also indicated that the use of gesturing, drawing, acting-it-out, and facial expressions were important for conveying the meanings of the spoken words. The rich cultural context and oral tradition was a key factor for the participating families, setting the stage for an emphasis on spoken language. Professionals working with African-American families need to understand the role of culture in the decisions that families make for their child (Borum, 2012).

Reflection: ●

In what ways does the intersections of race, hearing level, and language used impact identify formation?

Students who are deaf or hard of hearing, like most other populations of students with special needs, are a very heterogeneous population. Therefore, each child will need an individualized educational program (IEP) to specify their supports and services. A continuum of services is also essential to address the range of strengths and challenges of each student. In 2019–2020, 64 percent of students with hearing impairments were served primarily in regular classes (spending over 80 percent of their time in general education classrooms), 17 percent received services in both the resource room and general classroom, 10 percent received services primarily in special education classes (in general classroom, 40 percent or less of the time), and 12 percent attended separate environments or residential schools (U.S. Department of Education, 2020). Figure 11.3 shows the placements of children who are deaf and hard of hearing for their primary educational services. Making sure that students who are deaf receive support that is both intense and

Myrleen Pearson/Alamy Stock Photo

11-6  Educational Responses for Children Who Are Deaf or Hard of Hearing

Intensive support for communication is important to build a child’s skills and confidence.

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Chapter 11  |  Children and Youth Who Are Deaf or Hard of Hearing

12.0%

General classroom >80% of the day

10.0%

17.0%

General classroom 40–79% of the day General classroom