Disability Youth Overview

By Christina Lee Steele Chapan

Inclusion is a term used quite frequently in our society.  It means that as trainers and teachers, we will have students with disabilities in our classrooms and fitness facilities, and we must learn how to meet their unique needs in daily activities and welcome them in our schools, churches, and recreation/gyms, while striving to serve the general public as well. This is a daunting task even for those people who specialize in special education. I believe that this article is essential for anyone who works with children with disabilities. This article is divided into four categories addressing those students with physical, mental, learning and emotional/behavioral disabilities. Please read each of these sections since the persons you may be working with will have a variety of disabilities and perhaps a combination of multiple diagnoses.

Physical Disabilities

A physically disabled person will have various ranges of coordination, mobility, balance, agility, strength, and endurance challenges. It is important to remember when working with these individuals that many of them have normal and gifted mental abilities. Some disabilities have been a part of an individual’s life since birth, others have developed over time, and still others are the result of injuries that occurred after birth. 

Arthritis and Rheumatism

Many people think that arthritis and rheumatism only occur in the elderly, but this is not always the case. Arthritis is the inflammation of the muscle joint line and pains in the body’s muscles, tendons, and ligaments are rheumatism. Individuals with arthritis and rheumatism may tire easy and activities such as walking, climbing, going flights of stairs, rising and standing may be challenging. It is recommended that physical exercise be mild yet challenging and done at the same time of day for those with these conditions. Many people with these conditions have reported improved health with exercise. 

Cerebral Palsy

Cerebral Palsy is caused by conditions that affect body movement and muscle coordination. It ranges from mild to severe. Some people with cerebral palsy are mobile and have hardly any physical characteristics whereas others cannot move at all. Cerebral palsy first appears during infancy. Some cases of cerebral palsy are caused by a blood-type incompatibility or an infection that happens before or just after birth. Cerebral palsy effects body movement and muscle coordination. Some individuals with cerebral palsy have either decreased muscle tone (hypotonic), increased muscle tone (hypertonic), or stiff and rigid muscles. Faulty development and damage to motor areas of the brain cause this disability. People with cerebral palsy have average and above average mental abilities and should be treated cognitively on that level. Physical abilities should be tested under the direction of a physical and occupational therapist. After assessment, assisted elastic tube body weight training and weight machines are great to include in your strength training program. Cardiovascular training will depend on the individual’s physical stamina. Stationary cycling or swimming are excellent options for someone with cerebral palsy. Modification of equipment is also a great way to include the child in fitness activities. Use balloons, beach balls, or soft balls for safe tossing and catching. Modifying the rules of games, using large scooters, or enlarging targets gives students success. 

Tourette's Syndrome

Tourette's syndrome is a neurological or neuromechanical disorder characterized by tics of involuntary, rapid movements and repeated vocalization. This person frequently displays eye rolling, blinking, twitches, sniffing, and throat clearing. Speech disorders may include echolalia, the urge to repeat words spoken by someone else; palatial, repeating one’s own words; lexilalia, the urge to repeat read words, and coprolalia, using swear words or inappropriate words uncontrollably during speaking. Teachers and trainers can minimize embarrassment by educating the rest of the class about this condition and having activities where the individual’s strange behavior is ignored or minimized by redirection or by allowing that child an opportunity to display their behavior in a private space such as an extra classroom or gym.

Spinal Bifida

Spinal bifida is a birth defect that happens when the vertebral canal fails to close normally around the spinal cord. Disabilities with this disorder include paralysis or lack of feeling to the legs and feet and lack of bladder and bowel control.  Programs should be conducted in conjunction with a physical or occupational therapist.

Visual Impairments

A visual impairment is more than someone who wears eyes glasses. Their visual acuity is 20/70 or less, and they will struggle with vision, even when using a corrective prescription. A trainer or teacher may assist the student by using verbal directions and by asking the student for how the student learns best. Because of their limited vision, the student often has poor motor skills and displays easy fatigue. Ask them how they would feel comfortable being guided. Give students mental pictures and descriptive words. Simplifying the game or skill is also effective. 

Hearing Impairments

Those students who are hard of hearing and deaf may benefit from the use of sign language, lip reading, or written directions. Face the person when you are signing or talking with them, demonstrate, increase hands-on experience of the activity, and ask them to repeat anything that they did not understand. Reduce distractions and background noises. When talking to the hearing-impaired, face the person because they need to see your face to read your lips and see your gestures.

Speech or Language Disability

Some children have a hard time understanding what other people are saying. Students often do not hear greetings and mix up words and sounds. They suffer from disorganization, trouble with rote learning, noisy environments, and have difficulty following conversations. Some students struggle with expressive language and others have difficulty with receptive language, despite the fact that they are in a regular classroom. It is best with these children to use sign language, if they use it, visual or written directions, and a schedule. It is also perfectly acceptable to use a chalkboard, dry erase board, or pad of paper to communicate. A buddy is also effective, and most students enjoy taking a turn being someone’s assistant.

Motor Skills

Children with motor skills disabilities often have another disability. They move slowly and have a hard time controlling their muscles. Some children suffer from lack of ability with large motor movements such as running, jumping, kicking and throwing, and catching, and others with small motor movements such as using their hands and fingers. Teachers and trainers must work together with an adaptive physical educator to find simplified ways to teach fitness skills. It is helpful to teach academic and physical skills by breaking the tasks down into small parts.  Fine motor skills that should be integrated in academic and fitness activities include kneading with dough, working with modeling clay, using whole punchers, cutting with scissors, and writing in sand or shaving cream. Painting with a bucket of water on a chalkboard or driveway and writing words on a chalkboard or sidewalk are good activities to include in fine motor coordination. An occupational and physical therapist is helpful in the gym, classroom, and home. 

Proprieties System and Sensory Integrative Disorders

In these disorders, the central nervous system does not respond well to incoming stimuli and disorders of body position or space awareness. They suffer from not understanding their receptors of muscles, joints, and tendons. They may not give appropriate body space and may make others feel uncomfortable. The central nervous system does not respond well to incoming stimuli. Children often have trouble interpreting emotions and may become easily frightened or angered. They may avoid new things or fight with others frequently. A teacher or trainer may find that it is essential to see what sets that person off and to try to eliminate situations that will upset the individual. It is important to give that person space and not to allow others to get too close to that person if it upsets him/her.

Tactile and Vestibular Disorders

These persons have difficulty determining appropriate senses of touch and may overreact to light touches while other things that could potentially harm them, such as a bee sting or hot stove, do not affect them at all. They may be a picky eater, affected by various textures of fabrics, react negatively to hygiene such as washing hands and face, and be unwilling to try art projects that are messy such as finger paints, glue, and clay. Autism and sensory dysfunction also fall into this category. Vestibular is the system of movement that begins in the inner ear and controls the movement of the head, eyes, and body and causes balance. Students with this disorder may have difficulty accomplishing bilateral tasks such as cutting with scissors or riding a bike and may be developmentally delayed.

Traumatic Brain Injury and Environmentally Induced Impairments

This is where the brain has been damaged through an accident or abuse. There is generally a period of unconsciousness when injury occurs and the person, as a result, loses part of their cognitive abilities or physical functions. Lead poisoning, fetal alcohol syndrome, pre-and post-natal complications, and drug use can be environmentally induced impairments. In all of these disorders, these children generally suffer from problems and seizures. They may also sleep poorly and have irregular eating patterns. Often these children are adopted or with foster families since many of these cases occur as a result of parental abuse. Patience and contact with support staff and home is essential when dealing with students with these disorders.

Mental Disabilities

People with mental impairments develop at a slower rate emotionally, developmentally, and physically. Genetic conditions, problems with pregnancy, and early health problems may cause mental retardation. Mental retardation is very common, affecting 3 out of every 100 people. There are four basic levels of retardation. With all mental disabilities, structure is key. Advice for working with those students with mental retardation includes breaking down tasks into simpler steps, using concise simple directions, providing opportunities for repetition, repeating tasks and skills, and striving for appropriate age-level behavior. A good teacher or trainer will have more than one way to accomplish a goal if the first way they teach the student does not work.

Educable Mentally Handicapped (EMH) is characterized as a mild impairment. These individuals are typically mainstreamed in a regular education classroom with additional help from aides and special education support staff. Many EMH persons are able to lead normal lives, live independently, and hold employment.  Teachers and trainers find that providing visual directions with pictures and simple directions and pausing to give instructions at slower rate work well with these children. Eighty-five percent of persons with disabilities fall into this area. Poor motor coordination with fine or gross motor skills or both is a part of mental retardation.

Down’s Syndrome

Most students will Down’s fall under the EMH category. They learn at a slower rate, are often stubborn, but can also be very affectionate. These students may suffer from physical defects such as hearing or vision loss, heart defects, gastrointestinal problems, and respiratory problems. Using a firm, fair, friendly, fun, affirming, positive, and consistent environment will prove effective with these students. When they have an opportunity to spend time alone with a choice of teacher-directed activities, they will perform well in the classroom or gym. They have infectious personalities and easily make friends wherever they go. 

Prader-Willi Syndrome

Prader-Willi Syndrome is another EMH condition usually present from birth and characterized by obesity, decrease muscle tone, and decreased mental ability. These individuals may have immature physical development and short stature. This person has an uncontrollable need to eat and will sneak and steal food.  Food is not properly digested so rapid weight gain occurs even when portions are controlled.  Behavioral characteristic include sudden temper tantrums accompanied by violent outbursts, stubbornness, resistance to change, and poor social relationship.  Learning disabilities, speech and language difficulties, and short-term memory problems can also occur. A teacher or trainer can find alternatives to food by providing activities that the individual likes. Sport activities are limited because running and jumping can cause joint injuries due to poor muscle strength and poor coordination, possible bone fracture due to early osteoporosis, and decreased muscle bulk. Walking, swimming, and stationary exercise equipment are great alternatives. Training with weights or body weight can be effective to preserve muscle tone, and daily exercise at least 30 minutes can be helpful. 

Moderate Mental Impairment

Trainable Mentally Handicapped (TMH) individuals have moderate or severe disabilities. They are traditionally in self-contained classrooms with mainstreamed opportunities during social times of the day when they interact with students and special classes. They may be self-sufficient if supervised during instruction, but it very helpful to have physical occupational therapists and adaptive specialists help modify activities when working with these individuals. 

Severe Mental Impairment

These students are often grouped by themselves in a non-traditional school setting such as a cooperative or therapeutic school. Activities must be basic with a lot of emphasis on improvement and stabilization of fine and gross motor abilities. Some students may talk but many are non-verbal. It is essential for teachers and trainers to find an effective way to communicate with their students through the use of sign language and pictures. Often these students will have a secondary condition of a behavior disorder because of their lack of ability to communicate.

Profound Mental Impairment

These individuals learn at an extremely slow rate. Often they can’t talk and have limited self-help skills. They require supervised care throughout life. Even these students enjoy group games using a parachute, catching a ball, or taking a walk outside. 

Rhett’s Syndrome

This disorder only occurs in girls with severe and profound mental retardation.  The individual is born normally and develops until six to eighteen months of age. At that point, they lose mental and development ability. Signs of Rhett’s include repetitive hand movements, hand wringing, hand clapping, and hand mouthing.  Children with Rhett’s enjoy music, may benefit from working on small and large motor movements, and enjoy long supervised walks.

Learning Disability

A learning disability is a disorder in which spoken or written language, thinking, speaking, reading, writing, spelling, or mathematical calculations is a struggle. That learner is typically one or more grade levels below the average child, and for that individual, learning is quite difficult. Milestones in motor skills and memorization are inhibited. If a teacher or trainer can provide activities using the learner’s strengths, increased visual and verbal directions, and hand-on experiences, the learner can experience success. Many people misunderstand students with learning disabilities and mistakenly characterize them as lazy, weird, and socially impaired. These persons learn differently, and the attuned teacher or trainer must realize that learners should work in their own ways.

Dyslexia

Students with dyslexia have difficulty reading and writing. They often reverse letters and numbers in writing and read backwards. The brain is confused by the ways letters and words are arranged. The reader may also skip, repeat, or miss letters and numbers when reading silently or aloud. This disorder is not corrected with eyeglasses. A teacher or trainer might find that verbal directions or pictures are better tools with these children. A tape recorder with directions is also effective.

Behavioral Disorder

Students with a behavioral disorder generally have motor abilities within acceptable limits of other children. They use seek attention from adults by acting out, and use their disorder when they are frustrated or cannot communicate their feelings. They may be hyperactive, destructive, dangerous, impulsive, and at times inattentive. An environment with consistent rules, environment, and structure and fewer distractions and choices work best for this student. Allow him/her to have their own personal space and realize that they may not hear you if you force them to look at you while you are speaking. Positive reinforcement is most effective with this student, and a teacher/trainer must choose which behavior is important to correct at times. 

Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a behavioral and developmental disorder. Individual has poor concentration, hyperactivity, impulsiveness, figits and squirms, is aggressive, defiant, disorganized, and can get very emotional. They often do not sleep well at night and have high energy and activity levels. Students can be helped with simplified directions, extended wait period when answering questions, and activities that are broken up into parts. It is important when working with an ADHD student to eliminate distractions, organize the learning space, and minimize background noise. Students could also benefit from a buddy and a smaller group when doing activities, written and picture rules, directions, and schedules. Changes in the schedule should be minimized. Give directions both verbally and in writing. A redirected word or counting down system is also effective. They also enjoy helping the teacher and do well when given responsibility.

Hyperactivity

These learners need a safe place to move and may use their bodies or another object to manipulate energy. They do better with individual sports such as track, gymnastics, and weightlifting. They make excellent assistants and do well with structured time and with using a timer to chart activities.

Social Skills Disability

These children or teens have difficulty with appropriate social skills. They may have another diagnosis such as mental retardation. They also suffer from ritualistic behavior.  Obsessive Compulsive Disorder (OCD) is one of these disabilities. A chemical imbalance or genetic or neurological disorder can bring about OCD. These individuals may have trouble with space and tone of voice and may react at strange times. A stress or traumatic event can bring about OCD. They can also obsess about harming others or themselves. Compulsions are the urges to perform certain behaviors in response to the obsessions. These rituals seem to lesson the anxiety caused the by the obsessions. Some things include excessive hand washing or washing of other objects, repeating actions, a bad habit, obsessive speech, or counting to a certain number. These individuals have no control over the stopping and starting of obsessions and compulsions.  Redirection is effective and allows the child to try new things. These learners benefit from working on one skill at a time and, in that circumstance, have a high rate of success.

Autism Spectrum

Some learning differences such as autism can have a range of mental retardation to gifted status. Understanding these differences helps the teacher and trainer better understand how to work with and function with these disabilities.

Autism and Asperger’s Syndrome 

In autism and Asperger’s, the developmental disability affects verbal and nonverbal communication and is generally evident before age three. One out of every 300 children is affected by autism. The medical field has not narrowed down the cause of autism. Some studies suggest genetics, others suggest chemicals in the child’s environment or a vitamin deficiency, and others suggest the cause lies in dairy and gluten allergies. Students are not able to effectively communicate with one another; they are obsessed with repetitive activities and do best with a consistent, predictable daily routine. They also may have hyper- or hypo-sensitivity to people, materials, and objects. Often they enjoy doing activities by themselves. When working with these children, use pictures, provide a less stimulating environment, seek to introduce activities that will promote the student’s success, and offer two choices for activities instead of telling the child the way it will be done. Use literal speech and concrete examples. Make sure you don’t use jokes, sarcasm, double meanings, or idioms. Autistic individuals often  display egocentric behavior and may become obsessed or preoccupied with a particular topic or interest. An instructor, at appropriate times, must try to integrate that subject into the learning area. 

         When working with students with disabilities, be as consistent as possible in your goals and expectations. Use clear consistent, explicit communication and break tasks down into smaller units to keep students from getting overwhelmed. Small steps can keep you focused on goals and minimize distractions. Repetition will benefit students. Be patient and celebrate the small leaps. Use concrete directional words such a “first,” “next,” and “finally,” and explain who, what, where, and why in directions. Ask questions, and if possible, have the student repeat the directions in their own words. Increase wait time in your questioning and directions. Try to minimize unexpected surprises and use white noise to block out distractions. Use a schedule with minimum changes. When working with an individual with disabilities, give those options with a basic plan of action in mind. These tips will help you accomplish your goal while giving students ownership over their learning. All students and adults with disabilities respond well to positive reinforcement and genuine praise. Good notes, phone calls home, token rewards, and extra privileges are proven to be effective forms of reinforcement for those with disabilities. Don’t expect perfection but…Be Positive! Be Creative! Be Flexible!

References

Cummings, Rhoda and Fisher, Gary, (2003). The survival guide for kids with LD. Minneapolis, MN: Free Spirit

General Accommodations for Students with Physical Impairments

http://www.glc.k12.ga.us/passwd/trc/ttools/attach/accomm/physimp.pdf
            Tips for Teaching High Functioning People with

http://www.udel.edu/bkirby/asperger/moreno_tips_for_teaching.html

National Dissemination Center for Children with Disabilities

http://www.nichcy.org/index.html

           South Suburban Special Recreation Association, (2005). SSSRA staff and volunteer safety/orientation manual. Tinley Park, IL: SSSRA