Health Impairment

Health Impairment
A chronic or acute health problem such that the physiological capacity to function is significantly limited or impaired and results in one or more of the following: limited strength, vitality or alertness including a heightened alertness to environmental stimuli resulting in limited alertness with respect to the educational environment. The term shall include health impairments due to asthma, attention deficit disorder or attention deficit with hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome, if such health impairment adversely affects a student's educational performance.

IDEA lists a number of different chronic health problems as possible reasons for the other health impairment label, including asthma, attention deficit disorder, attention deficit hyperactivity disorder, diabetes, epilepsy, cardiac conditions, hemophilia, leukemia, rheumatic fever, sickle cell anemia, and nephritis. It would be impossible to list all of the possible characteristics under such a large disability category. This is the primary issue in other health impairment: whatever the condition, the resulting symptoms could adversely impact the student's educational performance. If a child has diabetes, but it is controlled through medication and does not impact learning, special education services are not appropriate for that child.

Impairments are extremely varied and disabilities range from mild to severe. There may be more than one disability present.

Students with AD/HD are categorized according to their characteristics into three distinct subtypes: predominantly inattentive AD/HD, predominately hyperactive-impulsive AD/HD and combined type AD/HD.

Students with the combined type of AD/HD will have some features of both the inattentive type and the hyperactive-impulsive type of AD/HD. This is the largest population of students carrying the AD/HD label. Students with AD/HD, no matter what subtype, can have deficits in three areas that may impact their educational performance. These three areas are executive functioning, intellectual functioning, and social/emotional functioning.

Executive functioning is the ability to process information, make decisions, and solve problems. Students with AD/HD display deficits in a number of executive functions, including working memory, internalization of speech, self-regulation, and reconstitution. These students often have an inability to learn from the experiences of the past, and can repeatedly make the same mistakes. This problem with memory is often impacted by issues with self-regulation, as these students also have difficulty understanding the effect that their behavior can have on others. In addition, students with AD/HD have trouble internalizing their thoughts and can blurt out inappropriate comments. Reconstitution is the skill of analyzing thoughts and behaviors. It is this deficit in executive functioning that can be the most frustrating to these students: they may know exactly what is expected of them, but are unable to act accordingly.

The average level of intellectual functioning of students with AD/HD is a matter of controversy, but what is certain is that these students frequently have problems with academic achievement. Ten to forty percent of these students are also diagnosed with a learning disability of some type, and 30% have a reading disability. However, these students also can display a high degree of creativity, and can display intense levels of focused concentration on a task of interest.
Students with AD/HD often exhibit a number of emotional issues as well and as many as 25% of these students have some type of anxiety disorder. These emotional issues can lead to conflict with parents, teachers and peers; low self-esteem; difficulty making social connections; and higher rates of alcohol and substance abuse.

Strategies that can be taught to these students:

• Allow extra time for these students to shift from one activity or environment to the next
• Teach these students specific techniques for organizing their thoughts and materials.
• Organize the classroom accordingly, and keep all materials in permanent locations for easy access
• Allow extra time for finishing assignments or for testing
• For more complex activities, simplify steps to make them more manageable
• Seat the student close to the teacher and away from any peers that might be distracting
• Post a daily and weekly schedule that clearly delineates each activity. These schedules can then be used as prompts to direct the student back on task
• Keep these schedules as consistent as possible, and keep unstructured time at a minimum
• As always, meeting with the parents is vital and provides up to date information on the childs progress and needs.
  
  
  Accommodations
  
• Protruding objects need to be removed or minimized to keep pathways safe.
  
• High contrast, large-print directional signs should be posted
  
• Provide at least one adjustable workstation so individuals who use wheelchairs and users of various heights and body types can access the computer comfortably. Computer adjustment controls also need to be accessible.
  
• Document holders should be available to position documentation so it can be easily read.
  
• Documentation needs to be provided in alternative formats, or available in a timely manner (e.g. Braille, large print, audio and electronic text).
  
• Printed materials should be within reach from a variety of heights.
  
• Hearing protectors should be provided for those who are easily distracted by noise in the facility.
  
• Foam wedges
  
• Switch operated toys
  
• adhesive to secure paper to wheelchair tray
  
• velcro fasteners on dress-up clothing
  
• table top easels
  
• thicken handles of writing and drawing utensils
• wristband puppets allow children to dramatize stories
• a mirror placed horizontally allows child to be included in role-play activites in the dramatic play area.
• milk carton blocks require less strength to lift and are cheap to make
  
  Use of computers greatly enhances learning. Computers should have the following features:
  
• Accessible on/off switches.
  
• Flexible positioning or mounting of keyboards, monitors, etc.
  
• Software utilities that consolidate multiple or sequential keystrokes.
  
• Mouth sticks, head sticks, or other pointing devices.
  
• Keyguards.
  
• Modified keyboards (e.g., expanded, mini, or one-handed).
  
• Trackballs or other input devices provide an alternative to a mouse.
  
• Keyboard emulation with specialized switches that allow the use of scanning or Morse code input.
  
  Annotations

http://www.doe.mass.edu/sped/links/healthimpair.html Website contains links to specific impairments

http://www.washington.edu/doit/Faculty/Strategies/Academic/Adaptive/ Good source for information about assistive technology

http://www.projectidealonline.org/documents/adhd-teaching-2008.pdf The best source for instructional teaching practices. Broken down and easy to read.

Miller, Susan Ed.D. (1997) Adapting The Environment For Children With Special Needs. Totline Magazine, September-October, 8-9 Excellent ideas for preschool environment

Handout from KAEYC, (2001). Share Fair. Manhattan, KS. Good section on adaptations. Very doable and beneficial for entire classroom.