The Individuals with Disabilities Education Act (IDEA) defines multiple disabilities as simultaneous impairments (e.g., intellectual disability-blindness, intellectual disability-orthopedic impairment) that cause severe educational needs. These needs are so significant that they cannot be met by addressing only one impairment. Deaf-blindness is excluded from this classification.

This category includes students with severe physical, cognitive, and communicative impairments who generally need extensive support across various skills. Examples include combinations like:

• Intellectual disability and blindness

• Intellectual disability and orthopedic impairment

The Persons with Disabilities Act (1995) defines multiple disabilities as a combination of two or more disabilities, such as:

1. Locomotor disability

2. Blindness/low vision

3. Speech and hearing impairment

4. Intellectual disability

5. Mental illness

Children with multiple severe disabilities need substantial care and support. The National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Intellectual Disability, and Multiple Disabilities was established to provide services and support for these children.

• Affected overall development

• Severe communication impairments

• Limited interaction with the environment

• Restricted mobility

• Need for regular assistance in daily activities

• Benefit from structured educational and rehabilitation programs

This category includes students with severe physical, cognitive, and communicative impairments. Despite these challenges, some students may have average or above-average intelligence. The commonality among these students is the need for extensive support across various skill areas due to having two or more coexisting impairments.

The 14 IDEA Classifications That Can Combine to Produce Multiple Disabilities

1. Autism

2. Deaf-Blindness

3. Deafness

4. Developmental Delay (ages 3-5)

5. Emotional Disturbance

6. Hearing Impairment

7. Intellectual Disability (formerly referred to as Mental Retardation)

8. Multiple Disabilities

9. Orthopedic Impairment

10. Other Health Impairment

11. Specific Learning Disability

12. Speech or Language Impairment

13. Traumatic Brain Injury

14. Visual Impairment (including blindness)

When a student has two or more of these disabilities requiring distinct educational programming, they are classified under the label of Multiple Disabilities. This classification highlights the necessity for specialized, comprehensive support to address the unique educational needs arising from their combined impairments.

Cerebral Palsy (CP)

Cerebral Palsy refers to a group of non-progressive neuromuscular problems caused by brain damage, affecting motor functions. It can result in varying degrees of disability, from difficulty with fine motor skills to severe movement impairments and swallowing difficulties.

Autism

Autism Spectrum Disorder (ASD) involves deficits in social interaction, communication, and repetitive behaviors or interests. Sensory experiences may also be unusual. Symptoms range from mild to severe, with unique presentations in each child.

Intellectual Disability

Characterized by below-average intelligence and limitations in daily functioning such as communication and self-care. Intellectual disability ranges from mild to profound and can be measured by IQ or the level of support needed.

Locomotor Disability

Involves impairments in bones, joints, or muscles, leading to restricted movement. This includes conditions like:

• Spinal Cord Injuries: Can cause paralysis or heal completely.

• Cerebral Palsy: Non-progressive muscle control issues.

• Polio: Infectious disease causing paralysis.

• Muscular Dystrophy: Muscle weakness and breakdown over time.

• Contractures: Permanent muscle and joint tightening.

• Club Foot: Deformity of the foot.

Hearing Impairment

Defined as a loss of 60 decibels or more in the better ear. Types include:

• Sensorineural Hearing Loss: Damage to the cochlea or auditory nerve, treated with hearing aids or cochlear implants.

• Conductive Hearing Loss: Defects in the outer or middle ear, often treatable with surgery or amplification.

• Mixed Hearing Loss: Combination of conductive and sensorineural loss.

• Central Auditory Disorder: Issues in the brain’s hearing centers, affecting understanding.

Visual Impairment

• Blindness: Total absence of sight or severe visual acuity loss.

• Low Vision: Significant visual impairment even after correction, affecting daily tasks and interaction with the environment.

Mental Illness

Includes conditions like:

• Anxiety Disorders: Fear and physical anxiety symptoms.

• Disruptive Behavior Disorders: Defiant and disruptive behaviors, including conduct disorder, oppositional defiant disorder, and ADHD.

Combined Sensory Disorders

Rare conditions involving both visual and auditory impairments, previously common with congenital rubella syndrome but now less frequent.

Multiple disabilities often coincide with epilepsy, severe hypotonia, motor control disorders, sensory impairments, and somatic disorders

Epilepsy is a neurological disorder marked by recurrent, unprovoked seizures. Seizures occur due to abnormal electrical activity in the brain. Treatment options include:

• Medications: Antiepileptic drugs (AEDs) to control seizures.

• Surgery: In cases where seizures are localized to a specific brain area.

• Lifestyle Adjustments: Adequate sleep, stress management, and avoidance of seizure triggers.

• Diet: Ketogenic diet has been found beneficial in some cases.

Epilepsy affects 40-50% of children with multiple disabilities. In about 20-25% of cases, seizures are difficult to control. Types of seizures include:

• Absence Seizures: Brief lapses in consciousness.

• Tonic Seizures: Sudden muscle stiffness.

• Falls: Caused by unpredictable seizures, leading to traumatic injuries and secondary impairments.

Behavioral disorders can result from repeated seizures, manifesting as drowsiness, hyperactivity, aggressiveness, or self-destructive behaviors. Severe, frequent seizures indicate a poor prognosis, particularly for life expectancy. Conversely, episodic seizures are more manageable with current treatments and have a lesser impact on daily life.

Severe Hypotonia:

Severe Hypotonia refers to pronounced muscle weakness and reduced muscle tone, leading to floppy or loose limbs. In the context of multiple disabilities, severe hypotonia can be associated with various conditions affecting the nervous system, such as brain deformities or progressive neurological diseases.

• Manifests as pronounced muscle weakness and tone abnormalities.

• Diagnosing peripheral or muscle lesions can be challenging.

• Some progressive nervous system diseases exhibit a combination of central, peripheral, and muscular lesions.

• Rare myopathies combined with mental retardation resemble multiple disabilities.

Motor Control Disorders

Motor Control Disorders encompass specific motor impairments observed in individuals with multiple disabilities, particularly those with conditions such as early epileptic encephalopathy or malformations of the brain. These disorders manifest as difficulties in controlling movement and posture, impacting mobility and coordination.

• Primarily observed in children with early epileptic encephalopathy.

• Characterized by severe central hypotonia, affecting motor skills development.

• Result in challenges with gait, balance, and awareness of body position, often leading to falls.

• Conditions like Angelman syndrome (genetic disorder causing developmental disabilities and nerve related symptoms) exhibit specific motor deficits, complicating mobility.

Secondary Motor Impairments:

• Arise from spasticity, abnormal postures, or motor stereotypes impacting joints.

• Include hip dislocations, progressive scoliosis, and limb deformities, limiting mobility and causing pain.

• Early intervention and orthopedic equipment aim to prevent these impairments.

Sensory Impairments:

• Commonly coexist with multiple disabilities, affecting auditory and visual functions.

• Audiological assessments challenging due to comprehension issues.

• Vision impairments prevalent, with ametropia, cataracts, and retinal lesions being common.

• Visual processing disorders, like cortical blindness, pose additional challenges, requiring specialized assessment methods.

• Common in individuals with multiple disabilities, especially with aging.

Somatic Disorders:

• Individuals with multiple disabilities prone to chronic respiratory failure, nutritional disorders, and gastroesophageal reflux.

• Elimination disorders like constipation and urinary tract infections are common.

• Skin fragility due to peculiar postures and nutritional issues increases risk of pressure sores.

• Leprosy, a chronic infectious disease caused by Mycobacterium leprae, can lead to physical disabilities if left untreated.

• Leprosy cured students may experience residual impairments such as nerve damage, muscle weakness, and deformities, even after successful treatment.

• Common disabilities include loss of sensation in extremities, muscle wasting, and disfigurement of the face and limbs.

• A "leprosy cured person" is someone who has successfully completed treatment for leprosy but may still experience residual impairments.

• These residual impairments may include: (i) Loss of sensation in hands or feet, as well as loss of sensation and weakness in the eye and eyelid, without visible deformity. (ii) Visible deformities and weakness, but with sufficient mobility in the hands and feet to participate in normal economic activities. (iii) Severe physical deformities or advanced age that prevent the individual from engaging in any gainful occupation.

• Despite being cured of leprosy, individuals in these categories may face challenges in mobility, economic participation, and social integration due to their residual impairments.

• Access to inclusive education, rehabilitation services, and social support is essential for leprosy-cured individuals to lead fulfilling lives and overcome the stigma associated with the disease. Special accommodations may be necessary to address the specific needs of leprosy-cured students in educational settings, such as assistive devices, adapted learning materials, and accessible facilities.

• Tuberous sclerosis complex (TSC) is a rare genetic disorder characterized by the growth of benign tumors in various organs, including the brain, kidneys, heart, lungs, and skin.

• Common symptoms include seizures, developmental delays, intellectual disability, behavioral problems, skin abnormalities (such as facial rash), and kidney tumors.

• The severity and manifestation of symptoms vary widely among individuals with TSC, ranging from mild to severe.

• Symptoms can manifest at any age but often begin early in childhood.

• The classic presentation of tuberous sclerosis includes a triad of symptoms:

  1. Seizures: Although seizures are common, they may be absent in about one-quarter of individuals.

  2. Mental retardation: Up to half of individuals may have normal intelligence, while the remaining may experience varying degrees of intellectual impairment.

  3. Adenoma sebaceum: Characterized by the presence of facial lesions, although it's not present in all cases.

• Learning problems are common in children with tuberous sclerosis, affecting nearly half of all cases.

• Learning difficulties can range from mild to severe and may include poor memory, attention span, planning and organizational skills, slow learning, and in severe cases, difficulty with communication and self-care.

• Management of TSC involves multidisciplinary care, including medication to control seizures, behavioral therapy, educational support, and surgical intervention for complications like kidney tumors.

• Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, leading to inflammation, demyelination, and neurodegeneration. It affects the brain and spinal cord, leading to various symptoms related to muscle control, vision, balance, and sensations.

• Common symptoms include fatigue, muscle weakness, numbness or tingling, Ataxia (balance and coordination problems), cognitive impairment, spasticity and vision disturbances.

• The condition is characterized by damage to the protective layer of protein called myelin, which surrounds nerve fibers in the brain and spinal cord.

• Myelin damage disrupts the transmission of nerve signals, resulting in a wide range of potential symptoms.