Exceptional Children
15. Severe/Multiple Disabilities
1. Introduction
2. Educating Exceptional Children
3. Legal Foundations
4. Merger of Special and General Education
5. Complex Health Care Needs
6. Early Childhood Intervention
7. Parental Involvement
8. Learning Disabilities
9. Behavior Disorders
10. Speech and Language Disorders
11. Deaf or Hard of Hearing Disorders
12. Visual Impairments
13. Physical Disabilities
14. Mental Retardation
15. Severe/Multiple Disabilities
16. Gifted and Talented Students
17. Wrap-Up

Children with Severe and Multiple Disabilities

Module 15       Children with Severe and Multiple Disabilities


People with severe disabilities are those who traditionally have been labeled as having severe to profound mental retardation. Such people require ongoing, extensive support in more than one major life activity in order to participate in integrated community settings and enjoy the quality of life available to people with fewer or no disabilities.


Children with multiple disabilities may have a combination of various disabilities that may include: speech, physical mobility, learning, mental retardation, visual, hearing, brain injury and possibly others. Along with multiple disabilities, they can also exhibit sensory losses and behavior and or social problems. Children with multiple disabilities - also referred to as multiple exceptionalities will vary in severity and characteristics. These students may exhibit weakness in auditory processing and have speech limitations. Physical mobility will often be an area of need. These students may have difficulty attaining and remembering skills and or transferring these skills from one situation to another. Support is usually needed beyond the confines of the classroom.


People with severe or multiple disabilities may exhibit a wide range of characteristics, depending on the combination and severity of disabilities, and the person’s age. There are, however, some traits they may share, including:

         Limited speech or communication;

         Difficulty in basic physical mobility;

         Tendency to forget skills through disuse;

         Trouble generalizing skills from one situation to another; and/or

         A need for support in major life activities (e.g., domestic, leisure, community use, vocational).


A variety of medical problems may accompany severe disabilities. Examples include seizures, sensory loss, hydrocephalus, and scoliosis. These conditions should be considered when establishing school services. A multi-disciplinary team consisting of the student's parents, educational specialists, and medical specialists in the areas in which the individual demonstrates problems should work together to plan and coordinate necessary services.


In order to be effective, educational programs need to incorporate a variety of components to meet the considerable needs of individuals with severe and/or multiple disabilities. Programs should assess needs in four major areas: domestic, leisure/recreational, community, and vocational. These assessments enable the identification of functional objectives (objectives which will result in the learner’s increased skill and independence in dealing with the routine activities of his/her life). Instruction should include: Expression of choice; communication; functional skill development; and age-appropriate social skills training.

Related services are of great importance, and the multidisciplinary approach is crucial. Appropriate people such as speech and language therapists, physical and occupational therapists, and medical specialists need to work closely with classroom teachers and parents. Because of problems with skill generalization, related services are best offered during the natural routine in the school and community rather than removing a student from class for isolated therapy.

Frequently, classroom arrangements must take into consideration students’ needs for medications, special diets, or special equipment. Adaptive aids and equipment enable students to increase their range of functioning. For example, in recent years computers have become effective communication devices. Other aids include: wheelchairs, typewriters, headsticks (head gear), clamps, modified handles on cups and silverware, and communication boards. Computerized communication equipment and specially built vocational equipment also play important roles in adapting working environments for people with serious movement limitations.

Integration with nondisabled peers is another important component of the educational setting. Attending the same school and participating in the same activities as their nondisabled peers are crucial to the development of social skills and friendships for people with severe disabilities. Integration also benefits nondisabled peers and professionals through positive attitude change.

Beginning as early as the elementary school years, community-based instruction is an important characteristic of educational programming. In order to increase the student’s ability to generalize (transfer) skills to appropriate situations, this type of instruction takes place in the actual setting where the skills will be used. As students grow older, increasing time is spent in the community; high school students may spend as much as 90 percent of their day there. Programs should draw on existing adult services in the community, including group homes, vocational programs, and recreational settings.


Here are some recommendations for parents and teachers: 


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  • Early intervention is necessary - as soon as the child begins school
  • Involvement of the appropriate professionals, i.e., occupational therapists, speech/language therapists, physio therapists, etc.
  • A team approach at the school level involving external agency/community liaison who meet on a regular basis is essential
  • The physical arrangement of the classroom will need to best accommodate this child. Consideration of special equipment and assistive technology is essential.
  • Integration among their peers is important to assist these students with social development. It's important to integrate multiply disabled children as much as is possible. Research does indicate that when these students attend their community school and participate in the same activities as their peers their social skills develop and are enhanced. (Sometimes these students are placed full time in a regular classroom with support; however, in the majority of cases, these students are place in a developmental skills type of classroom with some integration.
  • Ensuring that all students demonstrates respect for the multiply disabled student becomes a teacher responsibility and needs to be taken seriously with ongoing activities that develop respect from the other students in the class.
  • An Individual Education Plan will need to be carefully planned out and adjusted on a regular basis and will need to be aligned to the child.
  • Remember, these children are often completely dependent upon others for most/all of their daily needs.
  • Assistive technologies may assist this child and the support team will need to decide which assistive technologies will be most appropriate. (In the IDEA act: ASSISTIVE TECHNOLOGY. Consider whether the child requires assistive technology devices and services.
  • A safety plan will need to be developed and is often included in the IEP.
  • Care needs to be given in your expectations of this student to ensure the child doesn't become frustrated.

Other Resources:


National Dissemination Center for Children with Disabilities:



Fact Sheet on Severe and Multiple Handicaps:



Education World for Severe / Multiple Resources



Another Multiple Disability Fact Sheet:





Opinions expressed on this site are fully those of the author. No one else contributed to its content.  Arcadian Resources is a woman-owned, disabled veteran small business serving the youth service industry. For individual counseling or agency consulting services, contact Amy Stevens at amystevens@arcadianresources.com or call 770-509-1034