2. What does the term additional
disability indicate??
Deaf and hard of
hearing face additional
challenges related to one
or more neurodevelopmental or related
disabilities.
Autism, intellectual disabilities,
social-emotional disorders, sensory
integration dysfunction,
visual impairment, motor delays, and
learning differences.
In addition to hearing loss, presence
of one or more of these conditions
will result in multiple disabilities.
Holden-Pitt & Diaz, 1998; Karchmer, 1985; McCracken, 1998
3. Prevalence of children with HI & additional disability
61-88%
Speech Language
Disorder
4-57%
Visual impairment:
2-14%
Neurodevelopmental
disorder
Neurodevelopmental
disorders
ASD : 2-4.2%
CP : 2-13%
PDD: 2 %
6. How does the
combination
of disabilities
affect
the child?
POOR SPEECH
PERCEPTION
ABNORMAL BRAIN
AND NEURAL
DEVELOPMENT
POOR
INTELLIGENCE
POOR MOBILITY AND
ACCESSIBILITY
POOR SENSORY
PROCESSING SKILLS
EMOTIONAL/
BEHAVIOURAL
ISSUES
POOR
COMMUNICATION
SKILLS
POOR LEARNING
SKILLS
7. Impact on learning
Developing age-appropriate adaptive skills is a challenge for
students
Deficits in motor development can impact independence in self-care
areas and can also force limitations on mobility and access to the
environment.
Sensory impairments can cause difficulty in classroom compliance
Deficits in communication, makes it difficult to communicate their
wants, needs, and pains to those around them
8. IT’S IMPORTANT
TO UNDERSTAND
EXTEND OF
COMBINATION
EFFECTS
DEPENDS UPON.....
Which all individual
disabilities are involved
How severe (or moderate
or mild) each disability is
How each disability can
affect learning and daily
living
10. Approach to
Intervention
of deaf children
with Additional
Needs???
Team approach always wins
In-depth trans-disciplinary team
evaluation and intervention
Early identification of the associated
conditions
Providing early access to language
and communication
Enhance the access to literacy skills.
11. Educational
Programming for Deaf
Children with Additional
Disabilities
Educational programming
and accommodation of all
groups of multiply-
handicapped deaf children
cannot start without proper
assessment
(Chen & Haney, 1995; Roth,
1991; Van Dijk & Nelson,
2001).
12. Assessment
• Enable understanding of individual limitations,
competencies, and potentials of students.
• Allows a comprehensive assessment focusing on deaf
children with additional disabilities by professionals.
• Assessment provides information about the likelihood of the
child acquiring language, learning daily living skills, and
possibly acquiring academic skills.
• Preferred mode of communication by the children (sign
language or forms of augmentative communication Roth,
1991) during assessment allows better understanding of
child’s skills and limitations
14. Need for an Effective
Teaming Towards
Effective Intervention
A holistic and integrated approach to care.
Better Coordination of multiple interventions and services.
Built around the complex continuum of people’s needs,
personal strengths and limitations.
Enables joint assessments and care planning.
Goals and education plan will be more integrated.
Ensures greater involvement of the service user, or their
carers, in decisions about care
Better treatment planning and compliance
Greater continuity of care across different care setting
15. Assessment Areas....
Reliable and valid
assessments of
• Vision
• Hearing
• Cognition
• Overall development
Observational assessment of
the strength and weaknesses
of children in the domains of
• Perception
• Behavior
• Language
• Motor skills
Observation of
the environmental factors
• Socio economic
• Educational backgrounds
• Stimulating environment
Selection of appropriate
Technology
16. Classroom Management of
children who are deaf with
additional disabilities
1.Technology based
2.Classroom accommodation
3. IEP & Teaching strategies
This Photo by Unknown author is licensed under CC BY.
17. 1. A Customized, Tailored
Learning Experience
Empowered by Technology
Using technologies to
ensure audibility,
mobility, accessibility
and communication
Use of
Constant ongoing
instructional support
19. Assistive
Technologies
Mandatory note:
• Developing supporting
environment: It aims to develop
environments that support students
with significant disabilities.
• Expect competency:It is
important that teachers have
expectations for the students with
significant disabilities.
• All staff must expect that the
technology will provide a student
with access to engaged and
participatory learning.
20. To enable active participation in
classroom, it is important to ensure
the child who are deaf plus
additional disability have access to
audition, communication and
learning.
• Listening devices:
• Communication devices
• Accessibility Devices
Assistive technology solutions used for students
with CI + Additional disability in classroom
21. Listening Device
Primarily aimed to give accessibility to the auditory
information
• FM Systems
• Sound-Field Systems
• Personal microphone for teachers
• Personal amplification systems,
• Wireless TV listening systems,
• Vibrating alarm clocks
• Doorbell with flashing light alert,
• Closed Captioning
• Live transcription
22. Communication devices
Augmentative and alternative communication (AAC) devices
• Communication boards.
• Speech output Devices and software.
• Symbol-making software.
• Speech generating devices.
• Visual input devices.
• Tactile boards.
• Braille.
• Sign language.
https://youtu.be/d3zKPHLk6-Q
23. Accessibility Devices
Sip-and-Puff Systems ( Adaptive Switches):
• Adaptive switch is an accessibility device that allows
people with movement-limiting disabilities to control
technology and operate electronic devices while
additionally having the ability to move them.
• Instead of performing complex actions like turning a
knob, adaptive switches will provision easier
movement solutions such as pressing a button.
• It's feasible to be a switch adapter for toys, home
appliances, voice-output communication tools,
computers, and a variety of other things.
• Adaptive switches for special needs provision a link
between the technology and the person with a
disability.
24. Decision making & SETT Process
(Student, Environment, Task and Tool)
STUDENT ABILITIES/
DIFFICULTIES
ENVIRONMENTAL
CONSIDERATIONS
TASKS TOOLS
SOLUTION
GENERATION
TOOLS
STRATEGIES
SOLUTION
SELECTION TOOLS
& STRATEGIES
IMPLEMENTATION
PLAN
26. Teaching literacy
skills to children with
CI + ID
Literacy development
in children who are
DHH-ID is limited to
a larger extreme.
Communication and
literacy are blended
by using a low-
technology picture
dictionary & Sign
language( Highnote
and Allgood et al
2009)
Use of interactive
videos for teaching
answering to
questions.
Use of adapted and
interactive video clips
For inferential
processing
27. Teaching literacy skills to children
with CI + ASD
For pulling the children with CI-ASD along the
path to literacy when they start to exhibit
attention to pictures, tracking print and pictures
from left to right, and follows story
comprehension.
• Sign Language and AAC
• picture symbol systems
• picture schedule systems
• social stories
• video modeling
• Four block literacy model
28. Teaching literacy skills to
children with CI +
Blindness
• Augmentative and Alternative Communication (AAC)
• Objects, partial objects and textured boards,
• Gestures (invented and conventional)
• Sign language
• Hands-on learning
• Speech generating devices.
• e books in print and braille
• Auditory books
• Tactile books
• Accessible labeling of literacy materials
• Interactive software, and adapted commercial books (McKenzie 2019)
29. Classroom Accommodations
Modify The
Classroom Settings
1
Highly customized
IEPS
2
Teaching stratagies
3
An accommodation gives the student an alternative or more effective way of learning
30. Classroom setting modifications
• Working on classroom acoustics – less noise- better speech
perception.
• Tactile boards, symbol enabled display systems.
• Visual scheduling.
• Making the classroom disability friendly.
• Use sensory tools ( meeting the sensory needs).
• Use alerting devices in classroom
32. Classroom Schedules and
Routines- Visual scheduling
• Create a daily class routine that
changes minimally.
• Post class schedules, rules, and
expectations; make sure the student
sees them.
• Make a laminated card with the
student’s schedule on it.
• Provide verbal cues before transitions.
• Allow plenty of time to preview and
prepare for new activities like group
projects, field trips, and other changes
in routine.
33. Timing accommodations
• Give more time to complete a task or a test
• Allow extra time to process spoken information and directions
• Allow to take frequent breaks, such as after completing a worksheet
Scheduling accommodations
• Give more time to complete a project
• Give a test in several timed sessions or over several days
• Allow more sections of a test in different order
• Give tests at a specific time of day
34. Other classroom
Accommodation
Movement Breaks
Mental Break
Preferential Seating
Allow using assistive technologies for reading
and alternate to writing
Incorporate Visuals and Interactive/Hands-On
Experiences into Verbal Lessons/Lectures
35. Preparation of Education plan
"Not one size fits all"
Plan the curriculum for students
with regard to their individual
needs.
36. Contributing features in IEP : Child related
• Child's age
• Associated condition
• Time and type of intervention received
• Device usage
• Language and Communication skills
• Student’s capability to function in the
classroom
37. Environment Related factors
Accessibility
• physical accessibility
• Information
accessibility
• Communication
accessibility
• Programmatic
accessibility
Attitudes:
• Parent’s perceptions of
disability
• Societal and cultural
norms
• Children’s attitudes
towards disability,
• School staff
perceptions of disabilit
Affordability:
• Fees,
• Costs
• Resources availiabilty
• Availability of types of
assistance (financial,
assistive
devices, rehabilitation)
• Non-educational
benefits
38. Technology and Equipment
Assistive listening
devices,
Augmentative and
alternative
communication devices
Alerting devices.
Mobility devices Accessibility devices
39. Writing An IEP
• The next step is writing an IEP (Individualized
Education Program), which comes after
the evaluation and selection of appropriate AT
is completed.
• It includes student’s educational goals.
• Also, what services the child require.
• The overall goal is to help the student progress
within the school’s curriculum.
40. Look of a classroom designed with Specific IEP goals incorporating
AT technologies
41. Teaching Strategies...
• What they know
• What they want to know
• How to find out
• What they learned
In teacher guided program, teacher
guide the students to identify
Defining the skill
Simultaneous prompting
Differential reinforcements
Generalizations
1. Systematic instructions
Jameson, McDonnell, Johnson, Riesen, and
Polychronis (2007)
42. 1. Defining the skill
• The first step in using systematic instruction is to define an observable,
measurable skill to be taught.
• Skill can be categorized as discrete—one step— or chained— (
involves more steps to equate to a complex behavior (Alberto &
Troutman, 2009).
• Chained tasks can be taught by breaking components of the task into
the discrete steps (Spooner, 1984).
• This method can also be applied to academic skills (Courtade, Browder,
Spooner, and DiBiase 2010)
• Teachers use steps of a task analysis to teach science concepts to
students using inquiry-based science instruction.
• Sometimes, teachers may choose to focus on a set of discrete responses
like a list of sight words or math facts.
43. 2. Prompting
• After creating the target behavior, teacher plans the response prompting and fading
systems to use for instructing target skills (Wolery, Ault, & Doyle, 1992).
• These systems include
Simultaneous prompting. Time delay.
Least prompts to most-to-
least intrusive prompts.
Graduated guidance.
44. Simultaneous
prompting.
Providing one response prompt
(e.g., verbal, model/physical)
concurrently presented with the
target stimulus, which is eliminated
after several instructional trials.
An effective strategy for teaching
discrete or chained tasks and can be
simpler than other prompting
strategies (Morse & Schuster,
2004).
45. Time delay
• Time delay, a system in
which the prompt is
concurrently presented
with the target stimulus
and then faded with small
increments of time over
successive trials.
46. Least to most
intrusive prompting
Typically, it uses three different prompts sequenced
together to teach the student a new skill.
They can be verbal, gesture, model and/or physical
prompts.
The teacher sequences the prompts starting with the
least intrusive one. Verbal prompts are the least intrusive
type of prompt.
Gesture prompts are more intrusive than verbal prompts
but less intrusive than model prompts.
For example, the teacher points to the door as a gesture
prompt, but she walks to the door when providing a
model prompt. Physical prompts are the most intrusive.
47. The system of least to most prompts is designed to naturally fade the amount of
assistance provided during instruction.
Each trial begins by providing the student an opportunity to respond to the least
amount of assistance possible.
As the student begins to learn the task, he/she will gradually need lesser amounts of
assistance (prompting) to perform correctly until finally the student is independent.
48. Most-to-least
intrusive prompts.
• Most-to-Least Prompting is an evidence-based prompting
strategy that systematically provides predetermined prompts
from most to least intrusive by systematically fading them
over time.
• Full physical assistance
• Partial physical assistance
• Modeling
• Verbal prompts
• Gestures or cues
49. Reinforcement
• Reinforcement can be used to teach new skills, teach
a replacement behavior for an interfering behavior,
increase appropriate behaviors, or increase on-task
behavior (AFIRM Team, 2015).
• Reinforcement should always include praise and,
depending on the motivational needs of the student,
tangibles (e.g., stickers, extra computer time)
• In addition, teachers must decide on a schedule of
reinforcement for teaching a skill.
• Initially reinforce every correct response ,
eventually should fade it and desired skills is
attained reinforcement is provided.(Cooper, Heron,
& Heward, 2007).
50. Generalizations
• With systematic instruction, it is important to
train for generalization (Stokes & Baer,
1977).
• One way to promote generalization is to
teach in contexts in which skills are most
likely to occur naturally (e.g., general
education classrooms, cafeteria, and
community settings).
• Teaching in naturalistic environments can be
in simulated or authentic community settings
51. Self -directed learning
Pict o ria l self - instruction
Use of picture-based graphic organizer/
planner to complete assignments
and to engage in socially
appropriate behavior, prepare
food and complete vocational tasks
Applicability depends upon the
associated conditions.
(Hume, Plavnik, & Odom,
2012; Schneider & Goldstein, 2010);
D irect ed inquiry
Students have been taught to use a
directed-inquiry chart to answer questions
about science and social studies topics.
(Agran et al., 2006; Browder, Trela, et al.,
2012; Courtade et al., 2010)
52. Peer tutoring
• Peer tutoring in special education is a
strategy where higher-performing students
are paired with lower-performing students or
students with disabilities to review or teach
academic material
• . This strategy has been proven to help
students on both sides master content and
gain self-confidence in specific skills
• Introducing a peer tutoring program to help
students with disabilities and their typical
peers may be an effective and efficient way
to boost academic achievement
53. Building Self-
Regulation and
Social Skills
Teach to
Proactively
identify signs of
overstimulation
or frustration.
Teach them to use a nonverbal
signal / other communication means
with the student to indicate the need
for a brain break.
Teach to identify
a calming zone
at classroom
where the
student can go to
regroup and
relax.
Teach social rules like
how close to stand to
people and how to
interpret body language
and other nonverbal cues.
Teach social
skills using Pre-
correct and
prompt.
Teach to respond to
inappropriate behavior
using respectful
redirection.
Teach them how
to over come
perseveration
54. USEFUL TIPS
Introducing New Concepts
• Give a short review or connection to a previous
lesson before teaching new ideas.
• Use simple, concrete and clear language.
• Use visual representations
• Explain figures of speech as you use them.
• Break down abstract concepts and rephrase if
needed
56. Modification of teaching materials
• Put adaptive materials in with all of the
other materials.
• A sensory needs incorporated that allows
students who need to touch and feel —in
order to calm, self-regulate, and/or
focus—a safe way to meet that need.
• Interactive in nature
57. Parent involvement in classroom learning
• Studies of family engagement in children’s education reveal large
associations between family engagement and success for students.
• Family engagement improves classroom dynamics and increases teacher
expectations, student–teacher relationships, and cultural competence,
regardless of students’ age groups (Boberiene, 2013).
• Family engagement leads to enriched social experiences for
the children’s cognitive skills, and social-emotional skills, including
motivation, attention, impulse control, and self-confidence
58. References • Watson, Sue. (2021, October 14). Teaching Students With Multiple Disabilities or Handicaps.
Retrieved from https://www.thoughtco.com/multiple-disabilities-3111125
• Banerjee, Rashida & Sundeen, Todd & Hutchinson, Susan & Jackson, Lewis. (2016). Factors
that explain placement decisions for children with multiple disabilities: An analysis of national
data.. Journal of Research in Special Educational Needs. 17. 10.1111/1471-3802.12363.
• McConachie, H., Colver, A. F., Forsyth, R. J., Jarvis, S. N., & Parkinson, K. N. (2006).
Participation of disabled children: how should it be characterised and measured? Disability &
Rehabilitation, 28(18), 1157-1164.
• Highnote Allgood, M.; Heller, K.W.; Easterbrooks, S.R.; Fredrick, L.D. Use of picture
dictionaries to promote functional communication in students with deafness and intellectual
disabilities. Commun. Disord. Q. 2009, 31, 53–64, doi:10.1177/1525740108327078.
• Evmenova, A.S.; Behrmann, M.M. Enabling access and enhancing comprehension of video
content for postsecondary students with intellectual disability. Educ. Train. Autism Dev.
Disabil. 2014, 49, 45–59.
• McKenzie, A.R. Emergent literacy supports for students who are deaf-blind or have visual and
multiple impairments: A multiple-case study. J. Vis. Impair. Blind. 2009, 103, 291–302,
doi:10.1177/0145482X0910300507.
