UNIT ONE: INCLUSIVE EDUCATION

1.1 Definition of Special Needs Education

Many Definitions have been givena bout Special Needs Education by different educators. The following
are some of the definitions of special needs education:
Special needs education means instruction that is specially designed to meet the unique needs of
the exceptional children. It exists to aid exceptional children in developing their full human
potential.
In short, special needs education aims at making the education system inclusive by educating teachers
about identifying children with special needs, finding ways to facilitate active learning for all children,
and establishing support system.
1.2 Origins of Special Needs Education
Although many people believe that special needs education began in the United States in 1975 with the
passage of IDEA, special needs education actually began over 200 years ago with an amazing story in
southern France. In 1799, farmers in southern France found a young boy in the woods and brought that
“wild child” to a doctor in Paris. The child was named Victor. Jean-Marc-Gaspard Itard, the doctor who
now is recognized as the “father of special education,” used many of the principles and procedures of
explicit instruction implemented today to teach the boy, who most probably had intellectual disability.
Although special needs education and the idea of educating students with disabilities had emerged
centuries ago, its delivery was inconsistent with relatively few receiving the cervices they needed. Once
Congress stepped in and passed IDEA, special needs education services became consistently available
across the United States. These services are now guided by many rules and regulations, all with the
intent of protecting students with special needs and their right to education.

Special needs education is meant for infants, preschoolers, elementary through high school students with
disabilities, and in some cases individuals with disabilities up through the age of 21.
1.3 Purposes of Special Needs Education
As education plays an important role for the overall development of individuals, every citizen should
have this opportunity. Teaching children with special needs based on their individualized needs has also
the biggest value in making them productive citizens of the society. The following are some of the
purposes of special needs education:
It solves problems of exceptional children in the regular classroom.

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 It creates awareness about problems of children with special needs among parents, teachers and
the society at large. Hence, it brings about attitudinal changes.
It helps in providing exceptional children with the necessary psychological, educational and
social support that help them exploit and optimize their potentials.
It helps in designing interventions to help exceptional children achieve the greatest possible
personal self-efficiency and academic success.
1.4 Basic Terms and Concepts in Special Needs Education
The following are the basic terms and/or concepts in special need education:
1. Impairment: refers to any loss/abnormality of psychological, physiological or anatomical
structure/function. It is an abnormality of body structure, appearance/organ loss.
Examples: Hearing loss, mental illness, near sightedness, loss of a leg, etc.
2. Disability: is any restriction or lack of ability (resulting from impairment) to perform an activity
in the manner or within the range considered normal for a person of the same age, culture, and
education. It refers to a situation in which a person’s functioning is reduced as a result of
significant physical, learning or social problems.
Examples: Inability to read, see, put on ones clothes, hear, etc…

3. Handicap: refers to the societal level, the environmental and societal deficits influenced by
social norms and policy. It is a disadvantage for a given individual resulting from an impairment
or disability that limits or prevents the fulfillment of the role that is typical (depending on age,
gender, social, cultural, etc.) for that individual.

4. Early intervention: is an attempt to prevent or minimize the physical, cognitive, emotional and
resources limitations of young children with biological or environmental risk factors. The
intervention program has three basic parts. These are:
A) Preventive: it refers to measures taken a head of time to avoid factors that may lead to disability or
aims to reduce the severity of the condition. This can be achieved through education and awareness
training, nutrition, personal and environmental hygiene and medication.
B) Remedial/Remediation: it refers to the condition when the impaired part of the body continues to
perform its usual activity as a result of the special training/support given to the individual with
impairment. Examples, in schools a student can be taught academic skills (such as reading,

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 writing, computing or math’s skills) social skills (such as getting along with others; following
instructions, schedules and other daily routines) personal skills (such as eating, dressing, using the
toilet without assistance) and vocational skills (such as career and job skills).
C) Compensation/compensatory: it involves teaching specific skills or the use of devices that enable
successful functioning. For example, wheelchairs for persons who lose their legs and cannot
walk; people who have lost their voices compensate their problems by writing what they want to
say to others. Usually compensatory treatments are used only when it is impossible to correct the
condition or to remediate the situation.
5. Rehabilitation: refers to a process aimed at enabling persons with disabilities to reach and
maintain their optimal physical, sensory, intellectual, psychiatric, and/or social functional
levels thus providing them with the tools to change their lives towards a higher level of
independence.
6. Segregation: refers to separating persons with disabilities from society. Example, teaching
children in boarding schools or placing them in an institution due to their disabilities
7. Mainstreaming: refers to the return of handicapped children to the regular classroom from the
segregated setting. It is a maximum integration of handicapped students in to the regular
classroom.
8. Children with special needs: is the latest and socially accepted term given to all children with
impairment, disabilities and handicap; street children; children with HIVB/AIDS and other
chronic health problems; linguistically, culturally and economically minorized/deprived children;
children who are gifted and talented, etc.
9. Identification: detecting the existence of certain impairment or disorder. In the process of
identification many individuals are involved such as parents particularly mother, teachers, and
other specialists.
10. Assessment: is the process of determining whether a child exhibits developmental problem, what
the problem is, its cause, its potential course, its developmental consequence and the best
approaches to intervention.
11. Inclusive education: refers to an education system that is open to all learners, regardless of
poverty, ethnic backgrounds, language, learning difficulties and impairments.
12. Inclusive schools: it means ordinary (regular schools) open to all children and students
regardless of poverty, gender, language, impairment, etc.

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1.5 Historical Development of Special Needs Education
The development of special needs education (SNE) is closely related to the society’s economic, political,
cultural and religious development and civilization. For this reason, the historical development of
special needs education is different from country to country.
1.5.1 International Perspective
Understanding the historical development of special needs education on an international basis has the
following advantages.
 It helps to use other countries development as a model
 It helps to make comparisons and to make relation
 To support each other, etc.
The historical development of special needs education can be categorized in to four eras: Early History
(Before 1800), Era of Institution (1800 to 1900), Era of Pubic School/ Special Classes (1900-1960/70)
and Era of Accelerated Growth (1960s/70s onwards).
1. Early History (Before 1800): The early history of societal involvement with people with disability
was primarily one of misunderstanding and superstition. Early references clearly indicated that infants
born with disabilities were abandoned into a forest. Individuals who were considerably “different” from
the normal in appearance or behavior were seen as possessed by demons or evil spirits. As a result of
these and other reasons, during this time people with disabilities were seriously viewedas fools or
perhaps witch. Until the 16thC the general picture of disability was very dark. Generally during this time
people with disability were not accepted as totally humans and were misunderstood, mistreated, and in
many cases put to death.
2. Era of Institutions (1800 – 1900): Institutions for people with disabilities were established in Europe
and United States. Considerable support for institutionalization seems to have come from the fact that
such a practice kept these undesirable or physically unattractive persons out of the public eye.
Institutions for people with disabilities were initially established for the blind and deaf initiated at the
same time, while institutions for people with mental retardation were opened some 50- 60 years later.
The first institutional programs for people with disabilities were initiated in Europe (in France,
Germany, Scotland and England). By 1800, recognized program for the blind was existed in France,
England and Scotland. During the last phase of the 19 th century (1898) new ideas began to emerge.
Alexander Grham Bell proposed the ideas of special classes to teach individuals with visual impairment,
hearing impairment and mental retardation.

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3. Era of Public School /Special Classes (1900 – 1960/70): The first beneficiaries of educational
services (at the beginning of the 20th century) offered in special classes were those who were having
mild mental retardation then individuals with visual and hearing impairments. On the other hand,
children with severe/profound mental retardation were enrolled in residential and special schools like
individuals with hearing and visual impairment. But, after 1920 G.Cthe educable mentally retarded
individuals, person with low vision, hard of hearing, heart failure and children with physical impairment
began to attend their education in special classes with in the regular schools.
However, towards the end of this period, as a result of research findings and questions forwarded from
legal point of view, using special classes as the last option of educational modalities was seen as a form
of segregation. When people hear the term “special classes” they began to develop and manifest a
negative attitude towards the term.

This condition paved the way for the emergence of the following new era in the history of special needs.
4. Era of Accelerated Growth (1960s/70s on wards): At the end of the 20th century, services that had
been offered for persons with special needs were improved. Some of the changes seen during this
period were the following:
The acceptance of persons with special needs as a human being
The development of positive thinking and attitude among education professionals and the general
public towards persons with special needs
Measures taken by the courts, professionals, parents, governments, etc concerning the education
of children with disabilities enabled these children to have access to take part in continuous and
appropriate education with their natural peers. Examples:
 The US Congress passed Public Law 94-142 on “Education for handicapped Act of 1975”
 This Act eventually led to the development of “Individual with Disabilities Education Act
(IDEA) of the 1990”.
The above indicated movements and the initiative taken further by the American Congress enabled to
ensure the rights of children with special needs to have access to free and appropriate regular education.
In addition, legal supports had been practiced to ensure the rights of children to be integrated in the
society and have equal access to the resources of their country, take part in any social and economic
activity without being restricted by their disability.

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1.5.2 Historical Development of Special Needs Education in Ethiopia
In Ethiopia, religious organizations played a vital role in establishing special schools and centers as they
did in the development of special schools and centers internationally. People with disabilities were
participating in the traditional education though few in numbers. For instance, students with visual
impairment were educated in churches and mosques and they were successful since the education was
given orally. This was confirmed by the presence of teachers with visual impairment around mosques
and monasteries who teach Koran, Bible, Poem, and Rhythmical religious songs. Generally, the
following are the major achievements concerning the development of special needs in Ethiopia:
The first modern special school was established in 1917 E.C by Persian church followers for
people with visual impairment at DembiDollo Town.
The second school for people with visual impairment was established in 1936 E.C around
kazanchiz but later transferred to Sebeta where Emperor Haile Sellassie established a building
for the blind as a boarding school in 1950 E.C. This school is still functional.
In 1951 E.C. special school for people with visual impairment was established in Addis Abba
around Kechenie area by the followers of MekaneEyesus Church believers which were later
transferred to Baco.
In 1956 E.C. Mekanisa School for people with hearing impairment was established by the
MesereteKirstose Church believers.
In 1959 E.C. the Alpha Special School for the deaf was established around Bole area by the
American Missionaries. Now it is under the ministry of education and gives service as a special
day school for the deaf.
In 1980 E.C. special school for people with mental retardation was established by MekaneEyesus
around kazanchiz area, Addis Ababa.
From 1986 E.C. on wards (after the implementation of the new Educational and Training Policy)
so many special classes/units within regular schools were established for people with visual
impairment, for people with hearing impairment and for people with mental retardation.
1.7 Categories of Children and Youth with Special Needs
Even though the degree varies, all people have special needs. However, children and youth are
considered educationally exceptional only when it is necessary to alter the educational program. The
following are the main categories /groups of exceptional children.
 Children and Youth with Visual Impairment

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  Children and Youth with Hearing Impairment
 Children and Youth with Mental Retardation
 Children and Youth with Physical and Health Impairment
 Children and Youth with Communication Disorder
 Children and Youth with Multiple Disabilities
 Children and Youth with Learning disability
 Children and Youth with Emotional and Behavioral Disorder
 Children and Youth with Cultural, Linguistic and Environmental Deprivation
 Children and Youth with Gifted and/or Talented.

UNIT TWO: INCLUSIVE EDUCATION

2.1 Defining Inclusive Education
Inclusion is the process of systematically bringing together all children with or without disabilities
regardless of the nature and severity of disability in natural environment where children learn and play
together. Inclusion means the practice of educating students with special needs in regular classrooms
instead of in special education classes. The main tenet of inclusion is that all children with disabilities
have a right to be included in naturally occurring settings and activities with their neighborhood, peers,
sibling and friends. Inclusion is seen as a process of addressing and responding to the diversity of needs
of all learners through increasing participation in learning. It involves changes and modifications in
content, approaches, structures and strategies, with a common vision which covers all children of the
appropriate age range and a conviction that it is the responsibility of the regular system to educate all
children.
Inclusive education is different from integration is that it is not:-
 About changing the students to fit in the system. It is about changing the system to fit the
student.
 Automatic, it is a dynamic process which continues evolving according to the culture, socio-
economic, and political circumstances.
 Another name for ‘special needs education’.
 Just about a specific group. Inclusion education is for all.

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 UNIT THREE: VISUAL IMPAIRMENT (VI)
3.1 Definition of Visual Impairment (VI)
Visual impairment is one of the major known impairments in the world and even in our country,
Ethiopia. Visual impairment is a generic term that involves both low vision and blind. Children with
visual impairment are broadly classified into two groups based on the degree of visual impairment they
have. These include, the partially (the weak sighted) or persons with low vision and the blind. Now, let
us consider the legal and educational definition of the subgroups briefly.
1. Legal definition of visual impairment
According to the legal definition:
A. Blind (totally blind) children are those with an absence of functional vision. They are often
defined medically as having visual acuity of 20/200 or less in the better eye, with correction/ or
whose visual field of less than 20degree in the better eye.
B. Partially sighted (children with low vision) are children whose vision is sufficiently impaired
that they need assistive technology or special services. They are with visual acuity ranging
between 20/70 – 20/200.
2. Educational definition of visual impairment
With respect to the educational definition, partially sighted pupils are those pupils who by reason of
impaired vision cannot follow the normal regime of ordinarily schools without determent to their sights
or their educational development, but can be educated by special methods involving the use of sight
such as enlarged print /magnification. On the other hand, blind pupils are those who are totally without
sight or have little vision, which must be educated through channels other than sight (for example using
Braille or audio-tapes). In line with the education characteristics, Kirk and et al (1993) classified
children with visual impairment into three categories. These are:
1. Moderate visual disability: - children in this category can use their sight to learn with the use of
special aids and lighting. They can perform visual tasks almost like students with normal vision.
2. Severe visual disability: - in performing visual tasks may need more time and energy and be
less accurate even with visual aids and modifications. It is equivalent with low vision. They use
vision as a means of learning.
3. Profound visual disability: - performance of even gross visual tasks may be very difficult and
detailed tasks cannot be handled visually at all. They cannot use vision as an educational tool.
For these children, touch and hearing are the predominant earning channels

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3.2 Prevalence of People with Visual Impairment
In America, individuals with visual impairments make up one of the smallest disability areas, or about
0.04% of the school age population (U.S department of education, 1994). But in a study conducted in
Addis Ababa by Tirusew, et al (1995), visual impairment consists of 30.4% of the total persons with
disabilities (2.95% of the population).
3.3 Causes of Visual Impairment
There are various causes of visual impairments which could be either genetic or environmental. The
major causes of visual impairment include:
A. An opaque or cloudy lens: - is a condition in which the lens becomes opaque and light is blocked
from entering the eye. Cataracts may be caused by injury, heredity or disease factors.
B. Problems during child birth.
C. Drugs taken during pregnancy for treatment of diseases.
D. Accidents after birth.
E. Wounds on eyes or nerves associated with eyes because of trachoma, glaucoma, etc.
F. Certain infection diseases (such as small pox, measles diabetes etc).
3.4 Characteristics of Children with Visual Impairment
Children with visual impairment have the following characteristics that distinguish them from their
sighted peers. These are:
1. Cognition and Language: - sighted children are constantly learning from their experiences and
interactions with their environment. They produce great stories of useful knowledge from everyday
experiences. Visual impairment, however, precludes such incidental learning.
The sense of vision gives children the ability to organize and make connections between different
experiences; connections that help the child make the most of those experiences. Children who are blind
perform more poorly than sighted children do on cognitive tasks requiring comprehension or relating
different items of information. Impaired or absence of vision makes it difficult to see the connection
between experiences. This makes learning even simple language concepts such as “cats have tails” and
“bananas are smooth” difficult. Abstract concepts, analogies, and idiomatic expressions can be
particularly difficult for children who cannot see.
2. Motor Development and Mobility: - blindness or severe visual impairment often leads to delays or
deficits in motor development. First, the absence of sight reduces the baby’s motivation to move. For the
child who is blind, the world is no more interesting when sitting up and turning his/her head from side to
side than it is when he/she is lying on the floor. Second, a child without clear vision may move less often
because movements in the past have resulted in painful contact with the environment.

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In addition to limiting a child’s opportunities to learn through contact and experience with the physical
environment, decreased motor development and movement can lead to physical and social detachment.
Children with low vision have poorer motor skills than do children who are sighted. Their gross motor
skills, especially balance, are weak. They frequently are unable to perform motor activities through
imitation, and they are usually more careful of space and balance.
3. Social Adjustment and Interaction
Compared with normally sighted children, children with visual impairments interact less during free
time and are often delayed in the development of social skills. Some young children with sensory
impairments experience difficulty in receiving and expressing affection, behaviors that have been shown
to facilitate further development in other areas of social competence. Although many adolescents with
visual impairments have best friends, many also struggle with social isolation and must work harder than
their sighted peers to make and maintain friendship. Students with visual impairments are often not
invited to participate in group activities such as going to a ball game or a movie because sighted peers
just assume they are not interested. Many children with visual impairments are unable to benefit from
peers or adult role models who are experiencing the same challenges because of visual impairments.
Another factor contributing to social difficulties is that the inability to see and respond to the social
signals of others reduces opportunities for reciprocal interactions. During a conversation, for example, a
student who is blind cannot see the gesture, facial expressions, and changes in body posture and used by
his/her conversation partner. This inability to see important components of communication hampers the
blind with socially appropriate eye contact, facial expressions, and gestures suggests lack of interest in
his/her partner’s communicative efforts and makes it less likely that the individual will seek out his/her
company in the future.
Some individuals with visual impairments engage in repetitive body movements or other behaviors such
as body rocking, eye rubbing, hand flapping and head weaving. These behaviors were traditionally
referred to in the visual impairment literature as “blindisms” or “blind mannerisms”. Stereotypic
behavior (stereotyping) is a more clearly defined term that subsumes blindisms and mannerisms.
Although not usually harmful, stereotypic behaviors can place a person with visual impairment at a great
disadvantage because these actions are conspicuous and may call negative attention to the person. It is
not known why many children with visual impairments engage in stereotypic behaviors.

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3.5 Identification and Assessment of Children with Visual Impairment
Most children with severe and profound visual disabilities are identified by parents and physicians long
before they enter school. However, mild, correctable visual impairments often go undiagnosed until a
child enters elementary school. Eye specialists’ diagnosis of visual impairment and their measurement of
visual functioning constitute the starting point of the rehabilitation worker’s involvement. Classroom
teachers also play a major role in identifying children with visual impairment. Persons with visual
impairment show different symptoms or signs depending on the degree of the impairment that help
parents and teachers identify these children. Some of them are presented as follow.
1. Rubbing eyes excessively: - they shut or cover one eye/blink more than usual.
2. Light sensitivity: - they are unusually sensitive to bright or even normal light.
3. Losing place during reading: - they lose their place in a sentence or page while reading.
4. Unusual facial expressions and behavior
5. Eye discomfort: - they complain of burning, scratchiness of their eyes
6. Holding reading materials at an inappropriate distance
7. They have difficulty in distance vision
8. They have blurred or double vision
9. Reversals: – they have a tendency to reverse letters, syllables etc.
10. Letter confusion: - they may be confused of letters for similar shape, such as o & a, c & e, n &m
3.6 Educational Adaptation and Life Skills Training For People with VI
3.6.1 General Adaptation Mechanisms
A number of adaptations in materials and equipment as well as life skills trainings are needed to fully
utilize the senses of hearing, touch, smell, residual vision and even taste of children with visual
impairment. Generally, the following are some of the major educational adaptations and life skills
trainings that should be provided for children visual impairments.
A. Educational Adaptations: -Lowen Feld (1973), proposed three general principles of instructional
adaptations. These are:
a. Concreteness: - Children with severe and profound visual disabilities learn primarily through
hearing and touch. For these children to understand the surrounding world, they must work with
concrete objects that can be felt and manipulated.
b. Unifying Experiences: - The teacher must teach in a holistic manner not only by giving students
concrete experience but also by explaining relationships.

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 c. Learning by doing: - In order to enable students with visual impairment learn about their
environment, we have to motivate them to be active participants.
B. Communication Skills: - Learning to use Braille is a key skill for communication for people with
visual impairment. Braille is a tactile system of reading and writing in which letters, words,
numbers, and other systems are made from arrangements of raised dots. Braille was developed by
Louis Braille, a French man who was blind. Listening (the ability to hear, understand, interpret, and
critically evaluate what one hears) is another skill that should be developed for children with visual
impairment. It is an important skill for these children as much of the information they use is received
through listening.
C. Environmental Skills: Mastering the environment is especially important to children who are blind
for their physical and social independence. More specifically, they should learn a system of
marking and organizing clothes for both efficiency and good grooming. Orientation and mobility
are among the leading limitations imposed by blindness. The ability of mobility helps the child with
visual impairment become more self-sufficient and less likely to slump into periods of learned
helplessness. It is essential to move safely, efficiently, and gracefully within the environment.
Orientation means using sensory information to establish and maintain his or her position in the
environment.
3.6.2 Specific Support
1. Educational support for the Blind
 Teach the child to build an image of an object by touching ever bit of it
 Say orally whatever you are writing on the blackboard
 Encourage them to take part in many physical activities
 Avoid any obstacle that many hinder the blind’s activity
 Maintain a welcoming physical and social environment
2. Educational support for children with low vision
 Encourage them to use their vision through the help of aids
 Sit them close to the blackboard
 Use/supply a magnified written materials
 Usually low vision children have an identity crisis because they are neither accepted by the blind
nor by the sighted children. Therefore, they need to be assisted to be emotionally stable.

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 UNIT FOUR: HEARING IMPAIRMENT (HI)
4.1 Definition and Classification of Hearing Impairment
Like other disabilities, hearing loss can be defined and classified from different perspectives and from
different purposes. A medical definition, for example, describes the degree of hearing loss on a
continuum from mild to profound. Educational definitions of hearing loss, on the other hand, focus on
the child’s ability to use his/her hearing to understand speech and learn language and its adverse effects
on the child’s educational performance. Most special educators distinguish between children who are
deaf and those who are hard of hearing. A child who is deaf is not able to use hearing to understand
speech. Even with a hearing aid, the hearing loss is too great to allow a deaf child to understand speech
through the ears alone. Although a deaf person may perceive some sounds through residual hearing,
he/she uses vision as the primary modality for learning and communication.
A child who is hard of hearing has a significant hearing loss that makes some special adaptations
necessary. Children who are hard of hearing are able to use their hearing to understand speech, generally
with the help of a hearing aid. Though they may be delayed or deficient, the speech and language skills
of a hard of hearing child are developed mainly through the auditory channel. Generally, based on the
above facts, the term hearing impairment is a generic term that is used to describe both people who are
deaf and those who are hard of hearing.
When it comes to the classification, hearing impairment can be classified based on the following
classification criteria:
1. Based on the onset of the problem: - Although the degree of hearing loss is important, the age in
which the hearing loss occurs is also important. Individuals who become deaf before they learn to speak
and understand language are referred to as pre-lingually deaf. They are either born deaf or loss their
hearing ability as infants (shortly after birth) whereas those children who become deaf after they learn
and develop speech and language are called post-lingually deaf.
2. Based on the nature of the cause: - based on the nature of the cause hearing impairment can be
classified in to three. These are: conductive hearing loss, sensorineural hearing loss and mixed hearing
loss. Conductive hearing loss is caused by interference in the conduction of sound from the ear canal to
the inner ear. Because of a problem in either the outer or middle ear, the intensity of sound reaching the
inner ear is diminished. A blockage of the ear canal will interfere with the transmission of sound. This
breakdown in conduction of sound may occur for any number of reasons. Among these, objects lodged

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in the canal and excessive wax buildup is common problems. This problem can be corrected through
surgical/medical treatments. Sensorineural hearing loss is caused by damage to either the inner ear or
the auditory nerve. These losses may be complete or partial and may involve only certain frequencies.
Sensorineoral losses are often the result of destruction of receptors in the inner ear. Surgery/ medication
cannot correct most of sensorineural hearing loss. Amplification may not also help a person with it
except cochlea implant. Mixed hearing loss may occur as a consequence of both impairments in the
conduction of sound and sensorineural damage
3. Based on the degree of severity level: - one important approach to the classification of hearing
losses is to determine the intensity level of sound below which a person does not hear. We measure the
ability of hearing and hearing loss by using two dimensions: intensity and frequency. The decibel is a
unit used for the measurement of the loudness or intensity of sound. Decibel measures are used as
indicators of the range of intensity of sound that an individual is able to perceive. The range of human
hearing normally encompasses intensities from 0 to 30 decibels (dB).
Frequency or pitch is measured in hertz (Hz) or cycles per second. The range of the frequency for
conversational speech is between 500 and 2000Hzn. Both loudness and frequency of sound can be
measured with in instrument called audiometer.Accordingly,one approach to the classification of
hearing losses is to determine the intensity level of sound below which a person does not hear. The
following table shows the functional hearing in relation to language and behavior.

4.2 Causes of Hearing Impairment

The causes of hearing impairment can be studied in several ways. It is pointed out that hearing
impairment can happen in prenatal, perinatal and postnatal periods of human development due to
different reasons. Hearing impairment may also be caused by genetic (congenital causes) and
environmental (acquired causes) factors.
4. 3 Characteristics of Children with Hearing Impairment
1. Language and Vocabulary: - a child with a hearing loss-especially a Pre-lingual loss of 90 dB or
greater-is at a great disadvantage in acquiring language and vocabulary skills. Since reading and writing
involve graphic representations of a phonologically based language, the deaf child must strive to decode
and produce text based on a language for which he/she may have little or no understanding.
Students with hearing loss have smaller vocabularies when compared to peers with normal hearing, and
the gaps widen with age. Children with hearing loss learn concrete words and concepts more easily than

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abstract words and concepts. They may also have difficulty differentiating questions from sentences,
difficulty with function words and verb phrases like “the”, “an”, “are”, and “have been” and difficulty
understanding and writing with passive voice. Moreover, many students who are deaf write sentences
that are short, incomplete, or improperly arranged.
2. Speaking: - atypical speech is common in many children who are deaf or hard of hearing. All of the
challenges that hearing loss possess to learning the vocabulary, grammar, and syntax of a language, not
being able to hear one’s own speech makes it difficult to assess and monitor it. As a result, children with
hearing loss may speak too loudly or not loudly enough. They may speak in abnormally high pith or
sound like they are mumbling because of poor stress, poor inflection, or poor rate of speaking. The
speech of children with hearing loss may be difficult to understand because they omit quiet speech
sounds such as /s/, /ch/, /f/, /t/, and /k/, which they cannot hear.
3. Academic Achievement: - most children with hearing loss have difficulty with all areas of academic
achievement, especially reading and math. It is important not to equate academic performance with
intelligence. Deafness itself imposes no limitations on the cognitive capabilities of individuals, and some
deaf students read very well and excel academically. The problems that students who are often
experience in education and adjustment are largely attributable to the mismatch between their perceptual
abilities and the demands of spoken and written language.
In some, hearing impairment is closely related to language development again language is closely
related to reading and achievement in all academic areas. Many investigators have found that students
with hearing impairment are, as a group, significantly behind normally hearing children on standardized
tests of reading and academic achievement.
4. Social Functioning: - hearing loss can influence a child’s behavior and socio-emotional
development. Children with severe to profound hearing losses often report feeling isolated, depression,
social withdrawal, without friends, and unhappy in school, particularly when their socialization with
other children with hearing loss is limited.

These social problems appear to be more frequent in children with mild or moderate hearing losses than
in those with severe to profound losses. Studies have revealed that children with hearing loss are more
likely to have behavioral difficulties in schools and social situations than are children with normal
hearing. Even a slight hearing loss can cause a child to miss important auditory information, such as the

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tone of a teacher’s voice while telling the class to get out their spelling workbooks, which can lead to the
child’s being considered inattentive, distractible, or immature.
The extent to which a child with hearing loss successfully interacts with family members, friends,
teachers, and people in the community depends largely on others’ attitudes and the child’s ability to
communicate in some mutually acceptable way. Children who are deaf with deaf parents are thought to
have higher levels of social maturity and behavioral self-control than do deaf children of hearing
parents, largely because of the early use of manual communication between parent and child that is
typical in homes with deaf parents. Many individuals who are deaf choose to work, live, and socialize
primarily with other deaf people.
Generally, according to Moores (1985), four conditions appear to be most closely related to the
academic success of children with hearing impairment. These are:
a) The severity of the hearing impairment, the greater the hearing loss the more likely the child is to
experience difficulty in learning language and academic skills.
b) The age at the onset of the hearing loss.
c) The socio economic status of the family. A hearing impaired child whose parents are affluent
and college educated is more likely to achieve academic success than a child from a low –
income less educated family.
d) The hearing status of the parents. A deaf child with deaf parents is considered to have better
changes for academic success than a deaf child with normally hearing parents.
4.4 Identification and Assessment of Children with HI
A child with hearing problem can be assessed by considering the decibel level that the child hears is one
usual method, by using audio meter. It is possible to assess the hearing ability by using the following
methods.
Careful observation of the main symptoms is vital.
Studying the causes of hearing loss and its consequence together with parents.
Using destructing tests, introducing a sound source behind and to either side of the child.
The following behavioral manifestations/symptoms are helpful in identifying children with hearing
impairment.
 Lack of attention
 Best work in small groups
 Dependence on classmates for instructions
 Turning or cooking of head
 Acting out, stubborn, shy, or withdrawn behavior

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  Use of gestures
 Disparity between expected and actual achievement
 Reluctance to participate in oral activities
 Lack of attention when there is oral instruction
 Complains of earaches
 Speaks unusually very loudly or very slightly
 Shows delayed language development
4.5 Educational Interventions of Persons with HI
Communication is the most serious problem related to hearing impairment. As a result, an effective
communication method that enables person with hearing impairment to communicate among themselves
should exist. There are three basic approaches to teaching alternative means of communication to
students with hearing impairment who are unable to develop and/or use standard means of
communication. These approaches are:
4.5.1 The Manual Method: - the manual method of communication has two basic components. First,
sign language is used to represent words or concepts. The second component of the manual method is
finger spelling. Finger spelling is achieved by use of the manual alphabet. Hand positions are
designated for each letter of the English alphabet. Finger spelling usually serves as a supplement to sign
language.
4.5.2 The Oral Method: - the oral approach emphasizes the development of speech and speech reading.
There are several methods that are included in oral communication methods. These are:
A. Auditory training: In this oral communication method utilization of residual hearing and training to
listen oral language should be given from early childhood to develop normal
languages and speech.
B. Lip- reading: It is the visual interpretation of spoken communication.
C. Cued- speech: It is using hand shape and position while speaking.
4.5.3 Total Communication Method: - it is a method of communication for hearing children with
hearing impairment, which means the simultaneous or combined method presents, such as signs, finger
spelling, speech reading, speech and auditory amplification at the same time.

17
Total communication is meant the right of every deaf child to learn to use all forms of communication in
order that he/she may have the full opportunity to develop language competence at the earliest age
possible. Total communication has gained a great deal of acceptance in recent years among educators of
children with hearing impairments.
In addition to the above communication general methods of communication, teacher should use the
following specific support while they are teaching students with hearing impairment.
1. Educational support for the Deaf
Use sign language
Use face to face contact as much as possible
Avoid things that may affect their feeling
2. Educational support for the hard of hearing
2.1 For those with slight hearing loss
 Reduce distance between the teacher and the student
 Speak a little bit loudly than whispering
 Seat the students in front of the teacher
 Let them use a hearing aid
 Avoid distractions
2.2 For those mild hearing loss
 Use small group
 Not to be far more than 5 feet from the child
 Encourage them to use residual hearing, lip reading and hearing aid
 Avoid distractions
 Make the child seat in appropriate place
2.3 For those with moderate hearing loss
 Make your voice louder
 Help them individually to grasp abstract concepts
 Encourage them to use lip reading, residual hearing and hearing aid
2.4 For those with severe hearing loss
 Use sign language
 Better not use hearing aid for it creates discomfort for them
 Lip reading, cued speech and finger spelling can help them
 Be extremely close to the child while speaking

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 UNIT FIVE: PHSICAL AND HEALTH IMPAIRMENTS
5.1 Definition and Classification of Physical and Health Impairments
5.1.1 Definition of physical and health impairments
Physical disability is a condition that interferes with the child’s ability to use his or her body. Many but
not all, physical disabilities are orthopedic or neuromotor impairments. The term orthopedic impairment
involves the skeletal system-bones, joints, limbs, and associated muscles. Neuromotor impairment
involves the central nervous system, affecting the body’s ability to move, use, feel, or control certain
parts of the body. Although orthopedic and neurological impairments are two distinct and separate types
of disabilities, they may cause similar limitations in movement. Many of the same educational,
therapeutic and recreational activities are likely to be appropriate for students with these disabilities.
And there is also a close relationship between the two types: for example, a child who is unable to move
his/her legs because of damage to the central nervous system (neuromotor impairment) may also
develop disorders in the bones and muscles of the legs (orthopedic impairment), especially if he/she
does not receive proper therapy and equipment.
Health impairment, on the other hand, is a condition that requires ongoing or continuous medical
attention. It includes having limited strength, vitality, or alertness, due to acute health problems such as
heart condition, tuberculosis, rheumatic fever, nephritis, asthma, sickle cell anemia, hemophilia, lead
poisoning, leukemia, or diabetes, that adversely affects a child’s educational performance. Health
impairments include diseases, and special health conditions that affect a child’s educational activities
and performance, such as cancer, diabetes, and cystic fibrosis.
Physical disabilities and health conditions may be congenital (a child is born with a missing limb) or
acquired (a child without disabilities sustains a spinal cord injury after birth). Not all students with
physical disabilities and health conditions need special education. Most physical disabilities and health
conditions that result in special education are chronic conditions-that is, they are long lasting, most
often permanent conditions (e. g., cerebral palsy is a permanent disability that will affect a child
throughout his/her life). By contrast, an acute condition, while it may produce severe and debilitating
symptoms, is of limited duration (e. g., a child who acquires pneumonia will experience symptoms, but
the disease itself is not permanent).
5.1.2 Classification of physical and health impairments
Physical disability can be classified based on two classification systems. First, it is based on the degree
of severity of the physical disability and motor skills. This involves:
A. Mild physical disability: individuals with mild physical disability can walk without aids and
may make normal developmental progress.
B. Moderate physical disability: individuals with moderate physical disability can walk with
braces and crutches and may have difficulty with fine motor skills and speech production.
C. Severe physical disability: individuals with severe physical disability are wheelchair dependent
and may need special help to achieve regular development.

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The second classification system is primarily based on the affected area. This includes two major types
of physical disabilities: the neurological system (which are caused by brain, spinal cord and nerve
related problem), and musculo-skeletal system (which are caused by problems in muscles, bones and
joints due to various causes).
1. Neurological System: - Some of the physical disabling conditions under neurological system are the
following.
A. Cerebral palsy- a disorder of movement and posture- is the most prevalent physical disability
(orthopedic impairments) in school age children. The term cerebral palsy is used to designate the various
effects that damage to the brain may have on movement. The effect may be mild or severe. The problem
may be specific to a very small region of the body or the problem may involve most of the body.
The causes of cerebral palsy are varied and not clearly known. It has most often been attributed to the
occurrence of injuries, accidents, or illnesses that are prenatal (before birth), perinatal (at or near the
time of birth), or postnatal (soon after birth). The condition affects muscle tone which interferes with
voluntary movement and full control of muscles, and delay in gross and fine motor development.
Cerebral palsy is classified in terms of the affected parts of the body and by its effects on movement. The
term plegia (from the Greek “to strike”) is often used in combination with a prefix including the location
of limb movement. Accordingly, cerebral palsy can be classified in to seven groups as they are depicted
in the following table.

Classification/Type Involvement of the Limb (Affected Area)

Monoplegia Only one limb (upper or lower)
Hemiplegia Two limbs on same side of the body (an arm and leg)
Paraplegia Only legs
Triplegia Three limbs
Quadraplegia All four limbs (legs, arms, including trunk and face)
Diplegia Primarily the legs, with less severe involvement of the arms
Double-hemiplegia Primarily the arms, with less severe involvement of the legs

In many cases, cerebral palsy may be found in association with additional problems, such as learning
disability, mental retardation, seizures, speech impairment, sensory impairments( like vision or hearing),
and joints and bone deformities such as spinal curvatures and contractures. Approximately 40 percent of
those with cerebral palsy have normal intelligence, the remaining have from mild to severe retardation.
Persons with cerebral palsy are extremely heterogeneous group having unique abilities and needs.
B. Epilepsy is a disorder that occurs when the brain cells are not working properly and is often called a
seizure disorder. It is a neurological condition that involves rapid and unusually brief changes in
consciousness accompanied by involuntary movements.
Epilepsy has the longest history among mental disorders and many great men, like Julius Caesar,
Alexander the great and Napoleon were epileptics. Epilepsy is not a disease, it is not contagious and it is

20
not caused by evil spirits. Although the exact cause of a seizure is usually not known, it can result from
various conditions, including:
 Developmental brain abnormalities
 Infections
 Brain injury/trauma
 Hypoxia
 Hypoglycemia

Types of Epilepsy
Although there are several types of seizures, they all are caused by the same thing – an electrical
dysfunction, or an abnormal electrical discharge, in the brain. The following are the three major types of
epilepsy.
A. Grand mal /Great Illness: - I t is the most complex seizure as compared to the others.It consists of
the following four phases:
1. The aura phase: this phase is characterized by unusual sensory experiences/signals, such as
strange odors, strange sounds, etcwhich are warnings of the impending convulsion.
2. The tonic phase: here there is the actual convulsion which is followed by:
 Body rigidity
 Loss of consciousness
 Falling heavily on the ground
 Opening of the eyes
 Suspending of breathing for about 30 seconds
3. The clonic phase: it is characterized by:
o Secretion of muscles’’ spasms
o Violent, continuous and jerky movements of limbs
o Losing of spinster control
4. The coma phase: in this phase:
 The individual still remains unconscious
 The convulsion stops completely
 The victim wakes up either immediately or after several hours
B. Petit mal /absence seizure:- It is characterized by:
 Sudden head dropping
 Frequent blinking of the eyes
 Dropping/throwing of objects at hands
 Missing parts of verbal instruction
 May be loss of consciousness for 5-30 seconds
 It may occur 50-200 times a day
 If left untreated, it may be transformed in to grand mal seizure
C. Psychomotor seizure (complex petit mal seizure):- Here the attacks begin with the subjective
experience of sensations, such as peculiar odors. This is followed by psychic disturbances, such as

21
 restlessness, unusual fear, aggressiveness, eye blinking, lip smacking, facial grimacing repletion of
movements, etc. This in turn leads to clouding/loss of consciousness characterized by:
Climbing up a table/chair
Undress in public
Searching things they do not loss
Disrobing/laughing or crying for no reason
Educational and psychosocial support for children with epilepsy
 Avoiding misunderstanding and negative attitude towards these children
 Remain calm during its episode, be aware that you can’t stop a seizure once it has started
 If a person is standing make him/her lie in the floor
 Avoid anything harm and sharp around
 Turn the individual’s face to the side so that saliva can flow out of the mouth
 Do not insert anything between the individual’s teeth
 Stay with the person after emergency and allow him/her to sleep/rest if he/she wishes
 If the attack is followed immediately by another seizure or if it lasts more than 10 minutes, it is
recommended to call a doctor
 Notify the parents/guardians that a seizure has occurred
 If, after resting, the individual seems likely to collapse, confused or weak, it is good to
accompany him/her home

Educational support for children with physical disabilities

A. Medical Services
Physical therapy
Provide children with adaptive devices, such as:
 Wheelchair
 Adaptive devices
 Prosthesis- artificial replacement for the missing body part, such as artificial limb
 Orthosis- a device that enhances partial functioning of body part, such as leg brace
Physical exercise
Surgical services
B. School bound Services
 Removing all the barriers
 Teaching and encouraging children to use their unaffected body part
 Arranging educational activities to the students’ ability level
 Provide children with counseling services
 Allow the child more time to complete the assigned task
 Give less written works to a child whose hands are affected

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 Health-related Disorders
1. Diabetes
Diabetes is a chronic disorder of metabolism.It occurs when the body/specifically the pancreas either
does not produce insulin at all or it does not effectively use the produced insulin.
NOTE THAT:
 Pancreas gland: it regulates the level of blood sugar /glucose by producing two hormones:
o Glucagon raises the level of blood sugar in the body
o Insulin lowers the level of blood sugar in the body
 Pancreas:is hormone necessary for transporting specific sugar to the body.

Types of Diabetes
1.1 Type 1 diabetes: -it is normally called insulin dependent diabetes mellitus (IDDM). It occurs
when the body /pancreas does not produce insulin or produces it in a very small quantities.
When this happens it causes too little blood sugar level called Hypoglycemia or insulin
reaction/diabetic shock. Type 1 diabetes usually occurs during childhood.
1.2 Type 2 diabetes: -it is known as non-insulin dependent diabetes mellitus (NIDDM). Even
though there is insulin in the body, tissues do not respond to insulin. In other words, type 2
diabetes occurs when pancreas produces too little insulin or when the body uses the insulin
ineffectively. This condition causes excessive blood sugar level called Hyperglycemia/diabetic
coma. Type 2 diabetes typically emerges in adulthood. Its onset is gradual rather than sudden.
N.B.
If left untreated, especially type 2 diabetes causes high blood sugar level that results in damage
to the eyes, kidneys, heart and nerves.
About 90 percent of all diabetes cases are type 2 diabetes and usually occurs after the age of 45.
It is believed that there is a strong relationship between obesity and type 2 diabetes.
In general, both type 1 and type 2 diabetes complications many lead to blindness, kidney failure
and heart diseases for diabetes can cause tiny or large blood vessels to become blocked.
Diabetes, especially type 1diabetes is a common childhood disease, affecting about 1 in 600 school age
children, so it is likely that most teachers will encounter students with diabetes at one time or another.
Without proper medical management, the diabetic child’s system is not able to obtain and retain
adequate energy from food. Not only does the child lack oxygen, but also many important parts of the
body- particularly the eyes and kidneys- can be affected by untreated diabetes. Teachers who have a
child with diabetes in their classrooms should learn how to recognize the symptoms of both too little
sugar and too much sugar in the child’s bloodstream and the kind of treatment indicated by each
condition.
Symptoms of Diabetes
 Fatigue /dizziness /sleepiness
 Excessive thirst/an extreme desire to drink

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  Increased hunger/an extreme desire to food
 Blurred vision/visual problem/impairment
 Frequent urination/discharge of urine
 Dry, hot and itchy skin
 Cuts that are slow to heal
Risk factors
 Genetic predisposition
 Foods, particularly those which are too high in fats and carbohydrates
 Life styles (obesity, smoking, etc)

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 UNIT SIX: INTELLECTUAL DISABILITY (ID)
6.1 Definition and Classification of Intellectual Disability
6.1.1 Definition of intellectual disability
Intellectual disability is viewed differently across various periods, cultures as well as different scholars.
For instance, in ancient period people with the problem were known by different names like dumb,
stupid, immature, defective, subnormal, feeble minded, incompetent and dull as well as idiot and foolish,
which are very negative and immoral. Nowadays, such kinds of words are not used to name people with
intellectual disability. This indicates that there is change in the positive direction. Meanwhile, the
definition of intellectual disability has undergone many various changes during various periods. For our
case, let us see the two most recent definition of intellectual disability.
6.1.1.1 The Individual with Disabilities Education Act (IDEA) Definition
In IDEA, intellectual disability is defined as “significantly sub average general intellectual functioning
existing concurrently with deficits in adaptive behavior and manifested during the developmental period
that adversely affects a child’s educational performance” (U.S. Department of Education, 1997).
6.1.1.2 The American Association on Mental Retardation (AAMR’s) Definition
In 1992, the AAMR published a definition and approach for diagnosing and classifying intellectual
disability that represented a conceptual shift from viewing intellectual disability as an inherent trait or
permanent condition to a description of the individual’s present functioning and the environmental
supports needed to improve it. That definition was revised in 2002 and read as follows:
Intellectual disability refers to a disability characterized by significant limitations both in
intellectual functioning and in adaptive behavior as expressed in conceptual, social, and
practical adaptive skills.
6.1. 2 Classification of intellectual disability
Intellectual disability has been classified in different ways by different scholars from different
disciplines. The most widely used classifications are those forwarded by educators, psychologists (based
on the result of IQ test) and by other professionals (based on the level of support needed). Below are
brief descriptions of commonly used classification of intellectual disability.
6.1.2.1 Classification of intellectual disability by the degree of level of intellectual impairment
Persons with intellectual disability have traditionally been classified by the degree of level of intellectual
impairment as measured by an IQ test. Accordingly, the most widely used classification method cited in
the professional literature consists of four levels of intellectual disability according to the range of IQ
scores shown as follows:
Level Intelligence Test score
Mild intellectual disability 50-55 to approximately 70
Moderate intellectual disability 35-40 to 50-55
Severe intellectual disability 20-25 to 35-40
Profound intellectual disability Below 20-25

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6.1.2.2 Classification of intellectual disability based of the learning characteristics
In this approach, classification of intellectual disability is usually made on the basis of the available
educational provisions for people with intellectual disability. These individuals have a wide range of
ability and require diverse educational sources. Accordingly, intellectual disability has classified into
four educational levels. These are:
1. Educable Intellectually Disabled /Mildly Disabled: - individuals who have IQs between 50 and 70
are labeled as educable or mildly intellectually disabled (EID). In terms of their physical characteristics
and general health, they are not noticeably different from the “normal” ones. They are capable of
learning fundamental academics and personal responsibilities. They are also able to function within the
traditional level curriculum with only minor modification and assistance. As adults, they can be self-
sufficient and live independently as productive members of the community. However, they display
delays of 1 to 3 years in school performance. In addition, they may need assistance to pursue their
occupation when they face stressful situations.
2. Trainable Intellectually Disabled /TID /Moderately Disabled: - this category involves children
who have IQs between 35 and 49. Compared to mildly intellectually disabled, moderately disabled
children’s adaptive capacities are seriously impaired. They have a functional ability of approximately
one-half to one-third of expected for their chronological age. These children are able to master self-care
skills, basic language, and cognitive concepts. As adults, with supervision, they will be able to live in
community homes and work with supervised workshop facilities. They can benefit from vocational,
occupational and social trainings, and with supervision they can care for themselves. Traditionally, these
children have been educated within segregated schools, training centers, and private facilities.
Nowadays, they are being integrated into regular school compounds.
3. Supportable /severelyintellectuallydisabled/ Dependent: - these are children with IQs between 20
and 34. During their pre-school years, they manifest poor motor development and little or no speech.
Children in this category may learn to talk during their later school years and can learn basic hygiene
skills. They profit little from vocational training. As adults, they may be able to perform simple tasks
with close supervision. The educational emphasis for these children is on acquisition of self-care, motor,
and language skills focusing on their abilities to function effectively in various contexts.
4. Life Support/ Profoundly Intellectually Disabled: - profoundly intellectually disabled children have
IQs less than 20. During their preschool years, they manifest only minimal sensory motor functioning.
They may show some motor development during their latter school years, and may benefit minimal from
self-care training. As adults, they may develop some speech, able to take a very limited self-care; they
require constant supervisions in a very structured environment.
6.1.2.3 Classification based on the intensity of support needed
The focus here is not on IQ test results, rather on the intensity of supports needed. The following
classifications are made based on the intensity of supports needed.

26
A. Intermittent Support: - children in this category do not need help regularly. Hence, supports are
given as a “needed basis.” These children may need supports on the short term basis during some
situations in their lives. For instance, they may need help when:
 They enter into school for the first time
 They start job for the first time
 They lose jobs
 They have acute medical crisis, etc.
B. Limited Support: - this type of support is delivered in a consistent manner over limited time. The
time of giving and stopping supports is limited. The support givers clearly know how and when they
give support. For example, we can train an individual in this category for three months before she/he
starts working in a factory.
C.Extensive Support: - extensive supports are characterized by regular basis involvement in at least in
some environments. These supports are not time limited. Individuals in this category may need extensive
supports at home, or school, or work place. A child may need help in school but not at home
D. Pervasive Support: - constancy and high intensity are the main characteristics of pervasive supports.
These supports are also given across environments. They have potentially life-sustaining nature.
Pervasive supports need more staff members and intrusiveness than do extensive or time-limited
supports.
6.2 Causes of Intellectual Disability
Most causes of intellectual disability in most situations are not known. Research has shown that the
causes are clearly known in only 6% to 15% of the cases. That means 94% to 85% of the cases have
unknown causes. However, nearly four hundred causes of intellectual disability have been identified by
the American Association on Mental Retardation (1992). Such factors account for fewer than 2.5 % of
the retarded population. Generally, the causes of intellectual disability can be divided into two broad
categories which in turn are classified into specific factors. These are physiological/biological causes
and cultural-familial causes. They are briefly described in the following manner.
6.2.1 Biological /Hereditary Causes: - these include:
A. Chromosomal Abnormalities/Genetic Defects
There are a number of forms of intellectual disability that are caused by genetic factors. Any defect in
the genetic materials of the individuals could result in intellectual disability. In brief, given similar
environmental conditions, the hereditary factors the individuals inherit from their parents will have
prominent effects on their intellectual, social, and personality development. For example, Down’s
syndrome. Down’s syndrome is one of the most common chromosomal disorders, accounts for the
largest number of cases of intellectual disability in which extensive and pervasive supports are required.
It is caused by the presence of extra chromosomal materials in the cells. The most common form is
called Trisomy 21 because of an extra chromosome attached to the twenty-first chromosome pair. The
risk of giving birth with Down’s syndrome increases with maternal age after 30 or 35 years. Children
with Down’s syndrome are characterized by slower rate of mental and language development, and
difficulty in learning advanced or complex skills.

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6.2.2 Pre, Peri and Post natal Causes
Genetic and chromosomal causes of intellectual disability are present from the moment of conception.
Pre, peri and post natal causes, however, have their origins sometimes after conception but before birth,
during birth or soonafterbirth. Infections with virus (such as mumps, chickenpox, and in some forms of
influenza) in early pregnancy, heavy alcohol intake of pregnant women, poor nutrition, injuries,
prematurity, lead poisoning, birth injuries, carbon monoxide poisoning, injections of other toxins, blood
incompatibility, allergic reactions, accidents, anoxia, Infectious diseases, child abuse and neglect and the
like may result in brain damage of the fetus and consequent retardations.
6.2.3 Cultural - Familial Causes
Environmental influences (both physical and social) play remarkable roles in the prevalence of
intellectual disability. Cultural-Familial Cause is another major variable of intellectual disability. It is
the causes of 75% of the retarded children for whom there is no organic pathology and whose
retardation is presumed to be due to the combination of hereditary and environmental factors. Children
in this category are usually mildly intellectually disabled (50 to 70 IQs) and the incidence of the
disability is higher in their families. The lower socio-economic level is disproportionately represented.
The physiological function of these children may be below normal. Absence of good reinforcement for
intelligent behavior, harsh punishment for specific behaviors, homelessness, poverty, severe abuse and
neglect, malnutrition, psychosocial deprivations are some environmental factors that can cause
intellectual disability.
6.3 Characteristics of Children with ID
Individuals with intellectual disability have shown typical characteristics in intellectual/cognitive
functioning, education, social interaction, and physical appearance. These characteristics are briefly
described as follow.
6.3.1 Cognitive/ Intellectual Characteristics
Intelligence refers to a student’s general mental capability for solving problems, paying attention to the
relevant information, thinking abstractly, remembering important information and skills, learning from
everyday experiences, and generalizing knowledge from one setting to another. Intelligence is measured
by intelligence tests. The mean and standard deviation of intelligence test results are 100 and 15
respectively. With respect to intelligence, a person is regarded as having intellectual disability when
she/he has an IQ score approximately two standard deviation below the mean. Research findings have
revealed that persons with intellectual disability have limitations on the following intellectual
functioning.
1. Memory problem: - individuals with intellectual disability have impairments in memory,
especially in short-term memory. Short term memory is the mental ability to recall information
that has been stored for a few seconds to a few hours such as the step-by-step instructions
teachers give to their students. The problem is said to be due to the inability to use good learning
strategies such as grouping items and rehearsal.
2. Transference problem in learning: - persons with intellectual disability are said to experience
difficulties in applying information to new situations that are similar but somewhat different

28
 from those experiences during initial training. Students with intellectual disability typically have
difficulty of generalizing the skills they have learned in school to their home and community
settings.
3. Low Motivation: - motivation is a drive force that pushes us to achieve some goals. In this
regard, people/students with intellectual disability are characterized by low motivation. This low
motivation leads them to a problem solving style that is called outer-directedness - distrusting
one’s own solutions and looking excessively to others for guidance.
4. Imitation problem: - imitation is a skill which children develop naturally through play and
learning experiences at home and with peers. Many people with intellectual disability have
imitation problem and need specific instruction and practice before they can imitate a model.
5. Difficulty in discrimination: - the ability to discriminate between instances is one of the
foundations of learning. Materials vary on the dimensions of shape, color, size, brightness and
positions. Based on these dimensions, children should be able to identify and use that to
discriminate consistently. However, children with intellectual disability are usually in trouble to
do so.
6. Attention problem: - research has shown that children with intellectual disability have attention
deficits. It is manifested in three areas: short attention span, problem of focusing attention, and
problem of selective attention.
7. Adaptive behaviors: - these children have limitations in skills needed to function in different
environments.
6.3.2Educational/Academic/ Characteristics
Generally, students with intellectual disability are under achievers. They perform poorly in most
academic areas compared to that of their normal peers. However, their performance is as a level
expected from their intelligence test (IQ). This is one distinction between intellectual disability and
learning disability. Students with learning disabilities show a discrepancy between their score on
intelligence and achievement tests, i.e., they perform less than their intelligence scores
Most of students with intellectual disability have problem in reading comprehension, in mathematical
reasoning, and in basic statistics such as addition, subtraction, multiplication, and division. Professionals
in the area pointed out that repeated failure and frustrations in classroom, and inappropriate expectations
and tasks are the leading causes of low performance.
6.3.3Social/Emotional Characteristics
Compared to normal children, children with intellectual disability exhibit more social and behavioral
problems. By and large, individuals with intellectual disability show socially in appropriate behaviors
from the normal ones. They lack social skills to establish and maintain friendship. Because they are both
socially and emotionally immature, behavioral problems such as disruptiveness, attention deficits, poor
self-image or self-concept, rigidity, distractibility and the like are more prevalent on individuals with
intellectual disability than their normal peers.

6.3.4Physical/Motor Characteristics
29
Empirical research findings and our day-to-day experiences have shown that children with intellectual
disability have no significant physical impairments in height, weight, and skeletal maturity. However,
they lag behind their normal peers on measures of gross motor proficiency, and physical fitness. They
show a marked difference in body coordination, strength, and flexibility. According to Garwood (1983),
these limitations/deficits are manifested in activities that involve:
 Sequential patterns of movement
 Keeping body balance
 Basic physical abilities ( i.e., strength, flexibility, agility, and endurance)
 Fine motor activities that are timed
 Eye-hand coordination
 Eye- foot coordination
 Dexterity
6.3.5 Communication Characteristics
Language and cognitive development are very much related. They are positively correlated. Individuals
who show delay in cognitive functioning typically show delay in language and communication skills.
Due to cognitive deficits, the language proficiency of children with intellectual disability is below that of
their non-retarded peers. The most common speech problems associated with children with intellectual
disability are defects in articulation, voice and stuttering.
6.4 Intervention of Children with Intellectual Disability

Special assistance and care are essential for persons with intellectual disability to enable them lead better
and sustainable life. Education and good care are the main aspects of helping of most persons with
intellectual disability to achieve their maximum level of functioning. Medications, changes in diet, and
psychotherapy for persons with intellectual disability also contribute their parts to enable them function
better. The main supports needed to be delivered for person with intellectual disability have been
summarized as follow.
6.4.1 Family Support
Home is the most natural and usually the best environment for children with intellectual disability. It is
also obvious that parents of children with intellectual disability face many challenges to overcome
learning problems and promote optimal development for their children. Hence, parents need financial
support, an intensive counseling, and proper guidance as early as possible. Furthermore, parents need to
closely work with professionals and need to be involved in the planning and implementation of their
intellectual disability.
6.4.2School Support
School supports need to be given for students’ with intellectual disability based on their level of
intellectual disability which have been already mentioned under 6.1.2.2. Teachers also need to be trained
with the necessary skills that help them train, treat and manage children with intellectual disability.
Teachers should use the following SEVEN TIPS while they are teaching/training children with
intellectual disability. They are:

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 1. Using multimodalities and functional skills
2. Using concrete, varied and familiar examples
3. Providing supportive and corrective feedback
4. Using appropriate assessment
5. Making instruction interesting
6. Breaking lessons in to smaller parts
7. Employing repetitions
Behavioral techniques (such as operant conditioning), and psychotherapy are also used for children with intellectual
disability, especially for severely and profoundly intellectual disability

Prevention: - Prevention can be primary, secondary, or tertiary. Primary prevention is taken to

prevent the problem from its occurrence.. Both secondary and tertiary preventions mainly focus on
minimizing the severity of the problem. The following are samples of preventive measures at different
periods.
 Before pregnancy: good immunization programs, and genetic counseling regarding inheritable
disorders.
 During pregnancy: good parental care, good nutrition, restraint in the use of alcohol, toxins and
the like.
 After birth: immunizing the child, good and accessible medical care, balanced diet, and the like
can reduce the incidence and severity of retardation among children.

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 UNIT SEVEN: EMOTIONAL AND BEHAVIORAL DISORDERS
7.1 Definition of Emotional and Behavioral Disorders
Most children and youth have emotional or behavioral problems at some time during their school years.
The problems they may face vary from mild to profound. A small percentage of children have these
problems that are so serious and persistent that they are classified as having an emotional or behavioral
disorder. The term emotional or behavioral disorders comprise of one or more of the following
conditions over a long period of time and to a marked extent that adversely affect educational
performance and social interactions of children and youth with these disorders.
(1) An inability to learn that cannot be explained by intellectual, sensory, or other health factors.
(2) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.
(3) Inappropriate types of behavior or feelings under normal circumstances.
(4) A general pervasive mood of unhappiness or depression.
(5) A tendency to develop physical symptoms or fears associated with personal or school problems.
NOTE THAT:
While we are assessing and diagnosing children with emotional and behavioral disorders we must
consider the following criteria:
1. The problems must occur persistently for at least six months
2. The problems must occur across contexts
3. The problem must occur to a marked extent that it calls the attention of others
4. The problem must adversely affect a child’s educational performance and social life
7.2 Characteristic of Persons with Emotional and Behavioral Disorders
7.2.1 Behavioral Characteristics
Children with emotional and behavioral disorders are characterized primarily by behavior that falls
significantly beyond the norms of their cultural and age group on two dimensions: externalizing and
internalizing. Both patterns of abnormal behavior have adverse effects on children’s academic
achievement and social relationships.
Externalizing Behaviors: - the most common behavior pattern of children with emotional and
behavioral disorders consists of antisocial or externalizing behaviors. In the classroom, children with
externalizing behaviors frequently do the following:
Displays recurring pattern of aggression to ward objects/persons
Forces the submission of others through physical and/or verbal means
Exhibits persistent pattern of tantrums and arguments
Get out of their seats
Yell, talk out, and curse
Disturb peers, hit or fight
Frequently exhibits lack of self-control and acting-out behaviors
Are non-complaints with reasonable requests
Exhibits persistent pattern of lying and/or stealing
Destroy property, etc.

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Generally speaking students with externalizing behaviors are more likely to exhibit behavioral earth
quakes – high intensity but low frequency behavioral events such as setting fires, assaulting someone, or
exhibiting cruelty than their peers are. As a result of this fact, they are subjected to zero tolerance
policies that allow educators to expel a student who exhibits violent behavior or brings drugs or weapons
to school.
Internalizing Behaviors: - the following internalizing behaviors are the major manifestations of
students with emotional and behavioral disorders:
Exhibits sad affect, depression, and feelings of worthlessness, social withdrawal, etc
Has auditory or visual hallucinations
Cannot keep mind off certain thoughts, ideas/situations
Cannot keep self from engaging in repetitive and/or useless actions
Suddenly cries, cries frequently or displays totally unexpected affect for the situation
Talks of killing self-reports, suicidal thoughts and or is preoccupied with death
Shows decreased interest in activities that were previously of interest
Generally students with internalizing behaviors have poorer social skills and are less accepted than their
peers are. They tend to blend into the background to the point that teachers forget they are in the
classroom. Because their behaviors are not as disruptive, they are less like to be identified for special
educational services.
7.2.2 Academic Characteristics
Most students with emotional and behavioral disorders perform one or more years below grade level
academically. Many of these students exhibit significant deficiencies in reading and in math
achievement. In addition to the challenges to learning caused by their behavioral excesses and deficits,
many students with emotional and behavioral disorders also have learning disabilities and /or language
delays, which compound their difficulties in mastering academic skills and contents.
They do have a reciprocal relationship between their academic and social behaviors: students who
experience failure in one area also tend to experience failure in the other. Approximately 50 percent of
students with emotional and behavioral disorders drop out of school. Because of these and other factors,
most children with emotional and behavioral disorders are underachievers in their academic affairs and
most of them also exhibit a combination of school failure, antisocial and social withdrawal behaviors.
7.2.3 Cognitive/intellectual characteristics
Many children with emotional and behavioral disorders score in the slow learner or students with mild
intellectual disability range on IQ tests than do children without disabilities. According to research
findings students with emotional and behavioral disorders may be gifted or have mental retardation, but
most have IQs in the low average range. Over half have concurrent learning disabilities.
7.2.4 Social and Interpersonal Relationships
The ability to develop and maintain interpersonal relationships during childhood and adolescence is an
important predictor of personal and future adjustment. As might be expected, many students with
emotional and behavioral disorders experience great difficulties in making and keeping friends. These

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children have low levels of empathy towards others, participate in fewer curricular activities, have less
frequent contacts with friends, and they have lower quality relationships than their normal peers. Most
students with emotional and behavioral disorders have expressive and/or receptive language disorders.
Since many of them do not know how to express their feelings with words, they tend to act out their
feelings instead.
7.3 Causes of Emotional and Behavioral Disorders
Behavioral and emotional disorders can be caused by the interaction between several factors. Among
them the following are the major ones.
7.3.1 Biological Factors (Causes)
Behavior and emotions may be influenced by genetic, neurological, or biochemical factors or by
combinations of these. Although we do not know exactly how genetic, neurological, and other
biochemical factors contribute to emotional and behavioral disorders, nor do we know how to correct the
biological problems involved in these disorders, biological factors can be causal factors for behavioral
and emotional disorders. Example, children with autism, schizophrenia, ADHA, CD, etc frequently
show signs of neurological defects.
7.3.2 Environmental Factors (Stressors): - these include:
1. Family Factors: since the relationship between parents and children are interactional and
transactional, there is a reciprocal effect between them. Therefore, parents who:
 Do not have consistent and clear rules for disciplining their children
 Are cruel and hostile
 Are rejecting and unaffectionate
 Are inconsistent in dealing with misbehavior
 Have broken, divorced and disorganized homes
 Engaging in anti-social and deviant behaviors has delinquent and misbehaving children.
2. School Factors: the school environments serve both as exacerbating the already developed problems
and cause of newly developed ones due to:
 Too lax or too rigid/inconsistent discipline
 Negative and inappropriate interactions and feedback from peers and teachers
 Inappropriate instruction delivered
 Rewarding inappropriate behaviors and vice versa
 Serving as models (peers and teachers) for misbehaviors, etc.
3. Socio-cultural Factors: definitely, the culture in which a child is reared influences and shapes his/her
socio-emotional development. Therefore, culture which promotes:
 Aggression and violence through media
 The use of terrors as a means of coercion
 The use of substance abuse
 Religious demands and restrictions on behavior
 The influence of peers, etc enhances the development of these disorders.

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 UNIT NINE: LEARNING DISABILITIES (LDs)
9.1 Defining Learning Disabilities
Since Sam Kirk first coined the term LDs in 1963, legislations, parents and professionals have debated
about how to define LDs. Regardless of the controversies surrounded the attempt in defining learning
disabilities, here is a definition given by the National Joint Committee on Learning Disabilities which is
a coalition of professional and parent organizations. The definition reads as follows:
Learning disability is a general term that refers to a heterogeneous group of disorders manifested by
significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning
and mathematical abilities.
Important points to be considered about LDs
1. LD is a heterogeneous/varied. This implies that if you observe 20 students having LDs, you will
find 20 different ways in which the condition manifests itself.
2. Students with LDs may have associated social and behavioral difficulties, but they may not
qualify for services as having a specific LD primarily on the basis of these challenges alone.
They must also have significant academic difficulty.
3. LDs occur across the life span of an individual. That means, the disability is a lifelong condition.
4. The cause of LDs is intrinsic, or inside the student and is most likely the result of CNS
dysfunction.
5. Extrinsic causes for academic problems, such as poor instruction, cultural influences/differences,
etc can exists concomitantly with intrinsically caused LD; in other words, these other causes can
exist at the same time and along with LDs. But, LDs are not the result of these influences.
According to IDEA and NJCLD, to be diagnosed as having LDs, students must meet the following
major criteria:
1. Inclusionary Criteria: - are those related to listening, thinking, speaking, reading, writing,
spelling and calculating.
2. Exclusionary Criteria: -are those related to impairments arising from other disabilities and
handicapping conditions, such as HI, VI, ID, serious emotional disturbances, and cultural
differences.
3. IQ-Achievement Discrepancy: - the academic performance of these children markedly lower
than would be expected based on a child’s intellectual ability. This means although he/she has
normal intelligence, he/she does not achieve up to his/her expected performance.
In other words, there should be a statistically significant difference (severe discrepancy) between
perceived potential and actual achievement as measured by formal and informal assessment.
4. Need Criteria: - the student manifests a demonstrated need for special education services.
Without specialized support, the student’s disability will prevent him/her from learning.

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9.2 LDs, Other Disabilities, and Academic Achievement
Learning disabilities are one of the many factors which could cause academic underachievement. The
relationship among learning disabilities, other disability areas, and academic achievement can be
presented in the diagram under here:
3
Intrinsic Conditions Extrinsic Conditions
 Intellectual disability  Lack of opportunity to learn
 Sensory handicaps  Cultural disadvantage
 Serious emotional disturbance  Economic disadvantage
 Learning disabilities  Inadequate instruction

Academic Underachievement

9.3Prevalence of Children with Learning Disabilities

Recent evidences clearly show that the number of students with learning disabilities is increasing at an
alarming rate when compared to other areas of exceptionality. More specifically, students with learning
disabilities account for 50% of all students with other disabilities. The following are commonly cited
reasons for the dramatic increase in the number of Students with learning disabilities.
Better research done by specialists concerning the problem
Increased awareness of parents and teachers about the problem
LDs gained full acceptance from government, parents, professionals, schools, etc.
Children who were once misdiagnosed as having ID are now being recognized as having LDs.
Programs for LDs have been expanded to include preschool children and adolescents
LDs include children whose academic problems stem from environmental conditions
Improvements in procedures of identification, etc.

9.4 Classification of Learning Disabilities

Professionals in the area classify learning disabilities into two broad groups.
Learning Disabilities

Developmental Academic Learning

Learning Disabilities Disabilities
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Attention Memory Perceptual Thinking Language Reading Spelling Hand
Disabilities Disabilities & writing Arithmetic
disorder motor
written

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9.5 Characteristics of Individuals with Learning Disabilities
Individuals with learning disabilities have the following characteristics.
(a) Attention and Hyperactivity Disorders: - in most cases, attention and hyperactivity disorders
occur together with LDs. Students with LDs are characterized by attention problems which involve
difficulties in coming to attention, problems in decision making and problems in sustaining attention.
(b) Visual Perception, Perceptual-Motor and General Coordination Problems: - many studies
revealed that individuals with LDs are likely to exhibit visual perceptual problems, such as problems in
organizing and interpreting visual and auditory stimuli than students who are average or above average
readers. Students with the problem have also difficulties in the use of motor skills.
(c) Memory and Thinking Disorders: - research on short-term and long–term memory of students with
learning disabilities has revealed that:
 They have poor strategies for memorizing information
 They have insufficient meta-cognitive skills for recalling information
 They possess limited semantic memory capabilities
Children with learning disabilities have also impaired thinking; more specifically they have difficulties
in the cognitive operations of problem solving, concept formation and association which made students
to act before they think.
(d) Social Relationship Problems: - individuals with LDs have problems in social adjustment and often
they are rejected and neglected. Problems may be caused by students’ lack of knowledge about
important social affairs, inability to learn from appropriate modeling, inability to read social cues and
misinterpretation of the feelings of others.
(e) Motivational Problems: - it is a well-established fact that motivation is a prerequisite for learning
for it energizes the learner. However, students with LDs found to be less motivated in their learning and
experience repeated failure in their academics – a condition which creates a feeling of learned
helplessness. As a result of this, they attribute success to luck and failure to lack of ability.
(f) Problems in Academic Areas: - Children with learning disabilities show deficits in all scholastic
(academic) areas: spoken language, reading, written language, mathematics, etc. Students may also
have problems in one, two or more of these academic areas.
Spoken language problems: students with LDs usually exhibit problems in various aspects of
the spoken language such as phonology, morphology, syntax, semantics and pragmatics.
Reading problems/Dyslexia: these are serious problems experienced by students with LDs for
reading is so important to individual’s performance in most academic domains and to their
adjustment to most school activities.
Writing problems/Dysgraphia: individuals with LDs have difficulties in hand writing, spelling,
composition, productivity, text structure, sentence structure and word usage.
Problems in Mathematics/Dyscalculia: it is usually known as dyscalculia. It may include
problems in one or more of the following areas. These are:
o Visual perception – differentiating numbers or copying shapes
o Memory – recalling math facts
o Motor functioning – writing numbers legibly or in small space

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 o Language - relating arithmetic terms to meaning, functions or vocabulary
o Abstract reasoning - solving word problems and making comparisons
o Meta-cognition - identifying, using, and monitoring the use of strategies to solve
problems.

9.6Intervention: Helping Students with LDs Learn Best

Psychological and educational supports are vital in helping children with the problem learn to the best of
their potential. We can broadly group supports into two as general and specific.
(a) General Intervention Strategies: - these refer to set of general psychological and educational
considerations, principles, and theories which are important in modifying problems of students with
learning disabilities positively. These include:
 Capitalize on enhancing interest and motivation
 Organizing, sequencing, and ordering materials to be learned from simple to complex
 Applying reinforces, and rewards in increasing the likelihood of desirable behaviors
 Rehearsal/practice: conscious and organized repetition of materials enhances acquisition,
proficiency, maintenance, generalization and adopt of what is learned
 Providing immediate and task oriented feedback in order to defer inappropriate way of progress
on tasks/activities
 Use peers and teachers as models for students as to how they can do solve a certain problem
 Involving many sense organs and multimodalities
 Using self-monitoring skills
 Using study skills like the SQ3R, PQ4R, etc.
(b) Specific Intervention strategies: - these involve:
1. Improving Attention and Memory: the following measures if used appropriately they will help in
enhancing memory and attention of students with the problem.
 Reducing verbal destructions
 Using varied instructional materials
 Making tasks interesting
 Decreasing the length of the task
 Maintaining an eye contact with students
 Scheduling difficult tasks when the student is most alert
 Giving short assignments, tests, etc
 Using materials that appeal to sense organs
 Underlining, italicizing, highlighting, capitalizing, etc. important materials to be learned
 Grouping items into larger and meaningful units
2. Improving Relationship Problems: - the social relationship problems can be improved by:
o Arranging person – to person communication
o Giving specific instruction in the area of social skills
o Giving group work
o Arranging discussions and presentations.

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3. Improving Academic Problems: - this should involve:
a. Improving listening problems by using:
o Repeating words
o Listening words on a tape
o Presenting a pair of words
o Using experiential approach, i.e. using the context which is familiar to the learner
b. Improving speaking problems by using:
o Modeling(saying the correct one) and reinforcing the correct attempt of the student
o Giving different contexts so that students with learning disabilities can practice the language
o Allowing students to summarize texts/passages read by the teacher.
c. Improving problems in reading by using:
o Teaching sounds by combining consonants and vowels till they become automatic
o Presenting familiar materials/giving daily experience materials
o Making learning disabled students be responsible for their own learning by ordering them to
summarize materials and use self – questioning while reading
o Using continuous timed reading practice.
d. Improving Problems in mathematics by using:
o Rehearsal, repletion, over learning, etc.
o Games, concrete and abstract materials and multi-sensory materials.
o Using flash cards with symbols (such as +, , ,  ) prominently drawn and requiring students to
identify.
o Using simple language, vocabulary, sentence, etc.
e. Improving problems in writing by using:
o Guided as well as independent practice on narrative and technical aspect of writing will help a lot
in alleviation difficulties in writing.

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