Foundation of Special Education and Inclusive Education

Module 6- Learner with Difficulty Hearing (Hearing

Impairment)

Lesson 1. Description of Hearing Impairment

Some children are born with hearing loss while others develop hearing loss at
sometime. Many children have a mild hearing loss while some have severe or profound
hearing loss. Severe or profound hearing loss is known as deafness. Children who are
deaf before they learn language (2 to 3 years old) are known as prelingually deaf.
Deafness is an uncommon disability in children but many children have a mild or
moderate hearing loss. There are no exact data about how many children have hearing
impairments but special education resource centre workers have suggested that up to
50% of students could have some hearing loss in many areas. In any case, teachers
should expect to have some students with mild and moderate hearing impairments in
their classes and that some students in the local community and school may be deaf.

Prelingual deafness can be caused by a number of different conditions, including

exposure of the pregnant mother to German measles or certain drugs or chemicals,
cerebral palsy and some genetic conditions. However, most hearing loss is caused by
ear infections or injury in the early years of childhood. Mild or moderate hearing loss
can be a temporary condition in many children due to ear infections but ear infections
often also lead to permanent damage. Teachers should check regularly to see whether
students have developed ear problems as ear infections can occur very quickly. The best
ways to prevent ear infections or other ear damage include:
 avoid swimming or bathing in dirty water
 never place any object in the ear
 keep the outside parts of the ear clean
 avoid loud noises
 always use the BBC (blowing, breathing, coughing) strategy
Blowing Breathing Coughing for Healthy Ears
1. Blow the nose using a tissue or leaf that can be thrown in a bin
2. Breathe in and out strongly five times
3. Cough two times to clear the chest

All children should be taught the BBC strategy. Sniffing is a very common cause of ear
infections so children should be taught to blow their nose instead of sniffing.

Signs of hearing loss

 Student does not pay attention in class
 Student turns head or ear towards the teacher to listen
 Cannot follow instructions especially during group work
 Reluctant to volunteer in class
 Withdrawn behaviour
 Concentrates on speakers face or mouth when listening
 Complains of earache or has pus coming out of the ear (runny ear)

Lesson 2. Teaching Strategies

1. Mildhearing loss.
Students with mild hearing loss might not be able to hear soft sounds (such as
whispering) or they might not be able to hear certain types of sound. For example, many
children cannot hear high frequency sounds, such as some of the consonant sounds in
speech (e.g., `k’, `s’, `p’, `t’). Students with mild hearing loss often miss many of the
words spoken by their teacher and other students and they often miss word endings,
such as `sticks’,`playing’, `played’, and so on. These students often appear to have
learning difficulties and can become frustrated and upset at school as a result. Teachers
need to ensure that these students are placed near the teacher where they are most
likely to see and hear most clearly. These students do not usually require special
materials but the teacher does need to check regularly that the student has understood
their lessons. Teachers need to ensure that they use clear communication, always face
the children when talking and always use complete sentences. Effective teachers also use
natural gestures and body language to assist children’s understanding.

Teachers can easily make a mistake with students who have mild hearing loss and
think that the student has an intellectual disability or learning difficulties. The best, and
easiest way, for a teacher to check a students’ hearing is to say different, single words
in a normal, quiet voice behind the student and ask the student to repeat the words,
one at a time. If the child can repeat the words, then the child probably does not have a
hearing impairment but if the child cannot repeat the words, then the child probably
does have some hearing loss that may be causing other difficulties as well.

2. Moderate hearing loss.

Students with moderate hearing loss cannot hear normal speech properly without
wearing expensive hearing aids. Unless these students have hearing aids, the teacher
will need to pay special attention to these students, repeat instructions very clearly and
closely and use written material, gestures and body language more frequently. Teachers
would usually recognize moderate hearing loss easily but there have been plenty of
cases where students with moderate hearing loss stay very quiet an a their hearing loss
has not been identified. Teachers should always check the hearing of all students from
time to time. Vaughn et al (2000, p. 262) suggest the following practices for teachers to
use when teaching students with mild or moderate hearing loss:
 Use visual cues and demonstration
 Face the student directly when you talk
 Use natural gestures
 Use modeling to demonstrate how to do different procedures and tasks
 Do not try to talk to students while writing on the chalkboard
 Use pictures, diagrams and graphs
 Use experiential learning strategies
 Use cooperative learning strategies
 Use peer tutors to assist the student
 Choose clear speakers for class discussions

 Monitor the student’s understanding

 Ask the student to repeat important information and directions
 Reword information to make it clearer
 Provide written information as often as possible
3. Severe or profound hearing loss.
 Deaf students can be taught in regular classes but the teacher will need to acquire
some special skills. Deaf students need to be communicated with using a combination
of clear speech and sign language, in addition to extensive use of written materials.
Older students, who already know sign language and who can read, can usually
operate reasonably well in a regular classroom as long as their teacher provides
appropriate materials and plenty of assistance. Peer tutors and cooperative learning
strategies are very useful for assisting these students, especially if the student’s
classmates have learned some sign language.

However, young students who are learning sign language need very specific
kinds of assistance from their teacher so teachers will need to seek assistance from
the student’s parents or siblings, and the special education resource centre, to find out
what language signs to use and what special materials and strategies may be required.

Children who are deaf usually have associated problems. Deaf children cannot
usually use normal speech and usually have some difficulties with learning because they
have usually missed many learning activities and much information at home, in their
community and at school. Deaf children also experience frustration as they try to
communicate in their early years and can sometimes have behavioral problems as a
result. Teachers need to be careful not to confuse hearing impairment with intellectual
disability and they need to be sensitive to the special needs of deaf children.

Lesson 3. Assistive Technology

Hearing Aids
 A hearing aid is a small piece of equipment that makes sounds louder. Hearing aids
are used for children with hearing impairment. Hearing aids can be worn in one or
both ears, depending on the type of hearing loss a child has. They can help a child
who hears some sounds to hear sound better. If a child cannot hear any sounds, a
hearing aid will probably not help.
 Teachers need to support and encourage students in class to use their hearing aids.
A student might be shy to use their hearing aid, or afraid other children will tease
them. It is useful for the teacher to explain to all the other students about hearing
problems and why some people use a hearing aid. Playing the game described below
with all the students in class can help them understand and prevent teasing or name
calling of a students with hearing impairment.

Benefits of a hearing aid

 If a child can hear some sounds, a hearing aid will help the child hear sounds that are
too soft so they can hear by themselves.
 If a child can hear faint speech sounds, a hearing aid will make speech louder, and
may help them hear what others say. This can also help a child learn to speak.
 If a child can hear some sounds, a hearing aid may alert them to sounds that warn
them about danger e.g. the sound of a car or motorbike on the road
 When a child first gets a hearing aid they need to learn how to use it and adjust it so
they can hear clearly. The hearing aid has a volume control. It might need to be
turned to a higher volume (No. 4) in a noisy classroom or in the playground, and a
lower volume (No.2) at home or when the class is quieter
Foundation of Special Education and Inclusive
Education
Chapter 7 – Learners with Learning Disabilities

Lesson 1. Description of Learning Difficulties

► ► ► The students with special educational needs that teachers are most likely
to come across in their classes are students with learning difficulties. These are
students who do not necessarily have any disability but, for some reason, have
difficulty with learning. Usually, these students have difficulty in only some areas of
their learning, such as literacy, mathematics, and receptive language
(understanding instructions or directions, following stories, and so on). Put simply,
students with learning difficulties are students who are experiencing significant
difficulties with at least one area of their learning at school.

► ► ► Learning difficulties are often called learning disabilities or specific

learning disabilities, and trainee teachers will often find references to students
with learning disabilities in textbooks. Some school systems regard students as
having learning disabilities if there is a major difference between their intellectual
ability and their actual academic performance (see Vaughn et al, 2000, pp. 133-5).
However, this definition requires an accurate assessment of the student’s
intellectual ability, to be useful. Intellectual assessment tools and specially trained
personnel are generally not yet available in some parts of the country and, in any
case, there is no practical advantage for the teacher or the student in having this
kind of information. The term learning difficulties is used in some school systems
overseas and is a more general definition that is more suited to Philippine
Educational systems. It refers to students who are having significant difficulties
with at least one area of their learning at school. Trainee teachers should not
ignore textbooks about learning disabilities, however, as learning difficulties and
learning disabilities are much the same thing and most of the practical information
provided for use with students with learning disabilities is useful for students with
learning difficulties.

► ► ► It is important to point out that learning difficulties (or learning

disabilities) are not the same as intellectual disability. Students with learning
difficulties have normal intelligence but students with intellectual disability have
a level of intelligence that is significantly below the normal range. Teachers should
expect that students with learning difficulties in one or two academic areas, such
as literacy and mathematics, or literacy and language, will probably not
experience difficulties in other curriculum areas. If students appear to experience
difficulties with learning in most areas of school learning, they might actually have
an intellectual disability or another more serious disability.

Lesson 2. Categories of Learning Difficulties

Students with learning difficulties are most likely to have difficulties in the
following areas of school learning:
General difficulties
 difficulties in understanding and following directions
  difficulties remembering things (short-term and long-term memory
problems)
 a short attention span &being easily distracted
 being overactive or impulsive
 difficulties organizing work and time; difficulties `getting started’
 lack of confidence; reluctant to attempt difficult or new tasks
 difficulties with tasks that require rapid responses
 lack of effective learning strategies

1. Difficulties in reading
Difficulties in reading are sometimes called dyslexia (which is a Latin word
meaning can’t read!) if reading is the only area that the student has difficulties
with. Reading difficulties are by far the largest area of learning difficulties, with
over 80% of students with learning difficulties having reading difficulties as their
particular area of need (Vaughn et al, 2000). Particular areas of need are likely to
be:
 difficulties remembering sight words and patterns

 difficulties identifying the separate sounds in spoken words

 difficulties blending sounds

 confuses similar letters and words (e.g., b and d; man and men)

 difficulties decoding words (i.e., working out how written words sound and

what they might mean)

2. Difficulties in mathematics
If mathematics is the only area of difficulty, this area of difficulty is
sometimes (but rarely) called dyscalculia (meaning can’t do maths!).
Students with mathematics difficulties often have
 difficulty with counting and sorting groups of objects to match numbers

 difficulty remembering number facts (e.g., addition facts, times tables)

 difficulties with arithmetic operations.

Sometimes students develop difficulties in the early primary years but this is often
a result of problems they are having with reading and comprehension.
Understanding the order in equations, number sentences and so on, is also an
area where students frequently experience difficulty.

3. Difficulties in writing
Many children have difficulty forming letters, holding a pencil correctly,
tracing shapes with fingers, recognizing shapes, copying from the blackboard,
drawing, and so on (dysgraphia). In many cases, this is the only particular
difficulty that the student has. Teachers need to be careful not to assume that
students with poor handwriting have other difficulties. Teachers also need to
judge whether the student has difficulty understanding what or how to
write, or physically forming the letters.
Consequences and related difficulties
Students with learning difficulties sometimes have other difficulties that may be
related to their learning difficulties or may be a consequence of their learning
difficulties. Some of the frequently occurring difficulties are:

 Low confidence Students with learning difficulties often have little

and self-esteem confidence and may have a very poor opinion of
themselves and their ability. Often students believe
they are less capable than they really are.

 poor social Students with learning difficulties can be socially

relationships isolated and can have difficulty making friends. This
can be due to their lack of confidence and poor self-
esteem.

 clumsiness, lack Some students with learning difficulties are also

of coordination poorly coordinated, have difficulties with sports,
games and other physical activities. Students who
have poor coordination as well as learning
difficulties are at high risk of having very low self-
esteem.

 poor expressive Problems with memory and problems with learning

skills the more subtle skills of language, can often cause
students with learning difficulties to be poor
communicators.

Lesson 3. Causes of learning difficulties

There are a very large number of possible causes of learning difficulties and
there are many different theories. In the case of individual students, it is very
difficult to pinpoint the actual reason why that student is struggling at school.
There are likely to be a number of reasons.

For some reason, teachers, and parents too, usually look to some fault or
defect with the student when a student experiences learning difficulties. They
often look to theories about possible brain dysfunction, visual problems, hearing
impairment, and so on. Some even look at such things as diet and body chemistry.
Sometimes, there is a vision or hearing impairment that can be corrected (e.g., the
student may need glasses, have a hearing disease or ear blockage) but usually the
reasons remain unknown or untreatable. It is often more productive for teachers
to focus on possible causes that can be `treated’, such as
 quality and type of instruction given

 teacher’s expectations

 relevance of the schoolwork to the student

 classroom environment

 manner in which the teacher treats the student

 ways in which the student is treated by other students

 appropriateness of the curriculum (Westwood, 1997, p. 9)

Some researchers have said that students with learning difficulties should be called
curriculum disabled because they have found that poor quality curriculum and
instruction can be such an important cause of learning difficulties (Elliott & Garnett,
1994; cited in Westwood, 1997, p.9).

 One of the major known causes of severe learning difficulties is a phenomenon

known as the failure cycle. If a student experiences difficulty or failure early in
their school life, they can lose confidence, avoid difficult learning tasks, avoid
practicing their skills, avoid school altogether in some cases, and so
accumulate a whole lot more reasons to struggle at school. The following
diagram uses literacy to demonstrate this phenomenon:
Failure Cycle

 Effective teachers make sure that they find out which students are having
difficulties and they try to respond to their needs as early as possible. Effective
teachers do all they can to stop small problems becoming very big problems
that are much harder to address. The longer the time that students
experience difficulties at school, the greater the effort that is required to
eliminate or reduce the problem

Lesson 4. Teaching Strategies

Major considerations for teaching students with learning difficulties are:
 Use direct, explicit teaching to teach reading, writing, spelling and
mathematics.
 Build up the confidence of students by starting with easy tasks that they can

already do,move ahead gradually, introducing harder material very carefully.

 Monitor students’ work regularly and carefully so that you know when students

are experiencing difficulties and you can respond quickly.

 Teach skills in practical, meaningful ways, and use concrete materials

frequently.
 Give plenty of attention to phonics and decoding strategies in reading, as well

as plenty of attention to phonemic awareness skills (rhyming games, games

involving swapping beginning sounds, ending sounds and middle sounds in
words, clapping out the number of sounds and syllables in words). However, if
a student has a hearing impairment, place more emphasis on sight word
approaches to reading as students with a hearing impairment may not be able
to hear some sounds in words, even at close range.
 Provide plenty of practice and revision of skills and knowledge.
 Use peer tutors and parent helpers to provide extra instruction and practice.
Prevention
 Prevention of learning difficulties is all about providing the best teaching that
a teacher can provide, so that students do not experience difficulties, and
responding early to problems that do arise so that small problems do not
become major problems.

4.1 Strategies in teaching (dysgraphia)

Writing guides
 A writing guide is a piece of equipment that helps a student write neatly on
the page. Writing guides are useful for all students that find writing difficult
or just starting to learn. They especially help students with low vision,
students that have difficulty using their hands, and students with learning
difficulties.
 The writing guide helps them to locate each line, write straight on the line and
write letters the same size so they can produce neat and legible writing. The
writing guide can easily be made locally by the teacher using cardboard.
 This writing guide is made from an A4 piece of card with rectangular slits cut
out for each line. The card is clipped over the top of the paper. The student
writes in one slit at a time so the writing is straight on the line and the letters
are all the same size.
 The writing guide is made from a wooden board with strings across the board
to mark each line. The paper is placed under the strings. The student writes
above each piece of string.
 This is a small writing guide for one or a few words. This is used with students
when they are first learning to write or for students with visual impairments
that have ‘tunnel vision’ i.e. they can only see clearly in the centre and not at
the sides
 For students with physical impairment using a ruler with a handle can help
them to hold and use a ruler.

4.2 Strategies in Learning letters of the alphabet

(dyslexia)
 Exploring the world with their hands is important for all children to help them
learn. This is especially important for children with visual impairment and
learning difficulties since it can be more difficult to understand lessons when
they are just listening to the teacher talk.
 The child will not always understand the words. A child’s sense of touch helps
them to understand and learn.

 Learning letters by feeling the shape and drawing with fingers can help a
student learn to draw and write, rather than just trying to copy what they see.
 Letters can be made with different materials so students can feel them.
 Letters can be made by cutting them out of cardboard, or made on card with
sand, stones, or other materials that can be felt by the student’s fingers.
 Drawing in sand with a stick or the finger helps to learn drawing the letters as
the student feels more than with a pencil on paper.
♦ These methods help all students including students with visual
impairment, physical impairment and learning difficulties to learn and remember
the pattern of the letter so they can write it.

4.3 Teaching Methods to support Mathematics Introduction:

Math can be taught in different ways. Traditional methods included:
 Memorising calculations by talking or singing (1+1=2, 2+2=4, 3+3=6, etc.)

 Learning rules of calculations (but students sometimes do not understand

why the rules work)

 Copying work from the chalkboard and working individually

However, research has shown that the best methods to teach math concepts include:

1. Hands-on learning
►► ► Doing practical activities can help students learn and understand the
concepts of math. This is sometimes called a multi-sensory approach- using more
than one sense. The students are listening, watching, touching and talking.
Combining all these makes learning easier and quicker. This method helps
students with all types of disabilities (visual impairment, hearing impairment,
learning difficulties, physical impairment).

3. Group work
►► ► Students working together can share ideas, help each other and talk about
what they are doing to help them understand and learn.

Peer to peer support is important in class. Students can all help each other. Students
without disabilities can help students with disabilities learn when working together in
a group. This picture also shows hands-on learning using real life objects to learn
about properties of shapes by feeling, talking, listening and watching.

4. Using real and meaningful objects

►► ► A 3-stage approach including real objects helps students to learn math
concepts. The picture below shows an example using apples to teach 1+1=2. The
first stage uses real apples, the 2nd stages uses pictures of apples, the 3rd and final
stage uses numbers.

Using real objects

Using pictures of real objects
Using numbers

There are many objects in the village environment that can be used as real objects
to teach math concepts. This method is useful for students with visual impairment
as they can hold real objects, feel them, pick them up and hold them close to their
face. It also helps students with learning difficulties learn abstract math concepts.
Here students use sticks for addition and subtraction.
4. Applying math to real life
► ► ► Relating math to real life situations can help students understand and
learn. See the example below about selling food at the market. This method is
useful for students with learning difficulties that struggle to understand and learn
from abstract ideas.

Your mother goes to the market to sell eggs. She has 20 eggs to sell and charges 10
pesos per egg. She sells 15 eggs. How much money does she have? How many
eggs does she have left?

She is also selling pineapples for 40 pesos each. She sells 5 pineapples. How much
money does she have? All together how much money did your mother get from
selling eggs and pineapples?

These 4 key methods can help all students to learn math in class. They will also support
students with disabilities that might struggle to learn math using traditional methods.

5. Math Concepts and Skills at Primary Level

The table below lists some of the mathematic concepts and skills for primary school.
These concepts gradually increase in complexity.

Concept Skill
Number and place value • Counting forwards and backwards 1-100
• Reading and writing numbers
• Identify and represent numbers with objects
• Counting in steps/ skip counting:
¬ 2 (e.g. 2, 4, 6, 8, etc.)
¬ 5 (e.g. 5, 10, 15, 20, etc.)
¬ 10 (e.g. 10, 20, 30, 40, etc.)
Geometry- property of • Recognise and name common 2-D shapes (rectangle,
shapes square, circle, triangle)
• Recognise and name common 3-D shapes (sphere,
cube, pyramid)
• Know number of edges, corners and faces of shapes
Number fractions • Recognising and naming halves, quarters, thirds, etc

Measurement • Measure length, height and weight

• Tell the time- on the hour, half hour, minutes
Addition and subtraction • Read and write mathematical symbols (+ - =)
• Add one-digit numbers (3+4= 7)
• Add two-digit numbers (10+12= 22)
• Subtract one digit numbers (4-2=2)
• Subtract two-digit numbers (12-11= 1)
Multiplication and • Read and write mathematical symbols ( × ÷)
Division • Remember and use multiplication tables (2, 5, 10,
etc.)
 • Multiple and divide numbers
Teaching Methods for Mathematics
The following section provides information on different teaching methods. It includes
information on the math topic, how to make teaching aids, and the method to use the
teaching aid.

1. Learning numbers

Teaching Aid:
Tactile numbers- numbers that you can feel.
1. Wooden sticks with small dots
2. Card with numbers.
3. The lines are covered with an object the student can feel e.g. sand, seed from
tree, small stone
Topic: Learning numbers and starting to count
Teaching Method:
 The teacher can get the students to make the teaching aids.
 The students find small objects they can use to make the number cards.
 They learn the shape of the number and how to draw it by first feeling and
talking about the shape.
“Number 4: Go down, across and down again” as they feel the shape of the
number.
Number cards can be made with bamboo, rolled paper or seeds from plants
Teaching Aid:
Large print numbers and symbols on chalkboard or paper
Teaching Method:
 Student with visual impairment can see large size numbers and symbols better.
 Having numbers they can see easily is important so they can accurately copy
from the chalkboard.
 Making numbers on card with numbers and symbols in thick, black lines makes
them easier to see.

2. Counting, addition and subtraction

Teaching Aid:
Everyday objects (stones, sticks, bottle tops)
Topic: Counting, addition and subtraction
Everyday objects can be used to learn to count and complete simple addition and
subtraction.
1. The teacher writes a number on the board or paper. The student counts bottle
tops so they match the number
2. The student solves a problem (10-8=?) The student counts 10 bottle tops. They
count 8 bottle tops and take them away from the pile of 10. They count how
many are left, the answer is 2.
Below are more examples of how everyday objects can be used to teach maths
Use bottle tops to learn the sequence of
numbers: 1, 2, 3, 4…….
Learn numbers by matching- look at the number
on the bottle top and find the same number on
the paper
Put the correct number of bottle tops next to the How many fish do you see?
number Put the correct number on the
card.

Use bottle tops to solve equations. 4 + 1 = ? Find the Make number games using
bottle top with the correct answer. bottle tops

Put sticks into bundles of 5. Learn to skip count with Solve addition problems
bundles of sticks. 5…..10…15…20….. using real objects. 5 sticks
plus 5 sticks is 10 sticks! This
method can be used for
subtraction as well.
Math books are available where students can solve
problems using colourful pictures. These are useful
but cannot be accessed by all schools and families.
Real objects (sticks, stones, bottle tops) can be
found in all villages so children can practice maths,
plus its more fun!

Teaching Aid:
Number line with bead.
 A card with numbers marked on a line.

 A piece of string is above the line with a small bead that can move.

 The numbers can be changed to show skip counting ( 2, 4, 6, 8, 10) or

minus numbers (below 0)

Topic: Addition and subtraction
Teaching Method:
Students use the line to add and subtract numbers. For example: 2 + 5 = ?
 The student puts the bead on number 2. From the 2 they move the bead
5 times up the line and see where it stops. The answer is number 7.
 This method helps students with learning difficulties or with difficulties
concentrating. It is a good hands on approach to learning to add and
subtract.
 This method is useful for students that find counting everyday objects
too easy.

Teaching Aid:
String with knots
Topic: Counting, addition and subtraction
Teaching method: ►The method is the same as the number line. ►► The
string with knots helps students with visual impairment feel as they count.
3. Measurement

Teaching Aid:
A ruler or tape measure is modified so students can feel and see the
numbers/lines on the ruler that indicate the quantity of centimetres.
 A wooden or plastic ruler can have lines scratched on the ruler with a sharp

knife.
 The plastic tape measure can have small holes.

 Large print numbers can be stuck onto the ruler

Topic: Measurement
Teaching Method:
 The student with disabilities is able to easily see the numbers on the ruler and
feel them to help them measure.

4. Learning about shapes

Teaching Aid:
 Shapes are drawn on a piece of card with a
thick black line.
 The line can be made with tape so it is
raised and can be felt with the fingers by
the student.
 Shapes are made from cardboard.
 Different colours make the shapes look
more interesting.
 The shapes can be made with coloured
card, or with cardboard boxes and
coloured by the students.
Topic: Geometric shapes
Names of shapes, comparison and matching,
learning about the property of 2D shapes
(number of sides, number of corners),
measuring angles, measuring length,
calculating the area of shapes
Teaching Method:
 The student picks up the shape and feels
around the edge with their fingers. The
student counts how many corners and
edges and sides.
 The student compares the shape with the
pictures on the board. They match the
shape with the correct picture. They learn
the name of the shape e.g. triangle,
square, etc.
 The student can measure the sides of the
shape, and the size of the angles. They can
use the shapes to calculate the area.
 Shape boards can be made from different Sorting shapes- students get
materials- plastic and card board. different shapes and group
 The student can feel the shapes made them into sets- all the
from tape on the board. squares together, all the
stars together, all the circles
together.

Teaching Aid:
This is a pin board.
 It is a small piece of flat wood with nails.
 It can also be made out of strong card and pins.
 Rubber bands are put over the nails to make shapes

Topic: Learning about the properties of 2D shapes, how many sides and corners,
making different shapes, measuring angles
Teaching Method:
 Students put rubber bands over the nails to make different types of shapes
Here are some pin boards made from local materials wood, nails or pins.
 The nails are spaced evenly so 1cm distance between each nail. Elastic bands
are stretched over the nails to make shapes- square, triangle, rectangle.
 By counting the number of nails the student can measure the sides of the
shape or the area of the shape.
 Students can feel the shape by touching the nails.

See example below:

We have made a square with the rubber band.

Each side has 3 pins so how long in cm is the side of the square?
Answer: 2cm
What is the area of the square?
Answer: 2cm x 2cm= 4 cm
How many sides does the square have?
Answer: 4 sides
How many corners does the square have?
Answer: 4 corners

Teaching Aid: String with knots

A piece of thick string has knots tied in it at regular intervals.
There is a 1cm space in between each knot.

Topic: learning about the properties of shapes, how many sides, corners.
Measuring the size of shapes.
Teaching method:
 The student makes shapes using the string.
 They can measure the size of the shape by counting how many knots they can
feel on each side.
 This is a useful method for children with visual impairment and learning
difficulties

Teaching Aid: 3D shapes and everyday objects

3D shapes can be made from cardboard, paper, or sticks. They can also be
objects in everyday life that represent that shape.
Topic: learning the names and properties of 3D shapes (sphere, pyramid, cube,
cylinder)
Teaching Method:
 The teacher uses the everyday objects to teach students the names and
properties of 3D shapes.
 The student can feel the shape and count the number of sides, edges and
corners.
 Students can build shapes using toothpicks and small balls of mud.
 They work out how many sticks they need then build the shape by copying an
everyday object.

5. Fractions

Teaching Aid:
Raised circles and fractions made from cardboard.
 Shapes are drawn on a piece of card with a thick black line.

 The line can be made with tape so it is raised and can be felt with the fingers

by the student. Shapes representing fractions are made from cardboard.

 Different colours make the shapes look more interesting.

 The shapes can be made with coloured card, or with cardboard boxes and

coloured by the students.

Topic: Learning about fractions- ¼ ½ ⅓ ⅛ ⅕
Teaching Method:
 The student picks up the shape and feels around the edge with their fingers.
 They feel the whole shape on the card.
 They fill the whole shapes using the fraction shapes to learn about quarters,
halves, etc.

 These shapes helps us learn about whole numbers and halves This is a
fraction set made from plastic card. It can teach ALL students about different
fractions (thirds, quarters, halves and sixths) in a practical way.
 Students with visual impairment can feel the tape on the card so they
understand how many pieces the circle is divided into.
 These tools help students with learning disabilities that learn more slowly
6. Telling the Time

Teaching Aid:
Tactile Clock is a clock where you can see and feel to tell the time.
1. A clock made of straws/chopstick
2. A clock made of a paper plate and cardboard letters

Topic: Telling the time (learning about hours, minutes, seconds)

Teaching Method:
 This is a hands on approach where the students can move the hands of the
clock and feel the numbers to learn about seconds, minutes and hours.
 Clocks can be made from lots of different materials- plastic disposable
plates, bottle tops, sticks, etc.
 Students can make their own clocks in class and use them to tell the time.
 Be creative in using materials and keeping activities practical.

Chapter 8 – Learners with difficulty

Walking/Moving (Physical Disabilities)
Lesson 1. General Description of Physical Disabilities
 Physical disabilities place some limitation on a person’s ability to move
about, use their limbs or hands or control their own movement.
 Physical disabilities are the most obvious disabilities, as a rule, although
there are some conditions that limit movement and mobility in less
obvious or inconsistent ways (e.g., epilepsy, cystic fibrosis, diabetes).
 Students with more severe physical disabilities often have related health
problems and, of course, physical disabilities are often a symptom of
health problems. For an excellent review of types of physical disabilities
and ideas on identification and treatment,see Werner (1987). Physical
disabilities most likely to be encountered in schools are:

Disability due to injury or other trauma

► ► Accidents, natural disasters, abuse or neglect can cause children to

have amputated limbs, impaired limbs or spinal column, or many other
physical impairments. Burns victims, for example, often have a loss of
mobility in hands or feet. At Taipei, following the devastating tsunami of
1998, there were many children who lost limbs or suffered such severe
fractures and other injuries, that their limbs were amputated. Other children
have lost limbs or suffered spinal injuries through bone infections
(osteomyelitis) or other diseases, or complications following other injuries.
1. Cerebral palsy
 Cerebral palsy is a form of brain damage that can cause arange of different
physical disabilities, and, sometimes, intellectual disability.

 Cerebral palsy can result from the pregnant mother having an infection,
rubella, shingles or diabetes, or from problems at birth in which the child
is deprived of oxygen or suffers ahead injury; prematurity; or problems
after birth, such as a very high fever, ahead injury, poisoning or a near
drowning, a brain tumour or a circulatory problem. In many cases of
cerebral palsy, the cause remains unknown.

 Cerebral palsy is one of the most common forms of physical disability.

About 1 in 300 babies are born with or develop some form of cerebral
palsy (Werner, 1987) but, in most cases, the symptoms are relatively mild

The major types of cerebral palsy are:

Spasticity Very stiff muscles or high muscle tension.

Some parts of the body are rigid so movement can be very
awkward.

Athetosis Uncontrolled muscle movement. Parts of the body move and

inconsistently.
If the muscles needed for speech are affected, the child may have
difficulty communicating, even though their intellectual ability
may be normal.
Ataxia Poor balance and unusual clumsiness.
The child with ataxia may have difficulty walking and may be
teased by other children when clumsy, as children with ataxia may
not obviously appear to have a disability.

2. Poliomyelitis

 Polio is a common disease in many developing countries, and in some

parts of Papua New Guinea. Although the disease is mild in most cases, it
can cause permanent and severe paralysis of body parts, usually the legs
or feet, in about 30% of cases.

 Polio can also be fatal if breathing or swallowing is affected.

 Polio is a virus, spread by breath, that infects the central nervous system.
Immunization against polio is very effective, if it is available, but if a child
already has polio, medication can make the condition much worse.
3. Epilepsy
►►► Epileptic seizures (commonly called fits) are caused by brain
damage or an abnormal brain condition. Brain injury causes about 30% of
cases of epilepsy and many children with cerebral palsy also have epilepsy.
High fever, dehydration, poisoning and meningitis can cause epilepsy but
about 30% of cases of epilepsy are inherited. In many cases of epilepsy, no
cause can be identified. Some children only ever have one or a few seizures
but some other children develop chronic epilepsy. Seizures in young children
can be a symptom of other serious disease so medical assistance should
always be sought if a child has a seizure.

►►► Some children have major seizures that involve a loss of consciousness
and strong uncontrolled movement. Other children have minor seizures that
usually involve a short loss of consciousness; the child may fall down or just
cease movement for an instant. Seizures are usually temporary and the child
recovers fully, although the child may be tired and confused afterwards. In
some cases, seizures can cause brain damage but this is usually only in cases
where seizures are frequent and severe.

What to do when a child has a seizure:

 Learn to recognize any known warning signs (e.g., sudden fear or cry) and

quickly move the child to a safe place, free of obstacles or hazards.

 Do not try to move the child if a major seizure has started.

 Remove any sharp objects or obstacles away from the child.

 Do not try to forcefully control the child’s movements.

 Do not put anything in or near the child’s mouth during a seizure.

 Between spasms, gently turn the child’s head to the side to drain away

any spit.
 Let the child rest or sleep after a seizure. Give the child paracetamol or

aspirin if the child has a headache.

4. Spina bifida

►►► Spina bifida is a medical condition that develops in some children

before birth. When the vertebrae of the spine do not properly enclose the
spinal cord, a soft, unprotected area can be left, and the spinal cord can bulge
through the skin. This `bag of nerves’ looks like a dark bag and can leak fluid
from the brain and spinal cord.
 The cause of spina bifida is unknown but about 1 in 1000 children are born
with spina bifida (Vaughn et al, 2000, p. 267).
 It is not known how to prevent spina bifida although the effects of the
condition can be reduced through surgery and good management.
 Spina bifida can be mild or severe and children with spina bifida are at
high risk of developing other serious diseases, such as meningitis.
 Nowadays, most children born with spina bifida have surgery to correct
the condition.
 Nevertheless, even when surgery has been performed to place the exposed
nerves back within the spinal column, many children with spina bifida
continue to Experience the muscle weakness, continence problems and
paralysis associated with spina bifida. Werner (1987, p. 167) provides an
excellent description of spina bifida and its effects.

 Werner (1987) also describes the many different forms of treatment for
spina bifida and the special procedures that children can use to help with
mobility and toileting.
 Teachers should seek assistance from a health clinic or special education
resource centre to help design any special equipment or medical advice
that might be needed for a child with spina bifida.

Spina Bifida Symptoms From Werner (1987, p. 167)

5. Birth Conditions
► ►► About 1 in 100 children are born with conditions such as cleft lip or
cleft palate, joined fingers or toes, extra fingers or toes, or short or
deformed limbs. More serious birth conditions include Down syndrome,
cerebral palsy, spina bifida, blindness and deafness. In most cases, the cause
of such birth conditions is not known but the following circumstances can
cause them:

 Poor diet during early pregnancy

 Genetic causes (especially if parents are related)
 Exposure of the pregnant mother to some medicines, poisons, pesticides
and other chemicals
 Exposure of the pregnant mother to German measles (rubella)
 Older or very young mothers are more likely to have babies with birth
conditions such as Down syndrome

Some common birth conditions are:

Cleft lip and A cleft lip (sometimes called a hare lip) is an opening or
palate gap in the upper lip, often connected to the nose. A cleft
palate is an opening in the roof of the mouth connecting
with the canal of the nose. Cleft lips and palates can be
corrected by surgery but even after surgery, children may
continue to have some difficulty with speech. If surgery is
not performed, the child may need to use sign language
to help with communication
Joined fingers Surgery can usually separate joined fingers or toes but
or toes teachers may need to encourage students to stretch the
skin around areas where surgery has been performed, to
help with flexibility and movement.
Incomplete Children are sometimes born missing arms or legs, or
or missing with limbs that are very short or incomplete. Some
limbs medicines are known to have caused this kind of problem
but often the cause is unknown. Children without arms
can be taught to use their feet for many activities, such
as eating, drawing and writing. Special aids can also be
made to help children with missing limbs or with limbs
that do not function fully.

Other Conditions:
There are many other serious and minor medical and physical conditions that
can affect children and that teachers may need to gain an understanding of.
These include birth conditions such as:

 cystic fibrosis
 fetal alcohol syndrome
 brittle bone syndrome (osteogenesis imperfecta)
 Dwarfism

or chronic diseases or conditionsthat children may contract or develop after

birth, such as:

 diabetes ● HIV/AIDS
 cancer ● juvenile arthritis
 asthma ● muscular dystrophy
Lesson 2. Teaching Strategies
► ► Most students with physical disabilities do not have any other disabilities
(although some do) and it should never be assumed that students with
physical disabilities do not have normal intelligence. Indeed, some people
with very severe cerebral palsy, who cannot speak or control their body
movement very much at all, are very intelligent and very aware of the world
around them. For example, Stephen Hawking, one of the world’s leading
physicists, has very severe cerebral palsy and uses an electric wheelchair for
mobility, and a special electronic speaking device for speech. Teachers can
be very effective in developing positive attitudes about disabilities in their
school and community by talking about all the things that children with
disabilities can do and achieve, instead of talking about their limitations.

► ► Students with physical disabilities usually need to use some special

equipment and materials. Most of these things can be constructed easily by
teachers, parents or other community members. Older children can be a great
help too. Werner (1987) provide a very comprehensive range of special aids and
devices that can be constructed from local materials at little cost. Module 2 Topic
5 Utilizing Aids also provides many useful suggestions.

► ► Students with physical disabilities are often excluded from many school
activities and even from attending school altogether. This is often a form of
discrimination which is entirely unfair but it is sometimes done to protect
the child from harm or abuse. In fact, most children with disabilities do not
want to be excluded from activities and are much less likely to lead an
independent and fulfilling life if this occurs. Overprotecting children with
disabilities can do a great deal of harm. Teachers need to take sensible
precautions to prevent injury but students with disabilities should be
encouraged and helped to participate in as full a range of activities as
possible. Teachers can help all people with disabilities by promoting this
approach in their schools and communities too.

► ► Curriculum does not usually need to be adapted much for students with
physical disabilities, however, some adaptations need to be made in some
cases. Teachers should use common sense in this. For example, it is
inappropriate to expect a student to perform tasks that they simply cannot
physically perform, so the teacher must select a different task that it is
possible for the student to do. There have been cases where students with
physical disabilities have been denied passing grades at school because of
their inability to perform physical tasks in subjects such as physical
education. This approach is discriminatory and ridiculous. Effective teachers
find ways to accommodate special needs so that the student can learn and
achieve positive educational outcomes.

Effective teachers examine the activities that students need to participate in

at school and they examine the educational outcomes that they want their
students to achieve. They work out what practical adaptations need to be
implemented to assist students with disabilities to achieve those very same
outcomes. If necessary, they ask other students, colleagues, parents and
other community members to help them with any special equipment or
materials that might need to be built or developed.

Inclusive Physical Education (PE)

Physical Education (PE) is important for all children. Sometimes students with
disabilities sit and watch PE activities or sports as people think they do not have
the ability to join in. However, many people with disabilities around the world
participate in sports and games.

Playing badminton using one crutch Men’s wheelchair basketball

Chinese women’s team play basketball Athletics - sprinting races using a

on the floor wheelchair

Running on artificial legs (prostheses) Football using crutches

Benefits of Physical Education

PE has many benefits for all children:
 Maintain fitness

 Enjoyable and fun activity

 Develops team spirit and sportsmanship

 Develop confidence and self esteem

 Increase awareness of health and nutrition

The following physical skills are developed during PE activities:

 Increase body strength and flexibility

 Develop balance and awareness of the body (knowing the body parts and

how they work together)

 Movement skills- kicking, catching, jumping, hopping, running, etc.

 Observation and listening skills-following teachers instructions

 Team/ group cooperation- following rules of the game and working

together as a team

Basic PE activities
Movement games help to develop physical skills in primary school children to
prepare them to play sports. Below are some examples of simple movement
games that develop core physical skills that are needed to play sports games.

Kicking Games
 Kicking a ball around cones
 Kicking a ball into a goal
 Kicking a ball to each other
 Team game of football
Throwing and Catching Games
 Catching a ball on a string
 Throw/ catch with 2 people
 Ball games in large groups

Target Games
 Using bats to hit a ball into a goal.
 Throwing small bags into a circle or hoop
 Throwing objects into a basket
 Bowling- knocking down pins or plastic bottles with a ball

Balance Games
 Standing on one leg and hopping
 Jumping up and down, or jumping moving arms and legs
 Games using a rope- individually or in a group
 Walking along a piece of wood
 Balancing on a board

Walking and running games

 Making a path on the floor with stones or hand/foot prints. The child steps
along the path.
 Walking in/out of hoops or over sticks on the floor
 Running races

Body awareness games

 Making shapes with the body and climbing over, under and through.
 Touching body parts- listening to the teacher and following instructions to
touch your head or touch your nose. Instructions can be more complicated e.g.
put your right hand on your left ear.
 Watching the teacher and copying different body positions- ‘hands in the air’.
 Copying body movements by observing the teacher, listening to instructions or
looking at a picture- ‘pat your head, lift your arms, close your eyes, clap your
hands, etc.

PE Equipment from local materials

Different materials can be used to make equipment for PE:
 Balls - football, rattan ball, ball made from plastic bags or string, sponge ball,
bean-bags (small bag made from material with sand or small stones inside).
 Balls made from local materials

 Small square pieces of fabric sewn around edge and filled with sand or

small stones to make a ‘bean bag’ for throwing and catching. This is similar
to the chalk board duster
 Bats - plastic or wooden bat, rolled up flip chart paper, bamboo or wooden
stick
 String or rope for skipping, marking beginning or end of races, or goal posts
 Target games - using boxes, sticks, stones, chalk, etc. to make a target on a
wall or on the floor.
Cardboard box with holes cut out for Using plastic bottles for knocking down
target game with a ball
 Jumping and hopping games - Using a stick to draw on dirt floor, or chalk on
the concrete floor to draw squares or circles for jumping and hopping in.

What is Inclusive PE?

 All children have different abilities. Students with disabilities might find it more
difficult to participate in PE lessons because they have difficulty seeing, hearing
or moving their body. Inclusive PE is an approach that means all children can
be included in PE activities.
 The teacher uses the same PE activities in the core curriculum but adapts and
modifies the activity so all children can participate. There are three main ways
that activities can be modified:

Parallel activities
 All children play the same game but in their own way.
 Students with disabilities could join a game of football with the whole class by
using their wheelchair or kicking the ball whilst being on the floor

Adapt the game for all children

 All children play the game in a way that is different to the usual way so that the
child with disability is able to participate.
 For example, instead of standing far apart and throwing the ball, children stand
close together and slowly pass the ball into the next person’s hands.
 Another method is all children sit on the floor and roll the ball to each other.

Modify the activity so easier for the student with

disability
 All the children play the same game but the student with disability does it in an
easier way
 For example, the student with disability might only complete part of the game.
Or they use different equipment to make it easier e.g. using a ball with a bell
for a child that is blind.

Think about all the PE games and activities on the previous pages. Could you do
any new or different activities at your school? How could you modify or adapt
them so students with disabilities can be included?

Tips for Adapting Physical Education

Activities
1. Teach easier skills and slowly make them more difficult
2. Break down activities into smaller steps
3. Limit the size of the area where you play the game
4. Slow down the actions of the game
5. Use smaller or larger playing objects
6. Change or simplify the rules so everyone can play
7. Give the student with disabilities a buddy to help them during the activities
8. A student with visual impairment should be near the teacher or a buddy.
A. For low vision the student should be close to the teacher so they can see the
demonstration.
B. For blind students they should be close to the teacher to touch them to feel the
demonstration and listen to verbal instructions

Module 9 – Learner with difficulty remembering

and focusing/Intellectual Disability

Lesson 1. Description of Intellectual

Disability

Intellectual disability is a substantial limitation in cognitive functioning

(i.e., thinking skills). People with intellectual disability usually have limited
communication skills, limited self-care skills, poor social skills, and very
limited academic skills. Most importantly, people with intellectual disabilities
have great difficulty with learning and usually require special teaching
methods to learn efficiently.

A person with mild intellectual disability usually has severe learning

difficulties, limited or poor conversational skills and would usually have a
history of slow personal development. Most people with mild intellectual
disability learn independent living skills and are usually involved in
productive work at home, in the community or in a workplace.

A person with moderate intellectual disability usually has very severe

learning difficulties, very poor communication skills and very slow personal
development. For example, it may take a student with moderate intellectual
disability up to several years to learn very simple academic skills such as
writing their own name, recognizing 50 sight words, counting and counting
objects, and performing simple arithmetic operations. People with
moderate intellectual disabilities do not usually learn all the living skills they
need to live independently,without the support of family or other carers.
However, people with moderate intellectual disabilities often learn some
productive role in their home or village and some have been able to gain
limited employment.

A person with a severe intellectual disability is usually not able to

perform academic tasks, is unlikely to develop or learn self-care skills and
may not learn or develop ordinary communication skills. Pictorial
communication systems (using pictures to communicate) have been
successful, in some cases, in teaching students with severe intellectual
disabilities to communicate choices and needs.
People with severe intellectual disabilities do not learn to live independently
and require ongoing support for their survival.

In the past, intellectual disability was called mental retardation, a term

that continues to be used in some textbooks. People with intellectual
disability have formed international associations aimed at eliminating
discrimination against people with intellectual disability, and these
organizations have asked governments and others to use the term person
with an intellectual disability instead of person who is mentally retarded. For
that reason, most authors nowadays use person (or student, child, etc.) with
an intellectual disability.

Lesson 2. Causes and Prevention of

Intellectual Disability
Intellectual disability is the result of damage to the brain. Damage
to the brain can be a result of a developmental or genetic disorder (such
as Down syndrome (see Hall, 1994, pp. 40- 41), a disease before or after
birth, or a trauma before or after birth. In Individual cases it is often not
possible to identify the cause of intellectual disability. Some known
causes are:
Genetic Abnormalities in genes inherited from parents, errors
conditions when genes combine or damage to genes during or
before pregnancy from disease,radiation or poisoning.
Examples include Down syndrome and Fragile X
syndrome.

Problems Poisoning of the unborn baby from alcohol or other

during drugs; malnutrition; illnesses of the mother
pregnancy

Problems at birth
Problems after birth Diseases such as whooping cough, chicken pox, measles,
meningitis, malaria, encephalitis; head injury from accidents or abuse; oxygen
deprivation from neardrowning; poisoning; ingestion of pollutants; malnutrition;
high fever.
Some of these causes also cause other disabilities so some people have
multiple disabilities. For example, students with Down syndrome usually
have intellectual disability but often also have medical problems. Students
with cerebral palsy, often caused by fever of oxygen deprivation before
or during birth, usually have significant physical disabilities but sometimes
also have intellectual disability. Babies born with intellectual disability
due to the mother having rubella during pregnancy, often have deafness or
blindness, or both.

Prevention
Preventative measures that parents and others can take to reduce the
risk of intellectual disability include:

Before birth
 Avoid alcohol, smoking and other drugs
 Avoid HIV and other sexually transmitted diseases
 Have a good diet and a healthy lifestyle
 Obtain plenty of rest and avoid strain and overwork
 Seek medical assistance for any illness or infection

After birth
 Eliminate child abuse or neglect
 Avoid accidents and injury
 Obtain proper immunization against disease
 Avoid malaria
 Ensure that the child has a healthy diet and a healthy, active lifestyle
 Avoid dirty or polluted water
 Prevent infections by only using clean food and have good hygiene practices

Lesson 3. Teaching strategies

The most important thing for teachers to understand about
students with mild or moderate intellectual disabilities is that they will
have serious learning difficulties and will not be able to access the
whole school curriculum. Teachers need to discuss the student’s needs
with the student’s parents, and work out some educational priorities for
the student. The student’s learning at school will be limited so the
teacher must make sure that the educational objectives set for the
student are important, achievable and useful. The teacher must also
utilize peer tutors and others, if available, to assist the student with
learning. The student’s learning will occur gradually and the student will
always have difficulty, so the teacher needs to teach skill in small steps
using task analysis and make sure that all instruction is clear and direct.
Partial participation.

 All of the material in the primary school curriculum is useful and

important.
 However, only some material is absolutely essential for every student
to learn. Students with intellectual disability cannot cover an entire
curriculum. so teachers, in collaboration with the student’s parents,
have to decide which curriculum outcomes to concentrate on and
then focus on those ones only.
 While other students might be working on many curriculum outcomes
at a time, a student with an intellectual disability will probably only
be working towards three or four curriculum outcomes in a school
term, and may only be working on one or two objectives on each
school day.
 Students with intellectual disability, like all other students, need to be
involved in regular school activities with other students but, unless
the teacher has access to specialist assistance, the teacher will only
be able to provide a limited amount of instruction to the student.
 Effective teachers make sure that students with intellectual
disabilities are included in as many regular school activities as
possible but they can only provide instruction on one or two
objectives for each student with a disability each day.

Functional curriculum

 Because students with intellectual disability learn very slowly, what

they learn should be functional (i.e., useful in their daily lives).
 Functional skills are usually basic communication skills, self-
care skills, personal safety, money management, survival reading
skills, social skills and practical skills for making a living.
 Teachers should use real, practical materials for teaching functional
skills, and, if possible, ensure that students practice their skill in real
contexts.
 Parents can be a great help to teachers in this regard.

1. Make learning fun

Remember, students with intellectual disabilities have as much right
to be at school as any other child. To teach these students well, teachers
have to treat them with dignity and respect, and make learning fun.
Teachers should use plenty of encouragement, patience and praise to
build up confidence and feelings of success. For young students, or
students who aren’t used to attending school, it is also important to
make sure that the student is attentive. Setting up listening games and
other listening activities, making sure that students are engaged with
other students, and, overall, making the classroom an interesting and
busy environment, is a good set of strategies to use to encourage
attentiveness.

2. Task analysis
Breaking simple tasks into smaller, teachable steps, is a very important
and useful teaching strategy for students with intellectual disability. While a
task may be too difficult for a student to learn, if it’s broken down into
smaller steps, the student may learn to do all of it or some of it gradually.
Most tasks can be broken down in this way. Students with intellectual
disability need lots of repetition and practice before steps are truly learned
and they also need to perform their learning tasks with different materials
and in different contexts to generalize their skills. Teachers should always
reinforce students’ attempts and successes. Teachers need to monitor
students’ performances regularly and keep a record of progress. If an
approach to teaching isn’t resulting in any progress, then the teacher should
find a different way to teach it. Remember, if the student isn’t learning, then
the teacher hasn’t found the right way to teach that skill.

3. Peer tutoring

In a big, busy, crowded classroom, a teacher cannot give any one

student much more than a few minutes of individual instruction each day.
While those few minutes are very important and useful, teachers should
always use other students, parents and any other helpers to also help with
students with disabilities. Students with intellectual disability learn best
through regular, daily instruction and the instruction doesn’t need to be
lengthy. Peer tutors or other helpers can provide just a few extra minutes of
instruction for the student each day, and make a very big difference to the
student’s rate of learning. Cooperative learning strategies are also an
excellent way to include students with disabilities in learning and other
school activities.
Chapter 10. Learner with difficulty with self-care
(Autism Spectrum Disorder)

Lesson 1. General Characteristics of Autism

4.1 What is Autism Spectrum Disorder?
Autism spectrum disorder (ASD) is a development disability that can cause
significant social, communication and behavioral challenges. There is often
nothing about how people with ASD look that sets them apart from other people,
but people with ASD may communicate, interact, behave, and learn in ways that
are different from most other people. The learning, thinking, and problem-
solving abilities of people with ASD can range from gifted to severely challenged.
Some people with ASD need a lot of help in their daily lives; others need less.
A diagnosis of ASD now includes several conditions that used to be diagnosed
separately: autistic disorder, pervasive developmental disorder not otherwise
specified (PDD-NOS), and Asperger syndrome. These conditions are now all called
autism spectrum disorder.

1.2 Signs and Symptoms

People with ASD often have problems with social, emotional, and
communication skills. They might repeat certain behaviors and might not want
change in their daily activities. Many people with ASD also have different ways of
learning, paying attention, or reacting to things. Signs of ASD begin during early
childhood and typically last throughout a person’s life.

Children or adults with ASD might:

 not point at objects to show interest (for example, not point at an airplane
flying over)
 not look at objects when another person points at them
 have trouble relating to others or not have an interest in other people at all
 avoid eye contact and want to be alone
 have trouble understanding other people’s feelings or talking about their own
feelings
 prefer not to be held or cuddled, or might cuddle only when they want to
 appear to be unaware when people talk to them, but respond to other sounds
 be very interested in people, but not know how to talk, play, or relate to them
 repeat or echo words or phrases said to them, or repeat words or phrases in
place of normal language
 have trouble expressing their needs using typical words or motions
 not play “pretend” games (for example, not pretend to “feed” a doll)
 repeat actions over and over again
 have trouble adapting when a routine changes
 have unusual reactions to the way things smell, taste, look, feel, or sound
 lose skills they once had (for example, stop saying words they were using)

4.2 Diagnosis

Diagnosing ASD can be difficult since there is no medical test, like a

blood test, to diagnose the disorders. Doctors look at the child’s behavior
and development to make a diagnosis.
 ASD can sometimes be detected at 18 months or younger. By age 2, a
diagnosis by an experienced professional can be considered very reliable.
However, many children do not receive a final diagnosis until much older.
This delay means that children with ASD might not get the early help they
need.

In addition, treatment for particular symptoms, such as speech therapy

for language delays, often does not need to wait for a formal ASD diagnosis.

4.3 Causes and Risk Factors

We do not know all of the causes of ASD. However, we have learned

that there are likely many causes for multiple types of ASD. There may be
many different factors that make a child more likely to have an ASD, including
environmental, biologic and genetic factors.

 Most scientists agree that genes are one of the risk factors that can make
a person more likely to develop ASD.
 Children who have a sibling with ASD are at a higher risk of also having
ASD.
 Individuals with certain genetic or chromosomal conditions, such as
fragile X syndrome or tuberous sclerosis, can have a greater chance of
having ASD.
 When taken during pregnancy, the prescription drugs valproic acid and
thalidomide have been linked with a higher risk of ASD.
 There is some evidence that the critical period for developing ASD occurs
before, during, and immediately after birth.
 Children born to older parents are at greater risk for having ASD.

ASD continues to be an important public health concern. Like the many

families living with ASD, a lot of organizations wants to find out what causes
the disorder. Understanding the factors that make a person more likely to
develop ASD will help us learn more about the causes. They are looking at
many possible risk factors for ASD, including genetic, environmental,
pregnancy, and behavioral factors.

Lesson 2. Treatment and Intervention

Services for Autism Spectrum Disorder

2.1 Treatment
There is currently no cure for ASD. However, research shows that
early intervention treatment services can improve a child’s
development. Early intervention services help children from birth to 3
years old (36 months) learn important skills. Services can include
therapy to help the child talk, walk, and interact with others. Therefore,
it is important to talk to your child’s doctor as soon as possible if you
think your child has ASD or other developmental problem.

Even if your child has not been diagnosed with an ASD, he or she
may be eligible for early intervention treatment services. The
Individuals with Disabilities Education Act (IDEA) external icon says that
children under the age of 3 years (36 months) who are at risk of having
developmental delays may be eligible for services. These services are
provided through an early intervention system in your state. Through
this system, you can ask for an evaluation.

2.2 Interventions
Currently, no treatment has been shown to cure ASD, but several
interventions have been developed and studied for use with young children.
These interventions may reduce symptoms, improve cognitive ability and daily
living skills, and maximize the ability of the child to function and participate in
the community.

The differences in how ASD affects each person means that people
with ASD have unique strengths and challenges in social
communication, behavior, and cognitive ability. Therefore, treatment
plans are usually multidisciplinary, may involve parent-mediated
interventions, and target the child’s individual needs.

Behavioral intervention strategies have focused on social

communication skill development— particularly at young ages when the
child would naturally be gaining these skills—and reduction of restricted
interests and repetitive and challenging behaviors. For some children,
occupational and speech therapy may be helpful, as could social skills
training and medication in older children. The best treatment or
intervention can vary depending on an individual’s age, strengths,
challenges, and differences.
It is also important to remember that children with ASD can get
sick or injured just like children without ASD. Regular medical and
dental exams should be part of a child’s treatment plan. Often it is hard
to tell if a child’s behavior is related to the ASD or is caused by a separate
health condition. For instance, head banging could be a symptom of ASD,
or it could be a sign the child is having headaches or ear aches. In those
cases, a thorough physical examination is needed. Monitoring healthy
development means not only paying attention to symptoms related to
ASD, but also to the child’s physical and mental health.

Not much is known about the best interventions for older children
and adults with ASD. There has been some research on social skills
groups for older children, but there is not enough evidence to show that
these are effective. Additional research is needed to evaluate
interventions designed to improve outcomes in adulthood. In addition,
services are important to help individuals with ASD complete their
education or job training, find employment, secure housing and
transportation, take care of their health, improve daily functioning, and
participate as fully as possible in their communities.

The types of intervention generally can be broken down into the

following categories:
 Behavior and Communication Approaches

 Dietary Approaches

 Medication

 Complementary and Alternative Medicine

A. Behavior and Communication Approaches

According to reports by the American Academy of Pediatrics and

the National Research Council, behavior and communication
approaches that help children with ASD are those that provide
structure, direction, and organization for the child in addition to family
participation.

1. Applied Behavior Analysis (ABA)

A notable treatment approach for people with ASD is called applied
behavior analysis (ABA). ABA has become widely accepted among
health care professionals and used in many schools and treatment
clinics. ABA encourages positive behaviors and discourages
negative behaviors to improve a variety of skills. The child’s
progress is tracked and measured.
There are different types of ABA. Here are some examples:

 Discrete Trial Training (DTT)

 DTT is a style of teaching that uses a series of trials to teach each

step of a desired behavior or response. Lessons are broken down
into their simplest parts, and positive reinforcement is used to
 reward correct answers and behaviors. Incorrect answers are
ignored.

 Early Intensive Behavioral Intervention

(EIBI)

 This is a type of ABA for very young children with ASD, usually
younger than 5 and often younger than 3. EIBI uses a highly
structured teaching approach to build positive behaviors (such as
social communication) and reduce unwanted behaviors (such as
tantrums, aggression, and self-injury). EIBI takes place in a one-on-
one adult-to-child environment under the supervision of a trained
professional.

 Early Start Denver Model (ESDM)

 This is a type of ABA for children with ASD between the ages of 12-
48 months. Through ESDM, parents and therapists use play and
joint activities to help children advance their social, language, and
cognitive skills.

 Pivotal Response Training (PRT)

 PRT aims to increase a child’s motivation to learn, monitor their

own behavior, and initiate communication with others. Positive
changes in these behaviors are believed to have widespread effects
on other behaviors.

 Verbal Behavior Intervention (VBI)

 VBI is a type of ABA that focuses on teaching verbal skills.

2. Assistive Technology
There are other therapies that can be part of a complete treatment
program for a child with ASD:
Assistive technology, including devices such as communication
boards and electronic tablets, can help people with ASD
communicate and interact with others. For example, the Picture
Exchange Communication System (PECS) uses picture symbols
to teach communication skills. The person is taught to use
picture symbols to ask and answer questions and have a
 conversation. Other individuals may use a tablet as a speech-
generating or communication device.

3.Developmental, Individual Differences,

Relationship-Based Approach (also called
“Floortime”)
 Floortime focuses on emotional and relational
development (feelings and relationships with caregivers).
 It also focuses on how the child deals with sights, sounds, and
smells.

4.Treatment and Education of Autistic and

related Communication-handicapped
 Children (TEACCH) external icon TEACCH uses visual cues to
teach skills. For example, picture cards can help teach a child
how to get dressed by breaking information down into small
steps.

5. Occupational Therapy
 Occupational therapy teaches skills that help the person live as
independently as possible. Skills may include dressing, eating,
bathing, and relating to people.

6. Social Skills Training

 Social skills training teaches children the skills they need to
interact with others, including conversation and problem-
solving skills.

7. Speech Therapy
 Speech therapy helps to improve the person’s communication
skills. Some people are able to learn verbal communication
skills. For others, using gestures or picture boards is more
realistic.
B. Dietary Approaches

Some dietary treatments have been developed to address

ASD symptoms. However, a 2017 systematic review of 19
randomized control trials found little evidence to support the use
of dietary treatments for children with ASD.

Some biomedical interventions call for changes in diet. Such

changes can include removing certain foods from a child’s diet
and using vitamin or mineral supplements. Dietary treatments
are based on the idea that food allergies or lack of vitamins and
minerals cause symptoms of ASD. Some parents feel that dietary
changes make a difference in how their child acts or feels.

If you are thinking about changing your child’s diet, talk to

the doctor first or with a registered dietitian to be sure your
child’s diet includes the necessary vitamins and minerals for their
growth and development.

C. Medication

There are no medications that can cure ASD or treat the core
symptoms. However, there are medications that can help some
people with ASD function better. For example, medication might
help manage high energy levels, inability to focus, anxiety and
depression, behavioral reactivity, self-injury, or seizures.

Medications might not affect all children in the same way. It

is important to work with a health care professional who has
experience in treating children with ASD. Parents and health care
professionals must closely monitor a child’s progress and
reactions while he or she is taking a medication to be sure that
any negative side effects of the treatment do not outweigh the
benefits.

D. Complementary and Alternative Medicine

Treatments

To relieve the symptoms of ASD, some parents and health

care professionals use treatments that are outside of what is
typically recommended by pediatricians. These treatments are
known as complementary and alternative medicine (CAM)
treatments. CAM treatments refer to products or services that
are used in addition to or instead of traditional medicine. They
might include special diets, dietary supplements external icon,
chelation (a treatment to remove heavy metals such as lead from
the body), biologicals (for example, secretin), or mind-body
medicine .

Many of these treatments have not been studied for

effectiveness; moreover, a review of studies on chelation found
some evidence of harm and no evidence to indicate it is effective
in treating children with ASD. Current research shows that as
many as one-third of parents of children with ASD may have tried
CAM treatments, and up to 10% may be using a potentially
dangerous treatment. Before starting such a treatment, talk to
your child’s doctor.

Lesson 3. Teaching Strategies

The diagnostic criteria for autism changed in 2013 with the

latest edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5). Previously, there were separate diagnoses for
autism disorder, Asperger’s syndrome, and other pervasive
developmental disorders, says Clarissa Willis, associate professor
of teacher education at the University of Southern Indiana and
author of Teaching Young Children with Autism Spectrum
Disorder. Today, DSM-5 puts them in all in one category as
autism spectrum disorder (ASD).

“The criteria are much more comprehensive,” explains Willis.

“[DSM-5] recognizes that autism is a spectrum. Children are going
to have varying degrees of challenges with the common areas
considered part of autism, including communication, behavior,
social awareness, and sensory integration.” Instead of
“pigeonholing” children into subcategories, says Willis, DSM-5
focuses on how much support a child needs.
 Willis points out that the push toward inclusive classrooms
has also increased the number of children with ASD in the
general education setting. “Inclusion only works insofar as the
appropriate supports are set up for the child and the teacher,”
she says.

Those supports vary from child to child. Some can spend all
day in the inclusion classroom, while others can manage just a
half-day. Some students may have full-time aides. Others may be
able to function with computer assistance, such as apps to help
them communicate or learn social skills. And while technology
can be a powerful tool, Cooper suggests using it judiciously.
“With kids on the spectrum, it shouldn’t be used as a crutch or a
babysitter, but it can be used to help facilitate,” he says.

With the guidance of Willis, Cooper, and several other

educators trained in autism, we’ve compiled 10 strategies to help
you support the varying needs of students on the autism
spectrum.

1. USE VISUALS.

 Using visuals can help students with ASD in a wide range of areas—
from understanding rules to explaining social situations. For instance,
Willis has found visual “if/then” cards to be particularly useful to
address behavioral issues. Consider a student who loves to be on the
computer but doesn’t like to do math. On the “if” side of the card,
you would include a picture that represents math. On the “then”
side, you would show a computer. “Every time he starts to get off
task, the teacher can just point to the card,” Willis says.

2. STRUCTURE YOUR DAY.

 Routines are doubly important for students who require a tight

structure. In addition to a posted class schedule, students on the
spectrum can benefit from a personal daily schedule with built-in
visuals.

Willis points out that most children with ASD demonstrate unbelievable
inflexibility” when there are changes to a routine (think assemblies). You
can add these deviances into students’ schedules and provide extra
transition time.

3. TELL A SOCIAL STORY.

 Difficulties with social skills is a hallmark of ASD. Using “social

stories,” a technique developed by Carol Gray, president of the Gray
Center for Social Learning and Understanding, can help guide
students through interactions with peers and teach social norms.
Willis had a student with autism who would become physical when it
was his turn to use the computer and someone else was still on it.
She created a story that taught him to ask for a chance to participate
without pushing or shoving: “He would say to himself, ‘When
someone’s on the computer, I ask them to stop. I count to 10.’ ”

4. GO BEYOND THE "TEACHER LOOK."

 You know your disapproving ‘teacher look’ when the class is too
loud?” asks Julie Van Alst, a special-needs teacher consultant in the
Wexford-Missaukee Intermediate School District in Cadillac,
Michigan. “Your student with ASD will likely not understand your look
means you want your class to quiet down.” Children with ASD have a
difficult time reading nonverbal cues and gestures like facial
expressions. Van Alst recommends using direct language to
communicate exactly what you want the student to do.

5. KEEP IT SIMPLE.
 Following a long set of directions is difficult for most students. It’s
especially challenging for a student who struggles with oral language
processing, as is the case for many children on the spectrum. Both
Cooper and Van Alst say it’s crucial to keep oral directions short and
to the point. Cooper uses key words like first and then. Van Alst says
she gives only one or two directions at a time.

6. INTEGRATE SENSORY ACTIVITIES.

 Most children with ASD are over- or under-reactive to sensory stimuli.

Van Alst says the buzzing of fluorescent lights in the classroom or
echoes in the cafeteria can be triggers for some students.

“We typically set the lights on halfway,” says Christina Rodocker, an

ASD teacher of grades 3–5 at Turtle back Elementary School in San
Diego. Some of her students have scheduled sensory breaks every hour
or two, which include playing with a stress ball, sitting with a weighted
lap pad, chewing gum, or carrying a heavy backpack.

7. TAKE A BREAK.

 Willis says that sometimes students just need a quiet place to retreat.
“There should be a place in the classroom—not a place for
punishment—where a student can go to take a break from the
world,” she explains. You can set up a spot in the back of the room
with soft lighting for a getaway moment. “The only rule is, after you
take a break, you have to finish what you were working on,” adds
Willis.

8. CONSIDER PARENTS THE EXPERTS.

 As a stepparent of a child on the spectrum, Cooper knows about being

on both sides of the teacher–parent relationship. He recommends
you say to parents: “You’re the expert. Help me get to know your
kid.” Cooper says parents of children on the spectrum can provide
valuable insight into a child’s routines, triggers, and the reasons
behind behaviors. He collects information in various ways, including
surveys.

9. CREATE A CULTURE OF UNDERSTANDING.

 Cooper has had honest conversations about autism with all of his
students to educate them about the disorder. He has two go-to
books he recommends reading to upper-elementary and middle-
school students to begin those discussions: Al Capone Does My
Shirts, by Gennifer Choldenko, and ColderThan Ice, by David
Patneaude. “When you’re reading a particular section where behavior
is demonstrated by a character, it’s totally fine to point that out and
ask, ‘Why do you think this is?’ ” he says. “It brings it out in the open
to have that discussion. Kids are empathetic.”
10. TREAT THEM AS CHILDREN FIRST.

 Van Alst says we shouldn’t lose sight of the fact that “children with
ASD are unique and wonderful individuals. They are first and
foremost children.” Treat them as you would any other student—tap
into their interests, allow them to showcase skills, support them as
needed, and celebrate their successes.
 While the criteria is not easy to fulfill, in this way educators and
interveners are able to gain confirmation of effectiveness of a particular
intervention that enhances a child’s development and supports them in
a vital way.

A sample of ASD interventions that are considered

effective include:

 Antecedent-based intervention: Arranging events or

circumstances that precede an interfering, or problematic, behavior
in order to reduce that behavior. For example, say a student
repeatedly struggles to focus on her workbook exercises during class
time. An instructor using antecedent-based intervention might realize
that the issue is related to the student’s schedule, and offer a break
before workbook time.

 Functional behavior assessment: Systematic

collection of information about an interfering behavior designed to
identify circumstances that support the behavior. When an instructor
uses FBA, he describes the problem behavior, identifies events before
or after that control the behavior, and develops a hypothesis about
the behavior. Then, he tests the hypothesis.

 Modeling: Demonstration of a desired behavior that encourages

the student to imitate the behavior. This EBP is often combined with
other strategies such as prompting and reinforcement.

 Peer-mediated instruction and intervention:

Typically developing peers or help children with ASD to acquire new
behavior, communication, and social skills by interacting in natural
environments. Teachers or service providers teach peers strategies for
engaging children and youth with ASD in positive and extended social
interactions in both teacher-directed and learner-initiated activities.
 Social skills training: Group or individual instruction
designed to teach learners with autism spectrum disorders (ASD)
ways to appropriately interact with peers and adults. Most social skill
meetings include instruction, roleplaying or practice, and feedback to
help learners with ASD acquire and practice communication, play, or
social skills
 Keeping up with evidence-based practices takes some extra effort,
but being knowledgeable about the options available and how to
implement them properly makes a significant impact. Students deserve
the best education possible..