Exceptional Children

An Introduction to Special Education

Tenth Edition

William L. Heward

© 2013, 2009, 2006, 2003, 2000

Pearson Education, Inc. All rights reserved.
 Chapter 11

Physical Disabilities,
Health Impairments, and ADHD
 Focus Questions
How might the effects of an acute health condition on a
student’s classroom participation and educational progress
differ from those of a chronic condition?
Why is the prevalence of chronic medical conditions in
children much higher than the number of students receiving
special education under the disability categories of orthopedic
impairments and other health impairments?
What does a classroom teacher need to know about physical
disabilities and health impairments in children?
Why do you think attention-deficit/hyperactivity disorder
(ADHD) is not included as a separate disability category in
IDEA?
How might the visibility of a physical disability or health
impairment affect a child’s self-perception, social development,
and level of independence across different environments?
Heward
Exceptional Children, 10e 11-2
© 2013 Pearson Education, Inc. All rights reserved.
 Focus Questions (cont.)

What are some of the problems that members of

transdisciplinary teams for students with physical disabilities
and multiple health needs must guard against?
Of the many ways that the physical environment, social
environment, and instruction can be modified to support the
inclusion of students with physical disabilities, health
impairments, and ADHD, which are most important?

Heward
Exceptional Children, 10e 11-3
© 2013 Pearson Education, Inc. All rights reserved.
 Components of IDEA Definitions
Severe Orthopedic Impairment (OI)
• Congenital abnormality - club foot, absence of a limb
• Impairments caused by disease - poliomyelitis, bone
tuberculosis
• Impairments by other causes - cerebral palsy, fractures,
burns
• Adversely affecting educational performance

Other Health Impairment (OHI)

• Limited strength, vitality, or alertness due to chronic or acute
health problems
• Asthma, attention deficit/hyperactivity disorder, diabetes,
epilepsy, a heart condition, hemophilia, leukemia, sickle cell
anemia
• Adversely affecting educational performance
Heward
Exceptional Children, 10e 11-4
© 2013 Pearson Education, Inc. All rights reserved.
 Prevalence

Studies of the number of children with physical disabilities

and health impairments have produced hugely diverse findings
1% of children receiving special education services are
orthopedically impaired (OI)
11.6 % of children receiving special education services are
otherwise health impaired (OHI)
Two factors make the actual number of children with physical
disabilities and health conditions much higher than the number
receiving special education services under IDEA
Many children with OI and OHI receive services under
other categories
Some do not require specialized educational services

Heward
Exceptional Children, 10e 11-5
© 2013 Pearson Education, Inc. All rights reserved.
 Orthopedic Impairments
Cerebral Palsy
• A disorder of voluntary movement and posture
• Most prevalent physical disability in school age children
• No clear relationship between the degree of motor
impairment and degree of intellectual impairment (if any)
• Classified according to muscle tone and motor movement
– Spastic, Athetosis, Ataxia, Rigidity, Tremor, Mixed

Spina Bifida
• Congenital malformations of the brain, spinal cord, or
vertebrae
• Can result in paralysis below affected vertebra
• Hydrocephalic condition common; treated with a shunt
Heward
Exceptional Children, 10e 11-6
© 2013 Pearson Education, Inc. All rights reserved.
 Orthopedic Impairments
Muscular Dystrophy
• Progressive weakening and degeneration of the muscles
• No known treatment exists to stop or reverse any form of
muscular dystrophy

Spinal Cord Injuries

• Caused by penetrating injury, fracture, stretching, or
compression of spinal cord
• Car accidents, sports injuries, and violence most common
causes
• Results in paralysis below affected vertebra
• Males represent 80% of traumatic spinal cord injuries

Heward
Exceptional Children, 10e 11-7
© 2013 Pearson Education, Inc. All rights reserved.
 Other Health Impairments

Seizure disorder (epilepsy)

• Caused by abnormal electrical discharges in the brain
• Three different categories based on severity
• Seizures can be controlled with medicine

Diabetes
• Chronic disorder of metabolism
• Body unable to obtain and retain adequate energy from food
• Type 2 diabetes the most common form
• Treated with insulin, diet, and exercise

Heward
Exceptional Children, 10e 11-8
© 2013 Pearson Education, Inc. All rights reserved.
 Other Health Impairments
Asthma
• Chronic lung disease resulting in a narrowing of airways
• Leading cause of absenteeism in school
• Causes are unknown but considered an interaction of heredity
and environment
Cystic Fibrosis
• Genetic disorder affecting pulmonary and digestive systems
• No reliable cure has yet been found
HIV and AIDS
• Breakdown in the immune system prevents the body from
fighting infections
• No known cure or vaccine exists

Heward
Exceptional Children, 10e 11-9
© 2013 Pearson Education, Inc. All rights reserved.
 Attention-Deficit/Hyperactivity
Disorder
The essential feature is a persistent pattern of inattention
and/or hyperactivity-impulsivity that is more frequent and
severe than is typically observed
Three ADHD subtypes: combined, predominantly inattention,
and hyperactive-impulsive
Most students with ADHD have the combined type
Childrenwith ADHD can be served under the “other health
impairments” category or under Section 504
Estimates of prevalence of ADHD range from 3% to 7% of all
school-age children
Most children with ADHD struggle in the classroom
There is comorbidity with other disabilities
Heward
Exceptional Children, 10e 11-10
© 2013 Pearson Education, Inc. All rights reserved.
 Causes and Treatments for
ADHD
The causes of ADHD are not well understood
• Evidence indicates that genetic factors may place individuals at a
greater than normal risk of an ADHD diagnosis
• Research using neuroimaging technologies has shown that some
individuals with ADHD have structural or biochemical differences in
their brains
Drug treatment
• Prescription stimulant medication is the most common intervention
• No clear evidence indicates that stimulant medications lead to
improved academic achievement
Behavioral intervention
• Methods include positive reinforcement for on-task behavior,
modifying assignments and instructional activities to promote
success, and systematically teaching self-control
• A deficit of executive functioning is a primary characteristic of
children with ADHD
Heward
Exceptional Children, 10e 11-11
© 2013 Pearson Education, Inc. All rights reserved.
 Characteristics

As a group, students with physical disabilities or

health impairments function well below grade
level academically
Daily health care routines and medications have negative
side effects on academic achievement
Educational progress is often hampered by frequent and
sometimes prolonged absences from school for medical
treatment when flare-ups or relapses require hospitalization
As a group, students with physical disabilities and health
impairments perform below average on measures of social-
behavioral skills
Concerns about physical appearance are frequently
identified as reasons for emotional difficulties and feelings of
depression
Heward
Exceptional Children, 10e 11-12
© 2013 Pearson Education, Inc. All rights reserved.
 Variables Affecting Educational
Performance
Factors that affect educational needs include

• Severity with which the condition affects different

areas of functioning
• Age of onset - children with congenital or acquired
impairments have different needs

• Visibility
- the visibility of impairment may cause
some to underestimate the child’s abilities and limit
opportunities

Heward
Exceptional Children, 10e 11-13
© 2013 Pearson Education, Inc. All rights reserved.
 Educational Approaches
Students with physical disabilities or health
impairments may need intensive instruction in a
“parallel curriculum” to include
using adaptive methods and assistive technology for
mobility, communication, and daily-living tasks;
increasing independence by self-administering special
health care routines; and learning self-determination
and self-advocacy skills
Teaming often involves the collaboration of a
transdisciplinary team including physical and
occupational therapists, speech therapists, health care
aides, and other specialists who frequently provide
services to these students

Heward
Exceptional Children, 10e 11-14
© 2013 Pearson Education, Inc. All rights reserved.
 Educational Approaches (cont.)

Environmental modifications include

 Adaptations to provide increased access to a task
or an activity
 Changing the way in which instruction is delivered
 Changing the manner in which the task is done
 Examples of environmental modifications include
wheelchair accessible classrooms or other
assistive technology

Heward
Exceptional Children, 10e 11-15
© 2013 Pearson Education, Inc. All rights reserved.
 Educational Approaches (cont.)

Assistive technology
 IDEA defines assistive technology as assistive
technology devices and the services needed to
help a child obtain and effectively use devices
• Devices include any item, piece of equipment, or
product used to increase, maintain, or improve
functional capabilities
• Services mean any service that directly assists
with the selection, acquisition, or use of an
assistive technology device

Heward
Exceptional Children, 10e 11-16
© 2013 Pearson Education, Inc. All rights reserved.
 Educational Approaches (cont.)
Animal Assistance
Providing personal care attendants
Enhancing independence
Providing social values as companions

Special health care routines

• Individualized health care plan prescribes special health
related needs
• Importance of positioning, seating, and movement
○ Encourages the development of muscles and bones and
helps maintain health skin
• Lifting and transferring procedures
○ Prevents the development of pressure sores
○ Helps maintain proper seating and positioning
Heward
Exceptional Children, 10e 11-17
© 2013 Pearson Education, Inc. All rights reserved.
 Educational Approaches (cont.)

Independence and Self-Esteem

Children need encouragement to develop
 A positive, realistic view of themselves and their physical
conditions
 As much independence as possible
 The ability to explain their physical disability or health
condition and to respond to questions
 Collaboration with self-help groups for people with similar
disabilities

Heward
Exceptional Children, 10e 11-18
© 2013 Pearson Education, Inc. All rights reserved.
 Educational Placements
For no other group of exceptional learner is the
continuum of educational services and placement
options more relevant
During the 2008-2009 school year:
 52% of students who received special education services
under the category of orthopedic impairment were
educated in general education classrooms; 17% in
resource rooms; and 24% in separate classrooms
 60% of students with health impairments were educated in
general education classrooms; 24% in resource rooms;
and 11% in separate classrooms
 Technology-dependent students need both a medical
device and ongoing nursing care to avoid death or further
disability
Heward
Exceptional Children, 10e 11-19
© 2013 Pearson Education, Inc. All rights reserved.
 Related Services in the
Classroom
Controversial issues concerning including students with
physical impairments and special health care needs in general
education classrooms
 The extent of responsibility properly assumed by teachers
and schools
 Irving Independent School District v. Tatro
 Catheterization is a related service
 Cedar Rapids Community School District v. Garret F
 Nursing services are related services

Acceptance is the most basic need of children with physical

disabilities and health impairments

Heward
Exceptional Children, 10e 11-20
© 2013 Pearson Education, Inc. All rights reserved.