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Topic: Severe and  Multiple Disabilities In and Out of the Classroom
Researched and written byMegan N. Howard
                                                I attest that the following report is a product of my own original work.

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Severe and multiple disabilities has its own definition for the disabilities to be under the criteria of IDEA. Prenatal biomedical factors are just one known cause of severe and multiple disabilities. Having severe and multiple disabilities is one of the most stressful disabilities for the family and the child. When a student with multiple and severe disabilities is in the classroom, it makes it hard for the teacher to focus on the student with the disability and not neglect students without one. There are some treatment programs for students with multiple and severe disabilities, and a powerful one is collaborating with the family, school, and child. The collaboration team can come together and form a program that fits and helps the child through school and home.

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Severe and Multiple Disabilities In and Out of the Classroom


Severe and multiple disabilities have their own defining features for it to meet the criteria for IDEA, which stands for Individuals with Disability Education Act. The IDEA is a law that mandates schools to provide services to students, ages three to 21, with one or more disabilities. Severe disabilities are where the child is having intense problems in mental, emotional, or physical abilities.  Multiple disabilities are a combination of impairments, such as mental retardation and deafness. Both of theses disabilities qualify to have special need programs for education, social, and self-determination. Intellectual function is significantly impaired for children with severe and multiple disabilities. There are other problems in adapting skills, such as personal cares for the self, like brushing teeth. Motor development is delayed for many children with severe and multiple disabilities considering their muscle tone is abnormal for them to perform tasks, such as eating. Just about two of every five students with severe and multiple disabilities have sensory impairment. For example, these children would have hearing and vision problems. Communication is one of the challenges for children with severe and multiple disabilities due to their impairments (Turnbull et al, 2004).

Etiology and Statistics

There is about forty percent of unknown causes of severe and multiple disabilities, but prenatal biomedical is the majority known cause of the disabilities. Prenatal biomedical includes factors such as abnormal chromosomes, developmental problems in the brain, environmental issues and disorders in genetic metabolism. Complications in giving birth or after birth can also have contributing factors in severe and multiple disabilities. There is about 0.18% of the student population that is covered under IDEA for severe and multiple disabilities in the United States. There is no information saying which gender is affected more from the disabilities, but it seems to be an equal number of girls and boys affected (Turnbull et al, 2004).


Borgioli and Kennedy (2003) studied the students with multiple disabilities and how they transition from school to hospital. These students required special health care for their disability. Needing this special health care makes it more likely for the students to be absent from school because of their disabilities. The students were more likely to be ill and require hospitalization. The students would miss weeks or months of school during an academic school year. There were about 28.9 days of absence from school for students with this disability. A federal law mandates that educational services need to continue through the summer for students with disabilities who are at risk for regression. Borgioli and Kennedy (2003) recommend that each school district should have a plan to extend educational services to students with multiple disabilities when absent from school due to hospitalization so that the students will not fall behind in their schooling.

Kim and Turnball (2004) studied the transition of students to adulthood with severe and multiple disabilities. The students were more likely to stay home to finish high school, which made it more stressful to experience a transition to adulthood. The student and family go through a stressful and chaotic period in progressing into adulthood. A successful transition for the family and student includes person-family interdependent planning, that will bring about a better overall transition to adulthood. By having this program the student can gain self-determination, and the family can have support from the community and professionals.

Classroom Issues

Teachers are needed to teach students with multiple and severe disabilities, like autism, which is a challenge for most teachers alone. There is a shortage of teachers who are qualified to teach special education, and there is even a bigger challenge to find teachers who are qualified to teach students with severe and multiple disabilities. This is a very specialized area with a small population of students. Because of the small population of students with severe disabilities, there are few teachers within particular school districts, so those teachers don’t have the opportunity to learn from other teachers like themselves. Therefore, they may feel isolated and like they have to depend upon themselves without help of other special education professionals. School districts need to create professional development training specifically for teachers of students with severe and multiple disabilities. (Lang & Fox 2004).

Murray et al. (2002) found a teacher that is qualified to teach severe and multiple disabilities in a classroom. The teacher found it difficult teach the class when all of the teacher’s focus went towards the student with the disability. The teacher used a Positive Behavior System (PBS) that consisted of six weeks of collaborating with others, such as parents, teachers, special educators, and paraprofessionals. The team put together a plan that involved the strengths of the student with the disability. This plan had the student be able to be a part of activities with the rest of the class. The PBS process helped the teacher be more open to other ideas to have a more inclusive classroom with all the students.

On the other hand, Dymond and Russell (2004) found that instructional context in the classroom was not individualized for students with disabilities but more for students without disabilities. The students with disabilities gain their instructional context from paraprofessionals or peers. The student could even be removed to go to a resource room for more instructional help. Also, in the study, the students with severe disabilities received more adaptive instruction to the curriculum than mild disabilities students did. Also, students with severe disabilities received more individual attention in grades one and two during a general education classroom.

Schools are also trying to improve social skills and relationships for students with severe and multiple disabilities. Souza and Kennedy (2003) studied a school that developed a program to help students with severe and multiple disabilities improve their social relationships. The program consisted of three components: (1) students that volunteer to interact with the student with a disability; (2) a mutual activity with the two students; (3) monitored by an educator. This type of interaction had a positive impact on the student with a disability.


Browder and Cooper-Duffy (2003) looked at how the “No Child Left Behind” act could affect children with severe and multiple disabilities. They report that this act means that schools need to have collaborating teams promote inclusion for students with disabilities in general education and take away barriers in the program. This will challenge teachers to develop creative ways to have an inclusive program for severe and multiple disabilities students in the classroom. In reaching this goal, teachers will need to focus on teaching specific skills to the student with disabilities until each skill is mastered.

To have a positive outcome for severe and multiple disabilities students, the school must have an inclusive program including students, peers, teachers and the community with the idea of (1) increasing vocalization in the general education program; (2) being able to teach and understand new behaviors, like communications; and (3) improving the objectives of the student’s Individualized Education Program (IEP). A plan called Unified Plan of Support can help make this happen by (a) having the team meet on a regular basis; (b) increasing development of support in the classroom; (c) having an accountable system; and (d) have a flexible support that can change when needed for the student. The team should consist of parents and educators from the general and special education background (Hunt et al. 2003).

Another program that can help students with severe and multiple disabilities was done by Li (2003). Li (2003) created a program that focused on four characteristics: “individuality, integration, adaptability, and functionality,” in other words, the IIAF model. The model is shown by a triangle where individuality is on the bottom of the triangle that shows the student’s strength and where it can meet the other needs of the triangle. Integration is the individual’s cognitive thoughts and skills that can manifest. Adaptability means adapting the environment and materials for the students based on their particular disability or interests. On the top of the triangle is functionality, that is where the student can have his or her ultimate goal to accomplish in daily life.

Lancioni et al. (2002) found a positive tool called microswitches for students with multiple and severe disabilities to help them communicate with others. For students with severe communication disabilities, this allowed them to indicate a choice of something they would like to do or have. The microswitch is a tool the students can use to help them interact with their surroundings or with others. They can push a key that will activate something like a toy or a sound that will stimulate them.  Lancioni et al’s study found a successful use for multiple microswitches for interaction in the home and in the school. The students were able to control their environment immediately and increase stimulants that can promote satisfaction. The microswitches enhanced the students’ ability to gain self-determination by providing them with a way to make choices with their responses. (Singh et al.  2003).


The overview of the severe and multiple disabilities is where the child has impairment in physical, emotional, and mental areas. IDEA considers severe and multiple disabilities as one category but with two separation definitions. Two out of five students with severe and multiple disabilities have sensory impairment. The main cause of severe and multiple disabilities is prenatal biomedical problems. Some characteristics for students that have severe and multiple disabilities is that it is stressful and chaotic for them and their family to adapt to everyday living. The classroom issue is that it is hard for teachers to help students with a disability when they focus just on them and not the other students. But once there is a collaborating team to help the teacher in the classroom, a positive effect for everyone in the classroom will occur. The treatment issues for the classroom are to have a collaborating team, where the parents, special education teachers, and general education teachers join together on a regular basis to collect ideas on what strengths and weaknesses the student has and how they can include the student in a general education classroom. It usually takes about six weeks before a team can put together a successful program for the student with severe and multiple disabilities and the students without a disability.

Related Websites
1st hot link here:
Education World: Keyword Severe and Multiple Disabilities
2nd hot link here:
OACRS: Keyword Multiple Disabilities
3rd hot link here:
Disability Action Incorporated: Keyword Disability Agencies



Borgioli, J. A.; Kennedy C. H. (2003). Transitions between school and hospital for students with multiple disabilities: A survey of causes, educational community, and parental perceptions. Research & Practice for Persons with Severe Disabilities. 28 (1), 1-6. Retrieved September 16, 2004.

Browder, D. M.; Cooper-Duffy, K. (2003). Evidence-based practices for students with severe disabilities and the requirement for accountability in “no child left behind”. The Journal of Special Education 37 (3), 157-163. Retrieved September 16, 2004.

Dymond, S. K.; Russell, D. L.(2004). Impact of grade and disability on the instructional context of inclusive classrooms. Education and Training in Development Disabilities 39 (2), 127-140. Retrieved September 16, 2004.

Hunt, P.; Soto G.; Maire, J.; Doering, K. (2003). Collaborative teaming to support students at risk and students with severe disabilities in general education classrooms. Council for Exceptional Children 69 (3), 315-332. Retrieved September 16, 2004.

Kim, K.- H.; Turnbull, A. (2004). Transition to adulthood for students with severe intellectual disabilities: shifting toward person-family interdependent planning. Research & Practice for Persons with Severe Disabilities 29 (1), 53-57. Retrieved September 16, 2004.

Lancioni, G. E.; Singh, N. N.; O’Reilly, M. F.; Oliva, D. (2002). Multiple microswitches for children with multiple disabilities: assessing response maintenance. Journal of Positive Behavior Interventions 4 (2), 104-108. Retrieved September 16, 2004.

Lang, M.; Fox, L. (2004). Breaking with tradition: providing effective professional development for

<>                     instructional person supporting students with severe disabilities. Teacher Education and                    
                     Special Education 27
(2), 163-173. Retrieved September 16, 2004.

Li, A. (2003). A model for developing programs to improve the use of vision in students who are visually impaired with multiple disabilities. RE: view 35 (1) 35-47. Retrieved September 16, 2004.

Murray, M.; Clarke, S., Worcester, J. (2002). A teacher’s perspective of using PBS in a classroom for a girl with multiple disabilities. Journal of Positive Behavior Interventions 4 (3), 189-192. Retrieved September 16, 2004.

Singh, N. N.; Lancioni, G. E.; O’Reilly, M. F., Molina, E. J.;  Adkins, A. D.; Oliva, D. (2003). Self-determination during mealtimes through microswitch choice-making by an individual with complex multiple disabilities and profound mental retardation. Journal of Positive Behavior Interventions 5 (4), 209-215. Retrieved September 16, 2004.

Souza, G.; Kennedy, C. H. (2003). Facilitating social interactions in the community for a transition-age student with severe disabilities. Journal of Positive Behavior Interventions 5 (3), 179-182. Retrieved September 16, 2004.

Turnbull, R.; Turnbull, A.; Shank, M.; Smith, S. J. (2004) Exceptional lives: special education in today’s schools. Pearson Education, Inc. Fourth Editions, 254-281.

This website is a service learning project by the students of "Psychology of the Exceptional Child" at Frostburg State University.  Manager of web page and project: Dr. Megan E. Bradley