CHAPTER 6

Learners with Additional Needs

Learners who are Gifted and Talented

 Definition
 Learners who are gifted and talented are students with higher abilities than average and are often referred to as gifted students.
 This group refers to students whose talents, abilities, and potentials are developmentally advanced.
 They require special provisions to meet their educational needs, thus presenting a unique challenge to teachers.
 They often finish tasks ahead and might ask for more creative tasks or exercises. Exciting and energizing activities should be provided to continuously keep them motivated.
 This group includes students with exceptional abilities from all socio-economic, ethnic, and cultural populations.
 What is the difference then between gifted and talented?
The term giftedness refers to students with extraordinary abilities in various academic areas.
However, talent focuses on students with extraordinary abilities in a specific area.
There is also another way to look into giftedness which is conceptualized by Gardner in 1993. According to him, intelligence is multifaceted.
 Identification
 To identify gifted and talented students, one must do the following:
Locate the student's domain of giftedness
Describe the student's level of giftedness
Describe the student's fields of talent
 Learning Characteristics
 Not all learners will exhibit the learning characteristics listed below. However, these are the common manifestations of gifted and talented learners. One might possess a
combination of characteristics in varying degrees and amounts.
High level of intellectual curiosity
Reads actively
High degree of task commitment
Keen power of observation
Highly verbal
Gets bored easily
Can retain and recall information
Excited about learning new concepts
Independence in learning
Good comprehension of complex contexts
Strong, well-developed imagination
Looks for new ways to do things
Often gives uncommon responses to common questions
 General Educational Adaptations
 Learners who are gifted and talented usually get bored since they have mastered the concepts taught in classes. One thing that is common among gifted students is that they are
very inquisitive. Fulfilling their instructional needs may be a challenging task. These are some suggested strategies for teaching gifted students:
Teachers may give enrichment exercises that will allow learners to study the same topic at a more advanced level.
Acceleration can let students who are gifted and talented can move at their own pace thus resulting at times to in completing two grade levels in one school year.
Open-ended activities with no right or wrong answers can be provided, emphasizing on divergent thinking wherein there are more possibilities than pre-determined answers.
Leadership roles can be given to gifted students since studies have shown that gifted students are often socially immature.
Extensive reading on subjects of their own interest may be coordinated with the school librarian to further broaden their knowledge.
Long-term activities may be provided, that will give the gifted students an opportunity to be engaged for an extended period of time
Learners with Difficulty Seeing
 Definition
 Students in the classroom will exhibit different levels of clarity of eyesight or visual acuity. There may be some students with hampered or restricted vision. Learners with difficulty
seeing are those with issues regarding sight that interfere with academics.
 The definition from Individuals with Disabilities Education Act (IDEA) states that “an impairment in vision that, even with correction, adversely affects a child’s educational
performance, which includes both partial sight and blindness.”
 These students may need to have their eyesight corrected by wearing glasses or other optical devices.
 Identification
 Learners with difficulty seeing often have physical signs, such as crossed eyes, squinting, and eyes that turn outwards. They may also be clumsy, usually bumping into objects
which causes them to fall down. They like to sit near the instructional materials or at times would stand up and go near the visual aids.
 Learners with difficulty seeing will also show poor eye-hand coordination. This can be seen in their handwriting or poor performance in sporting activities. Another indication is poor
academic performance as these students might have difficulty reading as well as writing.
 Learning Characteristics
 Good visual ability is critical in learning. Most school lessons are done through blackboard writing, presentations, or handouts, in most major subjects. Visual impairments, whether
mild, moderate, or severe, affect the student’s ability to participate in normal classroom activities. In the past, students who are visually impaired are placed in special institutions.
Nowadays, most are enrolled with other children who are not visually impaired.
 Learners with difficulty seeing have restricted ways to learn incidentally from their surroundings since most of them learn through visual clues. Because of this, the other senses are
used to acquire knowledge. Due to the limited ability to explore the environment, low motivation to discover is present.
 General Educational Adaptations
 Modification in teaching is needed to accommodate students with difficulty seeing. The following strategies may be considered:
If the use of books is part of your lesson, students with difficulty seeing should be informed ahead of time so that they can be ordered in braille or in an audio recorded format.
Portions of textbooks and other printed materials may be recorded so that visually-impaired students can listen instead of focusing on the visual presentation.
All words written on the board should be read clearly.
Students with difficulty seeing should be seated near the board so that they can easily move close to the instructional materials used during the lesson.
A buddy can be assigned to a student with difficulty seeing as needed. This can be crucial to assist in the mobility of the student such as going to the other places in school
during the day.
Students with difficulty seeing might need more time to complete a task or homework. This might be on a case-to-case basis.
Teachers should be aware of terminology that would require visual acuity (such as over there or like this one) which the impaired student may not possess
 Teachers should monitor the students closely to know who needs extra time in completing tasks.
Learners with Difficulty Hearing
 Definition
 This refers to students with an issue regarding hearing that interferes with academics. The definition from Individuals with Disabilities Education Act (IDEA) defines it as "an
impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance but is not included under the definition of 'deafness'." Deafness is
considered when hearing loss is above 90 decibels. A hearing loss below 90 decibels is called hearing impairment.
 The main challenge of hearing-impaired students is communication, since most of them have varying ways of communicating. The factors affecting the development of
communication skills include intelligence, personality, the degree and nature of deafness and residual hearing, family environment, and the age of onset. The latter plays the most
crucial role in the development of language as those who have hearing loss present at birth are more functionally disabled than those who lose hearing after language and speech
development.
 Identification
 To identify learners with difficulty hearing, observe a student and see if he/she does the following items below.
Speaking loudly
Positioning ear toward the direction of the one speaking
Asking for information to be repeated again and again
Delayed development of speech
Watching the face of the speaker intently
Favoring one ear
Not responding when called
Has difficulty following directions
Does not mind loud noises
Leaning close to the source of sounds
 Learning Characteristics
 Since much of learning is acquired through hearing, students with hearing problems have deficiencies in language and in their experiences. Since they may miss out on daily
conversations, they may miss crucial information that non-hearing-impaired students learn incidentally. Students may overcome these problems by investing time, energy, and
combined effort by both parents and educators.
 Most learners with difficulty hearing use various methods of communication. The most common is the use of hearing aids, combined with lip-reading. These students are referred to
as "oral" since they can communicate thru speech as opposed to sign language. They might have delayed communication skills since the development of vocabulary is slower.
They understand concepts when the sentence structure is simpler. Interacting with students can be a challenge so they prefer to work on their own. Some hearing – impaired
students use note-takers in class since it is difficult to lip read and take notes simultaneously.
 General Educational Adaptations
 There is an assumption that the only adjustment for hearing impaired students is to make all instructional materials and techniques in written format. These are other ways to adapt
to hearing-impaired students:
Teachers should help students with difficulty hearing to use the residual hearing they may have.
Teachers should help students develop the ability for speech reading or watching others' lips, mouth, and expressions.
Teachers should be mindful to face the class at all times when presenting information while ensuring that the students with difficulty hearing sit near them.
Exaggerating the pronunciation of words should not be done for it just makes it difficult for the student with difficulty hearing.
Directions, as well as important parts of the lesson, should always be written on the board.
Written or pictorial directions instead of verbal directions may be given.
Steps to an activity may be physically acted out instead of verbally given.
A variety of multi-sensory activities should be given to allow the students to focus on their learning strengths.
Teachers should be more patient when waiting to hear a response from a hearing-impaired student which may take longer than usual.
Learners with Difficulty Communicating
 Definition
 Some learners are observed to have difficulty communicating, either verbally expressing their ideas and needs and/or in understanding what others are saying. Some may have
had a clinical diagnosis of a disability while others display developmental delays and difficulty in the speech and language domain. To have a clearer understanding of students who
have difficulty communicating, we will begin with a definition of communication and its accompanying concepts; how learners with communications difficulties are identified, their
learning characteristics, and ways how to help them manage and become successful in an inclusive setting.
 Types of Communication Impairments and Disorders
Communication is the interactive exchange of information, ideas, feelings, needs, and desires between and among people (Heward, 2013). Communication is used to serve
several functions, particularly to narrate, explain, inform, request (command), and express feelings and opinions.
How is speech different from language?
o Speech is the expression of language with sounds, or oral production. Speech is produced through precise physiological and neuromuscular coordination: (1) respiration (act
of breathing), (2) phonation (production of sound by the larynx and vocal cords), and (3) articulation (use of lips, tongue, teeth, and hard and soft palates to speak).
o Language is used for communication, a formalized code used by a group of people to communicate with one another that is primarily arbitrary (Heward, 2013). People
decide on symbols, their corresponding meaning, and that rules that make up a language. There are five dimensions of language describe its form (i.e., phonology,
morphology, syntax, content (semantics), and use (pragmatics). Table 6.1 provides a description for each dimension.

Table 6.1. Components of language

Components Description
Phonology refers to the sound system of a language. A phoneme is the smallest unit of sound within a language. For instance, the word dog is made up of three
Phonology
phonemes, namely /d/-/o/-/g/while beans has four phonemes, /b/-/ea/-/n/-/s/.
Morphology of a language refers to the smallest unit of language that has meaning and which are used to combine words. Sounds, syllables, or whole words are
Morphology
examples of morphemes.
Syntax is the system of rules governing the meaningful arrangement of words, which also include grammar rules. For instance, the sentence, ready get for the exam
Syntax
does not make sense until arranged in the right sequence as get ready for the exam.
Semantics refers to the meanings associated with words and combination of words in a language. This also includes vocabulary, concept development, connotative
Semantics
meaning of words, and categories.
Pragmatics revolves around the social use of language, knowing what, when, and how to communicate and use language in specific context. There are three kinds
of pragmatics skills: (1) using language for different purposes (e.g., narrating, explaining, requesting, etc.), (2) changing language according to the context (e.g.,
Pragmatics
talking to a peer as compared to speaking to a well – respected professor), and (3) following rules for conversations and story-telling (e.g., taking turns, rephrasing
when unclear, how to use facial expressions and eye contact, etc.) (American Speech-Language Hearing Association, 2011 cited in Heward, 2013).

Knowing these terms is necessary to understand the different disabilities that are associated with communication disorders, namely Speech Impairments and Language
Disorders. Speech Impairments are communication disorders such as stuttering, impaired articulation, and language or voice impairment. Such disorders are significant enough
that they can adversely affect a student’s academic performance.
There are four basic types of speech impairments: articulation, phonological, fluency, and voice disorder (see Table 6.2).
Table 6.2. Types of speech impairments
Speech Impairment Description Examples
"I want a blue lollipop."
A child is unable to produce a given sound physically. Severe articulation disorder may render a child's
"I want a boo wowipop."
Articulation disorder speech unintelligible. Examples are substitutions, omissions, distortions, and additions of speech
"Can I get three bananas?"
sounds.
"An I et tee nanas?"
A child produces multiple patterns of sound errors with obvious impairment of intelligibility. There is
Phonological "That pie is good."
also noted inconsistent misarticulation of sounds (i.e., sometimes a child is able to articulate it but not
disorder "Cat bye is tood.”
in other words).
Blocks:
"I want a ... banana." (blocks)
Difficulties with the rhythm and timing of speech. Stuttering is an example marked by rapid-fire
Prolongations:
Fluency disorder repetitions of consonant or vowel sounds especially at the beginning of words, prolongations,
"I waaaant a bbbanana."
hesitations, interjections, and complete verbal blocks (Ramig & Shames, 2006 cited in Gargiulo 2012).
Repetitions:
"I want a ba-ba-ba- banana."
Problems with the quality or use of one's voice resulting from disorders of the larynx. Voice may be Phonation disorder (breathiness, hoarseness),
Voice disorder
excessively hoarse, breathy, or too high-pitched. Hypernasality. Hyponasality

Language Disorders involve problems in one or more of the five components of language and are often classified as expressive or receptive . Language disorders are
characterized by persistent difficulties in acquiring use of language that result from deficits in comprehension that include reduced vocabulary, limited sentence structure, and
impairments in discourse, that limit a child's functioning (American Psychiatric Association 2013). To receive a diagnosis of language disorder, the difficulties must not be due to
an accompanying medical or neurological condition and other developmental disability (i.e., intellectual disability or global developmental delay).
There are different types of language disorder – expressive, receptive, and a combination of the two. An expressive language disorder interferes with the production of
language. A child may have very limited vocabulary that impacts communications skills or misuses words and phrases in sentences . On the other hand, a receptive language
disorder interferes with the understanding of language. A child may have difficulty understanding spoken sentences or following the directions a teacher gives. Some children
may be found to have a combination of receptive and expressive language disorder.
At this point, it is also essential to mention that students with autism spectrum disorder (also display speech and language difficulties. ASD is an umbrella term for related
disorders that affect social development and communication (Kirk et al. 2015). Students with ASD display a triad of impairments in social relationships, social communication,
and social understanding. Other disorders that are subsumed under ASD are Rett Syndrome, Pervasive Developmental Disorder, and Asperger’s Syndrome. Oftentimes,
students with ASD display deficits in the pragmatic use of language that impact their social relationships.
 Identification
 Communication difficulty is oftentimes one of the most common red flags observed by family members, daycare workers, and early childhood teachers. Noted absence, delays, and
difficulties in speech and/or language often prompt family members to consult their general pediatrician who then makes referrals to developmental pediatricians and other
specialists.
 To screen children with communication difficulties, early childhood professionals use questionnaires and developmental checklists to determine the severity of the delay as
compared with typical language development. Upon screening, a child may receive educational supports and accommodations to help address the delay. If the difficulty is
pronounced, referrals can already be made to developmental pediatrician and a speech and language pathologist. At times, referrals are also made to an occupational therapist if
speech difficulty is resulting from motor problems.
 How do specialists determine a speech and/or language problem? A comprehensive speech and language evaluation to determine the presence of a communication disorder
involves several components (Heward 2013).
Case history and physical examination. Assessment always begins with the case history that provides the specialist the necessary background about the child’s birth and
developmental history, health record, achievement test scores, and adjustment in school. The specialist examines the child’s Oral-Peripheral Mechanism which includes the
mouth, noting irregularities in the tongue, lips, teeth, palate, or other structures that may affect speech production.
Hearing is tested to determine whether an organic hearing problem is the cause of the suspected communication disorder, as discussed in the previous section. Thus, hearing
impairment needs to be treated to develop speech and language skills.
Articulation. A child’s articulation skills are assessed, which includes identifying speech errors (see Table 6.2).
Phonological awareness and processing. Phonological awareness and processing skills provide the foundation for beginning to read in young children (Adams 2013). Children
with difficulties in processing sounds in language as well as in hearing, segmenting, and identifying phonemes in words may experience problems with expressive and receptive
spoken language as well as in learning how to read.
Overall language development and vocabulary. Formal tests may be used to measure a child’s overall language development and vocabulary as these affects how well a child is
able to understand and use language in spontaneous speech and in academic settings.
Assessment of language function. Language is used to serve several functions such as to request, name, imitate, ask, and converse among others. B. F. Skinner (Sundberg
2007 cited in Heward 2013), emphasized how language is used rather than the structure and form of language.
Language samples and observation in natural settings. Language difficulties may also be identified through play-based, authentic assessment where a specialist plays with a
child during which spontaneous speech and verbalizations can be elicited. Observations in natural settings, such as a child’s home or school, allows the specialist to sample the
child’s language in daily activities and observe parent and child interaction and communication as part of holistic assessment. These are used to supplement assessment
information gathered in clinical settings.
 Assessments in speech, language, and communication must take into consideration the student’s cultural and language context, particularly for children growing up in bilingual
environments. At this point, it is essential to differentiate English Language Learners (ELL) from children with diagnosed communication disorder. ELLs are proficient in their mother
tongue or first language in both expressive and receptive language tasks; on the other hand, they display difficulties in understanding and speaking the second language, such as
English. In a multicultural setting, knowing the child’s first and second language aids teachers and language specialists to determine the possible sources of communication
difficulties and plan for needed supports and interventions. An English language learner is put at a disadvantage when his/her first language (i.e., mother tongue) is not identified
and assessed solely in the second language.
 Learning Characteristics
 Children with communication disorders frequently struggle across social settings, whether at home, school, or in other places in the community. Some of the difficulties that
characterize communication disorders are presented in Table 6.3.
 Children with communication disorders may also experience behavioral difficulties. Because they struggle in expressing their needs and ideas, some children resort to inappropriate
behaviors out of frustration or to get the attention of significant others. For instance, a five-year old child with expressive language disorder may resort to grabbing toys and hitting
his peers who try to take the toy he was playing with the day before. While typically developing children will be able to say, "May I please borrow?" or "It's my turn now," a child with
communication difficulties may not be able to utter these accurately and instead resort to using actions resulting to physical aggression. Thus, it is essential that teachers and
professionals take this into consideration when working with children with communication disorders and difficulties. Such feelings of frustration may even become worse when
peers or adults are unable to understand them (Gregg 2016).
 Despite these language difficulties, children with communication disorders are known to have their own strengths and abilities. This can be best understood using the theory of
multiple intelligences (Gardner 1983 cited in Armstrong 2012), as explained in Chapter 5 that shows the different strengths and abilities children have. In Gardner's theory, children
may have abilities in different areas or domains, which makes it necessary for parents and teachers to provide opportunities for such strengths and abilities to be displayed.
Children with communication disorders may have limitations in the linguistic and interpersonal areas but may possess good spatial, musical, and bodily-kinesthetic abilities. In other
words, a child may struggle with communication but can be very good in playing musical instruments, be very creative and artistic, and/or excel in sports. As parents, teachers, and
practitioners, knowing a student's strengths and highlighting such abilities in an inclusive classroom is as important as knowing and understanding his/her communication disorder.

Table 6.3. Language difficulties

Expressive Language Difficulties Receptive Language Difficulties
 Limited vocabulary  Following oral directions
 Incorrect grammar or syntax  Understanding humor or figurative language
 Expressive repetition of information  Comprehending compound and complex sentences
 Difficulty in formulating questions
 Responding to questions appropriately
 Difficulty constructing sentences

 General Educational Adaptations

 Different strategies and accommodations may be used to provide a level playing field for children with communication difficulties or disorders. This section discusses the use of
Universal Design for Learning (UDL) and practical tips to be used in the classroom.
 Universal Design for Learning
Use of UDL in the classroom allows children to learn information, demonstrate understanding, and stay engaged in multiple ways (i.e., multiple means of presentation,
expression, and engagement). Because of weaknesses resulting from communication difficulties or disorders, teaching and learning practices as well as assessment should be
presented in different modalities, such as visual, auditory, and kinesthetic-motor or tactile. This means that lessons are presented through various means, such as using pictures
and/or videos and hands-on experiential learning, and not solely by passive approaches such as reading from textbooks, lectures, and teacher-directed discussions. Presenting
learning activities in this manner gives children with communication difficulties or disorders the opportunity to use their strengths and stronger modalities to compensate for their
weaknesses and a chance to be successful in an inclusive classroom.
Practical Tips for the Classroom. In addition to using UDL, there are practical tips and techniques that teachers can use to provide students with communication difficulties the
support they need in order to be successful. The following list provides practical suggestions that teachers can use in the classroom. These suggestions are best implemented in
a classroom that promotes a supportive and respectful culture, one that acknowledges and accepts diversity, and allows accommodations for learners with difficulties.
 Allow the child to sit near the teacher and the blackboard, away from auditory and visual distractions such as the window and the door.
 Get the child’s attention before giving directions. Call the child's name or use a pre-arranged signal (e.g., tap on the table or hand on the shoulder) to help the child focus
and listen to the directions.
 Use picture, charts, and other visual aid when explaining content supplement auditory information.
 Speak slowly and clearly without exaggerating speech.
 Simply directions into short steps. Break down multi-step directions and give each one at a time instead of just repeating each one.
 Provide a written copy of directions for a task so the child can refer back to it at his/her own pace.
 Use gestures to clarify information.
 Use peer-mediated instruction so that peers without difficulties can serve as language models and learning buddies.
 Provide extra time to prepare for oral language activities. Do not call children with communication difficulties disorders to recite first in class. Call other typically developing
children first to serve as language models.
 Model correct language forms and use appropriate wait times (3 – 5 seconds or more) to give the child time to think and respond.
 Explicitly teach vocabulary that is needed in the learning context to promote better comprehension.
Universal Design for Learning, alongside different accommodations (i.e., presentation, response, setting, and timing) that are appropriate to the child, and collaboration between
the general education teacher and the special education professional, will all help ensure that children with communication difficulties/disorders have a chance to be successful
in an inclusive classroom.

Learners with Difficulty Moving/Walking

 Definition
 When a child has difficulty moving and/or walking, the physical domain of development is affected. Examples of physical disability are developmental coordination disorder or
dyspraxia, stereotypic movement disorder, tics and cerebral palsy. Each one is defined in the succeeding sections.
 Developmental coordination disorder is described in the DSM-5 (American Psychiatric Association 2013) refers to significant and persistent deficits in coordinated motor skills that
are significantly below expected typical development. Difficulties are manifested as clumsiness (e.g., dropping or bumping into objects), slowness, and inaccuracy of motor skills
(e.g., catching an object, using scissors or cutlery, handwriting, riding a bike, participating in sports). These observed deficits impact academic performance and other activities of
daily living which do not result from intellectual disability, visual impairment or any neurological condition affected movement (e.g., cerebral palsy). Dyspraxia, used synonymously
with developmental coordination disorder, is a term often used by occupational therapists.
 Another type of motor problem, Stereotypic movement disorder is characterized by repetitive, seemingly driven, and nonfunctional motor behavior (e.g., hand shaking or waving,
body rocking, head banging, self-biting, hitting own body). These behaviors interfere with social, academic or other activities and may result in self-harm or injury (American
Psychiatric Association 2013). Such motor behaviors do not result from any other neurodevelopmental or mental disorder.
 Cerebral Palsy refers to a disorder of movement and posture that results from damage to the areas of the brain that control motor movement (Kirk et al. 2015). This damage to
the brain can occur before, during, or after birth due to an accident or injury. Muscle tone (tension in the muscles) affects voluntary movement and full control of the muscle that
results in delays in the child’s gross and fine motor development. There are different classifications of cerebral palsy, depending on which parts of the body are affected and the
nature of the effects on muscle tone and movement. The term plegia, from the Greek word meaning "to strike," is used with a prefix that indicate the location of limb movement (see
Table 6.4).

Table 6.4. Classifications of cerebral palsy

Classification Description
Monoplegia Only one limb is affected (upper or lower)
Hemiplegia Two limbs on the same side of the body affected
TripIegia Three limbs are affected
Quadriplegia All four limbs, both arms and legs, are affected; movement of the trunk and face may also be impaired
Diplegia Legs are affected, less severe involvement of the arms
Double hemiplegia Impairment primarily involves the arms, less severe involvement of the legs

Learners with Difficulty Moving/Walking

 Identification
 Developmental Coordination Disorder. Identifying children with motor difficulties begins with family members and early childhood practitioners. Upon noticing that their child is
showing difficulties and delays in fine and/or gross motor movements, parents oftentimes consult their general pediatrician who in turn may refer them to other specialists such as a
developmental pediatrician, a physical therapist, or an occupational therapist. Some signs that a child may have developmental coordination disorder that is more than just typical
difficulty in moving or walking, presented in Table 6.5 (Nordqvist 2017).
 In conducting an assessment, a specialist determines the child’s developmental history, intellectual ability, and gross and fine motor skills. To differentiate between the two, gross
motor skills involve the use of large muscles in the body to coordinate body movement, which includes throwing, jumping, walking, running, and maintaining balance. On the other
hand, fine motor skills involve the use of smaller muscles that are needed in activities like writing, cutting paper, tying shoelaces, and buttoning.
 The evaluator needs to know when and how developmental milestones are achieved. Assessment is conducted to check the child's balance, sensitivity touch, and performance in
other gross and fine motor activities (Nordqvist 2017).
 Oral motor coordination in doing activities like blowing kisses or blowing out birthday candles may also be reported. Moreover, an evaluator will check for the following: (1) strength
and flexibility by palpating muscle bulk and texture, assessing flexibility of joints, and the quality and intensity of grasp and (2) motor planning which includes observing functional
fine and gross motor skills and determining hand dominance or lack thereof (Harris et al. 2015).
 Stereotypic Movement Disorder. Similar steps are followed in the identification of the presence of Stereotypic Movement Disorder (SMD) among children. Typically developing
children may display stereotypic movements, or behaviors, often referred to as stereotypies, between ages two and five as well as children with other neurological conditions such
as autism spectrum disorder and other developmental disabilities. Because of this, specialists classify SMD as “primary" when it occurs in an otherwise typically developing child, or
"secondary" if it exists alongside other neurological disorders (Valente et al. 2019).

Table 6.5. Signs of developmental coordination disorder

Developmental Stage Signs
 Difficulty in tying shoelaces, buttoning, using spoon and fork, and getting dressed; problems in jumping, skipping, catching, and kicking a ball; a
Early Childhood
higher tendency to bump into things, to fall over, or to drop things
The difficulties in early childhood become more pronounced; tries to avoid sports; works on writing tasks for a longer period of time in comparison to
School-Age
typically developing peers

Learners with Difficulty Moving/Walking

 Learning Characteristics
 Motor difficulties and disabilities are known to significantly affect a child's ability to perform daily activities, which include memory, perception and processing, planning, carrying out
coordinated movements. Speech may also be affected as motor control is needed in articulation and production. Moreover, developmental coordination disorder also affects
psychosocial functioning as children report to have lower levels of self-efficacy and competence in physical and social domains, experience more symptoms of being depressed
and anxious, as well as display externalizing behaviors (Harris et al. 2015). Children with stereotypic movement disorder also tend to have low self-esteem and have been reported
to be withdrawn (Valente et al. 2019).
 On the other hand, a “range of strengths” needs to be acknowledged in every child with a disability (Armstrong 2012). Students with motor/ movement disorders may excel in other
areas of intelligences that are not controlled by motor functions. They may have adequate intelligence, creativity, and language skills depending on the severity of the disorder and
the presence of a supportive adult. In fact, some children and adults who are physically handicapped or have cerebral palsy have learned to paint with their mouths or feet to
compensate for their rigid limbs and have done so successfully. Some children may do well in logical thinking and comprehension and even in writing using assistive technology.
Hence, for children with motor difficulties and disabilities, support systems are needed to ensure that they are given equal opportunities to access learning experiences in school
alongside their typically developing peers.
 General Educational Adaptations
 First and foremost, children with motor difficulties and disabilities need primary intervention with specialists such as physical and occupational therapists. These professionals are
responsible for setting goals in motor development, planning, and mobility as well as in providing teachers and others with information about the child's physical conditions,
limitations, and abilities (Kirk et al. 2015).
 Physical accessibility of a school and classrooms to children with motor difficulty/disability is essential. Ramps and elevators for schools with multiple levels of buildings is
necessary, as well as the provision of wheelchairs. Providing such structures and supports ensure that children with motor difficulty/disability would be able to access as well as
move around the classroom safely.
 The type of accommodations given will always be relative to the strengths, abilities, and difficulties of the child. For a child with developmental coordination or stereotypic movement
disorder who struggles or is unable to write but has adequate articulation and language skills, he/she may benefit from being given accommodations in the way understanding is
demonstrated (i.e., response). Some of the recommendations for a child with such a profile may include the following: (1) assigning an adult or a peer to be a scribe when
accomplishing written tasks may be an option and (2) being given a pencil or pen grip and different size/diameter for a pencil for those with poor fine-motor control.
 Table 6.6 presents practical classroom accommodations for children with developmental coordination/movement disorder (Pollock & Missiuna 2007; Beech 2010).
Table 6.6. Classroom accommodations for children DCD/SMD
Type of Accommodations Description
 Assign a peer/adult as scribe for note-taking
 Use different sizes of paper and graph paper to align numbers
 Try different writing tools and pencil grips
Response  Use a word processor/computer
 Use text-to-speech programs
 Allow for oral recitation/test-taking to supplement written tests
 Provide alternate assessment methods
 Allow for preferential seating near the teacher
 Adjust chair and/or desk height to maximize posture and stability
Setting
 Place a non-skid mat on the chair
 Provide opportunities for movement breaks
 Allow for extra time to complete tests and writing assignments
Schedule
 Provide extra time to change for physical education classes
 Photocopy notes and homework reminders for the child
 Allow to take photos of notes and homework reminders
Others
 Give advance organizers before a lesson/lecture to lessen/remove writing task
 Send lecture handouts via email

Learners with Difficulty Remembering and Focusing

 Definition
 The International Classification of Functioning, Disability, and Health of the World Health Organization (2001) provides definitions of specific mental functions and focusing.
 Memory functions include short–term memory, long–term memory, and retrieval, while attention functions include sustaining, shifting, dividing, and sharing attention.
 Santrock (2011) also provides a description of each of these functions (see Table 6.7).
 Understanding these concepts is necessary to have a clearer picture of how to enable learners with such difficulties to succeed and how to provide support in an inclusive
setting.
 Students with Learning Disability (LD) and/or Attention Deficit Hyperactivity Disorder (ADHD) are characterized by having difficulties with memory and attention functions.
 It was Samuel Kirk who coined the term, "learning disability" in 1962 when he met with parents and families as they discussed about students who encountered pronounced
difficulties in school despite having average to above-average intelligence. He further described students with learning disabilities as a heterogeneous mix of learners who all
had neurologically-based problems that affected their learning in different ways (Kirk et al., 2015).
 To better understand learning disabilities, Gargiulo (2012) provided common components on the definitions of a LD:
o Intellectual functioning within normal range
o Significant gap or discrepancy between a students’ assumed potential and actual achievement
o Inference that LD is not primarily caused by other disabilities or extrinsic factors
o Difficulty in learning in one or more academic areas
o Presumption of CNS dysfunction. (p.198)
 These components are also found in the definition provided by the National Joint Commission on Learning Disabilities (1990):
o Learning disabilities 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, or mathematical abilities.
 These disorders are intrinsic to the individual, presumed to be due to central nervous system dysfunction, and may occur across the life span. Problems in self-regulatory
behaviors, social perception, and social interaction may exist with learning disabilities but do not by themselves constitute a learning disability. Although learning disabilities may
occur concomitantly with other disabilities (for example, sensory impairment, intellectual disabilities, emotional disturbance), or with extrinsic influences (such as cultural or linguistic
differences, insufficient or inappropriate instruction), they are not the result of those conditions or influences."
 The term Learning Disability is differentiated from Specific Learning Disability which focuses on difficulties in "one or more basic psychological processes involved in
understanding or in using language, spoken, or written, which may manifest as difficulties in the ability to listen, think, spark, read, write, spell, or do mathematical calculations"
(Individuals with Disabilities Education Act, 1997 in Hallahan, 2014, p. 168). Thus, the term Learning Disability is a general term under which other difficulties are subsumed.
 There are different types of specific learning disabilities for each type of difficulty namely, Dyslexia for difficulties with reading, spelling, and oral reading fluency; Dyscalculia for
difficulties in math computation, problem-solving, and analysis; and Dysgraphia for difficulties with handwriting and written expression (see Table 6.8).
 DSM-5 (American Psychiatric Association 2013) provides the diagnostic criteria for ADHD, which include inattention, hyperactivity and impulsivity, and a combination of the two. For
a child to be diagnosed with ADHD, the observed behaviors should meet the following criteria:
 Display a persistent pattern for at least 6 months that significantly interferes with functioning or development
 Observed in two or more settings (e.g., at home, school, work; with friends or relatives; and in other activities)
 Several of the symptoms were present before the age of 12 years.
 The behaviors are not resulting from other disorders (e.g., schizophrenia, anxiety disorder, personality disorder, etc.)
 More behavioral manifestations are presented in Table 6.9
 Identification
  Identifying students with LD and ADHD begins with the parents and teachers. The presence of difficulties in mental functions provided in Table 6.8 and the behaviors
enumerated in Table 6.9, as well as meeting the provided criteria for persistence and consistency in more than on setting, may create the impetus for parents to consult specialists
and for teachers to apply pre-referral strategies before referring the student for special education testing.
 In identifying with LD, a discrepancy between academic achievement and intelligence needs to be established using tests that measure intelligence and standardized
achievement tests. Children with LD oftentimes display average to above average intelligence but perform below their grade placement in achievement tests of reading, spelling,
math and written expression. The problem, however, identifying with LD is establishing the discrepancy as there is no clear description or level of discrepancy to occur for a
student to be diagnosed to have LD (Garguilo 2012).
 In addition to the use for clinical testing, teachers can provide essential information about a student’s patterns of abilities and difficulties. Conducting student observations,
interviews, and error analysis of schoolwork will provide the supplementary information needed to determine ways to help a child who may be at-risk and/or have signs of a
learning disability. A clinical/educational psychologist and/or a special education diagnostician use all available data from norm referenced tests, teachers’ observations, analysis
of achievement tests, and parent interview to determine if the learning difficulties may be attributed to the presence of a learning disability presence of a learning disability.
 On the other hand, identifying children with specific learning disabilities, do not adhere to the achievement-potential discrepancy. In its place, what is measured is the
discrepancy between the current level of skills (i.e., reading, spelling, math, written expression) and the expected grade level in achievement tests in reading, spelling, oral
reading fluency, and math. This discrepancy needs to be established to ascertain that the underlying difficulties emanate from the disability and not due to other contributory
factors. To create a holistic picture of the learner, observations, and interviews with parents and teachers are essential.
 There are four components that are needed in identifying students ADHD: (1) medical examination, (2) clinic interviews, (3) use of teacher and parent rating scales, and (4)
behavioral observations (Hallahan et al, 2014). Each one is discussed as follows.
 Medical examinations are needed to rule out the presence of sensory impairment or middle ear infections that can cause hearing problems. Other medical conditions such
as seizure disorders, brain tumors, and thyroid problems that may be the underlying cause of the inattentive and/or hyperactive behaviors also need to be ruled out (Barkley
& Edwards 2006 cited in Hallahan et al. 2014)
 Clinical interview with the parent/s provides the specialists with holistic perspective of the child and essential information about the student's physical and psychological
characteristics, family and cultural background, and peer relationships. An ecological approach in assessment is necessary to rule out other contributing factors, like drastic
changes in family dynamics such as separation of parents, unexpected deaths, and others that may be causing observed behaviors of inattention and/or hyperactivity.
 Teacher and parent rating scales are used as additional tools to provide evidence of the student's inattention, hyperactivity, and/or combination of the two. Standardized
rating scales, such as the Conners Rating Scales (Conners 2007 cited in Hallahan et al. 2014), are used by clinical psychologists and special education diagnosticians to
identify the presence of ADHD in a student. The rating scale measures the following behaviors: hyperactivity, aggressive behavior, violent tendencies, compulsive
behaviors, perfectionism, and difficulty in class, extra trouble with math, difficulty with language, social issues, emotional distress, and separation anxiety (Johnson 2018).
The teachers' and parents' responses to the rating scales are based on their daily observations of the student for the past six months in their respective settings (home,
school, or workplace).
 Learning Characteristics
 Oftentimes, learning characteristics refer to the difficulties and challenges experienced by students with LD and ADHD. While these are also essential to determine possible
accommodations and interventions, it is equally important to present their strengths and abilities alongside their challenges as these can be used to help create a positive niche for
students (Armstrong 2012).
 Students with LD are known to have challenges in language, literacy, and memory (Kirk et al. 2015) as well as in math, writing, and focusing/attending skills. Nonetheless, it is
important to note that these are merely general characteristics as there are individual differences in terms of abilities and difficulties among children with LD and ADHD.
 In language development, they often display delays in learning how to speak, have difficulties in naming objects and retrieving words from memory, and have limited vocabulary in
comparison to typically developing peers. Students with LD oftentimes struggle with having to organize their thoughts that they are unable to use precise words to express their
ideas. On the other hand, there are students with LD who are better at oral expression in relation to their reading and writing skills. Such students are better at expressing
themselves, at times rather fluently, but are unable to transfer their thoughts to writing.
 In terms of reading skills, students with dyslexia display delays and difficult in phonological processing, word reading / decoding, spelling, and oral reading fluency. Fundamental to
reading is phonological awareness, or the knowledge that all words can be segmented into phonemes (sounds) and that the letters in a written word correspond to these sounds.
Individuals with dyslexia have poor phonological awareness that subsequently impedes word reading ability, fluency, and accuracy. This basic weakness, then, blocks access to
higher-order language processes and to gaining meaning from text. Thus, problems with comprehension may be attributed to inaccurate decoding and lack of oral reading fluency,
but they can use higher-level skills of vocabulary, reasoning, problem-solving, concept formation, and general intelligence (Shaywitz 2003).
 To a certain extent, their reading skills may be compared with younger children who are at the beginning reading level. Oral reading fluency tends to be slow and laborious, others
reading in a word-by-word fashion, at times substituting words, and lacking in proper intonation/expression due to poor decoding skills and sight word vocabulary. T able 6.11 shows
a sample oral reading of a nine-year old student with dyslexia. It is expected that the student will not be able to understand the passage well because of all the substitution errors
unless he/she uses his/her prior knowledge and experience revolving around the story.
 In terms of written language, students with LD have tendencies to reverse letters or words, have poor spelling skills and display difficulties in the quality, organization, sentence
fluency, and application of writing conventions, including handwriting, spelling, and grammar, as well as motivation to write (Graham, 2017).
 As for math skills, the difficulties manifest in relation to students' age and grade (Shalev 2004). For instance, students in the first-grade level have problems in the retrieval of basic
math facts and in computing exercises, while older children display severe difficulties in learning the multiplication table and understanding algorithms of the four basic operations
(addition, subtraction, multiplication, and division). Moreover, they are known to have incomplete or inadequate procedural knowledge of algorithms, which are reflected in the way
they misuse or substitute arithmetic sign, forgetting to regroup, misplacing digits, not following the proper alignment of digits when solving, or solving from left to right. As a result,
students with LD struggle with more complex math equations and problems as they lack the foundational arithmetic skills.

Learners with Difficulty Remembering and Focusing

 Learning Characteristics
 Moreover, students with LD also display problems with short-term and working memory (i.e., mental resources used to retain information while simultaneously engaged in another
activity), deficits in metacognition, display attention problems, and hyperactivity. As a result, they often have trouble focusing on tasks, exhibit excess movement, restlessness, and
fidgety behaviors that are characteristic of students with ADHD (see Table 6.9).
 Because of difficulties in executive functioning, students with LD and ADHD are known to be forgetful of daily activities and routines, can be disorganized with their personal
belongings and even schedules, and have problems monitoring comprehension. Parents complain about having to buy a new set of pens and pencils every week because their
children tend to lose them easily. Adults tend to be frustrated because such learners seem to be forgetful and/or absent-minded and they need to be constantly reminded of chores
and other daily routines, which typically developing learners would have already remembered easily. Moreover, due to their impulsivity, students with ADHD exhibit academic
underachievement as well as disruptive behavior that impact on family and peer relationships (DuPaul and Stoner 2003 cited in DuPaul et al. 2012).
 Anchoring on neurodiversity, children with LD and ADHD also have their strengths and abilities amidst such difficulties and limitations. Students with LD are known to have strong
artistic abilities and visual-spatial skills. As a result, they oftentimes display unusual skills in drawing, doing mechanical puzzles, as well as in building models. Moreover, they are
known to be creative, divergent thinkers, imaginative, and highly curious. For instance, a famous person with dyslexia is Charles Schwab, founder of Charles Schwab Corporation
who attributes his success to his dyslexia. He only learned he had dyslexia when he was 40 years old after his son was diagnosed with the same condition. Despite being excellent
in economics and business, he narrated that he would sound out words to understand them when he was younger and that he would still struggle understanding books about topics
unfamiliar to him. But because of his dyslexia, he was able to think of out-of-the-box solutions.
 In relation to this, Shaywitz (2003) presented a "Sea of Strengths Model of Dyslexia," where weakness in decoding is compensated through other strengths such as reasoning,
concept formation, comprehension, general knowledge, problem-solving, vocabulary, critical thinking, and reasoning abilities. This is the reason why students with dyslexia are
oftentimes active in class recitations and projects but struggle with literacy tasks that involve reading and writing stemming from their phonological deficits.

 General Educational Adaptations

 The use of Universal Design for Learning (UDL) principles, such as providing multiple means of representation, expression, and engagement are effective for all types of learners
and provide a level playing field for students with LD, SLD, and ADHD (see Table 6.11) Through a variety of approaches, students with difficulty remembering and focusing
are given opportunities to compensate for their weaknesses and use their strengths to learn as much as their typically developing peers.
 In addition to UDL, an approach that has been proven to be effective for students with memory and focusing difficulties is the use of explicit instruction of literacy skills,
comprehension, and writing strategies. Such approach uses a step-by-step instruction that includes modeling, providing guided practice, as well as independent practice, while
giving immediate corrective feedback so students will understand what and how to improve. Part of this approach is the use of think-aloud to model concrete steps in problem-
solving, such as how to attack an unfamiliar word, how to begin a writing task through brainstorming, and how to begin answering a math word problem.
 For instance, students with dyslexia and struggling readers benefit from the direct/explicit approach in phonological processing, phonics instructions, and spelling rules. Because of
their reading and spelling difficulties, learning through visual approach will not be effective. They may remember the words now, as they are processed in their short-term memory,
but forget them by tomorrow, because the words were not stored in their long-term memory, along with other accompanying difficulties. Gough (1993 in Magpuri-Lavell et al. 2014)
demonstrated that explicit instruction in phonemic awareness and phonics was essential to develop a firm understanding of the alphabetic principles. Another meta-analysis
conducted by Galuschka et al. (2014) found that phonics instruction is the most intensively investigated treatment approach and the only one that has been found to be effective
and statistically confirmed in improving the reading and spelling performance of children and adolescents with reading disabilities.
 Moreover, planning the classroom environment and how routines are implemented is equally important in an inclusive classroom. Because students with LD and ADHD show a
tendency to be restless, become hyperactive, and have short attention spans, providing a classroom that is highly structured and with clear expectations is essential. Class rules
 and norms, agreements, routines as well as schedules need to be written and accompanied by clear and simple images. These need to be explained, displayed, and implemented
consistently to make the classroom environment structured and safe for all children.
 One intervention that has been reported to be effective in helping students with ADHD is the use of the Daily Report Card (DRC), which is an individualized intervention to manage
target behaviors of a child (Moore et. al.2016). It begins with an assessment through observation and teacher/parent interviews to determine specific behaviors that need to be
managed and/or developed in a student (see Figure 6.2). Once identified, the target behaviors are framed positively, and teachers monitor the student's progress on the DRC
throughout the day by recording whether the targets have been met. A system of reinforcements and consequences is developed with the child. Reinforcements can be in the form
of tangible rewards such as stickers, stamps, puzzles, etc. but they can also be opportunities to do certain activities in school, such as having extra time in the classroom or library,
having an extra book to borrow, being the leader for the day, being the teacher's lunch buddy, and other activities. Parents are also included in the planning and implementation to
promote home-school communication and collaboration. In this manner, generalization of behaviors is targeted to the home setting or vice-versa. A meta-analysis of DRC literature
from 2007-2017 yielded results that ranged from weak to strong impact on the academic and social behavior of elementary students who were noted to have disruptive behaviors
as well as the ones diagnosed with disabilities (Riden et al. 2018). The study found important components that the DRC should have to make it effective: (1) clear and
operationalized target behaviors, (2) provide feedback to the student about his/her behavior, and (3) providing home-school communication.
 And finally, the provision of different types of accommodations in terms of presentation, response, setting, and scheduling is beneficial for students with difficulty remembering and
focusing (see Table 6.12).
Table 6.7. Definition of Memory and Attention Functions

Memory Functions: involves encoding, storage, and retrieval of information over time
Mental resources that allow for storing information temporarily, for only approximately 30 seconds, after which is lost if strategies are not used to integrate
Short-term memory
them into long-term memory (e.g., remembering a 7-digit landline number for a moment to be able to write it down).
Long-term memory Mental resources that allow for storing information for a long period of time
Retrieval Mental resources used to recall information stored in long-term memory

Attention Functions: involves focusing of mental resources on a stimulus for a required time period
Mental resources used to maintain attention for an extended period also called vigilance (e.g., staying focused while reading a chapter in a classical novel
Sustained attention
without any interruptions until it is finished)
Mental resources that allow for focusing on a specific stimulus that is important while ignoring others (e.g., focusing on the voice of a lecturer amidst the noise
Selective attention
of a group of used to refocus concentration from one stimulus to another).
Dividing attention Mental resources that involve focusing on ore more activities or tasks simultaneously (e.g., listening to music while driving).

Table 6.8. Specific learning disabilities

Type Definition
Characterized by difficulties with accurate and/or fluent word recognition and by poo spelling and word reading abilities that result from a deficit in phonological
Dyslexia processing abilities. The difficulties are often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction (IDA2002).
Limited vocabulary and background knowledge as well as problems in reading comprehension may result as secondary consequences (Shaywitz 2003).
A specific learning disability that affects how students acquire and develop their arithmetic skills despite average intelligence (Shalev 2011) and may manifest
Dyscalculia
as difficulty in retrieval of math facts and understanding number concepts or using symbols or functions
A specific learning disability that affects the development of writing abilities which may display as spelling, handwriting, and expressive writing difficulties
Dysgraphia
resulting from problems in organizing and putting thoughts on paper (NCLD 2007 cited in LD Online 2019).

Table 6.9. Signs of ADHD

Inattention
o Does not pay attention to details and works in a haphazard manner resulting in careless mistakes (e.g., school tasks, at work, in other activities)
o Finds it difficult to sustain attention in tasks
o Easily distracted and sidetracked by extraneous stimuli
o Often does not follow through on instruction and fails to finish schoolwork, chores, or duties in the workplace
o Appears not to listen or distracted when spoken to directly
o Has difficulty following instructions resulting in unfinished work
o Shows a tendency to be forgetful in daily tasks and routines
o Has problems in organizing tasks and activities
o Tends to lose things that are needed for schoolwork and other activities

Hyperactivity and Impulsivity

o Often restless and fidgety and cannot seem to stay still while sitting down
o Often stands from seat to roam around the room
o Often runs around or climbs in situations when sitting is required
o Often rather talkative, interrupts in conversations, and blurts responses
o Finds it difficult to wait for one's turn in tasks and activities
o Impulsive with words and actions
o May struggle in following instructions and rushes through tasks

Table 6.10. Sample oral reading and spelling of a student with dyslexia

Original Text Student's Oral Reading

A man got out of the car. In a man got out of the car.
He had a pretty box under his arm. He had a pet pate on his arm
A little girl ran from the house to meet the man. A let girl run form... farm the house to meet him
"Hello, Father" she said. "Hello, Father," she said. Father said, "I have some
"Do you have a surprise for me?" Father said, "I have something for a good girl." "Do you have a sharp for me?" thing for you got girl."
The girl laughed, "I am very good." The girl let her. "I have give good."
Words Student's Spelling
will wel
arm urm
dress bres
train tran
shout saot
watch wuch
grown gom

Table 6.11. Application of UDL in an inclusive classroom.

UDL Principle Examples

 Audio books alongside real books
 Multimedia presentations and videos to supplement textbooks
Multiple means of
 Math-manipulative materials and illustrations to reinforce lessons
representation
 Hands-on experiences, use of multisensorial activities in addition to teacher-talk
 Use reading that include materials rich visual representation in the form of photos, graphic organizers, diagrams, etc.
  In addition to traditional measures assessment, provide variety of ways to demonstrate understanding of concepts lessons: debates, build models,
Multiple means of
experimentation, digital audio presentations, writing activities, portfolio assessment, photographs/pictures, blogs, draw pictures/use graphic
expression
organizers to illustrate concepts or content
 Provide varied activities to support student engagement through:
 hands-on, kinesthetic activities
 plays/drama/dance
Multiple means of  simulation games
engagement  role playing
 discussion and debates
 give opportunity for student choice (e.g., range of reading materials, activities)
 use inquiry-based learning and project-based approach

Table 6.12. Types of accommodations to provide support for students with difficulty remembering and focusing

Type of
Accommodations/Supports
Accommodation
 Provide the following:
 Audio files to supplement a slide presentation
 Bigger font sizes in reading materials and worksheets
 Leveled books that match student's reading level
 Audio books and/or have a peer read aloud the selection
Presentation  Digital text that provides word meanings
 Advance organizers to serve as guide during lectures
 Preview of vocabulary or key points to provide the big picture
 Active involvement in class
 Use graphic organizers and mind mapping techniques for note-taking during class
 Explain and write directions step-by-step while making sure student is attentive and listening
 Allow students to use the following:
 Use text-to-speech software to facilitate writing
 Use word processor with spelling and grammar check
 Waive incorrect spelling in specific subjects (do not mark misspellings as incorrect provided content is accurate)
 Graphic organizers as a pre-writing task
Response
 Math supports:
 calculation devices (calculator)
 concrete material and manipulatives
 chart of math facts and formula
 special paper with grids for computation
 Preferential seating (away from sources of distraction)
Setting  Play appropriate background music through individual earphones while studying
 Allow students to move or run around a few times before class or in between classes
 Provide extended time
 Break tasks into sections
Scheduling
 Time limits for assignment and countdown
 Allow for quick brain breaks to move around and stretch in between activities
 Teach self-talk skills
Behavior  Teach physical relaxation techniques such as mindful breathing
management  Use squeeze balls to release tensions
 Allow students to doodle while listening to lecture (Andrade 2010 in Armstrong 2012)

Learners with Difficulty with Self-Care

 Definition
 Self-care often refers to a person's capacity to perform daily living activities or specific to body care such as the following skills: washing oneself, brushing teeth, combing, trimming
nails, toileting, dressing, eating, drinking, and looking after one's health.
 Self-care skills are gradually learned by very young typically developing children through adult modeling and direct instruction within developmental expectations.
 On the other hand, children with additional needs may struggle with the basic activities of daily living.
 Oftentimes, such students are those with moderate to severe cognitive deficits, including individuals with Intellectual Disability or Intellectual Developmental Disorder (ID or IDD).
 Intellectual disability is a developmental disorder that includes deficits in intellectual and adaptive functioning across domains of conceptual, social, and practical that occur during
the developmental period.
 To be diagnosed with ID/IDD, a student must have deficits in both the cognitive and adaptive domains (Kirk 2015). Children with Down's syndrome with moderate to severe
disability may also have problems with self-care.
 Identification
 Young children suspected to have cognitive deficits which manifest as difficulties with self-care can be identified at a very young age. The traditional approach to measuring levels
of severity of ID was determined through the use of intellectual tests:
 Mild level – IQ 50-70
 Moderate – IQ 35-50
 Severe – IQ 20-35
 Profound – IQ below 20
 However, based on the definition provided by the American Psychiatric Association (2013), using measures of intelligence is only one aspect as adaptive functioning also needs to
be assessed to identify if a child has an intellectual disability. In place of IQ levels, the support needed by a person with ID is used to determine the level or degree of severity of the
disability.
 The presence of ID or IDD is measured by direct observation, structured interviews, and standardized scales such as the AAMR Adaptive Behavior Scale (Lambert et al. 1993 in
Heward 2013) and Vineland Adapt Behavior Scales (Sparrow et. al. 2016).
 Some of the domains measured by AAMR Adaptive Behavior Scale include personal self – sufficiency, community self-sufficiency, and social adjustment.
 On the other hand, the Vineland Adaptive Behavior Scales cover communication, daily living skills, and socialization and motor skills.
 Learning Characteristics
 Students who have difficulty with self-care oftentimes reach developmental milestones at a later age compared to typically developing peers . They learn to sit up, crawl, walk, and
talk later than other children and may have trouble remembering and understanding consequences of actions. Due to cognitive difficulties, children with ID may also have deficits in
the areas of reasoning, planning, judgment, and abstract thinking.
 On the other hand, depending on the level of support needed, a student with ID learns adaptive skills at a slower pace, resulting in delay, and compared to same aged typically
developing students. They benefit from modeling and can imitate well. Moreover, adults with mild intellectual disability eventually learn to be functional and independent in society.
 Youths with intellectual disabilities are known to be friendly, sociable, and are reported to have positive coping skills . A study conducted by Carter et al. (2015) investigated the
strengths and positive traits of transition-age youth with intellectual disability and/or autism, as reported by their parents.
 Using quantitative and qualitative measures, the study yielded the following positive traits of the youths:
 they have a positive outlook in life,
 shows positive relations with others,
 have active coping skills, and
 have acceptance coping skills.
 In this study, they found that the youths were rated highest in items pertaining to the positive outlook factor. These results suggest the importance of having to find the strengths in
children with additional needs, make them aware of these strengths, and use them to their advantage.
 General Educational Adaptations
  Specific approaches have been found to be effective in teaching students with difficulty with self-care, namely the use of direct/explicit instruction, task analysis, forward and
backward chaining, as well as the use of video modeling.
 It is essential that the instructions given are simple and straight forward and that hands-on, experiential activities are used.
 Task analysis is a behavioral approach that breaks down a complex behavior or task into step-by-step procedures, thereby providing modeling and ample practice for the student
with difficulties. Gargiulo (2012) provided working guidelines on how to do task analysis.
 Define the target behavior or task.
 Identify the required skills needed to successfully complete the task.
 Identify the necessary materials to perform the task.
 Observe an able and competent person perform the task.
 List the needed steps in sequential order to complete the task.
 In an inclusive classroom, self-care skills such as washing hands and brushing teeth can be tasks analyzed into the simplest steps and presented in a poster accompanied by
pictures (see Figure 6.3). Using direct instructions, the teacher models how each step is done then allows the student to try the steps with guidance and prompts until he/she is able
to do the task independently. Hence, direct instruction and support from the environment in the form of prompts and as well as routines that are simplified are essential for students
to eventually become independent in using self-care skills (Heward, 2013).
 Forward and backward chaining is used alongside task analysis.
 In forward chaining, the program begins with the first step in the sequence, such as getting the toothbrush and toothpaste, then providing the needed hand–over–hand
assistance, and then gradually fading verbal and then gestural prompts. The goal is to allow the student to master the first step first and then followed by the next step in the
sequence until the entire task has been performed.
 On the other hand, in backward chaining, the teacher models all the steps from the beginning and then allows the child to do the last step of the behavior chain with assistance
and prompts.
 The use of video-based intervention including video modeling and video prompting for teaching daily living skills, such as brushing teeth, setting a table, washing dishes, etc. has
been found effective for learners with intellectual and learning difficulties (Rayner 2011, Bellini & Akullian 20017 cited in Heward 2013).
 With video modeling, a student watches a brief video of an able person performing a target skill or task and then imitates the behavior.
 In video self-modeling, the student watches a video of himself/herself performing a task.
 In video prompting, each step is shown in a video, which the student imitates before the next step is shown.
 This is helpful as the student can access the video anytime, replay it as often as needed to develop independence.

Figure 6.3. Task analysis for brushing teeth and washing hands.

In summary, this chapter has presented important definitions, identification and assessment, learning characteristics, and general educational adaptations for learners with additional
needs namely: (1) the gifted and talented; students with difficulties in (2) seeing, (3) hearing, (4) communicating, (5) walking and moving, (6) remembering and focusing, and (7) self-care.
You have learned the different disability labels that are associated with the difficulties, their challenges in learning, their strengths, and educational adaptations in the form of
accommodation.
While awareness and understanding of their disability and needs are essential, as educators supportive of inclusive education, it is of utmost importance that we see learners with
additional needs beyond their difficulties, to enable them to explore and use their range of strengths and abilities as well as provide opportunities for them to succeed and flourish in their
own positive niches.

CHAPTER 6
Learners with Additional Needs

Definition Identification Learning Characteristics General Educational Adaptations

Learners who are Gifted and Talented

Learners with Difficulty Seeing

Learners with Difficulty Hearing

Learners with Difficulty Communicating

Learners with Difficulty Moving/Walking

Learners with Difficulty Remembering and Focusing

Learners with Difficulty with Self-Care