Severe Handicapping Conditions Research Articles

When Rights Just Won’t Do: Ethical Considerations When Making Decisions for Severely Disabled Newborns

Children born with severe handicapping conditions, where survival and quality of survival is indeterminate, present special challenges for families and health-care professionals tasked with deciding the best courses of treatment and care. The case of Baby G presents an opportunity to compare the relative effectiveness of ethical versus rights theories in providing guidance about what obligations are owed to such children at bedside and how those obligations pertain to broader societal duties in a rights framework. We review common theories of determining the "best interests standard" of newborn decision-making and the priority of families to decide on behalf of their children. We then discuss what support the rights framework of the U.N. Convention on the Rights of the Child (CRC) might lend to the best implementation of clinical ethics decision-making. Finally, we conclude that the universal nature of rights theory does not provide the particular, specific guidance needed at the bedside of the critically ill infant.

School Expulsion: The Interface of Disabilities and Discipline

Since the implementation of a “zero tolerance” policy for possession of controlled substances and weapons on school campuses in California, a tenfold increase in the number of expulsions has been noted in some school districts. In the past five years, articles have appeared in the journals of Great Britain, Australia and New Zealand documenting the rise in use of expulsion as a disciplinary measure, but there have been few domestic publications addressing this pressing issue. The present study describes the characteristics of 38 special education students from among a larger sample of 158 expulsion referrals that occurred between school years 1992–93 and 1994–95 in one California school district. Students with more severe handicapping conditions who were served in more restrictive educational settings enjoyed greater protection from expulsion, whereas students with mild handicaps were at greater risk of exclusion. The use of non-special education interventions, a tendency to emphasize academic behaviors over more global functioning, and the developmental vulnerability of middle school students to expulsion proceedings are discussed. Recommendations for the practice of school psychology include assessment, consultation, and intervention strategies to assist these troubled and troubling students.

Stereotypical Behaviors and Handicapping Conditions in Infants and Children

Although the origin and function of stereotypical behaviors remain poorly understood, they appear to be common characteristics of both normal infants and infants with handicaps. However, there is limited information about the relative prevalence of stereotypical behaviors as a function of handicapping condition in infants and young children. This study documented the occurrence of stereotypical behaviors in young children with various handicapping conditions. The occurrence of stereotypical behaviors in young children with handicaps was rated by caregivers in early intervention programs. Most of the children in the study exhibited at least one stereotypical behavior, and some stereotypical behaviors were differentially associated with particular handicapping conditions. Children with more severe handicapping conditions exhibited stereotypical behaviors that may be indicative of central nervous system impairment.

A functional approach to meal planning, preparation, and shopping skills

Meal planning, meal preparation, and shopping skills are skills that have been associated with successful community placement. Although commercial materials are available to teach these skills, many individuals with moderate and severe handicapping conditions lack the reading and numerical identification skills needed to utilize these curricula. In addition, commercially available cooking curricula do not include methodologies to plan nutritionally balanced meals and to shop for and purchase meal items.In order to overcome these obstacles, a functional cooking program was developed. Components of the cooking program included: basic skills, meal planning, shopping/purchasing, and meal preparation. A photographic format and budget guide were incorporated into the program. Eight individuals, whose disabilities ranged from mild to severe, were involved in aspects of the program. The results indicated that nonreading individuals could successfully complete all aspects of meal preparation. In addition, probes i...

Oral hygiene for the severely handicapped: clinical evaluation of the University of Mississippi dental care system

The study reported here was a clinical evaluation of an automatic toothbrushing device for persons with severe handicapping conditions. This device, the University of Mississippi dental care system, is designed for patients who are unable to control their arms and hands. The effectiveness of this device was compared to routine (ordinary, manual) regimens of oral hygiene through use of gingival (Loe-Silness) and plaque (Turesky) indexes (GIs, PIs). Plaque indexes for patients under routine care averaged 2.11; PIs for patients under the dental care system averaged 1.47. Based on Ebbutt's extra period changeover design model, the t-test for difference in plaque scores is significant (P less than .001). The results indicate that the University of Mississippi dental care system improves the patients' ability to independently control plaque.

A Closer Look at Transition Issues for the 1990s: A Response to Rusch and Menchetti

A Closer Look at Issues for 1990s: A Response to Rusch and Menchetti Rusch and Menchetti present theme of their reply to our article, Transition Issues for 1990s, in last two sentences of their second paragraph: Specifically, we believe that ignoring an excellent body of literature because subjects were labeled 'severely handicapped' is unwarranted. Moreover, refocusing goals of transition programs to include independent living and social outcomes clashes with what we believe are important trends in special (this issue, p. 364). We will reply to each statement as two discrete issues. Rusch and Menchetti Issue #1: We believe that ignoring an excellent body of literature because subjects were labeled is unwarranted. We reaffirm our position (Knowlton & Clark, 1987, p. 562) that if transition movement in special education is to have a positive impact on quality of adult living for all exceptional persons, then the literature needs to broaden its focus and parameters so that a wider audience may identify with its findings and benefit from its implications. We do not ignore, nor do we recommend that others ignore any body of literature, excellent or otherwise, for any reason. A case in point is definition of transition portrayed in much of special education literature. The term transition does not have only one true professionally accepted definition, nor is it limited in professional scope to any one exceptionality or specific severity level. However, if one were to ignore all but majority of special education literature addressing transition, one might not get this impression. Our intent, and actual assertion, was to point out that current transition literature was focused too narrowly to appeal to diverse audiences that have histories of categorical specialization documented by their research and literature. Our statement was not an indictment of any of contributors to existing literature. Nor was it stated in a way that was intended to imply overrepresentation of any contributing group, since that would suggest a criticism of current literature on basis of its intended audience. Our statement was an observation about nature of transition literature and a recommendation for how literature could be more applicable. If any indictments are due, they more appropriately should be directed at audiences that have failed to stake their claims in transition movement by contributing actively and aggressively in theoretical and research literature of general special education and in literature of their respective disciplines. We view with respect contributions of those specializing in advocacy and programming for persons with severe handicapping conditions. The conceptual and technological break-throughs in this area are historic. Those of us, however, who do not specialize in services for individuals with severe handicapping conditions must adopt or adapt these concepts and technologies on basis of their relevance and usefulness for other populations with our own validation research. For example, Wehman, Hill, Wood, and Parent (1987) saw need to conduct an even more specific subgroup analysis of persons labeled mentally retarded, within broader population label of severely handicapped in order to see how these results might have implications for similar vocational interventions with other populations such as those labeled deaf-blind, autistic, and multiply (p.12). Would Rusch and Menchetti deem this procedure as merely changing subject descriptors . . . (to) make transitional literature more palatable? (p. 364) In short, we do not understand how a call for a broader focus in research and literature on transition is out of place. It is a logical consequence of need for ownership and participation by those who advocate for persons of varying exceptionalities and severity levels. …

Using Pretask Requests to Increase the Probability of Compliance for Students with Severe Disabilities

This article describes a nonaversive procedure to increase the probability that students with moderate and severe handicapping conditions will follow a directive to begin to work. Pretask requesting was evaluated using an ABA and BAB reversal design across four students with moderate and severe handicaps. The study suggests that familiar, rapidly paced, verbal directions with reinforcement can effectively mediate transitions from one activity to another. The theoretical implications of the procedure for a nonaversive technology of preemptive behavioral treatment are discussed.

Assessing Transition: An Inquiry Concerning Decision Making

The transition of Roy Seiver, a young adult with moderate to severe handicapping conditions, was assessed using interpretive naturalistic inquiry procedures (Guba, 1981; Lincoln & Guba, 1985). A series of structured and unstructured interviews with immediate family and service delivery personnel, as well as observations of Roy's home, community, and employment settings, revealed dilemmas related to decision making and comprehensive planning. Decision making was influenced by the personal and cultural values of the participants, was based on the services available, and reflected a lack of informed choices. Personal and cultural values also affected the planning process in the form of miscommunication compounded by confusion over role responsibilities. Implications of the case study's findings for the transition process and its relevant assessment are discussed.

School-Based Vocational Programs and Labor Laws

Vocational programs have become an important part of the educational curriculum for students with moderate to severe handicapping conditions. Community-based instruction beginning at the elementary level and emphasis upon placement during the latter school years have created a need for school staff to better understand labor rules and regulations. This article reviews the rules and regulations of the U.S. Fair Labor Standards Act in relation to school-based vocational programs and emphasizes the payment of wages across different training and placement options.

An Evaluation of the Effectiveness of an Extended Year Program

This study evaluates the effects of extended year programming for individuals with severe handicapping conditions. Over a 2-year period, summer educational programs were provided for a portion of the available population in a large Canadian city. Data were gathered before the beginning of the educational program, at the end, and at times within the subsequent academic school year. These data suggest that students enrolled in summer programming gain an equivalent or greater amount of skills per amount of time as that gained during the regular school year. In addition, these skills are additive to those gained during the regular academic year.

Acceptance of dental prophylaxis by the institutionalized patient.

SUMMARYInstitutionalized patients with moderate and severe handicapping conditions may have difficulty receiving routine dental treatment. One reason that prevents their access is negative practitioner expectations. Traditionally, this group has been treated in a hospital setting. This study assesses the ability of dental hygiene students in the general clinic setting to provide dental prophylaxis to patients with moderate and severe handicapping conditions. Of the 38 patients, 31 (82%) were successfully treated in the clinic or quiet room. The results suggest that greater numbers of patients can be treated in private practice situations when simple treatment adjuncts and mild physical restraint are used.

The Use of an Electronic Switch to Increase Independent Head Control in a Severely Handicapped Student

Children with severe handicapping conditions often need adaptive equipment and physical positioning in order to interact with their environment This paper discusses the use of active stimulation devices which use various types of electronic switches to provide positive reinforcement for desired movement. Data are presented that show the effects of using an electronic switch to increase independent head control in a spastic quadriplegic severely handicapped girl. The problems and benefits of using electronic switches are discussed.

Teaching Basic Photography Skills to a Severely Handicapped Young Adult Using Simulated Materials

Leisure skills programming for individuals with severe handicapping conditions has recently emerged as a prominent curricular domain. The present investigation examined acquisition, maintenance, and generalization aspects of teaching basic photography skills to a 20-year-old severely mentally retarded male with Down's syndrome. Training occurred in a public school setting and at the learner's place of residence. Training procedures combined simulation, a least-to-most intrusive prompting hierarchy, basic reinforcement strategies, and a method of assisting the learner make the connection between simulated and real materials. Within a multiple-probe design across four phases, the learner acquired and maintained the skills of loading film in a camera, using a flash attachment, deciding what to photograph, and taking a photograph. Additionally, generalization effects from simulated to real materials showed increasing covariation as the program progressed. Implications of this study focus on the viability of p...