INTRODUCTION
Multiple Disabilities is the simultaneous occurrence of two or more disabling conditions that affect learning or other important life functions. These disabilities could be a combination of both motor and sensory nature.
IDEA’s Definition of Multiple Disabilities
Multiple disabilities…
…means concomitant [simultaneous] impairments (such as intellectual disability-blindness, intellectual disability-orthopedic impairment, etc.), the combination of which causes such severe educational needs that they cannot be accommodated in a special education program solely for one of the impairments. The term does not include deaf-blindness.
Multiple Disabilities could be two different types of physical disabilities, two different mental disabilities, or a combination of physical and mental disabilities. Common examples of Multiple Disabilities are:
This condition can affect a person so severely that special measures would be required for her developmental and educational needs.
In countries like USA, deaf-blindness is not included in the category of Multiple Disabilities because there is a separate classification for deaf-blindness in laws like Individuals with Disabilities Education Act’s (IDEA).
In the Rights of Persons with Disabilities Act (RPWD) — there in no separate classification for deaf-blindness. So, in India deaf-blindness would be part of the category Multiple Disabilities.
CHARACTERISTICS OF CHILDREN WITH MULTIPLE DISABILITIES
Children with MD show some of the following characteristics:
Vision Problems: As children grow, some of them appear to always squeeze their eyes together to look at something closely, or keep looking at their moving fingers/paper, bump into things while walking, complain of too much light all the time. Their eyes may also look different from ‘normal’ eyes.
Hearing Problems: A child with a hearing problem may respond to only particular sounds. They may take a long time and repeated training to develop speech. And mostly they may only repeat what they hear. They may also learn to adapt to their routine environment by ‘guessing’ the conversations going around, but may actually face a lot of difficulty in a new place with unknown
people. Sometimes deaf children also show difficulty in balancing their body or walking in a straight line.
Learning Problems: Due to the combined loss of two or more disabilities, the rate and speed of learning of the children is very slow. Learning often becomes repetitive and meaningless, unless special care is taken to make the child feel safe about exploring the world around him. Multi handicapped children also have very limited ideas to play with toys or things around them.
Communication: Communication is probably the one area that is most significantly affected in children with multiple disabilities. The children are unable to see or hear or follow the different ways in which their brother and sister play with each other, elders are greeted, standing in a line to get a ticket or passing a bottle of water around a dining table.
Posture and Mobility: Our sight, hearing and body movements help us to move around, without bumping into things, remember the way to reach places or even to use our own hands to hold and look at things. Presence of Cerebral Palsy, locomotor disabilities and balance difficulties makes it hard for the child to manage his own body movements sometimes and so it becomes very difficult to use his body to move from one place to another.
Odd Behaviours: Most children with multiple disabilities show strange behaviours that are called ‘self-stimulating’ behaviours. Some of these are moving one’s body repeatedly, shaking head side to side, moving fingers in front of eyes, hitting or slapping the ears, swinging in one place and so on. The children mostly do this due to lack of anything else to do. Sometimes it is important for them to continue doing it from time to time as it helps them get some information about the world around them in their own special way. Sometimes these children also show disturbed sleep patterns.
Medical Conditions: Most multi-handicapped children also suffer from other medical conditions such as epilepsy, frequent eye and ear infections, respiratory disorders, muscular degeneration frequent surgeries and so on. Such medical conditions lead to frequent hospitalizations and the child again misses out on a lot of exposure and learning from the environment.
We can say that just as every child is different, similarly every child with MD is different. However there are some things that this group of children have in common.
· It affects the all-round development of the child
· Communication with the world around is most severely affected
· Opportunities to interact with the environment becomes very limited
· Ability to move around in the environment is restricted
· Need regular help in simple day-to-day activities such as wearing a shirt, opening a door, Finding a chair to sit down and so on.
· A highly structured educational / rehabilitation programme helps in their training.
· Deficits in self-help like dressing, eating, bowel and control.
· Deficits and difficulties in terms of learning behavior like slow acquisition rate for learning new information and skill.
· Deficits in terms of communication behavior like speech problems, inability to express oneself.
· Deficits in terms of physical and motor behavior like difficulty in moving from one place to another place.
· Deficits and deficiencies in terms of social skills like difficulty in having needed social interaction participation in group activities.
· Presence of inappropriate behavior and emotional disturbance like aggression, withdrawal and shyness, suicidal tendency.
CAUSES OF MULTIPLE DISABILITIES
There are several factors that cause severe and multiple disabilities & can be divided as follows:
Prenatal causes which include:
· Chromosomal abnormalities
· Viral infections
· Drug and Alcohol use during pregnancy
· Mother’s malnutrition
· Physical trauma to the mother
Perinatal causes which include:
· Lack of oxygen supply to the baby’s brain
· Physical injury to the baby’s brain at birth
· Contracted infections during birth
Postnatal causes which include:
· Childhood infections such as meningitis & encephalitis
· Traumatic brain injury from an accident or abuse
· Lead poisoning
· Reactions to medication
· Exposure to toxins or other environmental conditions
As with other disabilities, the severity and complexity of the disability depends on the genetic
abnormality, the amount of damage to the brain and the environment in which the child is raised.
DIAGNOSIS
An in-depth evaluation would be needed, including the nature and extent of the child’s disabilities. It is important to identify the individual disabilities and the severity of these disabilities that the child has, to understand how the combination of these disabilities affect the child’s learning, balance, use of the senses, etc. This information is required for professionals to decide the type of support, services and therapies the child would need.
TREATMENT
For children with Multiple Disabilities, physical and occupational therapy can help ease physical challenges, and this could help a child’s ability to function at school. Assistive Technology, Braille, hearing aids and sign language can be used to assist with communication problems and hearing and visual impairments. Hand held personal computers with touch screen and audio and visual information containing messages and instructions can be particularly helpful for children with motor control issues. Physical therapy and orthopedic supports could also be necessary, to help with mobility.
Most children with Multiple Disabilities will need some level of support and assistance throughout their lives, and the amount of help a child needs would depend on the disabilities involved. Children with mild multiple disabilities may need help only sometimes, and only with certain tasks, whilst children with multiple and severe disabilities may need ongoing support.